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De Bondt S, Carette Y, van Lenthe GH, Herteleer M. Evaluation of the superior pubic ramus and supra acetabular corridors using statistical shape modelling. Surg Radiol Anat 2024:10.1007/s00276-024-03420-y. [PMID: 38942934 DOI: 10.1007/s00276-024-03420-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 06/14/2024] [Indexed: 06/30/2024]
Abstract
INTRODUCTION The incidence of osteoporotic pelvic fractures is increasing. The broken anterior pelvic ring is preferentially fixed with long intramedullary screws, which require a good understanding of the patient-specific anatomy to prevent joint perforation. The aim of this study was to assess the variability of the superior pubic ramus and the supra acetabular corridors' length and width using statistical shape modelling. MATERIALS AND METHODS A male and female statistical shape model was made based on 59 forensic CT scans. For the superior pubic ramus and the supra acetabular corridor the longest and widest completely fitting cylinder was created for the first 5 principal components (PC) of both models, male and female pelvises separately. RESULTS A total of 59 pelvises were included in this study of which 36 male and 23 female. The first 5 principal components explained 75% and 79% of the pelvic variation in males and females, respectively. Within 3 PCs of the female statistical shape model (SSM) a superior pubic ramus corridor of < 7.3 mm was found, 5.5 mm being the narrowest linear corridor measured. Both corridors in all PCs of the male SSM measured > 7.3 mm. CONCLUSION Within females a 7.3 mm and 6.5 mm screw won't always fit in the superior pubic ramus corridor, especially if a flat sacrum, a small pelvis or a wide subpubic angle are present. The supra acetabular corridor did not seem to have sex-specific differences. In the supra-acetabular corridor there was always enough space to accommodate a 7.3 mm screw, both in males and females.
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Affiliation(s)
- Stijn De Bondt
- Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - Yannick Carette
- Department of Mechanical Engineering, University of Leuven, Leuven, Belgium
| | | | - Michiel Herteleer
- Department of Traumatology, University Hospitals Leuven, Leuven, Belgium.
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Ren BO, Goldberg RW, Standefer KD, Teplensky JR, Drain JP, Mccarthy CF, Birch JG, Liu RW. Analyzing Pelvic Asymmetry by Sex and Ancestry: Insights From an Osteological Collection. Cureus 2024; 16:e59291. [PMID: 38813324 PMCID: PMC11135652 DOI: 10.7759/cureus.59291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2024] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION Pelvic asymmetry has been noted in pelvic imaging, and might influence the development of various spinal pathologies, most notably scoliosis. There is a limited understanding of the relationship between pelvic asymmetry and sex and ancestry, and limited use of 3D modeling. The purpose of this study was to identify pelvic asymmetry and morphology differences between sex and ancestry utilizing 3D modeling on young adults in an osteological collection. METHODS Thirty-three osteological pelvic specimens aged 18-25 years (average age 21.4 ± 2.0 years) were scanned to create virtual 3D models for analysis. Pelvic asymmetry and morphology were measured and compared across sex (male and female) and ancestry (European American and African American). Multivariate regression analysis was performed to examine the relationship between the variables measured. RESULTS Multivariate regression analysis demonstrated statistically significant relationships between innominate-pelvic ring ratio and both sex (p < 0.001) and ancestry (p= 0.003) with larger ratios in male and African American specimens respectively. There was also a statistically significant relationship of greater sacral 1 coronal tilt in European American specimens (p= 0.042). There were no statistically significant differences with sex or ancestry in terms of innominate or sacral asymmetry. CONCLUSION Although there are differences in overall pelvic shape between sex and ancestry, there is no relationship between these two variables versus pelvic asymmetry in the axial or sagittal planes in young adult osteological specimens.
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Affiliation(s)
- Bryan O Ren
- Orthopaedic Surgery, University of Michigan, Ann Arbor, USA
| | - Robert W Goldberg
- Paediatric Pulmonology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, USA
| | | | | | - Joseph P Drain
- Orthopaedic Surgery, University of Utah, Salt Lake City, USA
| | - Conor F Mccarthy
- Orthopaedics, Walter Reed National Military Medical Center, Bethesda, USA
| | - John G Birch
- Orthopaedics, Scottish Rite Hospital for Children, Dallas, USA
| | - Raymond W Liu
- Paediatric Orthopaedics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, USA
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Chai Y, Chen XB, Estoque JA, Birbilis N, Qin Q, Ward T, Smith PN, Li RW. A Novel Approach of Customized Pelvic Implant Design Based on Symmetrical Analysis and 3D Printing. 3D PRINTING AND ADDITIVE MANUFACTURING 2023; 10:984-991. [PMID: 37886407 PMCID: PMC10599429 DOI: 10.1089/3dp.2021.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
In pelvic trauma patients, the mismatch of complex geometries between the pelvis and fixation implant is a fundamental cause of unstable and displaced pelvic ring disruption, in which secondary intervention is strongly considered. The geometrical matching in the current customized implant design and clinical practice is through the nonfractured hemi-pelvis for the fractured pelvis. This design philosophy overlooks the anatomical difference between the hemipelves, and further, the geometrical asymmetry at local area still remains unknown. This study analyzed the anatomical asymmetry of a patient's 3D pelvic models from 13 patients. The hemipelves of each patient were registered by using an iterative closet algorithm to an optimum position with minimum deviations. The high deviation regions were summarized between the hemipelves in each case, and a color map was drawn on a hemipelvis model that identified the areas that had a high possibility to be symmetrically different. A severe pelvic trauma case was used to comprehend the approach by designing a 3D printed implant. Each fracture was then registered to the mirrored uninjured hemipelvis by using the same algorithm, and customized fixation implants were designed with reference to the fractured model. The customized fixation plates showed that the implants had lower geometrical deviation when attached onto the re-stitched fracture side than onto the mirrored nonfractured bone. These results indicate that the symmetrical analysis of bone anatomy and the deviation color map can assist with implant selection and customized implant design given the geometrical difference between symmetrical bones. The novel approach provides a scientific reference that improves the accuracy and overall standard of 3D printed implants.
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Affiliation(s)
- Yuan Chai
- Trauma and Orthopaedic Research Laboratory, Department of Surgery, The Medical School, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Xiao-Bo Chen
- School of Engineering, RMIT University, Carlton, Victoria, Australia
| | - Jesse A. Estoque
- Trauma and Orthopaedic Research Laboratory, Department of Surgery, The Medical School, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nick Birbilis
- College of Engineering and Computer Science, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Qinghua Qin
- College of Engineering and Computer Science, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Tomas Ward
- Department of Emergency, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Paul N. Smith
- Trauma and Orthopaedic Research Unit, Clinical Orthopaedic Surgery, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Rachel W. Li
- John Curtin School of Medical Research, The Australian National University, Acton, Australian Capital Territory, Australia
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van Veldhuizen WA, van der Wel H, Kuipers HY, Kraeima J, Ten Duis K, Wolterink JM, de Vries JPPM, Schuurmann RCL, IJpma FFA. Development of a Statistical Shape Model and Assessment of Anatomical Shape Variations in the Hemipelvis. J Clin Med 2023; 12:jcm12113767. [PMID: 37297962 DOI: 10.3390/jcm12113767] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Knowledge about anatomical shape variations in the pelvis is mandatory for selection, fitting, positioning, and fixation in pelvic surgery. The current knowledge on pelvic shape variation mostly relies on point-to-point measurements on 2D X-ray images and computed tomography (CT) slices. Three-dimensional region-specific assessments of pelvic morphology are scarce. Our aim was to develop a statistical shape model of the hemipelvis to assess anatomical shape variations in the hemipelvis. CT scans of 200 patients (100 male and 100 female) were used to obtain segmentations. An iterative closest point algorithm was performed to register these 3D segmentations, so a principal component analysis (PCA) could be performed, and a statistical shape model (SSM) of the hemipelvis was developed. The first 15 principal components (PCs) described 90% of the total shape variation, and the reconstruction ability of this SSM resulted in a root mean square error of 1.58 (95% CI: 1.53-1.63) mm. In summary, an SSM of the hemipelvis was developed, which describes the shape variations in a Caucasian population and is able to reconstruct an aberrant hemipelvis. Principal component analyses demonstrated that, in a general population, anatomical shape variations were mostly related to differences in the size of the pelvis (e.g., PC1 describes 68% of the total shape variation, which is attributed to size). Differences between the male and female pelvis were most pronounced in the iliac wing and pubic rami regions. These regions are often subject to injuries. Future clinical applications of our newly developed SSM may be relevant for SSM-based semi-automatic virtual reconstruction of a fractured hemipelvis as part of preoperative planning. Lastly, for companies, using our SSM might be interesting in order to assess which sizes of pelvic implants should be produced to provide proper-fitting implants for most of the population.
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Affiliation(s)
| | - Hylke van der Wel
- Department of Oral and Maxillofacial Surgery/3D Lab, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Hennie Y Kuipers
- Department of Surgery, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Joep Kraeima
- Department of Oral and Maxillofacial Surgery/3D Lab, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Kaj Ten Duis
- Department of Surgery, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Jelmer M Wolterink
- Department of Applied Mathematics, Technical Medical Centre, 7500 AE Enschede, The Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Richte C L Schuurmann
- Department of Surgery, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
- Multimodality Medical Imaging Group, Technical Medical Centre, University of Twente, 7500 AE Enschede, The Netherlands
| | - Frank F A IJpma
- Department of Surgery, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
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Bibrowicz K, Szurmik T, Ogrodzka-Ciechanowicz K, Hudakova Z, Gąsienica-Walczak B, Kurzeja P. Asymmetry of the pelvis in Polish young adults. Front Psychol 2023; 14:1148239. [PMID: 37034935 PMCID: PMC10075204 DOI: 10.3389/fpsyg.2023.1148239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/23/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Symmetry is one of the criteria of correct body posture in upright position. The spatial positioning of the pelvic girdle is crucial to it. Functional and structural asymmetries within the lumbo-pelvic-hip complex can have a significant influence on the structure and functions of many human body organs and systems. The aim of the study was to present the results of inclinometer measurements of selected landmarks of the pelvic girdle in young adults aged 19-29. Methods The analysis of occurrence of spatial pelvic asymmetry was based on the authors' original, clinical classification and the significance of the body mass and height for the analyzed asymmetries. The inclinometer measurements of the selected landmarks of the pelvic girdle were performed in a sample consisting of 300 young individuals. Then, the occurrences of the spatial asymmetry of the pelvis were analyzed based on the authors' own clinical classification using alignment symmetry of the iliac crests, the anterior superior iliac spines and the trochanters major as a criterion. All study subjects with asymmetry <1 degree were treated as those with a symmetrical pelvis. Results The significance of gender, body mass and height for the analyzed asymmetries was assessed. Symmetric positioning of the iliac crests was observed in only 32% of the respondents. The iliac crest depression on the left side was more frequently observed - in 41% of the respondents. This occurred more often in women (44%) than in men (38%). In the group of women, the rotated pelvis was the most often observed (39.4%) asymmetry, while for men, it was the oblique pelvis (40%). More detailed analysis by pelvic asymmetry subtypes showed their statistical differentiation between women and men (p < 0.0001). Analysis of moderate rotation of the pelvis for men, were reported slightly higher values but these differences were not statistically significant (p = 0.253). Women, in turn, showed slightly higher mean values but here too, the differences were not statistically significant (p = 0.245). Discussion Asymmetries in the pelvis area are common; they were observed in less than three-quarters of the examined population. Oblique pelvis was found in less than a quarter of women and in more than one-third men with the predominant structural asymmetries. Rotated pelvis was observed in more than one-third of women and men with dominating functional asymmetries. There were no linear correlations between the body mass and height, and the angle of asymmetries.
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Affiliation(s)
- Karol Bibrowicz
- Science and Research Center of Body Posture, Kazimiera Milanowska College of Education and Therapy, Poznan, Poland
| | - Tomasz Szurmik
- Faculty of Arts and Educational Science, University of Silesia, Cieszyn, Poland
| | | | - Zuzana Hudakova
- Faculty of Health, Catholic University, Ružomberok, Slovakia
- Department of Health Care Studies, College of Polytechnics, Jihlava, Czechia
- SNP Central Military Hospital, Faculty Hospital, Ružomberok, Slovakia
| | | | - Piotr Kurzeja
- Institute of Health Sciences, Podhale State College of Applied Sciences, Nowy Targ, Poland
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