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World Journal of Emergency Surgery :... 2017Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of... (Review)
Review
Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.
Topics: Disease Management; Evidence-Based Practice; Fracture Fixation; Fractures, Bone; Guidelines as Topic; Hemodynamics; Humans; Injury Severity Score; Pelvis; Wounds and Injuries
PubMed: 28115984
DOI: 10.1186/s13017-017-0117-6 -
Annals of Medicine Dec 2022Pelvic venous disorders (PeVD) also known as Pelvic Congestion Syndrome (PCS) affect a great number of women worldwide and often remain undiagnosed. Gynecological... (Review)
Review
Pelvic venous disorders (PeVD) also known as Pelvic Congestion Syndrome (PCS) affect a great number of women worldwide and often remain undiagnosed. Gynecological symptoms caused by vascular background demand a holistic approach for appropriate diagnosis. This is a relevant cause of chronic pelvic pain and atypical varicose veins. The diagnosis is based on imaging studies and their correlation with clinical presentation. Although the aetiology of PCS still remains unclear, it may result from a combination of factors including genetic predisposition, anatomical abnormalities, hormonal factors, damage to the vein wall, valve dysfunction, reverse blood flow, hypertension and dilatation. The following paper describes an in-depth overview of anatomy, pathophysiology, symptoms, diagnosis and treatment of PCS. In recent years, minimally invasive interventions have become the method of first choice for the treatment of this condition. The efficacy of a percutaneous approach is high and it is rarely associated with serious complications.Key MessagesPelvic venous disorders demand a holistic approach for appropriate diagnosis.This article takes an in-depth look at existing therapies of Pelvic Congestion Syndrome and pathophysiology of this condition.Embolisation is an effective and safe treatment option.
Topics: Embolization, Therapeutic; Female; Humans; Pelvic Pain; Pelvis; Varicose Veins
PubMed: 34935563
DOI: 10.1080/07853890.2021.2014556 -
Anatomical Record (Hoboken, N.J. : 2007) Apr 2017The pelvis is an anatomically complex and functionally informative bone that contributes directly to both human locomotion and obstetrics. Because of the pelvis'...
The pelvis is an anatomically complex and functionally informative bone that contributes directly to both human locomotion and obstetrics. Because of the pelvis' important role in obstetrics, it is one of the most sexually dimorphic bony elements of the human body. The complex intersection of pelvic dimorphism, locomotion, and obstetrics has been reenergized by exciting new research, and many papers in this special issue of the pelvis help provide clarity on the relationship between pelvic form (especially female) and locomotor function. Compared to the pelvis of our ape relatives, the human pelvis is uniquely shaped; it is superoinferiorly short and stout, and mediolaterally wide-critical adaptations for bipedalism that are already present in some form very early in the history of the hominin lineage. In this issue, 13 original research papers address the anatomy, development, variation, and function of the modern human pelvis, with implications for understanding the selection pressures that shaped and continue to shape this bone. This rich collection of scholarship moves our understanding of the pelvis forward, while raising dozens of new questions that we hope will serve as inspiration for colleagues and students (both current and future) puzzled by this fascinatingly complex bone. Anat Rec, 300:628-632, 2017. © 2017 Wiley Periodicals, Inc.
Topics: Biological Evolution; Female; Humans; Locomotion; Parturition; Pelvic Bones; Pelvis; Pregnancy
PubMed: 28297176
DOI: 10.1002/ar.23561 -
European Spine Journal : Official... Sep 2011Standing in an erect position is a human property. The pelvis anatomy and position, defined by the pelvis incidence, interact with the spinal organization in shape and... (Comparative Study)
Comparative Study Review
INTRODUCTION
Standing in an erect position is a human property. The pelvis anatomy and position, defined by the pelvis incidence, interact with the spinal organization in shape and position to regulate the sagittal balance between both the spine and pelvis. Sagittal balance of the human body may be defined by a setting of different parameters such as (a) pelvic parameters: pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS); (b) C7 positioning: spino-pelvic angle (SSA) and C7 plumb line; (c) shape of the spine: lumbar lordosis.
BIOMECHANICAL ADAPTATION OF THE SPINE IN PATHOLOGY
In case of pathological kyphosis, different mechanical compensations may be activated. When the spine remains flexible, the hyperextension of the spine below or above compensates the kyphosis. When the spine is rigid, the only way is rotating backward the pelvis (retroversion). This mechanism is limited by the value of PI. Hip extension is a limitation factor of big retroversion when PI is high. Flexion of the knees may occur when hip extension is overpassed. The quantity of global kyphosis may be calculated by the SSA. The more SSA decreases, the more the severity of kyphosis increases. We used Roussouly's classification of lumbar lordosis into four types to define the shape of the spine. The forces acting on a spinal unit are combined in a contact force (CF). CF is the addition of gravity and muscle forces. In case of unbalance, CF is tremendously increased. Distribution of CF depends on the vertebral plate orientation. In an average tilt (45°), the two resultants, parallel to the plate (sliding force) or perpendicular (pressure), are equivalent. If the tilt increases, the sliding force is predominant. On the contrary, with a horizontal plate, the pressure increases. Importance of curvature is another factor of CF distribution. In a flat or kyphosis spine, CF acts more on the vertebral bodies and disc. In the case of important extension curvature, it is on the posterior elements that CF acts more. According to the shape of the spine, we may expect different degenerative evolution: (a) Type 1 is a long thoraco-lumbar kyphosis and a short hyperlordosis: discopathies in the TL area and arthritis of the posterior facets in the distal lumbar spine. In younger patients, L4 S1 hyperextension may induce a nutcracker L5 spondylolysis. (b) Type 2 is a flat lordosis: Stress is at its maximum on the discs with a high risk of early disc herniation than later with multilevel discopathies. (c) Type 3 has an average shape without characteristics for a specific degeneration of the spine. (d) Type 4 is a long and curved lumbar spine: this is the spine for L5 isthmic lysis by shear forces. When the patient keeps the lordosis curvature, a posterior arthritis may occur and later a degenerative L4 L5 spondylolisthesis. Older patients may lose the lordosis curvature, SSA decreases and pelvis tilt increases. A widely retroverted pelvis with a high pelvic incidence is certainly a previous Type 4 and a restoration of a big lordosis is needed in case of arthrodesis.
CONCLUSION
The genuine shape of the spine is probably one of the main mechanical factors of degenerative evolution. This shape is oriented by a shape pelvis parameter, the pelvis incidence. In case of pathology, this constant parameter is the only signature to determine the original spine shape we have to restore the balance of the patient.
Topics: Adaptation, Physiological; Biomechanical Phenomena; Humans; Kyphosis; Lordosis; Pelvis; Postural Balance; Radiography; Spine
PubMed: 21809016
DOI: 10.1007/s00586-011-1928-x -
Anaesthesia, Critical Care & Pain... Apr 2019Pelvic fractures represent 5% of all traumatic fractures and 30% are isolated pelvic fractures. Pelvic fractures are found in 10 to 20% of severe trauma patients and... (Review)
Review
OBJECTIVE
Pelvic fractures represent 5% of all traumatic fractures and 30% are isolated pelvic fractures. Pelvic fractures are found in 10 to 20% of severe trauma patients and their presence is highly correlated to increasing trauma severity scores. The high mortality of pelvic trauma, about 8 to 15%, is related to actively bleeding pelvic injuries and/or associated injuries to the head, abdomen or chest. Regardless of the severity of pelvic trauma, diagnosis and treatment must proceed according to a strategy that does not delay the management of the most severely injured patients. To date, in France, there are no guidelines issued by healthcare authorities or professional societies that address this subject.
DESIGN
A consensus committee of 22 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société Française d'Anesthésie et de Réanimation; SFAR) and the French Society of Emergency Medicine (Société Française de Médecine d'Urgence; SFMU) in collaboration with the French Society of Radiology (Société Française de Radiologie; SFR), French Defence Health Service (Service de Santé des Armées; SSA), French Society of Urology (Association Française d'Urologie; AFU), the French Society of Orthopaedic and Trauma Surgery (Société Française de Chirurgie Orthopédique et Traumatologique; SOCFCOT), and the French Society of Digestive Surgery (Société Française de Chirurgie digestive; SFCD) was convened. A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently from any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised.
METHODS
Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the recommendations were then conducted according to the GRADE methodology.
RESULTS
The SFAR Guideline panel provided 22 statements on prehospital and hospital management of the unstable patient with pelvic fracture. After three rounds of discussion and various amendments, a strong agreement was reached for 100% of recommendations. Of these recommendations, 11 have a high level of evidence (Grade 1 ± ), 11 have a low level of evidence (Grade 2 ± ).
CONCLUSIONS
Substantial agreement exists among experts regarding many strong recommendations for management of the unstable patient with pelvic fracture.
Topics: Anesthesia; Critical Care; Fractures, Bone; Humans; Pelvis; Trauma Severity Indices; Wounds and Injuries
PubMed: 30579941
DOI: 10.1016/j.accpm.2018.12.003 -
European Spine Journal : Official... Sep 2011In L5-S1 spondylolisthesis, it has been clearly demonstrated over the past decade that sacro-pelvic morphology is abnormal and that it can be associated to an abnormal... (Review)
Review
INTRODUCTION
In L5-S1 spondylolisthesis, it has been clearly demonstrated over the past decade that sacro-pelvic morphology is abnormal and that it can be associated to an abnormal sacro-pelvic orientation as well as to a disturbed global sagittal balance of the spine. The purpose of this article is to review the work done within the Spinal Deformity Study Group (SDSG) over the past decade, which has led to a classification incorporating this recent knowledge.
MATERIAL AND METHODS
The evidence presented has been derived from the analysis of the SDSG database, a multi-center radiological database of patients with L5-S1 spondylolisthesis, collected from 43 spine surgeons in North America and Europe.
RESULTS
The classification defines 6 types of spondylolisthesis based on features that can be assessed on sagittal radiographs of the spine and pelvis: (1) grade of slip, (2) pelvic incidence, and (3) spino-pelvic alignment. A reliability study has demonstrated substantial intra- and inter-observer reliability similar to other currently used classifications for spinal deformity. Furthermore, health-related quality of life measures were found to be significantly different between the 6 types, thus supporting the value of a classification based on spino-pelvic alignment.
CONCLUSIONS
The clinical relevance is that clinicians need to keep in mind when planning treatment that subjects with L5-S1 spondylolisthesis are a heterogeneous group with various adaptations of their posture. In the current controversy on whether high-grade deformities should or should not be reduced, it is suggested that reduction techniques should preferably be used in subjects with evidence of abnormal posture, in order to restore global spino-pelvic balance and improve the biomechanical environment for fusion.
Topics: Databases, Factual; Humans; Multicenter Studies as Topic; Pelvis; Postural Balance; Radiography; Spine; Spondylolisthesis
PubMed: 21809015
DOI: 10.1007/s00586-011-1932-1 -
International Journal of Gynaecology... Oct 2018Laparoscopy, with its many advantages, has revolutionized the field of pelvic surgery and enabled surgeons to gain a far greater understanding of pelvic anatomy. As...
Laparoscopy, with its many advantages, has revolutionized the field of pelvic surgery and enabled surgeons to gain a far greater understanding of pelvic anatomy. As technology evolves, our understanding is continuously improving. This article is a tribute to the anatomy of the pelvis, which itself has resisted evolutionary changes and remained the same, whereas our understanding of how to view and approach various organ structures has evolved.
Topics: Female; Gynecologic Surgical Procedures; Humans; Laparoscopy; Medical Oncology; Pelvis
PubMed: 30306582
DOI: 10.1002/ijgo.12616 -
Journal of Minimally Invasive Gynecology Feb 2020To show how the evaluation for endometriosis can be included in the routine pelvic ultrasound examination.
STUDY OBJECTIVE
To show how the evaluation for endometriosis can be included in the routine pelvic ultrasound examination.
DESIGN
Stepwise narrated video demonstration of the sonographic evaluation for endometriosis in routine pelvic ultrasound following the recommended sonographic approach published in the 2016 consensus paper by the International Deep Endometriosis Analysis (IDEA) group [1].
SETTING
Endometriosis is a common and often debilitating gynecological disorder that affects 5-10% of women [2]. The prevalence is even higher among women with symptoms of endometriosis [2], which include chronic pelvic pain, acquired dysmenorrhea, dyspareunia, dyschezia, menorrhagia, abnormal bleeding, and infertility. Approximately 80% of women who have endometriosis have superficial lesions, whereas 20% have deep infiltrating endometriosis (DIE; [3]). Laparoscopy is the gold standard for diagnosing endometriosis, because it allows the diagnosis of all forms of endometriosis and often immediate removal of superficial endometriosis. The removal of DIE is considerably more complicated and usually cannot be completed unless it was diagnosed preoperatively. The technique to diagnose DIE with transvaginal ultrasound (TVUS) was first described in detail in 2009 [4]. Since then, the accuracy of TVUS for the prediction of DIE has been well established in the literature [5-7]. TVUS is widely used as a first-line investigation for women with gynecological symptoms. The inclusion of an assessment for endometriosis in the routine pelvic ultrasound allows earlier diagnosis and better surgical outcomes for all women with DIE.
INTERVENTIONS
The evaluation for endometriosis in routine pelvic ultrasound based on the IDEA consensus promotes a 4-step dynamic ultrasound approach [1]: (1) routine evaluation of uterus and adnexa with particular attention for sonographic signs of adenomyosis and the presence or absence of endometriomas; (2) evaluation of transvaginal sonographic 'soft markers' such as site-specific tenderness and ovarian mobility; (3) assessment of status of pouch of Douglas using the real-time ultrasound-based "sliding sign;" and (4) assessment of DIE nodules in the anterior and posterior compartments, which involves assessment of the bladder, vaginal vault, uterosacral ligaments, and bowel, including rectum, rectosigmoid junction, and sigmoid colon. Because 5-10% of women with DIE also have ureteric endometriosis, it is useful to assess the kidneys. Silent hydronephrosis is easily identified in 50-60% of patients with ureteric involvement. Although it is possible to identify DIE involving the ureters more directly, this requires more advanced skills, and further studies are still needed to better define the accuracy of ureteric DIE detection by TVUS [8-10].
CONCLUSION
Traditionally, only pathologies of the uterus and ovaries are assessed during a routine pelvic ultrasound. Here we demonstrate that the routine ultrasound examination can easily be extended beyond the uterus and ovaries into the posterior and anterior pelvic compartments to evaluate structural mobility and to look for deep infiltrating endometriotic nodules, wherewith women suffering from DIE can benefit from a preoperative diagnosis and subsequently, a single, well-planned procedure in the hands of a well-prepared team.
Topics: Diagnostic Techniques, Obstetrical and Gynecological; Diagnostic Tests, Routine; Endometriosis; Female; Humans; Pelvis; Peritoneal Diseases; Preoperative Care; Sensitivity and Specificity; Ultrasonography; Vagina
PubMed: 31493569
DOI: 10.1016/j.jmig.2019.08.027 -
Med (New York, N.Y.) May 2021Endometriosis has long been viewed as a pelvic disease. New evidence suggests that endometriosis is a systemic disease with multisystem involvement. A more comprehensive...
Endometriosis has long been viewed as a pelvic disease. New evidence suggests that endometriosis is a systemic disease with multisystem involvement. A more comprehensive understanding of endometriosis will speed recognition and clarify diagnosis. Treatments should target the broad manifestations of the disease rather than focus exclusively on the pelvic lesions.
Topics: Endometriosis; Female; Humans; Pelvis
PubMed: 35590229
DOI: 10.1016/j.medj.2021.04.026 -
Ugeskrift For Laeger Sep 2022
Topics: Carcinoma, Verrucous; Groin; Humans; Pelvis
PubMed: 36178182
DOI: No ID Found