[Pelvic osseous infections: clinical outcome and surgical treatment]

Pelvic osteomyelitis is a bacterial infection of the pelvine skeleton. Apart from rare haematogen diffusion, it can occur after pelvic trauma or operation. Furthermore, it exists a sterile osteitis pubis after repetitive periostial microtrauma. Chronic progressions are possible. Further problems are fistulas and abscesses. With involvement of symphysis or iliosacral joint, the development of septic pelvine instability is possible. Due to the anatomic complexity of the pelvis, this affection can be neglected or underdiagnosed.

We have analysed septic pelvic operations performed during 1997 to 2006. We excluded septic affections of the hip joint after joint replacement. In 15 cases we found both radiological and microbiological signs of osseous inclusion in terms of pelvic osteomyelitis.

15 patients were operated after preoperatively performed bacterial asservation and conventional X-ray, fistula scanning and pelvic CT scans. In 3 cases we placed drainages into abscess formations under CT-guidance. In 14 cases osseous infected areas existed in the pelvic skeleton and we performed a local bony resection. In 3 patients we performed removal of bacterially contaminated metal implants. In 3 cases an additional pelvic instability due to involvement of the symphysis was present. Here we resected the infected joint and performed an arthrodesis to reestablish the pelvic ring stability. Due to the localisation of the infected pelvic bone, different regimes of therapy are necessary. Iliac osteomyelitis can be treated by resection or sequestrectomy, pubic osteomyelitis or sterile osteitis can be treated similarly. Septic iliosacral joint infections as well as septic symphysis joint infections can be treated by resection and can lead to a pelvic ring instability. Simple revision surgery of fistula without removement of the fistula's origin will fail, as 9 of our patients had already had several fistula revisions without any signs of healing.