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Orthopaedic Surgery May 2022To evaluate the morphological asymmetry of pelvic rings existing in healthy individuals in terms of three-dimensional (3D) geometric shapes.
OBJECTIVE
To evaluate the morphological asymmetry of pelvic rings existing in healthy individuals in terms of three-dimensional (3D) geometric shapes.
METHODS
This study was a retrospective self-control study. CT images of healthy pelvises, scanned from Jan 2014 to Jan 2019, were taken from 159 subjects (88 males and 71 females) aged 20 to 59 years (39.1 ± 8.7 years). Digital pelvic ring models were reconstructed from CT images and then flipped over the corresponding sagittal planes to obtain their mirrored models. A 3D deviation analysis of a pelvic ring was conducted between the original model and its mirrored model via model registration and quantification of the geometric differences. Next, the pelvic rings were split to the left and right hipbones. The same flipping procedures as done by pelvic rings were performed for left hipbones to obtain their mirrored models. A 3D deviation analysis was also performed between the left and right hip bones. Quantitative variables representing deviation mainly included the average deviation (AD) and the maximum deviation (MD). MDs over 4 mm and 10 mm were deemed as critical levels for evaluating the severity of asymmetry as per Matta's scoring system. The quantitative assessments of the asymmetry covered pelvic rings, bilateral hip bones and the specific anatomic regions of a hip bone.
RESULTS
157 out of 159 pelvic rings (98.74%) had more than 4 mm of the MD and 27 (16.98%) of them exceeded 10 mm of the MD. The MD of pelvic rings was 1.23 times as high as that for the bilateral hip bones (7.46 mm vs. 6.08 mm, P < 0.05). The ADs of pelvic rings and bilateral hip bones were 1.28 mm and 0.94 mm, respectively (P < 0.05); 2.27% of the surface points of a pelvic ring had more than 4 mm geometric deviations compared with its mirrored model, while 0.59% (P < 0.05) of bilateral hip bones were on the same level of deviation. 119 out of 159 pelvic iliac crests (74.8%) had MDs more than 4 mm, and 15 (9.4%) reached 10 mm or more. Only 15 (9.4%) pelvises presented asymmetric features in the area of obturator foramen where the MDs exceeded 4 mm.
CONCLUSIONS
Pelvic asymmetry exists in the general population, but 3D geometric symmetry is present in specific anatomic regions. It implies that restoring the 3D symmetry of specific anatomic regions is more reliable than "restoring the symmetry of pelvic ring" in pelvic ring reduction or pelvic fixation design.
Topics: Female; Humans; Male; Ilium; Imaging, Three-Dimensional; Pelvic Bones; Retrospective Studies; Young Adult; Adult; Middle Aged
PubMed: 35377554
DOI: 10.1111/os.13246 -
Scientific Reports Mar 2022Haemostatic procedures such as preperitoneal pelvic packing (PPP), pelvic angiography (PA), and internal iliac artery ligation are used for haemorrhage control in pelvic...
Haemostatic procedures such as preperitoneal pelvic packing (PPP), pelvic angiography (PA), and internal iliac artery ligation are used for haemorrhage control in pelvic fracture patients with haemodynamic instability. Pelvic external fixation (PEF) and pelvic binder (PB) are usually applied with haemostatic procedures to reduce the pelvic volume. This study aimed to compare the clinical outcomes between patients who underwent PEF and PB. Among 173 patients with pelvic fracture admitted to the emergency room of three regional trauma centres between January 2015 and December 2018, the electronic charts of haemodynamically unstable patients were retrospectively analysed. Among the 84 patients included in the analysis, 20 underwent PEF with or without PB, and 64 underwent only PB. There were significant differences in tile classification and laparotomy between the PEF and PB groups (p = 0.023 and p = 0.032). PPP tended to be more frequently preformed in the PEF group (p = 0.054), whereas PA tended to be more commonly performed in the PB group than in the PEF group (p = 0.054). After propensity score matching to adjust for differences in patient characteristics and adjunct haemostatic procedure, there was no significant difference in 7-day, 30-day, and overall mortality rates between the PEF and PB groups (10.5% vs 21.1%, p = 0.660, 21.1% vs 26.3%, p = 1.000, and 26.3% vs 26.3%, p = 1.000). Cox proportional hazard regression analysis and multivariate analysis for correction of covariates (age, lactate, and abdominal injury) showed that PEF was not an independent factor for 30-day mortality compared with PB (adjusted hazard ratio, 0.526; 95% confidence interval, 0.092-3.002; p = 0.469). Among the volume reduction procedures performed with other haemostatic procedures in patients with pelvic fracture and haemodynamic instability, PEF did not significantly reduce the 30-day mortality rate compared to PB.
Topics: External Fixators; Fracture Fixation; Fractures, Bone; Hemodynamics; Hemostatics; Humans; Pelvic Bones; Retrospective Studies; Treatment Outcome; Vascular Diseases
PubMed: 35256684
DOI: 10.1038/s41598-022-07694-3 -
The Orthopedic Clinics of North America Jan 2024Achieving high-quality intraoperative imaging is crucial for successful pelvic ring and acetabular fracture surgery, yet it remains clinically challenging. Due to the... (Review)
Review
Achieving high-quality intraoperative imaging is crucial for successful pelvic ring and acetabular fracture surgery, yet it remains clinically challenging. Due to the complex anatomy of the pelvic ring and acetabulum, it is necessary to obtain multiple images oriented in different planes to reliably confirm reduction accuracy and implant positioning. Intraoperative image quality can be compromised by factors such as patient body habitus, bowel gas, abdominal packing, contrast dye, and nonstandardized language between surgeon and radiology technician. This article reviews common intraoperative imaging challenges encountered during pelvic ring and acetabular fracture surgery, while providing practical and evidence-based solutions and prevention strategies.
Topics: Humans; Fractures, Bone; Pelvic Bones; Fracture Fixation, Internal; Acetabulum; Hip Fractures; Spinal Fractures
PubMed: 37980105
DOI: 10.1016/j.ocl.2023.07.004 -
Computers in Biology and Medicine Jan 2023Pelvic fracture is the most serious bone trauma and has the highest mortality and disability rate. Surgical treatment of pelvic fracture is very challenging for...
Pelvic fracture is the most serious bone trauma and has the highest mortality and disability rate. Surgical treatment of pelvic fracture is very challenging for surgeons. Minimally invasive close reduction of pelvic fracture is considered the most difficult operation due to the complex pelvic morphology and abundant soft tissue anatomy, both of which increase the difficulty of pelvic fracture reduction. The most challenging aspect of such surgery is how to hold the pelvic bone and effectively transmit the reduction force to the bone. Therefore, a safe and effective pelvic holding pathway for reduction is necessary for pelvic fracture operations. Existing research on the pelvic holding pathway addresses anatomical position and dimension. Few studies have focused on biomechanical properties or on surgical techniques related to these pathways. This paper studies the three holding pathways that are most commonly used in clinical practice. The most effective force direction for each holding pathway is identified through finite element modeling. Pathway 1 is suitable for internal rotation operation and open/close-book operation of the pelvis; Pathway 2 is suitable for translation of the fractured pelvis toward the sacrum and internal pelvic rotation operations; Pathway 3 is suitable for pulling and lifting of the fractured pelvis against gravity and open/close-book operation of the pelvis. In addition, we find through our simulation that the use of a combined holding strategy can reduce the reduction force during the reduction process. We compared the performances of the 2-pin combined holding strategy (2P-CH) and the 3-pin combined strategy (3P-CH). During translational reduction, 2P-CH and 3P-CH showed little difference in pelvic reduction force. However, in rotational reduction, 3P-CH shows advantages. It has less reduction force and the least combined muscle resistance. It can also maximize the displacement of the iliac crest under the same conditions. The results of this study can be applied to surgical planning and to the development of robot-assisted surgery systems in selecting holding pathways and operation strategies for fractured pelvis.
Topics: Humans; Fracture Fixation, Internal; Fractures, Bone; Pelvic Bones; Fracture Fixation; Pelvis
PubMed: 36462368
DOI: 10.1016/j.compbiomed.2022.106310 -
Emergency Radiology Oct 2023The purpose of our study was to identify the locations at which hip and pelvic fractures are commonly missed on radiographs.
PURPOSE
The purpose of our study was to identify the locations at which hip and pelvic fractures are commonly missed on radiographs.
METHODS
A retrospective study was performed at four non-Level 1 trauma center emergency departments. IRB approval was obtained. All emergency department hip or pelvic radiographs with subsequent CT performed within 48 h were identified from 2017 to 2022. Reports for each radiograph and CT were scored for the presence or the absence of fracture in the following locations: ilium, sacrum, superior pubic ramus, inferior pubic ramus, pubis, acetabulum, subcapital femoral, femoral neck, greater trochanter, lesser trochanter, intertrochanteric, and subtrochanteric. The CT report was used as the gold standard. The false-negative radiography cases were reviewed on a PACS workstation to determine whether the case had an "unexpected miss" of a fracture, a subtle fracture, radiographically occult fracture, or exam was limited by artifact. The percentage of missed fractures at each location was calculated.
RESULTS
Nine hundred seventy-five radiography cases with subsequent CT were identified. One hundred forty-six cases did not meet entry criteria; therefore, 829 cases were analyzed further. Seventy-four percent of patients were female with age of 74 ± 16 (mean ± standard deviation) years (range 1-103). Three hundred fifty-two cases had at least one fracture, and many cases had multiple fractures. There were 68 false-negative cases. The most commonly missed fractures by percentage were pubis, ilium, and greater trochanter. The most common unexpectedly missed fractures were greater trochanter and femoral subcapital.
CONCLUSION
A careful systematic evaluation of hip and pelvic radiographs, with particular attention to the pubis, ilium, greater trochanter, and subcapital region, may improve radiographic fracture detection and decrease delays in diagnosis.
Topics: Humans; Female; Infant; Child, Preschool; Child; Adolescent; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Male; Retrospective Studies; Radiography; Fractures, Bone; Pelvic Bones; Fractures, Closed; Hip Fractures
PubMed: 37452984
DOI: 10.1007/s10140-023-02156-3 -
The Bone & Joint Journal Mar 2022Pelvic incidence (PI) is a position-independent spinopelvic parameter traditionally used by spinal surgeons to determine spinal alignment. Its relevance to the...
AIMS
Pelvic incidence (PI) is a position-independent spinopelvic parameter traditionally used by spinal surgeons to determine spinal alignment. Its relevance to the arthroplasty surgeon in assessing patient risk for total hip arthroplasty (THA) instability preoperatively is unclear. This study was undertaken to investigate the significance of PI relative to other spinopelvic parameter risk factors for instability to help guide its clinical application.
METHODS
Retrospective analysis was performed of a multicentre THA database of 9,414 patients with preoperative imaging (dynamic spinopelvic radiographs and pelvic CT scans). Several spinopelvic parameter measurements were made by engineers using advanced software including sacral slope (SS), standing anterior pelvic plane tilt (APPT), spinopelvic tilt (SPT), lumbar lordosis (LL), and PI. Lumbar flexion (LF) was determined by change in LL between standing and flexed-seated lateral radiographs. Abnormal pelvic mobility was defined as ∆SPT ≥ 20° between standing and flexed-forward positions. Sagittal spinal deformity (SSD) was defined as PI-LL mismatch > 10°.
RESULTS
PI showed a positive correlation with parameters of SS, SPT, and LL (r-value range 0.468 to 0.661). Patients with a higher PI value showed higher degrees of standing LL, likely as a compensatory measure to maintain sagittal spine balance. There was a positive correlation between LL and LF such that patients with less standing LL had decreased LF ( = 0.49). Similarly, there was a positive correlation between increased SSD and decreased LF ( = 0.54). PI in isolation did not show any significant correlation with lumbar ( = 0.04) or pelvic mobility ( = 0.02). The majority of patients (range 89.4% to 94.2%) had normal lumbar and pelvic mobility regardless of the PI value.
CONCLUSION
The PI value alone is not indicative of either spinal or pelvic mobility, and thus in isolation may not be a risk factor for THA instability. Patients with SSD had higher rates of spinopelvic stiffness, which may be the mechanism by which PI relates to THA instability risk, but further clinical studies are required. Cite this article: 2022;104-B(3):352-358.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Female; Humans; Male; Middle Aged; Pelvic Bones; Posture; Prosthesis Failure; Retrospective Studies; Risk Factors; Sacrum; Young Adult
PubMed: 35227099
DOI: 10.1302/0301-620X.104B3.BJJ-2021-0894.R1 -
Injury Jul 2021To evaluate clinical and radiological results of vertically unstable pelvic fractures managed by open reduction and navigated iliosacral screws.
AIMS
To evaluate clinical and radiological results of vertically unstable pelvic fractures managed by open reduction and navigated iliosacral screws.
PATIENTS AND METHODS
The study included eleven patients with complex posterior ring fractures with vertical instability admitted to our hospital and managed with CT navigated iliosacral screws. There were 7 type C1, 2 C2 and 2 C3, according to Tile classification. Three patients presented a spino-pelvic dissociation and four a vertical sacral fracture affecting the foramina (Denis 2). Vertical displacement, pelvic deformity and asymmetry were measured. Tornetta and Matta criteria were used to assess the quality of pelvic reduction.
RESULTS
An excellent reduction was achieved in 9 fractures and a good reduction in two. Asymmetry index improved from 13.18 to 2.72. Deformity index improved from 0.049 to 0.010. Only two patients with a Denis 2 fracture showed secondary displacement during follow-up. Four patients presented neurological complications due to their initial injuries. Seven patients were able to resume their previous activities.
CONCLUSION
CT navigated IS screws provide enough stability after an anatomic reduction of the fracture. There was no complication related to screw insertion and adequate screw positioning was achieved in all the cases.
Topics: Bone Screws; Fracture Fixation, Internal; Fractures, Bone; Humans; Pelvic Bones; Retrospective Studies; Sacrum
PubMed: 33678464
DOI: 10.1016/j.injury.2021.02.082 -
Scientific Reports May 2024With the recent increase in traffic accidents, pelvic fractures are increasing, second only to skull fractures, in terms of mortality and risk of complications. Research...
With the recent increase in traffic accidents, pelvic fractures are increasing, second only to skull fractures, in terms of mortality and risk of complications. Research is actively being conducted on the treatment of intra-abdominal bleeding, the primary cause of death related to pelvic fractures. Considerable preliminary research has also been performed on segmenting tumors and organs. However, studies on clinically useful algorithms for bone and pelvic segmentation, based on developed models, are limited. In this study, we explored the potential of deep-learning models presented in previous studies to accurately segment pelvic regions in X-ray images. Data were collected from X-ray images of 940 patients aged 18 or older at Gachon University Gil Hospital from January 2015 to December 2022. To segment the pelvis, Attention U-Net, Swin U-Net, and U-Net were trained, thereby comparing and analyzing the results using five-fold cross-validation. The Swin U-Net model displayed relatively high performance compared to Attention U-Net and U-Net models, achieving an average sensitivity, specificity, accuracy, and dice similarity coefficient of 96.77%, of 98.50%, 98.03%, and 96.32%, respectively.
Topics: Humans; Deep Learning; Fractures, Bone; Pelvic Bones; Male; Female; Adult; Middle Aged; Algorithms; Aged; Pelvis; Image Processing, Computer-Assisted; Adolescent; Young Adult
PubMed: 38806582
DOI: 10.1038/s41598-024-63093-w -
Scientific Reports Mar 2020To optimize the placement of iliosacral screws in osteoporotic bone it is essential to know where to find the best purchase. The aim of this study was to determine and...
To optimize the placement of iliosacral screws in osteoporotic bone it is essential to know where to find the best purchase. The aim of this study was to determine and visualize the distribution of bone mass in the posterior pelvic ring by using a color-coded thermal map, to differentiate the bone distribution patterns in normal pelvises and in pelvises with impaired bone density and to identify zones in S1 and S2 with particularly good bone quality, in both healthy and osteoporotic pelvises. A total of 324 pelvises were included. The bone density of the posterior pelvic ring, the fifth lumbar vertebral body (L5) and screw corridors S1 and S2 were visualized. Each individual pelvis was measured with a 3D automated program. Two groups were selected - patients with mean bone density in L5 of ≤100 HU (group 1, n = 52) and those with mean bone density >100 HU (group 2, n = 272). Color-coded thermal maps are presented of the bone density distribution in the pelvises. Bone density in L5 correlated significantly with S1 and S2; bone density was significantly higher in the S1 than in the S2 corridor (p < 0.001). Bone was denser in the posterior and upper parts of the S1 body. Bone density was significantly lower in group 2 than in group 1 (p < 0.001). The color-coded "thermal" maps of bone mass distribution can help surgeons to decide where sacroiliac screws are likely to find optimal purchase.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Density; Bone Screws; Female; Humans; Imaging, Three-Dimensional; Lumbar Vertebrae; Male; Middle Aged; Osteoporotic Fractures; Pelvic Bones; Sacrum; Tomography, X-Ray Computed; Young Adult
PubMed: 32231222
DOI: 10.1038/s41598-020-61954-8 -
Journal of Orthopaedic Trauma May 2023High-energy pelvic ring injuries are associated with significant morbidity and mortality, elevating the importance of injury pattern identification. The purpose of this...
OBJECTIVES
High-energy pelvic ring injuries are associated with significant morbidity and mortality, elevating the importance of injury pattern identification. The purpose of this study was to use a novel 3D computed tomography (CT) unfolding process to both evaluate high-energy pelvic ring injures and to produce injury frequency maps based on injury patterns.
METHODS
Patients 18-65 years of age presenting to a level 1 trauma center with pelvic ring injuries between 2016 and 2020 were identified. Of the 482 patients reviewed, 355 were excluded primarily due to having a low energy mechanism, inadequate radiographs, or an isolated fracture. Unfolded pelvic CT images were created using syngo.via CT Bone Reading software. Pelvic ring injury frequency maps were created using the unfolded pelvic CT images and a previously described mapping technique.
RESULTS
One hundred twenty-seven patients analyzed had a mean age of 32.7 years. The most common mechanisms of injury (MOI) were motor vehicle collision (30.7%) and fall from height (23.6%). The breakdown of pelvic ring injuries included LC1 = 44.1%, LC2 = 7.1%, LC3 = 14.2%, APC1 = 2.4%, APC2 = 15.0%, APC3 = 5.5%, and VS = 11.8%, with OTA/AO-61B = 74.0% and OTA/AO-61C = 26.0%. Pelvic ring mapping revealed that articular and bony injuries varied markedly between the different types of pelvic ring disruptions, both in type and location.
CONCLUSIONS
Pelvic ring injury frequency maps created from unfolded CT images reflect consistent injury patterns providing distinctive information based on force vector mechanisms. Unfolded CT images allow for a novel way to visualize pelvic ring injuries which yield greater comprehension of failure patterns with implications for treatment.
Topics: Humans; Adult; Pelvic Bones; Retrospective Studies; Fractures, Bone; Tomography, X-Ray Computed; Radiography; Trauma Centers
PubMed: 36729522
DOI: 10.1097/BOT.0000000000002544