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Journal of Orthopaedic Surgery and... Jul 2021Diastasis of the pubic symphysis has been reported to occur in 13-16% of pelvic ring injuries. In Asians, there are only a few data showing the width of the pubic...
INTRODUCTION
Diastasis of the pubic symphysis has been reported to occur in 13-16% of pelvic ring injuries. In Asians, there are only a few data showing the width of the pubic symphysis. The aim of this study is to see the width of pubic symphysis relating to age and sex in Koreans.
METHODS
Width of pubic symphysis was measured in pelvis AP and pelvic CT of 784 peoples (392 males, 392 females).
RESULTS
In supine AP, the width at the upper end was 4.8±2.5 mm (males; 3.46±1.38 mm, females; 4.04±2.76 mm). The width at the midpoint was 4.7±2.0 mm (males; 4.64±1.58 mm, females; 4.75±2.29 mm). The width at the lower end was 4.8±2.5 mm (males; 4.58±2.19 mm, females; 5.08±2.76 mm). In abducted AP, the width at the upper end was 3.8±2.9 mm (males; 3.65±1.50 mm, females; 3.97±3.85 mm). The width at the midpoint was 4.6±2.3 mm (males; 4.45±2.16 mm, females; 5.18±3.79 mm). The width at the lower end was 4.8±3.1 mm (males; 4.55±1.30 mm, females; 4.74±3.06 mm). In axial CT, the width at the anterior border was 15.0±6.2 mm (males; 14.50±6.62 mm, females; 16.44±6.22 mm). The width at the narrowest point was 3.1±1.5 mm (males; 3.19±1.53 mm, females; 3.09±1.50 mm). The width at the widest point was 4.1±1.6 mm (males; 4.27±1.60 mm, females; 4.00±1.50 mm). The width at the posterior border was 2.3±1.3 mm (males: 2.20±1.30 mm, females; 2.44±1.40 mm). Axial thickness was 27.1±5.3 mm (males; 29.48±4.60 mm, females; 24.70±4.82 mm). In coronal CT, the width at the upper end was 3.1±4.1 mm (males; 2.28±1.26 mm, females; 3.83±5.48 mm). The width at beginning of widening was 3.6±4.5 mm (males; 2.68±1.63 mm, females; 4.54±6.08 mm). The width at the lower end was 20.5±8.2 mm (males; 17.49±4.53 mm, females; 23.60±9.86 mm). Coronal thickness was 20.4±7.1 mm (males; 24.50±5.98 mm, females; 16.23±5.61 mm). In supine film, width significantly increased with age at the upper end (p=0.022) and midpoint (p< 0.001); however, it decreased at the lower end (p< 0.001). In abduction film, width at midpoint increased with age (p=0.003).
CONCLUSION
Pelvic malunion should be defined according to the population and age. These results could be a reference in assessing the quality of reduction after internal fixation of the patients with traumatic diastasis of the pubic symphysis.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Pelvimetry; Pubic Symphysis; Radiography; Reference Values; Republic of Korea; Retrospective Studies; Sex Factors; Young Adult
PubMed: 34217332
DOI: 10.1186/s13018-021-02561-9 -
Acta Ortopedica Mexicana 2023The ilioinguinal approach described by Emile Letournel in 1961 allows an extensive exposure of the anterior elements of the pelvis and acetabular fractures involving the... (Review)
Review
The ilioinguinal approach described by Emile Letournel in 1961 allows an extensive exposure of the anterior elements of the pelvis and acetabular fractures involving the anterior wall and/or column, pubic symphysis, and sacroiliac joint. It also facilitates a rapid recovery of muscle function and leaves a cosmetic scar.
Topics: Humans; Fractures, Bone; Fracture Fixation, Internal; Acetabulum; Hip Fractures; Spinal Fractures; Pelvis
PubMed: 37857397
DOI: No ID Found -
Advances in Orthopedics 2022Investigation of the crossover sign (COS) in different degrees of tilt in pelvises made by three-dimensional printing of CT scans among patients with normal hip versions...
INTRODUCTION
Investigation of the crossover sign (COS) in different degrees of tilt in pelvises made by three-dimensional printing of CT scans among patients with normal hip versions was carried out.
METHODS
Radiology CT scans of 8 normal pelvises reconstructed in 3D and the effect of sequential tilting on the presence of the false-positive COS in 48 radiographs were investigated.
RESULTS
The COS was seen in 77% of the AP radiographs during tilt changes. The average distance between the tip of the coccyx and the symphysis pubis was 32.06 ± 10.99 mm. Also, COSs were present in all radiographs from 6 degrees tilt and above.
CONCLUSION
Minor tilting of the pelvis can result in a false-positive crossover sign on AP plain radiographs.
PubMed: 35663434
DOI: 10.1155/2022/4665342 -
Journal of Clinical Medicine Jun 2020The presence of the pathological movement of pubic symphysis under normal activities characterises a syndrome know as anterior pelvic ring instability [...].
The presence of the pathological movement of pubic symphysis under normal activities characterises a syndrome know as anterior pelvic ring instability [...].
PubMed: 32630362
DOI: 10.3390/jcm9061985 -
Archives of Orthopaedic and Trauma... Jun 2024Open book injuries are challenging injuries that oftentimes require surgical treatment. Currently, treatment is performed with symphyseal plating requiring extensive...
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.
Topics: Humans; Pubic Symphysis; Cadaver; Biomechanical Phenomena; Fracture Fixation, Internal; Male; Bone Plates; Female; Fractures, Bone
PubMed: 38801533
DOI: 10.1007/s00402-024-05390-7 -
Physical Therapy Apr 2022Pregnancy-related pelvic girdle pain (PGP) may persist or occur postpartum and negatively affects women's lives. There is uncertainty regarding the association between...
OBJECTIVE
Pregnancy-related pelvic girdle pain (PGP) may persist or occur postpartum and negatively affects women's lives. There is uncertainty regarding the association between the structures of the bony pelvis, diastasis recti abdominis (DRA), pain processing, and PGP and to what extent these factors should be considered during physical therapy. This study aimed to evaluate the differences between women with and without PGP shortly after delivery regarding the separation of a pubic symphysis, DRA, and pain catastrophizing.
METHODS
Women diagnosed with PGP 24 to 72 hours after vaginal delivery were matched to pain-free controls according to age and parity. Ultrasound evaluations of diastasis recti (interrecti distance [IRD]) during rest and curl-up task and pubic symphysis (interpubic width) were performed. The Pain Catastrophizing Scale was used to assess the level of catastrophizing. A special Cox regression model was used to fit a conditional logistic regression for a 1:2 matched case-control study.
RESULTS
Thirty-five women with clinically diagnosed PGP and 70 matched controls were included in the study. The PGP group had a significantly higher pre-pregnancy body mass index than the control group. After adjusting for body mass index in multiple conditional logistic regression, the interpubic distance (odds ratio = 1.64; 95% CI = 1.22 to 2.20) and IRD during curl-up (odds ratio = 2.01; 95% CI = 1.08 to 3.74) were significantly associated with PGP. Pain catastrophizing and IRD at rest were not associated with PGP in univariable or multivariable analysis.
CONCLUSIONS
Pain catastrophizing is similar for women with and without PGP early postpartum. However, the degree of the pubic symphysis and rectus abdominis separation during the curl-up task are positively associated with PGP shortly after delivery.
IMPACT
This study indicates that a reconsideration of the way we look at DRA is warranted. The development of a more comprehensive assessment including objective measurements and a biopsychosocial understanding is needed to inform directions for further postpartum physical therapy.
Topics: Case-Control Studies; Catastrophization; Diastasis, Muscle; Female; Humans; Pelvic Girdle Pain; Pregnancy; Pubic Symphysis; Rectus Abdominis
PubMed: 35079827
DOI: 10.1093/ptj/pzab311 -
Journal of Clinical and Diagnostic... Jan 2016The symphysis pubis is formed at the confluence of the pubic bones. Each pubic bone consists of a body and two rami; the superior ramus is joined with the ilium and the...
INTRODUCTION
The symphysis pubis is formed at the confluence of the pubic bones. Each pubic bone consists of a body and two rami; the superior ramus is joined with the ilium and the inferior ramus with the ischium. The two bones meet in the midline at the pubic symphysis. The two inferior rami at the lower border of pubic symphysis subtend the subpubic angle. In females the subpubic angle is more than 90° and in males it is less than 90°. Most of the previous studies on the subpubic angle have been in children or adults, therefore data on fetuses did merit.
AIM
The aims of the present study were to measure the subpubic angle in developing human fetuses of different gestational age, whether it is sex dependent and to compare the results with that in the adults.
MATERIALS AND METHODS
A cross-sectional study conducted in the Department of Anatomy JN Medical College, AMU Aligarh, over a period of two years. A total of 41 fetuses immersion fixed in 10% formalin were obtained from the museum department of anatomy. For the purpose of study fetuses were divided into five groups according to gestational age. Group I comprises fetuses of 14-18weeks, group II 19-22weeks, group III 23-26weeks, group IV 27-30weeks, groupV >30weeks of gestation. Pubic symphyses were dissected, cleaned and subjected to radiological examination in the anteroposterior plane. With the help of radiographs subpubic angle was measured. Readings obtained were analysed statistically.
RESULTS
Subpubic angle ranged between 58°-64° throughout intrauterine life. Maximum angle (63°- 64°) was observed in group I and V and in the rest of the groups it was less than 60°, with highly significant (p-value<0.001) increase in the last group. Statistically significant sexual dimorphism was observed in group I and II fetuses (p-value <0.001). Subpubic angle was more in females during the first half and in the terminal part of gestation.
CONCLUSION
Subpubic angle remained acute throughout the intrauterine life, with significant widening in fetuses more than 30 weeks of gestation. Marked sexual dimorphism was noticed only in fetuses of 14-18 weeks and 19-22 weeks of gestation fetuses, although the values were invariably less than 90° (acute) in both the sexes but in females towards the higher side as in adults. Assessment of symphysis and subpubic arch during antenatal ultrasonography of pregnant women can be done to diagnose congenital widening of the symphysis or absence of symphysis altogether.
PubMed: 26894049
DOI: 10.7860/JCDR/2016/17699.7051 -
Translational Medicine @ UniSa Sep 2014In elite athletes, osteitis pubis is a common painful degenerative process of the pubic symphysis and surrounding soft tissues and tendons. We report the diagnostic...
BACKGROUND AND PURPOSE
In elite athletes, osteitis pubis is a common painful degenerative process of the pubic symphysis and surrounding soft tissues and tendons. We report the diagnostic pathway and the rehabilitation protocol of six elite athletes with osteitis pubis in three different sports, and compare protocol stages and time to return to competition.
METHODS
6 athletes (2 soccer, 2 basketball, 2 rugby players) were diagnosed with osteitis pubis stage III and IV according to Rodriguez classification using standard clinical and imaging criteria. After performing a baseline lumbo-pelvic assessment, the rehabilitation protocol described by Verrall was adapted to each individual athlete.
RESULTS
The length of time for each stage of the protocol was as follows; Stage 1 (rest from sport) was 26 +/- 5 days, Stage 2 (to achieve pain free running), 18 +/- 5 days, Stage 3 (squad training) 63 +/- 7, Stage 4 (return to competition) 86 +/- 15. Soccer players took longer to return to competition than basketball and rugby players. No recurrences were reported at 2 year follow-up.
CONCLUSION
The protocol presented ensures a safe return to elite athletes. The time from diagnosis to full recovery is longer in football players, and seems to increase with age.
PubMed: 25147768
DOI: No ID Found -
International Urogynecology Journal Oct 2022Our study aims to determine the interobserver variability of different ultrasound measurements (pubis-cervix distance, pubis-uterine fundus distance, and... (Observational Study)
Observational Study
OBJECTIVES
Our study aims to determine the interobserver variability of different ultrasound measurements (pubis-cervix distance, pubis-uterine fundus distance, and pubis-Douglascul-de-sac distance) previously analyzed for the ultrasound differential diagnosis of uterine prolapse (UP) and cervical elongation CE without UP.
MATERIALS AND METHODS
We conducted a prospective observational study with 40 patients scheduled to undergo surgical correction of UP and CE without UP. All patients underwent pelvic floor ultrasound examination by an examiner (E1) who acquired ultrasound images. Using these images, E1 measured the distances for the ultrasound differential diagnosis of UP and CE without UP, and these distances were compared with those measured by the other examiner (E2). Values were analyzed by calculating ICCs with 95% CIs.
RESULTS
For UP, excellent reliability was obtained for all measurements except the pubis-Douglascul-de-sac measurement at rest, which was moderate (ICC 0.596; p = 0.028) and for the difference between the pubis-Douglascul-de-sac measurement at rest and during the Valsalva maneuver, which was good (ICC 0.691; p < 0.0005). For CE without UP, interobserver reliability was excellent for all measurements analyzed except the pubis-cervix measurement during the Valsalva maneuver, which was moderate (ICC 0.535; p = 0.052) and for the pubis-Douglascul-de-sac measurement at rest, which was good (ICC 0.768; p < 0.0005).
CONCLUSIONS
There is excellent interobserver reliability in measurements of the difference in the distance from the pubic symphysis to the uterine fundus at rest and during the Valsalva maneuver for both UP and CE without UP, which are used for the ultrasound differential diagnosis of UP and CE without UP.
Topics: Diagnosis, Differential; Female; Humans; Imaging, Three-Dimensional; Observer Variation; Pelvic Organ Prolapse; Reproducibility of Results; Ultrasonography; Uterine Prolapse; Valsalva Maneuver
PubMed: 34618192
DOI: 10.1007/s00192-021-04980-y