Search

Objectives This study aims to introduce a new low-cost universal laser aiming device (LAD) that can be used in existing C-arm fluoroscopy devices, independent of brand and model, and to determine whether this new universal LAD improves technician accuracy in locating the desired region at the midpoint of the fluoroscopic image. Materials and methods A low-priced universal LAD that is compatible with existing 12-inch C-arm fluoroscopy devices was designed. Eight radiology technicians with varied levels of experience in C-arm fluoroscopy participated in the study. A 12 mm cortical screw with a diameter of 3.5 mm was placed on proximal, diaphyseal, and distal points of femur, tibia, and humerus bones in the anteroposterior plane on L3 vertebrae and the left pubis arm in the pelvis bone model. Technicians were asked to align each screw in the image center 10 times from a distance of 30 cm in the anterolateral plane, first without the LAD and then with the LAD. The distance of the screw head to the center point was measured from the 3,520 images with the help of medical viewer software based on the X- and Y-axis. Results Each fluoroscopic image was divided into 48 equal parts and the length of a part was taken as one unit for distance measurements. The compliance between technicians without the LAD was 0.347 (95% confidence interval [CI]: 0.208-0.47, p=0.001) and with the LAD was 0.687 (95% CI: 0.621-0.741, p=0.001). The distance between the screw head and the center of the image without the LAD was 19.0±9.8 for technicians with more than 10 years of experience and 28.0±12.9 for those with less than 10 years of experience. This difference was statistically significant (p=0.001). When the LAD was used, the difference between the less experienced (3.1±1.5) and more experienced (3.3±2.0) technicians was statistically reduced, along with the distance (p=0.033). Conclusion The use of the LAD with C-arm fluoroscopy appears to be successful in helping technicians capture the desired point in the center of the fluoroscopic image. The use of the LAD reduces the experience gap between technicians.

The increased use of radiocarbon analyses for archeological, paleontological, and paleoclimate research has created a demand for robust and well characterized procedural blanks. Currently, blanks are distributed ad hoc throughout the radiocarbon community in limited quantities and are depleted quickly by high throughput labs. This forces AMS facilities to regularly seek out suitable blanks from other facilities, and the switch to different blank material inhibits assessment of long term procedural blank performance. An excellent source for well-preserved radiocarbon “dead” organic material is the permafrost-rich region of unglaciated Yukon and Alaska. Extensive placer mining operations and river bluffs expose Middle Pleistocene sediments that regularly yield pristine organic material. Here, we present an assessment of laboratory precision and overall measure of performance of two processing blanks from the region. The AVR-07-PAL-37 wood and Hollis Mammoth pelvis bone collected from Alaska and Yukon, respectively. Both are independently dated to the Middle Pleistocene and have been verified by 14C-AMS to be radiocarbon “dead”, with mean FmC of 0.0054 ± 0.0002 (n = 714) and 0.0031 ± 0.0002, (n = 219), respectively. Preliminary use at several AMS and stable isotope facilities in the U.S.A., Canada, United Kingdom, and China confirms that AVR-07-PAL-37 and Hollis Mammoth are suitable blanks for radiocarbon analyses. Both materials are available for wide distribution to other interested AMS labs.

The ideal treatment of pelvis bone metastases may be complex and involve multimodality treatment approaches to achieve optimal outcomes. The chapter describes the treatments indications of these patients. It is described from nonoperative treatments, through minimally invasive palliative procedures until reaching the surgical treatment, emphasizing types of pelvis resection and indications for surgical reconstruction of the acetabulum.

One of the main problems during in the treatment of anal cancer with chemotherapy and radiation is the occurrence of Hematologic Toxicity (HT). In particular, during radiotherapy it is crucial to spare Bone Marrow (BM), since the radiation dose received by BM in pelvic bones predicts the onset of HT. In this direction, the most popular strategies are based on the identification of the hematopoietically active BM (actBM), that is the part of BM in charge of blood cells generation, using MRI, SPECT or PET, but no approached have been proposed based on CT. In this study we compare four different classifiers in recognizing actBM from CT images using 36 radiomic features. We used Genetic Algorithms (GAs) to simultaneously optimize the feature subsets and the classifier parameters, separately for three pelvic subregions: iliac bone marrow (IBM), lower pelvis bone marrow (LPBM), and lumbosacral bone marrow (LSBM). The obtained classifiers were applied to CT sequences of a cohort of 25 patients affected by carcinoma of the anal canal. Classifiers results were compared with the actBM identified from 18FDG-PET (reference standard, RS). It emerged that the performances of the 4 classifiers are similar and they are satisfactory for IBM and LSBM subregions (Dice > 0.7) whereas they are poor for LPBM (Dice < 0.5).

Although it is possible for any osseous tumor or tumorlike lesion to occur in and around the hip and pelvis, there are preferential lesions. Most tumors share many imaging features with those arising elsewhere in the skeletal system, but some may show specific morphological and imaging features. Furthermore, specific criteria and rules of thumb are related to this anatomical area that radiologists should know, which together with the imaging findings and clinical context will lead to a more confident diagnosis.In this article we review the basic anatomical and imaging principles in the hip and pelvis and their diagnostic criteria, describe the most common regional benign and malignant bone tumors and pseudotumors, and highlight their main imaging features and common differential diagnosis while keep this article as relatively simple and straightforward as possible. Soft tissue tumors are beyond the scope of this article.

Introduction The posterior urethral lesions are associated with pelvis fractures in 5–10% of cases. The posterior urethra is attached to the pelvis bone by puboprostatic ligaments and the perineal membrane, which explains why disruption of the pelvic ring can injure the urethra at this level. Objectives To identify suspected cases of posterior urethral trauma and to perform the diagnosis and its immediate or deferred management. Acquisition of evidence Search in PubMed of articles related to traumatic posterior urethral lesions, written in English or Spanish. We reviewed the relevant publications including literature reviews and chapters from books related to the topic. Synthesis of the evidence With patients with pelvis fractures, we must always rule out posterior urethral lesions. The diagnostic examination of choice is retrograde urethrography, which, along with the severity of the condition, will determine the management in the acute phase and whether the treatment will be performed immediately or deferred. Early diagnosis and proper acute management decrease the associated complications, such as strictures, urinary incontinence and erectile dysfunction. Conclusions Despite the classical association between posterior urethral lesions and pelvic fractures, the management of those lesions (whether immediate or deferred) remains controversial. Thanks to the growing interest in urethral disease, there are an increasing number of studies that help us achieve better management of these lesions.

We assessed the effects of a 16-week primary-care-based exercise program on body composition in perimenopausal women. The women (n = 150) were randomized into control (n = 75) or exercise (n = 75) groups. Exercise was provided in a 16-week (60 min/session, 3 days/week) concurrent program. Body composition was measured using dual-energy X-ray absorptiometry. These are secondary analyses of the FLAMENCO Project (Clinical Trials Reference NCT02358109). In the intention-to-treat analyses, the control group showed no changes in body mass index (BMI) between post- and pre-test, whereas the exercise group showed a 0.75 kg/m2 decrease in BMI (95% CI: &minus, 1.29 to &minus, 0.22, p = 0.006). Gynoid and android fat mass in control group decreased by 98.3 g and 46.1 g after the 16 weeks, whereas they decreased by 213 g and 139 g in the exercise group, respectively (95% CI: &minus, 209 to &minus, 3.86, p = 0.042 and 95% CI: &minus, 164 to &minus, 26.9, p = 0.007, respectively). The control group decreased their pelvis bone mineral content by 2.85 g in the post-test compared with the pre-test, whereas the exercise group increased it by 1.13 g (95% CI: 0.93 to 7.81, p = 0.013). Per-protocol analyses showed similar results. These analyses suggest that the exercise intervention decreased fat depositions and BMI. Exercise might improve bone mineral content in specific areas such as the pelvis.

In brief: A 16-year-old high school football player and wrestler began experiencing groin and pubic pain, and a popping sensation with abduction movements, after sustaining an abduction injury to his lower extremities. Stress roentgenographs revealed instability of the pubic symphysis; there was no evidence of fracture or gross instability of the sacroiliac joints or the posterior sacrum. The patient was treated conservatively for one year, with an initial period of limited weight-bearing and rest followed by progressive stretching and strengthening exercises and a gradual return to full sports activity.

La medecine fondee sur les preuves a pour but d’assurer les meilleures decisions medicales a partir de donnees d’evidence issues d’une analyse scientifique. Elle cherche a preciser au mieux les risques et benefices des traitements et des tests diagnostiques. Ces donnees d’evidence proviennent au mieux de meta-analyses, d’etudes controlees en double insu plus pertinentes que de simples donnees d’experts ou de pratiques. Leurs applications en pelviperineologie sont nombreuses.

Un antecedent de chirurgie pelvienne peut affecter l’histoire naturelle d’une grossesse. Plus encore, la grossesse et l’accouchement peuvent modifier les resultats fonctionnels d’un geste de chirurgie pelvienne. Dans ces situations, il est important d’etre prudent et de s’entourer d’evaluation physiologique.

Resume L’hydatidose sevit a l’etat endemique au Maroc, sa localisation pelvienne primitive est rare et trompeuse. Nous rapportons l’observation d’une patiente âgee de 32 ans admise pour douleur pelvienne associee a des signes urinaires. L’echographie et le scanner ont permis de localiser une masse anechogene cloisonnee latero- et sus-uterine droite. Le diagnostique de kyste hydatique pelvien est fait en peroperatoire. Le traitement a consiste en une kystectomie. L’evolution etait favorable avec un recul d’une annee sans recidive locale ou peritoneale.

Resume Introduction L’actinomycose pelvienne est une affection suppurative rare qui pose le probleme du diagnostic differentiel avec les cancers gynecologiques. Observations Nous rapportons deux observations d’actinomycose pelvienne pseudotumorale chez des femmes de 40 et 41 ans. L’examen physique trouvait une masse pelvienne dans les deux cas. L’imagerie mettait en evidence une tumeur annexielle infiltrante dans les deux cas avec une metastase hepatique et une carcinose peritoneale dans un cas. L’intervention chirurgicale consistait en une annexectomie droite dans un cas et une biopsie peritoneale dans l’autre cas. Le diagnostic anatomopathologique etait une actinomycose. Un traitement par penicilline G 20 millions d’unite par jour pendant deux semaines relaye par amoxicilline 3 g par jour pendant six mois etait instaure chez les deux malades. L’evolution etait marquee par une amelioration clinique dans les deux cas avec disparition des lesions hepatiques et pelviennes sur la tomodensitometrie abdominale dans un cas. Conclusion L’actinomycose pelvienne est une affection rare, souvent associee au port prolonge d’un dispositif intra-uterin. Son diagnostic est difficile et elle peut evoquer une neoplasie gynecologique.

Le but de ce travail etait d’evaluer la valeur de l’angle d’incidence pelvienne (IP) comme facteur predictif de descente perineale. Ce facteur morphologique osseux, acquis a la fin de la croissance, n’a jamais ete correle a un trouble de la statique pelvienne. Dans une etude retrospective de 197 femmes, la descente du perinee au repos et durant la poussee est evaluee a partir de defecographies. L’angle d’IP (53° ± 9 °C, independant de la position du sujet) est defini comme l’angle entre la droite perpendiculaire au milieu du plateau superieur du sacrum et la droite reliant ce dernier avec le milieu de l’axe bicoxofemoral. L’angle d’IP etait correle a la descente perineale. L’angle d’IP etait statistiquement plus grand lors de la descente du perinee au repos (64 versus 53 °C; p 62 °C) avait une sensibilite (73 %), une specificite (82 %), une valeur predictive positive (81 %) et une valeur predictive negative (75 %). Une grande IP (> 62 °C) est un facteur predictif de la descente perineale au repos avant l’apparition des autres facteurs de risque lies a l’âge. Une grande IP (> 62 °C) s’accompagne d’un large porte-a-faux et d’une horizontalisation du perinee, provoquant une augmentation des contraintes entre les insertions de celui-ci. Une simple radiographie du bassin de profil pourrait permettre de depister un pelvis a risque de trouble de la statique pelvienne.

交通外傷による胸郭動揺・骨盤骨折を契機に発症した重力性無気肺に対して腹臥位療法・呼吸理学療法併用が有効であった1例を経験した．症例は49歳，男性．高速道路で側壁に衝突し当院救急搬送．胸郭動揺，骨盤骨折の為，長期安静が必要となり重力性無気肺を発症した．その後，選択的気管支送気術を行ったが無気肺は改善せず，呼吸状態が悪化し生命維持困難な状況となった．骨盤内再出血の危険性があったが腹臥位療法を実施したところ，著明に無気肺が改善した．重力性無気肺に対して腹臥位療法は，換気／血流比の改善，体位ドレナージ効果，臓器圧迫解除による横隔膜運動の改善が得られることで酸素化が改善する．本症例では呼吸理学療法の併用も有効であった．

Resume Introduction Le « PELVIS » ou « SACRAL » syndrome designe l’association d’un hemangiome regional a un syndrome malformatif de la region pelvienne. Nous en rapportons un cas, remarquable par l’aspect initialement livedoide de l’hemangiome et l’association a une bride amniotique d’un membre superieur. Observation Un nouveau-ne de sexe masculin subissait le jour de sa naissance une colostomie gauche dans un contexte d’imperforation anale et d’anomalies des organes genitaux externes avec ambiguite sexuelle. L’examen du tegument notait une hypopigmentation mal limitee de la region lombosacree et un sillon fibreux circonferentiel du bras droit, caracteristique d’une bride amniotique. L’IRM lombosacree et pelvienne montrait une deviation vers la gauche des trois dernieres vertebres sacrees, sans anomalie medullaire. La cystographie retrograde mettait en evidence une fistule recto-uretrale. L’evolution etait marquee par l’apparition des le premier mois d’une lesion angiomateuse violacee, plane, livedoide, de topographie mediane sur les fesses et le perinee et lineaire sur la face posterieure du membre inferieur droit. La biopsie cutanee de cette lesion montrait un unique lobule capillaire a la jonction dermo-hypodermique, d’aspect non specifique mais dont l’intense expression de Glut1 par les cellules endotheliales etait tres en faveur d’un hemangiome infantile. Discussion Les hemangiomes segmentaires sont volontiers associes a des anomalies extra-cutanees. Par analogie au « PHACE syndrome », defini par l’association d’un hemangiome segmentaire facial a des anomalies cerebrales, oculaires et cardio-aortiques, le « PELVIS »/« SACRAL » syndrome decrit l’association d’un hemangiome segmentaire de la region des langes (region lombosacree, fessiere ou perineale = napkin hemangioma) avec une dysraphie touchant dans des proportions variables le rachis lombosacre, le cone medullaire terminal, les organes genito-urinaires et la region anale. L’hemangiome du PELVIS/SACRAL syndrome peut etre de diagnostic retarde ou difficile du fait d’un caractere volontiers maculeux, telangiectasique ou livedoide. A notre connaissance, l’association d’une bride amniotique a un hemangiome ou a une dysraphie perineale n’avait pas ete decrite jusqu’ici.

Resume Objectifs Notre but a ete de decrire les caracteristiques des fractures osteoporotiques de la ceinture pelvienne et leur evolution. Methodes Nous avons recueilli les donnees cliniques et biologiques de 60 patients, ayant eu une fracture osteoporotique de la ceinture pelvienne et ayant ete hospitalises dans notre service de rhumatologie. Nous avons evalue l’evolution chez 51 d’entre eux, a l’aide d’un questionnaire rempli par telephone. Resultats Notre population etait composee principalement de femmes âgees (femmes 81,6 %, âge moyen : 79 ans) qui presentaient dans plus de la moitie des cas un antecedent d’osteoporose, de fracture ou de maladie cardiovasculaire. Dans 89 % des cas, la fracture etait survenue apres une chute consequence. Les branches pubiennes constituaient le principal siege de la fracture (65 %). Nous avons observe un pourcentage eleve de carence en vitamine D (80,6 %) associe a une hyperparathyroidie secondaire (51,6 %). Avant la survenue de la fracture, tous les patients vivaient a leur domicile et 84,1 % etaient autonomes. Au cours de l’hospitalisation, 52,5 % des patients ont eu une complication et dans la majorite des cas, une infection urinaire ou une escarre. A la sortie du service seulement 31 % des patients sont retournes a leur domicile. Au moment de l’evaluation finale (en moyenne, 29 mois apres la fracture), 11 patients sont decedes (en moyenne, 190 jours apres la fracture). Parmi les survivants, 74,5 % vivent a leur domicile, 60 % necessitent une assistance pour au moins une activite de la vie quotidienne et 18,6 % ont eu une nouvelle fracture. Seulement 63,2 % sont toujours traites pour osteoporose. Conclusion Les fractures de la ceinture pelvienne necessitant une hospitalisation initiale possedent des caracteristiques communes avec les fractures de l’extremite superieure du femur : population âgee a predominance feminine, carence en vitamine D, chute a l’origine de la fracture et, aussi, severite pronostique avec un taux eleve de morbidite et de mortalite et une perte d’autonomie.

MR imaging of large and rare pelvic masses from non-gynecological etiology The diagnosis and characterization of pelvic masses may be problematic, especially when they are larger than 5 cm in diameter. The majority of large pelvic masses in women originate from gynecological structures. However, they may also originate from the GI tract, urinary tract, retroperitoneum, pelvic soft tissue structures, peritoneum and bones. MRI is the imaging modality of choice because it provides excellent contrast resolution and allows direct multiplanar imaging capabilities. Diagnosis is usually suggested after careful evaluation of the tumor location, anatomical relationships, morphology and signal characteristics. In this article, we will discuss the MR imaging features of large rare pelvic masses of non-gynecological origin, along with associated clinical and histological findings.

The timing of surgical intervention as well as the optimal method of radiologic investigation for patients with incomplete, open loop small bowel obstruction has changed over the past two decades. This review focuses on the role of computed tomographic enteroclysis in the evaluation of patients with suspected small bowel obstruction. The technique of examination is described and an overview of its clinical applications and imaging controversy are presented.

The results of 61 Chiari's pelvic osteotomies carried out during a 10 years period are reported. Present role of the operation in the correction of acetabular dysplasia in comparison to Pemberton's acetabuloplasty, to triple pelvic osteotomies and to the prosthetic replacement of the hip joint is discussed. In conclusion the operation is still indicated in special cases. Depending on the age of the patients pain can be observed already after 3-5 years however a great part of the patients is completely free of complaints even 10 years postoperatively.

RESEARCH QUESTION Osteotomies are elective operations which require exact pre-operative planing. Computer assisted three-dimensional planning of orthopedic procedures requires a three-dimensional reconstruction of the region of interest. To be applicable, such a three-dimensional reconstruction must be an accurate mathematical description of the region of interest, and not only a 3-D-image. The purpose of this study was to create such an accurate 3-D reconstruction. METHODS We describe a method to create an exact reconstruction from CT-data, from the data acquisition, contour determination by an algorithm, triangulation of the resulting data and reconstruction of the region of interest. CONCLUSION The described method is a useful tool to obtain exact individual three-dimensional reconstructions of any skeletal region of interest. This makes pre-operative planning and simulation of the results of orthopedic procedures at the computer possible.

In this article an overview is given of the present knowledge of whole body MRI, MRI of the retroperitoneum, intestines and pelvis. Recommendations are based on current literature and clinical applications in daily routine focusing on efficacy rather than cost considerations. The contribution and complementary role of MRI relative to those of its competing modalities was the most important endpoint assessed. Perfusion and functional information, as well as specific contrast agents in the area of the pelvis are still considered research indications.

In this retrospective study, symphysis pubis (SP) distance was measured by transverse computed tomography scans. The relation between the SP distance and age, gender, number of birth and body-mass index was studied.Symphysis pubis joint distances were evaluated for the patients who had undergone abdominal or pelvic computed tomography examination for other medical reasons between the dates of March and May 2007. Anterior, middle, and posterior SP joint distances were measured at transverse planes. Normal joint width in women and men was determined. The relation between obtained values, and age, gender, number of birth, as well as body-mass index was studied.Symphysis pubis narrows at anterior concurrently with ageing (r = -0.150; P0.001) [corrected] Narrowing, though less, is also observed at posterior (r = -1.50 P = 0.000); however, middle part does not change (r = 0.030; P = 0.489). Number of birth and body-mass index values do not affect SP width. The widths measured at anterior and middle of the SP were significantly higher in women (P = 0.010 and P = 0.002).Osteoarthritic changes develop in SP with ageing. However, osteoarthritis in SP, was found to be clinically and radiologically different from that in other symphyseal joints, as SP hardly ever moves, and vertically processing interpubic disc combines pelvis girdle with counterforces, and is supported by very strong ligaments and muscles. Anterior and middle part of the SP joint is wider in women, because fibrocartilaginous disc is too thick to provide the mobility.

MRI is taking a growing place for pelvic prolapse diagnosis. A strict technical protocol with static and dynamic sequences is required with rectal and vaginal ultrasound gel. A good knowledge of physiology and anatomy of pelvic and perineal muscles is mandatory as well as a clinical approach of various pathologic prolapses. MRI fundings are presented and correlated with several clinical situations of prolapse and post operative features.

Because of loss of function and chronic pain total calcanectomy is a serious impairment for the patient. There are few reports concerning replacement procedures using ribs [Brenner P, Zwipp H, Rammelt S. Vascularized double barrel ribs combined with free serratus anterior muscle transfer for homologous restoration of the hindfoot after calcanectomy. J Trauma-Injury Infect Crit Care 2000;49(2):331-5; Lin CH, Wei FC, Levin LS, Su JI. Free composite serratus anterior and rib flaps for tibial composite bone and soft-tissue defect. Past Reconstr Surg 1997;99:1656-65; Moscona RA, Ullmann Y, Hirshowitz B. Free composite serratus anterior muscle-rib flap for reconstruction of severely damaged foot. Ann Plast Surg 1988;20:167-72] or homologeous bone graft [Mankin HJ, Gebhardt MC, Jennings LC, Springfield DS, Tomford WW. Long-term results of allograft replacement in the management of bone tumors. Clin Orthop 1996;324:86-97; Muscolo DL, Miguel AA, Aponte-Tinao A. Long-term results of allograft replacement after total calcanectomy. J Bone Joint Surg Am 2000;82(1):109-12; Ottolenghi CE, Petracchi LJ. Chondromyxosarcoma of the calcaneus; report of a case of total replacement of involved bone with a homogenous refrigerated calcaneus. J Bone Joint Surg 1953;35A(1):211-4]. We report a case of calcaneus replacement by vascularized iliac crest bone.

Thanks to a superior resolution and contrast, MRI allows recognizing the post therapeutic modifications of female pelvis, often very subtle and nonvisible by the other imaging modalities. The main surgical or medical therapies in the female pelvis will be described as well as the normal post therapeutic anatomical aspects. The main complications and failures will be mentioned and informed. Finally the keys that will allow to understand these complications and failures will be boarded.

The benefits provided by rapid prototyping (RP) of patient anomalies in complex surgeries of the pediatric spine and pelvis were elucidated and characterized.Surgeons involved in the study were solicited from the Texas Scottish Rite Hospital for Children and the network of Shriners Hospitals for Children throughout the United States. Rapid prototyping models were created at Boise State University through a federally funded Economic Development Agency grant (Economic Development Agency Project Number 07-79-05312). Rapid prototyping models and detailed survey forms were supplied to lead surgeons for 13 cases of multiplane spinal or pelvic deformity.Results indicated that surgeons found RP models useful for preoperative planning, reference during surgery, communication with patients, and for increasing the safety of the procedure. Rapid prototyping models also led to a reduction in operating time in 4 of the 5 surgeries to correct congenital scoliosis/kyphosis.Surgeons can expect properly constructed RP models to provide significant benefits for complex surgeries of the pediatric spine and pelvis in the areas of preoperative planning, intrasurgical navigation, and communication with patients. A reduction in operating time may also be expected for cases of congenital scoliosis/kyphosis.This study was a type II prospective observational study of physicians' perceptions of the use of RP models to assist with surgical cases. Results provided by this study suggest expected benefits from application of RP in surgeries of the pediatric spine and pelvis with complex deformities.

Background: Although the sites of recurrent ovarian cancer are individually described in the literature, patterns of recurrent disease are poorly understood. Purpose: To describe CT patterns of disease in recurrent ovarian cancer. To emphasize common patterns, recognise subtle and unusual sites of recurrent disease. Materials and Methods: We identified patients between 1981–2004 presenting with clinical recurrence or elevated CA 125 after complete primary clinical and radiological response. CT imaging at primary diagnosis, during and after treatment and at recurrence was retrospectively reviewed. Site, distribution, stage of disease and time to relapse was recorded. Results: 400 patients were treated for ovarian cancer. 214(54%) achieved complete primary response. 161(75%) relapsed with complete imaging available in 67 patients. Of the 67 patients, 14 (21%) recurred within 1 year, 44 (66%) relapsed between 1–5 years. Therefore 87% of relapses occurred within 5 years following primary treatment. Five (8%) relapsed between 5–10 years and 4 (6%) relapsed after 10 years. Commonest pattern of relapse was pelvic mass in 35 (48%) patients, solitary in 15 (22%). 27 (45%) relapsed with peritoneal thickening, 27 (45%) had small or large bowel serosal disease, 22 (33%) had enlarged lymphadenopathy, 6 as sole manifestation of recurrence, 20 (30%) presented with unusual sites of recurrence: 6 splenic, 10 hepatic, 2 biliary, 3 brain and 2 muscle. Conclusion: Our study is the first to describe common patterns of recurrence in ovarian cancer. Most frequent site is pelvis, followed by peritoneum, serosal surfaces and nodal disease. 30% presented with disease at ‘unusual’ sites.

Retrovesical hydatid cyst is rare, even in endemic regions. From a presentation of three cases, the authors will review the clinical findings and illustrate the imaging features of this pathology and relate diagnostic and therapeutic difficulties.

Background: Dedifferentiated chondrosarcomas that arise in osteochondromas are extremely rare lesions for which very little information on treatment and outcome is available in the literature. The purpose of the present study was to describe the specific clinical, radiographic, and histologic features of this lesion and to evaluate the oncologic outcome after different treatment strategies. Methods: We reviewed the files of the Rizzoli Institute between 1970 and 2002 and identified eighteen patients for whom adequate records and histologic images were available and in whom a high-grade sarcoma had been diagnosed at the same location as a preexisting osteochondroma. Radiographic studies, histologic slides, and clinical records were reviewed, the features of those studies were tabulated, and prognostic features and the results of treatment were identified. Results: The patients included twelve men and six women with an average age of forty-six years (range, twenty-two to seventy-four years). Eight lesions occurred in patients with multiple osteochondromas, and ten occurred in patients with solitary lesions. The most common locations were the pelvis (six lesions) and the femur (five lesions). Symptoms included pain, swelling, and a growing mass; the average duration of symptoms was eighteen months. Radiographically, ten lesions appeared as a conventional secondary chondrosarcoma arising in an exostosis, whereas eight showed typical signs of dedifferentiation. Histologic evaluation of the cartilage component demonstrated thirteen grade-1 and two grade-2 chondrosarcomas. In three cases, no cartilage component was recognized. The dedifferentiated component was considered to be an osteosarcoma in nine cases (including six cases in which it was osteoblastic and three in which it was fibroblastic), a malignant fibrous histiocytoma in eight, and a fibrosarcoma in one. The dedifferentiated component represented an average of 59% (range, 20% to 100%) of the lesion. For the fifteen patients who were managed at the authors' institution, the two and five-year survival rates were 47% and 29%, respectively; the median survival time was fourteen months. Patients who were managed with a combination of surgery and chemotherapy had a better overall survival rate than did those who were managed with surgery alone (p = 0.03). Conclusions: Dedifferentiated chondrosarcoma arising in a preexisting osteochondroma is an extremely rare lesion with a poor prognosis. In the present small series, overall survival was better when wide surgical resection was combined with adjuvant chemotherapy. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. Copyright © 2007 by the Journal of Bone and Joint Surgery, Incorporated.

In einer retrospektiven Studie wurden die Begleitverletzungen, Behandlungsmerkmale, Morbiditat, Mortalitat und das radiologische und funktionelle Endergebnis von 222 Patienten mit einer Beckenringverletzung vom Typ B oder vom Typ C nach der Klassifikation von M.Tile eruiert. 52 Patienten wiesen eine "Open-book-Verletzung" auf (Typ B1), 48 Patienten eine laterale Kompressionsverletzung (Typ B2/B3), 122 Patienten wiesen eine C-Verletzung auf. Die Zahl der neurologischen bzw.urologischen Begleitverletzungen lag bei den B1-Patienten mit 21% bzw. 9,6% deutlich hoher als bei den B2/B3 Patienten mit 12% bzw.2,1%.66% der Patienten mit einer B-Verletzung wurden mit einem Fixateur externe entversorgt. Die Rate an Sekundareingriffen lag bei den B1-Patienten bei 23%, bei den B2/B3-Patienten bei 6,25%. Die Gesamtmortalitat betrug 10,4%, 5% in der B-Gruppe und 14,8% in der C-Gruppe. Mit 92% sehr guten und guten Ergebnissen war das Outcome bei B2/B3-Verletzungen deutlich gunstiger als bei B1 mit nur 74%. Radiologisch dagegen zeigen 93% der Patienten mit einer B1-Verletzung ein anatomisches Ergebnis gegenuber 75% bei B2/B3. Wegen des unterschiedlichen Pathomechanismus der "Open-book-Verletzungen" und der lateralen Kompressionstraumen sollten die B-Verletzungen differenziert in "Open-book-Verletzungen", laterale Kompressionsverletzungen und vertikal stabile Kombinationsverletzungen eingeteilt wer- den. Weiterhin regen wir an, die laterale Kompressionsverletzung in der Klassifikation der AO als B1 und die "open book" Verletzung als B2 zu bezeichnen.

Resume Le but de ce travail est d’apprecier la mortalite a 1 an et le devenir fonctionnel apres fracture du bassin par insuffisance osseuse chez des patients âges. Patients et methodes. – Etude retrospective des dossiers des patients âges de plus de 65 ans hospitalises dans notre service avec le diagnostic de fracture par insuffisance osseuse du bassin. Pour chaque patient ont ete precises : les circonstances de survenue de la fracture, le delai diagnostic et l’imagerie necessaire au diagnostic, l’etat fonctionnel du patient, son lieu de vie pre et post fracture, l’etat general, la prise en charge therapeutique, le devenir a court terme et les eventuelles complications, la duree d’hospitalisation et enfin le devenir a un an. Resultats. – Soixante patients (54 femmes et 6 hommes) d’âge moyen 83 + 7,1 ans ont presente 49 fractures des branches pubiennes, 16 fractures du sacrum et 3 du cotyle. Le diagnostic de fractures du sacrum a pratiquement toujours necessite le recours a la scintigraphie, expliquant le delai diagnostic plus long. Quarante pour cent des patients avaient des antecedents fracturaires ou un facteur favorisant. Un seul deces est survenu en cours d’hospitalisation. Si aucune complication thromboembolique n’est retrouvee, d’autres evenements intercurrents sont notes chez 24 patients (retention d’urines, infections pulmonaires ou urinaires). La duree moyenne d’hospitalisation est de 45 + 28 j, plus longue chez les patients a autonomie prefracturaire reduite. A la sortie 50 % n’ont pas retrouve leur niveau d’autonomie anterieure et 15 patients ont du etre institutionnalises. Le pourcentage de deces a un an de cette population est de 14,3 %. En conclusion, les fractures par insuffisance du bassin frequentes chez le sujet âge, merite une attention particuliere, non pas tant du fait de leur risque vital que de leur retentissement fonctionnel important.

Wir berichten uber eine Patientin, die sich, in der 23.Woche schwanger, im Rahmen eines Verkehrsunfalls eine Acetabulumfraktur zuzog, die 6 Tage nach Trauma operativ versorgt wurde; 1 1/2 Jahre nach dem Unfall ist die Mutter klinisch beschwerdefrei, das Kind entwickelte sich unauffallig und es besteht keinerlei Anhalt fur eine Schadigung.Aufgrund dieses Falls sowie der entsprechenden Literatur sehen wir die operative Versorgung einer Acetabulumfraktur in der Schwangerschaft bei bestehender Indikation als die Methode der Wahl an, da sie fur die Mutter zweifellos die beste Behandlung darstellt und gleichzeitig fur Mutter und Kind mit nur minimalem Risiko einhergeht.

Purpose: Comparison of the radiation exposure of the head, midface and pelvis in multi-slice CT (MSCT) and single-slice CT (SSCT) for manufacturer-implemented standard protocols. Materials and Methods: An anthropomorphic Alderson-Rando phantom equipped with LiF-thermoluminescent dosimeters in the head, neck and pelvic region was examined with different MSCT and SSCT protocols, and the measured organ doses were compared. Results: In comparison with the SSCT protocols, the MSCT protocols delivered about twice the organ dose to the head and pelvis and about eight times the organ dose to the midface. The comparison indicates that the parameters (slice collimation, mAs, pitch) used for the MSCT protocols deliver increased radiation doses. Conclusions: The current standard MSCT protocols generally lead to higher organ doses to the head, midface and pelvis than the SSCT protocols, raising the question whether using the MSCT protocols recommended by the manufacturer can be justified. The dose parameters should be optimized to achieve an acceptable balance of dose reduction and adequate image quality.

Beckenverletzungen im Kindesalter sind sehr selten. Aufgrund der groseren knochernen Elastizitat und nachgiebigeren Knochen-Bandverbindungen sind hohe Energien zur Kontinuitatstrennung der statischen Stabilisierungselemente notwendig. Der Anteil an kindlichen Beckenfrakturen liegt auch in spezialisierten Zentren deutlich unter 5%. Komplexe Beckenverletzungen und Polytraumen treten im Vergleich zur Gruppe der Erwachsenen haufiger auf, da erst eine extrem starke Gewalteinwirkung zur Verletzung fuhrt. Die Kombination von seltener Verletzung, langer Kreislaufkompensation einer Hamorrhagie bei Kindern und dadurch verzogerter Therapie und Diagnostik kann das Behandlungsteam in gefahrlicher Sicherheit wiegen - bis eine abrupte Dekompensation eintritt. Anhand von 3 Kasuistiken soll die Problematik des Komplextraumas des Beckens dieser Altersgruppe aufgezeigt und etablierte Behandlungsalgorithmen dargestellt werden. Entscheidend ist die Berucksichtigung aller Verletzungskomponenten im Beckenbereich und die Ableitung der Behandlungshierarchie. Bei einer instabilen und dislozierten Fraktur gewahrleistet die offene Reposition mit interner Osteosynthese neben einer Stabilisierung und nervalen Dekompression die Blutstillung und die Voraussetzung zur effektiven Weichteilbehandlung. Haupttodesursache nach schweren Komplextraumen ist der akute hamorrhagische Schock, sodass die Behandlung der Blutung oberste Prioritat hat. Nach der Frakturstabilisierung, Weichteilversorgung und Stillung intraabdomineller Blutungen kann die selektive Katheterembolisation mit Arteriographie eine effiziente Beherrschung von pelvinen Gefasverletzungen im Stromgebiet der A. ilica interna ermoglichen. Das Ziel einer kompetenten Behandlung last sich nur durch eine enge Zusammenarbeit verschiedener Fachdisziplinen in einem Traumazentrum erreichen.

The accuracy of stereoscopic and standard three-dimensional (3D) CT in the classification of acetabular fractures was compared. A receiver operating characteristic (ROC) analysis was performed by two radiologists and two surgeons blinded to the presence of acetabular fractures in an animal model (a total of 62 porcine hips, 40 with artificial acetabular fractures). Classification of acetabular fractures was adopted from the literature. Interpretation was performed on a workstation using two specific volume rendering algorithms; unshaded and shaded bone. The ROC analysis did not demonstrate any benefit in stereoscopic 3D CT compared with standard 3D CT.

Bei Verletzungen des Beckenrings mit kombinierter vorderer und hinterer Instabilitat, Typ C nach der AO Klassifikation, ist sowohl die Stabilisierung des vorderen als auch des hinteren Beckenrings indiziert. Bei alleiniger Beteiligung der Bandverbindungen stellt die transileosacrale Schraubenosteosynthese eine biomechanisch gunstige, gering invasive Methode dar. Die Probleme dieser Methode liegen in der korrekten Schraubenplatzierung. Die Schraubenposition muss intraoperativ in 3 Ebenen kontrolliert werden (Inletview, Outletview und lateral). Daher ist die konventionelle Technik in der Regel mit einer hohen intraoperativen Strahlenexposition verbunden.

Resume INTRODUCTION : L’objectif de cette etude est d’apporter des donnees objectives sur l’etat neuro-orthopedique de la population des patients polyhandicapes afin d’ameliorer nos pratiques tant medicales que chirurgicales. MATERIEL ET METHODE : Il sˈagit dˈune etude transversale multicentrique descriptive de la population des patients polyhandicapees de plus de 15 ans, ne marchant pas. Chaque personne a beneficie dˈun examen clinique et radiographique a la recherche dˈune scoliose, dˈun bassin oblique et dˈune excentration de hanche (subluxation ou luxation) ainsi que des differents facteurs cliniques lies au polyhandicap. Le polyhandicap etait defini par un handicap grave associant deficience physique et mentale et entrainant une restriction extreme de l’autonomie. RESULTATS : La population etudiee etait de 120 personnes. La moyenne d’âge etait de 27,2 ans. L’etiologie principale etait la souffrance fœtale (38,3 % des patients). 69 % des patients avaient des possibilites de retournement. Lˈetat orthopedique etait severe : 75,9 % de scolioses, 65,2 % de bassins obliques (75 % a gauche et 25 % a droite), 19,1 % de luxations de hanche. Lˈetat general etait precaire : un patient sur deux avait un poids juge inferieur a la norme, 32,5 % avaient une escarre, 45,2 % souffraient de la hanche et seulement 13,6 % recevaient un traitement antalgique. DISCUSSION ET CONCLUSION : La description de lˈetat general et neuro-orthopedique de ces 120 personnes ne peut laisser indifferent. Bien que lˈesperance de vie de cette population soit diminuee, nous sommes devant un processus de vie et non dans le cadre dˈun accompagnement aux mourants. Il est urgent de revoir les soins reeducatifs preventifs dispenses en terme de qualite et de quantite ainsi que les propositions chirurgicales de traitement de lˈhypertonie, chez lˈenfant et lˈadulte.

Resume Une lesion osseuse dense fait craindre en premier lieu la presence d’une tumeur primitive ou secondaire. La stabilite radiologique dans le temps est un argument particulierement fort pour evoquer la benignite. L’ilot osseux benin solitaire est habituellement considere comme une lesion stable, non evolutive. Nous presentons le cas d’un patient chez lequel un suivi de 31 ans a permis d’objectiver une augmentation considerable de la taille d’un ilot osseux benin, prouve histologiquement et non fixant a la scintigraphie osseuse. L’aspect radiographique qui est caracteristique, ainsi que l’absence de captation scintigraphique meme en presence d’un processus pourtant evolutif, apparaissent comme des criteres majeurs du diagnostic.

In adults, pelvic computed tomography (CT) scanning plays an important role in the treatment of pelvic fractures; however, the role of CT scanning in the management of pediatric pelvic fractures is unclear. The purpose of this study was to investigate the efficacy of CT scanning in the management of pelvic fractures in children. One hundred three consecutive patients were identified. All patients underwent anteroposterior plain radiographic evaluation; CT scans were performed in 62. Three orthopaedic surgeons independently reviewed the plain radiographs and determined fracture classification and management. Subsequently, each observer was shown corresponding CT scans and again determined classification and management. Interobserver agreement was calculated using Kappa statistics. After the addition of CT scans, the mean changes in classification were nine (15%) and in management two (3%). Plain radiographs alone reliably predicted the need and type of operative intervention. Kappa statistics demonstrated "excellent" agreement for classification and management without and with CT scans. We reliably determined fracture classification and management based on plain radiographs alone.

In high-energy trauma there is a high incidence of pelvic fractures. Evaluating the long-term outcome of pelvic ring fractures it is difficult to separate the effects of the pelvic trauma from other injuries. To improve the treatment and prognosis of unstable pelvic ring fractures it is necessary to compare the results of the different conservative and surgical therapies. So far there have been no publications using different outcome evaluation protocols to improve the quality of the treatment. The aim of this study was to compare three scoring systems for the rating of long-term outcome after pelvic ring fractures. 36 patients who had received surgical stabilization of 19 Tile B- and 17 Tile C-type fractures were followed up for an average of 26 months. All of these patients had at least one additional injury, mainly craniocerebral trauma or injuries of the upper and lower extremity. The follow-up included a detailed clinical and radiological examination as well as an evaluation of the patients satisfaction as to the operative treatment. The information given by the patient on pain and ability to work as well as the social status was an important prognostic factor in the different protocols. However, these data often lacked objectivity. As our follows ups showed poor results compared to the Mennel test, we need to complete the different protocols by this test as an important prognostic factor.

In this study, we evaluated alternative technical markers for the motion analysis of the pelvic segment. Thirteen subjects walked eight times while tri-dimensional kinematics were recorded for one stride of each trial. Five marker sets were evaluated, and we compared the tilt, obliquity, and rotation angles of the pelvis segment: (1) standard: markers at the anterior and posterior superior iliac spines (ASIS and PSIS); (2) markers at the PSIS and at the hip joint centers, HJCs (estimated by a functional method and described with clusters of markers at the thighs); (3) markers at the PSIS and HJCs (estimated by a predictive method and described with clusters of markers at the thighs); (4) markers at the PSIS and HJCs (estimated by a predictive method and described with skin-mounted markers at the thighs based on the Helen-Hayes marker set); (5) markers at the PSIS and at the iliac spines. Concerning the pelvic angles, evaluation of the alternative technical marker sets evinced that all marker sets demonstrated similar precision across trials (about 1 degrees ) but different accuracies (ranging from 1 degrees to 3 degrees ) in comparison to the standard marker set. We suggest that all the investigated marker sets are reliable alternatives to the standard pelvic marker set.

Zwischen 1978 und 1999 wurden 22 Patienten (17 mannlich, 5 weiblich) wegen Apophysenfrakturen im Bereich des Beckens und Trochanter minors behandelt; 18 Patienten erlitten eine Avulsionsfraktur, 4 eine Apophysenfraktur durch direktes Trauma. Das durchschnittliche Alter betrug 12,5 (1–16) Jahre; 18 Patienten verletzten sich wahrend sportlicher Betatigung. Am haufigsten war die Spina iliaca anterior inferior betroffen (n=10) gefolgt von der Crista iliaca (n=4), Trochanter minor (n=3), Pfannendachapophyse (n=3) und Spina iliaca anterior superior (n=2). Die Diagnose erfolgte rontgenologisch. Die Behandlung war bis auf einen Fall konservativ. 20 Patienten wurden durchschnittlich nach 12 Monaten (3 Wochen bis 84 Monate) nachuntersucht; 15 Patienten (75%) waren zu diesem Zeitpunkt beschwerdefrei; 5 Patienten (25%) berichteten durchschnittlich 33 Monate nach dem Unfall uber Schmerzen im Bereich der ehemaligen Frakturstelle bei sportlicher Belastung. Die klinische Untersuchung ergab bei keinem der Patienten eine eingeschrankte Beweglichkeit der benachbarten Gelenke oder ein muskulares Defizit. Die Kontrollrontgenuntersuchung zeigte in allen Fallen bei guter knocherner Konsolidierung eine eine maximale Dislokation von 3 cm.

Resume Nous rapportons le cas d’un homme de 49 ans presentant une fracture pathologique inaugurale du deuxieme metacarpien. Celle-ci conduit dans un premier temps a un curetage-comblement iliaque sans diagnostic histologique prealable, associe a un brochage transfixiant la carpometacarpienne. Ce geste insuffisant ne parvient ni a consolider la fracture, ni a enrayer l’evolution de la lesion initiale, dont l’histologie exacte apres biopsie n’est precisee que quatre mois plus tard en faveur d’un osteosarcome. Apres chimiotherapie neo-adjuvante, une resection en bloc du deuxieme rayon emportant egalement le trapezoide est realisee. Dix-huit mois plus tard, considere comme gueri au niveau de la main avec un resultat fonctionnel satisfaisant, la decouverte d’une localisation sarcomateuse volumineuse au niveau de la zone de prelevement iliaque oblige a pratiquer une resection de l’hemibassin. Cette intervention de sauvetage n’empechera pas la survenue ulterieure de metastases pulmonaires et vertebrales, puis le deces du patient. A la lumiere de cette observation exemplaire, les regles elementaires concernant le traitement des tumeurs malignes sont rappelees. Elles auraient permis d’eviter la complication decrite au pronostic catastrophique.

Bei Patienten, die aufgrund einer schweren Beckenverletzung hamodynamisch instabil sind, ist die primare Stabilisierung des Beckens und damit die Reduktion des intrapelvinen Volumens entscheidend fur den Erfolg der weiteren Therapie. Die Beckenzwinge hat sich als Notfallmasnahme bewahrt, erfordert jedoch in den meisten Fallen eine weitere operative Versorgung. Dieser Sekundareingriff bedingt in vielen Fallen bei traumatisch geschadigten Weichteilen zusatzliche Wundheilungsstorungen. Ein weiteres Verfahren, der ventrale Fixateur externe, zeichnet sich durch einfache und schnelle Montage bei nur geringem Weichteilschaden aus. In vielen Fallen ist jedoch keine fur die Mobilisierung ausreichende biomechanische Stabilisierung des vertikal instabilen dorsalen Beckenringes zu erreichen. Anhand biomechanischer Uberlegungen wurde ein neuer schrag dorsaler Beckenfixateur fur Becken-C-Verletzungen entwickelt, der die Vorteile des supraazetabularen Fixateur externe nutzt und dabei den hinteren Beckenring von ventral mit einer der Beckenzwinge nahekommenden Effektivitat stabilisieren kann. Er ermoglicht bereits initial eine minimal-invasive sowie definitive Stabilisierung des dorsalen Beckenrings. Mehrere Variationen mit 2 unterschiedlichen Pinapplikationsformen dieses asymetrischen Fixateurs wurden getestet. In einer 2. Testreihe wurde die in der 1. Testreihe favorisierte Version des neuen schrag dorsalen Fixateurs mit dem supraazetabularem Fixateur externe und der Beckenzwinge (ACE) verglichen. Beide Testreihen erfolgten an Kunststoffbeckenmodellen im Einbeinstand in einer Materialprufmaschine. Als Instabilitatsmodell dienten Verletzungen vom Typ C1.2 sowie C1.3 entsprechend der AO-Klassifikation. In den Testreihen wurde kein signifikanter Unterschied des neuen verspannten schrag dorsalen Fixateurs zur Beckenzwinge gefunden. Er war jedoch deutlich stabiler als das unverspannte Modell oder der supraazetabulare Fixateur allein.

Purpose: To compare whole-body, lumbar, total spine, and pelvis bone mineral density (BMD), body mass index (BMI), body composition, energy expenditure for physical activity, and dietary intake of adolescents, aged 16–22 years. Methods: Three study groups included 25 girls with histories of eating disorders, 25 girls with no histories of eating disorders who exercised ≤ 7 hours/week, and 15 girls with no history of eating disorders who exercised> 7 hours/week. Bone mineral density was measured by dual-energy x-ray absorptiometry (DEXA), body composition by bioelectric impedance and DEXA, energy expenditure by Personal Activity Computer, nutrient intake by 4-day dietary recalls/records, and BMI by measures of height/weight. General linear models, LSM ± SEM, Student's t -tests, and correlation analyses were used to determine group differences. Results: No significant differences in whole-body, spinal, and pelvis BMD were found among the three groups. Mean body fat (percent) was significantly higher ( p = .0001) for the group with histories of eating disorders than other groups. Dietary intakes of adolescents with histories of eating disorders were significantly lower for energy ( p = .0001), fat ( p = .0001), calcium ( p = .0007), vitamin D ( p = .0180), and zinc ( p = .0057) than those without eating disorder histories who exercised ≤ 7 hours/week. Conclusion: Except for body fat (percent), measures of BMD, energy expenditure, and BMI were not significantly different among groups. Our data suggest that with full recovery from eating disorders, teenage girls can achieve normal bone mass and body composition.

Resume Objectifs Evaluation de la validite et de la reproductibilite des mesures rachimetriques de la mobilite globale et segmentaire spino-pelvi-femorale dans le plan sagittal. Materiel et methode Pour l'etude de la validite des mesures, des patients lombalgiques, ayant un spondylolisthesis ont eu quatre radiographies de profil : deux de la jonction lombosacree et deux du rachis dorsal haut, d'abord en position standard puis en flexion du tronc. La correlation entre les mesures radiographiques et celles du rachimetre a ete evaluee par le coefficient de correlation de Spearman (CCS), et les resultats exprimes par un nuage de points. La reproductibilite a ete evaluee chez des sujets sains en utilisant le coefficient de correlation intra-classe (CCI) et la methode de Bland et Altman. Resultats Dix patients (quatre hommes) âges de 42 ans (moyenne : 33–51) ont ete inclus pour l'etude de la validite. Le CCS entre les mesures radiographiques et celles du rachimetre etaient 0,96, 0,39 et 0,89 pour la flexion du tronc, du rachis et des hanches respectivement. Cinquante sujets (25 hommes) âges de 30 ans (moyenne : 18–49) ont ete inclus pour l'etude de la reproductibilite. En flexion le CCI etait de 0,93, 0,52 et 0,65 pour le tronc, le rachis et les hanches. La methode de Bland et Altman montrait une distribution homogene et centree. La reproductibilite des mesures pourrait etre amelioree par une meilleur standardisation de la prise des mesures. Conclusion Le rachimetre a des qualites metrologiques acceptables pour evaluer la mobilite des hanches lors de la flexion du tronc. Cet appareil pourrait etre utile dans l'evaluation clinique des sujets lombalgiques puisqu'il n'existe pas de mesure clinique simple permettant d'evaluer cette mobilite.