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Journal of Biomechanical Engineering Oct 2023Biomechanics of the human pelvis and the associated implants are still a medical and engineering debated topic. Today, no biomechanical testing setup is dedicated to...
Biomechanics of the human pelvis and the associated implants are still a medical and engineering debated topic. Today, no biomechanical testing setup is dedicated to pelvis testing and associated reconstructive implants with accepted clinical relevance. This paper uses the computational experiment design procedure to numerically design a biomechanical test stand that emulates the pelvis physiological gait loading. The numerically designed test stand reduces the 57 muscles and joints' contact forces iteratively to only four force actuators. Two hip joints' contact forces and two equivalent muscle forces with a maximum magnitude of 2.3 kN are applied in a bilateral reciprocating action. The stress distribution of the numerical model of the developed test stand is very similar to that of the numerical model of the pelvis with all 57 muscles and joint forces. For instance, at the right arcuate line, the state of stress is identical. However, at the location of superior rami, there is a deviation ranging from 2% to 20% between the two models. The boundary conditions and the nature of loading adopted in this study are more realistic regarding the clinical relevance than state-of-the-art. The numerically developed biomechanical testing setup of the pelvis in this numerical study (Part I) was found to be valid for the experimental testing of the pelvis. The construct of the testing setup and the experimental testing of an intact pelvis under gait loading are discussed in detail in Part II: Experimental Testing.
Topics: Humans; Pelvis; Hip Joint; Gait; Muscles; Mechanical Phenomena; Biomechanical Phenomena
PubMed: 37199569
DOI: 10.1115/1.4062538 -
Evolutionary Anthropology Oct 2023Recent research on the pelvis has clarified the flexibility of pelvic bones to manage nearly infinite possibilities in terms of selection and drift, while still... (Review)
Review
Recent research on the pelvis has clarified the flexibility of pelvic bones to manage nearly infinite possibilities in terms of selection and drift, while still maintaining excellent bipedalism. Despite this work, and the studies outlining the diversity of pelvic morphology across the hominin lineage, conversations continue to be stymied by distractions related to purported trade-offs that the different functions the pelvis must either allow for (e.g., parturition) or directly perform (e.g., attachment sites of muscles). Here we show that tight constraints on morphology are not evident in the pelvic variation of multiple human populations. We thus provide further evidence that human pelves are not geometrically similar and that pelvic morphology successfully balances the intersection of population history, active selective, and drift.
Topics: Animals; Humans; Pelvis; Pelvic Bones; Hominidae; Communication
PubMed: 37609957
DOI: 10.1002/evan.22001 -
Injury Dec 2023Civilian gunshot fractures of the pelvic ring represent a unique challenge for orthopaedic surgeons due to a high incidence of complicating associated injuries.... (Review)
Review
INTRODUCTION
Civilian gunshot fractures of the pelvic ring represent a unique challenge for orthopaedic surgeons due to a high incidence of complicating associated injuries. Internationally accepted guidelines for these injuries are not available. The aim of this review is to summarize the available literature and to provide concise management recommendations.
METHODS
Literature search was performed using PubMed. The review focuses on civilian gunshot fractures of the pelvic ring and includes the acetabulum and hip joint only where it was deemed necessary for the understanding of the management of these patients.
RESULTS
The management of civilian transpelvic gunshot fractures is complicated by potentially life-threatening associated injuries, the risk of contamination with bowel content and retained bullets in joints. The infection risk is higher compared to extremity gunshot fractures. There is no clear evidence for the use of antibiotics available. The studies focusing on civilian pelvic ring gunshot fractures reported no case of orthopaedic fracture fixation in their series. Routine wash-out and debridement of fractures is not warranted based on the literature but conflicting recommendations for surgical interventions exist.
CONCLUSION
There is limited evidence available for civilian transpelvic gunshot fractures. The high frequency of associated injuries requires a thorough clinical examination and multidisciplinary management. We recommend routine antibiotic prophylaxis for all transpelvic gunshots. For fractures with a high risk of infection, a minimum of 24 h broad-spectrum antibiotics is recommended. The indication for orthopaedic fixation of civilian transpelvic gunshot fractures is based on the assessment of the stability of the fracture and is rarely necessary. Although conflicting recommendations exist, routine wash-out and debridement is not recommended based on the literature. Bullets buried in bone without contact to synovial fluid do not warrant removal, unless they have traversed large bowel and are accessible without undue morbidity. Furthermore, bullets should be routinely removed if they are retained in the hip joint, if mechanical irritation of soft tissues by projectiles is expected or if the bullet traversed large bowel before entering the hip joint.
Topics: Humans; Fractures, Bone; Fracture Fixation; Pelvic Bones; Pelvis; Wounds, Gunshot; Anti-Bacterial Agents; Retrospective Studies
PubMed: 37827874
DOI: 10.1016/j.injury.2023.111086 -
Journal of the American Academy of... Sep 2023For over a century, the plain radiograph has been used to measure and predict the development of pediatric hip conditions. Classic measurements, such as the acetabular... (Review)
Review
For over a century, the plain radiograph has been used to measure and predict the development of pediatric hip conditions. Classic measurements, such as the acetabular index, the center-edge angle, and the migration percentage, have stood the test of time and remain the default tools for any pediatric orthopaedic surgeons. However, in contemporary research, the terminology regarding these measurements has become markedly inconsistent. A substantial number of synonyms, acronyms, and similar, but not identical, terms are used to label measurements. This is perhaps unsurprising, considering decades of use and numerous suggested modifications. The results of treatment cannot be reliably compared if the measured parameters are not identical, and scientific analysis of disease requires consistent terminology. In this review, we aim both to provide historical definitions and identification of radiographic landmarks commonly used in three parameters of interest on pediatric AP radiographs and to examine the variability of landmarks and definitions in contemporary research.
Topics: Humans; Child; Names; Pelvis; Acetabulum; Orthopedic Surgeons; Orthopedics
PubMed: 37734040
DOI: 10.5435/JAAOSGlobal-D-23-00120 -
Pediatric Radiology Dec 2023Hip displacement in children with cerebral palsy (CP) is monitored by measuring migration percentage on anteroposterior pelvis radiographs. However, proper positioning...
BACKGROUND
Hip displacement in children with cerebral palsy (CP) is monitored by measuring migration percentage on anteroposterior pelvis radiographs. However, proper positioning for radiography in children with spasticity is difficult. The reliability and accuracy of migration percentage as a function of patient positioning is unknown.
OBJECTIVE
To determine the effects of patient positioning on migration percentage measurements in children with CP.
MATERIALS AND METHODS
We identified children with CP (≤18-year-old) with pelvis CT and anteroposterior pelvis radiograph obtained <6 months apart (10/2018-11/2021). Digitally reconstructed radiographs were generated from each pelvis CT, to simulate nine different patient positions: neutral; 10° and 20° lordosis and kyphosis; and 10° and 20° right rotation and left rotation. Two radiologists measured migration percentages from the simulated and real pelvis radiographs. We used Spearman's rho to assess inter-rater reliability, and Wilcoxon signed rank test to determine statistical significance.
RESULTS
We studied sixty-three children (male=41; median age=8 years; range=4-18 years). The two radiologists' migration percentage measurements were highly correlated with each other across all simulated and real radiographs (Spearman's rho=0.86-0.99, P<0.01). For both readers and hips, migration percentages measured from real radiographs were significantly different from those measured from neutral simulated radiographs (P<0.01), with median absolute difference=5-6 percentage points (PP) and interquartile range (IQR)=9-12 PP. When comparing migration percentage measurements from neutral simulated radiographs to those in kyphosis/lordosis and right/left rotations, median absolute differences were 2-4 PP (IQR=3-8 PP) and 4-15 PP (IQR=6-17 PP), respectively.
CONCLUSION
Inter-rater reliability of measured migration percentages is high, but accuracy decreases with patient positional changes.
Topics: Humans; Child; Male; Adolescent; Lordosis; Cerebral Palsy; Reproducibility of Results; Hip Dislocation; Radiography; Kyphosis; Pelvis; Patient Positioning
PubMed: 37833504
DOI: 10.1007/s00247-023-05783-7 -
Post Reproductive Health Jun 2024Radiotherapy is an effective cancer treatment, particularly for pelvic tumours. The number of patients with pelvic cancer being diagnosed and successfully treated is... (Review)
Review
Radiotherapy is an effective cancer treatment, particularly for pelvic tumours. The number of patients with pelvic cancer being diagnosed and successfully treated is growing. Radiotherapy to the pelvis causes lasting side-effects collectively referred to as pelvic radiation disease (PRD), including bowel, bladder, sexual dysfunction, vaginal and cervical stenoses, and menopause. There is growing interest in management of menopause in cancer survivors, with the primary focus on the oncologic risk of hormone replacement therapy (HRT). Research examining if the modality with which the cancer was treated causes menopause-specific side effects is rare; however, malabsorption syndromes and anatomical changes in the pelvis post-radiotherapy may complicate effective delivery and monitoring of HRT. Consideration of these changes may significantly benefit patients in this young and growing cohort; thus, there is an urgent need to raise awareness of PRD among all clinicians, including those providing menopause care.
Topics: Humans; Female; Menopause; Pelvic Neoplasms; Radiation Injuries; Cancer Survivors; Radiotherapy; Hormone Replacement Therapy; Pelvis
PubMed: 38458182
DOI: 10.1177/20533691241235060 -
International Journal of Gynaecology... Sep 2023Apical support is an important component of pelvic floor reconstruction for pelvic organ prolapse. Sacrospinous ligament fixation is a recognized procedure for apical... (Review)
Review
Apical support is an important component of pelvic floor reconstruction for pelvic organ prolapse. Sacrospinous ligament fixation is a recognized procedure for apical support. Complications from sacrospinous ligament fixation include pain (buttock and leg) and bleeding. There is some debate as to the optimal location for placement of the sacrospinous fixation sutures. This review summarizes the neuroanatomy of the coccygeus sacrospinous ligament as it pertains to the sacrospinous ligament fixation procedure. An appreciation of the neuroanatomy will lead to a better understanding of methods to reduce operative complications and improve suture placement. This paper also describes a technique for the sacrospinous fixation procedure to better assist clinicians in dissecting the connective tissue off the ligament. Removing or clearing the connective tissue off the ligament will allow critical landmarks to be easily palpated and hence a more accurate placement of sutures. This in turn may reduce the risk of perioperative complications.
Topics: Female; Humans; Gynecologic Surgical Procedures; Ligaments; Pelvic Organ Prolapse; Pelvis; Plastic Surgery Procedures; Treatment Outcome
PubMed: 36939527
DOI: 10.1002/ijgo.14751 -
Ethiopian Journal of Health Sciences Nov 2023X-ray Computed Tomography dose levels have been varying among modalities and scanning body regions due to the absence of incessant routine follow-up. Thus, the study...
BACKGROUND
X-ray Computed Tomography dose levels have been varying among modalities and scanning body regions due to the absence of incessant routine follow-up. Thus, the study aimed to compute the dose index discrepancies in Ethiopia for the most recurring scan protocols (head, chest, abdomen, and pelvis).
METHODS
A purposive sampling method was employed to select the hospitals due to the rare existence of functional CT scanners in Ethiopia. From the selected hospitals, a total of 1,385 (249 heads, 804 chests, 132 abdomens, and 200 pelvis) were collected in terms of standard dose metric values in the period of December 2019-March 2020. Patients' DLP was computed into mean value using IBM SPSS Statistics 20 software. From the mean DLP, we can compute the effective dose.
RESULTS
Patients' dose level disparity was observed in this study though it is below the ICRP standard level for all body regions except for pelvis DLP (593.37 mGy-cm) at Black Lion. The dose level for the head and chest are computed within the recommended level at all hospitals. Effective doses for the pelvis at four hospitals (Teklehaimanot, Black Lion, ALERT, Paul's, and Ayder hospitals) were computed as 6.45, 8.90, 5.08, 6.54, and 6.84 mSv respectively, and the effective doses for abdomen at Ayder Hospital was obtained to be 8.90 mSv, which is above the recommended value.
CONCLUSION
X-ray CT scanners are somewhat properly functioning although some sort of justification and optimization for pelvis and abdomen examinations are strongly recommended to implement as low as reasonably achievable principle.
Topics: Humans; Ethiopia; Tomography, X-Ray Computed; Radiation Dosage; Pelvis; Hospitals; Head; Female; Abdomen; Male; Thorax
PubMed: 38784484
DOI: 10.4314/ejhs.v33i6.11 -
International Journal of Molecular... Mar 2024The placenta is a transient but essential organ for normal in utero development, playing several essential functions in normal pregnancy [...].
The placenta is a transient but essential organ for normal in utero development, playing several essential functions in normal pregnancy [...].
Topics: Female; Pregnancy; Humans; Pelvis; Placenta
PubMed: 38612405
DOI: 10.3390/ijms25073594 -
BJS Open Nov 2023Pelvic anatomy is critical in challenging rectal resections. This study investigated how pelvic anatomy relates to total mesorectal excision (TME) quality, anastomotic...
BACKGROUND
Pelvic anatomy is critical in challenging rectal resections. This study investigated how pelvic anatomy relates to total mesorectal excision (TME) quality, anastomotic leakage rate, and long-term oncological outcomes.
METHODS
Patients undergoing elective rectal cancer resection from 2008 to 2017 in an Austrian institution were retrospectively reviewed regardless of the surgical approach. CT scans were analysed for pelvic measurements and volumes. The primary outcomes of interest were the correlation between pelvic dimensions and the TME quality and anastomotic leakage. Subanalysis was done by surgical approach (open, laparoscopic, transanal TME). Secondary outcomes were overall and disease-free survivals.
RESULTS
Among 154 eligible patients, 112 were included. The angle between pubic symphysis and promontory significantly correlated with worse TME grades (TME grade 1: mean(s.d.) 102.7(5.7)°; TME grade 2: 92.0(4.4)°; TME grade 3: 91.4(3.6)°; P < 0.001). A significantly lower distance between tumour and circumferential resection margin (CRM) was observed in grade 3 resections, whereas no difference appeared in grade 1 and grade 2 resection (TME grade 1: mean(s.d.) 11.92(9.4) mm; TME grade 2: 10.8(8.1) mm; TME grade 3: 3.1(4.1) mm; P = 0.003). The anastomotic leakage rate was significantly higher in case of a lower CRM (patients with anastomotic leakage: mean(s.d.) 6.8(5.8) mm versus others: 12.6(9.8) mm, P = 0.027), but not associated with pelvimetry measurements. The transanal TME (TaTME) subgroup displayed a wider angle between the pubic symphysis and promontory, younger age and improved TME quality compared to others (respectively, mean TME grades in TaTME versus open versus laparoscopic: 1.0 ± 0.0, 1.5 ± 0.7 and 1.3 ± 0.5, P = 0.013). Finally, oncological survival was not impacted by pelvic measurements or worse TME quality.
CONCLUSION
The angle between the pubic symphysis and promontory and the distance between tumour and CRM were associated with worse TME grades. The anastomotic leakage was associated with a lower CRM but not with pelvimetric measures.
Topics: Female; Humans; Anastomotic Leak; Retrospective Studies; Rectal Neoplasms; Pelvis; Morbidity
PubMed: 38006203
DOI: 10.1093/bjsopen/zrad114