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RoFo : Fortschritte Auf Dem Gebiete Der... May 2020Avulsion injuries of the pelvis and hip region are typical injuries in adolescent athletes but can be found in adults as well. Typical sites for avulsion injuries... (Review)
Review
BACKGROUND
Avulsion injuries of the pelvis and hip region are typical injuries in adolescent athletes but can be found in adults as well. Typical sites for avulsion injuries include the origin/insertion of tendons and ligaments. Among adolescents, the not yet ossified apophysis is also frequently involved. The pelvis and hip are especially prone to such injuries due to their complex musculotendinous anatomy. Clinical history and physical examination in combination with the recognition of typical imaging findings are essential for correct diagnosis of these mostly acute, but sometimes also chronic injuries.
METHODS
This review article describes typical avulsion injuries of the pelvis and hip and illustrates common radiological findings. Taking current literature into account, there is a special focus on the trauma mechanism, clinical examination, typical imaging findings and clinical management.
RESULTS AND CONCLUSION
Detailed knowledge of musculotendinous anatomy and typical injury mechanisms allows a correct diagnosis of avulsion injuries often only based on clinical examination and radiographic findings. Further imaging with ultrasound and MRI may be necessary to evaluate tendon retraction in non-osseous avulsion injuries and extent of soft-tissue damage. Knowledge of potential complications of acute/chronic injuries can help to avoid unnecessary examinations or invasive interventions. Conservative management of avulsion injuries usually leads to functionally good results. However, in the case of competitive athletes, relatively wide bone fragment dislocation or marked tendon retraction, operative re-fixation may be considered in order to expedite the rehabilitation process.
KEY POINTS
· Avulsion injuries are common injuries at the pelvic region especially in adolescent athletes, due to not yet ossified apophysis.. · Excellent anatomical knowledge is essential for proper diagnostic evaluation and predicting the mechanism of injury.. · Imaging plays a crucial role in diagnosing avulsion injuries starting from X-Ray and using MRI and CT for anatomical details by utilizing multiplanar capabilities..
CITATION FORMAT
· Albtoush OM, Bani-Issa J, Zitzelsberger T et al. Avulsion Injuries of the Pelvis and Hip. Fortschr Röntgenstr 2020; 192: 431 - 440.
Topics: Abdominal Muscles; Adolescent; Adult; Athletic Injuries; Enthesopathy; Female; Fractures, Avulsion; Hip Fractures; Humans; Ilium; Imaging, Three-Dimensional; Ligaments; Magnetic Resonance Imaging; Male; Muscle, Skeletal; Pelvic Bones; Physical Examination; Tendon Injuries
PubMed: 32106326
DOI: 10.1055/a-1082-1598 -
Injury Oct 2022Historically most pediatric pelvic fractures were treated non-operatively because of the presumed potential of the pediatric pelvis to remodel and the subsequent... (Review)
Review
BACKGROUND
Historically most pediatric pelvic fractures were treated non-operatively because of the presumed potential of the pediatric pelvis to remodel and the subsequent increased fracture stability. Currently a wide variety of classifications in pediatric pelvic fractures is used to assess fracture stability and guide treatment, yet none have proven to be ideal since the structural behavior of the pediatric pelvis differs greatly from the adult pelvis. The aim of this review is to critically appraise the use of these different classification systems, fracture (in)stability, the treatment of pediatric pelvic fractures and how it reflects on long-term complications such as pelvic asymmetry and functional outcome.
METHODS
A literature search was performed in Medline, Embase, Cochrane, PubMed, Google Scholar and references of the selected articles. Studies that reported on pain, leg length discrepancy (LLD), abnormal gait (GA), pelvic asymmetry, and functional outcomes of pediatric pelvic fractures were included.
RESULTS
A total of six different classification systems were used, the most common were Tile (n= 9, 45%) and Torode and Zieg (n= 8, 40%). There was great disparity in treatment choice for the same type of fracture pattern, resulting in several pelvic ring fractures that were defined as unstable being treated non-operatively. Pelvic asymmetry is seen in rates up to 48% in non-operatively treated patients. In contrast, pelvic asymmetry in surgically fixated unstable pelvic fractures was rare, and these patients often showed excellent functional outcomes during follow-up.
CONCLUSION
There is a substantial heterogeneity in which fracture patterns are considered to be unstable or in need of surgical fixation. Functional outcomes seem to be correlated with the frequency of pelvic asymmetry and are likely due to an underestimation of the stability of the pelvic fracture. Taking into consideration the force that is necessary to cause a facture in the pediatric pelvis, a fracture of the pelvic ring alone could be suggestive for instability. The results of this review imply that the field of pediatric pelvic surgery is currently not grasping the full scope of the complexity of these fractures, and that there is a need for a pediatric pelvic classification system and evidence-based treatment guideline.
Topics: Adult; Child; Fracture Fixation; Fracture Fixation, Internal; Fractures, Bone; Humans; Leg Length Inequality; Pelvic Bones; Pelvis; Retrospective Studies
PubMed: 35882582
DOI: 10.1016/j.injury.2022.07.009 -
Homo : Internationale Zeitschrift Fur... Apr 2023Discussions of the evolution of sexual dimorphism in torso shape and the pectoral region assume that this dimorphism exists independently of body size. We test this... (Comparative Study)
Comparative Study
Discussions of the evolution of sexual dimorphism in torso shape and the pectoral region assume that this dimorphism exists independently of body size. We test this assumption in two human populations and further examine what is needed to understand sexual dimorphism in the pectoral region. Modern human males have broad shoulders and narrow hips relative to females, lending males a more triangular torso. The wider female pelvis is commonly attributed to obstetric pressures while the broader male pectoral girdle has been argued to be an adaptation that improves hunting or intrasexual competition. While sexual dimorphism in the pelvic girdle is known to exist after adjusting for body size across human populations, most studies of sexual dimorphism in the pectoral girdle have not adjusted the data to account for sexual size dimorphism or compared different ancestral groups. The aforementioned hypotheses explaining sexual dimorphism in the clavicle and scapula as products of natural selection are predicated on the untested assumption that sex differences do not scale with body size. This study tests this assumption by comparing various measurements of the pectoral girdle, the pelvic girdle, and six pectoral-pelvic indices of black and white South Africans of known sex and height to test whether the sexes and ancestral groups will differ in these values after adjusting for differences in body size. Comparisons of ancestral groups reveal that white South Africans have larger pectoral and pelvic dimensions than black South Africans, but that blacks have larger index values than whites. Regardless of differences in ancestry and body size, males have significantly broader pectoral regions as indicated by comparisons of both individual pectoral measurements and pectoral-pelvic indices. This pattern of sexual dimorphism is reversed in the pelvic region where females have larger skeletal elements. In addition to finding both absolute and relative differences in mean values for the pectoral and pelvic skeleton, females and males and blacks and whites differ in the scaling relationship of these traits, suggesting different allometric trajectories for these bones that may be explained by their distinct evolutionary functions, their adaptations to specific environments, or by changes in lengths due to age. These results suggest that sexual dimorphism in the pectoral region is not a product of scaling and that differences in this region reflect adaptive forces acting in unique ways on each sex, consistent with the assumptions of earlier evolutionary explanations.
Topics: Female; Humans; Male; Black People; Sex Characteristics; Pelvic Bones; White People; South Africa; Bones of Upper Extremity; Race Factors; Sex Factors; Body Height; Biological Evolution
PubMed: 36628541
DOI: 10.1127/homo/2023/1486 -
Acta Bio-medica : Atenei Parmensis Dec 2019Pelvic ring fractures represent a challenge for orthopaedic surgeon. Their management depends on patient's condition, pattern of fracture and associated injuries....
BACKGROUND AND AIM
Pelvic ring fractures represent a challenge for orthopaedic surgeon. Their management depends on patient's condition, pattern of fracture and associated injuries. Optimal timing for synthesis is not yet clear. The aim of this study was to define if surgical timing influenced clinic and radiographic outcomes following open reduction and internal fixation for Tile B and C fractures.
MATERIALS AND METHODS
38 patients were included. Patients underwent a clinical examination with the Majeed Score, Iowa Pelvic Score and Orlando Pelvic Score. The radiographic assessment was performed according to Matta Pelvic Score. A statistical analysis of the data compared patients who were operated within 3 weeks (group 1) and those operated later (group 2).
RESULTS
Both clinical and radiological outcomes were influenced by timing of surgery.
CONCLUSION
Pelvic ring fractures interest many polytrauma patients and, therefore, their surgical orthopedic approach is frequently delayed as consequence of the severity of the associated clinical conditions. An early surgery of pelvic rong fractures allows a better quality of reduction and osteosynthesis.
Topics: Adult; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Male; Middle Aged; Open Fracture Reduction; Pelvic Bones; Radiography; Time Factors; Treatment Outcome
PubMed: 31821288
DOI: 10.23750/abm.v90i12-S.8949 -
Asian Journal of Surgery Jan 2021Straddle fracture, a superior and inferior ramus fracture of both sides, is generally treated conservatively. However, posterior pelvic ring injury is often associated... (Review)
Review
Straddle fracture, a superior and inferior ramus fracture of both sides, is generally treated conservatively. However, posterior pelvic ring injury is often associated with straddle fracture, leading to unstable pelvic bone fracture that requires surgical treatment. The present study reports the clinical and radiological outcomes of straddle fracture with posterior pelvic ring injury. This study included 73 patients (41 men, 32 women) with a straddle fracture injury. The injury mechanism, injury severity score (ISS), accompanying injuries, presence of posterior pelvic ring injury, and fixation methods for the pelvic fracture were analyzed, and outcomes were evaluated functionally and radiologically. Of the 73 patients, 56 (77%) had a posterior pelvic ring injury and 7 died. In 43 patients, the posterior pelvic ring injuries constituted unstable pelvic injury and were treated surgically. The fixation method was determined based on the severity of the posterior pelvic injury. The patients' mean ISS was 24.7 points. Radiological evaluation of surgical outcomes in 43 patients revealed the outcomes as anatomic in 20, nearly anatomic in 14, moderate in 5, and poor in 4, whereas functional evaluation revealed the outcomes as excellent in 21, good in 9, fair in 7, and poor in 6. Posterior pelvic ring fracture can accompany straddle fractures, which may lead to pelvic injury instability. Thus, special attention is required for patients with a straddle fracture.
Topics: Adult; Aged; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Male; Middle Aged; Pelvic Bones; Pelvis; Radiography; Trauma Severity Indices; Treatment Outcome; Young Adult
PubMed: 32376214
DOI: 10.1016/j.asjsur.2020.03.021 -
Annals of the Royal College of Surgeons... Jun 2021Fractures of the pelvis and acetabulum (PAFs) are challenging injuries, requiring specialist surgical input. Since implementation of the major trauma network in England...
INTRODUCTION
Fractures of the pelvis and acetabulum (PAFs) are challenging injuries, requiring specialist surgical input. Since implementation of the major trauma network in England in 2012, little has been published regarding the available services, workforce organisation and burden of PAF workload. The aim of this study was to assess the recent trends in volume of PAF workload, evaluate the provision of specialist care, and identify variation in available resources, staffing and training opportunity.
METHODS
Data on PAF volume, operative caseload, route of admission and time to surgery were requested from the Trauma Audit and Research Network. In order to evaluate current workforce provision and services, an online survey was distributed to individuals known to provide PAF care at each of the 22 major trauma centres (MTCs).
RESULTS
From 2013 to 2019, 23,823 patients with PAF were admitted to MTCs in England, of whom 12,480 (52%) underwent operative intervention. On average, there are 3,971 MTC PAF admissions and 2,080 operative fixations each year. There has been an increase in admissions and cases treated operatively since 2013. Three-quarters (78%) of patients present directly to the MTC while 22% are referred from regional trauma units. Annually, there are on average 37 operatively managed PAF injuries per million population. Notwithstanding regional differences in case volume, the average number of annual PAF operative cases per surgeon in England is 30. There is significant variation in frequency of surgeon availability. There is also variation in rota organisation regarding consistent specialist surgeon availability.
CONCLUSIONS
This article describes the provision of PAF services since the reorganisation of trauma services in England. Future service development should take into account the current distribution of activity, future trends for increased volume and casemix, and the need for a PAF registry.
Topics: Acetabulum; England; Fracture Fixation; Fractures, Bone; Health Resources; Health Workforce; Humans; Patient Admission; Pelvic Bones; Referral and Consultation; Registries; Surgeons; Surveys and Questionnaires; Time-to-Treatment; Trauma Centers; Workload
PubMed: 33851891
DOI: 10.1308/rcsann.2021.0015 -
European Journal of Trauma and... Feb 2022Angioembolization (AE) has been questioned as first-line modality for hemorrhage control of pelvic fracture (PF)-associated bleeding due to its potential inconsistent...
PURPOSE
Angioembolization (AE) has been questioned as first-line modality for hemorrhage control of pelvic fracture (PF)-associated bleeding due to its potential inconsistent timely availability. We aimed to describe the patterns of AE use with hemostatic resuscitation and hypothesized that time to AE improved during the study period.
METHODS
A Level-1 trauma center's prospective PF database was analyzed. All consecutive PFs referred to angiography between 01/01/2009 and 12/31/2018 were included. All suspected pelvic hemorrhage was managed with AE; pelvic packing was not performed. Demographics, injury/shock severity, 24-h transfusion data, time to AE and mortality were recorded. Data are presented as median (IQR).
RESULTS
During the 10-year study period, 1270 PF patients were treated. Thirty-six (2.8%) [75% male, 49 (33;65) years, ISS 36 (24;43), base deficit 3.65 (5.9;0.6), transfusions 4(2;7)] had AE. The indication for AE was clinical suspicion (CS) of pelvic bleeding [CS 24(67%)] or arterial blush on CT [CT 12 (33%)]. Median time to AE was 141 min for CS, and 223 min for CT, with no change over the study period. Patients with CS had a higher ISS, worse base deficit, greater transfusion requirements and faster time to AE. Five patients (14%) died. There were no deaths attributed to exsanguination.
CONCLUSIONS
Time to AE did not improve. Patients referred from CT are physiologically different from CS and should be analyzed accordingly, with CS resulting in faster time to AE in sicker patients. Contemporary resuscitation challenges the need for hyperacute AE as no patients exsanguinated despite time to AE of more than 2 h.
Topics: Embolization, Therapeutic; Female; Fractures, Bone; Humans; Injury Severity Score; Male; Pelvic Bones; Pelvis; Prospective Studies; Retrospective Studies
PubMed: 33037465
DOI: 10.1007/s00068-020-01510-1 -
Anthropologischer Anzeiger; Bericht... Feb 2022The human pelvis has been reported to change in shape throughout adult lifetime, and also the expression of parturition scars, or "pelvic features", increases with age....
The human pelvis has been reported to change in shape throughout adult lifetime, and also the expression of parturition scars, or "pelvic features", increases with age. However, little is known about the causes and timing of these changes. Here we investigate changes in pelvic shape and the expression of pelvic features by applying a comprehensive geometric morphometric approach to a modern sample of 167 adult individuals with known age, parity, and cause of death. Our results confirm that the pelvis changes in shape during adult life, but to a larger magnitude in females compared to males. Moreover, females showed three different phases of pelvic shape change, coinciding with the main period of reproduction (from 17 to about 37-40 years), the period after that but before menopause, and the postmenopausal period (after 50 years of age). Males exhibited two phases with relatively similar shape changes. The expression of parturition scars increased in females until about 40 years of age and stayed relatively constant thereafter. Only a very weak increase of feature expression was found in males. We hypothesize that changes of adult pelvic shape and feature expression result from a combination of hormone-mediated and mechanically induced bone remodeling. Estrogen-induced and pregnancy-related bone remodeling dominates in premenopausal women, whereas bone remodeling in response to mechanical factors may underlie pelvic shape changes in men and postmenopausal women. The continual widening of the birth canal during the reproductive period eases childbirth in a population, but it is unlikely that this remodeling pattern specifically evolved as an obstetric adaptation in the human lineage. The highly conserved endocrine system and estrogen-induced pelvic bone remodeling were already in place when the neonatal brain increased in the human lineage. But the regularity control of this conserved pathway may have been "fine-tuned" by selective forces in the human lineage.
Topics: Adult; Female; Humans; Infant, Newborn; Male; Parturition; Pelvic Bones; Pelvis; Pregnancy
PubMed: 34664055
DOI: 10.1127/anthranz/2021/1463 -
Journal of Orthopaedics and... May 2020Iliosacral screw fixation is safe and effective but can be complicated by loss of fixation, particularly in patients with osteopenic bone. Sacral morphology dictates...
BACKGROUND
Iliosacral screw fixation is safe and effective but can be complicated by loss of fixation, particularly in patients with osteopenic bone. Sacral morphology dictates where iliosacral screws may be placed when stabilizing pelvic ring injuries. In dysmorphic sacra, the safe osseous corridor of the upper sacral segment (S1) is smaller and lacks a transsacral corridor, increasing the need for fixation in the second sacral segment (S2). Previous evidence suggests that S2 is less dense than S1. The aim of this cross-sectional study is to further evaluate bone mineral density (BMD) of the S1 and S2 iliosacral osseous pathways through morphology stratification into normal and dysmorphic sacra.
MATERIALS AND METHODS
Pelvic computed tomography scans of 50 consecutive trauma patients, aged 18 to 50 years, from a level 1 trauma center were analyzed prospectively. Five radiographic features (upper sacral segment not recessed in the pelvis, mammillary bodies, acute alar slope, residual S1 disk, and misshapen sacral foramen) were used to identify dysmorphic characteristics, and sacra with four or five features were classified as dysmorphic. Hounsfield unit values were used to estimate the regional BMD of S1 and S2. Student's t-test was utilized to compare the mean values at each segment, with statistical significance being set at p < 0.05. No change in clinical management occurred as a result of inclusion in this study.
RESULTS
A statistical difference in BMD was appreciated between S1 and S2 in both normal and dysmorphic sacra (p < 0.0001), with 28.4% lower density in S2 than S1. Further, S1 in dysmorphic sacra tended to be 4% less dense than S1 in normal sacra (p = 0.047). No difference in density was appreciated at S2 based on morphology.
CONCLUSIONS
Our results would indicate that, based on BMD alone, fixation should be maximized in S1 prior to fixation in S2. In cases where S2 fixation is required, we recommend that transsacral fixation should be strongly considered if possible to bypass the S2 body and achieve fixation in the cortical bone of the ilium and sacrum.
LEVEL OF EVIDENCE
Level III.
Topics: Adolescent; Adult; Bone Density; Bone Screws; Cross-Sectional Studies; Female; Humans; Ilium; Male; Middle Aged; Orthopedic Procedures; Pelvic Bones; Sacrum; Tomography, X-Ray Computed; Young Adult
PubMed: 32451838
DOI: 10.1186/s10195-020-00545-9 -
Journal of Neurosurgery. Spine Dec 2022The purpose of this study was to describe the genesis of the AO Spine Sacral and Pelvic Classification System in the context of historical sacral and pelvic grading... (Review)
Review
OBJECTIVE
The purpose of this study was to describe the genesis of the AO Spine Sacral and Pelvic Classification System in the context of historical sacral and pelvic grading systems.
METHODS
A systematic search of MEDLINE, EMBASE, Google Scholar, and Cochrane databases was performed consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all existing sacral and pelvic fracture classification systems.
RESULTS
A total of 49 articles were included in this review, comprising 23 pelvic classification systems and 17 sacral grading schemes. The AO Spine Sacral and Pelvic Classification System represents both the evolutionary product of these historical systems and a reinvention of classic concepts in 5 ways. First, the classification introduces fracture types in a graduated order of biomechanical stability while also taking into consideration the neurological status of patients. Second, the traditional belief that Denis central zone III fractures have the highest rate of neurological deficit is not supported because this subgroup often includes a broad spectrum of injuries ranging from a benign sagittally oriented undisplaced fracture to an unstable "U-type" fracture. Third, the 1990 Isler lumbosacral system is adopted in its original format to divide injuries based on their likelihood of affecting posterior pelvic or spinopelvic stability. Fourth, new discrete fracture subtypes are introduced and the importance of bilateral injuries is acknowledged. Last, this is the first integrated sacral and pelvic classification to date.
CONCLUSIONS
The AO Spine Sacral and Pelvic Classification is a universally applicable system that redefines and reorders historical fracture morphologies into a rational hierarchy. This is the first classification to simultaneously address the biomechanical stability of the posterior pelvic complex and spinopelvic stability, while also taking into consideration neurological status. Further high-quality controlled trials are required prior to the inclusion of this novel classification within a validated scoring system to guide the management of sacral and pelvic injuries.
Topics: Humans; Retrospective Studies; Sacrum; Pelvic Bones; Fractures, Bone; Pelvis; Spinal Fractures
PubMed: 35907199
DOI: 10.3171/2022.5.SPINE211468