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Orthopaedic Journal of Sports Medicine Feb 2022The cleft sign (CS) and bone marrow edema (BME) are considered magnetic resonance imaging (MRI) findings signifying a pubic pathology, which is associated with groin...
BACKGROUND
The cleft sign (CS) and bone marrow edema (BME) are considered magnetic resonance imaging (MRI) findings signifying a pubic pathology, which is associated with groin pain; however, their relationship with bony morphology related to femoroacetabular impingement (FAI) has not been established.
PURPOSE
To investigate the prevalence of CS and BME in symptomatic patients with acetabular labral tears and assess their possible association with bone morphology and sport-specific activities.
STUDY DESIGN
Cross-sectional study; Level of evidence, 3.
METHODS
This study enrolled 418 patients (469 hips) undergoing hip arthroscopic surgery for labral tears. Also included were patients with labral tears in the setting of either hip dysplasia or borderline hip dysplasia who were undergoing endoscopic shelf acetabuloplasty combined with hip arthroscopic labral repair, cam osteoplasty, and capsular plication. All patients were screened for superior CS (SCS), inferior CS (ICS), and BME of the ipsilateral side of the pubis using 3-T MRI. We measured the following angles: lateral center edge (LCE), Sharp, Tönnis, vertical-central-anterior, and alpha. Then, we evaluated the relationship between patient characteristics and abnormal findings on MRI scans (preoperatively vs 1 year postoperatively).
RESULTS
An overall 397 hips were included: 200 in men and 197 in women (mean ± SD age, 35.3 ± 16.0 years). There were hips in 214 athletes (53.9%) and hips in 183 nonathletes (46.1%). MRI findings revealed SCS, ICS, and BME in 18 (4.5%), 13 (3.3%), and 34 hips (8.6%), respectively. Abnormal MRI findings at the pubis were seen more often in athletes than nonathletes (23.8% vs 3.3%), and contact sports athletes had the most frequent abnormalities. There was no SCS in patients with an LCE angle <22°. SCS was more frequently seen in those who had an alpha angle ≥71°. More than 60% of abnormal findings at the pubis diminished after arthroscopic surgery that included FAI correction and labral repair.
CONCLUSION
In patients with labral tears, CS and BME were seen more frequently in athletes versus nonathletes, especially contact athletes with FAI-related bony abnormalities. More than 60% of abnormal MRI pubis findings resolved after arthroscopic treatment of FAI.
PubMed: 35141338
DOI: 10.1177/23259671211068477 -
Spartan Medical Research Journal 2023Sacral fractures are an important consideration in high-energy traumas associated with injuries to the pelvic ring that confer much of pelvic stability. A midline...
INTRODUCTION
Sacral fractures are an important consideration in high-energy traumas associated with injuries to the pelvic ring that confer much of pelvic stability. A midline longitudinal sacral fracture (MLS) is a relatively rare fracture pattern, with only 23 cases of MLS fractures reported in the literature to date. This systematic review evaluates overall mechanisms of MLS injury, associated injuries, complications, management, and fracture prognosis.
METHODS
A 1952-2021 PubMed literature search yielded 11 publications reporting the outcomes of a total of 23 MLS fracture cases.
RESULTS
Of the 23 MLS patients, 15 (65%) were male and eight (35%) were female, with an average age of 37.25. Ten (43.5%) MLS fractures occurred during motor vehicle collisions and eight (34.7%) because of motorcycle accidents. The most common pelvic ring injuries associated with MLS were pubic symphysis diastasis (n = 12, 57%) and pubic ramus fractures (n = 11, 48%). Patients most frequently suffered intra-pelvic organ dysfunction such as sexual dysfunction or bowel/bladder/urethral injuries. Fractures were treated both operatively or non-operatively and generally showed clinical meaningful resolution at 10 weeks post-injury.
CONCLUSIONS
MLS injuries most often occur in high-energy trauma due to motor vehicle or motorcycle accidents as well as crush injuries, leg splitting, direct perineal/perianal impacts. Pre-trauma sacral abnormalities could be potentially predisposing factors correlated with MLS fractures. Careful review of x-rays and CT scans may help reveal MLS fractures, which can go initially undiagnosed. Operative and nonoperative management strategies includes bedrest, transsacral transiliac screw, decompressive laminotomies, and/or pelvic external fixation. The outcomes reported to date have been generally favorable, with most patients healing at approximately 10 weeks. Keywords: Midline sacral fracture; vertical sacral fracture; sacrum; pelvic ring injury.
PubMed: 38084338
DOI: 10.51894/001c.38909 -
The Cochrane Database of Systematic... Sep 2015Symphysis fundal height (SFH) measurement is commonly practiced primarily to detect fetal intrauterine growth restriction (IUGR). Undiagnosed IUGR may lead to fetal... (Review)
Review
BACKGROUND
Symphysis fundal height (SFH) measurement is commonly practiced primarily to detect fetal intrauterine growth restriction (IUGR). Undiagnosed IUGR may lead to fetal death as well as increase perinatal mortality and morbidity.
OBJECTIVES
The objective of this review is to compare SFH measurement with serial ultrasound measurement of fetal parameters or clinical palpation to detect abnormal fetal growth (IUGR and large-for-gestational age), and improving perinatal outcome.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (14 July 2015) and reference lists of retrieved articles.
SELECTION CRITERIA
Randomised controlled trials including quasi-randomised and cluster-randomised trials involving pregnant women with singleton fetuses at 20 weeks' gestation and above comparing tape measurement of SFH with serial ultrasound measurement of fetal parameters or clinical palpation using anatomical landmarks.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.
MAIN RESULTS
One trial involving 1639 women was included. It compared SFH measurement with clinical abdominal palpation.There was no difference in the two reported primary outcomes of incidence of small-for-gestational age (risk ratio (RR) 1.32; 95% confidence interval (CI) 0.92 to 1.90, low quality evidence) or perinatal death.(RR 1.25, 95% CI 0.38 to 4.07; participants = 1639, low quality evidence). There were no data on the neonatal detection of large-for-gestational age (variously defined by authors). There was no difference in the reported secondary outcomes of neonatal hypoglycaemia, admission to neonatal nursery, admission to the neonatal nursery for IUGR (low quality evidence), induction of labour and caesarean section (very low quality evidence). The trial did not address the other outcomes specified in the 'Summary of findings' table (intrauterine death; neurodevelopmental outcome in childhood). GRADEpro software was used to assess the quality of evidence, downgrading of evidence was based on including a small single study with unclear risk of bias and a wide confidence interval crossing the line of no effect.
AUTHORS' CONCLUSIONS
There is insufficient evidence to determine whether SFH measurement is effective in detecting IUGR. We cannot therefore recommended any change of current practice. Further trials are needed.
Topics: Abdomen; Female; Fetal Growth Retardation; Humans; Palpation; Pregnancy; Pubic Symphysis; Randomized Controlled Trials as Topic; Ultrasonography, Prenatal; Uterus
PubMed: 26346107
DOI: 10.1002/14651858.CD008136.pub3 -
OTA International : the Open Access... Dec 2022To compare the stability of screw fixation with that of plate fixation for symphyseal injuries in a vertically unstable pelvic injury (AO/Tile 61-C1) associated with...
To compare the stability of screw fixation with that of plate fixation for symphyseal injuries in a vertically unstable pelvic injury (AO/Tile 61-C1) associated with complete disruption of the sacroiliac joint and the pubic symphysis. Eight fourth-generation composite pelvis models with sacroiliac and pubic symphyseal disruption (Sawbones, Vashon Island, WA) underwent biomechanical testing simulating static single-leg stance. Four were fixed anteriorly with a symphyseal screw, and 4 with a symphyseal plate. All had single transsacral screw fixation posteriorly. Displacement and rotation were monitored at both sacroiliac joint and pubic symphysis. There was no significant difference between the 2 groups for mean maximum force generated. There was no significant difference in net displacement at both sacroiliac joint and pubic symphysis. There was significantly less rotation but more displacement in the screw group in the -axis. The screw group showed increased stiffness compared with the plate group. This is the first biomechanical study to compare screw versus plate symphyseal fixation in a Tile C model. Our biomechanical model using anterior and posterior fixation demonstrates that symphyseal screws may be a viable alternative to classically described symphyseal plating.
PubMed: 36569108
DOI: 10.1097/OI9.0000000000000215 -
Archives of Orthopaedic and Trauma... Apr 2023Open reduction and internal fixation with plates is the most widespread surgery in traumatic pubic symphysis diastasis. However, implant failure or recurrent diastasis...
INTRODUCTION
Open reduction and internal fixation with plates is the most widespread surgery in traumatic pubic symphysis diastasis. However, implant failure or recurrent diastasis was commonly observed during follow-up. The aim of our study was to evaluate the radiologic findings and clinical outcomes.
MATERIALS AND METHODS
Sixty-five patients with traumatic pubic symphysis diastasis treated with plating between 2008 and 2019 were retrospectively reviewed. The exclusion criteria were a history of malignancy and age under 20 years. Radiographic outcomes were determined by radiograph findings, including pubic symphysis distance (PSD) and implant failure. Clinical outcomes were assessed according to the Majeed score at the final follow-up.
RESULTS
Twenty-eight patients were finally included. Nine patients (32%) experienced implant failure, including four (14%) with screw loosening and five (18%) with plate breakage. Only one patient underwent revision surgery. Postoperatively, a significant increase in PSD was observed at 3 months and 6 months. Postoperative PSD was not significantly different between patients with single plating and double plating, but it was significantly greater in the implant-failure group than in the non-failure group. The Majeed score was similar between patients with single plating and double plating or between the implant-failure group and the non-failure group. Body mass index, number of plates, age, and initial injured PSD were not significantly different between the implant-failure group and the non-failure group. Only a significant male predominance was observed in the implant-failure group.
CONCLUSION
A gradual increase in the symphysis distance and a high possibility of implant failure may be the distinguishing features of traumatic pubic symphysis diastasis fixation. The postoperative symphyseal distance achieved stability after 6 months, even after implant failure. Radiographic outcomes, such as increased symphysis distance, screw loosening, and plate breakage, did not affect clinical functional outcomes.
Topics: Female; Humans; Male; Young Adult; Adult; Pubic Symphysis Diastasis; Retrospective Studies; Fracture Fixation, Internal; Pubic Symphysis; Bone Plates
PubMed: 35278092
DOI: 10.1007/s00402-022-04411-7 -
Gaceta Medica de Mexico 2016Trauma is the most common cause of death in young adults. A multidisciplinary trauma team consists of at least a surgical team, an anesthesiology team, radiologic team,... (Review)
Review
BACKGROUND
Trauma is the most common cause of death in young adults. A multidisciplinary trauma team consists of at least a surgical team, an anesthesiology team, radiologic team, and an emergency department team.
OBJECTIVE
Recognize the integration of multidisciplinary medical team in managing the trauma patient and which must include the radiologist physician responsible for the institutional approach to the systematization of the trauma patient regarding any radiological and imaging study with emphasis on the FAST (del inglés, Focused Assessment with Sonography in Trauma)/USTA, Whole body computed tomography.
METHODS
Ultrasound is a cross-sectional method available for use in patients with major trauma. Whole-body multidetector computed tomography became the imaging modality of choice in the late 1990s.
RESULTS
In patients with major trauma, examination FAST often is the initial imaging examination, extended to extraabdominal regions. Patients who have multitrauma from blunt mechanisms often require multiple diagnostic examinations, including Computed Tomography imaging of the torso as well as abdominopelvic Computed Tomography angiography.
CONCLUSIONS
Multiphasic Whole-body trauma imaging is feasible, helps detect clinically relevant vascular injuries, and results in diagnostic image quality in the majority of patients. Computed Tomography has gained importance in the early diagnostic phase of trauma care in the emergency room. With a single continuous acquisition, whole-body computed tomography angiography is able to demonstrate all potentially injured organs, as well as vascular and bone structures, from the circle of Willis to the symphysis pubis.
Topics: Emergency Service, Hospital; Humans; Multidetector Computed Tomography; Multiple Trauma; Patient Care Team; Radiologists; Wounds, Nonpenetrating
PubMed: 27595259
DOI: No ID Found -
SpringerPlus 2016To examine whether the association between spinal alignment and sacral anatomical orientation (SAO) can be detected in skeletal populations, by comparing SAO values in...
To examine whether the association between spinal alignment and sacral anatomical orientation (SAO) can be detected in skeletal populations, by comparing SAO values in individuals with a typical SD to individuals with normal spinal alignment. 2025 skeletons were screened for Scheuermann's disease. Scheuermann's kyphosis was established by the presence of apophyseal abnormalities associated with more than 5° of anterior wedging in each of three adjacent vertebrae. SAO was measured as the angle created between the intersection of a line running parallel to the superior surface of the sacrum and a line running between the anterior superior iliac spine and the anterior-superior edge of the symphysis pubis (PUBIS). SAO was measured on 185 individuals with normal spines and 183 individuals with Scheuermann's kyphosis. Out of 2025 skeletons, 183 (9 %) were diagnosed with Scheuermann's kyphosis. The sacrum was significantly more horizontally oriented in individuals with Scheuermann's kyphosis compared with the control (SAO: 44.44 ± 9.7° vs. 50 ± 9.9°, p < 0.001). Alteration in spinal biomechanics due to a horizontally orientated sacrum may be an important contributing factor for the development of Scheuermann's kyphosis.
PubMed: 26933639
DOI: 10.1186/s40064-016-1772-x -
International Journal of Environmental... May 2022Pregnancy-related lumbopelvic pain is a common musculoskeletal problem, and postural changes are believed to be involved in these disorders. However, the lumbopelvic...
Pregnancy-related lumbopelvic pain is a common musculoskeletal problem, and postural changes are believed to be involved in these disorders. However, the lumbopelvic alignment changes in postpartum women remain unclear. This study aimed to determine whether there are changes in lumbopelvic alignment following vaginal or cesarean delivery and when these alignment changes occur after delivery. Thirty postpartum females (PP group) and 20 nulliparous female controls (CTL group) underwent anteroposterior, lateral pelvic, and lower-back X-ray in a static upright position. Digital radiographic images were analyzed and three radiographic variables, the pelvic incidence, pubic symphysis width, and sacral slope, were measured. The pubic symphysis width of the PP group was significantly larger immediately and one month after childbirth (PP group: 6.0 ± 1.1 mm (immediately), 5.0 ± 1.2 mm (one month); CTL group: 3.4 ± 0.4 mm; F = 31.79, p < 0.001). The sacrum slope in the PP group was significantly larger than in the CTL group 1 month after childbirth (PP group: 39.9 ± 6.6°; CTL group: 32.8 ± 5.1°; F = 2.59, p = 0.05). A two-way analysis of variance indicated no statistically significant main effects or interaction effects between the delivery modes on the pubic symphysis width or the sacrum slope. This study suggested that the course of lumbopelvic alignment progressed towards recovery for at least one month, and that these changes were independent of the delivery method.
Topics: Female; Humans; Parturition; Pelvis; Postpartum Period; Pregnancy; Pubic Symphysis; Spine
PubMed: 35627342
DOI: 10.3390/ijerph19105807 -
Acta Orthopaedica Et Traumatologica... Jul 2023This study aimed to improve the surgical anatomical knowledge of pelvic/acetabular trauma surgeons by providing detailed morphometric data on some of the most vulnerable...
OBJECTIVE
This study aimed to improve the surgical anatomical knowledge of pelvic/acetabular trauma surgeons by providing detailed morphometric data on some of the most vulnerable arteries and nerves due to constant bony landmarks during anterior intra-pelvic approach fixation of acetabular fractures in women.
METHODS
Ten hemipelvis were dissected from 5 female cadavers. The following measurements relative to the symphysis were performed: (1) the distance of the corona mortis anastomosis and (2) the bisection of the external iliac vein with the pubic ramus. In addition, dis- tance to the pelvic brim at the level of pectineal convexity of the following structures was measured: (3) depth of obturatory neurovascu- lar bundle, (4) superior vesical artery, and (5) vaginal artery. Also, the clock position of the (6) gluteal superior and inferior vessels due to sciatic notch in the supine position. Due to antero-superior corner of sacroiliac joint (7) location of the common iliac artery bifurcation, (8) location of the bifurcation of internal iliac vessels to truncuses, (9) bifurcation of superior gluteal artery and lateral sacral artery, and (10) L5 nerve were measured. The descriptive statistics were given as medians and ranges as this is a descriptive anatomical study without comparisons.
RESULTS
The median distance of corona mortis to symphysis pubis was 59.5 mm (range = 58-61). The external iliac vein bisected the pubic arm 68.5 mm (range=65-70) lateral to the symphysis pubis. At the level of pectineal convexity (about the middle of the pelvic brim), obturatory neurovascular bundle, superior vesical artery, and vaginal artery were 15 mm (range=13-16), 24 mm (range=23-25), and 36 mm (range=34-38) inferior to the pelvic brim, respectively. The superior gluteal vessels leave the sciatic notch at 12 o'clock position in supine position. Inferior gluteal vessels leave the sciatic notch at 31⁄2 o'clock position (given for left side). Common iliac artery bifurcation bisects the SI joint 5 mm (4-7) superior to antero-superior corner of the Sacro-iliac (SI) joint. The internal iliac artery gives its posterior trunk 18 mm (range=15-20) straightly anterior to antero-superior corner of the SI joint. Bifurcation of superior gluteal artery and lateral sacral artery was 11 mm (range = 10-12) away from the beginning of the posterior truncus. L5 root's medial margin was 9 mm (range = 7-10) medial to this landmark, where its lateral margin was on the SI joint (2 mm medial to 2 mm lateral).
CONCLUSION
The majority of the bleeding complications of the major branches of the internal and external iliac arteries and neurologic palsies due to obturatory nerve and L5 nerve root damage within the operative field of the anterior intra-pelvic approach can be avoided or managed by utilizing morphometric data provided from this study.
LEVEL OF EVIDENCE
N/A.
Topics: Female; Humans; Pelvis; Sacroiliac Joint; Arteries; Iliac Vein; Cadaver
PubMed: 37670452
DOI: 10.5152/j.aott.2023.23013