Management of pelvic instability secondary to chronic pyogenic sacroiliitis: case report

Pyogenic sacroiliitis is a rare musculoskeletal infection that is difficult to diagnose and treat. The consequences of delayed diagnosis or inadequate treatment are often the formation of abscesses and sinuses, destructive osteomyelitis, and sequestration.

Case report and literature review.

A 26-year-old woman developed chronic destructive pyogenic sacroiliitis and gross pelvic instability. Over a two-month hospitalization, she required six extensive surgical debridements with application of cement spacer, negative-pressure closure, intravenous antibiotics, and complex definitive fixation of the pelvic ring with autografting and application of bone morphogenetic protein-7. Radiologic union of her symphysis pubis fusion was verified during the fifth postoperative month. Thirteen months postoperatively, the patient was walking freely without aids and reported pain-free function for most of her daily activities.

Chronic destructive pyogenic sacroiliitis is one of the most demanding infections of the musculoskeletal system. A successful outcome depends on prompt referral, appropriate antibiotic treatment, correct timing of surgical intervention, surgical expertise, and multidisciplinary follow up.