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Arthroplasty Today Jun 2023Functional patient-specific acetabular component positioning is important in total hip arthroplasty. We preoperatively evaluate the pelvic tilt (PT) on standing...
BACKGROUND
Functional patient-specific acetabular component positioning is important in total hip arthroplasty. We preoperatively evaluate the pelvic tilt (PT) on standing anteroposterior (AP) pelvis radiographs using a novel measurement and then recreate this intraoperatively using imaging. The purpose of this study was to determine if there is a linear correlation between this novel measurement and the actual PT.
METHODS
A retrospective study of 200 patients was performed, measuring PT on standing lateral radiographs as the angle between the anterior superior iliac spines and the pubic symphysis. On the AP pelvis radiographs, the trans-teardrop (TT) line was drawn between the teardrops. The vertical distance between the TT line and the top of the pubic symphysis (TTPS) was then measured. A ratio was made between the lengths of both lines to account for the overall size of the pelvis (TTPS/TT). Linear regression analysis was then performed between PT and TTPS/TT.
RESULTS
There was a strong linear correlation between the TTPS/TT ratio on AP pelvis radiographs and PT on lateral radiographs (r = 0.785, r = 0.616, < .001). On subanalysis of the female cohort, the correlation became even stronger (r = 0.864, r = 0.747, < .001). Using regression analysis, a linear equation was created (PT = 97.32 [TTPS/TT] - 5.51), to calculate the PT using the TTPS/TT ratio.
CONCLUSIONS
There is a strong linear correlation between the TTPS/TT ratio and PT. Using this information, a surgeon can reliably use the distance between the TT line and the superior pubic symphysis on an AP radiograph to recreate the patient's functional PT intraoperatively, allowing for a more accurate patient-specific placement of the acetabular component.
PubMed: 37274836
DOI: 10.1016/j.artd.2023.101145 -
European Radiology Oct 2023To compare dedicated MRI with targeted fluoroscopic guided symphyseal contrast agent injection regarding the assessment of symphyseal cleft signs in men with athletic...
Comparison between dedicated MRI and symphyseal fluoroscopic guided contrast agent injection in the diagnosis of cleft sign in athletic groin pain and association with pelvic ring instability.
OBJECTIVE
To compare dedicated MRI with targeted fluoroscopic guided symphyseal contrast agent injection regarding the assessment of symphyseal cleft signs in men with athletic groin pain and assessment of radiographic pelvic ring instability.
METHODS
Sixty-six athletic men were prospectively included after an initial clinical examination by an experienced surgeon using a standardized procedure. Diagnostic fluoroscopic symphyseal injection of a contrast agent was performed. Additionally, standing single-leg stance radiography and dedicated 3-Tesla MRI protocol were employed. The presence of cleft injuries (superior, secondary, combined, atypical) and osteitis pubis was recorded.
RESULTS
Symphyseal bone marrow edema (BME) was present in 50 patients, bilaterally in 41 patients and in 28 with an asymmetrical distribution. Comparison of MRI and symphysography was as followed: no clefts: 14 cases (MRI) vs. 24 cases (symphysography), isolated superior cleft sign: 13 vs. 10, isolated secondary cleft sign: 15 vs. 21 cases and combined injuries: 18 vs. 11 cases. In 7 cases a combined cleft sign was observed in MRI but only an isolated secondary cleft sign was visible in symphysography. Anterior pelvic ring instability was observed in 25 patients and was linked to a cleft sign in 23 cases (7 superior cleft sign, 8 secondary cleft signs, 6 combined clefts, 2 atypical cleft injuries). Additional BME could be diagnosed in 18 of those 23.
CONCLUSION
Dedicated 3-Tesla MRI outmatches symphysography for purely diagnostic purposes of cleft injuries. Microtearing at the prepubic aponeurotic complex and the presence of BME is a prerequisite for the development of anterior pelvic ring instability.
CLINICAL RELEVANCE STATEMENT
For diagnostic of symphyseal cleft injuries dedicated 3-T MRI protocols outmatch fluoroscopic symphysography. Prior specific clinical examination is highly beneficial and additional flamingo view x-rays are recommended for assessment of pelvic ring instability in these patients.
KEY POINTS
• Assessment of symphyseal cleft injuries is more accurate by use of dedicated MRI as compared to fluoroscopic symphysography. • Additional fluoroscopy may be important for therapeutic injections. • The presence of cleft injury might be a prerequisite for the development of pelvic ring instability.
Topics: Male; Humans; Contrast Media; Groin; Pubic Symphysis; Athletic Injuries; Magnetic Resonance Imaging; Fluoroscopy; Sports; Pain
PubMed: 37145146
DOI: 10.1007/s00330-023-09666-1 -
Journal of Orthopaedic Surgery and... May 2023Several types of pelvic osteotomy techniques have been reported and employed by orthopedic surgeons to enhance the approximation of symphyseal diastasis in bladder...
BACKGROUND
Several types of pelvic osteotomy techniques have been reported and employed by orthopedic surgeons to enhance the approximation of symphyseal diastasis in bladder exstrophy patients. However, there is limited evidence on a long-term follow-up to confirm which osteotomy techniques provide the most suitable and effective outcomes for correcting pelvic deformities. This study aimed to describe the surgical technique of bilateral iliac bayonet osteotomies for correcting pelvic bone without using fixation in bladder exstrophy and to report on the long-term clinical and radiographic outcomes following the bayonet osteotomies.
METHODS
We retrospectively reviewed patients with bladder exstrophy who underwent bilateral iliac bayonet osteotomies with the closure of bladder exstrophy between 1993 and 2022. Clinical outcomes and radiographic pubic symphyseal diastasis measurements were evaluated. From a total of 28 operated cases, eleven were able to attend a special follow-up clinic or were interviewed by telephone by one of the authors with completed charts and recorded data.
RESULTS
A total of 11 patients (9 female and 2 male) with an average age at operation of 9.14 ± 11.57 months. The average followed-up time was 14.67 ± 9.24 years (0.75-29), with the average modified Harris Hip score being 90.45 ± 1.21. All patients demonstrated decreased pubic symphyseal diastasis distance (2.05 ± 1.13 cm) compared to preoperative (4.58 ± 1.37 cm) without any evidence of nonunion. At the latest follow-up, the average foot progression angle was externally rotated 6.25° ± 4.79° with full hips ROM, and no patients reported abnormal gait, hip pain, limping, or leg length discrepancy.
CONCLUSIONS
Bilateral iliac wings bayonet osteotomies technique demonstrated a safe and successful pubic symphyseal diastasis closure with an improvement both clinically and radiographically. Moreover, it showed good long-term results and excellent patient's reported outcome scores. Therefore, it would be another effective option for pelvic osteotomy in treating bladder exstrophy patients.
Topics: Humans; Male; Female; Infant; Bladder Exstrophy; Retrospective Studies; Ilium; Pelvic Bones; Pubic Symphysis Diastasis; Osteotomy
PubMed: 37131198
DOI: 10.1186/s13018-023-03810-9 -
The British Journal of Radiology Jun 2023Repeated CT simulation imaging is common at our institution due to failure to achieve acceptable bladder filling in patients undergoing prostate radiotherapy. There is...
OBJECTIVES
Repeated CT simulation imaging is common at our institution due to failure to achieve acceptable bladder filling in patients undergoing prostate radiotherapy. There is operational value in re-assessing the validity of the bladder filling assessment criteria by comparing the quality of two plans optimized based on either an "Accepted" or "Rejected" bladder status.
METHODS
Twenty prostate patients with repeated CT simulation imaging were included. For each patient, a VMAT plan created using the "Rejected" bladder was compared with the "Accepted" bladder plan. Then, delivered dose to bladder was estimated using ≥4 CBCTs to measure number of fractions with major bladderdose violation (>5% difference) for both plans. Bladder heights of fractions without major bladder dose violations were compared to those with a violation to determine a threshold height for bladder filling acceptability.
RESULTS
Using the "Accepted" bladder plans for treatment resulted in 30/175 fractions with major dose violations. These 30 bladders were significantly shorter than those without major violation (mean 28 vs 43mm, < 0.05). The "Rejected" bladder plans delivered a lower dose to the bladder by ≥5% than the '"Accepted" bladder plans in 59% of fractions, and the number of fractions with major dose violations was 17.
CONCLUSIONS
Using a shorter bladder for plan optimization resulted in better bladder sparing during treatment and improved compliance to protocol specific bladder dose constraints. A bladder height range of 20-40 mm measured between the bladder dome and the superior aspect of the symphysis pubis is recommended for prostate radiotherapy requiring a full bladder protocol.
ADVANCES IN KNOWLEDGE
Using real patient data from simulation and treatment, this study established a range of bladder height that can be measured easily in a clinical setting for assessing adequacy of bladder filling for prostate radiotherapy.
Topics: Male; Humans; Prostate; Radiotherapy, Intensity-Modulated; Urinary Bladder; Radiotherapy Planning, Computer-Assisted; Prostatic Neoplasms; Radiotherapy Dosage; Organs at Risk
PubMed: 37086060
DOI: 10.1259/bjr.20230020 -
New Microbes and New Infections Jun 2023, and have been recently described in the female genital tract. We present the first case of a postpartum septic arthritis of the pubic symphysis due to these...
, and have been recently described in the female genital tract. We present the first case of a postpartum septic arthritis of the pubic symphysis due to these organisms, identified by next generation sequencing.
PubMed: 37065965
DOI: 10.1016/j.nmni.2023.101112 -
Cureus Mar 2023Tuberculosis is a well-known and ancient disease with a wide range of clinical presentations. Although tuberculosis is a well-known infectious disease, involvement of...
Tuberculosis is a well-known and ancient disease with a wide range of clinical presentations. Although tuberculosis is a well-known infectious disease, involvement of the symphysis pubis is rare, with only a few documented cases in the medical literature. Distinguishing it from other more common conditions, such as osteomyelitis of the pubic symphysis and osteitis pubis, is essential to avoid delay in diagnosis and to minimize morbidity, mortality, and complications. We present a rare case of tuberculosis of the symphysis pubis in an eight-year-old female from India who was initially misdiagnosed with osteomyelitis. Following the correct diagnosis and commencement of anti-tuberculosis chemotherapy, the patient demonstrated improvement in symptoms and hematological parameters at the three-month follow-up. This case emphasizes the importance of considering tuberculosis as a differential diagnosis in cases of symphysis pubis involvement, especially in areas with a high incidence of tuberculosis. Early diagnosis and appropriate treatment can prevent further complications and improve clinical outcomes.
PubMed: 37065338
DOI: 10.7759/cureus.36149 -
Journal of Orthopaedic Case Reports Dec 2022Osteomyelitis pubis is a rare disease that presents with fever, pubic or hip pain, pain during hip movement, and claudication to avoid pain. It most frequently affects...
INTRODUCTION
Osteomyelitis pubis is a rare disease that presents with fever, pubic or hip pain, pain during hip movement, and claudication to avoid pain. It most frequently affects young athletes involved in sports that require twisting and cutting, but its exact cause is unknown and no definite treatment has been established. We report a case of pubic osteomyelitis in a young football player who was treated using the Masquelet technique and antibiotics with a good clinical course.
CASE REPORTS
A 22-year-old male football player in a national-level university club team visited a nearby clinic complaining of high fever and mild pain in his bilateral hip joints. As a result of examination, we diagnosed osteomyelitis pubis and reconstructed the pubic symphysis by the Masquelet technique. In this case, the joint-like structure of the pubic symphysis was successfully reconstructed, and the patient was able to continue playing the sport. Three years and 3 months after surgery, he had no limitation of bilateral hip joint range of motion and did not display any symptoms while playing football.
CONCLUSION
Masquelet technique could be a novel surgical method for managing osteomyelitis pubis, even in athletes.
PubMed: 37056586
DOI: 10.13107/jocr.2022.v12.i12.3456