238 results on '"Pelvic bones"'
Search Results
2. Minimally Invasive Percutaneous <scp>TightRope</scp> ® System Fixation for an Unstable Posterior Pelvic Ring: Clinical Follow‐up and Biomechanical Studies
- Author
-
Feng Gu, Jiting Zhang, Zhenjiang Sui, Ke Zhang, Xiaoping Xie, and Tiecheng Yu
- Subjects
Adult ,Fracture Fixation, Internal ,Fractures, Bone ,Bone Screws ,Humans ,Orthopedics and Sports Medicine ,Surgery ,Pelvic Bones ,Follow-Up Studies ,Retrospective Studies - Abstract
To evaluate the mechanical stability and clinical efficacy of minimally invasive percutaneous TightRope® systems applied via gun-shaped reduction forceps for unstable posterior pelvic ring fractures.This study consists of two parts: a clinical retrospective study and a randomized controlled biomechanical test. For the clinical study, a retrospective analysis of posterior pelvic ring fractures was performed between June 2015 and May 2020. Eighteen patients underwent surgery using two TightRope® systems to fix a broken posterior pelvic ring because of unstable AO type C1 and C2 pelvic ring fractures. The patients were followed up for at least 2 years, and all patients were evaluated using the Majeed scoring system and vertical displacement. In the biomechanical tests, six embalmed adult pelvic specimens were used. The fractures were subjected to TightRope®, IS screw, and TBP fixation in a randomized block design. The specimens were placed in a biomechanical testing machine in a standing neutral posture. A cyclic vertical load of up to 500 N was applied, and the displacement of the specimens was recorded by the testing machine. The ultimate load in each group of specimens was recorded. The displacement and ultimate load were compared and analyzed by statistical methods.At a mean follow-up of 38.89 ± 8.72 months, the functional Majeed score was excellent in 14 patients and good in four patients. The final radiological examinations showed that the outcome was excellent in 14 patients and good in four patients. In these patients, no serious clinical complications were found. Weight-bearing was delayed in four patients. In biomechanical tests, the displacement of the specimens fixed with TightRope® was significantly lower than that of the specimens fixed with TBP (P 0.05) when the load ranged from 300 to 500 N. The displacement in the IS screw group was significantly lower than that in either the TBP or TightRope® group (P 0.05) when the load ranged from 0 to 500 N. The ultimate load in the IS screw group (1798 ± 83.53 N) was significantly greater than that in the TBP group (1352 ± 74.41 N) (t = 9.78, P 0.0001) and the TightRope® group (1347 ± 54.28 N) (t = 11.11, P 0.0001). However, no significant difference was observed between the TightRope® and TBP groups (t = 0.13, P = 0.90).Percutaneous posterior TightRope® system shows strong stability in mechanical experiments and shows good results in clinical follow-up while this system has certain advantages in lower surgical requirements and lower risk of related nerve and vascular structural damage.
- Published
- 2022
3. Posterior <scp>INFIX</scp> for Treating Unilateral Unstable Sacral Fractures
- Author
-
Haotian Qi, Xin Geng, Xiaokun Yu, Wenhuan Chen, Jian Jia, and Wei Tian
- Subjects
Fracture Fixation, Internal ,Fractures, Bone ,Sacrum ,Humans ,Spinal Fractures ,Orthopedics and Sports Medicine ,Surgery ,Pelvic Bones ,Retrospective Studies - Abstract
To evaluate the clinical outcomes of the treatment of unilateral unstable sacral fractures by fixation with the posterior INFIX (posterior pelvic ring screw-rod internal fxation).Data of 60 patients with unilateral unstable sacral fractures who underwent surgery from March 2013 to March 2020 were retrospectively analyzed according to the selection criteria. All patients were associated with anterior pelvic ring injuries, and the operations were performed by the same team of surgeons. According to the different types of internal fixation, the patients were divided into two groups, which both included 30 patients: the posterior INFIX group and iliosacral screw fixation group. The demographic and clinical data of the two patient groups, such as age, sex, sacral fracture types based on the Denis classification, operation time, amount of intraoperative bleeding, intraoperative fluoros copy time, Majeed pelvic score at final follow-up, and quality of fracture reduction based on Mears and Velyvis's imaging classification criteria were collected by the same researcher and compared statistically.All patients were continuously followed up for 23.17 ± 3.34 months (range, 12 to 46 months). All sacral fractures healed with an average healing time of 9.3 ± 2.24 months (range, 6 to 18 months). None of the patients had re-displacement of the fracture or fixation failure. Compared to the iliosacral screw group, the posterior INFIX group patients had more intraoperative bleeding (t = 3.59, P 0.001), shorter operation time (t = 4.49, P 0.001), and shorter intraoperative fluoroscopy time (t = 6.26, P 0.001). There were no statistical differences between the two groups in terms of age, sex, fracture type, Majeed score, and quality of fracture reduction (P 0.05). In the posterior INFIX group, one patient had a superficial wound infection and one patient complained of discomfort due to a prominent fixation. In the iliosacral screw fixation group, one patient had intraoperative iatrogenic S1 nerve injury and vessel injury. The posterior INFIX fixation was a simpler manipulation with higher safety, shorter time of operation and intraoperative fluoroscopy, and similar clinical outcomes compared to iliosacral screw fixation.For the treatment of unilateral unstable sacral fractures, the posterior INFIX fixation can be recommended in clinic application.
- Published
- 2022
4. Incidence of genitourinary injuries in pelvic fractures: A 12‐year single‐center retrospective study
- Author
-
Tomoyuki Kaneko, Kazuki Yanagida, Kentaro Matsui, Masaki Kimura, Taketo Kawai, Yukio Yamada, Keisuke Ishii, Taketo Kurozumi, Takashi Suzuki, Yoshinobu Watanabe, Hirotaka Kawano, Tetsuya Sakamoto, and Tohru Nakagawa
- Subjects
Adult ,Male ,Fractures, Bone ,Urethra ,Incidence ,Urology ,Humans ,Neurology (clinical) ,Pelvic Bones ,Retrospective Studies - Abstract
This study aimed to determine the epidemiology of genitourinary injuries in pelvic fractures and elucidate the clinical outcomes of patients with pelvic fractures with and without genitourinary injuries at a tertiary trauma center in Japan.Patients with pelvic fractures in our tertiary trauma center between May 2009 and April 2021 were retrospectively assessed. The patients' demographics, mechanism of injury, and hospital course details were collected. The outcomes of patients with pelvic fractures with and without genitourinary injuries were compared.Of 402 patients with pelvic fractures, 18 (4.5%) had genitourinary injuries. Falls were the most common mechanisms of injury for all pelvic fractures The incidence of bladder, kidney, urethral, and testis injuries were 2.0%, 1.2%, 1.2%, and 0.5%, respectively. Patients with genitourinary injuries were significantly younger (median age, 26 vs. 51 years; p 0.001), had a higher rate of intensive care unit admission (94% vs. 58%; p = 0.002), remained hospitalized longer (median duration, 82 vs. 45 days; p 0.001), and had a longer intensive care unit stay (median duration, 6 vs. 2 days; p 0.001) when compared to patients without genitourinary injuries. Genitourinary injuries were not associated with in-hospital mortality.The incidence of genitourinary injuries with pelvic fractures was 4.5%. The presence of genitourinary injuries was associated with a higher rate of intensive care unit admission, longer hospital stay, and longer intensive care unit stay, but it was not associated with in-hospital mortality.
- Published
- 2022
5. An anatomical study defining the safe range of angles in percutaneous iliosacral and transsacral screw fixation
- Author
-
Raymond W. Liu, Michael T. Do, and Ari D. Levine
- Subjects
Adult ,Sacrum ,medicine.medical_specialty ,Histology ,Percutaneous ,Adolescent ,Bone Screws ,Pelvic inlet ,Ilium ,Fracture Fixation, Internal ,Young Adult ,Fixation (surgical) ,medicine ,Humans ,Pelvic Bones ,Aged ,Sacroiliac joint ,business.industry ,General Medicine ,Anatomy ,Middle Aged ,Neurovascular bundle ,medicine.anatomical_structure ,Orthopedic surgery ,business ,Cadaveric spasm - Abstract
Percutaneous iliosacral screw fixation and transsacral fixation are challenging procedures requiring extensive knowledge of sacral anatomy to avoid damaging nearby neurovascular structures. Greater knowledge of anatomical screw trajectory and size allowances would be helpful to guide surgical placement. An anatomical study of 40 cadaveric sacra in specimens ages 18-65 was performed. Three-dimensional surface scans were obtained, and computer modeling software was used to simulate a 7.3 mm diameter screw with 1 mm buffer inserted orthogonal to the sacroiliac joint in the pelvic inlet and outlet views. Transsacral screws were also inserted into S1 and S2 vertebrae. For screws orthogonal to the sacroiliac joint, the overall mean screw insertion angle was 4.1° ± 7.5° (range, -18.3° to 22.0°) in the inlet view in the posterior to anterior direction, and 21.7° ± 5.1° (range, 8.2°-36.3°) in the outlet view in the caudal to cranial direction. Before breaching the sacrum, the range of sacral tunnel lengths was between 31.1 and 70.1 mm with a range of diameters between 9.3 and 13.3 mm. Transsacral screws inserted into either the S1 or S2 vertebrae did not breach the sacrum in 40% (16/40) at each level. 30% (12/40) of sacra could not safely accommodate both S1 and S2 transsacral screws. There is an initial screw insertion angle range of -4° to 12° in the inlet view and 16°-27° in the outlet view. There was always adequate size to accept a 7.3 mm or larger screw.
- Published
- 2021
6. Management of Locked Posterior Shoulder Dislocation with Reverse Hill–Sachs Lesions via Anatomical Reconstructions
- Author
-
Jin-Ming Zhang, Xieyuan Jiang, Qiang Huang, and Meng Mi
- Subjects
Adult ,Male ,Humeral Fractures ,medicine.medical_specialty ,Shoulder ,Bone grafting ,medicine.medical_treatment ,Bone healing ,Iliac crest ,Fracture Fixation, Internal ,Surveys and Questionnaires ,Anatomical reconstruction ,medicine ,Humans ,Internal fixation ,Dislocation ,Orthopedics and Sports Medicine ,Pelvic Bones ,Reduction (orthopedic surgery) ,Pain Measurement ,Retrospective Studies ,Fixation (histology) ,Orthopedic surgery ,Bone Transplantation ,Clinical Article ,Impaction ,business.industry ,Shoulder Dislocation ,Middle Aged ,Allografts ,Surgery ,medicine.anatomical_structure ,Bankart Lesions ,Clinical Articles ,Female ,Reverse Hill‐Sachs lesion ,Range of motion ,business ,RD701-811 - Abstract
Objective To evaluate the outcomes of locked posterior shoulder dislocation with reverse Hill–Sachs lesions in patients treated with anatomical reconstructions. Methods Patients who were treated at our institution between January 2016 and June 2020 were retrospectively reviewed. The demographics of the patients including gender, age, occupation, and dominant arm were recorded. Eleven cases from 10 patients qualified in this study. Nine males and one female were included. The mean age of the patients was 44.8 years (range, 33–54 years). Mechanism of injury, duration between injuries and definitive diagnosis, misdiagnosis, size of humeral head impaction, treatment maneuver, and details of operation performed were reviewed. Plain radiographs and computed tomography (CT) scan were taken to determine the size of defects preoperatively and fracture healing during follow‐up. During surgery, the deltopectoral approach was employed. Anatomical reconstruction procedure including reduction, disimpaction, bone grafting, and fixation were sequentially performed. Either cancellous autograft from iliac crest or allograft were used and the fractures were anatomically reduced and stabilized by screws or plates. Visual Analog Scale (VAS) and Constant–Murley score were recorded to determine the functional outcomes preoperatively, at 3 months and 6 months postoperatively, and at the last follow‐up. The range of motion in forward flexion was recorded at 6 months follow‐up postoperatively. Results Causes of injuries included epileptic seizure in four cases, fall in three cases, and road traffic accident in three cases. Misdiagnoses occurred in five out of 10 patients. The mean time between injury and definitive treatment among those misdiagnosed was 112 days. The mean size of the impacted reverse Hill–Sachs lesions was 33.95% (range, 19.1%–42.6%). All patients received surgical management with anatomical reconstruction approach, including open reduction, disimpaction, bone grafting, and internal fixation. The mean amount of bleeding during operation was 450 mL. The mean follow‐up period was 22.6 months. Fracture healing was observed by 8 weeks in all cases postoperatively and evidence of bone grafting could not be further detected on CT scan at 6 month during follow‐up. VAS was significantly lower at the last follow‐up (0.68 ± 0.21) in comparison to preoperative scores (4.96 ± 0.97) (P, Fracture healing after treatment of locked posterior shoulder dislocation with reverse Hill–Sachs lesion via anatomical reconstructions.
- Published
- 2021
7. Spine‐Pelvis‐Hip Alignments in Degenerative Spinal Deformity Patients and Associated Procedure of One‐Stage Long‐Fusion with Multiple‐Level PLIF or Apical‐Vertebra Three Column Osteotomy–a Clinical and Radiographic Analysis Study
- Author
-
Deng-Bin Qi, Yan Wang, Zheng Wang, Tianhao Wang, and Zi-Fang Zhang
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Scoliosis ,Three‐column osteotomy ,Osteotomy ,Thoracic Vertebrae ,Posterior lumbar inter‐body fusion ,Lumbar ,medicine ,Humans ,Orthopedics and Sports Medicine ,Pelvic Bones ,Pelvis ,Aged ,Retrospective Studies ,Orthopedic surgery ,Clinical Article ,Lumbar Vertebrae ,business.industry ,Retrospective cohort study ,Bone Malalignment ,Hyper‐kyphosis ,Middle Aged ,medicine.disease ,Sagittal plane ,Surgery ,Radiography ,Spinal Fusion ,medicine.anatomical_structure ,Health‐related quality of life ,Coronal plane ,Thoracolumbar kyphosis ,Clinical Articles ,Quality of Life ,De‐novo scoliosis ,Female ,Hip Joint ,Spinal Diseases ,business ,RD701-811 - Abstract
Objective To explore the spine‐pelvis‐hip alignments in degenerative spinal deformity (DSD) patients, and compare the outcomes in the procedure of long‐fusion with posterior lumbar inter‐body fusion (PLIF) or single‐level three‐column osteotomy (STO) at lower lumbar level (LLL, L3‐S1) and thoracolumbar levels (TLL, T10‐L2) for those patients. Methods This is a retrospective study. Following institutional ethics approval, a total of 83 patients (Female, 67; Male, 16) with DSD underwent long‐fusion with PLIF or STO surgery between March 2015 and December 2017 were reviewed. All of those patients were assigned into LLL and TLL groups. The average age at surgery was 65.2 years (SD, 8.1). Demographic (age, gender, BMI, and comorbidities), radiographs (both coronal and sagittal parameters) and health‐related quality of life (HRQOL) assessments were documented. The radiographic parameters and HRQOL‐related measurements at pre‐ and post‐operation were compared with paired‐samples t test, and those variables in the two groups were analyzed using an independent‐sample t test. The relationships between pelvic incidence (PI) and other sagittal parameters were investigated with Pearson correlation analysis. The Pearson χ2 or Fisher's exact was carried out for comparison of gender, incidence of comorbidities and post‐operative complications. Results There were 53 and 30 patients in the LLL and TLL groups respectively. Those spino‐pelvic radiographic parameters had significant improvements after surgeries (P, Degenerative spinal deformity patients with low PI would be vulnerable to thoracolumbar degeneration, and those with high PI would suffer significant lumbar degeneration. Moreover, those radiographic data of hip joints in DSD patients with lower PI would be restored much easier after the procedure of long‐fusion with PLIF or STO.
- Published
- 2021
8. A geometric morphometric assessment of shape variation in adult pelvic morphology
- Author
-
Samantha L. Cox
- Subjects
Adult ,Population ,Biology ,Pelvis ,Pregnancy ,medicine ,Animals ,Humans ,Pelvic Bones ,education ,Pubic Bone ,Morphometrics ,Sex Characteristics ,education.field_of_study ,Hominidae ,Greater sciatic notch ,Regression ,Sexual dimorphism ,Variation (linguistics) ,medicine.anatomical_structure ,Evolutionary biology ,Anthropology ,Female ,Allometry ,Anatomy - Abstract
Objectives In humans, the pelvis is the most sexually dimorphic skeletal element and is often utilized in aging and sexing remains. The pelvis has become greatly relied upon in anthropological research (e.g., forensics, demographics, obstetrics, evolutionary history); however, pelvis morphology is highly variable, and very little is known about the nature, sources, patterning, and interpretation of this variation. This study aims to quantify pelvis shape variation, document sexual shape variation, and estimate the plasticity of morphology. This will ultimately give greater ability to interpret modern, archaeological, and evolutionary patterns to gain deeper insight into processes which shape human anatomy. Materials and methods Using a sample of 129 Medieval Danish skeletons, shape variation is documented in the greater sciatic notch (GSN), iliac crest (IC), arcuate line (AL), and sub-pubic angle (SPA) using 3D geometric morphometrics. The landmarking method applied here has the advantage of being applicable to fragmentary remains, rather than requiring whole bones. This allows it to be easily applied to archaeological samples and for the interpretation of separate bone features. Differences in shape were statistically analyzed by principle component analysis, linear discriminate analysis, and morphological disparity. Relationships between maximum femur length, body mass, and shape centroid size were also test by allometric regression. Results Results quantify the sexual dimorphism and shape variation present in these features. The GSN shape is the most variable, while the AL is the least. Similarly, the IC is the only feature which shows almost no dimorphism in shape, and instead best reflects lifestyle/activity patterns. Evidence of dimorphism in the IC is likely a result of cultural labor patterns rather than genetic and hormonal influence. Finally, the shapes of the GSN, AL, and SPA are more related to body mass than to femur length, such that individuals with increased mass exhibit more classically "male" shapes and those with less mass have more "female" shapes. Discussion The results have important implications for the evolution of pelvic anatomy, and sexual dimorphism, but also highlight the plasticity inherent in pelvic morphology. Analyzing pelvis features separately in a clearly defined, relatively genetically homogenous population gives insight into the determinants of bone morphology, which are not readily observable by other means. The relationship between body mass and shape suggests dimorphism in body size and composition may affect bone shape.
- Published
- 2021
9. Pelvic ring reconstruction with double‐barreled fibular free flap: A systematic review
- Author
-
Marco Innocenti, Giulio Menichini, Giacomo Cannamela, Stefano Bastoni, Elena Lucattelli, and Federico Cipriani
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Free flap ,Free Tissue Flaps ,Surgery ,Fracture Fixation, Internal ,Fractures, Bone ,Hemipelvectomy ,Fixation (surgical) ,External fixation ,Treatment Outcome ,Fracture Fixation ,Pelvic ring ,medicine ,Humans ,Statistical analysis ,Pelvic Bones ,business ,Bone Plates ,Statistical evidence ,Statistical correlation ,Retrospective Studies - Abstract
INTRODUCTION Pelvic ring reconstruction after internal hemipelvectomy is an extremely challenging surgical procedure, and mandatory reconstruction is to provide a durable and pain-free functional outcome, especially for young, active patients. One of the most widely employed techniques is reconstruction with a double-barreled fibular free flap (DBF). The aim of our work was an in-depth analysis of the outcome of pelvic ring reconstruction performed using the above-mentioned method, in particular looking for a correlation between the fixation technique and either ambulation status or complications. MATERIALS AND METHODS A systematic review was performed in November 2020 using PubMed and MedLine Ovid databases according to the PRISMA guidelines and the results were statistically analyzed. RESULTS Studies were published between 1994 and 2015. A DBF was used in each case, with a total of 30 patients. Reconstruction was performed with screws in 13 cases, Cotrel-Dubousset rod fixation in 6, screws and plate in 5, screws with external fixation in 4, and ISOLA in 2. Follow-up time ranged from 3 to 131 months. Functional outcome was excellent in 4 patients and good in 26 patients. Statistical analysis showed no statistical evidence of existing correlation between fixation technique and complications (p = .873), while statistical correlation between age and fixation technique was found (p
- Published
- 2021
10. Proximal seminal vesicle displacement and margins for prostate cancer radiotherapy
- Author
-
Michal Schneider, N. Anderson, Kenneth Wan, Nathan Lawrentschuk, Daryl Lim Joon, Margaret Benci, Morikatsu Wada, Monica Handley, Vincent Khoo, Farshad Foroudi, Wee Loon Ong, Rebecca Morrell, Trish Jenkins, Shomik Sengupta, Angelina Piccolo, Karen Daly, Michael Chao, and David Angus
- Subjects
Male ,displacement ,radiotherapy planning ,medicine.medical_treatment ,R895-920 ,margins ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Prostate cancer ,fiducial markers ,Medical physics. Medical radiology. Nuclear medicine ,0302 clinical medicine ,Seminal vesicle ,Prostate ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Displacement (orthopedic surgery) ,Pelvic Bones ,radiotherapy ,Radiological and Ultrasound Technology ,business.industry ,Radiotherapy Planning, Computer-Assisted ,Prostatic Neoplasms ,Seminal Vesicles ,Cancer ,Radiotherapy Dosage ,Original Articles ,medicine.disease ,prostate cancer ,Confidence interval ,Radiation therapy ,medicine.anatomical_structure ,Clinical target volume ,planning target volume ,030220 oncology & carcinogenesis ,Adenocarcinoma ,Original Article ,business ,Nuclear medicine ,Radiotherapy, Image-Guided - Abstract
Introduction Guidelines recommend that the proximal seminal vesicles (PrSV) should be included in the clinical target volume for locally advanced prostate cancer patients undergoing radiotherapy. Verification and margins for the prostate may not necessarily account for PrSV displacement. The purpose was to determine the inter‐fraction displacement of the PrSV relative to the prostate during radiotherapy. Methods Fiducials were inserted into the prostate, and right and left PrSV (RSV and LSV) in 30 prostate cancer patients. Correctional shifts for the prostate, right and left PrSV and pelvic bones were determined from each patient's 39 daily orthogonal portal images relative to reference digitally reconstructed radiographs. Results There was a significant displacement of the RSV relative to the prostate in all directions: on average 0.38 mm (95% confidence interval (CI) 0.26 to 0.50) to the left, 0.80–0.81 mm (CI 0.68 to 0.93) superiorly and 1.51 mm (CI 1.36 to 1.65) posteriorly. The LSV was significantly displaced superiorly to the prostate 1.09–1.13 mm (CI 0.97 to 1.25) and posteriorly 1.81 mm (CI 1.67 to 1.96), but not laterally (mean 0.06, CI −0.06 to 0.18). The calculated PTV margins (left–right, superior–inferior, posterior–anterior) were 4.9, 5.3–5.6 and 4.8 mm for the prostate, 5.2, 7.1–8.0 and 9.7 mm for the RSV, and 7.2, 7.5–7.6 and 8.6 mm for the LSV. Conclusion There is a significant displacement of the PrSV relative to the prostate during radiotherapy. Greater margins are recommended for the PrSV compared to the prostate., Seminal vesicles displacement is greater than that of the prostate during radiotherapy and requires a greater margin.
- Published
- 2021
11. Evaluating femoral augmentation to prevent geriatric hip fracture: A scoping review of experimental methods.
- Author
-
Bliven EK, Fung A, Cripton PA, Helgason B, and Guy P
- Subjects
- Humans, Aged, Femur, Bone Cements therapeutic use, Biomechanical Phenomena, Hip Fractures prevention & control, Hip Fractures surgery, Pelvic Bones
- Abstract
Various femoral augmentation designs have been investigated over the past decade for the prevention of geriatric hip fracture. The experimental methods used to evaluate the efficacy of these augmentations have not been critically evaluated or compared in terms of biofidelity, robustness, or ease of application. Such parameters have significant relevance in characterizing future clinical success. In this study we aimed to use a scoping review to summarize the experimental studies that evaluate femoral augmentation approaches, and critically evaluate commonly applied protocols and identify areas for concordance with the clinical situation. We conducted a literature search targeting studies that used experimental test methods to evaluate femoral augmentation to prevent geriatric fragility fracture. A total of 25 studies met the eligibility criteria. The most commonly investigated augmentation to date is the injection of bone cement or another material that cured in situ, and a popular subsequent method for biomechanical evaluation was to load the augmented proximal femur until fracture in a sideways fall configuration. We noted limitations in the clinical relevance of sideways fall scenarios being modeled and large variance in the concordance of many of the studies identified. Our review brings about recommendations for enhancing the fidelity of experimental methods modeling clinical sideways falls, which include an improved representation of soft tissue effects, using outcome metrics beyond load-to-failure, and applying loads inertially. Effective augmentations are encouraging for their potential to reduce the burden of hip fracture; however, the likelihood of this success is only as strong as the methods used in their evaluation., (© 2023 Orthopaedic Research Society.)
- Published
- 2023
- Full Text
- View/download PDF
12. Analysis of trans‐sacral corridors in stabilization of fractures of the pelvic ring
- Author
-
Mark-Tilmann Seitz, Mehool R. Acharya, Marc-Pascal Meier, Tobias Blüchel, Katharina Jäckle, Wolfgang Lehmann, Christopher Spering, and Matthias Paulisch
- Subjects
musculoskeletal diseases ,Sacrum ,medicine.medical_treatment ,Bone Screws ,Population ,Pelvis ,Screw placement ,Ilium ,Fracture Fixation, Internal ,Fractures, Bone ,03 medical and health sciences ,0302 clinical medicine ,Pelvic ring ,medicine ,Humans ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Pelvic Bones ,education ,Surgical treatment ,Reduction (orthopedic surgery) ,Orthodontics ,030222 orthopedics ,education.field_of_study ,business.industry ,equipment and supplies ,musculoskeletal system ,Stable fixation ,surgical procedures, operative ,Implant ,business ,Percutaneous screw fixation - Abstract
Percutaneous screw fixation combined with pelvic reduction is a surgical technique used to stabilize fractures of the posterior pelvic ring. This is the standard surgical treatment of unstable posterior pelvic ring injuries. The primary goal of this treatment is an anatomic reduction and stable fixation. This has been shown to reduce pain and improve the patients' long-term well-being. The aim of this analysis was to determine the possible screw lengths and the positioning of the screws in the S1 and S2 sacral segments. A population of 697 pelvises from the Stryker Orthopaedic Modeling and Analytics database were analyzed. The dimensions of the S1 and S2 screw corridors were determined and after assessing for sacral dysmorphism, the correct screw placement was chosen to determine the necessary screw length for surgical treatment. The measurements of the screw lengths show a Gaussian distribution for the analyzed population. The percentage of dysmorphic pelvises for the S1 screw corridor was 31.3% and for the S2 corridor 8%. Average screw length for S1 was 163.8 ± 16.2 mm and for the S2 137.3 ± 9.5 mm. The results show that the S1/S2 axis cannot be used for a trans-sacral screw placement in every patient. The study shows that intraosseous screw corridors are present in 68.7% of the patients in the S1 position and in 92% at the S2 level where an intended implant can be placed fully intraosseous.
- Published
- 2021
13. Kinematic pelvic tilt during gait alters functional cup position in total hip arthroplasty
- Author
-
Joachim Grifka, Sebastian Dendorfer, Markus Weber, Matthias Meyer, Franz Suess, Tobias Renkawitz, and Seth A Jerabek
- Subjects
Male ,Pelvic tilt ,component position, gait analysis, kinematics, pelvic tilt, total hip arthroplasty ,Arthroplasty, Replacement, Hip ,0206 medical engineering ,610 Medizin ,02 engineering and technology ,Kinematics ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Prospective Studies ,Range of Motion, Articular ,Pelvic Bones ,Gait ,Pelvis ,030203 arthritis & rheumatology ,Orthodontics ,ddc:610 ,business.industry ,Acetabulum ,020601 biomedical engineering ,Biomechanical Phenomena ,medicine.anatomical_structure ,Gait analysis ,Cup position ,Female ,business ,Range of motion ,Total hip arthroplasty - Abstract
Static pelvic tilt impacts functional cup position in total hip arthroplasty (THA). In the current study we investigated the effect of kinematic pelvic changes on cup position. In the course of a prospective controlled trial postoperative 3D-computed tomography (CT) and gait analysis before and 6 and 12 months after THA were obtained in 60 patients. Kinematic pelvic motion during gait was measured using Anybody Modeling System. By fusion with 3D-CT, the impact of kinematic pelvic tilt alterations on cup anteversion and inclination was calculated. Furthermore, risk factors correlating with high pelvic mobility were evaluated. During gait a high pelvic range of motion up to 15.6° exceeding 5° in 61.7% (37/60) of patients before THA was found. After surgery, the pelvis tilted posteriorly by a mean of 4.0 ± 6.6° (p < .001). The pelvic anteflexion led to a mean decrease of −1.9 ± 2.2° (p < .001) for cup inclination and −15.1 ± 6.1° (p < .001) for anteversion in relation to the anterior pelvic plane (APP). Kinematic pelvic changes resulted in a further change up to 2.3° for inclination and up to 12.3° for anteversion. In relation to the preoperative situation differences in postoperative cup position ranged from −4.4 to 4.6° for inclination and from −7.8 to 17.9° for anteversion, respectively. Female sex (p < .001) and normal body weight (p < .001) correlated with high alterations in pelvic tilt. Kinematic pelvic changes highly impact cup anteversion in THA. Surgeons using the APP as reference should aim for a higher anteversion of about 15° due to the functional anteflexion of the pelvis during gait.
- Published
- 2021
14. Computed tomography study of the relationship between pelvic incidence and bony contribution to lumbar lordosis in children
- Author
-
Joseph F. Baker
- Subjects
Male ,Histology ,Adolescent ,Lordosis ,Radiography ,Computed tomography ,03 medical and health sciences ,0302 clinical medicine ,Age groups ,medicine ,Humans ,Child ,Pelvic Bones ,Pelvis ,0303 health sciences ,Lumbar Vertebrae ,medicine.diagnostic_test ,business.industry ,Age Factors ,Infant, Newborn ,Infant ,Pelvic incidence ,030206 dentistry ,General Medicine ,Anatomy ,medicine.disease ,medicine.anatomical_structure ,030301 anatomy & morphology ,Child, Preschool ,Cohort ,Female ,Tomography, X-Ray Computed ,Lumbar lordosis ,business - Abstract
There is little data regarding the relationship in children and how it may change with aging. The aim of this radiographic study was to define the relationship between pelvic incidence (PI) and segmental vertebral body lordosis through childhood. In 150 children, CT scans of the lumbar spine and pelvis were analyzed measuring PI, sacral table angle (STA), sacral kyphosis (SK), and segmental lordosis (SL) individually L1-L5. Children were grouped by age: (1) 0-60 months; (2) 61-120 months; (3) 121-185 months. Mean PI for the entire cohort was 40.4, mean SL for L1-0.6, L2 0.0, L3 1.8, L4, 4.7, and L5 11.4. There were 40 children in Group 1, 63 in Group 2 and 37 in Group 3. SL differed between age groups at all levels except at L2. L1 and L2 became more kyphotic with increasing age; L3, L4, and L5 became more lordotic with increasing age. The correlation between PI and SL at each level became stronger with increasing age. Similarly, the correlation between PI and STA and between PI and SK also became stronger with increasing age. As children mature, the relationship between PI and segmental lordosis at each level of the lumbar spine becomes stronger-the relationship between PI and lordosis trends toward that seen in the adult. Future work should aim to define when the adult PI-LL relationship is realized.
- Published
- 2021
15. The obstetrical dilemma hypothesis: there's life in the old dog yet
- Author
-
Robert D. Martin, Martin Haeusler, Cinzia Fornai, Nicole D S Grunstra, Viktoria A. Krenn, and Nicole M. Webb
- Subjects
Primates ,0106 biological sciences ,pelvic width ,secondary altriciality ,pelvis ,010603 evolutionary biology ,01 natural sciences ,General Biochemistry, Genetics and Molecular Biology ,Developmental psychology ,03 medical and health sciences ,birth ,human evolution ,Pregnancy ,medicine ,Animals ,Childbirth ,Bipedalism ,Pelvic Bones ,Pelvis ,030304 developmental biology ,0303 health sciences ,obstetrical dilemma ,obstetrics ,Pelvic floor ,Obstructed labour ,Parturition ,bipedalism ,Flexibility (personality) ,Original Articles ,medicine.disease ,Biological Evolution ,medicine.anatomical_structure ,Human evolution ,antagonistic selection ,sexual dimorphism ,Obstetrical dilemma ,Female ,Original Article ,General Agricultural and Biological Sciences ,Psychology - Abstract
The term ‘obstetrical dilemma’ was coined by Washburn in 1960 to describe the trade‐off between selection for a larger birth canal, permitting successful passage of a big‐brained human neonate, and the smaller pelvic dimensions required for bipedal locomotion. His suggested solution to these antagonistic pressures was to give birth prematurely, explaining the unusual degree of neurological and physical immaturity, or secondary altriciality, observed in human infants. This proposed trade‐off has traditionally been offered as the predominant evolutionary explanation for why human childbirth is so challenging, and inherently risky, compared to that of other primates. This perceived difficulty is likely due to the tight fit of fetal to maternal pelvic dimensions along with the convoluted shape of the birth canal and a comparatively low degree of ligamentous flexibility. Although the ideas combined under the obstetrical dilemma hypothesis originated almost a century ago, they have received renewed attention and empirical scrutiny in the last decade, with some researchers advocating complete rejection of the hypothesis and its assumptions. However, the hypothesis is complex because it presently captures several, mutually non‐exclusive ideas: (i) there is an evolutionary trade‐off resulting from opposing selection pressures on the pelvis; (ii) selection favouring a narrow pelvis specifically derives from bipedalism; (iii) human neonates are secondarily altricial because they are born relatively immature to ensure that they fit through the maternal bony pelvis; (iv) as a corollary to the asymmetric selection pressure for a spacious birth canal in females, humans evolved pronounced sexual dimorphism of pelvic shape. Recently, the hypothesis has been challenged on both empirical and theoretical grounds. Here, we appraise the original ideas captured under the ‘obstetrical dilemma’ and their subsequent evolution. We also evaluate complementary and alternative explanations for a tight fetopelvic fit and obstructed labour, including ecological factors related to nutrition and thermoregulation, constraints imposed by the stability of the pelvic floor or by maternal and fetal metabolism, the energetics of bipedalism, and variability in pelvic shape. This reveals that human childbirth is affected by a complex combination of evolutionary, ecological, and biocultural factors, which variably constrain maternal pelvic form and fetal growth. Our review demonstrates that it is unwarranted to reject the obstetrical dilemma hypothesis entirely because several of its fundamental assumptions have not been successfully discounted despite claims to the contrary. As such, the obstetrical dilemma remains a tenable hypothesis that can be used productively to guide evolutionary research.
- Published
- 2021
16. Bilateral asymmetry of bone density adjacent to pelvic sarcomas: A retrospective study using computed tomography
- Author
-
Valerae O. Lewis, Benjamin J. Fregly, Ata Babazadeh-Naseri, Nicholas J. Dunbar, and Andrew J. Baines
- Subjects
medicine.medical_specialty ,Bone density ,medicine.medical_treatment ,0206 medical engineering ,Bone Neoplasms ,02 engineering and technology ,Prosthesis ,03 medical and health sciences ,0302 clinical medicine ,Bone Density ,Medical imaging ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Pelvic Bones ,Pelvis ,Retrospective Studies ,Fixation (histology) ,030203 arthritis & rheumatology ,business.industry ,Sarcoma ,Retrospective cohort study ,020601 biomedical engineering ,Hemipelvectomy ,medicine.anatomical_structure ,Cortical bone ,Radiology ,Tomography, X-Ray Computed ,business - Abstract
Limb-salvaging hemipelvectomy surgeries involving allograft or custom prosthesis reconstruction require high quality remaining pelvic bone for adequate device fixation. Modeling studies of custom pelvis prosthesis designs typically mirror contralateral pelvic bone material properties to the ipsilateral pelvis. However, the extent of bone material property and geometric symmetry, and thus the appropriateness of mirroring, remains unknown and should be considered when designing or analyzing the performance of pelvic prostheses. This study investigates preoperative differences between ipsilateral and contralateral pelvic bone for patients with a pelvic sarcoma. Computed tomography (CT) data were obtained retrospectively from eight patients with a pelvic sarcoma. Subject-specific computational models of the pelvic bones were constructed from the CT data. Bilateral asymmetry of bone material properties and cross-sectional areas between the ipsilateral and contralateral hemipelvis were quantified at points adjacent to the pelvic sarcoma. Large bilateral asymmetry (>20%) in trabecular but not cortical bone density was observed within 20 mm of the tumor location. Differences in trabecular bone density typically declined with increased distance from the tumor. The greatest bilateral difference in cross-sectional area occurred within 10 mm of the tumor boundary for three patients and within 40 mm from the tumor site for four patients. Our results suggest that pelvic sarcomas can cause significant bilateral asymmetries in trabecular bone density for patients with a pelvic sarcoma. These differences should be taken into account when designing custom implants for this patient population.
- Published
- 2021
17. Achieve Closed Reduction of Irreducible, Unilateral Vertically Displaced Pelvic Ring Disruption with an Unlocking Closed Reduction Technique
- Author
-
Wei Zhang, Peifu Tang, Zheng-guo Zhu, Hua Chen, Yan Wu, Qun Zhang, and Zuhao Chang
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Cohort Studies ,Fracture Fixation, Internal ,Fractures, Bone ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Screw fixation ,Blood loss ,Pelvic ring ,medicine ,Humans ,Internal fixation ,Orthopedics and Sports Medicine ,Pelvic fracture ,Pelvic Bones ,Pedicle screw ,Reduction (orthopedic surgery) ,Aged ,Retrospective Studies ,Fixation (histology) ,Orthopedic surgery ,Aged, 80 and over ,030222 orthopedics ,Clinical Article ,business.industry ,Retrospective cohort study ,Middle Aged ,Closed reduction ,medicine.disease ,Closed Fracture Reduction ,Surgery ,Clinical Articles ,Female ,business ,RD701-811 ,030217 neurology & neurosurgery - Abstract
Objective To be able to treat irreducible unilateral vertically displaced pelvic ring disruption (UVDPRD) using closed reduction, we introduced a technique named Unlocking Closed Reduction Technique (UCRT) and evaluated its effectiveness with improved pelvic closed reduction system (PCRS). Methods A retrospective study was performed in our department. Between January 2014 and December 2017, 43 patients whose UVDPRD were not successfully reduced using transcondylar traction. Subsequently, they were treated with UCRT using improved PCRS. The study included 19 male and 24 female patients, with a mean age at the time of the operation of 46.2 years. During surgery, operation time and blood loss were recorded. Post‐surgical reduction quality was evaluated using Matta scoring criteria and patient lower‐extremity functional outcome was evaluated using Majeed functional scoring criteria. Results When used with improved PCRS, UCRT achieved pelvic reduction in all 43 cases of irreducible UVDPRD with postoperative pelvic reduction quality rated excellent and good for 42/43 (97.6%) patients according to the Matta scoring criteria (Matta Score, Unlocking Closed Reduction Technique (UCRT) first unlocks the dislocated iliosacral joint or overlapping edges of the sacral fracture through a force generated by framed‐based unlocking reduction device (FBURD) that pulls the posterior ilium laterally and then corrects the cranial and posterior displacement of posterior ring through transcondylar traction force.
- Published
- 2021
18. Surgical Treatment and Proposed Modified Classification for Harrington Class III Periacetabular Metastases
- Author
-
Taiqiang Yan, Wei Guo, Ran Wei, Xiaodong Tang, Yi Yang, Chiao Yee Lim, and Rongli Yang
- Subjects
Adult ,Male ,medicine.medical_specialty ,Scoring system ,Adolescent ,Arthroplasty, Replacement, Hip ,Phases of clinical research ,Bone Neoplasms ,Class iii ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,lcsh:Orthopedic surgery ,medicine ,Humans ,Orthopedics and Sports Medicine ,Surgical treatment ,Pelvic Bones ,Aged ,Retrospective Studies ,Sacroiliac joint ,030222 orthopedics ,Clinical Article ,business.industry ,En bloc resection ,Middle Aged ,Plastic Surgery Procedures ,Intraoperative Hemorrhage ,Classification ,Confidence interval ,Surgery ,lcsh:RD701-811 ,medicine.anatomical_structure ,Periacetabular metastasis ,Endoprosthesis ,Clinical Articles ,Female ,Reconstruction ,business ,030217 neurology & neurosurgery - Abstract
Objectives This study aims to: (i) evaluate the outcome of patients with Harrington class III lesions who were treated according to Harrington classification; (ii) propose a modified surgical classification for Harrington class III lesions; and (iii) assess the efficiency of the proposed modified classification. Methods This study composes two phases. During phase 1 (2006 to 2011), the clinical data of 16 patients with Harrington class III lesions who were treated by intralesional excision followed by reconstruction of antegrade/retrograde Steinmann pins/screws with cemented total hip arthroplasty (Harrington/modified Harrington procedure) were retrospectively reviewed and further analyzed synthetically to design a modified surgical classification system. In phase 2 (2013 to 2019), 62 patients with Harrington class III lesions were classified and surgically treated according to our modified classification. Functional outcome was assessed using the Musculoskeletal Tumor Society (MSTS) 93 scoring system. The outcome of local control was described using 2‐year recurrence‐free survival (RFS). Owing to the limited sample size, we considered P, We propose a modified classification for Harrington class III periacetabular metastases by adding two subgroups and corresponding surgical strategies according to the involvement of bone destruction. The proposed classification showed significant improvement in functional outcome and local control, along with acceptable surgical complexity in surgical management for class III lesions.
- Published
- 2021
19. Height Loss in Old Age and Fracture Risk Among Men in Late Life: A Prospective Cohort Study
- Author
-
Jane A. Cauley, Allyson M. Kats, Kristine E. Ensrud, Peggy M. Cawthon, John T. Schousboe, Brent C Taylor, Nancy E Lane, Tien N Vo, Andrew R. Hoffman, and Lisa Langsetmo
- Subjects
Male ,0301 basic medicine ,Fracture risk ,OLDER MEN ,Endocrinology, Diabetes and Metabolism ,FRACTURE RISK ,030209 endocrinology & metabolism ,Medical and Health Sciences ,Article ,03 medical and health sciences ,Engineering ,0302 clinical medicine ,Bone Density ,Risk Factors ,medicine ,Humans ,Orthopedics and Sports Medicine ,Prospective Studies ,HEIGHT LOSS ,Pelvic Bones ,Prospective cohort study ,Osteoporotic Fractures in Men (MrOS) Research Group ,Aged ,Proportional Hazards Models ,Femoral neck ,Bone mineral ,Hip fracture ,Hip Fractures ,business.industry ,Weight change ,Biological Sciences ,Anatomy & Morphology ,Height loss ,medicine.disease ,Confidence interval ,030104 developmental biology ,medicine.anatomical_structure ,business ,Demography - Abstract
To assess the association of height loss in old age with subsequent risk of hip and any clinical fracture in men late in life while accounting for the competing risk of mortality, we used data from 3491 community-dwelling men (mean age 79.2 years). Height loss between baseline and follow-up (mean 7.0 years between examinations) was categorized as
- Published
- 2021
20. Development of Hip Bone Geometry During Gender‐Affirming Hormone Therapy in Transgender Adolescents Resembles That of the Experienced Gender When Pubertal Suspension Is Started in Early Puberty
- Author
-
Maria A T C van der Loos, Daniel T Klink, Martin den Heijer, Chantal M. Wiepjes, Mariska C. Vlot, Ilse Hellinga, Internal medicine, APH - Health Behaviors & Chronic Diseases, APH - Aging & Later Life, and Amsterdam Gastroenterology Endocrinology Metabolism
- Subjects
Adult ,Male ,0301 basic medicine ,Peak bone mass ,Pediatrics ,medicine.medical_specialty ,Adolescent ,medicine.drug_class ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Population ,030209 endocrinology & metabolism ,Transgender Persons ,GENDER‐AFFIRMING HORMONE TREATMENT ,03 medical and health sciences ,0302 clinical medicine ,HIP BONE GEOMETRY ,Gonadotropin-releasing hormone agonist ,Transgender ,medicine ,Humans ,Testosterone ,Orthopedics and Sports Medicine ,Pelvic Bones ,education ,TRANSGENDER ,education.field_of_study ,GONADOTROPIN‐RELEASING HORMONE AGONIST ,business.industry ,Puberty ,Infant, Newborn ,Original Articles ,030104 developmental biology ,medicine.anatomical_structure ,Estrogen ,Hip bone ,Female ,Original Article ,Hormone therapy ,business ,Transsexualism - Abstract
Bone geometry can be described in terms of periosteal and endocortical growth and is partly determined by sex steroids. Periosteal and endocortical apposition are thought to be regulated by testosterone and estrogen, respectively. Gender‐affirming hormone (GAH) treatment with sex steroids in transgender people might affect bone geometry. However, in adult transgender people, no change in bone geometry during GAH was observed. In this study, we investigated changes in bone geometry among transgender adolescents using a gonadotropin‐releasing hormone agonist (GnRHa) and GAH before achieving peak bone mass. Transgender adolescents treated with GnRHa and subsequent GAH before the age of 18 years were eligible for inclusion. Participants were grouped based on their Tanner stage at the start of GnRHa treatment and divided into early, mid, and late puberty groups. Hip structure analysis software calculating subperiosteal width (SPW) and endocortical diameter (ED) was applied to dual‐energy X‐ray absorptiometry scans performed at the start of GnRHa and GAH treatments, and after ≥2 years of GAH treatment. Mixed‐model analyses were performed to study differences over time. Data were visually compared with reference values of the general population. A total of 322 participants were included, of whom 106 were trans women and 216 trans men. In both trans women and trans men, participants resembled the reference curve for SPW and ED of the experienced gender but only when GnRHa was started during early puberty. Those who started during mid and late puberty remained within the reference curve of the gender assigned at birth. A possible explanation might be sought in the phenomenon of programming, which conceptualizes that stimuli during critical windows of development can have major consequences throughout one's life span. Therefore, this study adds insights into sex‐specific bone geometry development during puberty of transgender adolescents treated with GnRHa, as well as the general population. © 2021 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
- Published
- 2021
21. <scp>Treatment‐Related</scp> Changes in Bone Turnover and Fracture Risk Reduction in Clinical Trials of Antiresorptive Drugs: Proportion of Treatment Effect Explained
- Author
-
Eric Vittinghoff, Charles E. McCulloch, Jane A. Cauley, Richard Eastell, Anne E. de Papp, Li-Yung Lui, Fernando Marin, Arkadi Chines, Douglas C. Bauer, Bruce H. Mitlak, Sundeep Khosla, and Dennis M. Black
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Osteoporosis ,Urology ,030209 endocrinology & metabolism ,Collagen Type I ,Bone resorption ,Bone remodeling ,03 medical and health sciences ,0302 clinical medicine ,N-terminal telopeptide ,Bone Density ,Fracture Fixation ,medicine ,Humans ,Orthopedics and Sports Medicine ,Pelvic Bones ,Hip fracture ,Bone Density Conservation Agents ,Hip Fractures ,business.industry ,Surrogate endpoint ,Bisphosphonate ,medicine.disease ,Clinical trial ,030104 developmental biology ,Bone Remodeling ,business ,Risk Reduction Behavior ,Biomarkers - Abstract
Few analyses of antiresorptive (AR) treatment trials relate short-term changes in bone turnover markers (BTMs) to subsequent fracture reduction seeking to estimate the proportion of treatment effect explained (PTE) by BTMs. Pooling such information would be useful to assess new ARs or novel dosing regimens. In the Foundation for the National Institutes of Health (FNIH) Bone Quality project, we analyzed individual-level data from up to 62,000 participants enrolled in 12 bisphosphonate (BP) and four selective estrogen receptor modulator (SERM) placebo-controlled fracture endpoint trials. Using BTM results for two bone formation markers (bone-specific alkaline phosphatase [bone ALP] and pro-collagen I N-propeptide [PINP]) and one bone resorption marker (C-terminal telopeptide of type I collagen [CTX]) and incident fracture outcome data, we estimated the PTE using two different models. Separate analyses were performed for incident morphometric vertebral, nonvertebral, and hip fractures over 1 to 5 years of follow-up. For vertebral fracture, the results showed that changes in all three BTMs at 6 months explained a large proportion of the treatment effect of ARs (57 to >100%), but not for and non-vertebral or hip fracture. We conclude that short-term AR treatment-related changes in bone ALP, PINP, and CTX account for a large proportion of the treatment effect for vertebral fracture. Change in BTMs is a useful surrogate marker to study the anti-fracture efficacy of new AR compounds or novel dosing regiments with approved AR drugs. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
- Published
- 2020
22. Usefulness of a high‐speed surgical air drill in pubectomy during delayed anastomotic urethroplasty for pelvic fracture urethral injury
- Author
-
Yusuke Hirano, Akio Horiguchi, Ryuichi Azuma, Keiichi Ito, Masayuki Shinchi, Tomohiko Asano, Koetsu Hamamoto, and Kenichiro Ojima
- Subjects
Male ,Urethral injury ,medicine.medical_specialty ,Urology ,Urethroplasty ,medicine.medical_treatment ,030232 urology & nephrology ,Anastomosis ,Fractures, Bone ,03 medical and health sciences ,0302 clinical medicine ,Urethra ,Germany ,medicine ,Humans ,Anastomotic urethroplasty ,Pelvic Bones ,Retrospective Studies ,Urethral Stricture ,Drill ,business.industry ,Anastomosis, Surgical ,medicine.disease ,Surgery ,Stenosis ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Pelvic fracture ,business - Abstract
OBJECTIVES Pubectomy is an ancillary technique used to increase exposure of the disrupted urethra and reduce anastomotic tension, which can be difficult for inexperienced surgeons. The objective of the present study was to illustrate the use of an air drill enabling delicate and precise bone resection in pubectomy for delayed anastomotic urethroplasty for pelvic fracture urethral injury. METHODS Between 2009 and 2019, 88 male patients underwent delayed anastomotic urethroplasty with pubectomy for pelvic fracture urethral injury. A total of 73 procedures used a high-speed surgical air drill (HiLAN HS; Aesculap, Tuttlingen, Germany) equipped with a short-hand piece. Operative time and blood loss in the air drill patient group (group 1) were compared with that of patients who underwent pubectomy using a rongeur and/or gouge (group 2, n = 15). RESULTS In 65 group 1 patients, urethroplasty was carried out using the perineal approach, with partial inferior pubectomy. Eight group 1 patients, whose proximal urethral end was displaced upward superior to the upper edge of pubis, underwent urethroplasty using the perineal and abdominal approach, with a superior partial pubectomy and supracrural urethral rerouting. No difficulty was encountered using the air drill in any of the cases. There was no significant difference in median operative time between the groups (group 1 256 min vs group 2 228 min; P = 0.31). The median blood loss in group 1 was significantly lower than group 2 (149 mL vs 453 mL; P
- Published
- 2020
23. Sacroiliac joint cut accuracy: Comparing new technologies in an idealized sawbones model
- Author
-
Tessa Balach, Matthew A. Siegel, Matthew W. Colman, Kyle R. Sweeney, and Lukas M. Nystrom
- Subjects
Male ,Scanner ,Bone Neoplasms ,Models, Biological ,03 medical and health sciences ,0302 clinical medicine ,Male pelvis ,Humans ,Medicine ,Pelvic Bones ,Patient specific instruments ,Pelvis ,Sacroiliac joint ,business.industry ,Margins of Excision ,Soft tissue ,Sacroiliac Joint ,General Medicine ,Osteotomy ,medicine.anatomical_structure ,Surgery, Computer-Assisted ,Oncology ,030220 oncology & carcinogenesis ,Cutting guide ,030211 gastroenterology & hepatology ,Surgery ,Current technology ,Tomography, X-Ray Computed ,business ,Nuclear medicine - Abstract
Background and objectives The anatomical complexity of the pelvis creates challenges for orthopaedic oncologists to accurately and safely resect tumors involving the sacroiliac joint. Current technology may help overcome these obstacles. Methods Four fellowship-trained orthopaedic oncologists performed 22 all-posterior sacroiliac cuts using freehand, computerized navigation, and patient-specific cutting guides on a Sawbones male pelvis model. Cut accuracies to preoperative planned margins were analyzed via a high-resolution optical scanner. Soft tissue damage was determined by visually inspecting the Sawbones foam placed on the far side of the cut. Results Within 5 mm of the margins, the freehand technique resulted in 67.0% cut accuracy, the navigation technique had 71.1%, and the patient-specific cutting guide technique had 85.6% (P = .093). Within 2 mm, the techniques showed an accuracy of 25.8%, 32.5%, and 47.5%, respectively (P = .022). Regarding soft tissue damage, the freehand technique exhibited minimal penetration damage for 16.7% of the cuts, while navigation and patient-specific guide techniques exhibited 25.0% and 75.0%, respectively (P = .046). Years of surgical experience of the operator (1-7) did not influence the cut accuracy for any method. Conclusions Under ideal conditions, patient-specific guide technology possesses the same or better accuracy as other cutting techniques as well as the circumvention of soft tissue damage.
- Published
- 2020
24. Complication rate, functional outcomes, and risk factors associated with carbon ion radiotherapy for patients with unresectable pelvic bone sarcoma
- Author
-
Hidetatsu Outani, Hideki Yoshikawa, Tadashi Kamada, Satoshi Takenaka, Nobuhito Araki, Kenichiro Hamada, and Reiko Imai
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Bone Neoplasms ,Heavy Ion Radiotherapy ,Bone Sarcoma ,Young Adult ,03 medical and health sciences ,Femoral head ,0302 clinical medicine ,Quality of life ,Surveys and Questionnaires ,Humans ,Medicine ,030212 general & internal medicine ,Child ,Pelvic Bones ,Aged ,Pelvic Neoplasms ,Aged, 80 and over ,business.industry ,Sarcoma ,Middle Aged ,medicine.disease ,Survival Analysis ,Surgery ,Radiation therapy ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Quality of Life ,Pelvic fracture ,Pelvic tumor ,Carbon Ion Radiotherapy ,Female ,business - Abstract
To the authors' knowledge, carbon ion radiotherapy (CIRT) is one of the few curative treatments for unresectable pelvic bone sarcoma. The current study investigated the complications, functional outcomes, and risk factors of CIRT.Of 112 patients who were treated with CIRT for unresectable pelvic bone sarcoma, the authors enrolled 29 patients who were without local disease recurrence or distant metastasis. The mean follow-up was 93 months. Complications, functional outcomes, and quality of life scores were assessed. Risk factors were analyzed, including the dose-volume histogram of the femoral head.Femoral head necrosis occurred in approximately 37% of patients, pelvic fractures were reported in 48% of patients, and neurological deficits were noted in 52% of patients. Femoral head necrosis was found to be significantly more prevalent among patients with periacetabular tumors (P = .018). The dose-volume histogram of the femoral head indicated tolerable volume percentages of the femoral head to be33% for 40 grays (relative biological effectiveness) and 16% for 60 grays ( relative biological effectiveness). The mean Musculoskeletal Tumor Society score and Toronto Extremity Salvage Score were 53% and 64%, respectively, and the mean EuroQol 5 dimensions questionnaire index was 0.587. Patients aged50 years and those with periacetabular tumors were found to have significantly lower Toronto Extremity Salvage Scores.Femoral head necrosis, pelvic fracture, and nerve damage are common complications with the use of CIRT for pelvic bone sarcoma. To prevent femoral head necrosis, the radiation dose to the femoral head should be kept below the estimated tolerance curve presented in the current study. The functional outcome is nearly equivalent to that of surgery. CIRT may be a promising alternative to surgery for patients with unresectable pelvic bone sarcoma.
- Published
- 2020
25. Changes of acetabular anteversion according to pelvic tilt on sagittal plane under various acetabular inclinations
- Author
-
Suk Han Jung, Won Kee Choi, Tae-Hoon Kim, Myung Rae Cho, Suk Kyoon Song, and Hee Chan Kim
- Subjects
Male ,Pelvic tilt ,Materials science ,Radiography ,0206 medical engineering ,02 engineering and technology ,Pelvis ,03 medical and health sciences ,Imaging, Three-Dimensional ,0302 clinical medicine ,Orientation (geometry) ,Inclination angle ,Cadaver ,medicine ,Humans ,Orthopedics and Sports Medicine ,Computer navigation ,Pelvic Bones ,Observer Variation ,030203 arthritis & rheumatology ,Orthodontics ,business.industry ,Reproducibility of Results ,Acetabulum ,020601 biomedical engineering ,Sagittal plane ,medicine.anatomical_structure ,Plain radiography ,Coronal plane ,Tomography, X-Ray Computed ,business - Abstract
Improper functional orientation of the acetabular cup can result in improper positions when dynamic pelvic positions are not considered. The purpose of this study was to evaluate changes on acetabular anteversion according to pelvic tilt under various acetabular inclinations. Two artificial pelvic models were selected for this study. Acetabular inclinations on the coronal plane were 25°, 32°, 50°, and 60°. Acetabular anteversion of all components were 15°. Changes of anteversion according to pelvic tilt were measured at angles of 0°, 10°, 20°, 30°, and 40°. Computer Navigation, PolyWare 3D pro, CT, and plain radiography were used to measure each angle. The anatomical anteversions against pelvic tilt were calculated using the following formulae: anatomical anteversion (°) = -14.48Χ + 90.18 (inclination angle 25°); anatomical anteversion (°) = -12.26Χ + 80.10 (inclination angle 32°); anatomical anteversion (°) = -7.468Χ + 61.13 (inclination angle 50°); and anatomical anteversion (°) = -5.328Χ + 44.84 (inclination angle 60°) (Χ: pelvic tilt angle). Radiographic anteversion against pelvic tilt were calculated using the following formulae: radiographic anteversion (°) = -9.50Χ + 57.09 (inclination angle 25°); radiographic anteversion (°) = -8.577Χ + 50.89 (inclination angle 32°); radiographic anteversion (°) = -6.794Χ + 45.73 (inclination angle 50°); radiographic anteversion (°) = -5.226Χ + 33.08 (inclination angle 60°). In conclusion, changes in anteversion according to pelvic tilt were lesser at higher degrees of acetabular inclination.
- Published
- 2020
26. Imaging Approaches for Accurate Determination of the Quadriceps Angle
- Author
-
Yun‐jen Yeow, Chi-Chuan Wu, and Kee-Min Yeow
- Subjects
Adult ,Male ,Scientific Articles ,Full‐length standing scanogram ,Scanography ,03 medical and health sciences ,Magnetic resonance imaging ,0302 clinical medicine ,lcsh:Orthopedic surgery ,medicine ,Humans ,Scientific Article ,Orthopedics and Sports Medicine ,Femur ,Tibia ,Pelvic Bones ,Quadriceps angle ,Pelvis ,Aged ,Retrospective Studies ,030222 orthopedics ,medicine.diagnostic_test ,business.industry ,Soft tissue ,Retrospective cohort study ,Patella ,Middle Aged ,lcsh:RD701-811 ,medicine.anatomical_structure ,Coronal plane ,Female ,Surgery ,business ,Nuclear medicine ,030217 neurology & neurosurgery - Abstract
Objectives A retrospective study was conducted using magnetic resonance image (MRI) and a full‐length standing scanogram (FLSS) to measure the quadriceps angle (Q‐angle) while avoiding soft tissue interference. Methods Two steps were retrospectively carried out in two case series. The first step involved using MRI to define the standardized patellar center (PC) and the tibial tubercle (TT) on the frontal plane of the MRI in one group of 60 consecutive patients (from July 2016 to December 2016, 29 men and 31 women, average of 46 years). The next step was transferring the location of the standardized PC and the TT from the MRI to the FLSS in another group of 100 consecutive patients (from April 2009 to March 2014, 50 men and 50 women, average of 36 years). The pelvis and intact femur, knee, and tibia were used to determine the Q‐angle on the FLSS. Results The standardized PC was positioned 42% from the lateral end of femur trans‐epicondylar line. The TT was 2 cm distal to the tibial articular surface and 37% from the lateral end of tibial width. The average Q‐angle was 9.5° in 100 patients (8.8° in 50 men and 10.1° in 50 women, P = 0.02). The average femoral length was 42.9 cm in 100 patients (44.7 cm in 50 men and 41.1 cm in 50 women, P
- Published
- 2020
27. Inferior and Intra‐/Peri‐Articular Superior Sacroiliac Joint Injection Approaches Under Ultrasound Guidance to Treat Metastasis‐Related Posterior Pelvic Bone Pain
- Author
-
Lucas First, Amitabh Gulati, Daniel Chun-Suk Oh, Hanna Oh, and Neal Rakesh
- Subjects
Adult ,Male ,medicine.medical_specialty ,Population ,Bone Neoplasms ,Triamcinolone ,Methylprednisolone ,Article ,Injections, Intra-Articular ,Metastasis ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,medicine ,Humans ,Pelvic Bones ,education ,Bone pain ,Glucocorticoids ,Ultrasonography, Interventional ,Pelvis ,Retrospective Studies ,Sacroiliac joint ,education.field_of_study ,business.industry ,Gold standard ,Soft tissue ,Sacroiliac Joint ,Cancer Pain ,Middle Aged ,medicine.disease ,Sacrum ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Female ,Radiology ,medicine.symptom ,business ,Low Back Pain ,030217 neurology & neurosurgery - Abstract
Background Numerous mechanical and pathologic variables contribute to sacroiliac joint (SIJ) pain. The oncologic population has additional considerations, including tumor burden causing fracture, nerve compression, joint instability, and periosteal inflammation. Post-treatment changes may also restrict joint mobility, causing transitional pain. Currently, fluoroscopically guided SIJ injections, aimed at the inferior one third of the SIJ, are the gold standard for treatment but have only been described in the nononcologic population. Ultrasound (US) guidance may confer several benefits, including positioning, ease of procedure, lower costs, and, importantly, guidance to avoid neovascularization, metastatic disease, and other soft tissue structures. Objectives We aim to describe the advantages of US-guided SIJ injections for refractory malignant SIJ pain from extra-articular tumors. We then describe our technique and decision framework for accessing the superior or inferior SIJ in patients with metastatic sacroiliac pain. Methods A retrospective review was performed on 5 patients with refractory malignant SIJ pain who underwent US-guided superior or inferior approach SIJ injection. Using imaging and outcomes, we developed a decision framework. Results Patients received either inferior or superior approach SIJ injections depending on location of tumor, extent of tumor invasion, and stability of the SIJ as per our framework. All patients reported improvement in pain and function without complications. Conclusions We propose a decision framework for inferior vs. superior approach US-guided SIJ injections in the oncologic population with SIJ pain from metastases to the pelvis or sacrum. Having multiple techniques to approach the SIJ is important in the oncologic population, in whom metastatic tumor burden poses a technical challenge to performing these injections.
- Published
- 2020
28. Stop‐Flow Pelvic Chemoperfusion for the Treatment of Malignant Pelvic Bone Tumors: A Preliminary Study
- Author
-
Sen Dong, Xiaodong Tang, Chen Chen, Lu Xie, Wei Guo, and Han Wang
- Subjects
Adult ,Male ,medicine.medical_specialty ,Visual analogue scale ,medicine.medical_treatment ,Urology ,Antineoplastic Agents ,Bone Neoplasms ,Pelvic malignancies ,03 medical and health sciences ,0302 clinical medicine ,lcsh:Orthopedic surgery ,medicine ,Humans ,Chemotherapy ,Orthopedics and Sports Medicine ,Neoplasm Metastasis ,Pelvic Bones ,Adverse effect ,Pelvis ,Pain Measurement ,030222 orthopedics ,Clinical Article ,business.industry ,Area under the curve ,Blood flow ,Stop‐flow perfusion ,lcsh:RD701-811 ,Catheter ,medicine.anatomical_structure ,Chemotherapy, Cancer, Regional Perfusion ,Clinical Articles ,Female ,Surgery ,Cisplatin ,business ,Perfusion ,030217 neurology & neurosurgery - Abstract
Objective To preliminarily study the efficacy and safety of stop‐flow pelvic chemoperfusion, a novel therapeutic strategy for treating pelvic malignancies. Methods Stop‐flow chemoperfusion was performed six times in 5 patients with primary pelvic malignancies. Aortic and vena cave balloons and tourniquets were used to isolate pelvic blood flow from systemic circulation. Cisplatin was then perfused through a transarterial catheter to achieve exposure to a higher drug concentration. Pelvic and peripheral blood samples were collected to determine drug concentration during perfusion. The efficacy of stop‐flow pelvic perfusion was assessed by measuring the change in tumor size, the visual analogue scale, and the tumor necrosis rate after perfusion. Safety was assessed by classifying adverse events according to CTCAE v4.03. Results The mean area under the curve (AUC) and maximum drug concentration in the pelvis during perfusion were 246.23 min μg/mL and 17.29 μg/mL, respectively. These measures were significantly higher than the peripheral mean AUC and maximum drug concentration of 52.08 min μg/mL and 5.14 μg/mL, respectively. All 5 patients showed stable disease in response, with changes in tumor size of −4.7%, −5.4%, +4.7%, −8.4%, and 0.0%. Among the 5 patients, 3 (60%) experienced significant pain relief after perfusion. Three patients underwent surgery, with tumor necrosis of 63%
- Published
- 2020
29. Advancing patient age is associated with worse outcomes in low‐ and intermediate‐grade primary chondrosarcoma of the pelvis
- Author
-
Anthony M. Griffin, Matthew T. Houdek, Jay S. Wunder, Peter S. Rose, Mario Hevesi, Ahmet Salduz, Franklin H. Sim, Brent G. Witten, Doris E. Wenger, and Peter C. Ferguson
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Chondrosarcoma ,Bone Neoplasms ,Gastroenterology ,Disease-Free Survival ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Risk factor ,Intermediate Grade ,Young adult ,Pelvic Bones ,Pelvis ,Aged ,Proportional Hazards Models ,Aged, 80 and over ,business.industry ,Proportional hazards model ,Wide local excision ,Hazard ratio ,Age Factors ,General Medicine ,Middle Aged ,Plastic Surgery Procedures ,medicine.disease ,Treatment Outcome ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Surgery ,Neoplasm Grading ,business - Abstract
Background Conventional primary pelvic chondrosarcoma often presents as a low- or intermediate-grade tumor in older patients. Although this is the most common variant of pelvic chondrosarcoma, studies examining treatment outcomes are lacking. The purpose of this study was to evaluate patients with these tumors to determine their outcomes of treatment. Methods Seventy-three patients (grade I [n = 19, 26%] and grade II [n = 54, 74%]) were reviewed including 55 (75%) males and 18 (25%) females, with a mean age of 51 (range, 17-81) years and follow-up of 9 ± 5 years. Results The 10-year disease-specific survival was 71%. Grade II disease (hazard ratio [HR], 6.74; P = .04) and age ≥50 years (HR, 3.97; P = .02) was associated with death due to disease. The 10-year local recurrence- and metastatic-free survival were 79% and 72%. Of the patients with a local recurrence (n = 11), 7 (64%) recurred at a higher histological grade. Patient age ≥50 years was associated with local recurrence (HR, 10.03; P = .02) and metastatic disease (HR, 4.20; P = .02). Conclusion Advancing patient age was an independent risk factor for worse survival and disease recurrence. Tumors often recurred locally at a higher grade and as such wide local excision remains the treatment of choice for these tumors.
- Published
- 2020
30. En Bloc Resection and Pelvic Ring Reconstruction for Primary Malignant Bone Tumors Involving Sacroiliac Joint
- Author
-
Ming Xu, Jie Zhao, Wen-zhe Bai, Kai Zheng, and Xiuchun Yu
- Subjects
Adult ,Male ,musculoskeletal diseases ,medicine.medical_specialty ,Sacroiliac articulation ,Adolescent ,medicine.medical_treatment ,Nonunion ,Resection Margin ,Bone Neoplasms ,Bone grafting ,Disability Evaluation ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,lcsh:Orthopedic surgery ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Bone Cancer ,Pelvic Bones ,Retrospective Studies ,Sacroiliac joint ,030222 orthopedics ,Clinical Article ,business.industry ,Bone cancer ,Transarticular invasion ,Sacroiliac Joint ,Middle Aged ,Plastic Surgery Procedures ,musculoskeletal system ,Sacrum ,medicine.disease ,Surgery ,lcsh:RD701-811 ,medicine.anatomical_structure ,Clinical Articles ,Resection margin ,Female ,Chondrosarcoma ,Primary malignant bone tumors ,business ,030217 neurology & neurosurgery ,Brain metastasis - Abstract
Objective To observe the process of sacroiliac joint invasion by primary malignant tumors of sacrum and iliac bone, and to explore the methods of surgical resection and reconstruction. Methods From January 2009 to November 2017, there were nine patients with primary malignant bone tumors involving sacroiliac joints, five males and four females, aged from 16 to 63 years, with an average age of 35 years. Of these there were three cases of primitive neuroectodermal tumors, three cases of chondrosarcoma, and three cases of osteosarcoma. Pelvic ring reconstruction was performed with longitudinal half sacrum, sacroiliac joint and partial iliac bone block excision and screw-rod system combined with bone grafting. Results The operation time was 155-310 min, with an average of 245 ± 55 min, and the bleeding volume was 1400-8500 ml, with an average of 3111 ± 2189 ml. Follow-up ranged from 5 to 108 months, with a median follow-up of 24 months. Three patients (33.3%) had local recurrence, three patients (33.3%) survived without tumors, and one patient had lung metastasis 2 years after operation, and survived with tumors. Five patients (55.6%) died, of which four died of lung metastasis and one died of brain metastasis. Survival analysis showed that the 3-year overall survival rate was 57%. Bone grafts did not heal in four patients, and bone grafts healed in five patients. The healing time ranged from 5 to 7 months, with an average of 6.2 months. Complications one patient developed deep infection 2 months after operation; one patient had skin edge necrosis; titanium rod loosening and displacement were found in two patients with nonunion of bone graft, and no fracture of nail rod was found. The MSTS 93 functional score of nine patients ranged from 20% to 50%, with an average of 34%. Conclusion The tumors around the sacroiliac joint often invade the contralateral bone by ligament, and the en bloc resection and pelvic ring reconstruction for primary malignant bone tumors involving sacroiliac joint was feasible.
- Published
- 2019
31. The Critical Role of Stereopsis in Virtual and Mixed Reality Learning Environments
- Author
-
Bruce Wainman, Giancarlo Pukas, Liliana Wolak, Jason Lamb, Geoffrey R. Norman, and Sylvia Mohanraj
- Subjects
Male ,Models, Anatomic ,Embryology ,Histology ,business.product_category ,Adolescent ,Computer science ,Virtual reality ,Digital media ,User-Computer Interface ,Young Adult ,Software portability ,Human–computer interaction ,Humans ,Learning ,Pelvic Bones ,Students ,Depth Perception ,business.industry ,Virtual Reality ,General Medicine ,Mixed reality ,Identification (information) ,Stereopsis ,Female ,Educational Measurement ,Anatomy ,Computer monitor ,business ,Depth perception - Abstract
Anatomy education has been revolutionized through digital media, resulting in major advances in realism, portability, scalability, and user satisfaction. However, while such approaches may well be more portable, realistic, or satisfying than traditional photographic presentations, it is less clear that they have any superiority in terms of student learning. In this study, it was hypothesized that virtual and mixed reality presentations of pelvic anatomy will have an advantage over two-dimensional (2D) presentations and perform approximately equal to physical models and that this advantage over 2D presentations will be reduced when stereopsis is decreased by covering the non-dominant eye. Groups of 20 undergraduate students learned pelvic anatomy under seven conditions: physical model with and without stereo vision, mixed reality with and without stereo vision, virtual reality with and without stereo vision, and key views on a computer monitor. All were tested with a cadaveric pelvis and a 15-item, short-answer recognition test. Compared to the key views, the physical model had a 70% increase in accuracy in structure identification; the virtual reality a 25% increase, and the mixed reality a non-significant 2.5% change. Blocking stereopsis reduced performance on the physical model by 15%, on virtual reality by 60%, but by only 2.5% on the mixed reality technology. The data show that virtual and mixed reality technologies tested are inferior to physical models and that true stereopsis is critical in learning anatomy.
- Published
- 2019
32. Differences of Anteroposterior Pelvic Radiographs Between Supine Position and Standing Position in Patients with Developmental Dysplasia of the Hip
- Author
-
Guoyue Yang, Hong Zhang, Cheng Hui, Dianzhong Luo, Kai Xiao, and Yayue Li
- Subjects
Adult ,Male ,Pelvic tilt ,Shooting position ,Supine position ,Adolescent ,medicine.medical_treatment ,Radiography ,Pubic symphysis ,Osteotomy ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,lcsh:Orthopedic surgery ,Supine Position ,medicine ,Hip Dislocation ,Humans ,Orthopedics and Sports Medicine ,Prospective Studies ,Pelvic Bones ,Prospective cohort study ,030222 orthopedics ,Clinical Article ,Developmental dysplasia ,business.industry ,Middle Aged ,lcsh:RD701-811 ,Position (obstetrics) ,medicine.anatomical_structure ,Standing Position ,Clinical Articles ,Female ,Surgery ,business ,Nuclear medicine ,030217 neurology & neurosurgery ,Developmental dysplasia of the hip - Abstract
Objective To explore the difference in pelvic tilt and hip joint parameters with developmental dysplasia of the hip (DDH) comparing the anteroposterior (AP) pelvic radiographs taken in supine and standing positions. Methods A prospective study of DDH patients undergoing Bernese periacetabular osteotomy (PAO) was conducted. AP pelvic radiographs were taken in supine and standing positions before surgery The pelvic tilt and hip joint parameters from the two radiographs were compared. Contrast parameters included the distance between the pubic symphysis to sacrococcygeal distance (PSSC), lateral center‐edge angle (LCEA), Tönnis angle (TA), and angle of sharp (SA). Results A total of 110 young DDH patients were enrolled, including 32 men and 78 women, aged 18–49 years. The male PSSC was 45.63 ± 13.69 mm in supine position and 36.91 ± 12.33 mm in standing position (P
- Published
- 2019
33. In Vivo Pelvic and Hip Joint Kinematics in Patients With Cam Femoroacetabular Impingement Syndrome: A Dual Fluoroscopy Study
- Author
-
K. Bo Foreman, Andrew E. Anderson, Penny R. Atkins, Stephen K. Aoki, Christopher L. Peters, Niccolo M. Fiorentino, and Joseph A. Hartle
- Subjects
Adult ,Male ,Pelvic tilt ,Kinematics ,Asymptomatic ,Article ,Young Adult ,Femoracetabular Impingement ,Humans ,Medicine ,Fluoroscopy ,Orthopedics and Sports Medicine ,Pelvic Bones ,Gait ,Femoroacetabular impingement ,medicine.diagnostic_test ,business.industry ,Acetabular labrum ,Soft tissue ,medicine.disease ,Biomechanical Phenomena ,medicine.anatomical_structure ,Case-Control Studies ,Female ,Hip Joint ,medicine.symptom ,business ,Nuclear medicine ,Range of motion - Abstract
Femoroacetabular impingement syndrome (FAIS) may alter the kinematic function of the hip, resulting in pain and tissue damage. Previous motion analysis studies of FAIS have employed skin markers, which are prone to soft tissue artifact and inaccurate calculation of the hip joint center. This may explain why the evidence linking FAIS with deleterious kinematics is contradictory. The purpose of this study was to employ dual fluoroscopy (DF) to quantify in vivo kinematics of patients with cam FAIS relative to asymptomatic, morphologically normal control participants during various activities. Eleven asymptomatic, morphologically normal controls and seven patients with cam FAIS were imaged with DF during standing, level walking, incline walking, and functional range of motion activities. Model-based tracking calculated the kinematic position of the hip by registering projections of three-dimensional computed tomography models with DF images. Patients with FAIS stood with their hip extended (mean [95% confidence interval], -2.2 [-7.4, 3.1]°, flexion positive), whereas controls were flexed (5.3 [2.6, 8.0]°; p = 0.013). Male patients with cam FAIS had less peak internal rotation than the male control participants during self-selected speed level-walking (-0.2 [-6.5, 6.1]° vs. -9.8 [-12.2, -7.3]°; p = 0.007) and less anterior pelvic tilt at heel-strike of incline (5°) walking (3.4 [-1.0, -7.9]° vs. 9.8 [6.4, 13.2]°; p = 0.032). Even during submaximal range of motion activities, such as incline walking, patients may alter pelvic motion to avoid positions that approximate the cam lesion and the acetabular labrum. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:823-833, 2020.
- Published
- 2019
34. Accuracy and Precision of an Ultrasound‐Based Device to Measure the Pelvic Tilt in Several Positions
- Author
-
Hoel Letissier, R. Gérard, Aziliz Guezou-Philippe, Christian Lefèvre, Jean-Philippe Pluchon, Guillaume Dardenne, and Eric Stindel
- Subjects
Adult ,Pelvic tilt ,Accuracy and precision ,Test bench ,Supine position ,Posture ,Sitting ,Body Mass Index ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Reference Values ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Pelvic Bones ,Ultrasonography ,Observer Variation ,Measure (data warehouse) ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,business.industry ,Ultrasound ,Reproducibility of Results ,Tilt (optics) ,Clinical Competence ,business ,Biomedical engineering - Abstract
Objectives A new ultrasound-based device is proposed to measure the patient-specific pelvic tilt in different daily positions. The aim of this study was to assess the accuracy of this device as well as the intraobserver and interobserver precisions. Methods The accuracy was assessed by performing several tilt measurements with the device on a testing mechanical bench. The error was defined as the difference between the tilt measured with the device and the tilt provided by this test bench. Three physicians, a novice, an intermediate, and an expert user, were also asked to perform 10 measurements on 3 healthy volunteers with low, medium, and high body mass indices to analyze the intraobserver and interobserver precisions. These 10 measurements were performed in the standing, sitting, and supine positions. Results The mean accuracy of the device ± SD was 1.1° ± 0.7° (range, 0°-4.0°). The interobserver and intraobserver precisions were excellent whatever the body mass index and good to excellent according to the positions. There was no learning curve, and the time required to complete the measurements was approximately 5 minutes. Conclusions This study presents an accurate and precise noninvasive device for measurement of the pelvic tilt in different positions.
- Published
- 2019
35. Pelvic Incidence: Computed Tomography Study Evaluating Correlation with Sagittal Sacropelvic Parameters
- Author
-
Joseph F. Baker, Angus S. Don, and Peter A. Robertson
- Subjects
Adult ,Male ,Sacrum ,Histology ,Posture ,Computed tomography ,Normal values ,Correlation ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Pelvic Bones ,Aged ,Aged, 80 and over ,0303 health sciences ,Sacral kyphosis ,Lumbar Vertebrae ,medicine.diagnostic_test ,business.industry ,Pelvic incidence ,Mean age ,030206 dentistry ,General Medicine ,Middle Aged ,Sagittal plane ,medicine.anatomical_structure ,030301 anatomy & morphology ,Female ,Anatomy ,Tomography, X-Ray Computed ,Nuclear medicine ,business - Abstract
Normal values for spinal alignment are often based on the pelvic incidence (PI), defined as the angle subtended by a line from the bicoxofemoral axis to the midpoint of the sacral endplate and a line perpendicular to the midpoint. Despite widespread use, determinants of its values remain obscure. The aim of this study was to determine correlation of sacropelvic parameters with the PI on computed tomography (CT). CT scans performed for trauma were identified over a 1-year period. Patients aged over 16 were included. PI, sacral anatomic orientation, sacral table angle (STA), sacral kyphosis (SK), pelvic thickness (PTH), femorosacral pelvic angle, pelvisacral angle, and sacropelvic angle were measured. Additional novel measures including crest-to-pubis distance, crest-to-sacrum distance (CSD), inlet distance, outlet distance, and inlet-outlet angle were taken. One hundred and seventy-seven scans were analyzed. Mean age 44.3 years; 62% male. The mean PI was 50.1 (SD 10.8; range 29-87). SK (r = 0.769), inlet-outlet angle (r = -0.533), PTH (r = -0.370), CSD (r = 0.290), and STA (r = -0.276) significantly correlated with PI. Multivariate analysis developed a predictive equation of: PI = 101.45 - (0.52 × STA) + (0.67 × SK) - (0.34 × inlet-outlet angle), with an adjusted R2 0.734 (P < 0.001). Measures that represent the sacral morphology, particularly SK, and the position of the sacrum in space correlated strongly with the PI and contributed strongly to a predictive equation. These findings may direct further efforts to explore how the PI is determined and therefore how it may be modified. Clin. Anat. 33:237-244, 2020. © 2019 Wiley Periodicals, Inc.
- Published
- 2019
36. Prognostic nomograms to predict overall survival and cancer‐specific survival in patients with pelvic chondrosarcoma
- Author
-
Jiaxin Liu, Zhou Xiang, Li Chen, Xin Duan, and Cheng Long
- Subjects
0301 basic medicine ,Oncology ,Male ,Cancer Research ,Multivariate statistics ,Multivariate analysis ,Kaplan-Meier Estimate ,pelvis ,0302 clinical medicine ,Risk Factors ,Epidemiology ,Precision Medicine ,Child ,Original Research ,Aged, 80 and over ,chondrosarcoma ,Middle Aged ,Prognosis ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Tumor Burden ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Female ,Adult ,medicine.medical_specialty ,Adolescent ,overall survival ,Clinical Decision-Making ,Bone Neoplasms ,lcsh:RC254-282 ,nomogram ,03 medical and health sciences ,Young Adult ,cancer‐specific survival ,Internal medicine ,medicine ,Overall survival ,Humans ,Radiology, Nuclear Medicine and imaging ,Pelvic Bones ,Pelvis ,Aged ,Retrospective Studies ,business.industry ,Univariate ,Clinical Cancer Research ,Nomogram ,medicine.disease ,SEER ,Nomograms ,030104 developmental biology ,Chondrosarcoma ,business ,SEER Program - Abstract
Background The pelvis is the most common site of chondrosarcoma (CS), and the prognosis for patients with pelvic CS is worse than that for patients with CS in the extremities. However, clinicians have had few tools for estimating the likelihood of survival in patients with pelvic CS. Our aim was to develop nomograms to predict survival of patients with pelvic CS. Methods Data from the Surveillance, Epidemiology, and End Results (SEER) database of patients with pelvic CS between 2004 and 2016 were retrieved for retrospective analysis. Univariate and multivariate Cox analyses were used to identify independent prognostic factors. On the basis of the results of the multivariate analyses, nomograms were constructed to predict the likelihood of 3‐ and 5‐year overall survival (OS) and cancer‐specific survival (CSS) of patients with pelvic CS. The concordance index (C‐index) and calibration curves were used to test the models. Results In univariate and multivariate analyses of OS, sex, pathologic grade, tumor size, tumor stage, and surgery were identified as the independent risk factors. In univariate and multivariate analyses of CSS, pathologic grade, tumor size, tumor stage, and surgery were identified as the independent risk factors. These characteristics except surgery were integrated in the nomograms for predicting 3‐ and 5‐year OS and CSS, and the C‐indexes were 0.758 and 0.786, respectively. Conclusion The nomograms precisely and individually predict OS and CSS of patients with pelvic CS and could aid in personalized prognostic evaluation and individualized clinical decision‐making., Independent prognostic factors associated with overall survival and cancer‐specific survival of pelvic chondrosarcoma were identified.This is the first time to develop and validate nomograms to predict prognosis in patients with pelvic chondrosarcoma, and it could be beneficial to clinicians in making personalized survival evaluation.
- Published
- 2019
37. Comparative Fracture Risks Among United States Medicaid Enrollees With and Those Without Systemic Lupus Erythematosus
- Author
-
Hongshu Guan, Seoyoung C. Kim, Jennifer M. Grossman, Sara K. Tedeschi, and Karen H. Costenbader
- Subjects
Adult ,Male ,Humeral Fractures ,medicine.medical_specialty ,Immunology ,Lupus nephritis ,030209 endocrinology & metabolism ,Comorbidity ,Disease ,Bone health ,Article ,Cohort Studies ,Fractures, Bone ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Risk Factors ,immune system diseases ,Internal medicine ,medicine ,Humans ,Lupus Erythematosus, Systemic ,Immunology and Allergy ,Pelvic Bones ,skin and connective tissue diseases ,Glucocorticoids ,Poverty ,Proportional Hazards Models ,030203 arthritis & rheumatology ,Hip Fractures ,Medicaid ,business.industry ,Incidence ,Hazard ratio ,Middle Aged ,Wrist Injuries ,medicine.disease ,Lupus Nephritis ,United States ,Confidence interval ,Case-Control Studies ,Female ,business ,Nephritis ,Cohort study - Abstract
OBJECTIVE Poor bone health is common in systemic lupus erythematosus (SLE) patients. This study was undertaken to evaluate fracture risks among low-income SLE and lupus nephritis patients compared to those without SLE. METHODS We performed a cohort study among SLE patients for whom there were Medicaid claims in 2007-2010, and age- and sex-matched non-SLE comparators. SLE was defined by the presence of ≥3 International Classification of Diseases, Ninth Revision codes for SLE. Patients with lupus nephritis additionally had ≥2 codes for renal disease. The primary outcome measure was fracture of the pelvis, wrist, hip, or humerus. Demographics, prescriptions, and comorbidities were assessed during the 180-day baseline period. We calculated fracture incidence rates and 95% confidence intervals (95% CIs) in SLE, lupus nephritis, and non-SLE comparator cohorts, and estimated adjusted hazard ratios (HRs) for fractures. Sensitivity analyses evaluated the impact of glucocorticoids and comorbidities. We compared subsets of SLE patients with and those without lupus nephritis. RESULTS Among 47,709 SLE patients (19.8% with lupus nephritis) matched to 190,836 non-SLE comparators, the mean age was 41.4 years and 92.6% were female. The fracture incidence rate was highest among SLE patients with lupus nephritis (4.60 per 1,000 person-years). SLE patients had 2-fold higher fracture risks than matched comparators (HR 2.09 [95% CI 1.85-2.37]; P < 0.01). Lupus nephritis patients had the greatest fracture risks versus matched comparators (HR 3.06 [95% CI 2.24-4.17]; P < 0.01), and had a 1.6 times higher fracture risk than SLE patients without nephritis (HR 1.58 [95% CI 1.20-2.07]; P < 0.01). Adjustment for glucocorticoid use and comorbidities slightly attenuated risks. CONCLUSION Fracture risks were increased in SLE patients, particularly those with lupus nephritis, compared to matched non-SLE Medicaid recipients. Increased risks persisted after adjustment for baseline glucocorticoid treatment and comorbidities.
- Published
- 2019
38. Increased risk of pelvic fracture after radiotherapy in rectal cancer survivors: A propensity matched study
- Author
-
Tze-Fan Chao, Ti Hao Wang, Yu-Wen Hu, and Yu-Mei Kang
- Subjects
Male ,0301 basic medicine ,Cancer Research ,medicine.medical_specialty ,Colorectal cancer ,Urology ,lcsh:RC254-282 ,Risk Assessment ,Arm Bones ,Fractures, Bone ,03 medical and health sciences ,0302 clinical medicine ,pelvic insufficiency fracture ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,rectal cancer ,Pelvic Bones ,Propensity Score ,Original Research ,Proportional Hazards Models ,Femoral neck ,Radiotherapy ,Rectal Neoplasms ,business.industry ,Proportional hazards model ,Incidence ,Hazard ratio ,Clinical Cancer Research ,pelvic fracture ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.disease ,Sacrum ,Confidence interval ,030104 developmental biology ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Propensity score matching ,Pelvic fracture ,Female ,business - Abstract
To determine whether radiotherapy (RT) can increase pelvic fracture risk in rectal cancer survivors. Rectal cancer patients who underwent curative surgery between 1996 and 2011 in Taiwan were retrospectively studied using the National Health Insurance Research Database (NHIRD) of Taiwan. ICD‐9 Codes 808, 805.4‐805.7, 806.4‐806.7, and 820 (including pelvic, sacrum, lumbar, and femoral neck fracture) were defined as pelvic fracture. Propensity scores for RT, age, and sex were used to perform one‐to‐one matches between the RT and non‐RT group. Risks of pelvic and arm fractures were compared by multivariable Cox regression. Of the 32 689 patients, 7807 (23.9%) received RT, and 1616 suffered from a pelvic fracture (incidence rate: 1.17/100 person‐years). The median time to pelvic fracture was 2.47 years. After matching, 6952 patients each in the RT and non‐RT groups were analyzed. RT was associated with an increased risk of pelvic fractures in the multivariable Cox model (hazard ratio (HR): 1.246, 95% confidence interval (CI): 1.037‐1.495, P = 0.019) but not with arm fractures (HR: 1.013, 95% CI: 0.814‐1.259, P = 0.911). Subgroup analyses revealed that RT was associated with a higher pelvic fracture rate in women (HR: 1.431, 95% CI: 1.117‐1.834) but not in men, and the interaction between sex and RT was significant (P = 0.03). The HR of pelvic fracture increased 2‐4 years after RT (HR: 1.707, 95% CI: 1.150‐2.534, P = 0.008). An increased risk of pelvic fracture is noted in rectal cancer survivors, especially women, who receive RT.
- Published
- 2019
39. A method of sexing the human os coxae based on logistic regressions and Bruzek's nonmetric traits
- Author
-
Pierre Guyomarc’h, Frédéric Santos, Jaroslav Bruzek, and Rebeka Rmoutilová
- Subjects
Adult ,Male ,0106 biological sciences ,Scoring system ,Sample (statistics) ,Sexing ,Logistic regression ,010603 evolutionary biology ,01 natural sciences ,Young Adult ,Statistics ,Humans ,0601 history and archaeology ,Pelvic Bones ,Aged ,Mathematics ,Aged, 80 and over ,060101 anthropology ,06 humanities and the arts ,Middle Aged ,Sex Determination by Skeleton ,Logistic Models ,Sex estimation ,Anthropology ,North american population ,Forensic Anthropology ,Female ,Anatomy ,Tomography, X-Ray Computed ,Indeterminate ,Reference dataset - Abstract
Objectives This study aims at proposing a visual method for sexing the human os coxae based on a statistical approach, using a scoring system of traits described by Bruzek (2002). This method is evaluated on a meta-population sample, where the data were acquired by direct observation of dry bones as well as computed tomography (CT) scans. A comparison with the original Bruzek's (2002) method is performed. Materials and methods Five hundred and ninety two ossa coxae of modern humans are included in the reference dataset. Two other samples, composed respectively of 518 ossa coxae and 99 CT-scan images, are both used for validation purposes. The individuals come from five European or North American population samples. Eleven trichotomic traits (expressing female, male, or intermediate forms) were observed on each os coxae. The new approach employs statistical processing based on logistic regressions. An R package freely available online, PELVIS, implements both methods. Results Both methods provide highly reliable sex estimates. The new statistical method has a slightly better accuracy rate (99.2%) than the former method (98.2%) but has also a higher rate of indeterminate individuals (12.9% vs. 3% for complete bones). Conclusion The efficiency of both methods is compared. Low error rates were preferred over high ability of reaching the classification threshold. The impact of lateralization and the asymmetry of observed traits are discussed. Finally, it is shown that this visual method of sex estimation is reliable and easy to use through the graphical user interface of the R package.
- Published
- 2019
40. Comparative Study of Percutaneous Sacroiliac Screw with or without TiRobot Assistance for Treating Pelvic Posterior Ring Fractures
- Author
-
Jian‐song Mu, Zhiyong He, Jin‐hua Gao, Kai‐nan Li, Tao Long, Chao Peng, Tian‐hu Liu, and Xue‐jun Wang
- Subjects
Adult ,Male ,musculoskeletal diseases ,Sacrum ,medicine.medical_specialty ,Percutaneous ,Bone Screws ,Sacroiliac joint ,Bone healing ,Pelvis ,Fracture Fixation, Internal ,Fractures, Bone ,03 medical and health sciences ,Fixation (surgical) ,0302 clinical medicine ,lcsh:Orthopedic surgery ,Robotic Surgical Procedures ,medicine ,Percutaneous screw ,Humans ,Fluoroscopy ,Orthopedics and Sports Medicine ,Pelvic Bones ,Retrospective Studies ,030222 orthopedics ,Clinical Article ,medicine.diagnostic_test ,business.industry ,Middle Aged ,musculoskeletal system ,TiRobot ,Surgery ,lcsh:RD701-811 ,Sacroiliac screw ,Treatment Outcome ,medicine.anatomical_structure ,Clinical Articles ,Female ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Objectives To analyze the curative effect of TiRobot surgical robotic navigation and location system-assisted percutaneous sacroiliac screw fixation and percutaneous sacroiliac screw by traditional fluoroscopy, and to summarize the safety and benefits of TiRobot. Methods A total of 91 patients with pelvic posterior ring fractures from December 2015 to February 2018 were included in this study. According to the surgical methods selected by the patients, the patients were divided into a TiRobot surgical robotic navigation and location system group (TiRobot group) and a percutaneous sacroiliac screw fixation group (traditional group). Statistical indicators included the number of sacroiliac screws, the time of planning the sacroiliac screw path, fluoroscopy frequency, fluoroscopy time, operation time, length of incision, blood loss, anesthesia time, the healing process of skin incisions, and fracture healing time. Fracture reduction was evaluated according to the maximum displacement degree at the inlet and outlet view X-ray or CT. Matta standard was used to evaluate fracture reduction. At the last follow-up, the Majeed function system was used to evaluate the function. Results All patients were followed up for 8 to 32 months. A total of 66 sacroiliac screws were implanted in the TiRobot group. A total of 43 sacroiliac screws were implanted in the traditional group. There were statistically significant differences in terms of fluoroscopy frequency, fluoroscopy time, operation time, incision length, anesthesia time, and blood loss between the two groups; the TiRobot group was superior to the traditional group. The healing time of the TiRobot group and the traditional group was 4.61 ± 0.68 months (range, 3.5-6.3 months) and 4.56 ± 0.78 months (range, 3.4-6.2 months), respectively, and there was no statistical difference. Postoperatively, by Matta standard, the overall excellent and good rate of fracture reduction was 89.28% and 88.57%, respectively. At the last follow-up, by Majeed function score, the overall excellent and good rate was 91.07% and 91.43%. There was no statistical difference between the two groups. Conclusion Sacroiliac screw implantation assisted by TiRobot to treat the posterior pelvic ring fractures has the characteristics of less trauma, shorter operation time, and less blood loss. TiRobot has the characteristics of high safety and accuracy and has great clinical application value.
- Published
- 2019
41. Autologous Transplantation of Press‐fit Bone Cylinders in the Treatment of Pelvic Nonunion
- Author
-
Mika F. Rollmann, P. Mörsdorf, Jörg H. Holstein, Steven C. Herath, Tim Pohlemann, and Benedikt J. Braun
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Radiography ,Nonunion ,Transplantation, Autologous ,Fracture Fixation, Internal ,03 medical and health sciences ,0302 clinical medicine ,lcsh:Orthopedic surgery ,Pelvic ring ,Press‐fit cylinder ,medicine ,Humans ,Bone graft ,Autologous transplantation ,Orthopedics and Sports Medicine ,Surgical Technique ,Pelvic Bones ,Pelvic ring fracture ,Reduction (orthopedic surgery) ,030222 orthopedics ,Bone Transplantation ,business.industry ,Middle Aged ,Autologous bone ,medicine.disease ,Surgery ,Treatment ,Transplantation ,lcsh:RD701-811 ,surgical procedures, operative ,Trephine ,Fractures, Ununited ,Female ,business ,030217 neurology & neurosurgery - Abstract
The present study describes method for autologous bone transplantation to an area of nonunion at the pelvic ring in a way that ensures the best possible bone‐to‐bone interface (“press‐fit”) and provides optimal preconditions for the ingrowth of the bone graft. We modified a technique that has been used to transplant press‐fit bone‐baseplate‐cartilage cylinders for the repair of joint cartilage defects. The technique allows for precise harvesting of bone cylinders with a diamond‐coated and fluid‐cooled instrument. At the site where the graft shall be inserted, a cylindrical hole is created with a corresponding hollow diamond‐coated trephine. This ensures an optimal press‐fit implantation of the graft. The new surgical technique has been applied in four patients with nonunion of the pelvic ring. No intraoperative or postoperative complications occurred. In three patients, the procedure led to a reduction of pain and a higher level of mobility as well as a timely radiographic union (imaging not available for another patient). Our technique offers a valuable new treatment option for pelvic nonunion. The current article serves as a proof of concept. Future comparative studies will have to determine its value in detail.
- Published
- 2019
42. Bone mineral density and estimated hip strength in men with anorexia nervosa, atypical anorexia nervosa and avoidant/restrictive food intake disorder
- Author
-
Philip S. Mehler, Tara M. Holmes, Ashlie Watters, Gillian T. Lashen, Elaine W. Yu, Kate Santoso, Anne Klibanski, Karen K. Miller, Micol S. Rothman, Margherita Mascolo, Melanie Schorr, Anne Drabkin, Erinne Meenaghan, Madhusmita Misra, and Kamryn T. Eddy
- Subjects
Adult ,Male ,medicine.medical_specialty ,Anorexia Nervosa ,Adolescent ,Bone density ,Endocrinology, Diabetes and Metabolism ,030209 endocrinology & metabolism ,Gastroenterology ,Article ,vitamin D deficiency ,Avoidant/restrictive food intake disorder ,Eating ,Young Adult ,03 medical and health sciences ,Absorptiometry, Photon ,0302 clinical medicine ,Endocrinology ,Bone Density ,Internal medicine ,Prevalence ,medicine ,Vitamin D and neurology ,Humans ,Vitamin D ,Hip strength ,Pelvic Bones ,Retrospective Studies ,Bone mineral ,Avoidant Restrictive Food Intake Disorder ,business.industry ,Middle Aged ,Vitamin D Deficiency ,medicine.disease ,Calcium, Dietary ,Bone Diseases, Metabolic ,Eating disorders ,Anorexia nervosa (differential diagnoses) ,030220 oncology & carcinogenesis ,Body Composition ,business - Abstract
SUMMARY: OBJECTIVE: Few bone mineral density (BMD) data are available in men with anorexia nervosa (AN), and none in those with atypical AN (ATYP) (AN psychological symptoms without low weight) or avoidant/restrictive food intake disorder (ARFID) (restrictive eating without AN psychological symptoms). We investigated the prevalence and determinants of low BMD and estimated hip strength in men with these disorders. DESIGN: Cross-sectional: two centres. PATIENTS: A total of 103 men, 18–63 years: AN (n = 26), ARFID (n = 11), ATYP (n = 18), healthy controls (HC) (n = 48). MEASUREMENTS: Body composition, BMD and estimated hip strength (section modulus and buckling ratio) by DXA (Hologic). Serum 25OH vitamin D was quantified, as was daily calcium intake in a subset of subjects. RESULTS: Mean BMI was lowest in AN and ARFID, higher in ATYP and highest in HC (AN 14.7 ± 1.8, ARFID 15.3 ± 1.5, ATYP 20.6 ± 2.0, HC 23.7 ± 3.3 kg/m(2)) (P < 0.0005). Mean BMD Z-scores at spine and hip were lower in AN and ARFID, but not ATYP, than HC (postero-anterior (PA) spine AN −2.05 ± 1.58, ARFID −1.33 ± 1.21, ATYP −0.59 ± 1.77, HC −0.12 ± 1.17) (P < 0.05). 65% AN, 18% ARFID, 33% ATYP and 6% HC had BMD Z-scores
- Published
- 2019
43. Differences in Bone Mineral Density and Hip Geometry in Trochanteric and Cervical Hip Fractures in Elderly Chinese Patients
- Author
-
Houchen Lv, Sun Guofei, Hu Jianwei, Jianheng Liu, Cui Xiang, Peifu Tang, Ming Li, and Licheng Zhang
- Subjects
Male ,Trochanteric fractures ,Hip geometry ,medicine.medical_treatment ,Geometry ,Fracture group ,03 medical and health sciences ,Absorptiometry, Photon ,0302 clinical medicine ,Bone Density ,Risk Factors ,Bone mineral density ,medicine ,Humans ,Orthopedics and Sports Medicine ,Pelvic Bones ,Reduction (orthopedic surgery) ,Aged ,Femoral neck ,Bone mineral ,030222 orthopedics ,Hip fracture ,Clinical Article ,Cervical fracture ,Hip Fractures ,business.industry ,Age Factors ,Middle Aged ,musculoskeletal system ,medicine.disease ,medicine.anatomical_structure ,Cervical hip fractures ,Clinical Articles ,Female ,Surgery ,business ,Body mass index ,030217 neurology & neurosurgery - Abstract
Objective To assess the differences in bone mineral density (BMD) and hip geometry in trochanteric and cervical hip fractures in elderly Chinese patients. Methods A consecutive series of 196 hip fracture patients aged over 50 years was recruited from November 2013 to October 2015, including 109 cases of cervical fractures (36 males and 73 females) and 87 cases of trochanteric fractures (34 males and 53 females). All patients were evaluated through dual-energy X-ray absorptiometry, and baseline characteristics, BMD and structural parameters were collected and reviewed. Results There were statistically significant differences in age, height, and body mass index between patients with each type of fracture, and patients with trochanteric fractures were older than those with cervical fractures, especially in women. The BMD in trochanteric fractures was markedly lower than in cervical fractures in all five sites of the hip by an approximate reduction of 10%, in both men and women. The cross-sectional area, cross-sectional moment of inertia, and the cortical thickness in the cervical fracture group were significantly higher than in the trochanteric fracture group. However, the buckling ratio of both the femoral neck and trochanteric region were significantly lower in the cervical fracture group. Age (/10 years), cross-sectional moment of inertia in femoral neck and buckling ratio in trochanteric region were significant risk factors for trochanteric fractures compared with cervical fractures. Conclusions Compared with cervical hip fractures, patients with trochanteric fractures were older, had a lower BMD, and had less bone mechanical strength, especially in female patients. Age, femoral neck cross-sectional moment of inertia (FNCSMI), and trochanteric region buckling ratio (ITBR) were stronger risk factors for trochanteric hip fractures than for cervical fractures.
- Published
- 2019
44. Management of male pelvic fracture urethral injuries: Review and current topics
- Author
-
Akio Horiguchi
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Meatus ,Urology ,Urethroplasty ,medicine.medical_treatment ,030232 urology & nephrology ,Urethral stenosis ,Fractures, Bone ,03 medical and health sciences ,0302 clinical medicine ,Blunt ,Erectile Dysfunction ,Urethra ,medicine ,Humans ,Pelvic Bones ,Urethral Stricture ,business.industry ,Plastic Surgery Procedures ,medicine.disease ,Surgery ,Stenosis ,Treatment Outcome ,Urinary Incontinence ,medicine.anatomical_structure ,Erectile dysfunction ,030220 oncology & carcinogenesis ,Quality of Life ,Pelvic fracture ,business - Abstract
Pelvic fractures from high-energy blunt force trauma can cause injury to the posterior urethra, known as pelvic fracture urethral injury, which is most commonly associated with unstable pelvic fractures. Pelvic fracture urethral injury should be suspected if a patient with pelvic trauma has blood at the meatus and/or difficulty voiding, and retrograde urethrography should be carried out if the patient is stable. Once urethral injury is confirmed, urinary drainage should be established promptly by placement of a suprapubic tube or primary realignment of the urethra over a urethral catheter. Although pelvic fracture urethral injury is accompanied by subsequent urethral stenosis in a high rate and it has been believed that primary realignment can reduce the risk of developing urethra stenosis, it also has a risk of complicating stenosis and its clinical significance remains controversial. Once inflammation and fibrosis have stabilized (generally at least 3 months after the trauma), the optimal management for the resulting urethral stenosis is delayed urethroplasty. Delayed urethroplasty can be carried out via a perineal approach using four ancillary techniques in steps (bulbar urethral mobilization, corporal separation, inferior pubectomy and urethral rerouting). Although pelvic trauma can impair continence mechanisms, the continence after repair of pelvic fracture urethral injury is reportedly adequate. Because erectile dysfunction is frequently encountered after pelvic fracture urethral injury and most patients are young with a significant life expectancy, its appropriate management can greatly improve quality of life. In the present article, the key factors in the management of pelvic fracture urethral injury are reviewed and current topics are summarized.
- Published
- 2019
45. Meta‐Analysis of Genomewide Association Studies Reveals Genetic Variants for Hip Bone Geometry
- Author
-
Liesbeth Vandenput, John P. Kemp, Laura M. Yerges-Armstrong, Daniel S. Evans, Braxton D. Mitchell, Charles R. Farber, Scott Wilson, Munro Peacock, Kari Stefansson, Ching-Lung Cheung, Annie Kung, John A Robbins, Tamara B. Harris, Elizabeth A. Streeten, M. Carola Zillikens, Karol Estrada, Kristina Åkesson, Mattias Lorentzon, David Karasik, Gunnar Sigurdsson, Steven R. Cummings, Suzanne J. Brown, Unnur Styrkarsdottir, Candace M. Kammerer, Carolina Medina-Gomez, Thomas J. Beck, Anne B. Newman, Carrie M. Nielson, Kaare M. Gautvik, Cheryl L. Ackert-Bicknell, Fiona E. McGuigan, Douglas P. Kiel, Fernando Rivadeneira, Jonathan H Tobias, Laura D. Carbone, Daniel L. Koller, Sjur Reppe, Katerina Trajanoska, Terence D. Capellini, Tim D. Spector, Michael J. Econs, Evangelos Evangelou, Yi-Hsiang Hsu, Mariel Young, Debbie A Lawlor, Jane A. Cauley, Miryoung Lee, André G. Uitterlinden, Claes Ohlsson, Stefan A. Czerwinski, Serkalem Demissie, J. Brent Richards, Epidemiology, and Internal Medicine
- Subjects
Male ,0301 basic medicine ,Candidate gene ,Endocrinology, Diabetes and Metabolism ,Osteoporosis ,Geometry ,Genome-wide association study ,Linkage Disequilibrium ,human association studies ,Epigenesis, Genetic ,Mice ,0302 clinical medicine ,hip bone geometry ,Gene Regulatory Networks ,Orthopedics and Sports Medicine ,Cells, Cultured ,diseases and sisorders of/related to bone ,DXA ,Bone mineral ,Analysis/quantitation of bone ,genetic research ,medicine.anatomical_structure ,Hip bone ,Female ,candidate genes ,Adult ,Quantitative Trait Loci ,030209 endocrinology & metabolism ,Single-nucleotide polymorphism ,Biology ,Polymorphism, Single Nucleotide ,Article ,03 medical and health sciences ,Cortical Bone ,medicine ,Animals ,Humans ,RNA, Messenger ,Pelvic Bones ,genomewide association study ,Femoral neck ,Hip Fractures ,Genetic Variation ,Reproducibility of Results ,medicine.disease ,osteoporosis ,meta-analysis ,030104 developmental biology ,Gene Expression Regulation ,fracture ,polymorphisms ,Body mass index ,Genome-Wide Association Study - Abstract
Hip geometry (HG) is an important predictor of fracture. We performed a meta-analysis of GWAS studies in adults to identify genetic variants that are associated with proximal femur geometry phenotypes. We analyzed four phenotypes: 1) Femoral neck length; 2) Neck-shaft angle; 3) Femoral neck width, and 4) Femoral neck section modulus, estimated from DXA scans using algorithms of hip structure analysis. In the Discovery stage, 10 cohort studies were included in the fixed-effect meta-analysis, with up to 18,719 men and women ages 16-93 years. Association analyses were performed with ~ 2.5 million polymorphismsunder an additive model adjusted for age and body mass index; an additional analysis also adjusted for height. Replication analyses of meta-GWAS significant loci (at genome-wide significance, GWS, threshold p≤5x10-8) were performed in 7 additional cohorts in-silico. In meta-analysis not adjusting for height (combined Discovery and Replication stages), GWS associations were found on chr. 4 (in HHIP), chr. 8 (C8orf34), chr. 13 (FAM10A4 and DLEU2), and chr. 20 (inDDX27). The height-adjusted meta-analysis showed significant associations at 5p15 (IRX1 and ADAMTS16); 5q35 near FGFR4; at 12p11 (in CCDC91); 11q13 (near LRP5 and PPP6R3 (rs7102273)). Several HG signals overlapped with bone mineral density (BMD), including JAG1 on chr. 20, near TNFRSF11B (chr. 8), SOX6 and LRP5 (chr. 11). Chr. 11 SNP rs7102273 was associated with any-type fracture (p = 7.5 x 10-5). We used bone transcriptome data and discovered several significant eQTLs, including rs7102273 and PPP6R3 expression (p=0.0007), and rs6556301 (intergenic, chr.5) and PDLIM7 expression(p=0.005). In conclusion, we found associations between HG measures and several genes being part of biological pathways relevant to BMD and fractures. The results provide a defined set of genes facilitating further experimental exploration and validation to understand biological mechanisms underlying human bone geometry and etiology of bone fragility.
- Published
- 2019
46. In Vivo analysis of spinopelvic kinematics and peak head‐cup contact in total hip arthroplasty patients with lumbar degenerative disc disease
- Author
-
Young-Min Kwon, David W. Hennessy, Sakkadech Limmahakhun, Paul Arauz, Christian Klemt, and Hayden N. Box
- Subjects
Male ,musculoskeletal diseases ,Pelvic tilt ,Arthroplasty, Replacement, Hip ,Intervertebral Disc Degeneration ,Kinematics ,Degenerative disc disease ,Lumbar ,medicine ,Deformity ,Humans ,Orthopedics and Sports Medicine ,Pelvic Bones ,Gait ,Aged ,Lumbar Vertebrae ,business.industry ,In vivo analysis ,Middle Aged ,medicine.disease ,Sagittal plane ,Biomechanical Phenomena ,medicine.anatomical_structure ,Case-Control Studies ,Female ,Hip Prosthesis ,medicine.symptom ,Nuclear medicine ,business ,Total hip arthroplasty - Abstract
Anterior instability after total hip arthroplasty (THA) has been described in patients with thoracolumbar kyphotic deformity. Although compensatory posterior pelvic tilt with subsequent increased functional anteversion has been described as the mechanism, there is a paucity of in vivo data. The purpose of our study was to compare pelvic tilt, anteversion, inclination, and position of head-cup contact points in patients with lumbar degenerative disc disease (DDD) and a matched patient cohort without DDD. A total of 50 THA, 18 hips with lumbar DDD and 32 hips without DDD, underwent CT imaging for 3D hip reconstruction. Component orientations and in vivo hip gait kinematics was quantified using a validated dual fluoroscopic imaging system. Hip kinematics and head-cup contact points were compared. Patients with lumbar DDD demonstrated decreased maximum (5.9° ± 4.2° vs. 9.3° ± 5.4°, p = 0.02) and minimum (2.4° ± 4.1° vs. 6.2° ± 5.6°, p = 0.01) anterior pelvic tilt, and increased maximum cup anteversion (29.3° ± 8.7° vs. 25.1° ± 8.1°, p = 0.05). The peak head-cup contact points were shifted closer to the anterior edge of the polyethylene (7.8 ± 1.7 mm vs. 9.6 ± 2.2 mm, p = 0.02). Patients with lumbar degenerative disc disease demonstrated increased posterior pelvic tilt, functional acetabular anteversion, inclination as well as shifting of the peak head-cup contact pattern significantly closer to an anterior edge, suggesting sagittal spinopelvic deformity may predispose to anterior instability in THA patients during upright activities. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
- Published
- 2019
47. Robot‐assisted Minimally‐invasive Internal Fixation of Pelvic Ring Injuries: A Single‐center Experience
- Author
-
Liu, Hua‐shui, Duan, Sheng‐jun, Xin, Fu‐zhen, Zhang, Zhen, Wang, Xue‐guang, and Liu, Shi‐dong
- Subjects
Adult ,Male ,Bone Screws ,Minimally‐invasive surgery ,Pelvis ,Fractures, Bone ,Young Adult ,Postoperative Complications ,Robotic Surgical Procedures ,lcsh:Orthopedic surgery ,Humans ,Minimally Invasive Surgical Procedures ,Pelvic Bones ,Aged ,Retrospective Studies ,Fracture Healing ,Clinical Article ,Robotics ,Middle Aged ,Radiography ,body regions ,lcsh:RD701-811 ,Treatment Outcome ,Fracture fixation, Internal ,Clinical Articles ,Female - Abstract
Objective To investigate the indications, surgical strategy and techniques, safety, and efficacy of robot‐assisted minimally‐invasive internal fixation of pelvic ring injuries. Methods The clinical data of 86 patients with anterior and posterior pelvic ring injuries who underwent robot‐assisted minimally‐invasive internal fixation were retrospectively analyzed. The patients included 57 men and 29 women aged between 22 and 75 years, with an average age of (40.2 ± 13.6) years. According to the Tile classification, there were 5 (5.8%) type A2, 48 (55.8%) type B, and 33 (38.4%) type C fractures. The surgical plans were formulated based on the injury type of the pelvic ring, the effectiveness of the reduction, and the integrity of the osseous channel. Posterior pelvic ring injuries were treated with robot‐assisted percutaneous cannulated screw fixation of the sacroiliac joint. Anterior pelvic ring injuries were treated with robot‐assisted percutaneous cannulated screw fixation of the pubic ramus, INFIX fixation, or a “hybrid” fixation. The surgical complications and the efficacy of the surgical treatments were analyzed. Results A total of 274 screws were inserted with robotic assistance, of which 262 screws were successfully inserted to a satisfactory position on the first attempt. The number of screws placed per person was 3.2 on average, and the average operation time was 175 min (35–280 min). Fluoroscopies were performed an average of 29.1 times (range, 9–63 times), and it took 6.1 s to place each screw. There were 13 unsatisfactory guiding needle placements during the surgeries, among 7 of which cutting or penetration of the cortex was re‐planned until satisfactory insertions; 1 penetrated the pubic cortex, causing hemorrhage of the “crown of death,” and was changed to “hybrid surgery”. The robot‐assisted surgical wounds all healed by primary intention with satisfactory position and precision of screw insertions. All patients were followed up for 3–6 months, with an average of 4.2 months. There were two postoperative fixation failures, in which both patients had separated symphysis pubes after hybrid surgery. The average Majeed score at the last follow‐up was 92.4 points. Conclusions Robot‐assisted surgery is accurate and minimally invasive, with a high success rate for one‐time screw placement and satisfactory clinical results. The indications and surgical strategy should be rigorously selected, the level of surgical techniques mastered, and the operating procedures standardized, all of which may help to prevent surgical complications. Robot‐assisted surgery provides a novel modality for the minimally‐invasive treatment of pelvic ring injuries.
- Published
- 2019
48. Gross osteology and radiology of the pelvic limb of the adult small East African goat
- Author
-
M. Makungu
- Subjects
Male ,040301 veterinary sciences ,Anesthesia, General ,Tarsus, Animal ,Condyle ,0403 veterinary science ,03 medical and health sciences ,medicine ,Animals ,medicine.bone ,Femur ,Pelvic Bones ,Toe Phalanges ,Radiographic anatomy ,0303 health sciences ,Tibia ,General Veterinary ,Trochanter ,Osteology ,business.industry ,Goats ,Patella ,04 agricultural and veterinary sciences ,General Medicine ,Anatomy ,Hindlimb ,Metatarsus ,Radiography ,medicine.anatomical_structure ,030301 anatomy & morphology ,Fibula ,Sesamoid bone ,Female ,Muscles of the hip ,Sesamoid Bones ,business - Abstract
The aim of this study was to provide the detailed normal gross osteology and radiographic anatomy of the pelvic limb in adult small East African goats as a reference for clinical use, biomedical research and teaching. Radiography of the pelvic limb was performed in five adult small East African goats. Bone specimens of four skeletally mature small East African goats were used for gross osteological study. The ilial wing was wide. The ischiatic tuberosity was prominent and well developed. The acetabulum was rounded. The minor trochanter was located caudomedially, and the femoral trochlea was deep and narrow. The lateral and medial condyles of the femur were approximately of the same size. The tibial tuberosity was prominent, and the cochlea grooves were deep with a pronounced intermediate ridge. The trochlea of the talus was deep. The patella presented a prominent tuberosity on the cranial surface. The metatarsal sesamoid bone was seen in all animals. The observed gross osteology and radiographic anatomy of the pelvic limb of small East African goats was consistent with the presence of strong extensor muscles of the hip, stifle and tarsus for propulsion during terrestrial walking and trotting.
- Published
- 2019
49. In-hospital mortality of pelvic ring fractures in older adults now and then: A pelvic registry study
- Author
-
Michael D. Menger, Tim Pohlemann, Tina Histing, Benedikt J. Braun, Joerg H. Holstein, Steven C. Herath, and Mika F. Rollmann
- Subjects
Male ,medicine.medical_specialty ,Registry study ,Fractures, Bone ,03 medical and health sciences ,Injury Severity Score ,0302 clinical medicine ,Older patients ,030502 gerontology ,Pelvic ring ,Germany ,Internal medicine ,medicine ,Humans ,Hospital Mortality ,Registries ,Pelvic Bones ,Aged ,Retrospective Studies ,In hospital mortality ,business.industry ,Mortality rate ,Middle Aged ,Pelvic trauma ,Demographic change ,Female ,0305 other medical science ,business ,030217 neurology & neurosurgery - Abstract
With the predicted demographic change, the treatment of geriatric patients will become a major issue for health systems worldwide. The majority of pelvic ring fractures occur in older adults, and their treatment might be associated with a distinct mortality. Herein, we analyzed the data of 5665 patients with pelvic ring fractures aged ≥60 years included in the German Pelvic Trauma Registry from 1991 to 2013.The data were collected prospectively, multicentrically in hospitals participating in the German Pelvic Trauma Registry. Demographic data were retrospectively analyzed, stratified for age, sex, type of injury, mode of therapy, injury severity score (ISS) and mortality.The overall mortality decreased over the 22-year study period from 9.3% to 3.8% (P 0.05), whereas the median ISS significantly increased. During the observation period, mortality was higher in patients with type B and, particularly, type C fractures when compared with patients with type A fractures. Mortality rates of patients aged80 years did not significantly differ from those aged60 or70 years. Male patients showed a significantly higher mortality compared with female patients, as well as a significantly higher median ISS. The mortality rate of patients with surgically-treated type C fractures decreased over the study period from 35.7% to 6.9% (P 0.05).Over the past two decades, the mortality of older patients after pelvic ring fractures has significantly decreased. The higher overall mortality rate of male patients might mainly be accounted for by the relatively higher fraction of type C fractures and a higher ISS. Geriatr Gerontol Int 2019; 19: 24-29.
- Published
- 2018
50. 3D statistical model of the pelvic ring – a <scp>CT</scp> ‐based statistical evaluation of anatomical variation
- Author
-
Takeshi Sawaguchi, Robert Geoff Richards, Lukas Kamer, Hansrudi Noser, Daniel Wagner, Pol Maria Rommens, and Charlotte Arand
- Subjects
Adult ,Male ,0301 basic medicine ,Sacrum ,Pelvic brim ,Biometry ,Histology ,Symphysis ,Standard deviation ,Pelvis ,Ilium ,03 medical and health sciences ,Imaging, Three-Dimensional ,0302 clinical medicine ,Ala of sacrum ,Hounsfield scale ,medicine ,Humans ,Pelvic Bones ,Molecular Biology ,Ecology, Evolution, Behavior and Systematics ,Aged ,Mathematics ,Principal Component Analysis ,Models, Statistical ,Anatomic Variation ,Gender Identity ,Sacroiliac Joint ,Statistical model ,Original Articles ,Cell Biology ,Anatomy ,Acetabulum ,030104 developmental biology ,medicine.anatomical_structure ,Female ,Tomography, X-Ray Computed ,030217 neurology & neurosurgery ,Developmental Biology - Abstract
The pelvic ring is a highly complex construct with a central role for human stability and mobility. The observable interindividual differences in skeletal anatomy are caused by anatomical variation in the innominate bones as well as the sacrum, further to differences in the spatial arrangement of these bones to each other. The aim of this study was to generate a 3D statistical model of the entire pelvic ring in order to analyse the observed interindividual differences and anatomical variation. A series of 50 anonymized pelvic CT scans of uninjured Japanese adults [30 males, 20 females, average age of 74.9 years, standard deviation (SD) 16.9 years] were processed and analysed, resulting in a 3D statistical overall mean model and separate male and female mean models. Principal component analysis (PCA) of the overall statistical model predominantly showed size variation (20.39%) followed by shape variation (14.13%), and a variation of the spatial arrangement of the sacrum to the innominate bones in different anatomical peculiarities (11.39 and 8.85%). In addition, selected internal and external pelvic parameters were manually measured with the objective of further evaluating and quantifying the observed interindividual as well as the known sex‐specific differences. A separate statistical model of the grey value distribution based on the given Hounsfield unit (HU) values was calculated for assessing bone mass distribution, thus an indication of bone quality utilizing grey values as a quantitative description of radiodensity was obtained. A consistent pattern of grey value distribution was shown, with the highest grey values observed between the sacro‐iliac joint and the acetabulum along the pelvic brim. Low values were present in the sacral ala, in the area of the iliac fossa as well as in the pubic rami next to the symphysis. The present model allows a differentiated analysis of the observed interindividual variation of the pelvic ring and an evaluation of the grey value distribution therein. Besides providing a better understanding of anatomical variation, this model could be also used as a helpful tool for educational purposes, preoperative planning and implant design.
- Published
- 2018
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.