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Orthopedics 2023Accurate and reproducible acetabular component positioning is among the most important technical factors affecting outcomes of total hip arthroplasty. Although several...
Accurate and reproducible acetabular component positioning is among the most important technical factors affecting outcomes of total hip arthroplasty. Although several studies have investigated the influence of pelvic tilt and obliquity on functional acetabular anteversion, the effect of pelvic axial rotation has not yet been established. We analyzed a generic simulated pelvis created using preoperative full-body standing and sitting radiographs. A virtual acetabulum was placed in 144 different scenarios of acetabular anteversion and abduction angles. In each scenario, the effects of pelvic tilt and pelvic axial rotation on different combinations of acetabular orientations were assessed. The change in acetabular anteversion was 0.75° for each 1° of pelvic tilt and was most linear in abduction angles of 40°±45°. The change in acetabular anteversion was 0.8° for each 1° of pelvic axial rotation. Surgeons may consider adjusting acetabular anteversion in fixed axial pelvic deformities when the degree of deformity affects functional acetabular positioning, assessed from preoperative standing and sitting weight-bearing radiographs. [. 2023;46(1):e27-e30.].
Topics: Humans; Acetabulum; Rotation; Posture; Arthroplasty, Replacement, Hip; Pelvis
PubMed: 36206512
DOI: 10.3928/01477447-20221003-04 -
Clinical Spine Surgery Aug 2017Digitally reconstructed radiograph-based study.
STUDY DESIGN
Digitally reconstructed radiograph-based study.
OBJECTIVE
Using a computer-based method to determine what degree of pelvic rotation is acceptable for measuring the pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). The effectiveness of a geometrical formula used to calculate the angle of pelvic rotation proposed in a previous article was assessed.
SUMMARY OF BACKGROUND DATA
It is unclear whether PI, PT, and SS are valid with pelvic rotation while acquiring a radiograph.
MATERIALS AND METHODS
Ten 3-dimensionally reconstructed models were established with software and placed in a neutral orientation to orient all of the bones in a standing position. Next, 140 digitally reconstructed radiographs were obtained by rotating the models around the longitudinal axis of each pelvis in the software from 0 to 30 degrees at 2.5-degree intervals. PI, PT, and SS were measured. The rotation angle was considered to be acceptable when the change in the measured angle (compared with the "correct" position) was <6 degrees. The rotation angle (α) on the images was calculated by a geometrical formula. Consistency between the measured value and the set angle was assessed.
RESULTS
The acceptable maximum angle of rotation for reliable measurements of PI was 17.5 degrees, and the changes in PT and SS were within an acceptable range (<6 degrees) when the pelvic rotation increased from 0 to 30 degrees. The effectiveness of the geometrical formula was shown by the consistency between the set and the calculated rotation angles of the pelvis (intraclass correlation coefficient=0.99).
CONCLUSIONS
Our study provides insight into the influence of pelvic rotation on the PI, PT, and SS. PI changes with pelvic rotation. The acceptable maximum angle for reliable values of PI, PT, and SS was 17.5 degrees, and the rotation angle of the pelvis on a lateral spinopelvic radiograph can be calculated reliably.
Topics: Biomechanical Phenomena; Femur; Humans; Imaging, Three-Dimensional; Pelvis; Rotation; Sacrum
PubMed: 27642817
DOI: 10.1097/BSD.0000000000000444 -
The Journal of Arthroplasty May 2018The purpose of this study is to analyze the effect of pelvic tilt and rotation on radiographic measurement of cup orientation.
BACKGROUND
The purpose of this study is to analyze the effect of pelvic tilt and rotation on radiographic measurement of cup orientation.
METHODS
A total of 68 patients (79 hips) were included in this study. The patients had a computed tomography study and approximately 3 months of postoperative standing anteroposterior pelvic radiographs in both supine and standing positions. We used 2-dimensional (2D)/3-dimensional (3D) matching to measure pelvic tilt and rotation, and cup orientation.
RESULTS
There was a wide range of pelvic tilt between individuals in both supine and standing positions. Supine pelvic tilt was different from standing pelvic tilt (P < .05). There were differences in cup anteversion before and after 2D/3D matching in both supine and standing positions (P < .05). Supine and standing pelvic tilt correlated with differences in cup anteversion before and after 2D/3D matching. When all 79 hips were separated into right and left side, pelvic rotation inversely correlated with the pelvic tilt-adjusted difference in anteversion before and after 2D/3D matching of the right side but directly correlated with that of the left side in both supine and standing positions.
CONCLUSION
This study demonstrated that the measurement of cup anteversion on anteroposterior radiographs is significantly affected by both pelvic tilt and pelvic rotation (depending on the side). Improved understanding of pelvic orientation and improved ability to measure pelvic orientation may eventually allow for desired cup positioning to potentially protect against complications associated with malposition of the cup.
Topics: Acetabulum; Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Female; Hip Prosthesis; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Pelvis; Postoperative Period; Radiography; Rotation; Standing Position; Supine Position; Tomography, X-Ray Computed
PubMed: 29276116
DOI: 10.1016/j.arth.2017.11.069 -
Seminars in Ultrasound, CT, and MR Jun 2017Magnetic resonance imaging (MRI) is often "one stop shop" for evaluating female pelvic masses that helps in diagnosis, staging, and restaging of these tumors. A pelvic... (Review)
Review
Magnetic resonance imaging (MRI) is often "one stop shop" for evaluating female pelvic masses that helps in diagnosis, staging, and restaging of these tumors. A pelvic mass can arise from any tissue present within the pelvis. Although most masses in the female pelvis arise from the reproductive organs, masses may also arise from the gastrointestinal tract, urinary system, adjacent soft tissues, peritoneum, etc. It may not always be possible to determine the site of origin or distinguish these masses based on imaging characteristics. However, familiarity with the clinicopathologic and MRI features of most common pelvic masses helps in narrowing the differential diagnosis. Diagnosis of these masses needs a holistic approach as required for any tumor including clinical history, laboratory data, and imaging characteristics. We focus on MRI characteristics of commonly encountered pelvic masses. A compartmental imaging approach is discussed in this article that helps in identifying and characterizing these masses.
Topics: Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Neoplasm Staging; Pelvic Neoplasms; Pelvis
PubMed: 28705369
DOI: 10.1053/j.sult.2016.11.004 -
Tropical Doctor Oct 2020Pyomyositis commonly presents with fever, muscle pain and abscess formation involving deep soft-tissue compartments. is the main causative organism and diagnosis is...
Pyomyositis commonly presents with fever, muscle pain and abscess formation involving deep soft-tissue compartments. is the main causative organism and diagnosis is usually established clinically, supported by imaging, but confirmation may be achieved by histopathological examination. Broad-spectrum antibiotic therapy and surgical debridement are the cornerstone of treatment. Its prognosis is good but, as in all soft-tissue infections, it depends on early intervention, directed antibiotics and, if indicated, prompt surgery. In this paper, we describe a case of pelvic pyomyositis complicated with bacteraemia and bilateral septic pulmonary emboli in a young man in Colombia.
Topics: Anti-Bacterial Agents; Bacteremia; Colombia; Humans; Magnetic Resonance Imaging; Male; Pelvis; Pulmonary Embolism; Pyomyositis; Staphylococcal Infections; Staphylococcus aureus; Young Adult
PubMed: 32623976
DOI: 10.1177/0049475520938166 -
International Urogynecology Journal Jun 2016In the pelvis, the rectogenital septum (RGS) separates the urogenital compartment from the digestive compartment. In men, it corresponds to Denonvilliers' rectoprostatic... (Review)
Review
INTRODUCTION
In the pelvis, the rectogenital septum (RGS) separates the urogenital compartment from the digestive compartment. In men, it corresponds to Denonvilliers' rectoprostatic fascia or rectovesical septum (RVS). Its purpose-and, indeed, its existence-are controversial in women. The purpose of this review was to update knowledge about the RGS in women and, in particular, to clarify its relationship to pelvic nerves in order to deduce practical consequences of pelvic surgery and compare it to the RVS in men.
METHODS
A review of the anatomical and surgical literature was undertaken. Evidence for embryological origin, composition, and surgical importance of the RGS in women and men is suggested.
RESULTS
This manuscript presents evidence of the existence of the RGS in both women (rectovaginal septum, RVaS) and men (rectovesical septum, RVS). It originates from the genital structures and extends from the rectogenital pouch to the perineal body. It is composed of connective tissue associated with bundles of smooth muscle cells and has lateral expansions in close contact with neurovascular bundles originating from the inferior hypogastric plexus. During pelvic surgery for carcinoma, preservation of nerve fibers of erectile bodies is necessary if possible. The RGS is thus an important surgical landmark during urogenital sinus surgery, prolapse surgery, and proctectomy in women as well as during proctectomy and prostatectomy in men.
CONCLUSIONS
The RGS is present in women as well as in men, with great similarities between the two sexes. It represents an important surgical landmark during pelvic nerve-sparing surgery.
Topics: Female; Humans; Male; Pelvis; Rectum; Vagina
PubMed: 26690361
DOI: 10.1007/s00192-015-2878-3 -
Chirurgia (Bucharest, Romania : 1990) 2017The incidence of fragility fractures of the pelvis is increasing quickly. The characteristics of these fractures are different from pelvic ring disruptions in adults.... (Review)
Review
The incidence of fragility fractures of the pelvis is increasing quickly. The characteristics of these fractures are different from pelvic ring disruptions in adults. Fragility fractures of the pelvis are the consequence of a low-energy trauma which occurs in a patient with an important decrease of bone mineral density. Due to a consistent pattern of alteration of bone mass distribution in the sacrum, other fracture morphologies occur than in younger adults. The leading symptom is immobilizing pain in the lower back, in the buttocks, in the inguinal region and/or at the pubic symphysis. Conventional radiographs and CT will show the presence and localization of the fractures in the anterior and posterior pelvic ring. A new, comprehensive classification system distinguishes four categories of instability. This first criterion is most important, because it also gives hints for the preferred type of treatment. The second criterion, leading to the subtypes in the four categories, is the localization of the instability in the posterior pelvic ring. This criterion points the way towards the type of the surgical procedure to be used. When a surgical treatment is chosen, the procedure should be as minimal invasive as possible. Different techniques for percutaneous or less invasive fixation of the posterior pelvic ring have been developed. Their advantages and limitations are presented: sacroplasty, iliosacral screw osteosynthesis, cement augmentation, transiliac internal fixation, trans-sacral osteosynthesis, lumbopelvic fixation. Fractures of the anterior pelvic ring also need special attention. Retrograde transpubic screw fixation is recommended for pubic rami fractures. Fractures of the pubic body and instabilities of the pubic symphysis need bridging plate osteosynthesis. We do not recommend anterior pelvic external fixation in elderly because of the risk of pin track infection and pin loosening.
Topics: Aging; Bone Plates; Bone Screws; Fracture Fixation, Internal; Fracture Healing; Humans; Minimally Invasive Surgical Procedures; Osteoporotic Fractures; Pelvis; Treatment Outcome
PubMed: 29088552
DOI: 10.21614/chirurgia.112.5.524 -
The British Journal of Radiology May 2018To assess the extent of pelvic hemorrhage on CT and to estimate its significance on outcome in patients with blunt high-energy pelvic trauma.
OBJECTIVE
To assess the extent of pelvic hemorrhage on CT and to estimate its significance on outcome in patients with blunt high-energy pelvic trauma.
METHODS
576 patients with blunt high-energy pelvic fractures in 2005-2011 were identified in the hospital's Trauma Registry (a major Trauma Center). 60 of these met our further inclusion criteria of initial systolic blood pressure ≤100 mmHg and pelvic-related hemorrhage. CT scans of the patients were reviewed with regard to pelvic and abdominal retroperitoneal hemorrhage, type of fracture (Tile classification) and associated injuries. Extent of hemorrhage was correlated to 30-day mortality, transfusion requirements and need of angiography. Statistical methods include Pearson's Χ test and Fisher's exact test.
RESULTS
Pelvic hemorrhage extended beyond the pelvis to the abdominal area in 47% of the patients, to the thighs in 25% and to the gluteal areas in 81%. The extent of hemorrhage was significantly associated with the need for blood transfusions (p = 0.011) and angiography (p < 0.001), but not with 30-day mortality.
CONCLUSION
Traumatic pelvic bleeding frequently extends beyond the true pelvis. Extrapelvic hemorrhage correlates with an increased need of transfusions, but not with 30-day mortality. Further studies are needed to assess whether present techniques to control pelvic bleeding need to be modified in order to further reduce mortality in traumatic pelvic hemorrhage. Advances in knowledge: The study shows localization of pelvic hemorrhage in trauma patients. It may help to select patients in need of further interventions to control bleeding.
Topics: Adult; Cohort Studies; Female; Fractures, Bone; Hematoma; Humans; Male; Middle Aged; Pelvic Bones; Pelvis; Registries; Retrospective Studies; Sweden; Tomography, X-Ray Computed; Wounds, Nonpenetrating
PubMed: 29419325
DOI: 10.1259/bjr.20170840 -
BioMed Research International 2018Uterine fibroids are the most common benign pelvic tumor of the female genital tract and tend to increase with age; they cause menorrhagia, dysmenorrhea, pelvic pressure... (Review)
Review
Uterine fibroids are the most common benign pelvic tumor of the female genital tract and tend to increase with age; they cause menorrhagia, dysmenorrhea, pelvic pressure symptoms, back pain, and subfertility. Currently, the management is based mainly on medical or surgical approaches. The nonsurgical and minimally invasive therapies are emerging approaches that to the state of the art include uterine artery embolization (UAE), image-guided thermal ablation techniques like magnetic resonance-guided focused ultrasound surgery (MRgFUS) or radiofrequency ablation (RF), and percutaneous microwave ablation (PMWA). The purpose of the present review is to describe feasibility results and safety of PMWA according to largest studies available in current literature. Moreover technical aspects of the procedure were analyzed providing important data on large scale about potential efficacy of PMWA in clinical setting. However larger studies with international registries and randomized, prospective trials are still needed to better demonstrate the expanding benefits of PMWA in the management of uterine fibroids.
Topics: Female; Humans; Leiomyoma; Magnetic Resonance Imaging; Microwaves; Pelvic Neoplasms; Pelvis; Radiofrequency Therapy; Radiotherapy, Image-Guided; Treatment Outcome; Uterine Artery Embolization
PubMed: 29511672
DOI: 10.1155/2018/2360107 -
Anatomical Record (Hoboken, N.J. : 2007) Mar 2021The ontogeny of the paired appendages has been extensively studied in lungfishes and tetrapods, but remains poorly known in coelacanths. Recent work has shed light on...
The ontogeny of the paired appendages has been extensively studied in lungfishes and tetrapods, but remains poorly known in coelacanths. Recent work has shed light on the anatomy and development of the pectoral fin in Latimeria chalumnae. Yet, information on the development of the pelvic fin and girdle is still lacking. Here, we described the development of the pelvic fin and girdle in Latimeria chalumnae based on 3D reconstructions generated from conventional and X-ray synchrotron microtomography, as well as MRI acquisitions. As in other jawed vertebrates, the development of the pelvic fin occurs later than that of the pectoral fin in Latimeria. Many elements of the endoskeleton are not yet formed at the earliest stage sampled. The four mesomeres are already formed in the fetus, but only the most proximal radial elements (preaxial radial 0-1) are formed and individualized at this stage. We suggest that all the preaxial radial elements in the pelvic and pectoral fin of Latimeria are formed through the fragmentation of the mesomeres. We document the progressive ossification of the pelvic girdle, and the presence of a trabecular system in the adult. This trabecular system likely reinforces the cartilaginous girdle to resist the muscle forces exerted during locomotion. Finally, the presence of a preaxial element in contact with the pelvic girdle from the earliest stage of development onward questions the mono-basal condition of the pelvic fin in Latimeria. However, the particular shape of the mesomeres may explain the presence of this element in contact with the girdle.
Topics: Animal Fins; Animals; Biological Evolution; Fishes; Fossils; Magnetic Resonance Imaging; Pelvis; Phylogeny
PubMed: 32445538
DOI: 10.1002/ar.24452