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Orthopaedics & Traumatology, Surgery &... Oct 2021Floating hip is a rare and potentially serious injury. The objective of this study was to evaluate our management strategy for patients with floating hip.
BACKGROUND
Floating hip is a rare and potentially serious injury. The objective of this study was to evaluate our management strategy for patients with floating hip.
HYPOTHESIS
A standardized strategy with specialised multidisciplinary management is associated with a low mortality rate.
METHODS
Consecutive patients who had surgery to treat floating hip between January 2010 and December 2019 were included in this single-centre retrospective study. Epidemiological, clinical, and radiological data were collected and analysed. Patients were managed according to a standardised strategy adapted to the haemodynamic status and type of floating hip (type A, femoral and pelvic ring fractures; type B, femoral and acetabular fractures; and type C, femoral, acetabular, and pelvic ring fractures). The clinical outcome at last follow-up was determined by a telephone interview, based on the Majeed and Oxford scores, sports resumption, and work resumption. To assess the radiological outcomes, we applied Matta's criteria for the acetabulum and Tornetta's criteria for the pelvic ring.
RESULTS
We included 69 patients with a mean age of 38.5 years. Among them, 39 (57%) had haemodynamic instability requiring embolisation (n=15, 22%) or multiple blood transfusions (n=24, 35%). Type A injuries predominated (n=57, 83%). The need for multiple blood transfusions was significantly associated with type C floating hip, underlining the risk of heavy bleeding with this injury. Two (3%) patients died. When management was complete, the reduction was anatomical or satisfactory for 76% (13/17) of the acetabula according to Matta's criteria (maximum residual displacement <3mm) and for 85% (56/66) of the pelvic rings according to Tornetta's criteria (maximum residual displacement <10mm). One or more complications occurred in 45 (65%) patients. After a mean follow-up of 5 years, the mean Oxford Hip Score in patients with acetabular fractures was 35.5 and the mean Majeed score in patients with pelvic ring fractures was 71.5. Only 30% of patients were able to resume physical activities at the former level and to return to their former professional activities.
CONCLUSION
Type C floating hip, which combines fractures of the pelvic ring and acetabulum, carries a high risk of bleeding. Special attention should be directed to the reduction of pelvic ring fractures, to avoid malunion. Acetabular fractures that are complex in the Letournel classification carry a risk of imperfect reduction. The results of this study confirm the severity of these rare injuries and the need for specialised multidisciplinary management according to a standardised strategy that is appropriate for the haemodynamic status and type of floating hip (A, B, or C).
LEVEL OF EVIDENCE
IV; retrospective study.
Topics: Acetabulum; Adult; Fractures, Bone; Hip Fractures; Humans; Pelvic Bones; Radiography; Retrospective Studies; Treatment Outcome
PubMed: 34214653
DOI: 10.1016/j.otsr.2021.102998 -
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 -
Radiology Aug 2022Background Grading of pelvic fracture instability is challenging in patients with pelvic binders. Dual-energy CT (DECT) and cinematic rendering can provide ancillary...
Background Grading of pelvic fracture instability is challenging in patients with pelvic binders. Dual-energy CT (DECT) and cinematic rendering can provide ancillary information regarding osteoligamentous integrity, but the utility of these tools remains unknown. Purpose To assess the added diagnostic value of DECT and cinematic rendering, with respect to single-energy CT (SECT), for discriminating any instability and translational instability in patients with pelvic binders. Materials and Methods In this retrospective analysis, consecutive adult patients (age ≥18 years) were stabilized with pelvic binders and scanned in dual-energy mode using a 128-section CT scanner at one level I trauma center between August 2016 and January 2019. Young-Burgess grading by orthopedists served as the reference standard. Two radiologists performed blinded consensus grading with the Young-Burgess system in three reading sessions (session 1, SECT; session 2, SECT plus DECT; session 3, SECT plus DECT and cinematic rendering). Lateral compression (LC) type 1 (LC-1) and anteroposterior compression (APC) type 1 (APC-1) injuries were considered stable; LC type 2 and APC type 2, rotationally unstable; and LC type 3, APC type 3, and vertical shear, translationally unstable. Diagnostic performance for any instability and translational instability was compared between reading sessions using the McNemar and DeLong tests. Radiologist agreement with the orthopedic reference standard was calculated with the weighted κ statistic. Results Fifty-four patients (mean age, 41 years ± 16 [SD]; 41 men) were analyzed. Diagnostic performance was greater with SECT plus DECT and cinematic rendering compared with SECT alone for any instability, with an area under the receiver operating characteristic curve (AUC) of 0.67 for SECT alone and 0.82 for SECT plus DECT and cinematic rendering ( = .04); for translational instability, the AUCs were 0.80 for SECT alone and 0.95 for SECT plus DECT and cinematic rendering ( = .01). For any instability, corresponding sensitivities were 61% (22 of 36 patients) for SECT alone and 86% (31 of 36 patients) for SECT plus DECT and cinematic rendering ( < .001). The corresponding specificities were 72% (13 of 18 patients) and 78% (14 of 18 patients), respectively ( > .99). Agreement (κ value) between radiologists and orthopedist reference standard improved from 0.44 to 0.76 for SECT versus the combination of SECT, DECT, and cinematic rendering. Conclusion Combined use of single-energy CT, dual-energy CT, and cinematic rendering improved instability assessment over that with single-energy CT alone. © RSNA, 2022
Topics: Adolescent; Adult; Fractures, Bone; Humans; Male; Pelvic Bones; Radiography, Dual-Energy Scanned Projection; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 35438566
DOI: 10.1148/radiol.211679 -
Journal of Orthopaedic Research :... Mar 2022Limb-salvaging hemipelvectomy surgeries involving allograft or custom prosthesis reconstruction require high quality remaining pelvic bone for adequate device fixation....
Limb-salvaging hemipelvectomy surgeries involving allograft or custom prosthesis reconstruction require high quality remaining pelvic bone for adequate device fixation. Modeling studies of custom pelvis prosthesis designs typically mirror contralateral pelvic bone material properties to the ipsilateral pelvis. However, the extent of bone material property and geometric symmetry, and thus the appropriateness of mirroring, remains unknown and should be considered when designing or analyzing the performance of pelvic prostheses. This study investigates preoperative differences between ipsilateral and contralateral pelvic bone for patients with a pelvic sarcoma. Computed tomography (CT) data were obtained retrospectively from eight patients with a pelvic sarcoma. Subject-specific computational models of the pelvic bones were constructed from the CT data. Bilateral asymmetry of bone material properties and cross-sectional areas between the ipsilateral and contralateral hemipelvis were quantified at points adjacent to the pelvic sarcoma. Large bilateral asymmetry (>20%) in trabecular but not cortical bone density was observed within 20 mm of the tumor location. Differences in trabecular bone density typically declined with increased distance from the tumor. The greatest bilateral difference in cross-sectional area occurred within 10 mm of the tumor boundary for three patients and within 40 mm from the tumor site for four patients. Our results suggest that pelvic sarcomas can cause significant bilateral asymmetries in trabecular bone density for patients with a pelvic sarcoma. These differences should be taken into account when designing custom implants for this patient population.
Topics: Bone Density; Bone Neoplasms; Humans; Pelvic Bones; Retrospective Studies; Sarcoma; Tomography, X-Ray Computed
PubMed: 33914952
DOI: 10.1002/jor.25067 -
Injury Nov 2022Isolated iliac wing fracture is a rare pelvic fracture that is considered benign in the literature. As there is a complete lack of information on function and quality of...
INTRODUCTION
Isolated iliac wing fracture is a rare pelvic fracture that is considered benign in the literature. As there is a complete lack of information on function and quality of life in patients with this injury, the primary aim of this study was to evaluate the long-term functional results, and secondly to evaluate the patients' clinical function and fracture healing.
PATIENTS AND METHODS
All patients treated in Oslo University Hospital, Ullevaal (OUH-U), the Norwegian National Pelvic Service, in the time period 2006-2016 were included. Nine of 13 eligible patients (69%) were evaluated by the Patient Reported Outcome Measures (PROM); EQ-5D-3L and Majeed Score. For the secondary outcomes, the patients were clinically examined for Range of Motion (ROM) in the hips, pain, muscular function and nerve deficiencies. Finally, the patients underwent X-rays (AP-view and iliac and obturator oblique views).
RESULTS
All patients were injured in high-energy trauma with severe associated injuries. Five patients were operated and four received conservative treatment. At the time of follow-up (median seven years after injury), the mean EQ-5D VAS was 84, and the mean Majeed score was 87. Two out of nine reported moderate level of pain, three reported mild pain, and the rest reported no pain. Six patients were still working, two were retired, and the last one was receiving disability benefit of other reasons than the iliac fracture. One patient had difference in range of external rotation of >10° between the hips, while the rest had no differences in ROM. The follow-up X-rays showed healed fractures in all the patients.
CONCLUSION
Patients with isolated iliac wing fractures seem to have a good general state of health, scoring high on the PROMs, with minor and insignificant clinical sequela. This original finding is in accordance with the general assumption amongst pelvic surgeons that the injury is a benign one.
Topics: Humans; Pelvic Bones; Fracture Fixation, Internal; Quality of Life; Treatment Outcome; Fractures, Bone; Spinal Fractures; Neck Injuries; Retrospective Studies
PubMed: 36057487
DOI: 10.1016/j.injury.2022.08.033 -
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 -
Scientific Reports Oct 2021This study investigated feasibility of imaging lumbopelvic musculature and geometry in tandem using upright magnetic resonance imaging (MRI) in asymptomatic adults, and...
This study investigated feasibility of imaging lumbopelvic musculature and geometry in tandem using upright magnetic resonance imaging (MRI) in asymptomatic adults, and explored the effect of pelvic retroversion on lumbopelvic musculature and geometry. Six asymptomatic volunteers were imaged (0.5 T upright MRI) in 4 postures: standing, standing pelvic retroversion, standing 30° flexion, and supine. Measures included muscle morphometry [cross-sectional area (CSA), circularity, radius, and angle] of the gluteus and iliopsoas, and pelvic geometry [pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), L3-S1 lumbar lordosis (LL)] L3-coccyx. With four volunteers repeating postures, and three raters assessing repeatability, there was generally good repeatability [ICC(3,1) 0.80-0.97]. Retroversion had level dependent effects on muscle measures, for example gluteus CSA and circularity increased (up to 22%). Retroversion increased PT, decreased SS, and decreased L3-S1 LL, but did not affect PI. Gluteus CSA and circularity also had level-specific correlations with PT, SS, and L3-S1 LL. Overall, upright MRI of the lumbopelvic musculature is feasible with good reproducibility, and the morphometry of the involved muscles significantly changes with posture. This finding has the potential to be used for clinical consideration in designing and performing future studies with greater number of healthy subjects and patients.
Topics: Adult; Bone Retroversion; Cross-Sectional Studies; Feasibility Studies; Female; Humans; Lordosis; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Muscles; Pelvic Bones; Pelvis; Pilot Projects; Range of Motion, Articular; Standing Position; Young Adult
PubMed: 34635683
DOI: 10.1038/s41598-021-99305-w -
Scientific Reports Jan 2021Severe bleeding is the major cause of death in unstable pelvic ring fractures. Therefore, a quick and efficient emergency stabilization and bleeding control is...
Severe bleeding is the major cause of death in unstable pelvic ring fractures. Therefore, a quick and efficient emergency stabilization and bleeding control is inevitable. C-clamp and pelvic binder are efficient tools for temporary bleeding control, especially from the posterior pelvic ring. Yet the C-clamp requires more user knowledge, training and equipment. However, whether this makes up for a more efficient bleeding control, is still under debate. Patients with a type-C pelvic ring fracture were identified from the German Pelvic Registry (GPR) and divided into three groups of 40 patients (1. no emergency stabilization, 2. pelvic binder, 3. C-clamp). The matching occurred according to the parameters age, gender, initial RR and initial HB. Complication-and mortality rates were compared especially regarding bleeding control. Regarding ISS and fracture dislocation there was no difference. The use of the C-clamp resulted in more complications, a higher mortality rate due to severe bleeding and more blood transfusions were admitted. Moreover the pelvic binder was established noticeably faster. However, the C-clamp was more often rated as effective. There is no evidence of advantage comparing the C-clamp to the pelvic binder, regarding bleeding control in type-C pelvic ring fractures. In fact, using the pelvic binder even showed better results, as the time until established bleeding control was significantly shorter. Therefore, the pelvic binder should be the first choice. The C-clamp should remain a measure for selected cases only, if an adequate bleeding control cannot be achieved by the pelvic binder.
Topics: Emergency Service, Hospital; Fracture Fixation; Fractures, Bone; Hemorrhage; Humans; Pelvic Bones
PubMed: 33504874
DOI: 10.1038/s41598-021-81745-z -
Orthopaedic Surgery Aug 2021To investigate the sagittal hip-pelvic kinematics in symptomatic cam-type femoroacetabular impingement (FAI) patients in the process of sitting down and compare their... (Comparative Study)
Comparative Study
OBJECTIVE
To investigate the sagittal hip-pelvic kinematics in symptomatic cam-type femoroacetabular impingement (FAI) patients in the process of sitting down and compare their difference between patients with sitting pain complaint and those without.
METHODS
Twenty-nine symptomatic cam-type FAI patients were recruited from our clinic between May 2018 and October 2018. Patients were categorized into two groups depending on whether they complain of pain in prolonged sitting or not. The pelvic-femoral measurements were assessed with a set of lateral pelvic radiography in sitting and standing respectively. Pelvic incidence (PI), sacral slope (SS), and proximal femoral shaft angle (PFSA) were measured on lateral pelvic radiography, and then pelvic tilting, apparent hip flexion, true hip flexion, and the pelvic-femoral ratio were calculated to investigate the kinematic change from standing to sitting position. Demographic measurements, hip morphology measurements, functional measurements, visual analog scale (VAS), and pelvic-femoral measurements were compared between the two groups.
RESULTS
Thirteen cases without sitting pain complaint and 16 cases with sitting pain complaint were stratified to Group N and Group P respectively. No was significant difference in age, body mass index (BMI), and gender between the two groups. Hip morphology measurements (α angle and lateral center-edge angle) and functional measurements (iHOT-12) showed no significant difference between the two groups. However, the mean VAS of pain while sitting was 0.5 ± 0.4 and 1.6 ± 0.6 in Group N and Group P respectively (P = 0.005). Patients with sitting pain complaint have increased pelvic PI compared to those without (50.1° ± 6.5° and 44.2° ± 7.6°, P = 0. 042). The changes in SS (pelvic tilting) from standing to sitting in Group N was significantly larger than that in Group P (21.8° ± 7.0° and 15.1° ± 6.5°, P = 0.012). Although no significant difference in apparent hip flexion and true hip flexion was found. Patients without sitting pain complaint demonstrated a higher pelvic-femoral ratio (22.8% ± 7.9% and 16.1% ± 7.5%, P = 0.010) compared to those with sitting pain complaint.
CONCLUSION
Sagittal pelvic-femoral kinematics could have an influence on the symptomology of cam-type FAI. The small PI and insufficient sagittal pelvic tilting in the process of sitting down could be related to the complaint of sitting pain in patients with symptomatic cam-type FAI.
Topics: Adult; Biomechanical Phenomena; Female; Femoracetabular Impingement; Humans; Male; Middle Aged; Pain Measurement; Patient Positioning; Pelvic Bones; Radiography; Sitting Position; Standing Position
PubMed: 34411458
DOI: 10.1111/os.13038 -
Journal of Anatomy Sep 2022The pelvic ring is a complex anatomical structure building up the connection between the trunk and the legs. Whilst there is a broad discussion in the literature about...
The pelvic ring is a complex anatomical structure building up the connection between the trunk and the legs. Whilst there is a broad discussion in the literature about the dynamic interaction between spine, pelvis and the hip joints, there is still little information about the relation and interaction of the constant pelvic parameters. Based on a three-dimensional (3D) statistical model consisting of 150 uninjured and bony healthy pelves (100 Europeans, 50 Japanese; 81 males, 69 females; average age 74.3 years ± 17.5 years) an evaluation of pelvic incidence (PI) and acetabular orientation in anteversion and inclination was performed and potential correlations of these intraindividual constant parameters were investigated. Pelvic incidence is defined as the angle between the perpendicular to the sacral plate at its midpoint and the line connecting this point to the middle axis of the femoral heads. Acetabular anteversion is defined as the angle between the perpendicular to the best-fit plane on the acetabular rim and the coronal plane measured in strict lateral view. Acetabular inclination is defined as the angle between the perpendicular to the best-fit plane on the acetabular rim and the sagittal plane in strict frontal view. Data were further analysed with regard to different subgroup's age, sex and ethnicity. A positive correlation between PI and acetabular anteversion could be demonstrated. Further, PI and also the acetabular parameters anteversion and inclination were found to be significantly higher in the European individuals than in the Asian. The results of the present study demonstrate a relation between the anatomical configuration of the constant pelvic parameters building up the connection points to the next proximal respectively caudal skeleton section. The findings might lead to more comprehensive treatment strategies in case of trauma or degenerative pathologies of the pelvis in the future.
Topics: Acetabulum; Aged; Female; Hip Joint; Humans; Male; Models, Statistical; Pelvic Bones; Pelvis
PubMed: 35662008
DOI: 10.1111/joa.13708