Presentation
Fall 2 m onto bottom. Pain in right groin and lower back, tender at L3.
Patient Data
CT Pelvis:
There is diastasis of the symphysis pubis (12 mm) with a large adjacent extraperitoneal right pelvis hematoma. No fracture.
Paget's changes in the left hemipelvis.
There is a degree of diastasis of the pubic symphysis. Stork views show instability of the symphysis pubis when patient takes weight on the right leg (left leg raised).
Note is made of Paget's disease of the left hemipelvis.
Case Discussion
Instability shown on the Stork views in this patient was an indication for surgical fixation of the symphysis pubis.
Anterior pelvic injury refers to injury through the symphysis pubis or the pubic rami. It may occur in association with open book injury with disruption of the sacroiliac joints and associated ligaments (open book injury)
Pubic diastasis can be classified as follows 2:
- diastasis >1 cm: unstable symphysis pubis
- diastasis >2.5 cm: sacroiliac joint ligamentous injury - this is controversial however since anterior sacroiliac ligamant may remain in tact with a diastasis of up to 4.5 cm 3.
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