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BMC Pregnancy and Childbirth Feb 2015Fetal growth restriction is among the most common and complex problems in modern obstetrics. Symphysis-fundus (SF) height measurement is a non-invasive test that may... (Review)
Review
BACKGROUND
Fetal growth restriction is among the most common and complex problems in modern obstetrics. Symphysis-fundus (SF) height measurement is a non-invasive test that may help determine which women are at risk. This study is a systematic review of the literature on the accuracy of SF height measurement for the prediction of small-for-gestational-age (SGA) status at birth in unselected and low-risk pregnancies.
METHODS
The Medline, Embase, Cinahl, SweMed, and Cochrane Library databases were searched with no limitation on publication date (through September 2014), which returned 722 citations. Two reviewers then developed a short list of 51 publications of possible relevance and assessed them using the following inclusion criteria: cohort study of test accuracy performed in a routine prenatal care setting; SF height measurement for all participants; classification of SGA, defined as birth weight (BW) < 10th, 5th, or 3rd percentile or ≥ one or two standard deviations below the mean; study conducted in Northern, Western, or Central Europe; USA; Canada; Australia; or New Zealand; and sufficient data for 2 × 2 table construction. Quality of the included studies was assessed in duplicate using criteria suggested by the Cochrane Collaboration. Review Manager 5.3 software was used to analyze the data, including plotting of summary receiver operating curve spaces.
RESULTS
Eight studies were included in the final dataset and seven were included in summary analyses. The sensitivity of SF height measurement for SGA (BW < 10(th) percentile) prediction ranged from 0.27 to 0.76 and specificity ranged from 0.79 to 0.92. Positive and negative likelihood ratios ranged from 1.91 to 9.09 and from 0.29 to 0.83, respectively.
CONCLUSIONS
SF height can serve as a clinical indicator along with other clinical findings, information about medical conditions, and previous obstetric history. However, SF height has high false-negative rates for SGA. Clinicians must understand the limitations of this test. The protocol has been registered in the international prospective register of systematic reviews, PROSPERO (Registration No. CRD42014008928, http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42014008928 ).
Topics: Adult; Female; Fetal Growth Retardation; Humans; Infant, Newborn; Infant, Small for Gestational Age; Predictive Value of Tests; Pregnancy; Pubic Symphysis; Ultrasonography, Prenatal
PubMed: 25884884
DOI: 10.1186/s12884-015-0461-z -
The Pan African Medical Journal 2023posterior urethral injuries can occur in polytrauma settings, and may contribute to morbidity post-trauma. The aim of this study is to determine the occurrence of pelvic...
Epidemiology of posterior urethral injury among adults with traumatic pelvic ring disruptions: a 10-year retrospective review from a trauma care centre in Southeast Nigeria.
INTRODUCTION
posterior urethral injuries can occur in polytrauma settings, and may contribute to morbidity post-trauma. The aim of this study is to determine the occurrence of pelvic fracture urethral injury (PFUI) in adult polytrauma patients who were successfully stabilized and to appraise the nature of associated injuries.
METHODS
the medical records of stabilized polytrauma patients≥ 18 years of age from January 2010 to December 2019 were retrospectively reviewed focusing on those presenting with bony pelvis disruptions. Injuries were categorized using the injury severity scale (ISS) while bony pelvis disruptions were classed according to the Young-Burgess classification. Data on the demography of the patient, mechanism of injury, nature, and severity of injuries, class of pelvic fracture-disruption, and urethral integrity were collected and analyzed accordingly.
RESULTS
of 111 patients with bony pelvis disruptions, 95 of them had adequate information and were included in our analysis. The mean age of participants was 37.3 ± 11.8 years and most of them were males (87.4%). Blunt pelvic trauma occurred in 96.8%. Lateral compression pelvic injuries were prevalent at 39.0%. In 54.7% of the patients, the injury severity score (ISS) was ≥ 27. At 25.3% and 24.2% respectively, the abdomen and the lower extremities most frequently sustained a grade ≥ 3 injuries (abbreviated injury scale (AIS) ≥3). At a rate of 2.1%, spinal cord injury was the least observed. In the 10 years, there were 6 PFUI among 83 stabilized polytraumatized men with mean ISS of 35.5 ± 8.3. The incidence rate of PFUI was 0.6 per 8.3 pelvic disruptions in men per year. Symphysis pubis disruption or fracture of the pubis or both was consistently seen in all PFUI. Higher ISS significantly relates to PFUI (p <0.001). The mechanism of bony pelvis disruption and the class of bony pelvis injury are determined by the severity and trajectory of the impact apparently relates to PFUI only through fracture-disruption of the pubic symphysis or the pubis.
CONCLUSION
about 7.2% of men presenting with traumatic disruption of the bony pelvis in polytrauma setting sustain PFUI. In polytrauma settings, PFUI should be suspected in cases of fracture-disruption of the pubis or symphysis pubis from any mechanism.
Topics: Male; Humans; Adult; Middle Aged; Female; Retrospective Studies; Nigeria; Pelvis; Fractures, Bone; Pelvic Bones; Urethral Diseases; Multiple Trauma; Wounds, Nonpenetrating; Emergency Medical Services
PubMed: 37575524
DOI: 10.11604/pamj.2023.45.43.34603 -
Cureus Jan 2023Pubic symphysis diastasis following childbirth is a rare orthopedic condition that can be debilitating in the postpartum period. There have been treatment options...
Pubic symphysis diastasis following childbirth is a rare orthopedic condition that can be debilitating in the postpartum period. There have been treatment options documented, ranging from conservative to surgical; however, no standard of care has been established. We present a 44-year-old female patient who underwent open reduction and internal fixation for continued instability from postpartum pubic symphysis diastasis with a good overall outcome. We demonstrate good outcomes in a patient treated with surgical fixation of postpartum pelvic diastasis. We hope to deliver insight to future orthopedic surgeons with the challenges in treating this condition.
PubMed: 36788881
DOI: 10.7759/cureus.33707 -
Anatomy & Cell Biology Mar 2014by partial body weight, by ligament tension, and by muscles forces stabilizing the hip joints. For the symphysis ossis pubis there exist data concerning the type and...
by partial body weight, by ligament tension, and by muscles forces stabilizing the hip joints. For the symphysis ossis pubis there exist data concerning the type and magnitude of stresses. In one-leg-standing pressure, shear forces are predominant, and in both-leg-standing tensile forces are acting on the pelvic ring. Rupture of the symphysis is problematic due to the variety of its movements. Most literature descriptions of stress in the symphysis reflect only the frontal plane. Our intention was to make morphological as well as experimental investigations on the symphysis ossis pubis to delineate how it will be stressed in the horizontal plane. Twenty pubic bones taken from embalmed adult human cadavers (12 male, 8 female) were used. Horizontal and frontal slices (3 mm thick) of the symphyseal part of the os pubis were made. X-rays and densitometric analysis were performed. The width of the symphysis cartilage in the dorsal and the ventral regions was measured on 15 whole skeleton specimens coming from adult human cadavers. For experimental study an embalmed pelvic ring which had no abnormality was used. The symphysis pubis was cut completely in the midsagittal plane and then the ring was stressed via the cranial sacrum. Our results demonstrate that the symphysis is stressed by bending in the horizontal plane in one-leg-standing. In both-leg-standing the symphysis is stressed by tensile forces.
PubMed: 24693481
DOI: 10.5115/acb.2014.47.1.40 -
Revista Brasileira de Ortopedia Apr 2019To compare the accuracy of ultrasound (US) with that of magnetic resonance imaging (MRI) in the detection of aponeurosis lesions of the rectus abdominis/adductor...
To compare the accuracy of ultrasound (US) with that of magnetic resonance imaging (MRI) in the detection of aponeurosis lesions of the rectus abdominis/adductor longus muscles, to study the characteristics of the athletes and imaging findings associated with pubalgia, and to demonstrate the importance of each method in evaluating this condition. The present study was conducted from 2011 to 2016 with 39 professional soccer players: 15 with pubalgia and 24 without pubalgia. Age, field position, body mass index (BMI), weekly training load, career length, and history of thigh/knee injury and lower back pain were recorded. The following tests were performed: radiographs (anteroposterior view of the pelvis in standing and flamingo positions) to evaluate hip impingement, sacroiliac joint, and pubic symphysis instability; US to analyze the common aponeurosis of the rectus abdominis/adductor longus muscles and inguinal hernias; and MRI for pubic bone degenerative alterations and edema, and lesions in the adductor and rectus abdominis muscles and their aponeurosis. There was an association between pubalgia, high BMI ( = 0.032) and muscle alterations ( < 0.001). Two patients with pubalgia had inguinal hernias and one patient with pubalgia and two controls had sports hernias. Pubic degenerative changes were frequent in both groups. Aponeurosis lesions were more frequent in patients with pain. The US detection had 44.4% sensitivity and 100% specificity. The evaluation of athletic pubalgia should be performed with radiography, US, and MRI. High BMI, muscle injuries, geodes, and osteophytes are findings associated with pubalgia; US has low sensitivity to detect injuries of the common aponeurosis of the rectus abdominis/adductor longus muscles.
PubMed: 31363256
DOI: 10.1016/j.rbo.2017.12.012 -
Acta Reumatologica Portuguesa 2011
Topics: Female; Humans; Middle Aged; Osteitis; Pubic Symphysis; Recurrence
PubMed: 22472936
DOI: No ID Found -
Medicine Sep 2003We report a novel case of septic arthritis of the symphysis pubis due to Streptococcus pneumoniae and review 99 previously reported cases of infection of this joint.... (Review)
Review
We report a novel case of septic arthritis of the symphysis pubis due to Streptococcus pneumoniae and review 99 previously reported cases of infection of this joint. Typical features of pubic symphysis infection included fever (74%), pubic pain (68%), painful or waddling gait (59%), pain with hip motion (45%), and groin pain (41%). Risk factors included female incontinence surgery (24%); sports, especially soccer (19%); pelvic malignancy (17%); and intravenous drug use (15%). Septic arthritis of the pubic symphysis is often misdiagnosed as osteitis pubis, a sterile inflammatory condition. Causative organisms differed according to risk factors. Staphylococcus aureus was the major cause among athletes, Pseudomonas aeruginosa among intravenous drug users, and infections among patients with pelvic malignancies were usually polymicrobial, involving fecal flora. Patients with recent urinary incontinence surgery usually had monomicrobial infection, with no predominant pathogen. Since osteomyelitis is present in 97% of patients, we recommend antibiotic courses of 6 weeks' duration. Surgical debridement is required in 55% of patients.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Arthritis, Infectious; Child; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Pubic Symphysis; Risk Factors; Streptococcal Infections; Streptococcus pneumoniae; Treatment Outcome
PubMed: 14530783
DOI: 10.1097/01.md.0000091180.93122.1c -
Case Reports in Orthopedics 2014Osteomyelitis of the pubis symphysis is a rare condition. There have been various reports in the literature of inflammation and osteomyelitis as well as septic arthritis...
Osteomyelitis of the pubis symphysis is a rare condition. There have been various reports in the literature of inflammation and osteomyelitis as well as septic arthritis of pubic symphysis. However, due to the fact that these conditions are rare and that the usual presenting symptoms are very nonspecific, osteomyelitis of the pubic symphysis is often misdiagnosed, thus delaying definitive treatment. We present a case that to our knowledge is the first case in literature of osteomyelitis of the pubic symphysis in a 17-year-old boy with juvenile idiopathic arthritis (JIA), which was initially misdiagnosed and progressed to bilateral adductor abscesses. A high suspicion of such condition should be considered in a JIA patient who presents with symphysis or thigh pain.
PubMed: 25580335
DOI: 10.1155/2014/982171 -
Communications Medicine Dec 2022Traumatic separation of the pubic symphysis can destabilize the pelvis and require surgical fixation to reduce symphyseal gapping. The traditional approach involves open...
BACKGROUND
Traumatic separation of the pubic symphysis can destabilize the pelvis and require surgical fixation to reduce symphyseal gapping. The traditional approach involves open reduction and the implantation of a steel symphyseal plate (SP) on the pubic bone to hold the reposition. Despite its widespread use, SP-fixation is often associated with implant failure caused by screw loosening or breakage.
METHODS
To address the need for a more reliable surgical intervention, we developed and tested two titanium cable-clamp implants. The cable served as tensioning device while the clamp secured the cable to the bone. The first implant design included a steel cable anterior to the pubic symphysis to simplify its placement outside the pelvis, and the second design included a cable encircling the pubic symphysis to stabilize the anterior pelvic ring. Using highly reproducible synthetic bone models and a limited number of cadaver specimens, we performed a comprehensive biomechanical study of implant stability and evaluated surgical feasibility.
RESULTS
We were able to demonstrate that the cable-clamp implants provide stability equivalent to that of a traditional SP-fixation but without the same risks of implant failure. We also provide detailed ex vivo evaluations of the safety and feasibility of a trans-obturator surgical approach required for those kind of fixation.
CONCLUSION
We propose that the developed cable-clamp fixation devices may be of clinical value in treating pubic symphysis separation.
PubMed: 36550296
DOI: 10.1038/s43856-022-00227-z