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Delayed Bone Infarct in the Ilium Following a Pelvic Crush Injury and Embolization: A Case Report
Paul W Millhouse1, Andrew J Miller1, Jonathan Paul2
1Thomas Jefferson University, Philadelphia, Pennsylvania.
JBJS Case Connector
|December 30, 2017
Summary
Delayed osteonecrosis of the ilium can occur after pelvic trauma and surgery. This bone infarction may mimic other conditions, necessitating careful diagnosis for effective treatment of pelvic pain.
Area of Science:
- Orthopaedic Surgery
- Radiology
- Bone Pathology
Background:
- Pelvic crush injuries often require complex orthopaedic interventions.
- Embolization and surgical procedures are common in managing severe pelvic trauma.
Observation:
- A patient developed delayed posterior pelvic pain and sacroiliac joint tenderness post-treatment for a pelvic crush injury.
- Clinical presentation included tenderness over the posterior superior iliac spine and pain on sacroiliac joint compression.
Findings:
- Magnetic resonance imaging (MRI) revealed a bone infarction in the left ilium.
- The infarction was located adjacent to the sacroiliac joint, consistent with osteonecrosis of the ilium.
Implications:
- Iliac osteonecrosis symptoms can mimic sacroiliitis or other pelvic pain etiologies.
- Maintaining a high index of suspicion for iliac osteonecrosis is crucial in patients with a history of pelvic trauma and hardware.
- Accurate diagnosis is essential for appropriate management of persistent posterior pelvic pain.
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