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Chronic osteomyelitis of the pubic bones following radiotherapy for urological malignancy

We have observed osteomyelitis of the pubic bones in elderly comorbid patients with a significant urological history involving previous radiotherapy and subsequent radiation-induced osteonecrosis. The prevalence and incidence of pubic osteomyelitis in this setting is unknown. We distinguish our case series from other manifestations of pelvic osteomyelitis because radiation osteonecrosis limits the treatment options; by constraining surgery due to wound healing concerns, and by causing difficulty in defining the resection margins when excising diseased bone/tissue. Changes on imaging are often difficult to discern from post-radiotherapy changes,1,2 and recurrence of infection may occur. Our aim is to raise an awareness of this complex condition and discuss optimum management strategies.