Ankylosed Pubic Symphysis: A Case Report of an Idiopathic Clinico-radiological Mismatch in an Emergency Trauma

Abstract

The aim of the case presented was to highlight the assessment of an incidental radiographic finding of fused symphysis for emergency clinicians and trauma surgeons involved in the assessment and management of emergency trauma cases. The objective was to understand the symphyseal affections and to review the literature for approach and management strategy for an ankylosed pubis symphysis. A road traffic accident case of a 62-year old male presented with head, face and pelvic trauma. Standard trauma protocol evaluation was done. Computerised tomography of head revealed basal ganglia bleed and facial tomographic reconstruction was normal. No fractures were evident on the radiography of the pelvis however, an incidental ankylosed symphysis pubis was revealed. Head injury required intensive care management. The incidental radiographic finding had no history suggestive of any possible aetiological cause leading to the ankylosis of pubic symphysis. A clinico-radiological mismatch presented with an idiopathic asymptomatic symphyseal ankylosis. A broader clinician’s perspective during the radiological evaluation of an emergency trauma is needed. The case highlights the necessity of taking a detailed and thorough clinical history. The trauma surgeon and the emergency physician need to be aware of the pathological affections of the pubis symphysis leading to ankylosis to strategize for an effective management.