RESUMEN
Pelvic fracture is a serious injury, which has a profound impact on sexual function due to concurrent nervous and urethral injuries. In this case report, we describe a 29-year-old single man who had retrograde ejaculation as a result of a pelvic fracture-related posterior urethral stricture. The patient wanted to improve his ejaculatory ability after experiencing urethral stricture for 8 years and retrograde ejaculation for 3 years following the pelvic fracture. We precisely located and measured the patient's urethral stricture using a retrograde urethrogram, and we used transrectal color Doppler ultrasound to track the patient's ejaculation process in real time. Next, we used urethral balloon dilatation to relieve the urethral stricture. Urinary obstruction symptoms have completely resolved, and the patient was able to urinate without any obstructions. Meanwhile, the real-time transrectal color Doppler ultrasound result showed that some semen might ejaculate externally by passing through the initial stricture area, while some semen continued to flow retrogradely into the bladder.
Asunto(s)
Eyaculación , Estrechez Uretral , Humanos , Masculino , Adulto , Ultrasonografía Doppler en Color , Fracturas Óseas/complicaciones , Fracturas Óseas/diagnóstico por imagen , Huesos Pélvicos/lesiones , Huesos Pélvicos/diagnóstico por imagen , Eyaculación RetrógradaRESUMEN
High-energy impacts, like vehicle crashes or falls, can lead to pelvic ring injuries. Rapid diagnosis and treatment are crucial due to the risks of severe bleeding and organ damage. Pelvic radiography promptly assesses fracture extent and location, but struggles to diagnose bleeding. The AO/OTA classification system grades pelvic instability, but its complexity limits its use in emergency settings. This study develops and evaluates a deep learning algorithm to classify pelvic fractures on radiographs per the AO/OTA system. Pelvic radiographs of 773 patients with pelvic fractures and 167 patients without pelvic fractures were retrospectively analyzed at a single center. Pelvic fractures were classified into types A, B, and C using medical records categorized by an orthopedic surgeon according to the AO/OTA classification system. Accuracy, Dice Similarity Coefficient (DSC), and F1 score were measured to evaluate the diagnostic performance of the deep learning algorithms. The segmentation model showed high performance with 0.98 accuracy and 0.96-0.97 DSC. The AO/OTA classification model demonstrated effective performance with a 0.47-0.80 F1 score and 0.69-0.88 accuracy. Additionally, the classification model had a macro average of 0.77-0.94. Performance evaluation of the models showed relatively favorable results, which can aid in early classification of pelvic fractures.
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Aprendizaje Profundo , Fracturas Óseas , Huesos Pélvicos , Radiografía , Humanos , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/clasificación , Huesos Pélvicos/lesiones , Huesos Pélvicos/diagnóstico por imagen , Masculino , Femenino , Estudios Retrospectivos , Adulto , Persona de Mediana Edad , Radiografía/métodos , Anciano , Adulto Joven , Algoritmos , Pelvis/diagnóstico por imagen , Pelvis/lesiones , AdolescenteRESUMEN
BACKGROUND: The ossification centers in rabbit limbs are related to fetal age and bone maturation. OBJECTIVE: To address the limited studies on ossification in the hind limbs of New Zealand rabbits, we investigated the prenatal and postnatal development of the pelvic and femur bones. METHODS: Double staining with Alcian Blue and Alizarin Red, computed tomography (CT), and 3D reconstruction were employed to visualize and analyze ossification centers in detail. RESULTS: Using double staining, we observed these patterns: At prenatal days 18 and 21, ossification centers appeared in the ilium. By prenatal days 23 and 25, ossification began in the ischium. On postnatal day 1, ilium ossification centers spread across most of the ilium wings, except for the iliac crest, and new centers appeared in the pubis and cotyloid bones. Most bones had ossified by the third week and one month postnatal, except for the iliac crest and ischial tuberosity. At 1.5 months, both were fully ossified. On day 18 post coitum, an ossification center was visible in the middle of the femur shaft. By day 28 post coitum, ossification extended through the shaft, and postnatally, new ossification spots appeared at the extremities by day one and week one. By the third week, complete ossification of the femur head, lesser trochanter, third trochanter, medial condyle, and lateral condyle was observed. At 1.5 months, the entire proximal extremity was ossified. CONCLUSION: 3D CT provided clear imaging of ossification progression in the pelvic and femur bones. This study enhances our understanding of vertebrate skeletal development.
Asunto(s)
Fémur , Imagenología Tridimensional , Osteogénesis , Huesos Pélvicos , Tomografía Computarizada por Rayos X , Animales , Conejos , Fémur/crecimiento & desarrollo , Fémur/diagnóstico por imagen , Fémur/anatomía & histología , Osteogénesis/fisiología , Imagenología Tridimensional/métodos , Huesos Pélvicos/diagnóstico por imagen , Huesos Pélvicos/crecimiento & desarrollo , Huesos Pélvicos/anatomía & histología , Femenino , Coloración y Etiquetado/métodos , Animales Recién Nacidos/crecimiento & desarrolloRESUMEN
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.
Asunto(s)
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.
Asunto(s)
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
OBJECTIVE: This study aimed to evaluate the prevalence of severe hemorrhage as a potentially life-threatening complication in elderly patients with isolated, low-energy pelvic ring fractures, which may be more common than previously described. PATIENTS AND METHODS: A retrospective cohort study was conducted at an academic level 1 trauma center, including 579 patients aged over 65 who suffered from isolated low-energy pelvic fractures between 2006 and 2020. Pelvic computer tomography (CT) scans, with or without contrast, were performed and reviewed for patients with suspected posterior ring injury or bleeding. Patients without CT scans were excluded from the study. RESULTS: Among the 123 patients with isolated pubic rami fractures, 30 (24.4 %) had bleeding with a significant hemoglobin drop (>2 g%). 21(70 %) patients of these had posterior pelvic ring involvement as compared to 45 who did not bleed (51 %, p = 0.07). There was a significantly larger proportion of patient who received anticoagulant therapy (ACT) with posterior ring injury among the bleeding group (20 % vs 3.2 % p < 0.01). Treatment included blood transfusion (19/123, 15.5 %), and arterial angiographic embolization (5/123, 4 %). No complications related to angio-embolization were observed, and all patients survived the initial 90-day period. No other source of bleeding was identified in any of these patients. CONCLUSION: Severe pelvic hemorrhage in the older adults due to a minor pelvic injury after a low-energy trauma is not an uncommon complication, especially with combination of ACT and posterior pelvic ring fracture. This indicates that these injuries more challenging than previously believed. Geriatric pelvic ring injuries should be monitored carefully with serial blood counts, and low threshold for imaging including contrast enhanced CT scans and angiography.
Asunto(s)
Fracturas Óseas , Hemorragia , Huesos Pélvicos , Tomografía Computarizada por Rayos X , Humanos , Femenino , Masculino , Anciano , Estudios Retrospectivos , Huesos Pélvicos/lesiones , Huesos Pélvicos/diagnóstico por imagen , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/complicaciones , Anciano de 80 o más Años , Hemorragia/etiología , Hemorragia/terapia , Centros Traumatológicos , Embolización Terapéutica , Transfusión Sanguínea/estadística & datos numéricosRESUMEN
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.
Asunto(s)
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
Background and Objectives: Anterior sacroiliac fracture dislocation (ASFD), also known as locked pelvis, is a rarely reported diagnosis. The types of ASFDs are often misdiagnosed as lateral compression fractures due to the presence of crescent fractures. In this study, we distinguished ASFD from lateral compression fractures (LC 2) and studied their characteristics. Materials and Methods: This is a retrospective study involving patients from a Level 1 trauma center. Fifty-nine patients under the age of 65 years with crescent fractures caused by a high-energy mechanism were investigated. Results: The incidence of ASFD was 25% (15 of 59) in patients with crescent fractures. Among the 15 patients, 6 had override of the ilium over the sacrum, inhibiting reduction in the sacroiliac joint. Pre-operative radiographic evaluations revealed that vertical displacement of the ASFD was larger than that of lateral compression fracture (LC 2) in the outlet view (mean 9.5 vs. 1.9 mm, p = 0.013), and the pelvic asymmetry ratio was larger in ASFD (mean 7.8 vs. 4.1, p = 0.006) in the pelvis AP view. All patients achieved union after surgery. Post-operative radiography showed no significant vertical displacement difference. There was no difference in vascular injury or hemodynamic instability requiring embolization or preperitoneal pelvic packing (PPP) between the two groups. Conclusions: Patients with ASFD have greater vertical displacement and asymmetry compared to patients with LC 2 fractures. These fractures must be distinguished for appropriate reduction and anterior plate fixation.
Asunto(s)
Huesos Pélvicos , Articulación Sacroiliaca , Humanos , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Articulación Sacroiliaca/lesiones , Articulación Sacroiliaca/diagnóstico por imagen , Adulto , Huesos Pélvicos/lesiones , Huesos Pélvicos/diagnóstico por imagen , Fracturas Óseas/diagnóstico por imagen , Radiografía/métodos , Anciano , Fractura-Luxación/diagnóstico por imagenRESUMEN
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.
Asunto(s)
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.
Asunto(s)
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
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.
Asunto(s)
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
Malalignment is one of the most critical risk factors for knee osteoarthritis (KOA). Biomechanical factors such as knee varus or valgus, hip-knee-ankle angle, and femoral anteversion affect KOA severity. In this study, we aimed to investigate KOA severity predictive factors based on hip and pelvic radiographic geometry. In this cross-sectional study, 125 patients with idiopathic KOA were enrolled. Two investigators evaluated the knee and pelvic radiographs of 125 patients, and 16 radiological parameters were measured separately. KOA severity was categorized based on the medial tibiofemoral joint space widths (JSW). Based on JSW measurements, 16% (nâ =â 40), 8.8% (nâ =â 22), 16.4% (nâ =â 41), and 56.8% (nâ =â 147) were defined as grades 0, 1, 2, 3, respectively. There were significant differences between the JSW groups with respect to hip axis length, femoral neck-axis length, acetabular width, neck shaft angle (NSA), outer pelvic diameter, midpelvis-caput distance, acetabular-acetabular distance, and femoral head to femoral head length (Pâ <â .05). Two different functions were obtained using machine learning classification and logistic regression, and the accuracy of predicting was 74.4% by using 1 and 89.6% by using both functions. Our findings revealed that some hip and pelvic geometry measurements could affect the severity of KOA. Furthermore, logistic functions using predictive factors of hip and pelvic geometry can predict the severity of KOA with acceptable accuracy, and it could be used in clinical decisions.
Asunto(s)
Osteoartritis de la Rodilla , Radiografía , Índice de Severidad de la Enfermedad , Humanos , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/patología , Osteoartritis de la Rodilla/fisiopatología , Femenino , Masculino , Estudios Transversales , Persona de Mediana Edad , Anciano , Radiografía/métodos , Huesos Pélvicos/diagnóstico por imagen , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/patología , Articulación de la Rodilla/fisiopatología , Factores de Riesgo , Pelvis/diagnóstico por imagen , Pelvis/patología , AdultoRESUMEN
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
Aims: Venous tumour thrombus (VTT) is a rare finding in osteosarcoma. Despite the high rate of VTT in osteosarcoma of the pelvis, there are very few descriptions of VTT associated with extrapelvic primary osteosarcoma. We therefore sought to describe the prevalence and presenting features of VTT in osteosarcoma of both the pelvis and the limbs. Methods: Records from a single institution were retrospectively reviewed for 308 patients with osteosarcoma of the pelvis or limb treated between January 2000 and December 2022. Primary lesions were located in an upper limb (n = 40), lower limb (n = 198), or pelvis (n = 70). Preoperative imaging and operative reports were reviewed to identify patients with thrombi in proximity to their primary lesion. Imaging and histopathology were used to determine presence of tumour within the thrombus. Results: Tumours abutted the blood vessels in 131 patients (43%) and encased the vessels in 30 (10%). Any form of venous thrombus was identified in 31 patients (10%). Overall, 21 of these thrombi were determined to be involved with the tumour based on imaging (n = 9) or histopathology (n = 12). The rate of VTT was 25% for pelvic osteosarcoma and 1.7% for limb osteosarcoma. The most common imaging features associated with histopathologically proven VTT were enhancement with contrast (n = 12; 100%), venous enlargement (n = 10; 83%), vessel encasement (n = 8; 66%), and visible intraluminal osteoid matrix (n = 6; 50%). Disease-specific survival (DSS) for patients with VTT was 95% at 12 months (95% CI 0.87 to 1.00), 50% at three years (95% CI 0.31 to 0.80), and 31% at five years (95% CI 0.14 to 0.71). VTT was associated with worse DSS (hazard ratio 2.3 (95% CI 1.11 to 4.84). Conclusion: VTT is rare with osteosarcoma and occurs more commonly in the pelvis than the limbs. Imaging features suggestive of VTT include enhancement with contrast, venous dilation, and vessel encasement. VTT portends a worse prognosis for patients with osteosarcoma, with a similar survivability to metastatic disease.
Asunto(s)
Neoplasias Óseas , Osteosarcoma , Trombosis de la Vena , Humanos , Osteosarcoma/patología , Osteosarcoma/mortalidad , Osteosarcoma/complicaciones , Masculino , Femenino , Neoplasias Óseas/patología , Estudios Retrospectivos , Adulto , Adolescente , Persona de Mediana Edad , Niño , Adulto Joven , Trombosis de la Vena/patología , Trombosis de la Vena/diagnóstico por imagen , Huesos Pélvicos/patología , Huesos Pélvicos/diagnóstico por imagen , Anciano , Extremidades/irrigación sanguíneaRESUMEN
Haemorrhagic shock, which arises as a complication of pelvic fracture subsequent to severe trauma, represents a perilous state. The utilization of interventional endovascular haemostasis assumes a pivotal role in the management of patients with vascular injury following pelvic fracture. This article reports the treatment of a patient with pelvic fracture caused by a serious work-related vehicle accident. Despite the implementation of timely blood and fluid transfusion to combat shock, the application of aortic balloon obstruction, and interventional iliac artery embolization for haemostasis, the patient's condition failed to display any discernible improvement. Repeat angiography further revealed a displacement of the interventional embolization material, and the patient subsequently died of multiple organ failure. The occurrence of spring coil displacement is infrequent, but the consequences thereof are considered grave, necessitating meticulous discernment in the selection of haemostatic materials for this type of patient. The diagnostic and therapeutic processes encompassing the particular case described here were analysed and are discussed with the objective of augmenting the efficacy and success rate of treatment modalities for patients in similar circumstances.
Asunto(s)
Embolización Terapéutica , Fracturas Óseas , Huesos Pélvicos , Humanos , Embolización Terapéutica/métodos , Embolización Terapéutica/instrumentación , Huesos Pélvicos/lesiones , Huesos Pélvicos/diagnóstico por imagen , Fracturas Óseas/terapia , Fracturas Óseas/complicaciones , Masculino , Adulto , Choque Hemorrágico/etiología , Choque Hemorrágico/terapia , Arteria Ilíaca/lesiones , Arteria Ilíaca/diagnóstico por imagen , Resultado Fatal , Accidentes de Tránsito , AngiografíaRESUMEN
The development of the pelvis follows a predictable pattern of ossification that involves the maturation of bone, synchondroses, and apophyses. These growth centers appear and close at distinct times during skeletal maturity and give rise to structural changes in the pelvis that can be distinctively appreciated on various imaging modalities. Accurate interpretation of radiologic images requires knowledge of skeletal development because the varying appearance of the maturing pediatric pelvis may be mistaken for pathology. In addition, many normal features within the pelvis can be erroneously perceived as injury. This article incorporates a multimodality review of normal pelvic maturation, a discussion of developmental variants, and a description of common injuries unique to the pediatric pelvis.
Asunto(s)
Huesos Pélvicos , Humanos , Niño , Huesos Pélvicos/diagnóstico por imagen , Huesos Pélvicos/lesiones , Pelvis/diagnóstico por imagen , Preescolar , Lactante , Diagnóstico por Imagen/métodosRESUMEN
BACKGROUND: Ewing's sarcoma is a primary bone tumor predominantly observed in children and adolescents, necessitating a multidisciplinary treatment approach. While localized cases have a 5-year survival rate of 60-70%, the prognosis is significantly worse in pelvic advanced cases with metastasis. Moreover, pelvic Ewing's sarcoma has the unique problem of leading to high rates of postoperative infection. CASE PRESENTATION: We present the case of a Japanese 14-year-old boy with left iliac Ewing's sarcoma and multiple metastases. At the initial visit, imaging revealed a large tumor in the left iliac bone with extraosseous extension and metastasis to multiple sites. Neoadjuvant chemotherapy resulted in significant tumor reduction. Surgical resection was performed without pelvic ring reconstruction to enable early postoperative chemotherapy and minimize postoperative infection risk. Despite complete abductor muscle removal, the patient achieved a stable gait postoperatively by centering the load axis. CONCLUSION: Our case highlights the successful management of a left iliac Ewing's sarcoma with multiple metastases, with a focus on functional preservation and infection risk reduction. Pelvic ring reconstruction was not performed to avoid postoperative complications, emphasizing the importance of early postoperative chemotherapy. The patient achieved a stable gait postoperatively, demonstrating the potential benefits of this approach in similar cases.
Asunto(s)
Neoplasias Óseas , Ilion , Sarcoma de Ewing , Caminata , Humanos , Sarcoma de Ewing/cirugía , Masculino , Neoplasias Óseas/cirugía , Neoplasias Óseas/secundario , Adolescente , Ilion/trasplante , Huesos Pélvicos/cirugía , Huesos Pélvicos/diagnóstico por imagen , Procedimientos de Cirugía Plástica/métodos , Resultado del Tratamiento , Terapia NeoadyuvanteRESUMEN
PURPOSE: Acetabular reconstruction in situ after extensive pelvic resection is technically challenging. The aim of this study was to investigate the feasibility of positioning guiders for acetabular reconstruction following pelvic tumor resection and the clinical benefit brought by the approach. METHODS: The study included patients who underwent acetabular reconstruction following periacetabular tumor resection using a modular hemipelvic prosthesis. In the guider-assisted group (n = 14), guiders were designed and applied to assist acetabular reconstruction. In the traditional operation group (n = 18), the patients underwent the same surgery but without the guiders. The displacement of the hip rotation center before and after surgery was calculated. The complications and the Musculoskeletal Tumor Society-93 scores were documented. RESULTS: The overall displacement of the hip rotation center was significantly reduced in the guider-assisted group compared with the traditional operation group (13.83 ± 4.06 vs. 22.95 ± 9.18 mm in P = 0.000, 95%CI 3.90-12.96), especially in the anteroposterior axis (3.77 ± 3.03 versus 13.51 ± 9.43 mm in P = 0.000, 95%CI 3.45-13.09). Guider-assisted acetabular reconstruction reduced the risk of prosthesis dislocation compared with the traditional operation (dislocation risks: 1/14, 7.1% vs. 4/18, 22.2%). CONCLUSION: Positioning guiders can effectively and conveniently help place the modular hemipelvic prosthesis at the native position, which might potentially reduce the risk of prosthesis dislocation. LEVEL OF EVIDENCE: Therapeutic level III.
Asunto(s)
Acetábulo , Neoplasias Óseas , Huesos Pélvicos , Humanos , Acetábulo/cirugía , Femenino , Masculino , Adulto , Neoplasias Óseas/cirugía , Huesos Pélvicos/cirugía , Huesos Pélvicos/diagnóstico por imagen , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/instrumentación , Estudios de Factibilidad , Adulto Joven , Adolescente , Prótesis de CaderaRESUMEN
Pelvic fractures present a severe and complex clinical challenge. This study aimed to compare ultrasound-guided ilioinguinal (IIN) and iliohypogastric nerve (IHN) blocks with conventional general anesthesia (GA) in patients undergoing internal fixation surgery for pelvic fractures. A retrospective analysis was conducted on 100 patients equally divided into ultrasound-guided and control groups. The study monitored hemodynamics, intraoperative anesthesia drug usage, postoperative pain levels, and the incidence of adverse reactions between the 2 groups. The ultrasound-guided group underwent ultrasound-guided IHN and IIN blocks combined with GA. The ultrasound-guided group exhibited significant advantages for hemodynamic measurements at specific time points, lower consumption of Propofol and Remifentanil, and reduced pain intensity across all evaluated time intervals (Pâ <â .05). The incidence rate of adverse reactions was significantly lower in the ultrasound group (Pâ =â .016). Ultrasound-guided anesthesia is a superior alternative to conventional GA for managing pelvic fractures through internal fixation surgery. It offers advantages in terms of hemodynamic stability, drug consumption, postoperative pain management, and adverse reaction reduction.
Asunto(s)
Fijación Interna de Fracturas , Fracturas Óseas , Bloqueo Nervioso , Dolor Postoperatorio , Huesos Pélvicos , Ultrasonografía Intervencional , Humanos , Bloqueo Nervioso/métodos , Bloqueo Nervioso/efectos adversos , Masculino , Femenino , Estudios Retrospectivos , Fracturas Óseas/cirugía , Ultrasonografía Intervencional/métodos , Adulto , Huesos Pélvicos/lesiones , Huesos Pélvicos/diagnóstico por imagen , Persona de Mediana Edad , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/etiología , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/efectos adversos , Anestesia General/métodosRESUMEN
PURPOSE: To clarify the morphological factors of the pelvis in patients with developmental dysplasia of the hip (DDH), three-dimensional (3D) pelvic morphology was analyzed using a template-fitting technique. METHODS: Three-dimensional pelvic data of 50 patients with DDH (DDH group) and 3D pelvic data of 50 patients without obvious pelvic deformity (Normal group) were used. All patients were female. A template model was created by averaging the normal pelvises into a symmetrical and isotropic mesh. Next, 100 homologous models were generated by fitting the pelvic data of each group of patients to the template model. Principal component analysis was performed on the coordinates of each vertex (15,235 vertices) of the pelvic homologous model. In addition, a receiver-operating characteristic (ROC) curve was calculated from the sensitivity of DDH positivity for each principal component, and principal components for which the area under the curve was significantly large were extracted (p<0.05). Finally, which components of the pelvic morphology frequently seen in DDH patients are related to these extracted principal components was evaluated. RESULTS: The first, third, and sixth principal components showed significantly larger areas under the ROC curves. The morphology indicated by the first principal component was associated with a decrease in coxal inclination in both the coronal and horizontal planes. The third principal component was related to the sacral inclination in the sagittal plane. The sixth principal component was associated with narrowing of the superior part of the pelvis. CONCLUSION: The most important factor in the difference between normal and DDH pelvises was the change in the coxal angle in both the coronal and horizontal planes. That is, in the anterior and superior views, the normal pelvis is a triangle, whereas in DDH, it was more like a quadrilateral.