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Scientific Reports Nov 2020The dugong (Dugong dugon Müller) is recognized as an endangered marine mammal. There is limited available anatomical data on the dugong's skeletal system, while what is...
The dugong (Dugong dugon Müller) is recognized as an endangered marine mammal. There is limited available anatomical data on the dugong's skeletal system, while what is available has not been well established due to the limited number of archived samples and limited access to them. Importantly, there are certain key questions that should be answered when examining the bones and/or remains of animals such as; what kind of bone is it?; what species does it belong to?; what sex was the animal?; how old was the animal? or how big was it?, etc. In this study, we have focused on the pelvic bone of the dugong by asserting the hypothesis that pelvic bone morphology is related to age, sex, and body size. Here, we have established certain morphometric data encompassing 8 parameters and 5 indexes to analyze the morphology of the pelvic bones obtained from 88 specimens (45 dugongs). We will present three main findings: (1) the pelvic bone in mature male subjects is larger than it is in female subjects, (2) a high rate of accuracy can be established for sex identification using morphometric data obtained from the pelvic bone, and (3) the pelvic bone has the highest degree of correlation with body length, followed by body weight and age. Notably, the important data on the pelvic bone of the dugong acquired in this study can be reliable and extremely useful in sex identification and body size estimation.
Topics: Algorithms; Animals; Body Size; Dugong; Female; Male; Pelvic Bones; Principal Component Analysis; Reproducibility of Results; Sex Determination Analysis; Sex Factors
PubMed: 33168870
DOI: 10.1038/s41598-020-76545-w -
Injury Feb 2022Fractures of the pelvic ring and acetabulum generally result after high energy trauma. Pelvic fractures, especially, are considered complex injuries from a therapeutic...
Fractures of the pelvic ring and acetabulum generally result after high energy trauma. Pelvic fractures, especially, are considered complex injuries from a therapeutic point of view, in relation to the frequent coexistence of skeletal and / or parenchymal lesions affecting other areas, and the abundant bleeding invariably associated with the latter. The systematic study of these injuries, starting from the 1950s, has led to a significant prognostic improvement, while generally remaining a non-negligible degree of disability. The knowledge of the characteristics of the lesions and of the classification systems, as well as an accurate assessment of the anatomo-functional repercussions, represent therefore the fundamental prerequisites for the correct assessment of physical damage. Herein, we aim to examine whether the medico-legal assessment parameters of physical damage being used in Italy and Europe are appropriate and consistent with the complexity of similar injuries.
Topics: Acetabulum; Fractures, Bone; Hip Fractures; Humans; Pelvic Bones; Pelvis; Spinal Fractures
PubMed: 34865817
DOI: 10.1016/j.injury.2021.11.063 -
Current Opinion in Critical Care Dec 2017Complex traumatic pelvic ring disruptions are associated with a high mortality rate due to associated retroperitoneal hemorrhage, traumatic-hemorrhagic shock, and... (Review)
Review
PURPOSE OF REVIEW
Complex traumatic pelvic ring disruptions are associated with a high mortality rate due to associated retroperitoneal hemorrhage, traumatic-hemorrhagic shock, and postinjury coagulopathy. The present review provides an update on current management strategies to improve survival rates form hemodynamically unstable pelvic ring injuries.
RECENT FINDINGS
Recently published international consensus guidelines have attempted to standardize the classification of hemodynamically unstable pelvic ring injuries and provided classification-based management algorithms for acute resuscitation and pelvic ring stabilization.
SUMMARY
Acute management strategies for pelvic ring disruptions with associated hemorrhagic shock include resuscitative endovascular balloon occlusion of the aorta for patients 'in extremis' in conjunction with point-of-care guided resuscitation for postinjury coagulopathy. Recent data indicate that a protocol of early pelvic external fixation in conjunction with direct preperitoneal pelvic packing and subsequent angioembolization in patients with ongoing hemorrhage results in significantly improved survival from retroperitoneal exsanguinating hemorrhage in at-risk patients with historic mortality rates as high as 50-60%.
Topics: Blood Coagulation Disorders; Blood Transfusion; Critical Pathways; Embolization, Therapeutic; Exsanguination; Fracture Fixation; Fractures, Bone; Hemodynamics; Humans; Pelvic Bones; Resuscitation; Retroperitoneal Space; Survival Rate
PubMed: 29095714
DOI: 10.1097/MCC.0000000000000454 -
Orthopaedics & Traumatology, Surgery &... Oct 2021Floating hip is a rare and potentially serious injury. The objective of this study was to evaluate our management strategy for patients with floating hip.
BACKGROUND
Floating hip is a rare and potentially serious injury. The objective of this study was to evaluate our management strategy for patients with floating hip.
HYPOTHESIS
A standardized strategy with specialised multidisciplinary management is associated with a low mortality rate.
METHODS
Consecutive patients who had surgery to treat floating hip between January 2010 and December 2019 were included in this single-centre retrospective study. Epidemiological, clinical, and radiological data were collected and analysed. Patients were managed according to a standardised strategy adapted to the haemodynamic status and type of floating hip (type A, femoral and pelvic ring fractures; type B, femoral and acetabular fractures; and type C, femoral, acetabular, and pelvic ring fractures). The clinical outcome at last follow-up was determined by a telephone interview, based on the Majeed and Oxford scores, sports resumption, and work resumption. To assess the radiological outcomes, we applied Matta's criteria for the acetabulum and Tornetta's criteria for the pelvic ring.
RESULTS
We included 69 patients with a mean age of 38.5 years. Among them, 39 (57%) had haemodynamic instability requiring embolisation (n=15, 22%) or multiple blood transfusions (n=24, 35%). Type A injuries predominated (n=57, 83%). The need for multiple blood transfusions was significantly associated with type C floating hip, underlining the risk of heavy bleeding with this injury. Two (3%) patients died. When management was complete, the reduction was anatomical or satisfactory for 76% (13/17) of the acetabula according to Matta's criteria (maximum residual displacement <3mm) and for 85% (56/66) of the pelvic rings according to Tornetta's criteria (maximum residual displacement <10mm). One or more complications occurred in 45 (65%) patients. After a mean follow-up of 5 years, the mean Oxford Hip Score in patients with acetabular fractures was 35.5 and the mean Majeed score in patients with pelvic ring fractures was 71.5. Only 30% of patients were able to resume physical activities at the former level and to return to their former professional activities.
CONCLUSION
Type C floating hip, which combines fractures of the pelvic ring and acetabulum, carries a high risk of bleeding. Special attention should be directed to the reduction of pelvic ring fractures, to avoid malunion. Acetabular fractures that are complex in the Letournel classification carry a risk of imperfect reduction. The results of this study confirm the severity of these rare injuries and the need for specialised multidisciplinary management according to a standardised strategy that is appropriate for the haemodynamic status and type of floating hip (A, B, or C).
LEVEL OF EVIDENCE
IV; retrospective study.
Topics: Acetabulum; Adult; Fractures, Bone; Hip Fractures; Humans; Pelvic Bones; Radiography; Retrospective Studies; Treatment Outcome
PubMed: 34214653
DOI: 10.1016/j.otsr.2021.102998 -
European Radiology Sep 2021To compare ultra-low-dose CT (ULD-CT) of the osseous pelvis with tin filtration to standard clinical CT (CT), and to assess the quality of computed virtual pelvic...
OBJECTIVES
To compare ultra-low-dose CT (ULD-CT) of the osseous pelvis with tin filtration to standard clinical CT (CT), and to assess the quality of computed virtual pelvic radiographs (VRs).
METHODS
CT protocols were optimized in a phantom and three pelvic cadavers. Thirty prospectively included patients received both standard CT (automated tube voltage selection and current modulation) and tin-filtered ULD-CT of the pelvis (Sn140kV/50mAs). VRs of ULD-CT data were computed using an adapted cone beam-based projection algorithm and were compared to digital radiographs (DRs) of the pelvis. CT and DR dose parameters and quantitative and qualitative measures (1 = worst, 4 = best) were compared. CT and ULD-CT were assessed for osseous pathologies.
RESULTS
Dose reduction of ULD-CT was 84% compared to CT, with a median effective dose of 0.38 mSv (quartile 1-3: 0.37-0.4 mSv) versus 2.31 mSv (1.82-3.58 mSv; p < .001), respectively. Mean dose of DR was 0.37 mSv (± 0.14 mSv). The median signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of bone were significantly higher for CT (64.3 and 21.5, respectively) compared to ULD-CT (50.4 and 18.8; p ≤ .01), while ULD-CT was significantly more dose efficient (figure of merit (FOM) 927.6) than CT (FOM 167.6; p < .001). Both CT and ULD-CT were of good image quality with excellent depiction of anatomy, with a median score of 4 (4-4) for both methods (p = .1). Agreement was perfect between both methods regarding the prevalence of assessed osseous pathologies (p > .99). VRs were successfully calculated and were equivalent to DRs.
CONCLUSION
Tin-filtered ULD-CT of the pelvis at a dose equivalent to standard radiographs is adequate for assessing bone anatomy and osseous pathologies and had a markedly superior dose efficiency than standard CT.
KEY POINTS
• Ultra-low-dose pelvic CT with tin filtration (0.38 mSv) can be performed at a dose of digital radiographs (0.37 mSv), with a dose reduction of 84% compared to standard CT (2.31 mSv). • Tin-filtered ultra-low-dose CT had lower SNR and CNR and higher image noise than standard CT, but showed clear depiction of anatomy and accurate detection of osseous pathologies. • Virtual pelvic radiographs were successfully calculated from ultra-low-dose CT data and were equivalent to digital radiographs.
Topics: Humans; Pelvic Bones; Radiation Dosage; Radiographic Image Interpretation, Computer-Assisted; Radiography; Tin; Tomography, X-Ray Computed
PubMed: 33710371
DOI: 10.1007/s00330-021-07824-x -
Emergency Nurse : the Journal of the... Oct 2023Pelvic fractures caused by high-energy trauma such as falling from a height or road traffic collisions have a high mortality rate and patients are also at high risk of...
Pelvic fractures caused by high-energy trauma such as falling from a height or road traffic collisions have a high mortality rate and patients are also at high risk of life-changing injuries. High-energy trauma to the pelvis is associated with major haemorrhage and injuries to the internal pelvic organs. Emergency nurses have a fundamental role in the initial assessment and management of patients, as well as in their ongoing care once the fracture has been stabilised and bleeding is controlled. This article describes the anatomy of the pelvis, discusses the initial assessment and management of patients who have sustained high-energy pelvic trauma, details the complications of pelvic fractures and explains patients' ongoing care in the emergency department.
Topics: Humans; Adult; Fractures, Bone; Pelvic Bones; Pelvis; Emergency Service, Hospital
PubMed: 36880213
DOI: 10.7748/en.2023.e2151 -
European Journal of Orthopaedic Surgery... Jan 2021Pelvic ballistic injuries threaten critical gastrointestinal, vascular, and urinary structures. We report the treatment patterns and injury profiles of ballistic pelvic...
INTRODUCTION
Pelvic ballistic injuries threaten critical gastrointestinal, vascular, and urinary structures. We report the treatment patterns and injury profiles of ballistic pelvic fractures and the association between location of ballistic fractures of the pelvis and visceral injuries.
METHODS
A prospectively collected database at an academic level I trauma center was reviewed for clinical and radiographic data on patients who sustained one or more ballistic fractures of the pelvis. Main outcomes compared included: procedures with orthopedic surgery, emergent surgery, concomitant intrapelvic injuries, and mortality.
RESULTS
Eighty-six patients were included. Eight patients (9.3%) underwent surgical debridement with orthopedic surgery, no ballistic pelvic fractures required surgical stabilization. The anatomical locations of ballistic pelvic fractures included: 10 (14.7%) anterior ring, 13 (19.1%) posterior ring, 27 (39.7%) anterior column, and 18 (20.9%) posterior column. There was a statistically significant association between anterior ring and rectal injury. The association between anterior ring injury and bladder injury approached significance.
CONCLUSIONS
This case series included 86 patients with a ballistic fracture of the pelvis, none requiring pelvic ring surgical stabilization. The unpatterned behavior of these injuries demands a high suspicion for visceral injury, with special attention to the rectum and bladder in the setting of anterior ring involvement.
LEVEL OF EVIDENCE
IV.
Topics: Abdominal Injuries; Acetabulum; Adolescent; Adult; Female; Fractures, Bone; Humans; Male; Middle Aged; Multiple Trauma; Pelvic Bones; Retrospective Studies; Trauma Centers; Wounds, Gunshot; Young Adult
PubMed: 32720105
DOI: 10.1007/s00590-020-02744-w -
Journal of Orthopaedic Research :... Mar 2022Limb-salvaging hemipelvectomy surgeries involving allograft or custom prosthesis reconstruction require high quality remaining pelvic bone for adequate device fixation....
Limb-salvaging hemipelvectomy surgeries involving allograft or custom prosthesis reconstruction require high quality remaining pelvic bone for adequate device fixation. Modeling studies of custom pelvis prosthesis designs typically mirror contralateral pelvic bone material properties to the ipsilateral pelvis. However, the extent of bone material property and geometric symmetry, and thus the appropriateness of mirroring, remains unknown and should be considered when designing or analyzing the performance of pelvic prostheses. This study investigates preoperative differences between ipsilateral and contralateral pelvic bone for patients with a pelvic sarcoma. Computed tomography (CT) data were obtained retrospectively from eight patients with a pelvic sarcoma. Subject-specific computational models of the pelvic bones were constructed from the CT data. Bilateral asymmetry of bone material properties and cross-sectional areas between the ipsilateral and contralateral hemipelvis were quantified at points adjacent to the pelvic sarcoma. Large bilateral asymmetry (>20%) in trabecular but not cortical bone density was observed within 20 mm of the tumor location. Differences in trabecular bone density typically declined with increased distance from the tumor. The greatest bilateral difference in cross-sectional area occurred within 10 mm of the tumor boundary for three patients and within 40 mm from the tumor site for four patients. Our results suggest that pelvic sarcomas can cause significant bilateral asymmetries in trabecular bone density for patients with a pelvic sarcoma. These differences should be taken into account when designing custom implants for this patient population.
Topics: Bone Density; Bone Neoplasms; Humans; Pelvic Bones; Retrospective Studies; Sarcoma; Tomography, X-Ray Computed
PubMed: 33914952
DOI: 10.1002/jor.25067 -
Seminars in Pediatric Surgery Feb 2017Although traumatic pelvic fractures in children are relatively rare, these injuries are identified in about 5% of children admitted to level 1 trauma centers after blunt...
Although traumatic pelvic fractures in children are relatively rare, these injuries are identified in about 5% of children admitted to level 1 trauma centers after blunt trauma. Such injuries differ from adult pelvic fractures in important ways and require distinct strategies for management. While the associated mortality rate for children with pelvic fractures is much lower than that for adults, the patient may require urgent surgical intervention for associated life-threatening injuries such as head trauma and abdominal injury. Unstable pelvic ring fractures should be acutely managed using an initial approach similar to that used in adult orthopedic traumatology. Although very few pediatric pelvic fractures will ultimately need surgical treatment, patients with these injuries must be followed over time to confirm proper healing, ensure normal pelvic growth, and address any potential complications. The trauma team suspecting a pelvic fracture in a child must understand the implication of such a finding, identify fracture patterns that increase suspicion of associated injuries, and involve pediatric or adult orthopedic specialists as appropriate during the management of the patient.
Topics: Acetabulum; Adolescent; Child; Fractures, Bone; Humans; Pelvic Bones
PubMed: 28302282
DOI: 10.1053/j.sempedsurg.2017.01.006 -
The American Surgeon Aug 2021Traumatic bladder injuries are commonly associated with pelvic fractures. While the majority of intraperitoneal bladder injuries are surgically repaired, extraperitoneal... (Review)
Review
Traumatic bladder injuries are commonly associated with pelvic fractures. While the majority of intraperitoneal bladder injuries are surgically repaired, extraperitoneal bladder injuries (EBIs) can be managed nonoperatively in the absence of complex injury patterns such as bladder neck injury or presence of bone spicules in the bladder. Concern for pelvic hardware contamination is one of the most common reasons for repairing EBIs at the time of orthopedic interventions for pelvic fracture (usually open reduction and internal fixation). However, given the inconsistent and limited evidence, practice patterns are different and largely depend on surgeon preferences and institutional management. In this review, we explore the roots for this concern and summarize the current evidence on risk of pelvic hardware infection with nonoperative management of EBIs.
Topics: Equipment Contamination; Evidence-Based Medicine; Fracture Fixation, Internal; Fractures, Bone; Humans; Open Fracture Reduction; Pelvic Bones; Risk Factors; Surgical Wound Infection; Urinary Bladder
PubMed: 33350852
DOI: 10.1177/0003134820956342