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Journal of Orthopaedic Surgery and... Jan 2021Anterior-posterior compression (APC) type II pelvis fracture is caused by the destruction of pelvic ligaments. This study aims to explore ligaments injury in APC type II...
BACKGROUND
Anterior-posterior compression (APC) type II pelvis fracture is caused by the destruction of pelvic ligaments. This study aims to explore ligaments injury in APC type II pelvic injury.
METHOD
Fourteen human cadaveric pelvis samples with sacrospinous ligament (SPL), sacrotuberous ligament (SBL), anterior sacroiliac ligament (ASL), and partial bone retaining unilaterally were acquired for this study. They were randomly divided into hemipelvis restricted and unrestricted groups. We recorded the separation distance of the pubic symphysis and anterior sacroiliac joint, external rotation angle, and force when ASL ruptured. We observed the external rotation damage to the pelvic bone and ligaments.
RESULT
When ASL failed, there was no significant difference in pubic symphysis separation (28.6 ± 8.4 mm to 23.6 ± 8.2 mm, P = 0.11) and anterior sacroiliac joint separation (11.4 ± 3.8 mm to 9.7 ± 3.9 mm, P = 0.30) between restricted and unrestricted groups. The external rotation angle (33.9 ± 5.5° to 48.9 ± 5.2°, P < 0.01) and force (553.9 ± 82.6 N to 756.6 ± 41.4 N, P < 0.01) were significantly different. Pubic symphysis separation between two groups ranged from 14 to 40 mm. In the restricted group, both SBL and SPL were injured. SPL ruptured first, and then SBL and the interosseous sacroiliac ligament were damaged while the posterior ligament remained unharmed. In the unrestricted group, interosseous sacroiliac ligament and posterior sacroiliac ligaments were damaged, while SBL and SPL were not. When the ASL, SBL, and SPL all failed, pubic symphysis and anterior sacroiliac joint separation between two groups increased significantly (from 28.6 ± 8.4 to 42.0 ± 7.6 mm, 11.4 ± 3.8 to 16.7 ± 4.2 mm respectively, all P < 0.05).
CONCLUSION
Pelvic external rotation injury is either hemipelvic restricted or unrestricted, which can result in different outcomes. When the ASL ruptures, the unrestricted group needs greater external rotation angle and force, without SBL or SPL injury, while both SBL and SPL were injured in another group. When ASL fails in two groups, pubic symphysis separation fluctuates considerably. Finally, when the ASL ruptures, SBL and SPL may be undamaged.
Topics: Adult; Biomechanical Phenomena; Cadaver; Female; Fractures, Compression; Humans; Ligaments; Male; Middle Aged; Pelvic Bones; Rupture
PubMed: 33430913
DOI: 10.1186/s13018-020-02156-w -
Journal of the Chinese Medical... Mar 2017Gender determination from skeletal remains is one of the primary factors in forensic medicine. This study aimed to identify the gender of patients referred to the...
BACKGROUND
Gender determination from skeletal remains is one of the primary factors in forensic medicine. This study aimed to identify the gender of patients referred to the radiology ward of the Rasoul Akram Hospital of Tehran using anteroposterior pelvic radiography.
METHODS
A total of 200 patients (100 male and 100 female) referred to the radiology ward of the Rasoul Akram Hospital for anteroposterior pelvic radiography during 2013-2014 were included in this study. After taking a standard radiographic image of all patients in the supine position and an anteroposterior view of the pelvis, factors including subpubic angles, pubic angle, X angle, ischiopubic index, ratio of the length of the symphysis pubis to the mid and minimum width of the pubis body, and ratio of the length of the symphysis pubis to the minimum width of the pubic superior ramus were measured on radiographs. The Student t test and receiver operating characteristic curve were used to compare the data of male and female patients. Values were significant at p<0.05.
RESULTS
All the evaluated variables were significantly different in male and female patients (p=0.000), with the highest level of measurement accuracy noted in the subpubic angle, Pubic Angle 1, X angle, Pubic Angle 2, minimum width of the pubic superior ramus, and ischiopubic index. Length of the symphysis pubis, length of the pubis, and ratio of the length of the pubis to the minimum width of the pubic superior ramus showed the lowest accuracy.
CONCLUSION
The results of this study revealed that the evaluation of the radiographic images of pelvic bones by assessing the mentioned factors can be useful for sex determination from skeletal remains. However, ethical considerations should also be taken into account while using these factors.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Pelvic Bones; ROC Curve; Sex Determination by Skeleton; Young Adult
PubMed: 28215933
DOI: 10.1016/j.jcma.2016.06.009 -
Ultraschall in Der Medizin (Stuttgart,... Jun 2023To describe the urethral course and position during urine leakage based on the visualized urethral mobility profile (UMP) and to explore the differences between supine...
OBJECTIVES
To describe the urethral course and position during urine leakage based on the visualized urethral mobility profile (UMP) and to explore the differences between supine and standing positions.
METHOD
This was a prospective study of 100 women with SUI and 100 control women who underwent a cough stress test (CST) with transperineal ultrasound (TPUS) in supine and standing positions. In the mid-sagittal plane, the UMP software automatically placed six equidistant points from the bladder neck (point 1) to the external urethral meatus (point 6). It determined the x and y coordinates of the points relative to the symphysis pubis. The distance between the points and symphysis pubis (dist. 1 to 6) was calculated using the formula SQRT (x2 + y2). The visualized UMP was created by reproducing the six points on a bitmap.
RESULTS
Valid UMP data of 78 control women and 90 women with SUI were analyzed. In the two positions, distances 1 to 6 were significantly greater in the SUI group than the continent group (all p < 0.05). During Valsalva, the distance between the mid-urethra (dist. 3 and 4) and the symphysis was significantly increased (all p < 0.001) in the SUI group. The visualized UMP showed a similar upper-urethral course in the two groups. The gap between the mid-urethra (points 3 and 4) and symphysis was wider in the SUI group.
CONCLUSION
The visualized UMP in supine and standing positions showed no difference in the bladder neck and upper urethral stability between incontinent and continent women, but mid-urethral stability was weaker in SUI.
Topics: Female; Humans; Urethra; Urinary Incontinence, Stress; Prospective Studies; Standing Position; Urodynamics
PubMed: 35168283
DOI: 10.1055/a-1700-2862 -
The British Journal of General Practice... Apr 1997
Topics: Back Pain; Female; Humans; Joint Diseases; Locomotion; Pain; Physical Therapy Modalities; Pubic Symphysis
PubMed: 9196977
DOI: No ID Found -
Journal of Anatomy Nov 2010The pubic symphysis is a unique joint consisting of a fibrocartilaginous disc sandwiched between the articular surfaces of the pubic bones. It resists tensile, shearing... (Review)
Review
The pubic symphysis is a unique joint consisting of a fibrocartilaginous disc sandwiched between the articular surfaces of the pubic bones. It resists tensile, shearing and compressive forces and is capable of a small amount of movement under physiological conditions in most adults (up to 2 mm shift and 1° rotation). During pregnancy, circulating hormones such as relaxin induce resorption of the symphyseal margins and structural changes in the fibrocartilaginous disc, increasing symphyseal width and mobility. This systematic review of the English, German and French literature focuses on the normal anatomy of the adult human pubic symphysis. Although scientific studies of the joint have yielded useful descriptive data, comparison of results is hampered by imprecise methodology and/or poorly controlled studies. Several aspects of the anatomy of the pubic symphysis remain unknown or unclear: the precise attachments of surrounding ligaments and muscles; the arrangement of connective tissue fibres within the interpubic disc and the origin, structure and function of its associated interpubic cleft; the biomechanical consequences of sexual dimorphism; potential ethnic variations in morphology; and its precise innervation and blood supply. These deficiencies hinder our understanding of the normal form and function of the joint, which is particularly relevant when attempting to understand the mechanisms underlying pregnancy-related pubic symphyseal pain, a neglected and relatively common cause of pubic pain. A better understanding of the normal anatomy of the human pubic symphysis should improve our understanding of such problems and contribute to better treatments for patients suffering from symphyseal pain and dysfunction.
Topics: Adult; Biomechanical Phenomena; Connective Tissue; Female; Humans; Ligaments; Pregnancy; Pubic Symphysis
PubMed: 20840351
DOI: 10.1111/j.1469-7580.2010.01300.x -
Orthopaedic Journal of Sports Medicine Feb 2022The cleft sign (CS) and bone marrow edema (BME) are considered magnetic resonance imaging (MRI) findings signifying a pubic pathology, which is associated with groin...
BACKGROUND
The cleft sign (CS) and bone marrow edema (BME) are considered magnetic resonance imaging (MRI) findings signifying a pubic pathology, which is associated with groin pain; however, their relationship with bony morphology related to femoroacetabular impingement (FAI) has not been established.
PURPOSE
To investigate the prevalence of CS and BME in symptomatic patients with acetabular labral tears and assess their possible association with bone morphology and sport-specific activities.
STUDY DESIGN
Cross-sectional study; Level of evidence, 3.
METHODS
This study enrolled 418 patients (469 hips) undergoing hip arthroscopic surgery for labral tears. Also included were patients with labral tears in the setting of either hip dysplasia or borderline hip dysplasia who were undergoing endoscopic shelf acetabuloplasty combined with hip arthroscopic labral repair, cam osteoplasty, and capsular plication. All patients were screened for superior CS (SCS), inferior CS (ICS), and BME of the ipsilateral side of the pubis using 3-T MRI. We measured the following angles: lateral center edge (LCE), Sharp, Tönnis, vertical-central-anterior, and alpha. Then, we evaluated the relationship between patient characteristics and abnormal findings on MRI scans (preoperatively vs 1 year postoperatively).
RESULTS
An overall 397 hips were included: 200 in men and 197 in women (mean ± SD age, 35.3 ± 16.0 years). There were hips in 214 athletes (53.9%) and hips in 183 nonathletes (46.1%). MRI findings revealed SCS, ICS, and BME in 18 (4.5%), 13 (3.3%), and 34 hips (8.6%), respectively. Abnormal MRI findings at the pubis were seen more often in athletes than nonathletes (23.8% vs 3.3%), and contact sports athletes had the most frequent abnormalities. There was no SCS in patients with an LCE angle <22°. SCS was more frequently seen in those who had an alpha angle ≥71°. More than 60% of abnormal findings at the pubis diminished after arthroscopic surgery that included FAI correction and labral repair.
CONCLUSION
In patients with labral tears, CS and BME were seen more frequently in athletes versus nonathletes, especially contact athletes with FAI-related bony abnormalities. More than 60% of abnormal MRI pubis findings resolved after arthroscopic treatment of FAI.
PubMed: 35141338
DOI: 10.1177/23259671211068477 -
OTA International : the Open Access... Dec 2022To compare the stability of screw fixation with that of plate fixation for symphyseal injuries in a vertically unstable pelvic injury (AO/Tile 61-C1) associated with...
To compare the stability of screw fixation with that of plate fixation for symphyseal injuries in a vertically unstable pelvic injury (AO/Tile 61-C1) associated with complete disruption of the sacroiliac joint and the pubic symphysis. Eight fourth-generation composite pelvis models with sacroiliac and pubic symphyseal disruption (Sawbones, Vashon Island, WA) underwent biomechanical testing simulating static single-leg stance. Four were fixed anteriorly with a symphyseal screw, and 4 with a symphyseal plate. All had single transsacral screw fixation posteriorly. Displacement and rotation were monitored at both sacroiliac joint and pubic symphysis. There was no significant difference between the 2 groups for mean maximum force generated. There was no significant difference in net displacement at both sacroiliac joint and pubic symphysis. There was significantly less rotation but more displacement in the screw group in the -axis. The screw group showed increased stiffness compared with the plate group. This is the first biomechanical study to compare screw versus plate symphyseal fixation in a Tile C model. Our biomechanical model using anterior and posterior fixation demonstrates that symphyseal screws may be a viable alternative to classically described symphyseal plating.
PubMed: 36569108
DOI: 10.1097/OI9.0000000000000215 -
Archives of Orthopaedic and Trauma... Apr 2023Open reduction and internal fixation with plates is the most widespread surgery in traumatic pubic symphysis diastasis. However, implant failure or recurrent diastasis...
INTRODUCTION
Open reduction and internal fixation with plates is the most widespread surgery in traumatic pubic symphysis diastasis. However, implant failure or recurrent diastasis was commonly observed during follow-up. The aim of our study was to evaluate the radiologic findings and clinical outcomes.
MATERIALS AND METHODS
Sixty-five patients with traumatic pubic symphysis diastasis treated with plating between 2008 and 2019 were retrospectively reviewed. The exclusion criteria were a history of malignancy and age under 20 years. Radiographic outcomes were determined by radiograph findings, including pubic symphysis distance (PSD) and implant failure. Clinical outcomes were assessed according to the Majeed score at the final follow-up.
RESULTS
Twenty-eight patients were finally included. Nine patients (32%) experienced implant failure, including four (14%) with screw loosening and five (18%) with plate breakage. Only one patient underwent revision surgery. Postoperatively, a significant increase in PSD was observed at 3 months and 6 months. Postoperative PSD was not significantly different between patients with single plating and double plating, but it was significantly greater in the implant-failure group than in the non-failure group. The Majeed score was similar between patients with single plating and double plating or between the implant-failure group and the non-failure group. Body mass index, number of plates, age, and initial injured PSD were not significantly different between the implant-failure group and the non-failure group. Only a significant male predominance was observed in the implant-failure group.
CONCLUSION
A gradual increase in the symphysis distance and a high possibility of implant failure may be the distinguishing features of traumatic pubic symphysis diastasis fixation. The postoperative symphyseal distance achieved stability after 6 months, even after implant failure. Radiographic outcomes, such as increased symphysis distance, screw loosening, and plate breakage, did not affect clinical functional outcomes.
Topics: Female; Humans; Male; Young Adult; Adult; Pubic Symphysis Diastasis; Retrospective Studies; Fracture Fixation, Internal; Pubic Symphysis; Bone Plates
PubMed: 35278092
DOI: 10.1007/s00402-022-04411-7 -
Arthritis Research & Therapy Oct 2012We aimed to describe the distribution of radiographic chondrocalcinosis (CC) and to examine whether metacarpophalangeal joint (MCPJ) calcification and CC at other joints... (Comparative Study)
Comparative Study
INTRODUCTION
We aimed to describe the distribution of radiographic chondrocalcinosis (CC) and to examine whether metacarpophalangeal joint (MCPJ) calcification and CC at other joints occurs in the absence of knee involvement.
METHODS
This was a cross-sectional study embedded in the Genetics of Osteoarthritis and Lifestyle study (GOAL). All participants (n = 3,170) had radiographs of the knees, hands, and pelvis. These were scored for radiographic changes of osteoarthritis (OA), for CC at knees, hips, symphysis pubis, and wrists, and for MCPJ calcification. The prevalence of MCPJ calcification and CC overall, at each joint, and in the presence or absence of knee involvement, was calculated.
RESULTS
The knee was the commonest site of CC, followed by wrists, hips, and symphysis pubis. CC was more likely to be bilateral at knees and wrists but unilateral at hips. MCPJ calcification was usually bilateral, and less common than CC at knees, hips, wrists, and symphysis pubis. Unlike that previously reported, CC commonly occurred without any knee involvement; 44.4% of wrist CC, 45.9% of hip CC, 45.5% of symphysis pubis CC, and 31.3% of MCPJ calcification occurred in patients without knee CC. Those with meniscal or hyaline articular cartilage CC had comparable ages (P = 0.21), and neither preferentially associated with fibrocartilage CC at distant joints.
CONCLUSIONS
CC visualized on a plain radiograph commonly occurs at other joints in the absence of radiographic knee CC. Therefore, knee radiographs alone are an insufficient screening test for CC. This has significant implications for clinical practice, for epidemiologic and genetic studies of CC, and for the definition of OA patients with coexistent crystal deposition.
Topics: Aged; Chondrocalcinosis; Cross-Sectional Studies; Female; Hip Joint; Humans; Knee Joint; Male; Mass Screening; Metacarpophalangeal Joint; Middle Aged; Osteoarthritis; Prevalence; Radiography; Retrospective Studies; Sensitivity and Specificity; Wrist Joint
PubMed: 23036436
DOI: 10.1186/ar4043 -
The Cochrane Database of Systematic... Sep 2015Symphysis fundal height (SFH) measurement is commonly practiced primarily to detect fetal intrauterine growth restriction (IUGR). Undiagnosed IUGR may lead to fetal... (Review)
Review
BACKGROUND
Symphysis fundal height (SFH) measurement is commonly practiced primarily to detect fetal intrauterine growth restriction (IUGR). Undiagnosed IUGR may lead to fetal death as well as increase perinatal mortality and morbidity.
OBJECTIVES
The objective of this review is to compare SFH measurement with serial ultrasound measurement of fetal parameters or clinical palpation to detect abnormal fetal growth (IUGR and large-for-gestational age), and improving perinatal outcome.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (14 July 2015) and reference lists of retrieved articles.
SELECTION CRITERIA
Randomised controlled trials including quasi-randomised and cluster-randomised trials involving pregnant women with singleton fetuses at 20 weeks' gestation and above comparing tape measurement of SFH with serial ultrasound measurement of fetal parameters or clinical palpation using anatomical landmarks.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.
MAIN RESULTS
One trial involving 1639 women was included. It compared SFH measurement with clinical abdominal palpation.There was no difference in the two reported primary outcomes of incidence of small-for-gestational age (risk ratio (RR) 1.32; 95% confidence interval (CI) 0.92 to 1.90, low quality evidence) or perinatal death.(RR 1.25, 95% CI 0.38 to 4.07; participants = 1639, low quality evidence). There were no data on the neonatal detection of large-for-gestational age (variously defined by authors). There was no difference in the reported secondary outcomes of neonatal hypoglycaemia, admission to neonatal nursery, admission to the neonatal nursery for IUGR (low quality evidence), induction of labour and caesarean section (very low quality evidence). The trial did not address the other outcomes specified in the 'Summary of findings' table (intrauterine death; neurodevelopmental outcome in childhood). GRADEpro software was used to assess the quality of evidence, downgrading of evidence was based on including a small single study with unclear risk of bias and a wide confidence interval crossing the line of no effect.
AUTHORS' CONCLUSIONS
There is insufficient evidence to determine whether SFH measurement is effective in detecting IUGR. We cannot therefore recommended any change of current practice. Further trials are needed.
Topics: Abdomen; Female; Fetal Growth Retardation; Humans; Palpation; Pregnancy; Pubic Symphysis; Randomized Controlled Trials as Topic; Ultrasonography, Prenatal; Uterus
PubMed: 26346107
DOI: 10.1002/14651858.CD008136.pub3