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Emergency Medicine Clinics of North... Feb 2020Traumatic injuries of the hip and pelvis are commonly encountered in the emergency department. This article equips all emergency medicine practitioners with the... (Review)
Review
Traumatic injuries of the hip and pelvis are commonly encountered in the emergency department. This article equips all emergency medicine practitioners with the knowledge to expertly diagnose, treat, and disposition these patients. Pelvic fractures occurring in young patients tend to be associated with high-energy mechanisms and polytrauma. Pelvic and hip fractures in the elderly are often a result of benign trauma but are associated with significant morbidity and mortality.
Topics: Disease Management; Emergencies; Fractures, Bone; Humans; Multiple Trauma; Orthopedic Procedures; Pelvic Bones; Radiography
PubMed: 31757246
DOI: 10.1016/j.emc.2019.09.011 -
Scandinavian Journal of Surgery : SJS :... Sep 2023Primary sarcomas of bone are rare malignant mesenchymal tumors. The most common bone sarcomas are osteosarcoma, Ewing's sarcoma, and chondrosarcoma. The prognosis has... (Review)
Review
Primary sarcomas of bone are rare malignant mesenchymal tumors. The most common bone sarcomas are osteosarcoma, Ewing's sarcoma, and chondrosarcoma. The prognosis has improved over the years, but bone sarcomas are still life-threatening tumors that need a multidisciplinary approach for diagnosis and treatment. Bone sarcomas arising in the pelvis present a unique challenge to orthopedic oncologists due to the absence of natural anatomical barriers, the close proximity of vital neurovascular structures, and the high mechanical demands placed on any pelvic reconstruction following the excision of the tumor. While radiotherapy has an important role especially in Ewing's sarcoma and chemotherapy for both Ewing's sarcoma and osteosarcoma, surgery remains the main choice of treatment for all three entities. While external hemipelvectomy has remained one option, the main aim of surgery is limb salvage. After complete tumor resection, the bone defect needs to be reconstructed. Possibilities to reconstruct the defect include prosthetic or biological reconstruction. The method of reconstruction is dependent on the location of tumor and the surgery required for its removal. The aim of this article is to give an insight into pelvic bone sarcomas, their oncological and surgical outcomes, and the options for treatment based on the authors' experiences.
Topics: Humans; Sarcoma, Ewing; Bone Neoplasms; Prognosis; Sarcoma; Osteosarcoma; Pelvic Bones; Pelvis; Soft Tissue Neoplasms
PubMed: 37438963
DOI: 10.1177/14574969231181504 -
Skeletal Radiology Jul 2021The anatomic extent of a pelvic bone tumor and the need for reconstruction dictate the type of pelvic resection (limb salvage pelvic resection or amputation). If a... (Review)
Review
The anatomic extent of a pelvic bone tumor and the need for reconstruction dictate the type of pelvic resection (limb salvage pelvic resection or amputation). If a pelvic bone tumor resection involves two or more critical anatomic structures (the sciatic nerve, femoral neurovascular bundle or the hip joint), then reasonable functional recovery after limb salvage is less likely and amputation should be considered. Both limb salvage and amputation approaches to the pelvis are technically arduous surgeries with significant associated morbidity and complications. As such, imaging plays an important role in the post-operative management of patients who have undergone pelvic bone tumor resection. In this article, we will review optimal imaging techniques as well as the expected post-operative appearance after pelvic bone tumor resection and important complications including infection, tumor recurrence, and complications related to complex soft tissue and osseous reconstruction.
Topics: Bone Neoplasms; Hip Joint; Humans; Neoplasm Recurrence, Local; Pelvic Bones; Treatment Outcome
PubMed: 33399942
DOI: 10.1007/s00256-020-03703-6 -
The Journal of Bone and Joint Surgery.... Oct 2021The proper diagnosis and treatment of patients with concurrent hip and spine pathological processes can be challenging because of the substantial overlap in... (Review)
Review
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The proper diagnosis and treatment of patients with concurrent hip and spine pathological processes can be challenging because of the substantial overlap in symptomatology.
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There is no consensus on which pathological condition should be addressed first.
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Factors such as advanced spinal degeneration, deformity, and prior fusion alter the biomechanics of the spinopelvic unit. Attention should be paid to recognizing these issues during the work-up for a total hip arthroplasty as they can result in an increased risk of dislocation.
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In patients with concurrent spine and hip degeneration, the surgeon must pay close attention to appropriate implant positioning and have consideration for implants with enhanced stability to minimize the risk of dislocation.
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A proper understanding of sagittal balance and restoration of this balance is integral to improving patient outcomes following spinal surgery.
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The advent of new imaging modalities, increased awareness of spinopelvic mobility, as well as a better understanding of sagittal alignment will hopefully improve our treatment of patients with hip-spine syndrome.
Topics: Acetabulum; Hip Joint; Humans; Joint Diseases; Pelvic Bones; Range of Motion, Articular; Spinal Diseases
PubMed: 34612850
DOI: 10.2106/JBJS.20.01728 -
Zeitschrift Fur Orthopadie Und... Aug 2019Pelvic fractures may range from highly severe, life-threatening injuries to less acute clinical entities. There are several sub-entities that are summed up as pelvic... (Review)
Review
Pelvic fractures may range from highly severe, life-threatening injuries to less acute clinical entities. There are several sub-entities that are summed up as pelvic injuries. Anatomically, there are fractures of the anterior or posterior pelvic ring. Apart from these, there are fractures of the acetabulum that make up about one fifth of all pelvic injuries. The indication for surgical treatment of pelvic ring injuries depends on the type of injury, involvement of anterior and/or posterior elements of the pelvic ring, demands and the general condition of the patient. In acetabular fractures, indications depend on the dislocation of the fracture and of course also the needs of the patient and his general condition. An intraarticular step-off of more than 2 mm is usually considered as an indication for open reduction and osteosynthesis. Usually in all these injuries, a preoperative CT scan is mandatory to allow precise planning of the operative approach and technique. Intraoperatively, the surgeon should be familiar with the acquisition of the 2D standard views, including 2D imaging of the pelvic ring and the acetabulum. These consist of the anteroposterior view for both pelvic ring and acetabular osteosyntheses. For further assessment of pelvic ring treatments, inlet and outlet views are achievable by angulating the C-arm cranially and caudally. To assess aspects of the anterior and posterior column of the acetabulum, iliac oblique views are used. Here, the C-arm is rotated laterally. As evaluation of 2D views can be limited due to anatomy and superposing structures, intraoperative 3D imaging has become common in the last decade. Special C-arms allow the automatic acquisition of large numbers of projections and create CT-like views of the central volume. Although this method has significantly widened the possibilities of intraoperative imaging, some issues remain. Depending on the amount of implants placed in the imaging field, assessment can be seriously impaired due to artefacts caused by the implants. Intraoperative CT imaging promises enhanced image quality for artefacts and allows a considerably larger field of view. The use of radiation-free navigation facilitates implant placement in minimally invasive procedures like screw placement in the sacroiliacal joint or the acetabulum by visualisation of instruments and implants in a pre- or intraoperative 3D data set.
Topics: Acetabulum; Fracture Fixation; Fracture Fixation, Internal; Fractures, Bone; Humans; Intraoperative Care; Pelvic Bones; Tomography, X-Ray Computed
PubMed: 30419588
DOI: 10.1055/a-0732-5986 -
Injury Apr 2023Open pelvic ring injuries are rare clinical entities that require multidisciplinary care. Due to the scarcity of this injury, there is no well-defined treatment... (Review)
Review
Open pelvic ring injuries are rare clinical entities that require multidisciplinary care. Due to the scarcity of this injury, there is no well-defined treatment algorithm. As a result, conflicting evidence surrounding various aspects of care including wound management and fecal diversion remain. Previous studies have shown mortality reaching 50% in open pelvic ring injuries, nearly five times higher than closed pelvic ring injuries. Early mortality is due to exsanguinating hemorrhage, while late mortality is due to wound sepsis and multiorgan system failure. With advancements in trauma care and ATLS protocols, there has been an improved survival rate reported in published case series. Major considerations when treating these injuries include aggressive resuscitation with hemorrhage control, diagnosis of associated injuries, prevention of wound sepsis with early surgical management, and definitive skeletal fixation. Classification systems for categorization and management of bony and soft tissue injury related to pelvic ring injuries have been established. Fecal diversion has been proposed to decrease rates of sepsis and late mortality. While clear indications are lacking due to limited studies, previous studies have reported benefits. Further large-scale studies are necessary for adequate evaluation of treatment protocols of open pelvic ring injuries. Understanding the role of fecal diversion, avoidance of primary closure in open pelvic ring injuries, and importance of well-coordinated care amongst surgical teams can optimize patient outcomes.
Topics: Humans; Pelvic Bones; Pelvis; Fractures, Open; Fracture Fixation; Sepsis; Fractures, Bone; Retrospective Studies
PubMed: 36792402
DOI: 10.1016/j.injury.2023.02.006 -
Acta Oncologica (Stockholm, Sweden) Oct 2023Pelvic insufficiency fractures (PIFs) are a late complication of radiotherapy for pelvic malignancies. We evaluated the incidence, radiologic findings, clinical course,...
BACKGROUND
Pelvic insufficiency fractures (PIFs) are a late complication of radiotherapy for pelvic malignancies. We evaluated the incidence, radiologic findings, clinical course, and outcome of PIFs in patients treated with neoadjuvant (chemo)radiotherapy ((C)RT) for rectal cancer.
MATERIAL AND METHODS
Data of patients diagnosed with rectal cancer from a large teaching hospital treated from 2002 to 2012 were extracted from the Dutch Cancer Registry. All hospital records were reviewed for the diagnosis of PIFs or pelvic bone metastases. An expert radiologist reassessed all imaging procedures of the lower back, abdomen, and pelvis.
RESULTS
A total of 513 rectal cancer patients were identified of whom 300 patients (58.5%) were treated with neoadjuvant (C)RT (long- vs. short-course radiotherapy: 91 patients [17.7%] vs. 209 [40.7%], respectively). Twelve PIFs were diagnosed initially according to hospital records and imaging reports of all 513 patients. These 12 patients were treated with neoadjuvant (C)RT. After reassessment of all pelvic imaging procedures done in this patient group (432 patients (84.2%)), 20 additional PIFs were detected in patients treated with neoadjuvant (C)RT, resulting in a 10.7% PIF rate in irradiated patients. One PIF was detected in the group of patients not treated with neoadjuvant (C)RT for rectal cancer. This patient had palliative radiotherapy for prostate cancer and is left out of the analysis. Median follow-up time of 32 PIF patients was 49 months. Median time between start of neoadjuvant (C)RT and diagnosis of PIF was 17 months (IQR 9-28). Overall median survival for patients with PIF was 63.5 months (IQR 44-120).
CONCLUSION
PIFs are a relatively common late complication of neoadjuvant (C)RT for rectal cancer but are often missed or misdiagnosed as pelvic bone metastases. The differentiation of PIFs from pelvic bone metastases is important because of a different treatment and disease outcome.
Topics: Male; Humans; Fractures, Stress; Neoadjuvant Therapy; Pelvic Bones; Pelvis; Rectal Neoplasms; Chemoradiotherapy; Retrospective Studies; Neoplasm Staging
PubMed: 37656773
DOI: 10.1080/0284186X.2023.2252168 -
The Urologic Clinics of North America Aug 2022Posterior pelvic fracture urethral distraction defects (PFUDD) can present formidable challenges in genitourinary reconstruction. Once the acuity of trauma subsides, the... (Review)
Review
Posterior pelvic fracture urethral distraction defects (PFUDD) can present formidable challenges in genitourinary reconstruction. Once the acuity of trauma subsides, the patient is often faced with chronic, debilitating genitourinary injuries. Treatment requires an astute diagnostic and technical approach, with definitive repair best accomplished in the hands of experts. A delayed, stepwise approach to repair following the resolution of acute injuries remains a time-tested platform for optimal outcomes. The evaluation, relevant anatomy, and approach to surgical repair are described herein.
Topics: Fractures, Bone; Humans; Pelvic Bones; Retrospective Studies; Urethra
PubMed: 35931431
DOI: 10.1016/j.ucl.2022.04.003 -
Der Unfallchirurg May 2020The main injury mechanism of rare pelvic girdle injuries in children is high-energy trauma with a high rate of accompanying injuries and a mortality up to 6%....
The main injury mechanism of rare pelvic girdle injuries in children is high-energy trauma with a high rate of accompanying injuries and a mortality up to 6%. Anatomical features often result in complex pelvic trauma. Emergency treatment is based on established standards in adults. Definitive treatment is mostly conservative and implants adapted for children are increasingly used. Long-term consequences have to be considered, especially after unstable pelvic ring injuries. A correlation exists between clinical and radiological results. Due to the difficult radiological assessment, acetabular injuries are easily overlooked. The Salter-Harris classification appears to be prognostically useful. Most acetabular injuries can be treated conservatively. Considerable displacement or additional intra-articular injuries necessitate open reduction and internal fixation. Frequent follow-up examinations up to the end of the growth phase avoid posttraumatic acetabular dysplasia being overlooked.
Topics: Acetabulum; Adult; Child; Fracture Fixation, Internal; Fractures, Bone; Humans; Multiple Trauma; Pelvic Bones
PubMed: 32328713
DOI: 10.1007/s00113-020-00799-2 -
Orthopaedics & Traumatology, Surgery &... Feb 2020Pelvic fractures in children are rare and often the result of high-energy trauma. The possibility of associated lesions cannot be ignored. Treatment at a specialized... (Review)
Review
Pelvic fractures in children are rare and often the result of high-energy trauma. The possibility of associated lesions cannot be ignored. Treatment at a specialized children's hospital is a must. The multidisciplinary care team must include a paediatric orthopaedic surgeon. In the emergency room, the surgeon contributes to haemodynamic stabilization of the child by reducing and stabilizing posterior arch fractures and restoring the skeletal cohesion to make it easier to move the child and allow other examinations to be performed. Imaging modalities are used to determine the stability of the pelvic ring fracture, the risk of epiphysiodesis of an acetabulum fracture if the triradiate cartilage is open and the joint congruency if the triradiate cartilage is closed. Internal fixation can be used if surgery is being performed for associated non-orthopaedic injuries. Most vertically stable fractures are treated non-surgically. Fractures that are unstable vertically will require surgical treatment. Treatment of acetabulum fractures depends on the status of the triradiate cartilage. In older children, it is similar to the treatments used in adults. In children with open growth plates, the goal is to make sure the acetabulum continues growing. In all cases, the patients must be instructed to start physical therapy as soon as possible. Full recovery can be expected after stable pelvic fractures. Unstable pelvic fractures can lead to sequelae, the severity of which depend on the residual pelvic displacement and involvement of the growth plates that can cause epiphysiodesis. Surgery to correct these deformities is challenging. The most serious occur when the vertical displacement of the hemipelvis must be corrected. After an acetabulum fracture, removal of the growth blocker can be done in children under 10 years of age. In older children, acetabular dysplasia requires periacetabular osteotomy.
Topics: Acetabulum; Arthrodesis; Bone Screws; Child; Emergency Service, Hospital; Fracture Fixation, Internal; Fractures, Bone; Humans; Osteotomy; Pelvic Bones; Radiography
PubMed: 31521559
DOI: 10.1016/j.otsr.2019.05.017