RESUMEN
The current primary treatment approach for malignant pelvic tumors involves hemipelvic prosthesis reconstruction following tumor resection. In cases of Enneking type II + III pelvic tumors, the prosthesis necessitates fixation to the remaining iliac bone. Prevailing methods for prosthesis fixation include the saddle prosthesis, ice cream prosthesis, modular hemipelvic prosthesis, and personalized prosthetics using three-dimensional printing. To prevent failure of hemipelvic arthroplasty protheses, a novel fixation method was designed and finite element analysis was conducted. In clinical cases, the third and fourth sacral screws broke, a phenomenon also observed in the results of finite element analysis. Based on the original surgical model, designs were created for auxiliary dorsal iliac, auxiliary iliac bottom, auxiliary sacral screw, and auxiliary pubic ramus fixation. A nonlinear quasi-static finite element analysis was then performed under the maximum load of the gait cycle, and the results indicated that assisted sacral dorsal fixation significantly reduces stress on the sacral screws and relative micromotion exceeding 28 µm. The fixation of the pubic ramus further increased the initial stability of the prosthesis and its interface osseointegration ability. Therefore, for hemipelvic prostheses, incorporating pubic ramus support and iliac back fixation is advisable, as it provides new options for the application of hemipelvic tumor prostheses.
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Análisis de Elementos Finitos , Neoplasias Pélvicas , Humanos , Neoplasias Pélvicas/cirugía , Ilion/cirugía , Femenino , Tornillos Óseos , Huesos Pélvicos/cirugía , Masculino , Diseño de Prótesis , Impresión Tridimensional , Prótesis e Implantes , Sacro/cirugíaRESUMEN
During the last decades, effective pain reduction and early mobilization were identified as the central priorities in therapy of insufficiency fractures of the pelvis. For operative treatment minimally-invasive stabilization techniques are favored. While there is consensus on the significance of sufficient dorsal stabilization the role of additional fixation of the anterior fracture component stays under discussion. Within the present study we developed an internal ring fixator system (RingFix) with the question whether an in-itself-closed construct can improve stability of the entire ring structure. RingFix was evaluated on an osteoporotic bone model with a standardized FFP IIIc fracture within an established biomechanical setup regarding its primary stabilization potential. Further, it was compared to transiliac-transsacral screw fixation with and without stabilization of the anterior fracture component. The transiliac-transsacral fixation with separate screw fixation of the anterior fracture showed significantly higher stability than the RingFix and the transiliac-transsacral screw fixation without anterior stabilization. Our results show that stabilization of the anterior fracture component relevantly improves the stability of the entire ring construct. As a bridging stabilizer, RingFix shows biomechanical advantages over an isolated dorsal fracture fixation, but inferior results than direct stabilization of the single fracture components.
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Fijación Interna de Fracturas , Huesos Pélvicos , Humanos , Huesos Pélvicos/lesiones , Huesos Pélvicos/cirugía , Fenómenos Biomecánicos , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Tornillos Óseos , Fijadores Internos , Fracturas Óseas/cirugía , Osteoporosis/cirugíaRESUMEN
AIMS: Primary malignant bone tumor of the pelvis is an uncommon lesion, the resection of which via freehand osteotomy is subject to inaccuracy due to its three-dimensional anatomy. Patient-Specific Guides (PSG), also called Patient-Specific Instruments (PSI) are essential to ensure surgical planning and resection adequacy. Our aim was to assess their use and effectiveness. METHODS: A monocentric retrospective study was conducted on 42 adult patients who underwent PSG-based resection of a primary malignant bone tumor of the pelvis. The primary outcome was the proportion of R0 bone margins. The secondary outcomes were the proportion of overall R0 margins, considering soft-tissue resection, the cumulative incidence of local recurrence, and the time of production for the guides. A comparison to a previous series at our institution was performed regarding histological margins. RESULTS: Using PSGs, 100% R0 safe bone margin was achieved, and 88% overall R0 margin due to soft-tissue resection being contaminated, while the comparison to the previous series showed only 80% of R0 safe bone margin. The cumulative incidences of local recurrence were 10% (95% CI: 4-20%) at one year, 15% (95% CI: 6-27%) at two years, and 19% (95% CI: 8-33%) at five years. The median overall duration of the fabrication process of the guide was 35 days (Q1-Q3: 26-47) from the first contact to the surgery date. CONCLUSIONS: Patient-Specific Guides can provide a reproducible safe bony margin.
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Neoplasias Óseas , Márgenes de Escisión , Recurrencia Local de Neoplasia , Humanos , Femenino , Masculino , Estudios Retrospectivos , Persona de Mediana Edad , Neoplasias Óseas/cirugía , Neoplasias Óseas/patología , Adulto , Recurrencia Local de Neoplasia/cirugía , Recurrencia Local de Neoplasia/patología , Anciano , Estudios de Seguimiento , Pronóstico , Huesos Pélvicos/cirugía , Huesos Pélvicos/patología , Adulto Joven , Osteotomía/métodos , Cirugía Asistida por Computador/métodos , Neoplasias Pélvicas/cirugía , Neoplasias Pélvicas/patología , AdolescenteRESUMEN
BACKGROUND: The Internal Fixator (INFIX) is a popular method, known for its minimal invasiveness and short operation time, for treating anterior pelvic ring fractures. Studies have shown that postoperative complications may occur, including anterolateral femoral cutaneous nerve injury, the femoral nerve paralysis, and delayed fracture healing. These complications are believed to be related to surgical stimulation, an excessively long lateral end of the connecting rod, a small distance between the screw and bone surface, insufficient pre-bending of the connecting rod, and difficulties in fracture reduction. CASE PRESENTATION: We report two unique cases of lower abdominal pseudocyst complicated with suspected infection after INFIX treatment of pelvic fractures at our trauma center. Following surgical removal of the internal fixation, resolution of the cysts was observed in both patients, and subsequent postoperative follow-up revealed the absence of any residual sequelae. These cases have not been reported in previous literature reviews. DISCUSSION: The lower abdominal cysts, potentially arising from the dead space created during intraoperative placement of the INFIX rod, may increase infection risk. The etiology remains uncertain, despite the presence of abnormal inflammation markers in both cases, and staphylococcus aureus found in one. These cysts were confined to the lower abdomen, not involving the internal fixation, and hence, only the INFIX was removed. Postoperative oral cefazolin treatment was successful, with resolved pseudocysts and no subsequent discomfort. CONCLUSION: We report two unprecedented cases of post-INFIX abdominal cysts, with a suspected link to intraoperative dead space. Despite uncertain etiology, successful management involved INFIX removal and oral cefixime therapy. These findings necessitate further exploration into the causes and management of such complications.
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Quistes , Fijación Interna de Fracturas , Fracturas Óseas , Huesos Pélvicos , Humanos , Antibacterianos/uso terapéutico , Quistes/etiología , Quistes/cirugía , Fijación Interna de Fracturas/efectos adversos , Fracturas Óseas/cirugía , Fracturas Óseas/complicaciones , Huesos Pélvicos/lesiones , Huesos Pélvicos/cirugía , Huesos Pélvicos/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico , Infecciones Estafilocócicas/etiología , Infecciones Estafilocócicas/diagnósticoRESUMEN
PURPOSE: The present retrospective study aimed to analyze patient characteristics, perioperative complications, and short-term outcomes of surgery for fragility fractures of the pelvis (FFP). METHODS: We selected 42 patients who underwent surgery for FFP between October 2019 and October 2022 and could be followed for more than 6 months postoperatively, including one male patient and 41 female patients with an average age of 83.5 (65-96) years. The following demographic data were collected: Rommens classification, surgical method, reoperation rate, implant loosening, perioperative complications, interventional radiology (IVR) indication rate, perioperative blood transfusion indication rate, Parker Mobility Score (PMS) before surgery and at final follow-up, and numerical rating scale (NRS) score before surgery and on day 3 postoperatively. RESULTS: Rommens classification was as follows: type IIa (n = 2), type IIb (n = 13), type IIIa (n = 8), type IIIc (n = 3), type IVb (n = 13), and type IVc (n = 3). For surgical procedure, 35 patients (83.3%) were successfully stabilized with percutaneous screw fixation alone, and 7 patients further required open plate fixation. Implant loosening was observed in 16 patients (38.1%), including minor cases, and implant removal was required in 1 patient. Minor perforation of the screw was observed as an intraoperative complication in 6 patients; there were no patients with neurological symptoms. At the time of injury, IVR was indicated in 3 patients (7.1%) because of hemorrhage. Thirty patients (71.4%) had medical complications at the time of admission. One patient died due to postoperative pneumonia. Mean PMS before injury and at final follow-up were 6.51 points and 5.38 points, respectively. Mean NRS scores before surgery and on day 3 postoperatively were 5.26 and 3.49, respectively, showing a significant improvement (p < 0.01). CONCLUSION: We retrospectively reviewed 42 patients who required surgery for FFP. More than 80% of cases could be treated with percutaneous screw fixation, but it is always important to consider hemorrhagic shock at the time of injury and indications for IVR. Implant loosening was observed in 38.1% of patients, including minor cases, and was considered an issue to be improved on in the future, such as by using cement augmentation. A significant improvement in mean NRS score on day 3 postoperatively relative to the mean preoperative score was observed, suggesting that surgery may contribute to early mobilization.
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Fijación Interna de Fracturas , Huesos Pélvicos , Complicaciones Posoperatorias , Reoperación , Humanos , Masculino , Femenino , Anciano , Estudios Retrospectivos , Anciano de 80 o más Años , Huesos Pélvicos/lesiones , Huesos Pélvicos/cirugía , Huesos Pélvicos/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/efectos adversos , Complicaciones Posoperatorias/etiología , Reoperación/estadística & datos numéricos , Fracturas Osteoporóticas/cirugía , Fracturas Osteoporóticas/diagnóstico por imagen , Resultado del Tratamiento , Tornillos Óseos , Placas Óseas , Transfusión Sanguínea/estadística & datos numéricosRESUMEN
BACKGROUND AND OBJECTIVES: Internal hemipelvectomy is a limb sparing procedure most commonly indicated for malignant bone and soft tissue tumors of the pelvis. Partial resection and pelvic reconstruction may be challenging for orthopedic oncologists due to late presentation, high tumor burden, and complex anatomy. Specifically, wide resection of tumors involving the periacetabular and sacroiliac (SI) regions may compromise adjacent vital neurovascular structures, impair wound healing, or limit functional recovery. We aimed to present a series of patients treated at our institution who underwent periacetabular internal hemipelvectomy (Type II) with or without sacral extension (Type IV) in combination with a systematic review to investigate postoperative complications, functional outcomes, and implant and patient survival following pelvic tumor resection via Type II hemipelvectomy with or without Type IV resection. MATERIALS AND METHODS: A surgical registry of consecutive patients treated with internal hemipelvectomy for primary or secondary pelvic bone tumors at our institution since 1994 was retrospectively reviewed. All type II resection patients were stratified into two separate cohorts, based on whether or not periacetabular resection was extended beyond the SI joint to include the sacrum (Type IV), as per the Enneking and Dunham classification. Patient demographics, operative parameters, complications, and oncological outcomes were collected. Categorical and continuous variables were compared with Pearson's chi square or Fisher's exact test and the Mann-Whitney U test, respectively. Literature review according to PRISMA guidelines queried studies pertaining to patient outcomes following periacetabular internal hemipelvectomy. The search strategy included combinations of the key words "internal hemipelvectomy", "pelvic reconstruction", "pelvic tumor", and "limb salvage". Pooled data was compared using Pearson's chi square. Statistical significance was established as p < 0.05. RESULTS: A total of 76 patients were treated at our institution with internal hemipelvectomy for pelvic tumor resection, of whom 21 had periacetabular resection. Fifteen patients underwent Type II resection without Type IV involvement, whereas six patients had combined Type II/IV resection. There were no significant differences between groups in operative time, blood loss, complications, local recurrence, postoperative metastasis, or disease mortality. Systematic review yielded 69 studies comprising 929 patients who underwent internal hemipelvectomy with acetabular resection. Of these, 906 (97.5 %) had only Type II resection while 23 (2.5 %) had concomitant Type II/IV resection. While overall complication rates were comparable, Type II resection alone produced significantly fewer neurological complications when compared to Type II resection with sacral extension (3.9 % vs. 17.4 %, p = 0.001). No significant differences were found between rates of wound complications, infections, or construct failures. Local recurrence, postoperative metastasis, and survival outcomes were similar. Type II internal hemipelvectomy without Type IV resection on average produced higher postoperative MSTS functional scores than with Type IV resection. CONCLUSION: In our series, the two groups exhibited no differences. From the systematic review, operative parameters, local recurrence or systemic metastasis, implant survival, and disease mortality were comparable in patients undergoing Type II internal hemipelvectomy alone compared to patients undergoing some combination of Type II/IV resection. However, compound resections increased the risk of neurological complications and experienced poorer MSTS functional scores.
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Acetábulo , Neoplasias Óseas , Hemipelvectomía , Complicaciones Posoperatorias , Articulación Sacroiliaca , Humanos , Neoplasias Óseas/cirugía , Neoplasias Óseas/patología , Acetábulo/cirugía , Acetábulo/patología , Estudios Retrospectivos , Hemipelvectomía/métodos , Femenino , Masculino , Adulto , Articulación Sacroiliaca/cirugía , Articulación Sacroiliaca/patología , Persona de Mediana Edad , Sacro/cirugía , Sacro/patología , Pronóstico , Estudios de Seguimiento , Tasa de Supervivencia , Adulto Joven , Adolescente , Huesos Pélvicos/cirugía , Huesos Pélvicos/patologíaRESUMEN
OBJECTIVES: The aim of this study was to evaluate the effect of extreme weight loss on low back pain and spinopelvic parameters. PATIENTS AND METHODS: A total of 45 patients (11 males, 34 females; mean age: 40.2±9.4 years; range, 18 to 57 years) who had bariatric surgery between January 2018 and December 2021 were retrospectively analyzed. Radiological spinopelvic parameters including lumbar lordosis (LL), pelvic incidence (PI), spinopelvic harmony (when PI is within LL±10°), pelvic tilt (PT) and sacral slope (SS) were evaluated pre- and postoperatively. Clinical outcomes were assessed using the Visual Analog Scale-Back Pain (VAS-BP) and Oswestry Disability Index (ODI). RESULTS: The mean BMI loss at the end of the first year after surgery was 28.1±6.7% (range, 21 to 36%). The mean PI was 55.75°±12.47° preoperatively and 53.64°±11.86° at one year and the difference was -3.10°±5.25 (p=0.02), 1.10°±4.95° for PT (p=0.46), -2,70°±3.50° for SS (p<0.001), and 3.1±6.55 for LL (p<0.001). At one year, spinopelvic harmony remained unchanged in 31 patients, nine patients regained harmony, and was lost in five patients who had previously. No significant correlation between alterations in spinopelvic alignment and ODI scores was shown (p<0.05). The mean VAS-BP score was 40±30 mm preoperatively, and 20±3.5 mm postoperatively, indicating a difference of -39±29.5 (p<0.001). The mean ODI was 34.71±20.87 preoperatively, and 16±24 postoperatively, indicating a difference of -15±13 (p<0.001). Subgroup analyses showed that the change in SS was more pronounced with regard to PT change, particularly in young and female patients with >10 kg/m2 reduction in BMI (p<0.001). CONCLUSION: Weight loss after bariatric surgery improves lower back pain leading to changes in PT without affecting SS and altering PI.
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Cirugía Bariátrica , Dolor de la Región Lumbar , Pérdida de Peso , Humanos , Femenino , Adulto , Estudios Retrospectivos , Masculino , Pérdida de Peso/fisiología , Persona de Mediana Edad , Adulto Joven , Adolescente , Dolor de la Región Lumbar/cirugía , Huesos Pélvicos/diagnóstico por imagen , Huesos Pélvicos/cirugía , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Lordosis/cirugía , Lordosis/diagnóstico por imagen , Dimensión del Dolor , Obesidad Mórbida/cirugíaRESUMEN
Pelvic acetabular fractures(PAFs) are one of the most common types of pelvic fractures, mostly high-energy injuries, with complex pelvic acetabular structure and limited surgical methods. The trauma of the acetabular fracture itself and the need for long-term bed rest after surgery cause particularly complicated clinical complications. Venous thromboembolism (VTE) is one of its high incidence and serious complications. This review mainly focuses on VTE after PAFs, and describes the epidemiology, risk factors and prevention measures of VTE, aiming to help improve the prognosis and avoid the occurrence of serious complications.
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Acetábulo , Fracturas Óseas , Huesos Pélvicos , Tromboembolia Venosa , Humanos , Tromboembolia Venosa/etiología , Fracturas Óseas/cirugía , Fracturas Óseas/complicaciones , Acetábulo/lesiones , Huesos Pélvicos/lesiones , Huesos Pélvicos/cirugía , Factores de RiesgoRESUMEN
Objective: To explore the effectiveness of reduction robot combined with navigation robot-assisted minimally invasive treatment for Tile type B pelvic fractures. Methods: Between January 2022 and February 2023, 10 patients with Tile type B pelvic fractures were admitted. There were 6 males and 4 females with an average age of 45.5 years (range, 30-71 years). The fractures were caused by traffic accident in 5 cases, bruising by heavy object in 3 cases, and falling from height in 2 cases. The interval between injury and operation ranged from 4-13 days (mean, 6.8 days). There were 2 cases of Tile type B1 fractures, 1 case of Tile type B2 fracture, and 7 cases of Tile type B3 fractures. After closed reduction under assistance of reduction robot, the anterior ring was fixed with percutaneous screws with or without internal fixator, and the posterior ring was fixed with sacroiliac joint screws under assistance of navigation robot. The time of fracture reduction assisted by the reduction robot was recorded and the quality of fracture reduction was evaluated according to the Matta scoring criteria. The operation time, intraoperative fluoroscopy frequency and time, intraoperative bleeding volume, and incidence of complications were also recorded. During follow-up, the X-ray film of pelvis was taken to review the fracture healing, and the Majeed score was used to evaluate hip joint function. Results: The time of fracture reduction was 42-62 minutes (mean, 52.3 minutes). The quality of fracture reduction according to the Matta scoring criteria was rated as excellent in 4 cases, good in 5 cases, and poor in 1 case, with excellent and good rate of 90%. The operation time was 180-235 minutes (mean, 215.5 minutes). Intraoperative fluoroscopy was performed 18-66 times (mean, 31.8 times). Intraoperative fluoroscopy time was 16-59 seconds (mean, 28.6 seconds). The intraoperative bleeding volume was 50-200 mL (range, 110.0 mL). No significant vascular or nerve injury occurred during operation. All patients were followed up 13-18 months (mean, 16 months). X-ray films showed that all fractures healed with the healing time of 11-14 weeks (mean, 12.3 weeks). One case of ectopic ossification occurred during follow-up. At last follow-up, the Majeed score was 70-92 (mean, 72.7), and the hip joint function was rated as excellent in 2 cases and good in 8 cases, with the excellent and good rate of 100%. Conclusion: The reduction robot combined with navigation robot-assisted minimally invasive treatment for Tile type B pelvic fractures has the characteristics of intelligence, high safety, convenient operation, and minimally invasive treatment, which can achieve reliable effectiveness.
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Fijación Interna de Fracturas , Fracturas Óseas , Procedimientos Quirúrgicos Mínimamente Invasivos , Huesos Pélvicos , Procedimientos Quirúrgicos Robotizados , Humanos , Masculino , Persona de Mediana Edad , Femenino , Huesos Pélvicos/lesiones , Huesos Pélvicos/cirugía , Adulto , Estudios Retrospectivos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Fracturas Óseas/cirugía , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Anciano , Procedimientos Quirúrgicos Robotizados/métodos , Resultado del Tratamiento , Tornillos Óseos , Fijadores Externos , Cirugía Asistida por Computador/métodosRESUMEN
Pelvic fracture is a severe trauma with life-threatening implications. Surgical reduction is essential for restoring the anatomical structure and functional integrity of the pelvis, requiring accurate preoperative planning. However, the complexity of pelvic fractures and limited data availability necessitate labor-intensive manual corrections in a clinical setting. We describe in this paper a novel bidirectional framework for automatic pelvic fracture surgical planning based on fracture simulation and structure restoration. Our fracture simulation method accounts for patient-specific pelvic structures, bone density information, and the randomness of fractures, enabling the generation of various types of fracture cases from healthy pelvises. Based on these features and on adversarial learning, we develop a novel structure restoration network to predict the deformation mapping in CT images before and after a fracture for the precise structural reconstruction of any fracture. Furthermore, a self-supervised strategy based on pelvic anatomical symmetry priors is developed to optimize the details of the restored pelvic structure. Finally, the restored pelvis is used as a template to generate a surgical reduction plan in which the fragments are repositioned in an efficient jigsaw puzzle registration manner. Extensive experiments on simulated and clinical datasets, including scans with metal artifacts, show that our method achieves good accuracy and robustness: a mean SSIM of 90.7% for restorations, with translational errors of 2.88 mm and rotational errors of 3.18°for reductions in real datasets. Our method takes 52.9 s to complete the surgical planning in the phantom study, representing a significant acceleration compared to standard clinical workflows. Our method may facilitate effective surgical planning for pelvic fractures tailored to individual patients in clinical settings.
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Fracturas Óseas , Huesos Pélvicos , Tomografía Computarizada por Rayos X , Humanos , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/cirugía , Huesos Pélvicos/diagnóstico por imagen , Huesos Pélvicos/lesiones , Huesos Pélvicos/cirugía , Simulación por Computador , Cirugía Asistida por Computador/métodosRESUMEN
To determine the presence of a consistent osseous corridor from the lateral-posterior aspect of the anterior inferior iliac spine to the sacral wing that could be used for safe trans percutaneous screw fixation for pelvic fragility fractures of the iliac wing and fracture dislocations of the sacroiliac joint (FFP types IIIa and IIIb). Computed tomography (CT) scans were obtained from 100 patients and imported to Mimics software for 3D reconstruction. Then, a cylinder was drawn to imitate the modified LC-II screw and adjusted to a maximum radius and length to obtain the feasible region. Thirteen parameters of the osseous corridor of the modified LC-II screw were measured. Differences between sex groups were compared, and significant statistical correlations were carefully studied to determine potentially important clinical relationships. The records of patients with FFP type IIIa and IIIb fragility fractures of the pelvis were extracted from our hospital. Patients who underwent modified LC-II screw fixation, LC-II screw fixation or reconstruction plate fixation were included. Patients' operative characteristics and complications were recorded at follow-up. Fracture reduction quality was assessed using the Matta standard. Functional outcomes were evaluated using the Majeed grading system. The mean maximum diameters of the osseous corridors of the modified LC-II screw in males and females were 12.73 and 10.83 mm, respectively. The mean maximum lengths of the osseous corridors of the modified LC-II screw in males and females were 96.37 and 93.37 mm, respectively. In the treatment of patients with FFP IIIa and FFP IIIb fractures, the group of treatment by the modified LC-II screws fixation was shown significantly shorter operative time and fewer intraoperative blood loss in comparison to that by the reconstruction plates. In the present study, all the males and females had a complete osseous corridor of the modified LC-II screw. The clinical results of the patients who were treated with modified LC-II screw fixation suggest that the novel method has a good preliminary outcome.
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Tornillos Óseos , Fijación Interna de Fracturas , Huesos Pélvicos , Humanos , Femenino , Masculino , Anciano , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Persona de Mediana Edad , Huesos Pélvicos/lesiones , Huesos Pélvicos/cirugía , Huesos Pélvicos/diagnóstico por imagen , Anciano de 80 o más Años , Tomografía Computarizada por Rayos X , Fracturas Óseas/cirugía , Fracturas Óseas/diagnóstico por imagen , Ilion/cirugía , Resultado del Tratamiento , Articulación Sacroiliaca/cirugía , Articulación Sacroiliaca/diagnóstico por imagen , Articulación Sacroiliaca/lesionesRESUMEN
INTRODUCTION: Giant cell tumors of the bone (GCTB) are aggressive neoplasms, with rare occurrences in the posterior pelvis and sacral area. Surgical challenges in this region include the inability to apply a tourniquet and limited cementation post-curettage due to proximity to neurovascular structures, leading to potential complications. This case-control study explores the impact of preoperative embolization on GCTB located in the iliosacral region. METHODS: Five surgeries (January-December 2021) for pelvic GCTB (3 sacrum, 2 posterior ilium) were performed on four patients. Diagnosis was confirmed through preoperative CT-guided biopsies. One surgery involved curettage with PMMA cement filling, while four surgeries had curettage without cavity filling. Preoperative embolization of the tumor feeding vessel occurred approximately 16 h before surgery in two cases. Denosumab treatment was not administered. RESULTS: Tumor volume, assessed by preoperative MRI, was comparable between patients with and without preoperative embolization (p = .14). Surgeries without embolization had a mean intraoperative blood loss of 3250 ml, erythrocyte transfusion volume of 1125 ml, and a mean surgical time of 114.5 min for two surgeries. Surgeries with preoperative embolization showed a mean intraoperative blood loss of 1850 ml, no erythrocyte transfusion requirement, and a mean surgical time of 68 min. CONCLUSION: Curettage of GCTB in the posterior pelvis and sacrum presents challenges, with significant intraoperative blood loss impacting surgical time and transfusion needs. Preoperative embolization may be beneficial in reducing blood loss during surgery in these cases.
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Neoplasias Óseas , Embolización Terapéutica , Tumor Óseo de Células Gigantes , Cuidados Preoperatorios , Sacro , Humanos , Embolización Terapéutica/métodos , Tumor Óseo de Células Gigantes/patología , Tumor Óseo de Células Gigantes/cirugía , Tumor Óseo de Células Gigantes/terapia , Neoplasias Óseas/patología , Neoplasias Óseas/cirugía , Neoplasias Óseas/terapia , Femenino , Adulto , Estudios de Casos y Controles , Masculino , Sacro/cirugía , Sacro/patología , Ilion/patología , Persona de Mediana Edad , Estudios de Seguimiento , Pronóstico , Adulto Joven , Huesos Pélvicos/patología , Huesos Pélvicos/cirugía , Legrado/métodosRESUMEN
PURPOSE: Surgical intervention for lateral compression (LC) 1 and 2 pelvic ring fractures is controversial. Posterior ring stabilization remains the most common mode of initial fixation. However, greater mechanical instability is observed in the anterior component of LC pelvic fractures. This study tested whether reduction and percutaneous superior ramus fixation will decrease the instability of LC pelvic fractures on intraoperative fluoroscopic imaging. METHODS: All adult patients (≥ 18 years) presenting with either a Young-Burgess LC1 or LC2 pelvic ring disruption treated operatively with percutaneous anterior followed by posterior fixation by a single surgeon from July 2021 to June 2023 were retrospectively reviewed. Displacement of the anterior ring to intraoperative manual internal rotation stress examination under fluoroscopy was compared before and after anterior pelvic ring reduction and fixation and prior to posterior pelvic ring fixation. Pre- and post-operative visual analog scores (VAS) for pain were also compared. RESULTS: Twenty-one patients with a mean age of 48.7 years were included. Fifteen patients (71.4%) presented with an LC1, and six (28.6%) with an LC2 injury patterns. Anterior pelvic fixation alone provided 7.5mm reduction in mean displacement of the anterior pelvic ring (pre-operative = 9.2 mm vs. post-operative = 1.6 mm, p < 0.001). VAS significantly decreased from 7.2 one-day pre-operatively to 2.2 twenty-four h post-operatively (p < 0.001). CONCLUSIONS: Reduction and fixation of the anterior pelvic ring prior to posterior fixation for LC1 and LC2 pelvic ring disruptions substantially improves mechanical stability on intraoperative stress examination. Combination of percutaneous anterior and posterior fixation significantly decreased VAS above the MCID 24 h after stabilization.
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Fracturas Óseas , Huesos Pélvicos , Humanos , Huesos Pélvicos/lesiones , Huesos Pélvicos/diagnóstico por imagen , Huesos Pélvicos/cirugía , Persona de Mediana Edad , Masculino , Femenino , Estudios Retrospectivos , Adulto , Fracturas Óseas/cirugía , Fracturas Óseas/diagnóstico por imagen , Fluoroscopía , Anciano , Fracturas por Compresión/cirugía , Fracturas por Compresión/diagnóstico por imagen , Fijación Intramedular de Fracturas/métodos , Fijación Intramedular de Fracturas/instrumentación , Fijación Intramedular de Fracturas/efectos adversosRESUMEN
Anal squamous cell carcinoma, typically associated with human papillomavirus infection, remains a rare malignancy. This article outlines a case of local recurrence in a male patient with a history of HIV and hepatitis C virus infection, previously treated with chemoradiotherapy. Extensive tumour involvement called for total pelvic exenteration extended to anterior osteomuscular compartment and genitalia. The surgical approach involved multidisciplinary collaboration and detailed preoperative planning using three-dimensional reconstruction. Key surgical considerations comprised the following: achieving tumour-free margins (R0 resection), extensive osteotomies and intricate pelvic floor reconstruction with prosthetic mesh and flap reconstruction. The procedure successfully yielded an R0 resection, maintaining adequate lower limb functionality. Our case report underscores the benefits of pelvic exenteration in locally advanced or recurrent pelvic tumours, invariably following careful patient selection and exhaustive preoperative studies.
Asunto(s)
Neoplasias del Ano , Carcinoma de Células Escamosas , Quimioradioterapia , Recurrencia Local de Neoplasia , Huesos Pélvicos , Exenteración Pélvica , Procedimientos de Cirugía Plástica , Colgajos Quirúrgicos , Humanos , Masculino , Neoplasias del Ano/terapia , Neoplasias del Ano/cirugía , Carcinoma de Células Escamosas/terapia , Carcinoma de Células Escamosas/cirugía , Recurrencia Local de Neoplasia/cirugía , Quimioradioterapia/métodos , Huesos Pélvicos/cirugía , Procedimientos de Cirugía Plástica/métodos , Persona de Mediana EdadRESUMEN
BACKGROUND: The management of pediatric patients afflicted with pelvic fracture urethral injury (PFUI) remains a topic of ongoing debate and controversy within the realm of urology. There is persistent discourse concerning the optimal timing for intervention, specifically between immediate primary realignment (PR) and delayed urethroplasty via suprapubic cystostomy (SCDU). This study was undertaken with the objective of conducting a systematic review of the existing body of evidence, with a focus on comparing the outcomes associated with PR and SCDU as interventions for PFUI among pediatric population. METHODS: A systematic search across databases (PubMed, ScienceDirect, Web of Science and Cochrane Library) was conducted without time or language limitations. Both medical subject heading and free text terms as well as variations of keywords were searched. Randomized controlled trials (RCTs), nonrandomized comparative studies and single-arm case series were included. Data were narratively synthesized considering methodological and clinical heterogeneity. The risk of bias of each included study was assessed. RESULTS: From 1,776 identified articles, 5 studies encompassing 95 PR and 180 SCDU pediatric patients met our eligibility criteria. All studies were non-randomized comparative studies. In general, included studies were of moderately quality. Follow-up durations ranged from 3 to 204 months. Meta-analysis demonstrated that PR and SCDU had similar stricture rates (OR = 0.63, [95 %CI 0.29-1.36], p = 0.24), similar rates of urinary incontinence (OR = 0.65, [95 %CI 0.28-1.48], p = 0.3), and similar rates of ED (OR = 0.59, [95 %CI 0.23-1.53], p = 0.28). CONCLUSION: This study demonstrated that primary realignment procedure did not yield superior outcomes in terms of stricture formation, urinary incontinence, and rates of erectile dysfunction compared to SCDU in pediatric populations with PFUI. It is noteworthy that the predominant inclusion of non-randomized retrospective studies in this analysis introduces a potential for bias. Consequently, there is a pressing requirement for further high-quality research, notably prospective studies and randomized controlled trials, to bolster the robustness of the existing evidence base.
Asunto(s)
Fracturas Óseas , Huesos Pélvicos , Uretra , Humanos , Uretra/lesiones , Uretra/cirugía , Huesos Pélvicos/lesiones , Huesos Pélvicos/cirugía , Fracturas Óseas/cirugía , Fracturas Óseas/complicaciones , Niño , Masculino , Resultado del Tratamiento , Endoscopía/métodos , Cistostomía/métodos , Procedimientos de Cirugía Plástica/métodosRESUMEN
Surgical fixation of pediatric pelvic ring injuries is gaining popularity to avoid the poor long-term outcomes of pelvic asymmetry. The surgical techniques and fixation choices depend on the individual injuries affecting the anterior and posterior pelvic ring areas. The immature bony pelvis of young children has anatomic differences including soft bones, elastic ligaments, and the presence of growth centers. Understanding the unique pediatric lesions with unstable pelvic fractures is essential for treatment decisions. Anterior lesions include pubic symphysis disruption through the pubic apophysis, single ramus fractures, pubic rami fractures through the triradiate cartilage, and/or the ischiopubic synchondrosis; ischiopubic ramus infolding injury; or the unstable superior and inferior quadrant lesions. Posterior pelvic lesions include iliac wing infolding and sacroiliac joint dislocation or transiliac (crescent) fracture/dislocations through the iliac apophysis growth plate. Pubic symphysis and sacroiliac disruptions are physeal injuries in children, and they have excellent healing potential. External fixation is an ideal choice for anterior ring fixation including bony and pubic symphysis injuries. Posterior lesions are mostly sacroiliac joint disruptions with iliac apophysis separation that can serve as a landmark for vertical displacement correction. Posterior lesions can be treated by percutaneous iliosacral screw fixation or open reduction techniques.
Asunto(s)
Fracturas Óseas , Huesos Pélvicos , Humanos , Fracturas Óseas/cirugía , Fracturas Óseas/diagnóstico por imagen , Huesos Pélvicos/lesiones , Huesos Pélvicos/cirugía , Niño , Articulación Sacroiliaca/lesiones , Articulación Sacroiliaca/cirugía , Fijación de Fractura/métodos , Fijación Interna de Fracturas/métodos , Sínfisis Pubiana/lesionesRESUMEN
The challenge in treating traumatic hemipelvectomy is the dynamics of the complex and life-threatening consequences of the injury. These include skin and soft tissue defects, osseous, neural and vascular injuries as well as the subsequent hemostatic derangement and organ dysfunction as part of the shock process. The treatment requires rapid and targeted decisions to save the patient's life. In this particular case a 34-year-old farmer was trapped between a wheeled loader and a stationary trailer. Upon arrival at the hospital the patient was in a state of hemorrhagic shock with accompanying acute traumatic coagulopathy and a grade III open pelvic trauma with complete ischemia of the left leg and a bladder injury. After performing emergency surgery and a two-stage approach for pelvic stabilization the patient's condition deteriorated up to multiorgan failure, necessitating left-sided hemipelvectomy as an immediate life-saving salvage procedure. In the further course multiple revision surgeries and plastic reconstructions due to wound infections and the presence of skin and soft tissue damage were required. Due to the rare confrontation with this type of injury in everyday practice and the absence of a universal treatment algorithm, the following case report is intended to contribute to a better understanding of the treatment and to illustrate the coherent interactions of the individual organ systems affected.
Asunto(s)
Hemipelvectomía , Humanos , Adulto , Masculino , Hemipelvectomía/métodos , Traumatismo Múltiple/cirugía , Resultado del Tratamiento , Huesos Pélvicos/lesiones , Huesos Pélvicos/cirugía , Traumatismos de la Pierna/cirugía , Cirugía de Cuidados IntensivosRESUMEN
BACKGROUND: Management of inferior ramus of the pubis-ischium ramus remains controversial, and related research is sparse. The main intention of this study is to describe the biomechanical and clinical outcomes of pubis-ischium ramus fractures in Tile B pelvic injuries and to identify the feasibility and necessity of fixation of the inferior ramus of the pubis-ischium ramus. METHODS: This study comprised two parts: a biomechanical test and a retrospective clinical study. For the biomechanical tests, Tile B-type pelvic injuries were modeled in six cadaver specimens by performing pubis-ischium osteotomies and disruption of the anterior and interosseous sacroiliac ligaments. The superior and/or inferior rami of the pubis-ischium ramus were repaired with reconstruction plates and separated into three groups (A, B, and C). Specimens were placed in the standing position and were loaded axially with two-leg support for three cycles at 500 N. The displacements of sacroiliac joints at osteotomy were measured with Vernier calipers and compared using statistical software. To investigate the clinical outcomes of this technique, 26 patients were retrospectively analyzed and divided into a superior ramus fixation group (Group D) and a combined superior and inferior ramus of the pubis-ischium ramus fixation group (Group E). The main outcome measures were time of operation, blood loss, postoperative radiographic reduction grading, and functional outcomes. RESULTS: In the vertical loading test, Group E showed better pelvic ring stability than Group D (P < 0.05). However, the shift of the sacroiliac joints was almost identical among the three groups. In our clinical case series, all fractures in Group E achieved bony union. Group E demonstrated earlier weight-bearing functional exercise (2.54 ± 1.45 vs 4.77 ± 2.09; P = 0.004), earlier bony union (13.23 ± 2.89 vs 16.55 ± 3.11; P = 0.013), and better functional outcomes (89.77 ± 7.27 vs 82.38 ± 8.81; P = 0.028) than Group D. The incidence of sexual dysfunction was significantly lower in Group E than that in Group D (2/13 vs 7/13; P = 0.039). Bone nonunion occurred in two patients in Group D, and two patients in Group E had heterotopic ossification. None of the patients exhibited wound complications, infections, implant failures, or bone-implant interface failures. CONCLUSIONS: Fixation of the inferior ramus of a pubis-ischium ramus fracture based on conventional fixation of the anterior pelvic ring is mechanically superior in cadaveric Tile B pelvic injury and shows rapid recovery, good functional outcomes, and low incidence of complications.
Asunto(s)
Placas Óseas , Huesos Pélvicos , Humanos , Fenómenos Biomecánicos , Masculino , Femenino , Adulto , Huesos Pélvicos/cirugía , Huesos Pélvicos/lesiones , Huesos Pélvicos/diagnóstico por imagen , Persona de Mediana Edad , Fenómenos Mecánicos , Cadáver , Fracturas Óseas/cirugía , Estudios Retrospectivos , Fijación Interna de Fracturas/instrumentaciónRESUMEN
BACKGROUND: Fundamental morphologic differences between male and female pelvises are historically recognised. Despite this, little consideration has been given as to whether or not conventional positioning supports used for primary total hip arthroplasties (THAs) performed in the lateral position do an equally effective job of maintaining the intended set up position when comparing genders. Given that recent research has highlighted that unintended pelvic roll occurs commonly during hip surgery, and that such movement may have a mechanically-deleterious consequence upon final construct performance and complication rates, this study was undertaken to explore the differences in pelvic roll between genders. METHODS: The output of a high-precision, commercially-available, imageless intra-operative navigation system was prospectively-collected for 85 consecutive patients undergoing unilateral, primary THAs. These data were separated by gender and were utilised to determine differences in pelvic movement around a central sagittal axis. RESULTS: Demographic data were similar between genders, with no between-group differences in mean BMI (p = 0.09) or indication for surgery (p = 0.66), however participating males (mean 68.04) were slightly younger than females (mean 73.31). The mean anterior pelvic roll for females was 9.50°, and for males 8.68°. There were no statistically significant independent correlations observed between gender (p = 0.21) and pelvic roll. CONCLUSION: The findings of this novel study do not suggest gender differences in the magnitude of unintended, intra-operative, anterior roll, even when corrected for BMI and surgical indication. Average roll of ~ 9° was demonstrated across both groups. An awareness of such positional change during THA surgery may reduce potentially-avoidable post-operative complications.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Posicionamiento del Paciente , Humanos , Masculino , Femenino , Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Cadera/efectos adversos , Anciano , Persona de Mediana Edad , Posicionamiento del Paciente/métodos , Estudios Prospectivos , Caracteres Sexuales , Anciano de 80 o más Años , Factores Sexuales , Huesos Pélvicos/cirugía , Pelvis/cirugíaRESUMEN
Unstable trauma lesion of the spinopelvic junction, including U-shaped sacral fractures and Tile C pelvic ring disruptions, require surgical stabilization in order to realign the bone arches of the pelvis thus reducing the upcoming orthopaedic impairment during sitting, standing, and walking positions, decompress the nerves roots of the cauda equina in a view of reducing neurological impairment, and allow early weight bearing. Even though posterior open modified triangular spinopelvic fixation is particularly efficient for treating unstable trauma lesions of the spinopelvic junction, it may not be sufficient alone in order to prevent long-term counter-nutation, i.e. rotation and anteflexion deformity of the anterior pelvis under load bearing conditions. Such progressive deformation is caused by either the slight rotation of the iliac connectors within the head of iliac screws for spinopelvic constructs, or the slight rotation of sacral cancellous bone around transsacral screws in case of percutaneous procedure. Regardless of the posterior surgical technique that is used, complementary anterior pelvic fixation appears mandatory in order to prevent such deformation over time, which can lead to pelvic asymmetry and then gait imbalance.