Musculoskeletal
Pubic symphysis diastasis
- Etiology / Risk Factors:
- Postpartum: Macrosomia, operative vaginal delivery, multiparity, precipitous labor.
- Trauma: High-energy anteroposterior (AP) compression (“open-book” injury).
- Clinical Features:
- Acute pubic/groin pain postpartum or post-trauma.
- Focal tenderness over pubic symphysis, waddling gait, inability to bear weight.
- Diagnosis:
- Pelvic AP X-ray: Gap > 10 mm (normal pregnancy ≤ 10 mm).
- Gap > 2.5 cm indicates associated posterior pelvic ring / sacroiliac ligament disruption.
- Management:
- < 2.5 cm gap: Conservative (NSAIDs, pelvic binder, bed rest, progressive PT).
- > 2.5 cm gap or persistent pain/instability: Surgical (ORIF).
- High-Yield Differentials:
- Osteitis pubis: Subacute onset in athletes/post-op, X-ray shows peri-symphyseal sclerosis/erosion.
- Septic arthritis: Acute fever, ↑ ESR/CRP, MRI shows joint fluid collection.