Search

Purpose: Pelvic osteotomies present a surgical option to restore pelvic alignment, improve function and pain in sequelae of pelvic ring fractures. Understanding the three-dimensional deformity is a crucial step within preoperative planning; furthermore, accurate intraoperative execution of the planning can be challenging. In recent years, patient-specific guides and 3D modeling have emerged as promising technologies in orthopedic and trauma surgery to enhance surgical precision and facilitate intraoperative decision-making. Methods: We present the case of a 41-year-old male patient with a pelvic malunion, resulting from a vertical shear fracture occurring 8 years prior. The patient presented with a 4-cm cranial displacement of the right hemipelvis, accompanied by pubic symphysis disruption and fusion of S1 to L5 vertebra. Severely altered posture in the coronal and sagittal plane was associated with sitting imbalance, impaired gait, and chronic pain. Results: We analyzed the deformity and planned the surgical correction on a 3D interactive virtual model. Moreover, we developed 2 patient-specific cutting guides and one patient-specific reduction guide, allowing accurate bilateral pelvic osteotomies, subsequent realignment, and restoration of the pelvic anatomy. Conclusion: For the first time, 3D modeling and 3D-printed patient-specific guides were effectively employed in pelvic malunion surgery, enhancing the precision of preoperative planning, and providing valuable assistance during intraoperative procedures. [ABSTRACT FROM AUTHOR]

Incarcerated gravid uterus (IGU) is a rare and serious obstetric complication. IGU is defined as the entrapment of the gravid uterus between the pubic symphysis and the sacral promontory. The incidence of IGU is 1 in 3000–10 000 cases. IGU is associated with significant obstetric complications, including preterm labor, intrauterine fetal death, growth restriction, renal failure, uterine ischemia/rupture and thrombosis. Here, we present the case of a primigravida with urinary retention at 14 weeks. On transabdominal ultrasound at 19+5/7 weeks the cervix was difficult to visualize, and the anterior uterine wall appeared thickened. The bladder was elongated superior to the uterus and the placenta was low‐lying. Initially the patient was managed with intermittent self‐catheterization, and subsequently indwelling catheterization was required from 22 weeks. At 30 weeks, the patient was transferred to a tertiary center and magnetic resonance imaging (MRI) was preformed due to challenging visualization of the cervix on ultrasound and the patient's continued symptoms of constipation and recurrent urinary infections. The MRI found a retroflexed gravid uterus, with vagina and endocervix displaced anteriorly and compressed by the gravid uterus. The findings were consistent with an incarcerated uterus. The patient subsequently had positive urinary cultures for Pseudomonas and rising creatinine. Given the obstructive uropathy and associated morbidity and mortality, a plan for elective pre‐term delivery at 33+6/7 weeks was made. Delivery was by midline laparotomy, normal anatomy was restored after manual evacuation of the fundus from below the sacral promontory, and an uncomplicated lower segment transverse uterine cesarean section was performed. Synopsis: A primigravida symptomatic with urinary retention and constipation diagnosed with incarcerated gravida uterus develops obstructive uropathy and is subsequently delivered late preterm by midline laparotomy. [ABSTRACT FROM AUTHOR]

Purpose: To minimize radiation exposure to the small bowel (SB) in patients undergoing treatment for gynecological tumors by adopting a comfortable positioning method. Methods and patients: All 76 women undergoing Intensity-Modulated Radiation Therapy (IMRT) were included in this study. Patients were immobilized in a supine position using a vacuum bag and thermoplastic cast formation. In the trial group (n = 36), patients raised their buttocks and a solid foam pad was placed under the sacral tail before immobilization. The control group (n = 40) received treatment in the standard supine position. The SB was delineated from the pubic symphysis to the total iliac bifurcation in computed tomography (CT) scans. Result: In the trial group, a significant reduction in SB volume within the pelvic cavity was observed (mean 399.17 ± 158.7 cc) compared to the control group (mean 547.48 ± 166.9 cc), with a p-value less than 0.001. The trial group showed a statistically significant reduction in the absolute volume of irradiated SB at each dose, ranging from the low dose (10 Gy) to the high dose (45 Gy). In the control group, a negative correlation was found between SB and bladder volumes (R = -0.411, P = 0.008), whereas in the trial group, this correlation was weaker (R = -0.286, P = 0.091), with no significant relationship observed between bladder volume and SB. Conclusion: The high buttocks supine position effectively reduces SB radiation exposure without the need for bladder distension. This positioning method holds promise for reducing SB irradiation in various pelvic tumors. [ABSTRACT FROM AUTHOR]

Background/Objectives: Long-standing groin pain is a severe issue for athletes, often associated with the cleft sign on magnetic resonance imaging (MRI) scans, yet its underlying causes are poorly understood. The purpose of this study is to histologically examine the pubic plate structure in cadavers with and without the cleft sign on MRI, shedding light on the pathology behind the cleft sign. Methods: Three fresh human pelvic cadavers underwent 3.0T MRI to detect the cleft sign before histological dissection of pubic plates. Pubic plate tissues were fixed in formalin, decalcified, and processed. Of the two cleft sign-negative specimens, one was cut into sagittal sections, and the other was cut into coronal sections for histology. For the cleft sign positive specimen, a sagittal section was cut. Moreover, 5 µm thick sections were cut at different axial levels for each orientation. Sections were subjected to Safranin O, Alcian blue, and Herovici's staining or hematoxylin and eosin staining. Results: MRI confirmed that one specimen had a cleft sign in the inferior region on both sides of the pubis and that two specimens had no cleft sign. Both sagittal and coronal sections showed the presence of a cartilage structure continuing from the pubic symphysis to 3 mm laterally within the pubic plate. In the specimen with a positive cleft sign, cartilage damage within the pubic symphysis and pubic plate was identified as revealed by Safranin O staining, Herovici's staining, and H&E staining. Conclusions: This study elucidated the existence of a cartilage component extending from the pubic symphysis to the pubic plate. The cleft sign in MRI correlated with a disruption in the cartilage component in histology within this specific area. [ABSTRACT FROM AUTHOR]

The purpose of this study is to evaluate whether the periprostatic adipose tissue thickness (PPATT) is an independent prognostic factor for prostate cancer patients after laparoscopic radical prostatectomy (LRP). This retrospective cohort study included consecutive prostate cancer patients who underwent LRP treatment at Wuhan Union Hospital from June 2, 2016, to September 7, 2023. PPATT was defined as the thickness of periprostatic fat and was obtained by measuring the shortest vertical distance from the pubic symphysis to the prostate on the midsagittal T2-weighted MR images. Subcutaneous adipose tissue thickness (SATT) was obtained by measuring the shortest vertical distance from the pubic symphysis to the skin at the same slice with PPATT. The primary outcome of the study was biochemical recurrence (BCR), and the secondary outcome was overall survival (OS). Multivariable Cox regression analysis was used to identify independent prognostic factors for prostate cancer survival and prognosis. Based on the optimal cutoff value, 162 patients were divided into a low PPATT/SATT group (n = 82) and a high PPATT/SATT group (n = 80). During the entire follow-up period (median 23.5 months), 26 patients in the high PPATT/SATT group experienced BCR (32.5%), compared to 18 in the low PPATT/SATT group (22.0%). Kaplan–Meier curve analysis indicated that the interval to BCR was significantly shorter in the high PPATT/SATT group (P = 0.037). Multivariable Cox regression analysis revealed that an increase in the PPATT/SATT ratio was associated with BCR (hazard ratio: 1.90, 95% CI, 1.03–3.51; P = 0.040). The PPATT/SATT ratio is a significant independent risk factor for BCR after LRP for prostate cancer patients. [ABSTRACT FROM AUTHOR]

Background: Managing infectious complications after kidney transplantation (KT) remains a major challenge. Infections are the leading non-cardiovascular cause of death among kidney transplant recipients (KTr). The urinary tract is particularly vulnerable to infections in this group, leading to high levels of morbidity and mortality, as well as significant economic costs. Case presentation: This case report presents the first documented instance of extensive thigh pyomyositis resulting from cystic fistulae in an 84-year-old KTr. The patient was referred to our hospital with acute onset fever, pain in the inner thighs and pyuria. A CT scan revealed bilateral pyomyositis of the thighs, characterized by multiple abscesses in the adductor muscles and hydroaerobic levels. Additionally, cystic fistulae complicated by pubic symphysis osteitis were identified. Conclusion: In KTr, lower limb pyomyositis resulting from a urinary tract infection is an extremely rare and significantly worsens the overall prognosis for these patients. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusions Level of Evidence Different methods for quantifying joint‐line obliquity (JLO) have been described, including joint‐line obliquity angle (JLOA), Mikulicz joint‐line angle (MJLA) and medial proximal tibial angle (MPTA). The goal of the present study was to quantify the variation of JLOA based on the position of the hip. The hypothesis of our study is that JLO is significantly influenced by the abduction/adduction of the limb, unlike MJLA.One hundred long‐leg‐weightbearing X‐rays were used. At time 0 and after 30 days, two observers performed different measurements, including (1) distance between pubic symphysis and center of the femoral head, (2) distance between center of the femoral head and center of the ankle joint, (3) distance between center of the ankle and medial malleolus, (4) hip‐knee‐ankle angle, (5) MPTA, (6) lateral distal femoral angle, (7) joint‐line congruency angle, (8) JLOA, (9) MJL and (10) angle between Mikulicz line and line perpendicular to the ground. The changes of the JLOA based on the position of the hip (abducted, neutral, bipedal stance adduction and monopodal stance adduction) were calculated with trigonometric formulas and with simulation on an orthopaedic planning digital software.The JLOA change between adducted and abducted positions was on average 12.8° (SD 0.9 mm). The MJL did not vary significantly based on hip position.The adduction/abduction of the lower limb has a considerable impact on JLOA. Methods like MJLA which are not affected by hip position should be preferred for JLO evaluation.Diagnostic study, level III. [ABSTRACT FROM AUTHOR]

Background There are few data on the impact of periacetabular osteotomy (PAO) on sagittal spinopelvic alignment. Prior studies have attempted to delineate the relationship by performing measurements on AP radiographs and using mathematical models to determine changes in postoperative pelvic tilt. This information is clinically significant to a surgeon when evaluating acetabular/pelvic position intraoperatively and understanding spinopelvic alignment changes postoperatively; therefore, radiographic changes from PAO should be described in more detail. Questions/purposes In this study, we asked: (1) Does the performance of PAO result in consistent changes in spinopelvic alignment, as measured on EOS radiographs? (2) Does this differ for unilateral versus bilateral PAOs? (3) Does this differ in the setting of a mobile spine versus an immobile spine? (4) Does this differ based on preoperative pelvic tilt? Methods Mean preoperative and at least 1-year postoperative (15 ± 8 months from surgery, minimum 11 months, maximum 65 months) EOS hip-to-ankle standing and sitting radiographs for 55 patients in a prospectively collected registry who underwent PAO with a single surgeon from January 1, 2019, to January 11, 2022, were measured for pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, lateral center-edge angle, L1 pelvic angle, and pubic symphysis to the sacroiliac index. Normality was assessed and paired sample t-tests (normally distributed data) or Wilcoxon signed rank tests (not normally distributed data) were utilized to assess if any measurements changed from preoperative to postoperative. Patients were then divided based on whether they had unilateral or bilateral dysplasia and unilateral or bilateral surgery, and these subgroups were analyzed the same way as the entire cohort. Two more subgroups were then formed based on lumbar mobility, defined as a change in sitting-to-standing lumbar lordosis less or greater than 1 SD from the population mean preoperatively, and the subgroups were analyzed the same way as the entire cohort. Finally, two additional subgroups were formed, preoperative standing pelvic tilt less than 10° and more than 20°, and analyzed the same as the entire cohort. Results For the entire cohort, the median (IQR) standing lateral-center edge angle increased 17°, from a median of 21° (10°) to a median of 38° (8° [95% confidence interval (CI) 16° to 20°; p < 0.001). The median sitting lateral center-edge angle increased 17°, from a median of 18° (8°) to a median of 35° (8° [95% CI 14° to 19°]; p < 0.001). Standing pelvic incidence increased from 50° ± 11° to 52° ± 12° (mean difference 2° [95% CI 1° to 3°]; p = 0.004), but there were no changes for other measured parameters. There were no changes in any of the spinopelvic parameters for patients with unilateral dysplasia receiving a unilateral PAO, but patients with bilateral dysplasia who underwent bilateral PAOs demonstrated an increase in pelvic incidence from 57° (14°) to 60° (16°) (95% CI 1° to 5°; p = 0.02) and a decrease in pubic symphysis to sacroiliac index from 84 mm (24 mm) to 77 mm (23 mm) (95% CI -7° to -2°; p = 0.007). Patients with mobile lumbar spines preoperatively did not exhibit any changes in sagittal spinopelvic alignment, but patients with immobile lumbar spines preoperatively experienced several changes after surgery. Patients with less than 10° of standing pelvic tilt demonstrated a median (IQR) 2° increase in pelvic incidence from median 43° (9°) to 45° (12° [95% CI 0.3° to 4°]; p = 0.03), but they did not experience any other changes in sagittal spinopelvic alignment parameters postoperatively. Patients with preoperative pelvic tilt more than 20° did not experience any change in sagittal spinopelvic parameters. Conclusion PAO increases pelvic incidence, potentially because of anterior translation of the hip center. There were no changes in other spinopelvic parameters postoperatively except after bilateral PAO. Additionally, patients lacking spine mobility preoperatively, indicated by a minimal change in lumbar lordosis between standing and sitting positions, may experience several changes in spinopelvic alignment, including increased mobility of their spine after PAO. This may be because of decreased compensatory spine splinting after increasing acetabular coverage, but further research including patient-reported outcomes is warranted. Level of Evidence Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

Previous studies have poorly described the initial development process of the tendinous intersections of the rectus abdominis muscle (RAM). The present study aimed to observe the formation of tendinous intersections in the RAM during the early fetal period using diffusion tensor imaging (DTI). Fifteen human fetal specimens (crown‐rump length [CRL]: 39.5–93.7 mm) were selected. Three‐dimensional measurements revealed that Zone‐4 (i.e., the zone between the pubic symphysis and the caudal base of the umbilical ring in the RAM) had a smaller width and was thicker than Zone‐1 and Zone‐2 (i.e., the zones between the costal arch and the cranial base of the umbilical ring) and Zone‐3 (i.e., the zone at the umbilical ring). Characteristics of tendinous intersections in the RAM during the early fetal period were assessed according to number, size, type, laterality, and sex. The mean number of tendinous intersections on both sides was 3.1 (range: 2.0–4.0), and 21% of specimens had only two tendinous intersections, which was higher than that reported in previous adult studies. The present data suggest that the formation of tendinous intersections was still in progress in specimens with two tendinous intersections in the RAM and that the third tendinous intersection was formed in Zone‐2. Ordinal logistic regression via generalized estimating equations revealed that the odds for a higher type of tendinous intersections in Zone‐1 and Zone‐2 were significantly higher than those in Zone‐4 (adjusted odds ratio: 14.85, 8.84). The odds for the presence of incomplete types (tendinous intersections that could not completely transverse the RAM) in Zone‐3 were significantly higher than those in Zone‐1 (adjusted odds ratio: 7.4). The odds for missing tendinous intersections in Zone‐4 were significantly higher than those in Zone‐1 (adjusted odds ratio: 20.5). These zonal differences in the formation of tendinous intersections were consistent with those observed in previous adult studies. In this study, DTI detected tendinous intersections in a sample with a CRL of 45.8 mm (approximately 11 weeks of gestation), which is earlier than that in previous histological findings, indicating that the RAM does not have mature tendinous intersections until the 17th week of gestation. In conclusion, DTI could detect the premature differentiation of tendinous intersection formation. Our data may aid in elucidating the developmental processes of tendinous intersections in the RAM. [ABSTRACT FROM AUTHOR]

This review is based on the literature published between 2000 and 2023 and presents an up-to-date evidence-based discussion of anatomical considerations relevant to the management of pelvic trauma. In addition, it discusses the significance of the pelvic ligaments in stabilizing the pelvic ring and of bone mineral density (BMD) in fragility fracture of the pelvis (FFP), which is becoming increasingly common in today’s aging societies. Following an overview of the anatomy and function of the sacroiliac joint (SIJ), the pubic symphysis, and the surrounding ligaments, the suitability of the widely-used Young-Burgess classification (YB) of high-energy impact pelvic ring fractures, which emphasizes the role of the ligaments in pelvic ring injuries, is discussed. Based on the current body of knowledge, using 2.5 cm of pubic symphysis diastasis as the determinant for surgical intervention in anterior-posterior compression fracture is questioned, and evaluation under anesthesia and lateral stress radiography for accurate diagnosis and treatment planning is proposed instead. The review underscores the need for further research on how the pelvic ligaments can provide optimal stability in the treatment of various types of pelvic fracture. On the other hand, for fragility fracture of pelvis (FFP) in older adults caused by low-energy trauma, the emphasis is on the fragility of the bones. To better manage FFP, the importance of understanding the distribution of BMD in the pelvis is highlighted. Dual-energy X-ray absorptiometry is a common method for measuring BMD, but it has drawbacks. The advantages of measuring BMD using Hounsfield units on computed tomography scans as an alternative method are discussed. An understanding of these issues may lead to better management of the increasing number of FFP cases in older people with reduced BMD.

Aim – to study the dynamics of pubic symphysis parameters in men in the early adulthood, early and middle old age according to computed tomography (CT) data. Material and methods. In the study, we used the results of a CT examination of 80 men without bone or pelvic organ pathology. All participants gave their consent to routine examination to exclude possible pathology of the pelvic bones. The CT investigation included the measurement of the height, width and thickness of the pubic symphysis in 3D reconstruction mode. The subjects were divided into three groups according to anatomical age classification. The first group included 25 early adulthood men (21 to 35 years old); the second group included 29 early old age men (56 to 74 years old); the third group included 26 middle old age men (75 to 88 years old). Results. When comparing the parameters of height, width and thickness of the pubic symphysis, their statistically significant decrease by middle old age was revealed. Its height decreased from the early adulthood to early old age by 7.1% (t = 12.82, p 0.01) and further remained unchanged in middle old age. The width of the pubic symphysis was decreasing by 22.7% (t = 8.3, p 0.01) from the early adulthood to early old age and by 26.5% (t = 8.32, p 0.01) from early to middle old age. The symphysis thickness was growing from the early adulthood to early old age by 6.4% (t = 6.10, p 0.01) and from early to middle old age – by 1.1% (t = 1.08, p 0.05). Conclusion. The results obtained in this study can be helpful for doctors of such specialties as traumatology, sports medicine and rehabilitation, forensic science, forensic medicine and many others.

Background: Patients presenting with partially impacted lower third molars (M3) have a higher likelihood of experiencing angle fractures while simultaneously decreasing the risk of condylar fractures. However, the specific biomechanical mechanism responsible for this occurrence remains unclear. Moreover, there is an ongoing debate regarding whether the removal of M3s might actually increase the risk of condylar fractures. This study aimed to evaluate how the presence of M3s influences mandibular fractures resulting from blows to the symphysis and lateral mandibular body, and to determine the indication for extracting M3s in such cases. Methods: Models of the mandible with a partially M3-impacted model (M3I), M3-extracted model (M3E), and M3-absent model (M3A) were generated using a computer. A traumatic blown force of 2000 N was applied to the symphysis and the right body of the mandible. Von Mises and principal stresses were analyzed, and failure indexes were determined. Two cases of mandibular linear fractures were chosen for model verification and interpretation. Results: When force was applied to the symphysis, the condylar region exhibited the highest stress levels, while stress in the mandibular angle region was much less regardless of the M3 state. On applying the force to the right mandibular body, stress in the condylar region decreased while stress in the mandibular body increased, especially in the blown regions. Impacted tooth or cavity formation post-M3 extraction led to uneven stress distribution on the blown side of the mandible, increasing the risk of mandibular angle fractures. In cases where M3 was absent or the extraction socket had healed, stress from lateral traumatic blown force was evenly distributed along both the inner and outer oblique lines of the mandible, thereby reducing the risk of mandibular fractures. Conclusions: The reduced risk of condylar fractures in patients with partially impacted lower M3s and mandibular angle fractures is mainly due to lateral blows on the mandible, which generate less stress in the condylar region than blows on the mandibular symphysis, rather than being caused by the M3 itself. Extraction of the lower M3 can decrease the risk of mandibular fractures, with a minor influence on condylar fractures. [ABSTRACT FROM AUTHOR]

The Early Cretaceous Jehol Biota in northeastern China has yielded a diversity of feathered dromaeosaurid dinosaurs and expanded our knowledge of avian origin and flight evolution. However, histology-based ontogenetic references and detailed morphological studies remain limited relative to the abundant fossils. Here, a new specimen of microraptorine from the Lower Cretaceous Jiufotang Formation is described. This specimen includes a nearly complete postcranial skeleton and inferred as a Microraptor based on revised osteological characters. The femoral length of the new specimen is less than 5 cm, making it the smallest dromaeosaurid individual reported from the Jehol Biota until now. Osteohistological analysis reveals that this individual was a juvenile that is less than one-year old. The new specimen provides additional morphological details that are poorly preserved in the other Microraptor specimens, including aspects of the coracoid, ilium, and tail. Additionally, the sacrals and pubic symphysis of the new specimen have respectively fused at the juvenile stage. This phenomenon suggests caution should be taken in using skeletal fusion for assessing the ontogenetic stage of Microraptor specimens, highlighting the importance of histological analysis. [ABSTRACT FROM AUTHOR]

Background: Urethral duplication is a rare urogenital anomaly with varying anatomical orientations leading to diverse clinical presentations. We present a case of urethral duplication in a neonate featuring a large dorsal cystic mass on the penis, an unusual presentation. Case presentation: A term male neonate with a prenatally diagnosed 10 × 10 cm genitourinary cystic mass was delivered via caesarean section. Examination revealed a large cystic mass extending dorsally from the pubic symphysis over a flattened, elongated penile shaft with a single urethral opening in the glans and undescended testes. A size 6-French feeding tube inserted into the urethra drained the bladder. Urethral communication with the cystic mass was confirmed via voiding cystourethrogram and cyst enlargement noted during voiding. Cyst fluid analysis indicated a urinary origin. Computed tomography and ultrasound were not diagnostic. Initial imaging revealed a dorsal cystic mass projecting from the pubic symphysis without bladder connection. Surgical intervention at 3 weeks revealed a Type IIA-2 urethral duplication, with a dorsal hypoplastic urethra communicating with the posterior urethra. Correction included resection of the dorsal urethra, cyst excision, and reconstruction of the penis with the orthotopic ventral urethra and bilateral orchidopexies. Satisfactory functional and cosmetic outcomes were observed at 2 and 8 months after surgery. Conclusion: This case highlights the significance of identifying unique urethral duplication presentations. The novel occurrence of Type IIA-2 urethral duplication terminating in a dorsal cystic mass underscores diagnostic complexity, surgical intricacies, and aesthetic considerations associated with such cases. [ABSTRACT FROM AUTHOR]

Background: The assessment of pubic diastasis is important for the surgical planning of patients with bladder exstrophy-epispadias complex. Understanding how the diastasis changes during surgical follow-up may help predict patient morbidity. Radiography can follow diastasis but may be affected by patient and technical imaging factors including body size, imaging protocol, and equipment. Using imaging calibration and anatomic ratios may mitigate differences due to these aspects. Objective: Use imaging phantoms to assess the effect of radiographic calibration on measurements of pubic diastasis and an internal anatomic ratio as a child grows. Materials and methods: Radiographic images were obtained of three different sizes of computed tomography phantoms (older child, child, and infant) using three imaging techniques that include the osseous pelvis in children. All phantoms were imaged with abdomen and pelvis techniques. The infant phantom was additionally imaged using a thoracoabdominal technique. These exposures were all repeated with systems from three manufacturers. Linear measurements were made between radiographic markers placed to simulate pubic diastasis and sacral width. A ratio was also created between these distances. Measurements with and without image calibration were made by two pediatric radiologists using rulers placed at the time of image acquisition. Results: There was excellent interrater agreement for measurements, ICC >0.99. Anterior distances were more affected by magnification than posterior ones with a significant difference between uncalibrated versus calibrated anterior distances (p=0.04) and not for posterior ones (p=0.65). There was no difference between radiographic equipment manufacturers without or with calibration (p values 0.66 to 0.99). There was a significant difference in simulated pubic distance between thoracoabdominal and abdomen (p=0.04) as well as pelvic (p=0.04) techniques which resolved with calibration, each p=0.6. The ratio between the simulated pubic diastasis and sacral width differed by phantom size (all p<0.01) and imaging technique (p values 0.01 to 0.03) with or without calibration. However, the numerical differences may not be clinically significant. Conclusion: Image calibration results in more uniform measurements that are more accurate than uncalibrated ones across patient size, imaging techniques, and equipment. Image calibration is necessary for accurate measurement of inter-pubic distances on all projection imaging. Small differences in the pelvic ratio likely are not clinically significant, but until there is a better understanding, image calibration may be prudent. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

It is currently unknown whether cancer and cancer treatment affect age-related skeletal changes used in the biological profile for skeletonized remains. This research examines the effects of cancer on skeletal age estimation using computed tomography (CT) scans of the pubic symphyses for 307 individuals from the New Mexico Descendent Image Database. The Suchey–Brooks method was applied to 125 individuals without documented cancer and 182 individuals with documented cancer. Individuals were correctly aged if their chronological age fell within the original study's 95% prediction range. Though not statistically significant, the results show that females with cancer were aged correctly 74.7% of the time, and females without cancer were aged correctly 85.1% of the time; males with cancer were aged correctly 46.0% of the time, and males without cancer were aged correctly 55.7% of the time. Additionally, a total of 30 individuals were reanalyzed to examine intraobserver error, and a Cohen's kappa value of k = 0.600 indicated a moderate level of agreement. While no statistical differences were found between cancer and control groups, CT scans may lack the resolution needed to visualize the nuanced effects of bone mineral density loss, if present, and the overall quality of bone, despite their proven utility in dry-bone skeletal analyses. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort study. Objective: This study aimed to evaluate the association between nerve lengthening after adult deformity correction and motor deficits dervied from the upper lumbar plexus or femoral nerve. Summary of Background Data: Adult spinal deformity (ASD) surgery is associated with high rates of neurological deficits. Certain postoperative deficits may be related to lengthening of the upper lumbar plexus (ULP) and/or femoral nerve (FN) after correction of lumbar deformity. Methods: Patients with ASD who underwent posterior-only corrective surgery from the sacrum to L3 or above were included. The length of each lumbar nerve root was calculated geometrically using the distance from the foramen to the midpoint between the anterosuperior iliac crest and pubic symphysis on AP and lateral radiographs. The mean lengths of the L1 to 3 and L2 to 4 nerve roots were used to define the lengths of the ULP and FN, respectively. Preoperative to postoperative changes in nerve length were calculated. Neurological examination was performed at discharge. Proximal weakness (PW) was defined as the presence of weakness compared with baseline in either hip flexors or knee extensors. Multiple linear regression analysis was used for estimating the postoperative lengthening according to the magnitude of pre-operative curvature and postoperative correction angles. Results: A total of 202 sides were analyzed in 101 patients, and PW was present on 15 (7.4%) sides in 10 patients. Excluding the 10 cases with three-column osteotomies, those with PW had a significantly higher rate of pure sagittal deformity (P<.001) and greater nerve lengthening than those without PW (ULP 24 vs. 15 mm, P=0.02; FN 18 vs. 11 mm, P=0.05). No patient had advanced imaging showing neural compression, and complete recovery of PW occurred in eight patients at one-year follow-up. Conclusions: After ASD surgery, lengthening of the ULP was associated with PW. In preoperative planning, surgeons must consider how the type of correction may influence the risk for nerve lengthening, which may contribute to postoperative neurological deficit. [ABSTRACT FROM AUTHOR]

Purpose: Open surgical approaches for the treatment of anterior pelvic arc lesions are associated with several complications. We present the first retrospective descriptive case series on the use of laparoscopy as an alternative. Methods: This descriptive, retrospective, single-centre study enrolled all patients who underwent laparoscopy for the treatment of pelvic ring disruption between May 2020 and March 2022. The primary outcome was the procedure failure rate based on conversion to open surgery. Secondary outcomes were the duration of the surgical procedure, x-ray exposure, length of hospitalisation, postoperative pain assessment, and functional scores at the last follow-up. Results: The study included two females and 12 males. The mean age of the study participants was 44.2 (23–67) years. In total, nine (64.3%) patients had pubic symphysis disjunction, four (28.6%) had bilateral fractures of the obturator frames, and one (7%) had both. None of the patients required conversion to open surgery. The median operating times for symphysis pubis disruption, obturator frame fracture, and patients with both injuries were 90.0 (60–120), 135 (105–180), and 240 min, respectively. The median overall operating time was 102.5 (60–240) min. The median Iowa Pelvic Score and Majeed Functional Score at the last follow-up were 87 (70–99) and 84 (70–100), respectively. Conclusion: Laparoscopic internal fixation is a reliable treatment for pelvic ring disruption. The clinical and radiological outcomes of our patients suggest the usefulness of this technique as an alternative to open approaches. [ABSTRACT FROM AUTHOR]

Pubic symphysis, also known as osteitis pubis, is an inflammatory condition of the pubic symphysis, clinically characterized by severe pelvic pain, abnormal gait with the increased base of support, and bone destruction of the pubic symphysis margins. Initially associated with certain surgical interventions, speculation about its pathogenesis includes infection, trauma, local vascular anomalies, and reflex-sympathetic dystrophy. This confusion about its etiology is reflected in the wide variety of treatments that have been used over the years, including radiation, bed rest for long periods, infiltration with local anesthetics, anti-inflammatories nonsteroidal drugs, antibiotics, heparin, surgical debridement, wedge resection of the pubic symphysis, and autologous iliac bone transplantation. Both bony infection and inflammation of the pubic area are rare. In the medical literature these two entities have been frequently confused, so that many diagnosed cases of osteitis pubis have actually been shown to be misdiagnosed osteomyelitis pubis. For this reason, an aggressive diagnostic approach is recommended, especially in post-surgical cases, with biopsy and arthrocentesis of the symphysis guided by computed tomography. [ABSTRACT FROM AUTHOR]

Background: Magnetic resonance imaging (MRI) findings associated with athletic pubalgia are well documented in the adult literature. Objective: To describe the spectrum of MRI findings in adolescents with pubic symphyseal injuries/athletic pubalgia. Materials and methods: This is an institutional review board approved, retrospective study of all patients < 18 years who were referred for MRI, over the last 10 years. Two pediatric musculoskeletal radiologists evaluated the MRI in consensus for the following findings: Chronic Salter-Harris (SH)-I equivalent fracture or asymmetric parasymphyseal ossific fraying, non-retractile muscular tear or retraction, and edema of the aponeurosis and arcuate ligament. Radiographs were also reviewed for Risser stage. Results: Fifteen patients were identified (100% male, median age 17 years, IQR 16–17.6). Most patients (14/15, 93%) had either asymmetric parasymphyseal ossific fraying (4/15, 27%) or chronic SH-1 equivalent fracture (10/15, 67%) of the pubic symphysis, and all patients (15/15, 100%) had aponeurotic and arcuate ligament edema. Few patients had rectus abdominis muscular retraction (2/15, 13%), non-retractile muscular tear of the rectus abdominis (2/15, 13%), and/or adductor muscle (4/15, 27%). Risser stage was as follows: stages 0 (13%), 3 (7%), 4 (47%), and 5 (33%). The injuries in our limited data set were independent of skeletal maturity with no statistically significant association between any of the MRI findings and Risser stage. Conclusion: The MR imaging spectrum of adolescent athletic pubalgia differs from the described findings in adults due to skeletal immaturity. The cleft sign described in adults manifests in adolescents as asymmetric parasymphyseal ossific fraying and chronic SH-1 equivalent fractures. [ABSTRACT FROM AUTHOR]

The validity of Doiguchi's pelvic tilt measurement method has not been proven. The objective in our study was to validate the method. Our investigation included 73 total hip arthroplasties (THAs) performed using our cup placement procedure from July 2020 to November 2021. Pelvic tilt formed by the pubic symphysis and sacral promontory (PT PS) in supine and lateral positions was calculated by two methods (the Doiguchi method and the digital reconstructed radiograph (DRR) method using a 3D computer templating system) based on the transverse and longitudinal diameters of the pelvic ring measured immediately before THA. There was a strong/moderate correlation in the values of PT PS between the Doiguchi and DRR methods. However, the value of PT PS calculated by the Doiguchi method was significantly lower than that calculated by DRR, and there was a partially direct match. On the other hand, there was no significant difference in the value of PT change from supine to lateral position between the Doiguchi and DRR methods. The PT changes based on both methods were strongly correlated, and the PT change calculated by the Doiguchi method was almost identical to that calculated by the DRR method. Doiguchi's pelvic tilt measurement method was validated for the first time. These results demonstrated that the ratio of the transverse and longitudinal diameters of the pelvic ring was an important factor defining the change in pelvic tilt. The slope in the linear function of the Doiguchi method was found to be almost the correct value, although the intercept of the linear function exhibited individual differences. [ABSTRACT FROM AUTHOR]

To study prostate specific membrane antigen – positron emission tomography (Ga68PSMA-PETCT) based patterns of relapse at biochemical failure (BCF) after prostate-only radiotherapy (PORT) in high-risk (HR) prostate cancer and its implications on pelvic contouring recommendations. Patients with clinico-radiological high-risk node-negative prostate cancer treated with curative PORT and androgen deprivation therapy (ADT), either within the POP-RT randomised trial or off trial, who underwent a Ga68PSMA-PETCT upon BCF were included. Patterns of regional and distant recurrence on Ga68PSMA-PETCT were studied. Pelvic nodal recurrences were mapped with reference to the superior border of pubic symphysis. Pelvic lymph nodal caudal border (PLN cb) recommendations in the published contouring guidelines (RTOG cb , GETUG cb , PIVOTAL cb , NRG cb , GFRU cb) were evaluated. Of the total 262 patients screened, 68 eligible patients were included (POP-RT trial 35 patients; off-trial 33 patients). Median follow-up was 91 months (IQR, 72–117) and median time to BCF was 65 months (IQR, 49–83). Regional and distant recurrence was seen in 31 (46%) and 31 (46%) patients, respectively. Of the nodal recurrences, nearly half (46%, 14/31) had no distant metastases and 64% (20/31) had a failure in the common iliac nodal region. The lower-most nodal recurrence was 20 mm cranial to the top of pubic symphysis (RTOG cb , GETUG cb , GFRU cb) and 10 mm cranial to the PIVOTAL cb. The PLN cb recommended by NRG guideline (NRG cb) had an inter-patient variability of 32 mm, ranging from 16 mm above to 16 mm below the top of pubic symphysis, and the lower most nodal recurrence ranged from 4 mm to 36 mm cranial to NRG cb. Pelvic failures accounted for a major proportion of recurrences after prostate-only radiotherapy, with the caudal most nodal recurrence being 20 mm cranial to the top of pubic symphysis. This could have implications in defining the caudal border of contouring recommendations. • Roughly half of men with localised HRCaP have pelvic failures post prostate-only RT. • Pelvic nodal lower-border definition lacks consensus across existing guidelines. • Caudal-most nodal failure was mapped 20 mm superior to the top of pubic symphysis. [ABSTRACT FROM AUTHOR]

Introduction: Open book injuries are challenging injuries that oftentimes require surgical treatment. Currently, treatment is performed with symphyseal plating requiring extensive surgery and entirely limiting physiological movement of the symphyseal joint, frequently resulting in implant failure. Therefore, we investigated the biomechanical properties of a minimally invasive tape suture construct (modified SpeedBridge™) as an alternative stabilization technique for the treatment of open book injuries in human cadaver pelvic rings. Materials and Methods: The symphysis of 9 human cadaver pelvises was dissected and dilated to 3 cm creating an open book injury. Next, the two osteosynthesis methods (plating, modified SpeedBridge™) were applied. All specimens then underwent cyclic horizontal and vertical loading, simulating biomechanical forces while sitting, standing and walking. For statistical analysis, 3D dislocation (mm) was calculated. Results: Total displacement (mm) of the pubic symphysis displayed the following means and standard deviations: native group 1.34 ± 0.62 mm, open book group 3.01 ± 1.26 mm, tape group 1.94 ± 0.59 mm and plate group 1.37 ± 0.41 mm. Comparison between native and open book (p = 0.029), open book and plate (p = 0.004), open book and tape (p = 0.031), as well as tape and plate group (p = 0.002) showed significant differences. No significant differences were found when comparing the native and tape (p = 0.059), as well as the native and plate (p = 0.999) group. Conclusion: While both osteosynthesis techniques sufficiently stabilized the injury, symphyseal plating displayed the highest rigidity. The modified SpeedBridge™ as a tape suture construct provided statistically sufficient biomechanical stability while maintaining symphyseal micro mobility, consequently allowing ligamental healing of the injured joint without iatrogenic arthrodesis. [ABSTRACT FROM AUTHOR]

The bony pelvis is an irregular but complete bony ring made up of the right and left hip bones anterolaterally and the sacrococcygeal part of the vertebral column posteriorly. The two hip bones are firmly united anteriorly at the pubic symphysis, and together constitute the pelvic girdle. The pelvic girdle articulates with the femoral heads and thereby connects the vertebral column (axial skeleton) to the two femora (appendicular skeleton). The main functions of the pelvic girdle are to transmit weight from the upper body to the lower limbs during locomotion and while standing, and to support the weight of the upper body when seated or stationary. Another important function of the bony pelvis is to provide attachment for the powerful muscles (e.g. gluteal muscles) that act on the lower limb and those muscles that support the abdominal wall. The bony pelvis also provides ample protection to the many delicate viscera, vessels and nerves that lie within the pelvic cavity. Successful orthopaedic management of disruptions of the bony pelvis and management of associated injuries to intrapelvic viscera require a sound appreciation of the anatomy of the pelvic ring and pelvic cavity. [ABSTRACT FROM AUTHOR]

PurposeTo explore the percutaneous minimally invasive treatment of pubic symphysis and its adjacent fractures.MethodSince May 2021, 13 cases of fractures involving the pubic symphysis and its adjacent parts were treated with x-ray fluoroscopic localization and percutaneous cannulated screw fixation across the symphysis pubis, the guide pin pierced the symphysis pubis and the fracture end and stopped at the inner edge of the acetabulum. Visual analogue scale (VAS) was used to evaluate the effect of the operation, and the patients were followed up.ResultThe screw insertion operation time was 25–40 min, with an average of 31.45 min; The number of perspectives is 20–40, with an average of 28.75. The average intraoperative blood loss was 10 ml, and there were no puncture complications such as nerve or vascular damage. The initial stability of the fractured end of the patient after surgery was good. The VAS score decreased from preoperative 8–10 points to postoperative 1–2 points (average of 1.5 points). The follow-up time was 3–25 months, with an average of 8.5 months. At the last follow-up, the excellent and good rate of pelvic function according to Majeed pelvic function scoring system was 100%. One patient had screws removed 1.5 years after surgery, while the remaining twelve patients did not have screws removed. All patients did not experience any discomfort symptoms caused by pubic symphysis fixation.ConclusionPercutaneous hollow nail internal fixation is an effective method for treating fractures of the pubic symphysis and its adjacent parts.

The EFAST technique is a rapid ultrasound method introduced into ATLS guidelines since 2006 for the evaluation of trauma patients. It allows for the detection of free fluid in the abdomen, pericardial tamponade, and pneumothorax within 2 to 3 minutes without impacting management times in pre-hospital settings. Recently, the EFAST-PS protocol has been introduced, which includes an additional scan of the pubic symphysis to identify “open book” pelvic fractures. This mini review examines the efficacy of the EFAST-PS protocol in pre-hospital environments through a literature review and analysis of a clinical case. It is demonstrated that EFAST has high specificity and sensitivity in detecting free fluid in abdominal and thoracic recesses, improving the management of trauma patients and reducing time to definitive intervention. The addition of the pubic symphysis scan did not cause any issues but increased safety in managing patients with suspected fractures and hemodynamic instability. Emergency ultrasound assessment, including the EFAST-PS protocol, should be integrated into the overall clinical picture to provide useful data for the decision-making process.

Background: Open reduction and plate fixation is a standard procedure for treating traumatic symphyseal disruptions, but has a high incidence of implant failure. Several studies have attempted to identify predictors for implant failure and discussed its impact on functional outcome presenting conflicting results. Therefore, this study aimed to identify predictors of implant failure and to investigate the impact of implant failure on pain and functional outcome. Methods: In a single-center, retrospective, observational non-controlled cohort study in a level-1 trauma center from January 1, 2006, to December 31, 2017, 42 patients with a plate fixation of a traumatic symphyseal disruption aged ≥ 18 years with a minimum follow-up of 12 months were included. The following parameters were examined in terms of effect on occurrence of implant failure: age, body mass index (BMI), injury severity score (ISS), polytrauma, time to definitive treatment, postoperative weight-bearing, the occurrence of a surgical site infection, fracture severity, type of posterior injury, anterior and posterior fixation. A total of 25/42 patients consented to attend the follow- up examination, where pain was assessed using the Numerical Rating Scale and functional outcome using the Majeed Pelvic Score. Results: Sixteen patients had an anterior implant failure (16/42; 37%). None of the parameters studied were predictive for implant failure. The median follow-up time was six years and 8/25 patients had implant failure. There was no difference in the Numerical Rating Scale, but the work-adjusted Majeed Pelvic Score showed a better outcome for patients with implant failure. Conclusion: implant failure after symphyseal disruptions is not predictable, but appears to be clinically irrelevant. Therefore, an additional sacroiliac screw to prevent implant failure should be critically discussed and plate removal should be avoided in asymptomatic patients. [ABSTRACT FROM AUTHOR]

During the process of labor, the intrapartum transperineal ultrasound examination serves as a valuable tool, allowing direct observation of the relative positional relationship between the pubic symphysis and fetal head (PSFH). Accurate assessment of fetal head descent and the prediction of the most suitable mode of delivery heavily rely on this relationship. However, achieving an objective and quantitative interpretation of the ultrasound images necessitates precise PSFH segmentation (PSFHS), a task that is both time-consuming and demanding. Integrating the potential of artificial intelligence (AI) in the field of medical ultrasound image segmentation, the development and evaluation of AI-based models rely significantly on access to comprehensive and meticulously annotated datasets. Unfortunately, publicly accessible datasets tailored for PSFHS are notably scarce. Bridging this critical gap, we introduce a PSFHS dataset comprising 1358 images, meticulously annotated at the pixel level. The annotation process adhered to standardized protocols and involved collaboration among medical experts. Remarkably, this dataset stands as the most expansive and comprehensive resource for PSFHS to date. [ABSTRACT FROM AUTHOR]

Aim: In order for a person to stand in a balanced way, the pelvis and spine must be in harmony. The aim of this study was to determine the normal ranges of spinopelvic parameters in children and adolescents in Türkiye. Material and Method: In our study, computed tomography images of 1018 healthy 7-17 year olds were examined. As a result of this examination, sacrum pubic incidence, lumbar lordosis, sacral slope, sacral kyphosis, pelvic tilt and pelvic incidence were measured. Results: The sacrum pubic incidence was 58.71±6.17°, sacral slope 37.26±5.77, lumbar lordosis 42.98±8.06°, sacral kyphosis 21.27±9.96°, pelvic incidence 46.77±6.38, and pelvic tilt 9.51±5.06°. The calculations revealed that, with age, all parameters except pelvic tilt increased significantly. A statistically significant difference was found between the age groups. Conclusion: The results of this study will contribute to the existing literature and may give clinicians insight into sagittal corrections in spine and pelvic surgery. [ABSTRACT FROM AUTHOR]

The study aimed to explore an extra-articular screw placement strategy in Stoppa approach. Radiographic data of patients who underwent pelvic computed tomography from January 2016 to June 2017 were imported into Materiaise's interactive medical image control system software for three-dimensional reconstruction. Superior and lower margins of acetabulum and ipsilateral pelvic brim could be observed simultaneously through inlet-obturator view. A horizontal line from superior acetabular margin intersected pelvic brim at point "A" and another vertical line from lower margin intersected pelvic brim at point "B" were drawn, respectively. Lengths form sacroiliac joint to "A" (a), "A" to "B" (b), and "B" to pubic symphysis (c) were measured. Patients were divided into four groups depending on gender and side difference of measured hemi-pelvis: male left, male right, female left, and female right. Lengths of adjacent holes (d) and spanning different holes (e) of different plates were also measured. Mean lengths of a, b, c in four groups were 40.94 ± 1.85 mm, 40.09 ± 1.93 mm, 41.78 ± 3.62 mm, and 39.77 ± 2.23 mm (P = 0.078); 40.65 ± 1.58 mm, 41.48 ± 1.64 mm, 40.40 ± 1.96 mm, and 40.66 ± 1.70 mm (P = 0.265); 57.03 ± 3.41 mm, 57.51 ± 3.71 mm, 57.84 ± 4.40 mm, and 59.84 ± 4.35 mm (P = 0.165), respectively. Mean d length of different plates was 12.23 mm. Average lengths spanning 1, 2, 3 and 4 holes were 19.33 mm, 31.58 mm, 43.80 mm, and 55.93 mm. Our data showed that zones a and c could be safely inserted three and four screws. Penetration into hip joint could be avoided when vacant 3-hole drilling was conducted in zone b. Fracture line in zone b could serve as a landmark for screw placement. [ABSTRACT FROM AUTHOR]

The forAge program estimates the age-at-death of human pubic symphysis using 3-dimensional scans. It was developed by Dennis E. Slice and Bridget F. B. Algee-Hewitt, and utilizes three distinct scores: the Slice and Algee-Hewitt (SAH) score, bending energy (BE), and ventral curvature (VC). However, these scores and age estimation regression equation were obtained through European American pubic symphysis. Changes in the pubic symphysis surface are evaluated as one of the most reliable indicators for estimating age, but in connection with this, using Korean materials, changes in the pubic symphysis surface and the actual changes are evaluated. There is no bar where the relationship between ages is grasped, and there are cases where a methodology developed for a specific group is applied to a Korean group. Changing the pubic symphysis surface by aging was evaluated as one of the most reliable indicators for estimating age. However, there is no study conducted on the relationship between changes in the pubic symphysis and actual age and applied the age estimation method for a specific population among Korean population. The purpose of this study is to compare the difference between the actual age and the estimated age in Korean to see if the forAge program is applicable to other population of different ancestral origin. One hundred and four modern Korean pubic symphyseal surfaces (47 to 96 years old) were used in this study. Through the pubic symphyseal surface 3-dimensional images, age-at-death was estimated via prediction equation and new regression lines using SAH, VC, and BE scores. Firstly, the estimated age via prediction equation using the first version of SAH score was lower than the actual age according to all pubic symphyseal surfaces for those older than 56. With aging, the difference between the actual age and estimated age became markedly larger. Secondly, the estimated ages via the new regression lines using VC, the second version of SAH score, and BE were shown a similar pattern to the previous prediction equation. The current study explored the applicability of a quantitative method using pubic symphyseal surface for age estimation in a modern Korean population. This study showed the forAge program cannot be applied to a modern Korean population, as they present relatively low correlations with the actual age-at-death. [ABSTRACT FROM AUTHOR]

Hip dysplasia (CFD) is the most common orthopedic case in small animal clinics, and, from this, other conditions can arise, such as lateral dislocation of the patella. The objective of this work is to present the preventive surgical treatment for DCF, using the technique of juvenile pubic symphysiodesis (SPJ), and also the surgical treatment to correct lateral patellar dislocation using the trochlear chondroplasty technique in a 4-month-old canine patient., who had hip instability and a history of lameness in the right pelvic limb. SPJ constitutes a prophylactic treatment for FCD that consists of the induced suspension of bone growth in the pubic symphysis region. Trochlear chondroplasty was the technique for deepening the trochlear groove which, together with intervention in the soft tissues, had the function of fixing the patella in its anatomical position. It is concluded that the use of the SPJ technique had the main function of preventing CFD in a young animal, just as trochlear chondroplasty had the reestablishment of normal function of the affected limb. [ABSTRACT FROM AUTHOR]

Objectives: This study was to evaluate the application of automatic measurement based on convolutional neural network (CNN) technology in intracavitary ultrasound cine of anterior pelvic. Methods: A total of 500 patients who underwent pelvic floor ultrasound examination at Peking University Shenzhen Hospital from July 2021 to February 2022 were retrospectively retrieved by the picture archiving and communication system (PACS) system, and 300 cases were used as a training set. The training set was labeled by three experienced ultrasound physicians to train CNN models and develop an automatic measurement software. The remaining 200 cases were used as a test set. Automatic measurement software identified relevant anatomical structures frame by frame and determined the two frames with the greatest difference, calculated the bladder neck descent (BND), urethral rotation angle (URA), and retrovesical angle (RA). Meanwhile, two experienced ultrasound physicians evaluated the resting frame and the maximum Valsalva frame on the cines by manual visual evaluation, labeled the anatomical structures in the corresponding frame, such as the inferoposterior margin of pubic symphysis, the mid‐axis of pubic symphysis, bladder contour, and urethra in the front, and calculated BND, URA, and RA. Considering that the residual urine volume (RUV) in the bladder may affect the results, enrolled patients were grouped according to the RUV (10–50 mL, 50–100 mL, and >100 mL). The consistency of the results by automatic measurement and manual visual evaluation was evaluated using the intraclass correlation coefficient (ICC) and the Bland–Altman graph. Results: Of the 200 cases in the test set, 120 cases were successfully identified by the CNN automatic software with a 60% recognition rate. In the case of successful identification, the ICC of manual visual evaluation measurement and automatic measurement was 0.936 (BND), 0.911 (URA), 0.756 (RA in rest), and 0.877 (RA at maximum Valsalva), respectively. In addition, the RUV had a negligible effect on the consistency. The Bland–Altman plot shows the proportion of samples outside the limit was below 5%. Conclusions: CNN‐based automatic measurement software exhibited high reliability in anterior pelvic measurement, which results in a significantly enhanced measurement efficiency. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of hypotension in cesarean section operations performed with spinal anesthesia varies between 55-90%. In this study, the relationship between the patient's abdominal circumference, symphyseal fundal height, and vertebral column length with the incidence of hypotension and the level of block in cesarean section operations performed under spinal anesthesia was investigated. Methods: The prospective, single-center study was conducted with patients who had undergone cesarean section with spinal anesthesia at the Training and Research Hospital. Pregnant and ASA II group patients older than 37 weeks who were to undergo cesarean section with spinal anesthesia were included in the study. Patients with multiple pregnancies, patients with premature rupture of membranes, preterm patients, and patients in active labor were excluded from the study. Those with diagnoses of abnormal presentation, polyhydramnios, oligohydramnios, macrosomic babies, and intrauterine growth retardation were also excluded from the study. Abdominal circumference was measured at the umbilicus level at the end of expiration in the supine position. Vertebral column length was measured and recorded from the C7 vertebra to the sacral hiatus. The distance of the patient from the symphysis pubis to the highest point of the uterine fundus in the supine position was measured and recorded. Spinal anesthesia was performed in the sitting position with a 26G Quincke spinal needle for the first time through the L4-5 interval and 2 mL of 0.5% hyperbaric bupivacaine was administered. When the block reached T6, the operation was started. Electrocardiogram (ECG), SpO2, and arterial blood pressure were monitored, and the first values were recorded. Results: A total of 98 parturient patients were included in this study. Overall, the incidence of hypotension was 87.78% (87 out of 98 parturients). Symphyseal fundal height correlated positively with spinal blockade levels at each different time point except for "Min. 4". Discussion and Conclusion: Symphyseal fundal height is a sensitive marker to determine the risk of hypotension after spinal anesthesia. We found that the symphyseal fundal height is a more sensitive marker for hypotension that will develop after spinal anesthesia compared to the other two parameters. [ABSTRACT FROM AUTHOR]

Introduction: pain in the pubic symphysis, even if studied in athletes, still sets out diagnostic and therapeutic challenges in other patient groups. Within this context, refractory osteorthritis of the pubic symphysis presents itself as an issue lacking clear therapeutic consensus. Material and methods: two women over 65 years old and presenting osteoarthritis of the pubic symphysis were evaluated. Following unsuccessful conventional therapies, arthrodesis via subpubic plate, wire suture and autologous graft from the iliac crest was performed. Results: after a one-year of following, both patients experienced clinical and radiographic improvement. Bone arthrodesis was achieved without significant complications, proving to be a viable surgical option. Conclusion: this study supports the medium and long-term efficacy of arthrodesis of the pubic symphysis in refractory cases of osteoarthrisis. Therefore, the technique can be considered a surgical option in the management of said condition. [ABSTRACT FROM AUTHOR]

Female athletes subjected to various types of impact loading, especially over a long period of time, may experience changes in their pelvic orientation, which may affect their sport performance and increase the likelihood of injury. The aim of the present study was to determine whether female athletes involved in high-impact loading sports (HILS), odd-impact loading sports (OILS), and repetitive non-impact loading sports (NILS) demonstrate changes in pelvis orientation compared to non-athletes (NATH). Pelvic orientation was determined using Euler/Cardan angles, calculated from the coordinates of the right, and left anterior superior iliac spines and pubic symphysis via a novel method. Two-way ANOVA tests showed significant differences between groups for pelvis position in the frontal plane (p < 0.05), with HILS and OILS demonstrating greater pelvic obliquity compared to NILS athletes and NATH. Significant main effects were also obtained for directions within the sagittal plane (p < 0.001). Significant within-group differences were observed in sagittal pelvic position among female athletes engaged in NILS (p < 0.01) and non-athletes (NATH) (p < 0.05), with a greater anterior pelvic tilt compared to posterior. Our findings suggest that pelvis orientation in female athletes across sports is influenced by sport-specific impact loads, potentially affecting performance and injury occurrence. [ABSTRACT FROM AUTHOR]

Transurethral prostate surgery can lead to a rare and late complication known as a prostatosymphyseal fistula. In the literature, there are only a limited number of reported cases of this type of fistula. This case underscores the complexities involved in disease management, as well as the challenges in establishing an initial diagnosis, given the inadequacy of conventional imaging methods to detect prostate-symphyseal fistulas. The presence of non-urological symptoms in patients often impedes the recognition of prostatesymphyseal fistulas, leading to a delay in diagnosis. In this case report, a patient who presented to the emergency department with complaints of sudden-onset difficulty walking and fever in the second month after bipolar transurethral resection of the prostate is presented. The diagnosis of pubic osteomyelitis and prostatosymphyseal fistula was made using advanced examinations such as contrast-enhanced pelvic computed tomography and magnetic resonance imaging. In the treatment, transperitoneal fistula tract excision and repair with an omental flap were performed. No complaints were observed during the 1-year postoperative follow-up. The surgeon's vigilant approach is paramount for promptly identifying this rare complication. [ABSTRACT FROM AUTHOR]

Background. The rapid advancement of modern surgical methods for treating pelvic bone fractures has underscored the necessity for developing a new terminological framework. This is because the classical anatomical terminology of the pelvis no longer aligns with the demands of the therapeutic process and scientific research in this field. The traditional set of anatomical names and landmarks falls short in providing detailed descriptions of all intricacies of injuries when employing contemporary surgical techniques. The existing terminology system needs to catch up with the level of contemporary pelvic surgery, enabling a comprehensive and understandable characterization of existing pathology and the treatment being administered for all medical professionals. Purpose of the study was to create names for certain parts of the pelvic bones and their areas that currently lack specific designations and to propose the developed terms for professional discussion. Methods. A retrospective analysis was conducted on X-rays and computer tomography scans of patients with pelvic bone injuries, performed from 2020 to 2022. A list of potential new anatomical terms was compiled through a literature review. Results. In several cases, we encountered a deficiency of terms in diagnosing pelvic injuries and describing surgical procedures. New terms were developed to denote areas of the pelvis and their injuries, including the pubic bone base, vertical fractures of the pubic bone base, longitudinal fractures of the pubic bone base, incomplete rupture of the pubic symphysis, the base of the ilium, longitudinal fracture of the iliac base, fracture-subluxation and fracture-dislocation of the iliac base, calcar of the iliac bone, calcar spike, and the bone corridor. Conclusions. The incorporation of new anatomical terms into clinical practice will help enhance the precision of diagnosis and surgical planning in pelvic fractures. Standardizing the terminology will promote uniformity in approaches and knowledge sharing among specialists, ultimately improving the quality of surgical care for patients with pelvic injuries.

Symphysis (symphysis pubica) is the connection of the two pubic bones and anatomically represents a synchondrosis. In the normal state, there is little mobility of the symphysis in adults with a rotation of 3° and a physiological width of 2-6 mm. Osteitis pubis (symphysitis) occurs especially in athletes with shooting, rapid acceleration and deceleration movements as well as changes in the direction of movement. The incidence of pregnancy-associated symphyseal instability is up to 1:300. Both conditions should initially be treated intensively conservatively, including immobilization with a pelvic or symphysis compression belt. Surgical treatment of sports-associated symphysitis is (mini-) open or endoscopic curettage/partial resection of the symphysis, symphyseodesis with bone graft or wedge resection. Surgical treatment of pregnancy-associated symphyseal instability is indicated after unsuccessful conservative therapy of 6 months or if the symphysis pubis width is > 2.5 cm or if instability recurs after removal of the pelvic belt. [ABSTRACT FROM AUTHOR]

Background: Pubic symphysis osteomyelitis can result from urosymphyseal fistula formation. High rates of sacropelvic insufficiency fractures have been reported in this population. The aim of this study was to describe the presentation and risk factors for sacral insufficiency fractures (SIF) associated with surgical treatment of pubic symphysis osteomyelitis. Methods: A retrospective review was performed for 54 patients who underwent surgery for pubic symphysis osteomyelitis associated with a urosymphyseal fistula at a single institution from 2009 to 2022. Average age was 71 years and 53 patients (98%) were male. All patients underwent debridement or partial resection of the pubic symphysis at the time of fistula treatment. Average width of the symphyseal defect was 65 mm (range 9–122) after treatment. Results: Twenty patients (37%) developed SIF at a mean time of 4 months from osteomyelitis diagnosis. Rate of sacral fracture on Kaplan–Meier analysis was 31% at 6 months, 39% at 12 months, and 41% at 2 years. Eleven patients developed SIF prior to pubic debridement and 12 patients developed new or worsening of pre-existing SIF following surgery. Width of pubic resection was higher in patients who developed SIF (76 mm vs. 62 mm), but this did not meet statistical significance (p = 0.18). Conclusion: Sacral insufficiency fracture is a common sequela of pubic symphysis osteomyelitis. These fractures are often multifocal within the pelvis and can occur even prior to pubic resection. Pubectomy further predisposes these patients to fracture. Clinicians should maintain a high index of suspicion for these injuries in patients with symphyseal osteomyelitis. [ABSTRACT FROM AUTHOR]

To compare characteristics and outcomes in patients who had radiotherapy (RT) for prostate cancer (PCa) and underwent urinary diversion (UD) due to prostatic fistula (Fistula) vs localized radiation injury (Localized). This study was a retrospective single-institution study. Exclusion criteria included follow-up <3 months, large pelvic tumor, and surgery for cancer control. The Fistula group included fistulization outside of the urinary tract (rectal, soft tissue, thigh, pubic symphysis, and extensive necrosis surrounding the prostate). The group Localized had a multitude of problems; however, all were confined to the urinary tract. Patient characteristics, perioperative variables, and outcomes were compared between groups. Sixty-nine patients were included and had UD from 2009-2022. Median age and time from RT to UD were 73 (interquartile range (IQR) 67.9, 78.1) and 7.3 (IQR 3.2, 12.5) years. There were 29 (42%) and 40 (58%) patients in the Fistula and Localized groups. The Fistula group had a higher rate of abdominal/perineal approach (62.1% vs 12.5%, P <.001), a lower rate of right colon pouch (17.2% vs 40%, P =.043), and a longer operative time (515.7 vs 414.2 minutes, P =.017). Clavien-Dindo complications ≥3 were higher in the Fistula group (44.8% vs 20%, P =.027), including a higher rate of re-operation for recurrent pelvic abscess (37.9% vs 5%, P <.001). Survival for the cohort was 85.5% and did not differ between groups. Patients with prostate fistula after RT for PCa undergoing UD had longer, more complex operations, and higher rates of complications, notably post-operative pelvic abscesses, compared to men with localized RT injury. Long-term survival was comparable in both groups. [ABSTRACT FROM AUTHOR]

BACKGROUND: In hip arthroplasty, placement of the acetabular cup using only the acetabular anatomy will change the direction of the functional acetabular cup. Computer navigation for hip arthroplasty can improve the accuracy of prosthesis placement. OBJECTIVE: To simulate the operation, simulate the stress size and area of the acetabular cup, and plan the placement direction of the acetabular cup in hip arthroplasty combined with the pelvic tilt angle to explore the influence of the pelvic tilt angle on the stress distribution of the acetabular prosthesis in hip arthroplasty using finite element model. METHODS: X-ray and CT data of the pelvis in six cases (marked A-F) were collected. The ABAQUS 6.14-4 (SIMULIA Inc., French) was used to construct hip models. Six models were established to simulate hip arthroplasty with the front pelvic plane in the supine position as the coordinate plane. According to the pelvic tilt angle in the standing position, for those with pelvic tilt angle ≤ -10° and pelvic tilt angle > 10°, the reference plane of prosthesis implantation was adjusted to establish nine models, which were divided into pre-adjusted models: A(-14°), B(-29°), C(11°); post-adjusted models: Aa(-7°), Bb(-18°), Cc(1°); normal models: D(-8°), E(-2°), F(-9°). In the finite element solving software, constraint fixation simulated the standing on one foot. Joint loading was loaded at the sacroiliac joint, pubic symphysis and greater trochanter. The maximum Von Mises stress distribution of the acetabulum, acetabular cup, and lining of each model were compared. RESULTS AND CONCLUSION: (1) Model B showed non-convergence and model A showed non-convergence tendency; model B showed convergence with the supine anterior pelvic plane coordination adjusted. In the nine models, the maximum von Mises stress of the acetabulum was 4.9 MPa in model Cc. The minimum stress was 1.07 MPa in model D. The maximum stress of the acetabular cup was 29.87 MPa in model Bb. The minimum stress was 17.21 MPa in model D. The maximum stress of polyethylene liner weight-bearing was 12.45 MPa in model Bb. The minimum stress was 5.21 MPa in model D. The weightbearing area was located at the middle and upper parts of the acetabulum. (2) The models of the pelvic tilt angle of -14°, -25°, and 11° in the standing position showed maximum values of von Mises stress than the models of -10° < pelvic tilt angle ≤10°. The stress was near the values of models of -10° < pelvic tilt angle ≤10° after adjusting the anterior pelvic plane coordination in the model pelvic tilt angle of -14°, indicating that pelvic tilt angle beyond the range of -10° and 10° is a risk factor for wear and dislocation after total hip arthroplasty. The reset of the anterior pelvic plane in the case of increased pelvic retroversion can reduce the complication in total hip arthroplasty [ABSTRACT FROM AUTHOR]

Background: The disruption of the pubic symphysis during the peripartum period is a rare injury to the pelvic ring. In most cases, conservative treatment is successful. Nonetheless, there are cases where surgical intervention is necessary. We analyzed five surgical cases treated in our department and performed a literature review. Case presentations: Five women, ranging in age from 25 to 38, who experienced peripartum symphysis rupture were primarily treated with a conservative approach. Patients who did not show improvement and met certain criteria, such as experiencing pain starting from childbirth, having a separation in the pubic bone of more than 10 mm, and/or having a vertical instability greater than 5 mm, were recommended to undergo surgery. The average length of time between childbirth and surgery was 5.6 months, ranging from 1 to 14 months. One patient was treated with an external fixator, another patient received a combination of an external fixator and an anterior plate, and three patients were treated with anterior plates. In four cases, we observed a failure in fixation and a partial or complete loss of reduction. The plate and screws were removed in one case, and in three cases, revision surgery was performed. One case involved using a larger plate, while the other used 90-90 plating, known as "box plate fixation." The mean follow-up was 7.4 years. Two cases had good results, and two had excellent results on the Lindahl scale. Conclusion: For patients with peripartum pubic symphyseal dislocation, our case series and literature review demonstrated that early reduction and fixation correlate with improved clinical outcomes and lower implant failure. For patients with subacute/chronic injuries, there was a higher incidence of implant failure. Orthogonal plate fixation and/or pubic symphysiodesis was associated with improved clinical outcomes. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to determine the topographic position of the corona mortis on fresh cadavers and also to determine anatomical landmarks that will facilitate surgeons to consider to this structure during operations by clarifying the relationship of the corona mortis with the surrounding anatomical structures. Methods: A total of 50 autopsy cases of 31 men and 19 women, all examined within 24 hours post-mortem, were evaluated bilaterally for the presence of corona mortis. When identified, the vascular characteristics (arterial/venous) of the corona mortis were documented. The topographic position of the corona mortis was determined by measuring the distances to the pubic symphysis, promontory, obturator nerve and anterior superior iliac spine. The study also investigated whether some anthropometric measurements affect these distances. Results: Out of the 100 hemipelves examined, corona mortis were observed in 50 cases. Among these, 34% were arterial (n=17), and 66% were venous (n=33). Anastomoses were identified in the hemipelves of 22 women and 28 men, with no significant gender difference (p>0.05). The average distances to anatomical landmarks were as follows: 5.43 cm to the pubic symphysis, 1.77 cm to the obturator nerve, 9.87 cm to the promontory, and 10.56 cm to the anterior superior iliac spine. Conclusion: Corona mortis poses a significant risk in surgical procedures. Knowing the vascular anatomy of the pelvis is vital for gynecological, urological and orthopedic interventions, while investigating deaths caused by pelvic trauma is important for forensic practice. This anatomical study contributes to a better understanding of the complex and intricate pelvic structure. [ABSTRACT FROM AUTHOR]

Background: The increasing number of late complications described after cesarean sections is prompting a reexamination of the indications for them in pregnant women. The high percentage of pregnancies terminated by preventive cesarean section for non-obstetric reasons also largely involves orthopedic conditions. A challenge for obstetricians is pregnant patients with orthopedic conditions both before and during pregnancy. Pregnant women with a history of orthopedic surgery require special attention. The lack of consensus in this area, physicians' fear of patients' claims and the skewing of patients' requests for surgical termination of pregnancy have prompted an analysis and systematization of existing knowledge in this field. Methods: References published up to 30 June 2023 in five databases Pubmed, Embase are included. Keywords have been checked for the following: pubic symphysis diastasis, lumbar disc herniation, past hip arthroplasty and fractures in the pelvic bones. In the described conditions complicating pregnancy, the mode of delivery was taken into account. Results: All included studies were screened and reviewed by at least two authors until an overall consensus of 50 articles was reached. Conclusions: Orthopedic indications for cesarean section in many cases should not be treated imperatively, since natural delivery after correct fusion of a pelvic fracture, implantation of a hip endoprosthesis or a limited dissection of the pubic symphysis is possible and is not associated with a higher risk of obstetric or orthopedic complications. Extra-obstetric indications for cesarean section should be determined individually for each pregnant woman in a multidisciplinary team, since orthopedic conditions may overlap with obstetric pathology in the pelvis. [ABSTRACT FROM AUTHOR]

Background/Purpose: The surgical fixation of a symphyseal diastasis in partially or fully unstable pelvic ring injuries is an important element when stabilizing the anterior pelvic ring. Currently, open reduction and internal fixation (ORIF) by means of plating represents the gold standard treatment. Advances in percutaneous fixation techniques have shown improvements in blood loss, surgery time, and scar length. Therefore, this approach should also be adopted for treatment of symphyseal injuries. The technique could be important since failure rates, following ORIF at the symphysis, remain unacceptably high. The aim of this biomechanical study was to assess a semi-rigid fixation technique for treatment of such anterior pelvic ring injuries versus current gold standards of plate osteosynthesis. Methods: An anterior pelvic ring injury type III APC according to the Young and Burgess classification was simulated in eighteen composite pelvises, assigned to three groups (n = 6) for fixation with either a single plate, two orthogonally positioned plates, or the semi-rigid technique using an endobutton suture implant. Biomechanical testing was performed in a simulated upright standing position under progressively increasing cyclic loading at 2 Hz until failure or over 150,000 cycles. Relative movements between the bone segments were captured by motion tracking. Results: Initial quasi-static and dynamic stiffness, as well as dynamic stiffness after 100,000 cycles, was not significantly different among the fixation techniques (p ≥ 0.054).). The outcome measures for total displacement after 20,000, 40,000, 60,000, 80,000, and 100,000 cycles were associated with significantly higher values for the suture technique versus double plating (p = 0.025), without further significant differences among the techniques (p ≥ 0.349). Number of cycles to failure and load at failure were highest for double plating (150,000 ± 0/100.0 ± 0.0 N), followed by single plating (132,282 ± 20,465/91.1 ± 10.2 N), and the suture technique (116,088 ± 12,169/83.0 ± 6.1 N), with significantly lower values in the latter compared to the former (p = 0.002) and no further significant differences among the techniques (p ≥ 0.329). Conclusion: From a biomechanical perspective, the semi-rigid technique for fixation of unstable pubic symphysis injuries demonstrated promising results with moderate to inferior behaviour compared to standard plating techniques regarding stiffness, cycles to failure and load at failure. This knowledge could lay the foundation for realization of further studies with larger sample sizes, focusing on the stabilization of the anterior pelvic ring. [ABSTRACT FROM AUTHOR]

It is currently unknown whether cancer and cancer treatment affect age-related skeletal changes used in the biological profile for skeletonized remains. This research examines the effects of cancer on skeletal age estimation using computed tomography (CT) scans of the pubic symphyses for 307 individuals from the New Mexico Descendent Image Database. The Suchey–Brooks method was applied to 125 individuals without documented cancer and 182 individuals with documented cancer. Individuals were correctly aged if their chronological age fell within the original study’s 95% prediction range. Though not statistically significant, the results show that females with cancer were aged correctly 74.7% of the time, and females without cancer were aged correctly 85.1% of the time; males with cancer were aged correctly 46.0% of the time, and males without cancer were aged correctly 55.7% of the time. Additionally, a total of 30 individuals were reanalyzed to examine intraobserver error, and a Cohen’s kappa value of k = 0.600 indicated a moderate level of agreement. While no statistical differences were found between cancer and control groups, CT scans may lack the resolution needed to visualize the nuanced effects of bone mineral density loss, if present, and the overall quality of bone, despite their proven utility in dry-bone skeletal analyses.