Pelvic Condition (Continued)





pelvis2IMAGING:

In suspected cases a flamingo/stork view demonstrates pelvic instability quite clearly.  Further imaging in the form of an MRI scan helps to delineate pathology both at the front of the pelvis and also the sacroiliac joint.






TREATMENT:

Post pregnancy pelvic instability is initially treated conservatively with pelvic and core strengthening exercises and a pelvic belt/support.  

In advanced cases where there is frank evidence of instability and ligament rupture, which does not respond to non operative management, surgical stabilisation of the symphysis pubis (front joint of the pelvis) is carried out.  In delayed and chronic cases where there is evidence of secondary sacroiliac joint involvement, these joints are also stabilised through a keyhole percutaneous method.






OPERATION:

The symphysis pubis is approached under a general anaesthetic through a groin incision (like a caesarean section incision).  The joint is cleared and stabilised typically with one of two plates and screws.  The symphysis itself is fused with the use of bone graft.  Patients are discharged home in 48-72 hours and require crutches for up to four to six weeks.  It takes approximately twelve weeks for the symphysis to be fused solidly.  






COMPLICATIONS:

A very small minority of patients undergoing this operation could have wound complication such as infection and wound breakdown, prominence of metal work and very rarely injury to the urinary bladder.