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The purpose of this study was to compare the preliminary effects of movement pattern training (MoveTrain) versus strengthening/flexibility (standard) treatment on hip and pelvic biomechanics in patients with chronic hip-related groin pain. This is a secondary analysis of data collected during a pilot randomized clinical trial. Thirty patients with hip pain, between the ages of 15 and 40 years, were randomized to MoveTrain or standard. Both groups completed 10 treatment sessions over 12 weeks along with a daily home exercise program. Three-dimensional motion analysis was used to collect kinematic and kinetic data of the pelvis and hip during a single-leg squat task at pretreatment and immediately posttreatment. Compared with the standard group, the MoveTrain group demonstrated smaller hip adduction angles (P =.006) and smaller hip external adduction moments (P =.008) at posttreatment. The desired changes to hip joint biomechanics, as found in this study, may require specificity in training that could allow health care professionals to better customize the rehabilitation of patients with hip pain. These findings can also be applied to the design and implementation of future clinical trials to strengthen our understanding of the long-term implications of different rehabilitation techniques for patients with hip pain. [ABSTRACT FROM AUTHOR]

Background: Postoperative scoliosis is often seen after hemipelvectomy for malignancies involving the pelvic area, but the details remain unclear. The objectives were to investigate the development patterns and risk factors of scoliosis after hemipelvectomy. Methods: We retrospectively reviewed 30 patients who underwent hemipelvectomy at our hospital between 1998 and 2020. The risk factors of scoliosis with a Cobb angle of ≥10° were investigated. Results: The postoperative Cobb angle significantly increased in all patients compared with the preoperative one (p < 0.001), and the change ratio of the Cobb angle was significantly higher during the first postoperative year than thereafter. The external hemipelvectomy (EH) group demonstrated a larger Cobb angle and a higher change ratio than the internal hemipelvectomy group. Nine patients developed scoliosis with a final Cobb angle of ≥10°, and the risk factors were EH (p = 0.017), P1+2+3+4 resection according to the Enneking classification (p = 0.005), iliac crest resection (p = 0.004), L5/S resection (p = 0.020), and no pelvic ring reconstruction after hemipelvectomy (p = 0.004). Conclusions: Approximately 30% of patients who underwent hemipelvectomy developed scoliosis with a Cobb angle of ≥10°, and this angle increased rapidly during the first postoperative year. Hence, careful follow-up of scoliosis is required after hemipelvectomy. [ABSTRACT FROM AUTHOR]

Benign fibrous histiocytoma of the bone (BFHB) is a rare mesenchymal tumor, representing less than 1% of all benign bone tumors. This controversial entity is characterized by a mixture of fibroblasts arranged in a storiform pattern, varying amounts of osteoclast-type giant cells and foamy macrophages. Curettage or simple resection is usually curative. However, it was reported that up to 11% of the patients suffer from relapse. Here, we report a case of malignant transformation of BFHB after long-lasting disease stabilization under denosumab therapy. [ABSTRACT FROM AUTHOR]

Age-at-death estimation is an important issue in forensic medicine and anthropology. Initially, methods relied on morphological criteria, but with the advancement of radiology, new techniques such as morphological studies on multi-slice computed tomography (CT) reconstructions have emerged. Recent studies have shown promising results by investigating the correlation between age and bone mineral density (BMD). However, there is currently a lack of data on post-mortem CTs (PMCT) involving decomposed bodies, and limited information exists regarding changes in Hounsfield Units measurement in a post-mortem context. In light of these gaps, our study aimed to examine the relationship between age at death and pubic and ilium BMD using a sample of forensic bodies. We also aimed to determine whether post-mortem processes, such as putrefaction, could interfere with this correlation. Our retrospective analysis encompassed 637 PMCTs conducted before medicolegal autopsies at Tours University Hospital. Utilizing simple and multiple linear regressions, we investigated the correlation between age and pubic and ilium BMD, as well as the relationship between BMD and the radiologic alteration index (RAI), a scale employed to quantify the degree of putrefaction. Our findings indicate promising outcomes in age-at-death estimation using pubic and/or ilium BMD for bodies exhibiting no or moderate decomposition (RAI < 80), particularly among individuals under 40 years old. However, for highly decomposed corpses (RAI ≥ 80), the presence of gas infiltration significantly influences the BMD of both the ilium and pubis. Consequently, we advocate for the incorporation of the RAI score into the age estimation equation to enhance the accuracy of our results in such cases. Further investigation involving a larger cohort of decomposed bodies could facilitate refinement and validation of our method within this specific population. [ABSTRACT FROM AUTHOR]

Thanks to technical progress and the availability of virtual data, sex estimation methods as part of a biological profile are undergoing an inevitable evolution. Further reductions in subjectivity, but potentially also in measurement errors, can be brought by approaches that automate the extraction of variables. Such automatization also significantly accelerates and facilitates the specialist's work. The aim of this study is (1) to apply a previously proposed algorithm (Kuchař et al. 2021) to automatically extract 10 variables used for the DSP2 sex estimation method, and (2) to test the robustness of the new automatic approach in a current heterogeneous population. For the first aim, we used a sample of 240 3D scans of pelvic bones from the same individuals, which were measured manually for the DSP database. For the second aim a sample of 108 pelvic bones from the New Mexico Decedent Image Database was used. The results showed high agreement between automatic and manual measurements with rTEM below 5% for all dimensions except two. The accuracy of final sex estimates based on all 10 variables was excellent (error rate 0.3%). However, we observed a higher number of undetermined individuals in the Portuguese sample (25% of males) and the New Mexican sample (36.5% of females). In conclusion, the procedure for automatic dimension extraction was successfully applied both to a different type of data and to a heterogeneous population. [ABSTRACT FROM AUTHOR]

Frogs have a highly conserved body plan, yet they employ a diverse array of locomotor modes, making them ideal organisms for investigating the relationships between morphology and locomotor function, in particular whether anatomical complexity is a prerequisite for functional complexity. We use diffusible iodine contrast‐enhanced microCT (diceCT) imaging to digitally dissect the gross muscle anatomy of the pelvis and hindlimbs for 30 species of frogs representing five primary locomotor modes, including the first known detailed dissection for some of the world's smallest frogs, forming the largest digital comparative analysis of musculoskeletal structure in any vertebrate clade to date. By linking musculoskeletal dissections and phylogenetic comparative methods, we then quantify and compare relationships between anatomy and function across over 160 million years of anuran evolution. In summary, we have found that bone lengths and pelvic crest sizes are generally not reliable predictors of muscle sizes, which highlights important implications for future palaeontological studies. Our investigation also presents previously unreported differences in muscle anatomy between frogs specialising in different locomotor modes, including several of the smallest frog hindlimb muscles, which are extremely difficult to extract and measure using traditional approaches. Furthermore, we find evidence of many‐to‐one and one‐to‐many mapping of form to function across the phylogeny. Additionally, we perform the first quantitative analysis of how the degree of muscle separation can differ between frogs. We find evidence that phylogenetic history is the key contributing factor to muscle separation in the pelvis and thigh, while the separation of shank muscles is influenced more strongly by locomotor mode. Finally, our anatomical 3D reconstructions are published alongside this manuscript to contribute towards future research and serve as educational materials. [ABSTRACT FROM AUTHOR]

Dinosaur locomotion and biomechanics, especially of their pelvic girdles and hindlimbs, have been analyzed in numerous studies. However, detailed volumetric musculoskeletal models of their tails are rarely developed. Here, we present the first detailed threedimensional volumetric reconstruction of the caudal epaxial and hypaxial musculature of the Late Jurassic sauropod Giraffatitan brancai, and highlight the importance and necessity of 3D modeling in musculoskeletal reconstructions. The tail of this basal macronarian is relatively short compared to diplodocids and other coexisting macronarians. The center of mass lies well in front of the hindlimbs, which support only ca. half the body weight. Still, our reconstruction suggests a total weight for the entire tail of ca. 2500 kg. We conclude that the hypaxial and tail-related hindlimb muscles (most specifically the M. caudofemoralis longus and its counterpart the M. ilioischiocaudalis) in Giraffatitan were well developed and robustly built, compensating for the shorter length of the M. caufodemoralis longus, the main hindlimb retractor muscle, in comparison with other sauropods. Our methodology allows a better-constrained reconstruction of muscle volumes and masses in extinct taxa, and thus force and weight distributions throughout the tail, than non-volumetric approaches. [ABSTRACT FROM AUTHOR]

Background: Operative treatment of fragility fractures of the pelvis has become a gold standard. Preoperative planning, including the assessment of the pathway for iliosacral screws, is crucial. The anchorage of the screw depends on the bone quality. Some recent studies have concentrated on assessing bone mineral density (BMD) with the use of Hounsfield unit (HU) values obtained from CT scans. The aim of the present study is to determine the best sacral levels of S1–S3 on the pathway of iliosacral screws for sacroiliac joint fixation. Methods: Patients admitted to the Independent Public Healthcare Center in Rypin between 1 of September and 1 of December in 2023, who had CT scans of the pelvis performed on them for different reasons, were included in this study. In total, 103 patients—56 men and 47 women—were enrolled in the study and consecutively separated into two groups of different ages: 18–60 years old (group A) and above 60 years old (group B). The volumetric bone density expressed in HU values was measured with sacral levels of S1, S2 and S3. Apart from the bodies of sacral vertebrae S1–S3, our measurements involved the ala of the ilium in the vicinity of the sacroiliac joint and the wing of the sacrum. All the measurements were performed on the pathway of presumptive iliosacral screws to stabilize the sacroiliac joint. Results: In group A (58 patients) the highest bone density in sacral bodies was found in S1 that gradually decreased to S3, while the opposite tendency was demonstrated in the ala of ilium. The HU values in the wing of the sacrum did not display statistical significance. In group B (45 patients), the highest bone density was also found in the sacral body S1 that decreased toward S3 but in the ala of ilium, the highest bone density was found with level S1 and lowest with level S2. In both groups, the highest bone density referred to the wing of the sacrum. Conclusion: While the perfect construct for posterior pelvic ring fixation remains unclear, our findings may imply that sacroiliac joint screws inserted into the wing of the sacrum of greater bone density could provide much more successful fixation in comparison to those anchored in the body of sacral vertebra of lesser bone density. [ABSTRACT FROM AUTHOR]

Keel bone damage, include deviations and fractures, is common in both white and brown laying hens, regardless of the housing system. Radiography for assessing birds' keel bones is was proposed by previous studies. However, radiographs show only 2 out of 3 dimensions of the dissected keel bones. The current study aimed to (1) investigate the association of radiographic optical density (keel and tibiotarsal) and geometry (keel) with dissected keel bone pathology. Previous studies suggested that keel bone fractures may result from internal pressure exerted by pelvic cavity contents. The current study also aimed to (2) investigate the potential associations between pelvic dimensions and measures of keel bone damage. A sample of 200 laying hens on a commercial farm were radiographed at 16, 29, 42, 55, and 68 weeks, and culled at the end of the laying period (week 74). The birds were examined post-mortem for pelvic dimensions and underwent whole-body radiography, followed by keel and tibiotarsal bone dissection and radiography, and keel bone scoring. The radiographs were used to estimate radiographic optical density (keel and tibiotarsal bone) and keel bone geometry (ratio of keel bone length to mid-depth). The method for on-farm radiography of laying hens, including live bird restraint, positioning for live keel imaging, and post-imaging measurements, was developed, tested, and found to be reproducible. The radiographs (1,116 images of 168 birds) and the respective measurements and post-mortem scores of keel bones are also provided for further development of radiographic metrics relevant to keel bone damage. Some longitudinal radiographic measurements of keel geometry (ratio of length to mid-depth) and optical density (keel and tibiotarsal) showed associations with the damage (deviations/fractures) observed on the dissected keel bones. The associations of keel damage were clearer with the radiographic keel geometry than with keel and tibiotarsal optical density, also clearer for the keel deviations than for keel fractures. The higher radiography ratio of keel length to middepth at weeks 42, 55 and 68 of age, the larger deviations size observed on the dissected keels at age of 74 weeks. The higher the tibiotarsal radiographic optical density at week 55 of age, the lower deviations size and fractures count observed on the dissected keels at age of 74 weeks. Pelvic dimensions showed a positive correlation with body weight, but a larger pelvic cavity was associated with increased keel bone damage. These findings lay the foundations for future use of on-farm radiography in identifying appropriate phenotypes for genetic selection for keel bone health. [ABSTRACT FROM AUTHOR]

The evolution of limb reduction in squamates is a classic example of convergence, but the skeletal morphological patterns associated with it are underexplored. To provide insights on the biomechanical and developmental consequences of transitions to limb reduction, we use geometric morphometrics to examine the morphology of pectoral and pelvic girdles in 90 species of limb-reduced skinks and their fully limbed relatives. Clavicle shapes converge towards an acute anterior bend when forelimbs are lost but hindlimbs are retained—a morphology typical of sand-swimmers. This may either indicate functional adaptations to locomotion in fine substrates, or a developmental consequence of complete limb loss. The shape of limb-bearing elements of both girdles (coracoid and pelvis) instead closely mirrors limb reduction, becoming more simplified as undulation replaces limbed locomotion. Integration between girdles decreases in taxa lacking elements of the forelimbs but not hindlimbs, indicating differential selection on each girdle in response to distinct locomotory strategies. However, this pattern becomes less clear when considering phylogenetic history, perhaps because it is limited to one specific clade (Lerista). We show how the functional demands of locomotion can induce changes at different levels of organismal organization, including both external and internal structures. [ABSTRACT FROM AUTHOR]

Ewing's sarcoma, a rare primary bone malignancy primarily affecting adolescents and young adults, typically manifests in the pelvic bones and femur. Primary Ewing's sarcoma of the sternum is exceptionally rare, constituting less than 1% of cases. We present a case of a 34-year-old man with a 2-month history of anterior chest wall pain initially attributed to muscular spasm. Subsequently, the patient developed a palpable mass and imaging demonstrated a mid-lower sternal lesion with cortical destruction and soft tissue involvement, confirmed as Ewing's sarcoma on biopsy. In addition, a suspicious lesion was identified in the left distal tibia, which was histologically confirmed as a metastasis from the primary sternal sarcoma. Neoadjuvant chemotherapy preceded partial sternotomy with rib resection and reconstruction, achieving clear surgical margins. Postoperative evaluation showed shrinkage in the sternal lesion and near-resolution of the tibial metastasis. Subsequent chemotherapy cycles resulted in no evidence of the disease on the follow-up positron emission tomography scan. This case underscores the diagnostic challenges of primary sternal Ewing's sarcoma and emphasizes the importance of early recognition and comprehensive evaluation in managing such rare presentations. [ABSTRACT FROM AUTHOR]

Background: 3D printing has a wide range of applications and has brought significant change to many medical fields. However, ensuring quality assurance (QA) is essential for patient safety and requires a QA program that encompasses the entire production process. This process begins with imaging and continues on with segmentation, which is the conversion of Digital Imaging and Communications in Medicine (DICOM) data into virtual 3D-models. Since segmentation is highly influenced by manual intervention the influence of the users background on segmentation accuracy should be thoroughly investigated. Methods: Seventeen computed tomography (CT) scans of the pelvis with physiological bony structures were identified, anonymized, exported as DICOM data sets, and pelvic bones were segmented by four observers with different backgrounds. Landmarks were measured on DICOM images and in the segmentations. Intraclass correlation coefficients (ICCs) were calculated to assess inter-observer agreement, and the trueness of the segmentation results was analyzed by comparing the DICOM landmark measurements with the measurements of the segmentation results. The correlation between segmentation trueness and segmentation time was analyzed. Results: The lower limits of the 95% confidence intervals of the ICCs for the seven landmarks analyzed ranged from 0.511 to 0.986. The distance between the iliac crests showed the highest agreement between observers, while the distance between the ischial tuberosities showed the lowest. The distance between the upper edge of the symphysis and the promontory showed the lowest deviation between DICOM measurements and segmentation measurements (mean deviations < 1 mm), while the intertuberous distance showed the highest deviation (mean deviations 14.5—18.2 mm). Conclusions: Investigators with diverse backgrounds in segmentation and varying experience with slice images achieved pelvic bone segmentations with landmark measurements of mostly high agreement in a setup with high realism. In contrast, high variability was observed in the segmentation of the coccyx. In general, interobserver agreement was high, but due to measurement inaccuracies, landmark-based approaches cannot conclusively show that segmentation accuracy is within a clinically tolerable range of 2 mm for the pelvis. If the segmentation is performed by a very inexperienced user, the result should be reviewed critically by the clinician in charge. [ABSTRACT FROM AUTHOR]

A key best practice to prevent and treat pressure injuries (PIs) is to ensure at-risk individuals are repositioned regularly. Our team designed a non-contact position detection system that predicts an individual's position in bed using data from load cells under the bed legs. The system was originally designed to predict the individual's position as left-side lying, right-side lying, or supine. Our previous work suggested that a higher precision for detecting position (classifying more than three positions) may be needed to determine whether key bony prominences on the pelvis at high risk of PIs have been off-loaded. The objective of this study was to determine the impact of categorizing participant position with higher precision using the system prediction F1 score. Data from 18 participants was collected from four load cells placed under the bed legs and a pelvis-mounted inertial measurement unit while the participants assumed 21 positions. The data was used to train classifiers to predict the participants' transverse pelvic angle using three different position bin sizes (45°, ~30°, and 15°). A leave-one-participant-out cross validation approach was used to evaluate classifier performance for each bin size. Results indicated that our prediction F1 score dropped as the position category precision was increased. [ABSTRACT FROM AUTHOR]

Purpose: Pelvic and sacral bone metastases cause significant morbidity. The primary aim of the study is to thoroughly evaluate the increase in functional capacity resulting from combined RF ablation and cementoplasty surgery applied to malignant bone metastases of the pelvic bones. Methods: Twenty patients who underwent RF ablation and cementoplasty for malign pelvic bone and sacrum metastases between January 2014 and December 2021 were retrospectively identified. The inclusion criteria were having a life expectancy of more than 1 month, being > 18 years old, and having at least 1 month of follow-up. The Visual Anlogue Scale (VAS) pain, Karnofsky Performance Status (KP), and Musculoskelatal Tumor Society (MSTS) scores were calculated. Results: VAS pain values decreased, and KP values increased postoperatively (p = 0.006 and p = 0,013). There was no statistically significant increase in MSTS (p > 0.05). The correlation relationships between lesion filling ratio and VAS pain, KP, and MSTS scores were not statistically significant (p > 0.05). Cement leakage was observed in 5 patients (25.0%), and no symptoms related to this leakage were observed. Conclusion: The pelvic region, given its close proximity to blood vessels, nerves, and joint areas, along with the distinct challenges associated with its surgery, requires separate evaluation. In studies evaluating applications in the isolated pelvic ring region, as in our study, functional gains have been most comprehensively assessed in this study, demonstrating that the procedure results in significant functional improvements. [ABSTRACT FROM AUTHOR]

Purpose: To review surgical complications after fixation of stress-positive minimally displaced (< 1 cm) lateral compression type 1 (LC1) pelvic ring injuries. Methods: A retrospective study at a level one trauma center identified patients who received surgical fixation of isolated LC1 pelvic ring injuries. Surgical complications and additional procedures were reviewed. Results: Sixty patients were included. The median age was 61 years (Interquartile range 40–70), 65% (n = 39) were women, and 57% (n = 34) had high-energy mechanisms. Anterior–posterior, posterior-only, and anterior-only fixation constructs were used in 77% (n = 46), 15% (n = 9), and 8% (n = 5) of patients. Anterior fixation was performed with rami screw fixation in 82% (49/60), external fixation in 2% (1/60), and open reduction and plate fixation in 2% (1/60). There were 15 surgical complications in 23% (14/60), and 12 additional procedures in 17% (10/60). Complications included loss of reduction ≥ 1 cm (8%), symptomatic hematomas (8%), symptomatic backout of unicortical retrograde rami screws (5%), deep infection of the pelvic space after a retrograde rami screw (1.6%), and iatrogenic L5 nerve injury (1.6%). All losses of reduction involved geriatric females with distal rami fractures sustained in ground-level falls. Loss of reduction was found to be more likely in patients with low energy mechanisms (proportional difference (PD) 62%, 95% confidence interval (CI) 18% to 76%; p = 0.01) and 2 versus 1 posterior pelvic screws (PD 36%; CI 0.4% to 75%; p = 0.03). Conclusions: Surgical complications and additional procedures routinely occurred after fixation of LC1 injuries. Patients should be appropriately counseled on the risks of surgical fixation of these controversial injuries. Level of Evidence: Diagnostic, Level III. [ABSTRACT FROM AUTHOR]

Purpose: Hemipelvis reduction in the setting of AO/OTA 61-C1.2 (APC3) pelvic injuries can be challenging. A common strategy is to provisionally reduce or fix the anterior ring prior to definitive fixation of the posterior ring. In this scenario, it is difficult to assess whether residual sacroiliac joint (SIJ) widening is due to hemipelvis flexion/extension or lateral displacement. This simulation sought to identify a radiographic marker for posterior ilium flexion or extension malreduction in the setting of a reduced anterior ring. Methods: Symphyseal and both anterior and posterior SIJ ligaments were cut in 8 cadaveric pelvis. The symphysis was reduced and wired. One centimeter of posterior flexion or extension at the SIJ was created to mimic the clinical scenario of hemipelvis flexion or extension malreduction, and a lateral compressive force was applied. SIJ widening and the direction of anterior or posterior ileal displacement relative to the contralateral joint were assessed via inlet views. SIJ widening and the direction of cranial or caudal ileal displacement were assessed using outlet views. Comparisons between flexion and extension models used Fisher's exact test. Results: On outlet views, all flexed hemipelvis demonstrated caudal ileal translation at the superior SIJ, in contrast to all extended hemipelvis demonstrated cranial translation (p < 0.0005); the scenarios were easily distinguishable. Conversely, inlet imaging was unable to identify the direction of malreduction. Flexion/extension scenarios resulted in similar amounts of SIJ widening. Conclusion: Residual flexion and extension hemipelvis malreductions in APC3 injuries after provisional anterior fixation can be differentiated by the direction of ileal displacement at the superior SIJ on the outlet view. [ABSTRACT FROM AUTHOR]

Incomplete sacroiliac joint injuries are often associated with external rotation and extension deformities on the injured hemipelvis. To appropriately correct this deformity, an oblique reduction force from caudal to cranial and lateral to medial is helpful. These injuries are often associated with traumatic disruption of the pubic symphysis. However, in injuries without traumatic disruption to the pubic symphysis, a two-pin oblique anterior external fixator can be used to obtain and maintain reduction of the sacroiliac joint, while percutaneous fixation is subsequently placed. Through a small case series and three specific patient examples, we demonstrate that the oblique anterior external fixator frame is a simple and effective strategy with the reduction and stabilization process of these multiplanar hemipelvis deformities. [ABSTRACT FROM AUTHOR]

Purpose: While decreased time to fixation in femur fractures improves mortality, it remains unclear if the same relationship exists for pelvic fractures. The National Trauma Data Bank (NTDB) is a data repository for trauma hospitals in the United States (injury characteristics, perioperative data, procedures, 30-day complications), and we used this to investigate early, significant complications after pelvic-ring injuries. Methods: The NTDB (2015–2016) was queried to capture operative pelvic ring injuries in adult patients with injury severity score (ISS) ≥ 15. Complications included medical and surgical complications, as well as 30-day mortality. Multivariable logistic regression was used to investigate the association between days to procedure and complications after adjusting for demographic characteristics and comorbidities. Results: 2325 patients met inclusion criteria. 532 (23.0%) sustained complications, and 72 (3.2%) died within the first 30 days. The most common complications were deep vein thrombosis (DVT) (5.7%), acute kidney injury (AKI) (4.6%), and unplanned intensive care unit (ICU) admission (4.4%). In a multivariate analysis, days to procedure was independently significantly associated with complications, with an adjusted odds ratio (95% confidence interval) of 1.06 (1.03–1.09, P < 0.001), best interpreted as a 6% increase in the odds of complication or death for each additional day. Conclusion: Time to pelvic fixation is a significant and modifiable risk factor for major complications and death. This suggests we should prioritize time to pelvic fixation on trauma patients to minimize mortality and major complications. [ABSTRACT FROM AUTHOR]

Purpose: To describe and evaluate the serendipitous pelvic binder stress radiographs of lateral compression type (LC) pelvic ring injuries. Methods: This was a retrospective case series performed at a single, level I academic trauma center from 2016 to 2018. All patients presenting with a minimally displaced LC pelvic ring injury were reviewed (< 10 cm displacement on static pelvic radiographs). Patients with X-rays (XR) in a pelvic binder (EMS stress) and with the pelvic binder removed were included. Pelvic ring stability was determined by attending surgeon evaluation of EMS stress radiographs versus static XR of the pelvis. Patients were treated non-operatively and allowed to weight bear or taken to the operating room for exam under anesthesia (EUA) and potential operative fixation. Clinical success of treatment was determined by evaluation of further displacement at the completion of their most recent follow-up. Results: Thirty-seven patients of the initial 398 reviewed met inclusion criteria. Fourteen of 37 patients (38%) were categorized as stable with no significant pelvis displacement seen on EMS stress and were treated non-operatively without further sequelae (4.6 months mean follow-up). The remaining 23/37 (62%) were treated operatively. Occult instability was identified on EMS stress in 14 (61%) of those 23 patients and the remainder were determined to be unstable based upon fracture pattern or EUA. All patients went on to successful treatment without significant pelvic deformity (7.8 months mean follow-up). Conclusion: The EMS stress XR is a valuable, opportunistic evaluation in LC pelvic ring injuries. This evaluation is a useful diagnostic adjunct to alert the provider that additional stress imaging may be indicated to evaluate for occult pelvic ring instability. [ABSTRACT FROM AUTHOR]

Purpose: Prostate-Specific Membrane Antigen (PSMA)-targeted Positron Emission Tomography (PET) has revolutionised prostate cancer (PCa) diagnosis and treatment, offering superior diagnostic accuracy over traditional methods and enabling theragnostic applications. However, a significant diagnostic challenge has emerged with identifying unspecific bone uptakes (UBUs), which could lead to over-staging and inappropriate treatment decisions if misinterpreted. This systematic review explores the phenomenon of UBUs in PCa patients undergoing PSMA-PET imaging. Methods: Studies assessing the prevalence, topographical distribution, and potential clinical implications of UBUs were selected according to the Preferred Reporting Items for a Systematic Review and Meta-Analysis (PRISMA) method and evaluated with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Results: The percentage of PCa patients with UBUs on PSMA-PET scans ranged from 0 to 71.7%, depending on the radiopharmaceutical used, with [18F]PSMA-1007 showing the highest incidence. The ribs are the primary site of UBUs across all PSMA-targeted radiopharmaceuticals. The spine is the second most frequent UBU site for [68Ga]Ga-PSMA-11, [18F]DCFPyL, [18F]rhPSMA-7, while the pelvic girdle represents the second most frequent site for [18F]PSMA-1007. The average maximum Standardized Uptake Value (SUVmax) of UBUs varied from 3.4 to 7.7 and was generally lower than that of bone metastases. Conclusions: Our findings underscore the need for heightened awareness and precise interpretation of UBUs to avoid potential over-staging and subsequent inappropriate treatment decisions. Considering the radiopharmaceutical used, PET-derived semiquantitative parameters, the topographical distribution of UBUs, and accurately evaluating the pre-test probability based on clinical and laboratory parameters may aid nuclear medicine physicians in interpreting PSMA-PET findings. [ABSTRACT FROM AUTHOR]

Background: The management of hemodynamically unstable pelvic ring injuries necessitates surgical intervention, often involving procedures such as external fixation and percutaneous screw placement. Given the infrequent performance of these procedures, regular training is imperative to ensure readiness for emergencies. Our pre- post simulation study aimed to adapt and validate a realistic simulation model for stabilizing unstable pelvic ring injuries, facilitating participants' knowledge retention and procedural confidence enhancement. Methods: A standardized simulator of an unstable pelvic ring utilizing synthetic pelvic bones featuring complete disruption of the symphysis and sacroiliac joint was developed. Trauma surgeons of a level one academic hospital were invited to perform external fixation and emergency sacroiliac screw application under C-arm guidance. Prior to and following the simulation session, participants completed a subjective questionnaire assessing their confidence in emergency interventions on a 10-point Likert scale (10-LS). Objective parameters, such as intraoperative imaging quality, reduction accuracy, and the positioning of screws, wires, and external fixators, were also evaluated as secondary outcome measures. Results: Fifteen trauma surgeons (10 residents, 5 consultants) participated in the simulation over the course of one day. The mean total operation time was 20.34 ± 6.06 min, without significant differences between consultants and residents (p = 0.604). The confidence for emergency SI-Screw placement increased significantly after the simulator (10-LS: Before = 3.8 ± 3.08 vs. After = 5.67 ± 2.35; p = 0.002) as well as after external fixation (10-LS: Before = 3.93 ± 2.79 vs. After = 6.07 ± 2.52; p = 0.002). In addition, confidence in (intraoperative) pelvic imaging increased significantly (10-LS: Before = 4.60 ± 3.0 vs. After = 6.53 ± 2.39; p = 0.011). Overall, the model was rated as a realistic simulation of clinical practice (10-LS = 7.87 ± 1.13). Conclusions: Our unstable pelvis fracture model is a tool to practice emergency interventions such as external fixation and percutaneous techniques. Participants benefitted from this in terms of technical instrumentation as well as intraoperative imaging. Further studies are required to validate the objective benefits and improvements that participants undergo through frequent training. [ABSTRACT FROM AUTHOR]

Background: Artificial intelligence has been increasingly used in medical imaging and has demonstrated expert level performance in image classification tasks. Objective: To develop a fully automatic approach for determining the Risser stage using deep learning on abdominal radiographs. Materials and methods: In this multicenter study, 1,681 supine abdominal radiographs (age range, 9–18 years, 50% female) obtained between January 2019 and April 2022 were collected retrospectively from three medical institutions and graded manually using the United States Risser staging system. A total of 1,577 images from Hospitals 1 and 2 were used for development, and 104 images from Hospital 3 for external validation. From each radiograph, right and left iliac crest patch images were extracted using the pelvic bone segmentation model DeepLabv3 + with the EfficientNet-B0 encoder trained with 90 digitally reconstructed radiographs from pelvic computed tomography scans with a pelvic bone mask. Using these patch images, ConvNeXt-B was trained to grade according to the Risser classification. The model's performance was evaluated using accuracy, area under the receiver operating characteristic curve (AUROC), and mean absolute error. Results: The fully automatic Risser stage assessment model showed an accuracy of 0.87 and 0.75, mean absolute error of 0.13 and 0.26, and AUROC of 0.99 and 0.95 on internal and external test sets, respectively. Conclusion: We developed a deep learning-based, fully automatic segmentation and classification model for Risser stage assessment using abdominal radiographs. [ABSTRACT FROM AUTHOR]

Simple Summary: Sugar gliders are exotic animals that have become pets in recent years. As a result, these small marsupials are increasingly coming to the veterinary practices. Marsupials are a group of mammals characterized by their peculiar way of reproduction. This translates into the distinct anatomy of their genital apparatus, both male and female. There are not many references concerning the anatomy of this particular species. The male reproductive system of the Petaurus breviceps follows the general pattern in marsupials, but each species has its own peculiarities that the veterinary clinician should know. It includes two testes, epididymis, and deferent ducts, as well as two types of accessory glands: the prostate and the bulbourethral glands, in addition to the male urethra and the penis, which is bifid at its end. The purpose of this study was to describe the male genital gross anatomy of the sugar gliders (supplemented with some microscopic observations), to provide detailed information to veterinary clinicians to facilitate accurate diagnosis and surgery. The present study provides a detailed macroscopic examination (with some microscopic insights) of the genital apparatus of seven adult and intact male sugar gliders, as well as one castrated individual. The scrotum is pendulous and attached to the ventral abdominal wall, situated in the caudal part of the abdomen and cranial to the cloacal opening. The testes are oval shaped with their long axes oriented vertically. The epididymides are attached along the caudomedial border of their respective testes. The head and tail of the epididymides are in close proximity to the poles of the testes but are not directly attached. The deferent ducts are positioned laterally to their ipsilateral ureter as they run near the dorsal surface of the urinary bladder. The ampulla of the deferent duct is absent. The penis is located post-scrotally, lacks insertion into the bony pelvis, and has a bifid distal end. The crura of the penis originate within the ischiocavernosus muscles, and there are two bulbs of the penis. When flaccid, the entire penis is concealed in the perineal region and externalizes through an orifice situated in the ventral part of the cloaca, traversing its floor towards the cloacal opening. The urethral external orifice is positioned at the point where the bifurcation of the free part of the penis begins. The prostate gland resides in the pelvic cavity and consists of two parts: a macroscopically visible body surrounding the urethra and a microscopically identifiable portion embedded within the walls of the duct. Sugar gliders possess two pairs of bulbous bulbourethral glands, located dorsally and laterally to the rectum, but lack vesicular glands. [ABSTRACT FROM AUTHOR]

Managing pelvic osteomyelitis (POM) in the setting of stage IV pressure injuries requires multidisciplinary evaluation as well as patient and caregiver engagement and is complicated by the lack of high-evidence data to guide best practices. In this review, we describe our approach to pressure injury and POM evaluation and management through multidisciplinary collaboration and highlight areas of future research that are necessary to enhance patient outcomes, reduce healthcare costs, and improve the quality of life of those affected by POM. [ABSTRACT FROM AUTHOR]

Background: Bone density is affected by age- and sex-related changes in the os coxae, often known as the pelvic bone. Recent developments in computed tomography (CT) imaging have created new opportunities for quantitative analysis, notably regarding Hounsfield Units (HU). Objectives: The study aims to investigate the possibility of using HU obtained from os coxae CT scans to estimate age in the Romanian population. Methods: A statistical analysis was conducted on a sample of 80 pelvic CT scans in order to find any significant correlation between age, sex, and variation in density among the different pelvic bone locations of interest. According to the research, pelvic radiodensity measurements varied significantly between male and female participants, with men having greater levels. This technique may be valuable for determining an individual's sex precisely, as evidenced by the substantial association found between HU levels and changes in bone density associated with sex. Results: The analysis of variance underscores that HU values exhibit a significant negative relationship with radiodensity, with a general trend of decreasing HU with increasing age. The equation derived from the ordinary least squares OLS regression analysis can be used to estimate the age of individuals in the Romanian population based on their HU values at specific pelvic sites. Conclusions: In conclusion, the application of HU analysis in CT imaging of the coxae represents a non-invasive and potentially reliable method for age and sex estimation, and a promising avenue in the field of human identification. [ABSTRACT FROM AUTHOR]

During the last decades, effective pain reduction and early mobilization were identified as the central priorities in therapy of insufficiency fractures of the pelvis. For operative treatment minimally-invasive stabilization techniques are favored. While there is consensus on the significance of sufficient dorsal stabilization the role of additional fixation of the anterior fracture component stays under discussion. Within the present study we developed an internal ring fixator system (RingFix) with the question whether an in-itself-closed construct can improve stability of the entire ring structure. RingFix was evaluated on an osteoporotic bone model with a standardized FFP IIIc fracture within an established biomechanical setup regarding its primary stabilization potential. Further, it was compared to transiliac–transsacral screw fixation with and without stabilization of the anterior fracture component. The transiliac–transsacral fixation with separate screw fixation of the anterior fracture showed significantly higher stability than the RingFix and the transiliac–transsacral screw fixation without anterior stabilization. Our results show that stabilization of the anterior fracture component relevantly improves the stability of the entire ring construct. As a bridging stabilizer, RingFix shows biomechanical advantages over an isolated dorsal fracture fixation, but inferior results than direct stabilization of the single fracture components. [ABSTRACT FROM AUTHOR]

BACKGROUND: Chronic ankle instability (CAI) presents neuromuscular control and functional performance difficulties. Although ankle-focused rehabilitation is widely practised, the relative effects of exercises targeting thoracic mobility and lumbopelvic stabilization in addressing CAI have not been thoroughly investigated. OBJECTIVE: The study aims to compare the effects of thoracic mobility and lumbopelvic stabilization exercises in patients with CAI. METHODS: The study was designed as a prospective randomized controlled clinical trial. A total of 30 participants (mean age = 31.93 ± 7.31; 21F/9M) who scored 27 points or on the Cumberland ankle instability tool voluntarily were enrolled in the study. The participants were randomly divided into two groups. In addition to the rehabilitation protocols, each participant was given a home exercise program, including ankle-strengthening exercises (3 times a week). The first group trained with thoracic mobility (TM), while the second group did lumbopelvic stabilization (LS) exercises under supervision twice a week for eight weeks. Participants' pre and post-treatment assessments spanned an 8-week rehabilitation period, during which ankle and hip joint range of motion measurements were obtained using an electronic goniometer. Additionally, dynamic balance was assessed through the Y balance test, while ankle proprioception was evaluated using joint position sense measurements. The flexibility was assessed with an active straight leg raise test. RESULTS: Y balance, CAIT, and active straight leg raise test scores were improved in the eighth week in the thoracic mobility group (p < 0.05), while only active straight leg raise test and CAIT scores were significantly different in the lumbopelvic stabilization group (p < 0.05) according to intra group variables. In comparing the post-treatment scores between the groups, the thoracic mobility group had superior results in the joint position sense test for the right side of the hip and plantarflexion. (hip; TM: 70.71 ± 6.80, LS: 68.76 ± 5.50, plantarflexion; TM: 44.24 ± 7.28, LS: 38.30 ± 5.08). CONCLUSION: The findings suggest that while both interventions are effective in addressing various aspects of ankle instability, the thoracic mobility exercises may offer additional benefits, particularly in enhancing joint position sense, thereby providing valuable insights for the optimization of rehabilitation protocols for individuals with chronic ankle instability. [ABSTRACT FROM AUTHOR]

Sarcoglycanopathies are among the most frequent and severe forms of autosomal recessive forms of limb-girdle muscular dystrophies (LGMDs) with childhood onset. Four subtypes are known: LGMDR3, LGMDR4, LGMDR5 and LGMDR6, which are caused, respectively, by mutations in the SGCA, SGCB, SGCG and SGCD genes. We present the clinical variability of LGMD 2C/R5 among a genetically homogeneous group of 57 patients, belonging to 35 pedigrees. Molecular genetic analysis showed that all 57 patients were homozygous for the C283Y variant. The muscles of the pelvic girdle and the trunk were affected early and were more severely affected, followed by the shoulder girdle. Macroglossia, hypertrophy of the calves, scapular winging and lumbar hyperlordosis were common in the ambulatory phase. A great intra and interfamilial variability in the clinical presentation of LGMD 2C/R5 was observed, despite having the same underlying molecular defect. Females demonstrated a relatively milder clinical course compared to males. Mean creatine phosphokinase (CK) CK levels were 20 times above normal values. Muscle computer tomography (CT) CT or MRIs showed earlier and more severe involvement of the flexor proximal limb muscles in comparison to extensor muscles. [ABSTRACT FROM AUTHOR]

Background: Current studies assessing the change in pelvic tilt for ambulatory patients with cerebral palsy (CP) after surgical hamstring lengthening (SHL) lack a comparison cohort without prior SHL and are limited to younger patients. This study presents gait data of middle-aged adults with CP, primarily focusing on the pelvis, and compares pelvic tilt, trunk tilt, and knee flexion between those with and without prior SHL. Materials and Methods: A consecutive series of 54 adults with CP, a mean age of 36±13 years, and Gross Motor Function Classification System (GMFCS) levels I–III were included. Thirty-two (59%) had SHL performed at a mean age of 8±5 years. Three-dimensional gait analysis data prospectively collected at a mean of 28±14 years postoperatively were retrospectively analyzed. Chi-square tests were used to compare demographic and surgical history data and statistical parameter mapping was used to compare knee flexion during stance and pelvic and trunk tilts during the gait cycle between SHL and SHL-naive groups. Results: Age, GMFCS level, sex, race, topography, and ethnicity were not different between the groups (P=.217–.612). Anterior pelvic tilt throughout gait was significantly greater in the SHL group compared with the SHL-naive group (63%–87%; P=.033). This difference was augmented after accounting for other surgical history and revision SHL (0%–32%, P=.019; and 46%–93%, P=.007). Conclusion: Within a cohort of adults with CP, GMFCS levels I–III, and a mean age of 36 years, those with a history of SHL, performed a mean of 28 years prior to 3-dimensional gait analysis, walked with increased anterior pelvic tilt compared with those without a history of SHL. [Orthopedics. 2024;47(5):270–275.] [ABSTRACT FROM AUTHOR]

Objective: Complete resection is the curative treatment choice for recurrent gynecological malignancies. Laterally extended endopelvic resection (LEER) is an effective surgical salvage therapy for lateral recurrence. However, when a recurrent tumor occupies the ischial spine and sacrum, LEER is not indicated, and surgical salvage therapy is abandoned. Theoretically, complete resection of such a tumor is possible by additional pelvic bone resection along with the standard LEER. Nevertheless, owing to the anatomical complexities of the beyond-LEER procedure, 2 major issues should be solved: sciatic nerve injury and tumor disruption during pelvic bone amputation. To overcome these technical challenges, we applied a multidirectional beyond-LEER approach, a novel salvage surgical procedure, with an aim of demonstrating its technical feasibility. Methods: We created a simulation model of a laterally recurrent tumor that occupied the right ischial spine and sacrum in a Thiel-embalmed cadaver. Results: Multidirectional approaches, including laparoscopic, perineal, and dorsal phases, were safely applied. We laparoscopically marked the L4-L5-S1 complex and S2 nerve with different colored tapes, and by pulling them out into a dorsal surgical field, the sciatic nerve was safely preserved. The dissection lines of the multidirectional approaches were aligned using tapes as landmarks, and complete tumor clearance without tumor disruption was accomplished. By following the cadaveric training, the first laparoscopic-assisted beyond- LEER procedure was successfully performed in a patient with recurrent ovarian cancer. Conclusion: Using a Thiel-embalmed cadaver, we demonstrated the technical feasibility of a sciatic nerve-preserved beyond-LEER procedure, which was successfully performed in a patient with recurrent ovarian cancer. [ABSTRACT FROM AUTHOR]

Large acetabular bone defects are challenging in hip revision surgery. Clinical assessment is crucial to evaluate modern technologies in surgical reconstruction. We aimed to better understand the bone remodeling that occurs following acetabular reconstruction. Our objectives were: (1) To characterize changes in the shape of the pelvis by studying sequential computed tomography (CT) scans collected immediately and 1‐year postoperatively and (2) to identify which part of the pelvis is most susceptible to remodeling. We used the CT scans taken at two timepoints, of 24 patients with acetabular bone defects classified as Paprosky IIIB, treated with three‐dimensional (3D)‐printed custom‐made acetabular implants. Segmented 3D models of the bony pelvis were co‐registered using three different techniques. A global co‐registration of the full pelvis was conducted, followed by the co‐registration of the innominate bone and then ilium only, on the ipsilateral reconstructed side. The relative movements of the ilium, ischium, and pubis were analyzed from visual inspection and using co‐registration metrics (root mean square error and intersection over union). No bone remodeling was found in 14/24 patients (58%). The co‐registration of the innominate bone indicated bone remodeling in five cases (21%), while the remaining five cases (21%) presented remodeling in the global co‐registration but not the innominate bone co‐registration, suggestive of changes occurring at the sacroiliac joint. Changes in the pelvic shape were greatest at the pubis and ischium. Bone remodeling may occur in complex cases of Paprosky type IIIB defects, after acetabular reconstruction (occurrence of 21%, 5/24 cases). Surgeons and engineers should consider this when monitoring implant migration. [ABSTRACT FROM AUTHOR]

Purpose: Pathogenesis of sacral fragility fractures is not fully understood. This study investigates zonal distribution of calcium salt and fat marrow in intact bone-healthy and osteoporotic pelvis. In addition, in unilateral sacral fractures, the fracture side was compared with the intact side. Methods: CT and MRI images of 37 pelves were analyzed. Zonal calcium salt distribution by Hounsfield units (HU) was recorded for each CT dataset. Fat marrow content was measured in MRI mDixon–Quant sequence. The cohort was divided: intact pelves with (PEO, HU < 100, n = 8) and without osteoporosis (PE, HU ≥ 100, n = 14) based on the mean HU value in LWK5. A third group consisted of patients with osteoporosis and unilateral fractures (PEOFx, n = 10). Conclusion: The results suggest that in PEO sacral alae experience disproportionate skeletal rarefaction. This concerns the sacral ala at the S1 level (− 25 ± 55), whereby the calcium salt content is so low that it corresponds to the S3 level of healthy bone (− 20 ± 21 HU). This explains the occurrence of transalar fractures in the load-transmitting zone S1. In PEOFx, the calcium salt density was higher and the fat content was lower on the fractured side than on the intact side, indicating bony compacting due to lateral compression and fat displacement due to hematoma in the accident mechanism. This study makes an important contribution to the understanding of the development of sacral fragility fractures. Furthermore, impaction of the cancellous bone within the fracture can be demonstrated. [ABSTRACT FROM AUTHOR]

Purpose: Metastatic disease of the pelvis is frequently associated with severe pain and impaired ambulatory function. Depending on the patient's characteristics, primary tumor, and metastatic pelvic disease, the treatment choice may be varied. This study aims to report on the current management options of metastatic pelvic disease. Methods: We comprehensively researched multiple databases and evaluated essential studies about current concepts of managing a metastatic bone disease of the pelvis, focusing on specific indications as well as on the result of treatment. Results: Pelvic metastases not in the periacetabular region can be managed with modification of weight-bearing, analgesics, bisphosphonates, chemotherapy and/or radiotherapy. Minimally invasive approaches include radiofrequency ablation, cryoablation, embolization, percutaneous osteoplasty, and percutaneous screw placement. Pathological or impending periacetabular fracture, excessive periacetabular bone defect, radioresistant tumor, and persistent debilitating pain despite non-surgical treatment and/or minimally invasive procedures can be managed with different surgical techniques. Overall, treatment can be divided into nonoperative, minimally invasive, and operative based on specific indications, the expectations of the patient and the lesion. Conclusion: Different treatment modalities exist to manage metastatic pelvic bone disease. Decision-making for the most appropriate treatment should be made with a multidisciplinary approach based on a case-by-case basis. [ABSTRACT FROM AUTHOR]

Purpose: Resection of pelvic bone tumours and subsequent pelvic girdle reconstruction pose formidable challenges due to the intricate anatomy, weight-bearing demands, and significant defects. 3D-printed implants have improved pelvic girdle reconstruction by enabling precise resections with customized guides, offering tailored solutions for diverse bone defect morphology, and integrating porous surface structures to promote osseointegration. Our study aims to evaluate the long-term efficacy and feasibility of 3D-printed hemipelvic reconstruction following resection of malignant pelvic tumours. Methods: A retrospective review was conducted on 96 patients with primary pelvic malignancies who underwent pelvic girdle reconstruction using 3D-printed custom hemipelvic endoprostheses between January 2017 and May 2022. Follow-up duration was median 48.1 ± 17.9 months (range, 6 to 76 months). Demographic data, imaging examinations, surgical outcomes, and oncological evaluations were extracted and analyzed. The primary endpoints included oncological outcomes and functional status assessed by the Musculoskeletal Tumor Society (MSTS-93) score. Secondary endpoints comprised surgical duration, intraoperative bleeding, pain control and complications. Results: In 96 patients, 70 patients (72.9%) remained disease-free, 15 (15.6%) had local recurrence, and 11 (11.4%) succumbed to metastatic disease. Postoperatively, function improved with MSTS-93 score increasing from 12.2 ± 2.0 to 23.8 ± 3.8. The mean operating time was 275.1 ± 94.0 min, and the mean intraoperative blood loss was 1896.9 ± 801.1 ml. Pain was well-managed, resulting in substantial improvements in VAS score (5.3 ± 1.8 to 1.4 ± 1.1). Complications occurred in 13 patients (13.5%), including poor wound healing (6.3%), deep prosthesis infection (4.2%), hip dislocation (2.1%), screw fracture (1.0%), and interface loosening (1.0%). Additionally, all patients achieved precise implantation of customized prosthetics according to preoperative plans. T-SMART revealed excellent integration at the prosthesis-bone interface for all patients. Conclusion: The use of a 3D-printed custom hemipelvic endoprosthesis, characterized by anatomically designed contours and a porous biomimetic surface structure, offers a potential option for pelvic girdle reconstruction following internal hemipelvectomy in primary pelvic tumor treatment. Initial results demonstrate stable fixation and satisfactory mid-term functional and radiographic outcomes. [ABSTRACT FROM AUTHOR]

Purpose: It is not uncommon for patients with hip disorders to present with pelvic obliquity (PO), and residual PO after total hip arthroplasty (THA) may not only affect hip joint function but also cause adjacent intervertebral joint disorders. This study aimed to investigate the postoperative PO impact on clinical outcomes and risk factors by comparing patients who had PO after THA to those who did not. Methods: A single-center, retrospective cohort study was conducted. A total of 103 patients who underwent THA were included in this study from 2018 to 2020. Demographics, functional outcomes, and spinopelvic parameters were compared between post-THA PO of less than 2° (NT group, 55 patients) and PO of 2° or more (O group, 48 patients). Multivariate analysis was performed using factors with significant differences in univariate analysis. Results: Postoperative Harris Hip Score Activity was significantly lower in the T group than in the NT group (p = 0.031). Preoperative PO was smaller in the NT group than in the T group (p = 0.001). Preoperative lumbar bending range (LBR) was significantly more flexible in the NT group than in the T group. In the logistic regression analysis, Age (odds ratio 0.957, 95% CI 0.923–0.993, p = 0.020), preoperative PO (odds ratio 1.490, 95% CI 1.100–2.020, p = 0.001), and LBR (odds ratio 0.848, 95% CI 0.756–0.951, p = 0.005) were found to be significant factors. Conclusion: Younger age and large preoperative PO, and poor lumbar spine mobility were identified as risk factors for residual postoperative PO. [ABSTRACT FROM AUTHOR]

Purpose: Acetabular reconstruction in situ after extensive pelvic resection is technically challenging. The aim of this study was to investigate the feasibility of positioning guiders for acetabular reconstruction following pelvic tumor resection and the clinical benefit brought by the approach. Methods: The study included patients who underwent acetabular reconstruction following periacetabular tumor resection using a modular hemipelvic prosthesis. In the guider-assisted group (n = 14), guiders were designed and applied to assist acetabular reconstruction. In the traditional operation group (n = 18), the patients underwent the same surgery but without the guiders. The displacement of the hip rotation center before and after surgery was calculated. The complications and the Musculoskeletal Tumor Society—93 scores were documented. Results: The overall displacement of the hip rotation center was significantly reduced in the guider-assisted group compared with the traditional operation group (13.83 ± 4.06 vs. 22.95 ± 9.18 mm in P = 0.000, 95%CI 3.90–12.96), especially in the anteroposterior axis (3.77 ± 3.03 versus 13.51 ± 9.43 mm in P = 0.000, 95%CI 3.45–13.09). Guider-assisted acetabular reconstruction reduced the risk of prosthesis dislocation compared with the traditional operation (dislocation risks: 1/14, 7.1% vs. 4/18, 22.2%). Conclusion: Positioning guiders can effectively and conveniently help place the modular hemipelvic prosthesis at the native position, which might potentially reduce the risk of prosthesis dislocation. Level of evidence: Therapeutic level III. [ABSTRACT FROM AUTHOR]

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Recent fieldwork in the late Middle Jurassic Balabansai Formation of Kyrgyzstan has yielded a partial skeleton of a large theropod dinosaur. The material includes a few bones of the skull (postorbital, quadratojugal), dorsal and sacral vertebrae, fragments of the pectoral girdle and forelimbs, and an almost complete pelvic girdle and hindlimbs, and is here made the type of a new theropod taxon, Alpkarakush kyrgyzicus gen. et sp. nov. Alpkarakush can be diagnosed by an extremely developed orbital brow on the postorbital, a pneumatic opening leading into cavities in the neural arch from the centroprezygodiapophyseal fossa in the posterior dorsal vertebrae, an almost enclosed ventral sulcus in manual phalanx II-1, a narrow and deep intercondylar groove on the anterior side of the distal femur, and an epicondylar crest on the distal femur that is offset from the distal end. A second, fragmentary, and smaller specimen from the same site represents the same taxon. Based on long bone histology, the type of Alpkarakush represents a late subadult individual, whereas the smaller specimen is a juvenile, possibly indicating gregarious behaviour. Phylogenetic analysis places Alpkarakush in the Metriacanthosauridae, underlining the diversity and wide distribution of this clade in the Jurassic of Asia. [ABSTRACT FROM AUTHOR]

Background: Bleeding pelvic fractures have high mortality rates, primarily due to severe hemorrhage. Treatment options include mechanical stabilization based on preperitoneal pelvic packing (PPP), resuscitative endovascular balloon occlusion of the aorta, and angioembolization (AE). The bilateral preperitoneal approach, which uses three pads on each side, is the conventional PPP method. We aimed to compare the bilateral preperitoneal approach with a modified approach, involving selectively packing only heavily bleeding areas, in terms of clinical outcomes and mortality risks. Methods: We included patients who underwent PPP and compared the outcomes between conventional (three sponges placed on each side) and modified PPP (selective packing of critical areas). The primary outcome was 30-day mortality; the secondary outcomes included 24 h mortality, pelvic complications, and transfusion requirements. Univariate and multivariate analyses were performed to determine risk factors for 30-day and 24 h mortality. Results: Among the 47 included patients, 19 and 28 underwent conventional and modified PPP, respectively. There were no significant between-group differences in the 24 h (26.3% vs. 42.9%, p = 0.247) and 30-day mortality rates (47.4% vs. 60.7%, p = 0.366). Using univariate and multivariate analyses, initial lactate levels and the decision to perform AE were found to be significant risk factors for mortality. However, the selected PPP method was not a risk factor for 30-day mortality (odds ratio [OR], 2.22; 95% confidence interval [CI], 0.27–18.26; p = 0.457) or 24 hr mortality (OR, 1.77; 95% CI, 0.24–13.19; p = 0.557). Conclusions: The modified PPP method may be considered in patients with bleeding pelvic fractures for effective bleeding control while minimizing potential complications associated with the conventional PPP. [ABSTRACT FROM AUTHOR]

Hind limb of the animals are playing major role to bear the weight as they are playing important role in locomotion and gait determination. Present study was designed to elucidate the gross morphological characteristics of bones of Gluteal, Thigh, Stifle, Crural and Pes region of a female calf of Indian Rhinoceros. Bony pelvis was formed by the right and left hip bones consisted of three bones Ilium, Ischium and Pubis. Ilium was a triangular bone situated at the craniaolateral aspect of the pelvis. Ischium was roughly quadrilateral plate of bone situated behind the pubis and forms part of the pelvic floor. Pubis was a small triangular plate of bone situated at the antero medial aspect of the pelvic floor. Femur was largest bone in the skeleton directed downward and forward in an oblique manner. This bone articulate with the hip bone above to form hip joint and with tibia, fibula and patella to form the stifle joint. Third trochanter was present at the lateral part of the lateral border, in the form of an extra prominence curved anteriorly. Lateral border of the lateral groove of tibia attached with the distal end of the fibula. Fibula was long and thin bone extended the whole length of the tibia. There were six tarsals, three metatarsals, three digits bearing three phalanges each. [ABSTRACT FROM AUTHOR]

Purpose: Determine if anterior internal versus supra-acetabular external fixation of unstable pelvic fractures is associated with care needs or discharge. Methods: A retrospective cohort study was performed at two tertiary trauma referral centers. Adults with unstable pelvis fractures (AO/OTA 61B/61C) who received operative fixation of the anterior and posterior pelvic ring by two orthopedic trauma surgeons from October 2020 to November 2022 were included. The primary outcome was discharge destination. Secondary outcomes included intensive care unit (ICU) or ventilator days, length of stay, and hospital charges. Results: Eighty-three eligible patients were 38.6% female, with a mean age of 47.2 ± 20.3 years and BMI 28.1 ± 6.4 kg/m2. Fifty-nine patients (71.1%) received anterior pelvis internal fixation and 24 (28.9%) received external fixation. External fixation was associated with weight-bearing restrictions (91.7% versus 49.2%, p = 0.01). No differences in demographic, functional status, insurance type, fracture classification, or injury severity measures were observed by treatment. Internal versus external anterior pelvic fixation was not associated with discharge to home (49.2% versus 29.2%, p = 0.10), median ICU days (3.0 [interquartile range (IQR) 7.8 versus 5.5 [IQR 4.3], p = 0.14, ventilator days (0 [IQR 6.0] versus 0 [IQR 2.8], p = 0.51), length of stay (13.0 [IQR 13.0] versus 17.5 (IQR 20.5), p = 0.38), or total hospital charges (US dollars 180,311 [IQR 219,061.75] versus 243,622 [IQR 187,111], p = 0.14). Conclusions: Anterior internal versus supra-acetabular external fixation of unstable pelvis fractures was not significantly associated with discharge destination, critical care, hospital length of stay, or hospital charges. This sample may be underpowered to detect differences between groups. Level of Evidence: Therapeutic Level IV. [ABSTRACT FROM AUTHOR]

Introduction: Computerized surgical navigation system guidance can improve bone tumor surgical resection accuracy. This study compared the 10-mm planned resection margin agreement between simulated pelvic-region bone tumors (SPBT) resected using either skin fiducial markers or Kirschner (K)-wires inserted directly into osseous landmarks with navigational system registration under direct observation. We hypothesized that skin fiducial markers would display similar resection margin accuracy. Methods: Six cadaveric pelvises had one SPBT implanted into each supra-acetabular region. At the left hemi-pelvis, the skin fiducial marker group had guidance from markers placed over the pubic tubercle, the anterior superior iliac spine, the central and more posterior iliac crest, and the greater trochanter (5 markers). At the right hemi-pelvis, the K-wire group had guidance from 1.4-mm-diameter wires inserted into the pubic tubercle, and 3 inserted along the iliac crest (4 K-wires). The senior author, a fellowship-trained surgeon performed "en bloc" SPBT resections. The primary investigator, blinded to group assignment, measured actual resection margins. Results: Twenty of 22 resection margins (91%) in the skin fiducial marker group were within the Bland–Altman plot 95% confidence interval for actual–planned margin mean difference (mean = −0.23 mm; 95% confidence intervals = 2.8 mm, − 3.3 mm). Twenty-one of 22 resection margins (95%) in the K-wire group were within the 95% confidence interval of actual–planned margin mean difference (mean = 0.26 mm; 95% confidence intervals = 1.7 mm, − 1.1 mm). Conclusion: Pelvic bone tumor resection with navigational guidance from skin fiducial markers placed over osseous landmarks provided similar accuracy to K-wires inserted into osseous landmarks. Further in vitro studies with different SPBT dimensions/locations and clinical studies will better delineate use efficacy. [ABSTRACT FROM AUTHOR]

Purpose: To review outcomes of spinopelvic dissociation treated with open lumbopelvic fixation. Methods: We reviewed all cases of spinopelvic dissociation treated at three Level-I trauma centers with open lumbopelvic fixation, including those with adjunctive percutaneous fixation. We collected demographic data, associated injuries, pre- and postoperative neurologic status, pre- and postoperative kyphosis, and Roy-Camille classification. Outcomes included presence of union, reoperation rates, and complications involving hardware or wound. Results: From an initial cohort of 260 patients with spinopelvic dissociation, forty patients fulfilled inclusion criteria with a median follow-up of 351 days. Ten patients (25%) had a combination of percutaneous iliosacral and open lumbopelvic repair. Average pre- and postoperative kyphosis was 30 degrees and 26 degrees, respectively. Twenty patients (50%) had neurologic deficit preoperatively, and eight (20%) were unknown or unable to be assessed. All patients presenting with bowel or bladder dysfunction (n = 12) underwent laminectomy at time of surgery, with 3 patients (25%) having continued dysfunction at final follow-up. Surgical site infection occurred in four cases (10%) and wound complications in two (5%). All cases (100%) went on to union and five patients (13%) required hardware removal. Conclusion: Open lumbopelvic fixation resulted in a high union rate in the treatment of spinopelvic dissociation. Approximately 1 in 6 patients had a wound complication, the majority of which were surgical site infections. Bowel and bladder dysfunction at presentation were common with the majority of cases resolving by final follow-up when spinopelvic dissociation had been treated with decompression and stable fixation. [ABSTRACT FROM AUTHOR]

Background: In forensic medicine, sexually dimorphic bones such as pelvic bones like the os sacrum, greater sciatic notch parameter, and sacral dimensions are typically used to determine a person's sex. Before complex autopsy preparations are made, a postmortem CT scan offers a quick and simple way to illustrate and measure bone structures. Aim: To emphasize the role of pelvic bone measurements in sex determination, to estimate sex using based on morphometric data from computed tomography images of sacrum and greater sciatic notch. Methods: This cross-sectional study was carried out in Tripoli Medical Center, Center for Judicial Expertise and research, Libya and Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Zagazig University, Egypt. Subjects were divided into group I: included 65 male and group II: included 65 female. All participiants were subjected to Pelvic CT scan examinations. Results: All the CT measurements of the sacral vertebra (m.t.d, a.p.d, area and perimeter except m.s.d) were significantly higher in males compared to females, while all CT measurements of the greater sciatic notch were significantly higher in females compared to males. The area of the sacral vertebra and the the width of the greater sciatic notch were the only significant variable in sex determination. Conclusion: CT scan was a valuable method in measuring the selected pelvic sacral dimensions. The estimated values of pelvic measurements by using 3D CT images could develop a pelvic model with a regression formula with high accuracy value. [ABSTRACT FROM AUTHOR]

Introduction: Extra-articular hip resection may be necessary in cases of malignant tumour of the pelvic bone or of the proximal femur invading the hip joint. When the tumour is in the proximal femur, it is possible to resect the acetabulum en bloc by performing a periacetabular osteotomy, but this creates a discontinuity in the pelvic ring with difficult reconstruction and diminished function. Several techniques described recently seek to be as sparing as possible on the pelvic bone by preserving the posterior column or both columns in order to facilitate reconstruction and improve function. However, these still require complex reconstructions and can necessitate intra-pelvic dissection. Technique: We describe here an extra-articular hip resection technique for tumours of the proximal femur invading the joint, with maintenance of pelvic continuity by preserving both columns and the quadrilateral plate of the acetabulum, without intra-pelvic dissection, that can be performed on patients in whom the medial wall of the acetabulum is thick enough. Our preliminary assessments have included studies on dry bone and imaging analyses. The technique was first tested on a single cadaver pelvis (encompassing 2 hips) and subsequently performed on a patient with a pathological fracture of the femoral neck due to osteosarcoma secondary to Paget's disease. Conclusions: Further clinical applications are essential to evaluate the overall effectiveness, safety and impact on patient functionality of this experimental technique. [ABSTRACT FROM AUTHOR]

Purpose: To explore the value of 3D amide proton transfer weighted imaging (APTWI) in the differential diagnosis between benign and malignant bone tumors, and to compare the diagnostic performance of APTWI with traditional diffusionweighted imaging (DWI). Materials and methods: Patients with bone tumors located in the pelvis or lower limbs confirmed by puncture or surgical pathology were collected from January 2021 to July 2023 in the First Affiliated Hospital of Zhengzhou University. All patients underwent APTWI and DWI examinations. The magnetization transfer ratio with asymmetric analysis at the frequency offset of 3.5 ppm [MTRasym(3.5 ppm)] derived by APTWI and the apparent diffusion coefficient (ADC) derived by DWI for the tumors were measured. The Kolmogorou-Smirnou and Levene normality test was used to confirm the normal distribution of imaging parameters; and the independent sample t test was used to compare the differences in MTRasym(3.5 ppm) and ADC between benign and malignant bone tumors. In addition, the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of different imaging parameters in differentiation between benign and malignant bone tumors. P<0.05 means statistically significant. Results: Among 85 bone tumor patients, 33 were benign and 52 were malignant. The MTRasym(3.5 ppm) values of malignant bone tumors were significantly higher than those of benign tumors, while the ADC valueswere significantly lower in benign tumors. ROC analysis shows thatMTRasym(3.5 ppm) and ADC values perform well in the differential diagnosis of benign and malignant bone tumors, with the area under the ROC curve (AUC) of 0.798 and 0.780, respectively. Combination of MTRasym(3.5 ppm) and ADC values can further improve the diagnostic performance with the AUC of 0.849 (sensitivity = 84.9% and specificity = 73.1%). Conclusion: MTRasym(3.5 ppm) ofmalignant bone tumors was significantly higher than that of benign bone tumors, reflecting the abnormal increase of protein synthesis in malignant tumors. APTWI combined with DWI can achieve a high diagnostic efficacy in differentiation between benign and malignant bone tumors. [ABSTRACT FROM AUTHOR]

The pelvic ring is a complicated anatomical structure which consists of the sacral bone, the iliac, ischial and pubic compartments and the pubic symphysis. In the elderly, osteoporotic fractures of the pelvic ring are often caused by low energy trauma. They are very rarely accompanied by neurological, vascular or endopelvic organ injuries. There has been a rise in the incidence of such trauma due to the increase of life expectancy, population aging and improvement of diagnostic and evaluation techniques. Pelvic ring fractures are often missed or under evaluated, resulting in remaining pain and great disability. Thorough assessment of the clinical presentation and medical history of the patient along with the needed imaging tests are vital for choosing the suitable therapeutic approach. Pelvic ring fractures are classified according to many systems. The most popular one is Denis et al classification, which is slowly replaced by the Young-Burgess classification, based on the applied force's direction. FFP classification aids in the diagnosis and leads the treatment algorithm. The AO/OTA cooperative categorization can help improve common understanding of such pathologies. Treatment sequence can be conservative or surgical and aims to pain management and rapid mobilization. However, it must always include the suitable osteoporotic therapy. [ABSTRACT FROM AUTHOR]

Gondwanan dinosaur faunae during the 20 Myr preceding the Cretaceous–Palaeogene (K/Pg) extinction included several lineages that were absent or poorly represented in Laurasian landmasses. Among these, the South American fossil record contains diverse abelisaurids, arguably the most successful groups of carnivorous dinosaurs from Gondwana in the Cretaceous, reaching their highest diversity towards the end of this period. Here we describe Koleken inakayali gen. et sp. n., a new abelisaurid from the La Colonia Formation (Maastrichtian, Upper Cretaceous) of Patagonia. Koleken inakayali is known from several skull bones, an almost complete dorsal series, complete sacrum, several caudal vertebrae, pelvic girdle and almost complete hind limbs. The new abelisaurid shows a unique set of features in the skull and several anatomical differences from Carnotaurus sastrei (the only other abelisaurid known from the La Colonia Formation). Koleken inakayali is retrieved as a brachyrostran abelisaurid, clustered with other South American abelisaurids from the latest Cretaceous (Campanian–Maastrichtian), such as Aucasaurus, Niebla and Carnotaurus. Leveraging our phylogeny estimates, we explore rates of morphological evolution across ceratosaurian lineages, finding them to be particularly high for elaphrosaurine noasaurids and around the base of Abelisauridae, before the Early Cretaceous radiation of the latter clade. The Noasauridae and their sister clade show contrasting patterns of morphological evolution, with noasaurids undergoing an early phase of accelerated evolution of the axial and hind limb skeleton in the Jurassic, and the abelisaurids exhibiting sustained high rates of cranial evolution during the Early Cretaceous. These results provide much needed context for the evolutionary dynamics of ceratosaurian theropods, contributing to broader understanding of macroevolutionary patterns across dinosaurs. [ABSTRACT FROM AUTHOR]

Aims: We endeavored to introduce a novel scoring system (Lumbar Functional Index, LFI) capable of evaluating lumbar function in pelvic bone sarcoma patients who underwent surgical resection and spinal pelvic fixation, while simultaneously identifying the incidence, outcomes, and risk factors of lumbar function impairment among these populations. Patients and Methods: A cohort of 304 primary bone sarcoma patients were recruited. The LFI was created based on the Oswestry Dysfunction Index (ODI) and Japanese Orthopaedic Association (JOA) scores. Lumbar function impairment was defined as LFI score ≥ 18 points, which was identified as high LFI. Demographic data, clinical characteristics, and oncological outcomes were analyzed. Results: The cohort included chondrosarcoma (39.8%), osteosarcoma (29.9%), Ewing sarcoma (8.6%), bone‐derived undifferentiated pleomorphic sarcoma (7.2%), giant cell tumor of bone (7.2%), chordoma (2.3%), and other bone sarcomas (5.0%). The LFI score exhibited significant negative correlation with common scoring systems of bone sarcoma. The incidence of high LFI was 23.0%. Patients with high LFI demonstrated a higher prevalence of type I + II + III + IV pelvic tumor, more sacrificed nerve roots and bilateral lumbar spine fixation during surgery, while lower percentage of R0 resection and local control of pelvic tumor. Decreased median overall survival (30 vs. 52 months, p < 0.001) and recurrence‐free survival (14 vs. 24 months, p < 0.001) time were observed in these patients. Type I + II + III + IV pelvic tumor and sacrificed nerve roots≥2 were identified as risk factors for high LFI, while R0 resection and local control were identified as protective factors. Conclusion: The LFI scoring system exhibited a significant negative correlation to current scoring systems. High LFI patients had worse prognosis and distinct characteristics. The risk factors of high LFI included type I + II + III + IV pelvic tumor and sacrificed nerve roots≥2, and the protective factors included R0 resection and local control. [ABSTRACT FROM AUTHOR]