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American Journal of Physical... Mar 2021Pelvic features, mostly known as parturition scars, have been extensively studied in the last decades and are frequently investigated in archaeological and forensic...
OBJECTIVES
Pelvic features, mostly known as parturition scars, have been extensively studied in the last decades and are frequently investigated in archaeological and forensic contexts. It is still unclear, however, whether they really relate to pregnancy and birth, or whether these features are caused by other biomechanical factors. Because the length and difficulty of labor correlates with the form of the birth canal, we studied the association between the expression of pelvic features and pelvic shape using geometric morphometrics.
MATERIALS AND METHODS
We scored the expression of the preauricular sulcus, margo auricularis groove, sacral preauricular extension, dorsal and ventral pubic pitting for 54 individuals from a 19th century collection and 19 individuals from the Bronze Age cemetery of Hainburg-Teichtal, Austria. Based on photogrammetric surface models, pelvic shape was captured by 331 landmarks and semilandmarks. The multivariate association between pelvic features and pelvic shape was explored by partial least squares analysis.
RESULTS
Within the female subsample, we detected a significant association of a constrained birth canal with a strong expression of the preauricular sulcus, the margo auricularis groove, and a retroverted position of the acetabulum. No significant association was found among males.
DISCUSSION
This suggests that difficult or prolonged labor may indeed cause more strongly expressed pelvic features, presumably because of increased strain of the pelvic ligaments during birth. Furthermore, the retroversion of the acetabulum, which is known to cause sacroiliac joint dysfunction, changes the strain on pelvic ligaments and can thus also result in the development of pronounced pelvic features.
Topics: Acetabulum; Anthropology, Physical; Female; History, 19th Century; History, Ancient; Humans; Labor, Obstetric; Male; Parturition; Pelvic Bones; Pregnancy
PubMed: 33295660
DOI: 10.1002/ajpa.24196 -
Annals of Surgical Oncology Feb 2022In advanced cancer patients, pelvic bone metastasis often causes pain and gait disturbance. The use of percutaneous bone cement [polymethylmethacrylate (PMMA)] injection...
BACKGROUND
In advanced cancer patients, pelvic bone metastasis often causes pain and gait disturbance. The use of percutaneous bone cement [polymethylmethacrylate (PMMA)] injection for pain management and strengthening in pelvic bone metastasis has rarely been reported. To evaluate this method, we aimed to determine surgical outcomes and complications over a long-term follow-up period using a large patient group.
PATIENTS AND METHODS
We retrospectively collected data from 178 patients who underwent percutaneous cementoplasty for pelvic metastatic lesions, 201 in total. Surgical outcomes evaluated included pain reduction and improvement of ambulation. Mortality within 1 month after procedure and pulmonary embolism caused by thrombus, fat, tumor emboli, or bone cement were investigated as surgical complications. For long-term survivors, pain relapse and mechanical failure were analyzed. The mean follow-up period was 12.6 months, and there were 159 fatalities at last follow-up.
RESULTS
The mean regional pain numerical rating scale scores decreased from 6.1 preoperatively to 2.4 1 month after procedure (p < 0.01). Gait function was maintained, worsened, and uncheckable in 68%, 24%, and 8% of patients, respectively, 1 month after procedure. Of long-term survivors followed up for > 12 months (n = 53), there were no significant changes in serial plain radiographs, and regional pain aggravation was observed in 9%. Pulmonary cement embolism and bone cement implantation syndrome was observed in 11% and 10%, respectively. However, all patients with these complications were asymptomatic.
CONCLUSIONS
Percutaneous cement injection into the pelvis is a feasible and safe palliative surgical option for patients with advanced malignancy in terms of pain reduction and maintenance of ambulatory function under regional anesthesia.
Topics: Bone Cements; Bone Neoplasms; Cementoplasty; Humans; Pelvic Bones; Pelvis; Retrospective Studies; Treatment Outcome
PubMed: 34448054
DOI: 10.1245/s10434-021-10640-8 -
Orthopaedics & Traumatology, Surgery &... Apr 2022Posterior pelvic ring disruption includes sacral fractures, sacroiliac joint fracture dislocations and ilium fractures. Percutaneous iliosacral screw fixation of sacral...
INTRODUCTION
Posterior pelvic ring disruption includes sacral fractures, sacroiliac joint fracture dislocations and ilium fractures. Percutaneous iliosacral screw fixation of sacral fractures and sacraoiliac joint fracture dislocations have been prevailing, it has the advantages of minimal invasiveness, less blood loss and low wound infection rate.
HYPOTHESIS
This study was to evaluate the application of three-dimensional (3D) printed patient-specific guide template in closed reduction and iliosacral screw fixation of posterior pelvic ring disruption.
MATERIAL AND METHODS
The data of patients, who were treated with closed reduction and iliosacral screw fixation of posterior pelvic ring disruption with the assistance of 3D printed guide template from December 2014 to September 2018, were collected. The screw placement time, fluoroscopy time, intraoperative blood loss, fracture reduction, screw position, and functional assessment were recorded.
RESULTS
There were 17 cases of unstable pelvic fractures,and 20 screws were inserted for fixation of sacral fractures or sacroiliac joint dislocations, with bilateral screw placement in 3 cases. The average time for each screw placement was 45.9±8.6min (30-60min). The average fluoroscopy time for each screw insertion was 50.3±19.7s (24-96 s). The mean blood loss for each screw placement was 32.0±11.1ml (20-50ml). According to Matta scale, the fracture reduction was graded as excellent in all the 17 cases. According to the modified Gras classification, the 3D CT reconstruction of the pelvis demonstrated Grade 1 for 18 screws and Grade 2 for 2 screw. Functional outcome 1 year postoperatively was rated as 15 excellent and 2 good, according to the Majeed functional scale.
DISCUSSION
It is feasible and safe to stabilize the posterior pelvic ring disruption using iliosacral screw fixation under assistance of the 3D printed guide template. It could reduce fluoroscopy time, screw placement time and intraoperative blood loss and achieve good postoperative recovery.
LEVEL OF PROOF
IV; Retrospective study.
Topics: Blood Loss, Surgical; Bone Screws; Fracture Dislocation; Fracture Fixation, Internal; Fractures, Bone; Humans; Joint Dislocations; Pelvic Bones; Pelvis; Retrospective Studies; Sacrum; Spinal Fractures
PubMed: 35077898
DOI: 10.1016/j.otsr.2022.103210 -
Diagnostic and Interventional Imaging 2022The purpose of this study was to evaluate the efficacy of cone-beam computed tomography (CBCT) navigation to achieve percutaneous screw fixation (PSF) of pelvic bone...
PURPOSE
The purpose of this study was to evaluate the efficacy of cone-beam computed tomography (CBCT) navigation to achieve percutaneous screw fixation (PSF) of pelvic bone metastases (PBM).
MATERIALS AND METHODS
Thirty-five consecutive patients (12 men and 23 women; mean age, 62 ± 11.3 [SD]; range: 39-89 years) treated between 2019 and 2021 were retrospectively included. CBCT navigation software was systematically used. Manual drawing of the entry point (MDEP) was performed when CBCT automatic positioning failed. Influence of metastasis pattern, ablation, body mass index, number of screws, and MDEP on procedure duration (PD) and total Air Kerma (AK) was evaluated. Local pain was assessed before, one and six months after treatment. Variables were compared using Pearson correlation, Student t and Wilcoxon tests.
RESULTS
Seventy-five screws were inserted successfully (mean: 2.1 ± 1.1 [SD]; range: 1-5 per patient). CBCT automatic positioning was obtained for 41 screws (55%, 41/75), whereas 34 (45%, 34/75) required MDEP. Mean procedure duration, fluoroscopy time, kerma air product and AK were 73.3 ± 44.8 (SD) min (range: 19-233 min), 13.1 ± 9.5 (SD) min (range: 1.4-38.6 min), 73.8 ± 66.3 (SD) Gy.cm (range: 11.6-303.7 Gy.cm) and 301.7 ± 242.1 (SD) mGy (range: 49.4-1111.5 mGy), respectively. Procedure duration was not significantly longer in patients with mixed or blastic PBM compared to those with lytic PBM or when performing ablation, and no significant correlations were observed with the number of screws inserted (P = 0.19), MDEP (P = 0.37) and BMI (P = 0.44). No adverse events were reported during the follow-up (median: 6 months; IQR: 6-6.5 months). Thirteen patients died during the follow-up related to cancer progression. Local pain decreased from 35 ± 32 (SD) mm (range: 0-10 mm) to 11 ± 20 (SD) mm (range: 0-80 mm) at one month (P = 0.001); and to 22 ± 23 (SD) mm (range: 0-60 mm) at six months (P = 0.001).
CONCLUSION
CBCT navigation allows to effectively performing PSF of PBM even in the presence of steep angulations.
Topics: Adult; Aged; Aged, 80 and over; Bone Screws; Cone-Beam Computed Tomography; Female; Fluoroscopy; Humans; Male; Middle Aged; Pain; Pelvic Bones; Retrospective Studies; Surgery, Computer-Assisted
PubMed: 35033489
DOI: 10.1016/j.diii.2022.01.002 -
Scientific Reports Nov 2020The dugong (Dugong dugon Müller) is recognized as an endangered marine mammal. There is limited available anatomical data on the dugong's skeletal system, while what is...
The dugong (Dugong dugon Müller) is recognized as an endangered marine mammal. There is limited available anatomical data on the dugong's skeletal system, while what is available has not been well established due to the limited number of archived samples and limited access to them. Importantly, there are certain key questions that should be answered when examining the bones and/or remains of animals such as; what kind of bone is it?; what species does it belong to?; what sex was the animal?; how old was the animal? or how big was it?, etc. In this study, we have focused on the pelvic bone of the dugong by asserting the hypothesis that pelvic bone morphology is related to age, sex, and body size. Here, we have established certain morphometric data encompassing 8 parameters and 5 indexes to analyze the morphology of the pelvic bones obtained from 88 specimens (45 dugongs). We will present three main findings: (1) the pelvic bone in mature male subjects is larger than it is in female subjects, (2) a high rate of accuracy can be established for sex identification using morphometric data obtained from the pelvic bone, and (3) the pelvic bone has the highest degree of correlation with body length, followed by body weight and age. Notably, the important data on the pelvic bone of the dugong acquired in this study can be reliable and extremely useful in sex identification and body size estimation.
Topics: Algorithms; Animals; Body Size; Dugong; Female; Male; Pelvic Bones; Principal Component Analysis; Reproducibility of Results; Sex Determination Analysis; Sex Factors
PubMed: 33168870
DOI: 10.1038/s41598-020-76545-w -
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 -
Orthopaedics & Traumatology, Surgery &... Sep 2020Acetabular and pelvic fracture accounts for 1.5% of fractures in adults and 2-5% of fractures requiring hospital admission. Several national-level epidemiological...
INTRODUCTION
Acetabular and pelvic fracture accounts for 1.5% of fractures in adults and 2-5% of fractures requiring hospital admission. Several national-level epidemiological studies have been conducted outside France, but French national data are not known. We therefore assessed all patients admitted for acetabular or pelvic fracture in France between 2006 and 2016. The study objectives were: 1) to determine incidence of acetabular and pelvic fracture, 2) to determine progression in incidence between 2006 and 2016, and 3) to determine progression in treatment.
HYPOTHESIS
Incidence of acetabular and pelvic fracture in France is increasing.
METHODS
The following data for the period 2006-2016 were collated from the French national health insurance (CPAM: Caisse Primaire d'Assurance Maladie) database: gender, age, type of treatment, and geographical distribution by administrative area (Département). Two-tailed Student tests were used for comparison of means for numerical variables between independent samples; linear regression was used to analyze correlations; and the Chi test was used to compare percentages of categoric variables.
RESULTS
There were 32,614 acetabular and 164,694 pelvic fractures, with male predominance for the acetabulum and female predominance for the pelvis. Mean age at acetabular fracture was 66±22 years (range, 1-108 years), and 74±20 years (range, 1-112 years) for pelvic fracture. The rate of acetabular fracture increased to 3,301 in 2016 from 2,316 in 2006, with a strong increase in the rate of pelvic fracture, to 18,902 in 2016 from 10,806 in 2006. Incidence of acetabular fracture per 100,000 increased from 3.67 in 2006 to 4.95 in 2016, and from 17.06 to 23.18 in over-75 year-olds. Incidence of pelvic fracture per 100,000 increased from 17.1 to 28.33, and from 129.30 to 210.69 in over-75 year-olds. Linear regression predicts incidence per 100,000 of 5.9 for acetabular fracture and of 41 for pelvic fracture by 2030 in young subjects and 32 and 309 respectively in over-75 year-olds. Management was surgical for acetabular fracture in 12.31% of cases in 2006 and in 14.33% in 2016, and in 1.43% and 2.16% respectively for pelvic fracture.
DISCUSSION
The present data agree with previous reports, with strong increase in incidence of fracture in young and especially in elderly subjects. In elderly subjects, such fractures may require surgery.
LEVEL OF EVIDENCE
IV, retrospective study without control group.
Topics: Acetabulum; Aged; Female; Fractures, Bone; France; Humans; Male; Pelvic Bones; Pelvis; Retrospective Studies
PubMed: 32019733
DOI: 10.1016/j.otsr.2019.11.019 -
European Journal of Trauma and... Apr 2023Although many articles report complications after pelvic ring and acetabular fracture surgery, a general overview of complication rates and potential risk factors is... (Review)
Review
INTRODUCTION
Although many articles report complications after pelvic ring and acetabular fracture surgery, a general overview of complication rates and potential risk factors is lacking. The current review provides a comprehensive summary of the complications after pelvic ring and acetabular fracture surgery in relation to the surgical approach.
MATERIAL AND METHODS
Pubmed and Embase databases were systematically searched using the key words: pelvic fracture, acetabular fracture, fixation, surgical approaches, complications, and their synonyms. Extracted data included patient and fracture characteristics, surgical approaches, and post-operative complications; surgical site infections (SSI), implant-related complications, malunion and non-union. Study data were summarized using descriptive statistics.
RESULTS
Twenty-two studies (twenty-one retrospective cohort studies, of which three comparative, and one randomized controlled trial) were included in this review. The overall complication rates reported for the included surgical approaches were: 17% for the (Modified) Stoppa approach, 11% for percutaneous fixation, 5% for the Kocher-Langenbeck approach, 7% for the ilioinguinal approach and 31% for external fixation. The most frequent complications were SSI (22%) and neurological (31%) complications, which were most often reported in patients treated with an external fixator. Re-operation rates were comparable for the surgical approaches (4-8%). Two studies reported on risk factors and identified concomitant traumatic injuries, prolonged ICU stay and high body mass index as risk factors for SSI.
CONCLUSION
External fixation of pelvic fractures is associated with highest complications rates including SSI's and neurological complications. Although post-operative complications are frequently reported after pelvic fracture surgery, more studies are needed that identify potential risk factors. These will assist the surgeon in (pre)operative decision making and development of preventive strategies.
Topics: Humans; Fracture Fixation, Internal; Acetabulum; Retrospective Studies; Fractures, Bone; Pelvic Bones; Hip Fractures; Spinal Fractures; Surgical Wound Infection; Randomized Controlled Trials as Topic
PubMed: 36434301
DOI: 10.1007/s00068-022-02118-3 -
Orthopaedic Surgery Jun 2020To preliminarily study the efficacy and safety of stop-flow pelvic chemoperfusion, a novel therapeutic strategy for treating pelvic malignancies.
OBJECTIVE
To preliminarily study the efficacy and safety of stop-flow pelvic chemoperfusion, a novel therapeutic strategy for treating pelvic malignancies.
METHODS
Stop-flow chemoperfusion was performed six times in 5 patients with primary pelvic malignancies. Aortic and vena cave balloons and tourniquets were used to isolate pelvic blood flow from systemic circulation. Cisplatin was then perfused through a transarterial catheter to achieve exposure to a higher drug concentration. Pelvic and peripheral blood samples were collected to determine drug concentration during perfusion. The efficacy of stop-flow pelvic perfusion was assessed by measuring the change in tumor size, the visual analogue scale, and the tumor necrosis rate after perfusion. Safety was assessed by classifying adverse events according to CTCAE v4.03.
RESULTS
The mean area under the curve (AUC) and maximum drug concentration in the pelvis during perfusion were 246.23 min μg/mL and 17.29 μg/mL, respectively. These measures were significantly higher than the peripheral mean AUC and maximum drug concentration of 52.08 min μg/mL and 5.14 μg/mL, respectively. All 5 patients showed stable disease in response, with changes in tumor size of -4.7%, -5.4%, +4.7%, -8.4%, and 0.0%. Among the 5 patients, 3 (60%) experienced significant pain relief after perfusion. Three patients underwent surgery, with tumor necrosis of 63%, <60%, and 93%. No severe complications were observed in this study.
CONCLUSIONS
Stop-flow pelvic chemoperfusion resulted in exposure to drug higher concentration with fewer serious complications. These preliminary results suggest that further studies are required to comprehensively assess the therapeutic potential of stop-flow pelvic chemoperfusion in pelvic malignancies.
Topics: Adult; Antineoplastic Agents; Bone Neoplasms; Chemotherapy, Cancer, Regional Perfusion; Cisplatin; Female; Humans; Male; Neoplasm Metastasis; Pain Measurement; Pelvic Bones
PubMed: 32243077
DOI: 10.1111/os.12666 -
Osteoporosis International : a Journal... Sep 2023Identifying the full scope of pelvic fracture patterns in older adults has gained clinical importance since the last decennium. CT is recommended as the golden standard;... (Review)
Review
Identifying the full scope of pelvic fracture patterns in older adults has gained clinical importance since the last decennium. CT is recommended as the golden standard; however, MRI has even greater diagnostic accuracy. Dual energy computed tomography (DECT) is a new and promising imaging technique, but the diagnostic accuracy in the context of pelvic fragility fractures (FFPs) has not been widely established. The aim was to provide insight into the diagnostic accuracy of different imaging techniques and the relevance for clinical practice. A systematic search was performed in the PubMed database. All studies that reported on CT, MRI or DECT imaging techniques in older adults who suffered a pelvic fracture were reviewed and, if relevant, included. Eight articles were included. In up to 54% of the patients, additional fractures were found on MRI compared to CT, and in up to 57% of the patients on DECT. The sensitivity of DECT for posterior pelvic fracture detection was similar to MRI. All patients without fractures on CT appeared to have posterior fractures on MRI. After additional MRI, 40% of the patients had a change of classification. DECT and MRI showed very similar results in terms of diagnostic accuracy. Over a third of all patients appear to have a more severe fracture classification after MRI, the majority changing to Rommens type 4. However, in only a few patients who changed of fracture classification, a change of therapy was advised. This review suggests that MRI and DECT scans are superior in diagnosing FFPs.
Topics: Humans; Aged; Tomography, X-Ray Computed; Fractures, Bone; Magnetic Resonance Imaging; Pelvic Bones; Radionuclide Imaging; Sensitivity and Specificity; Retrospective Studies
PubMed: 37286662
DOI: 10.1007/s00198-023-06812-9