Chronic symptomatic symphyseal instability
This presentation is the property of its rightful owner.
Sponsored Links
1 / 21

Chronic Symptomatic Symphyseal Instability PowerPoint PPT Presentation


  • 77 Views
  • Uploaded on
  • Presentation posted in: General

Chronic Symptomatic Symphyseal Instability. M.L. Chip Routt, Jr., M.D. Patient #1. 28 yo Female G1P1 2.5 Years after NSVD of Term Baby Son Anterior and Posterior Chronic Pain Unable to Walk > 100 ft Unable to Lift/Carry Son Dyspareunia & Stress Urinary Incontinence

Download Presentation

Chronic Symptomatic Symphyseal Instability

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Chronic symptomatic symphyseal instability

Chronic Symptomatic Symphyseal Instability

M.L. Chip Routt, Jr., M.D.


Patient 1

Patient #1

28 yo Female

G1P1

2.5 Years after NSVD of Term Baby Son

Anterior and Posterior Chronic Pain

Unable to Walk > 100 ft

Unable to Lift/Carry Son

Dyspareunia & Stress Urinary Incontinence

Employed-Sedentary Job-Computer Work-Fulltime

“Relatively Comfortable” Sitting 45-60 Minute Intervals

Takes No Medications – “Nothing Works, Why Take Them?”

Pelvic Instability on Compression Exam, Causes Pain


Presentation pelvic films

Presentation Pelvic Films

AP


Presentation pelvic films1

Presentation Pelvic Films

Alternating LE Standing Films


Pelvic ct scan

Pelvic CT Scan

In Binder


Pelvic ct scan1

Pelvic CT Scan

Axials @ S1 & S2

SI Joints


Surgery

Surgery

Supine

Pfannenstiel

Unstable Symphysis

Compressive Reduction Clamped

Symphyseal Plating – Frail Bone

Perc Upper and 2nd Sacral Segment IS Screws


Postop ct imaging

Postop CT Imaging


Postop ct imaging1

Postop CT Imaging

Axials @ S1 & S2 Levels


Rehabilitation

Rehabilitation

1st 6 Weeks - Bed or Chair Restricted and Isometrics

“Marginally Compliant” Due to “Comfort”

2nd 6 Weeks - Tandem Bilateral Protected WB, Stretching, Strengthening Program, Aquatic Program

Non-Compliant Due to “Comfort”


4 months after surgery

4 Months After Surgery

Plain Films

Notable Plate Segmental Breakage


4 months after surgery1

4 Months After Surgery

No Pain Complaints

Normal Gait without Distance Limit

Lifts/Carries Son

“Normal” Sexual Activity

No GU Complaints

Still Working FT


Patient 2

Patient #2

51yo Male

Was D1 College Baseball Player “back in the day”

Remained Fit & Active

Executive - Employed FT

8-12+ Years Progressive Pelvic-Groin-Back Pain

Anterior Pelvic “Grinding”

Bilateral Posterior Pelvic Pain

Worsened By Essentially Any Activities

Antalgic Gait

Dyspareunia (But Fights Thru It!)

Has Had Spinal Injections Without Relief – Body MRI In Hand

? Pelvic Instability on Exam


Plain films

Plain Films

Inlet-Outlet


Initial plain films

Initial Plain Films

Single LE Alternating Stance Films


Pelvic ct imaging

Pelvic CT Imaging

SI Joints


Surgery1

Surgery

Supine

Pfannenstiel

Fluid Filled “Cyst” Around Unstable Symphysis

Compressive Reduction Clamped

Symphyseal Plating

Perc Bilat IS Screws at Upper Sacral Segment


Postop imaging

Postop Imaging

CT Scan


Rehabilitation1

Rehabilitation

1st 6 Weeks - Bed or Chair Restricted and Isometrics

2nd 6 Weeks - Tandem Bilateral Protected WB, Stretching, Strengthening Program, Aquatic Program

“Very” Compliant Due to “Fear of Pain Return”


3 months after surgery

3 Months After Surgery

Left Adductor Sporadic “Cramping”

No Prior Pelvic & Low Back Symptoms

“Slowly Evolving Normal-Pareunia”

“Scared and Cautious Recoverer”

Back to Work

Durable Implants Thus Far


3 months after surgery1

3 Months After Surgery

Plain Films

No Implant Breakage….Yet!


  • Login