Introduction: Pelvic bones, probably due to their anatomical features (deep location, good blood supply and other unknown reasons), are rarely affected by exogenous or hematogenous infections. Usually, the flora isolated from the infected pelvic bone is polymicrobial, with the most common microorganisms causing this type of infection being Staphylococcus aureus, Streptococcus, Pseudomonas aeruginosa. The ischial bone (os ischii) is the pelvic bone most often affected by infections, adjacent to deep IV degree decubitus wounds. These wounds are typical for patients with severe neurological symptoms—paraplegics or quadriplegics, as well as those with cerebral disorders, and the process may remain undiagnosed for a long time.
Aim: The aim of this article is to focus on the difficulties associated with the early diagnosis of an infection affecting the entire ischial bone and the soft tissues of the adjacent pelvis, as well as the high risk to the patient if adequate treatment is not carried out.
Patient and Methods: One patient, a 60-year-old man, with lower-limb paraplegia, after a spinal cord trauma dating back to 10 years ago, is presented.
Results: After the applied treatment—resection, removal of the entire ischial bone, and soft tissue debridement, the surgical wound healed primarily, the bone and soft tissue infection of the pelvis was successfully managed. General intoxication of the body was prevented.
Conclusion: Accurate and timely debridement, including the risky total excision of the os ischii, as well as the infected adjacent soft tissues in the pelvis, combined with appropriate drainage, may prove to be the only effective and life-saving procedure for the patient.
Naim F, Elessi K. Osteomyelitis of the ischium: An often missed diagnosis, case study report. Int Musculoskelet Med. 2014;36(2):79-81. doi:10.1179/1753614614Z.00000000072.
Edsberg LE, Black JM, Goldberg M, McNichol L, Moore L, Sieggreen M. Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System: Revised Pressure Injury Staging System. J Wound Ostomy Continence Nurs. 2016 Nov/Dec;43(6):585-97. doi: 10.1097/WON.0000000000000281.
Dudareva M, Ferguson J, Riley N, Stubbs D, Atkins B, McNally M. Osteomyelitis of the Pelvic Bones: A Multidisciplinary Approach to Treatment. J Bone Jt Infect. 2017 Oct 9;2(4):184-193. doi: 10.7150/jbji.21692.
Bodavula P, Liang SY, Wu J, VanTassell P, Marschall J. Pressure Ulcer-Related Pelvic Osteomyelitis: A Neglected Disease? Open Forum Infect Dis. 2015 Aug 6;2(3):ofv112. doi: 10.1093/ofid/ofv112.
De Mulder P, Harth C, Ide L, Vallaeys J, Baelde N, De Bo T. An uncommon cause of sciatic pain: tuberculous osteomyelitis of the ischial tuberosity. Acta Clin Belg. 2017 Oct;72(5):357-360. doi: 10.1080/17843286.2016.1271499.
Hamzaoui A, Salem R, Koubaa M, Zrig M, Mnif H, Abid A, et al. Escherichia coli osteomyelitis of the ischium in an adult. Orthop Traumatol Surg Res. 2009 Dec;95(8):636-8. doi: 10.1016/j.otsr.2009.09.010.
Sgarzani R, Tedeschi S, Trapani F, Capirossi R, Battilana M, Gaiani L, et al. Osteomyelitis of the pelvic bones in patients with spinal cord injury: Is magnetic resonance useful for preoperative diagnosis? Integr Mol Med. 2019. doi: 10.15761/IMM.1000373.
