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Fan S, Liao Y, Xiao Z, Chen Y, Li T, Mai Q, Chen S, Xiang H, Hou Z, Zhang Y. Anterior peri-sacroiliac joint osteotomy in the treatment of malunion and nonunion of complex pelvic ring fracture: techniques and preliminary results. INTERNATIONAL ORTHOPAEDICS 2024; 48:1849-1858. [PMID: 38627330 PMCID: PMC11176099 DOI: 10.1007/s00264-024-06173-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/28/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE To introduce anterior peri-sacroiliac joint osteotomy (APSJO) through the lateral-rectus approach (LRA) for treating pelvic fracture malunion and nonunion, and to evaluate the safety, feasibility, and potential effectiveness. METHODS Data of 15 patients with pelvic fracture malunion and nonunion who underwent treatment by APSJO were selected and analyzed. The reduction quality was assessed using the Mears and Velyvis criteria, while the pre-operative and post-operative function was revealed by the Majeed scoring system. The British Medical Research Council (BMRC) grading system was recruited for the evaluation of lumbosacral plexus function. RESULTS The average operative duration was 264.00 ± 86.75 min, while the intra-operative blood loss was 2000 (600, 3000) mL. Anatomical reduction was complete in three cases, satisfactory in ten cases, and unsatisfactory in two cases. Among the seven patients with lumbosacral plexus injury, the pre-operative Majeed grades were good in two cases, fair in two cases, and poor in three cases, while the post-operative Majeed grades were excellent in three cases, good in three cases, and fair in one case. Muscle strength recovered to M5 in two cases, M4 in three cases, and showed no recovery in two cases. The pre-operative Majeed grades were good in five cases, fair in two cases, and poor in one case of the series without lumbosacral plexus injury, while the post-operative Majeed grades were excellent in seven cases and good in one case. CONCLUSION APSJO through LRA may be a feasible strategy for treating pelvic fracture malunion and nonunion with promising application.
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Affiliation(s)
- Shicai Fan
- Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
- Department of Traumatic Surgery, Center for Orthopedic Surgery, the Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Yilan Liao
- Department of Traumatic Surgery, Center for Orthopedic Surgery, the Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Zhipeng Xiao
- Department of Traumatic Surgery, Center for Orthopedic Surgery, the Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Yuhui Chen
- Department of Traumatic Surgery, Center for Orthopedic Surgery, the Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Tao Li
- Department of Traumatic Surgery, Center for Orthopedic Surgery, the Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Qiguang Mai
- Department of Traumatic Surgery, Center for Orthopedic Surgery, the Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Sheqiang Chen
- Department of Traumatic Surgery, Center for Orthopedic Surgery, the Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Haibo Xiang
- Department of Traumatic Surgery, Center for Orthopedic Surgery, the Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Zhiyong Hou
- Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China.
| | - Yingze Zhang
- Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China.
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Rikhter O. Late surgical correction after complex unstable pelvic fracture 61 C3 (OTA/AO) of an 18-year-old woman. OTA Int 2024; 7:e334. [PMID: 38680134 PMCID: PMC11049736 DOI: 10.1097/oi9.0000000000000334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/22/2023] [Accepted: 02/25/2024] [Indexed: 05/01/2024]
Abstract
Surgical fixation of pelvic fractures is often necessary to restore fracture stability and improve patient outcomes. However, early operative management of pelvis fractures is not widely available in many health systems, resulting in conservative treatment approaches. Conservative approaches can lead to uncorrected pelvic deformities, which are challenging to treat and increase the risk of serious complications such as malunion. Treatment of pelvic malunion requires specialized care, access to necessary equipment, and a clearly defined treatment protocol. However, there is a lack of literature describing treatment algorithms for pelvic fracture malunion. This case report aims to incrementally fill this gap in the literature and highlight a logical step-by-step approach for reconstruction of pelvic malunion. This report is a single case of an 18-year-old woman who sustained complex unstable pelvic fracture, indicated for a 3-step reconstruction at a hospital with limited resources but access to computed tomography scan and some specialized pelvis reduction instruments. Postoperative imaging of the pelvis indicated satisfactory reduction and stable fixation of the pelvic reconstruction. After surgery, the patient was able to perform full axial load with no reported pain. This report provides a detailed description of each step of the operative management of a pelvic malunion case with clearly defined sequences, reduction tools, and positioning maneuvers necessary. Demonstrated in this case report, strategic preoperative planning is critical to successfully treating pelvic malunion and improving patient outcomes. This case report provides the necessary information on the management of pelvic reconstruction to inform other surgeons in underserved regions.
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O’Callaghan WB, Thompson M, Wuestemann T, Whitehouse SL, Crawford RW. Three-Dimensional CT-Based Limb Length Evaluation Is Highly Dependent on Anatomical Landmark Selection and Pelvic Asymmetry. Arthroplast Today 2023; 23:101206. [PMID: 37745966 PMCID: PMC10514420 DOI: 10.1016/j.artd.2023.101206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/29/2023] [Accepted: 07/24/2023] [Indexed: 09/26/2023] Open
Abstract
Background Pelvic skeletal asymmetry can result in rotational differences and morphologic bony prominence variance between the left and right hemipelvis. When selecting bony reference points for modern computed tomography-based robotic total hip arthroplasty planning, it is unclear which bony landmarks are the most reliable and accurate, especially in the presence of significant pelvic asymmetry. Methods A retrospective study was conducted utilizing a database of computed tomography scans. Multiple bony landmarks in the pelvis and femur were selected for comparison, with the aim of measuring pelvic asymmetry. Specifically, the study measured the average difference in lateral offset between the left and right hemipelvis caused by pelvic asymmetry. Landmarks were also compared to determine the impact of pelvic asymmetry on hip length, femur length, and limb length discrepancies. Furthermore, a scenario was simulated in the software whereby a total hip replacement was inserted, potentially changing the hip length. The impact of pelvic reference point selection on the measurement of this simulated change in hip length was examined. Results This study population showed widespread pelvic asymmetry. The anatomical landmarks of the opposite side cannot be relied upon for predicting the anatomy of the affected side. The center of rotation axis is more reliable than the inferior obturator foramen axis for hip length discrepancy due to pelvic asymmetry (P < .05). Conclusions Current computer-assisted surgery THR software reports measurements of global offset and hip length that do not consider pelvic asymmetry. Surgeons are not given confidence ranges to represent the potential impact of asymmetry on the global offset and hip length values. Surgeons following these numbers to guide implant position may incur implant placement error should significant pelvic asymmetry be present in a given patient.
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Affiliation(s)
- William B. O’Callaghan
- Department of Orthopaedics – Queensland Health, The Prince Charles Hospital, Chermside, Queensland, Australia
- Orthopaedic Research Institute of Queensland (ORIQL), Townsvillle, Queensland, Australia
| | | | | | - Sarah L. Whitehouse
- Department of Orthopaedics – Queensland Health, The Prince Charles Hospital, Chermside, Queensland, Australia
- Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Ross W. Crawford
- Department of Orthopaedics – Queensland Health, The Prince Charles Hospital, Chermside, Queensland, Australia
- Queensland University of Technology, Kelvin Grove, Queensland, Australia
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Baumann F, Pagano S, Alt V, Freigang V. Bony Sacral Volume after Sacro-Iliac Screw Fixation of Pelvic Fractures Is Dependent on Reduction of the Anterior Pelvic Ring. J Clin Med 2023; 12:4169. [PMID: 37373862 DOI: 10.3390/jcm12124169] [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: 05/03/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Pelvic ring injuries are uncommon but serious injuries. Percutaneous sacro-iliac screw fixation (SSF) is the standard treatment for posterior stabilization of pelvic fractures. Compression forces of the SSF might cause deformity of the sacrum and the pelvic ring. The aim of this radio-volumetric study is to evaluate the morphometry of the sacrum and pelvic ring in SSF for posterior pelvic fractures. (1) Methods: We conducted a radio-volumetric study measuring the bony sacral volume before and after SSF for a pelvic fracture based on a three-dimensional reconstruction of the pre- and postoperative computed tomography scan of 19 patients with a C-type pelvic fracture. In addition to the bony sacral volume, we assessed the pelvic deformity and the load bearing axis. We compared the results of patients without anterior stabilization (Group A) to patients who had additional ORIF of the anterior pelvic ring. (2) Results: Median age of the patients was 41.2 years (±17.8). All patients received percutaneous SSF with partially threaded 7.3 mm screws. The sacral volume decreased from 202.9 to 194.3 cm3 in group A (non-operative treatment anterior, n = 10) and an increase of sacral volume from 229.8 to 250.4 cm3 in group B (anterior ORIF; n = 9). Evaluation of the pelvic deformity also reflected this trend by a decrease of the ipsilateral load-bearing angle in group A (37.0° to 36.4°) and an increase of this angle in group B (36.3 to 39.9°). (3) Conclusions: Bony sacral volume and pelvic deformity after sacro-iliac screw fixation in pelvic fractures depend on treatment of the anterior pelvic ring. Reduction and fixation of the anterior fracture shows an increase of the bony sacral volume and the load bearing angle leading to a closer to normal reconstruction of the pelvic anatomy.
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Affiliation(s)
- Florian Baumann
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Stefano Pagano
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Viola Freigang
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
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Kanna RM, Rajasekaran S, Schroeder GD, Schnake K, Vaccaro AR, Benneker L, Oner CF, Kandziora F, Vialle E. Lumbo-sacral Junction Instability by Traumatic Sacral Fractures: Isler's Classification Revisited - A Narrative Review. Global Spine J 2022; 12:1925-1933. [PMID: 35192399 PMCID: PMC9609506 DOI: 10.1177/21925682221076414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVES Multiple classifications have been proposed for sacral fractures since the last century. While initial classifications focussed on vertical and transverse fractures, the recent fracture classifications encompass all injury patterns. In 1990, Isler classified unilateral vertical sacral fractures based on its potential influence on lumbo-sacral joint (LSJ) stability. METHODS We re-visited the original description of Isler's classification of sacral fractures and subsequent studies that have cited it. We will further describe basic LSJ anatomy, evolution of sacral classification systems and the use of Isler's classification system as it relates to LSJ instability and chronic low back pain. RESULTS Isler described a subset of unilateral vertical sacral fractures where the fracture line exited medial or through the L5-S1 facet joint, based on radiographic review of 193 sacral fractures (incidence -3.5%). He stated that such a fracture should be recognised as it can impede hemi-pelvis reduction and can result in late LSJ instability. The article has been cited in 106 studies and only a few studies have described the incidence of this variant. Nevertheless, the injury is considered as an indication for surgical fixation. CONCLUSION A review of various classifications indicates that sacral fractures have three important bio-mechanical implications, namely, pelvic ring continuity (vertical fractures), spino-pelvic alignment (high transverse fractures) and lumbo-sacral joint integrity (Isler's fractures). Though there is a universal recognition of Isler's fractures and its impact on LSJ integrity, there is a lack of clinical and bio-mechanical evidence regarding the concept of instability caused by a unilateral Isler fracture.
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Affiliation(s)
- Rishi M Kanna
- Ganga Medical Centre and Hospitals
Pvt Ltd, Coimbatore, Tamil Nadu,Rishi M Kanna, MS, MRCS, FNB, Ganga Medical
Centre and Hospitals Pvt Lt, 130/9 Mahilampoo Flat, Coimbatore 641009, Tamil
Nadu.
| | | | | | - Klaus Schnake
- Center for Spine and Scoliosis
Surgery, Malteser Waldkrankenhaus St Marien
gGmbH, Erlangen, Germany
| | | | - Lorin Benneker
- Department of Orthopaedics, Sonnenhofspital, Bern, Switzerland
| | - Cumhur F Oner
- Orthopaedics, Universitair Medisch Centrum
Utrech, Netherlands
| | - Frank Kandziora
- Center for Spinal Surgery, Berufsgenossenschaftliche
Unfallklinik Frankfurt am Main, Frankfurt, Germany
| | - Emiliano Vialle
- Spine Surgery Group, Cajuru University
Hospital, curitiba, Brazil
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Luo Y, He L, Li Y, Xie J, Gong S, Zhang Q, Yin E, Gu M, Yi C. Sacral osteotomy combined with triangular osteosynthesis in the treatment of malunion and nonunion of vertically displaced pelvic fractures. J Orthop Surg Res 2022; 17:409. [PMID: 36064584 PMCID: PMC9446817 DOI: 10.1186/s13018-022-03296-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 08/24/2022] [Indexed: 11/20/2022] Open
Abstract
Background Malunion and nonunion of vertically displaced pelvic fractures result in lower limb length discrepancies, claudication, and pain. There have been few previous reports of this type of corrective surgery for these old pelvic fractures. We present a surgical technique of sacral osteotomy combined with triangular osteosynthesis in the treatment of malunion and nonunion of vertically displaced pelvic fractures and report on its short-term clinical results. Methods We retrospectively reviewed nine patients (five males and four females) with malunion or nonunion of vertically displaced pelvic fractures treated with sacral osteotomy and triangular osteosynthesis from April 2015 to January 2020. The age ranged from 14 to 45 years (average, 30.7 years). The time from injury to deformity correction surgery ranged from 3 months to 5 years (average, 12.8 months). The vertical displacement of a unilateral hemipelvis was 3.0–4.5 cm (average, 3.80 cm). According to AO/OTA classification at the initial fracture, there are eight cases in type C1.3 and one case in type C3.3. Sacral osteotomy and triangular osteosynthesis were used in all nine patients. The degree of unilateral hemipelvic reduction was assessed postoperatively based on measurements from the anteroposterior (AP) X-ray. Majeed score and pain visual analog scale (VAS) were used to assess the therapeutic effect of the patients during follow-up. Results In all nine patients, postoperative AP X-ray showed correction displacement of 1.7–3.9 cm (average, 3.20 cm). All the patients were followed up for 6–36 months (average, 12.7 months). At the last follow-up, the Majeed score of pelvic fracture increased from an average of 53.9 points (30–84 points) preoperatively to 87.0 points (72–94 points), and the VAS score for pain decreased from an average of 6.0 points (4–8 points) preoperatively to 1.2 points (0–3 points). None had complications like infection, implant broken, screw loosening, iatrogenic nerve, and blood vessel injury. Conclusion Sacral osteotomy combined with triangular osteosynthesis for the treatment of pelvic malunion and nonunion caused by sacral fractures can correct significantly vertical displacement of a unilateral pelvis, prolong limb length, and reconstruct the stability of a pelvic ring, achieving good clinical results.
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Affiliation(s)
- Yangxing Luo
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan, 430030, China
| | - Li He
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan, 430030, China
| | - Yue Li
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan, 430030, China
| | - Jie Xie
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan, 430030, China
| | - Song Gong
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan, 430030, China
| | - Qian Zhang
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan, 430030, China
| | - Enzhi Yin
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan, 430030, China
| | - Meiqi Gu
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan, 430030, China
| | - Chengla Yi
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan, 430030, China.
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Stine S, Washington A, Sen RK, Nasr K, Vaidya R. Pelvic Malunion: A Systematic Review, Dichotomy of Definitions and Treatment. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081098. [PMID: 36013565 PMCID: PMC9415997 DOI: 10.3390/medicina58081098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/04/2022] [Accepted: 08/11/2022] [Indexed: 11/24/2022]
Abstract
Background and Objectives: Pelvic nonunion and malunion have been documented as rare complications in pelvic fractures and literature describing these topics is severely limited. Articles dedicated solely to pelvic malunion are nearly nonexistent. We conducted a literature search with the goal of providing a summary of the definition, causes, treatment strategies, and outcomes of pelvic malunion correction. Materials and Methods: An initial review of the literature was performed using the PubMed, ScienceDirect, and Cochrane Database of Systematic Reviews databases. Search terms used were “malunion” AND “pelvic” OR “pelvis”. Duplicate articles, non-English language articles without translations available and non-human subject studies were excluded. Results: Eleven original publications were found describing experiences with pelvic malunion. Seven of the articles were exclusively dedicated to the topic of pelvic fracture malunion, and only two reported on a series of patients treated for malunion with variably staged procedures. Most reports define pelvic pain as the main indication for surgical correction, along with gait disturbance, standing or sitting imbalance, and urinary or sexual dysfunction. Radiographically, vertical displacement of one to two centimeters and rotation of the hemipelvis of fifteen degrees or more have been described in defining malunion. No treatment algorithms exist, and each patient is treated with a unique work-up and operative plan due to the complexity of the problem. Only one series reported a patient satisfaction rate of 75% following malunion treatment. Conclusions: Pelvic malunion is a rare complication of pelvic ring injury and is seldom discussed in the literature. We found two small case series reporting exclusively on malunion treatment and complications. While some of the combination studies made the distinction in the diagnosis of malunion and nonunion, they rarely differentiated the treatment outcomes between the two categories. This paper describes pelvic malunion and highlights the need for more research into surgical outcomes of treatment specifically regarding functionality, patient satisfaction, and recurrence of preoperative symptoms.
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Affiliation(s)
- Sasha Stine
- Detroit Medical Center; 3990 John R Street, Harper 7-Brush, Detroit, MI 48201, USA
- Correspondence: ; Tel.: +1-218-591-5301
| | - Austen Washington
- Detroit Medical Center; 3990 John R Street, Harper 7-Brush, Detroit, MI 48201, USA
| | - Ramesh Kumar Sen
- Max Hospital Mohali, Phase 6 Mohali (PB), Chandigarh 160055, India
| | - Kerellos Nasr
- Detroit Medical Center; 3990 John R Street, Harper 7-Brush, Detroit, MI 48201, USA
| | - Rahul Vaidya
- Detroit Medical Center; 3990 John R Street, Harper 7-Brush, Detroit, MI 48201, USA
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Hörlesberger N, Hohenberger G, Grechenig P, Schwarz A, Grechenig C, Ornig M, Tackner E, Gänsslen A. Danger zone - The spermatic cord during anterior plating of the symphysis pubis. Injury 2022; 53:519-522. [PMID: 34620470 DOI: 10.1016/j.injury.2021.09.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 09/08/2021] [Accepted: 09/26/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Distances between anatomic landmarks and anatomic structures at risk are often underestimated by surgeons. PURPOSE The goal of the study was to evaluate the distances between anatomic landmarks and the spermatic cord in case of anterior plating of the symphysis. METHODS A total of 25 pelves (50 hemipelves) of male embalmed cadavers were dissected. A 5-hole 3.5mm locking compression plate (Synthes GmbH) was fixed from directly anterior on the symphysis. Measurements were taken 1) distance between the tips of both pubic tubercles, 2) horizontal interval between the lateral border of the plate and the medial margin of the SC (bilateral), 3) distances between the medial border of the SC and the tip of the pubic tubercle (bilateral), 4) distances between the medial border of the SC and the lateral basis of the pubic tubercle (bilateral). RESULTS The distance between the pubic tubercles was 60.3mm in average (SD: 5.7). The interval between the lateral border of the plate and the medial margin of the SC was on average 4.5mm (SD: 1.9) on the right and 4.7mm (SD: 2.6) on the left side. The distance between the tip of the pubic tubercle and the medial border of the SC was in average 11.2mm (SD: 2.7) on the right, and 11.0mm (SD: 2.7) on the left side. The average distance between the medial border of the SC and the lateral basis of the pubic tubercle was 8.1mm (SD: 2.4) on the right and 8.2 mm (SD: 2.4) on the left side. CONCLUSION The SC is at risk not only during dissection but also during anterior plating of the symphysis, because of its close relation to the SC. CLINICAL RELEVANCE Average distances between the palpable pubic tubercle and the SC are below one finger breadth (as reference).
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Affiliation(s)
- Nina Hörlesberger
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria.
| | - Gloria Hohenberger
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria; Department of Trauma Surgery, State Hospital Feldbach-Fürstenfeld. Address: Ottokar-Kernstock-Straße 18, 8330 Feldbach, Austria.
| | - Peter Grechenig
- Department of Orthopedics and Trauma, Paracelsus Medical University. Address: Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Angelika Schwarz
- AUVA Trauma Hospital Styria, Graz. Address: Göstinger Str. 24, 8020 Graz, Austria
| | - Christoph Grechenig
- Department of Ophthalmology, Medical University of Vienna. Address: Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Martin Ornig
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria.
| | - Ellen Tackner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria.
| | - Axel Gänsslen
- Clinic for Trauma Surgery, Orthopedics and Hand Surgery, Klinikum Wolfsburg. Address: Sauerbruchstraße 7, 38440 Wolfsburg, Germany
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Brumat P, Mihalič R, Benulič Č, Kristan A, Trebše R. Patient-specific template and electromagnetic navigation assisted bilateral periacetabular osteotomy for staged correction of bilateral injury-induced hip dysplasia: a case report. J Hip Preserv Surg 2021; 8:192-196. [PMID: 35145717 PMCID: PMC8825680 DOI: 10.1093/jhps/hnab054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/01/2021] [Accepted: 07/19/2021] [Indexed: 11/12/2022] Open
Abstract
ABSTRACT
Periacetabular osteotomy (PAO) for pelvic fracture sequelae presents a challenge in hip preservation surgery due to a combination of complex conditions involving post-traumatic altered anatomy and technically demanding procedure, with high surgical risk involved. To address these challenging conditions and evade potential devastating complications, a combination of patient-specific template (PST) and electromagnetic navigation (EMN) guidance can be used to increase the safety of the procedure and the accuracy of the acetabular reorientation. Herein we report our experience utilizing a combined PST- and EMN-assisted bilateral PAO for staged correction of bilateral severe, injury-induced hip dysplasia. The presented case report describes a unique method of successful surgical treatment of severe, bilateral injury-induced hip dysplasia with combined 3-D printing technology (PST) and intra-operative electromagnetic computer-assisted navigation (EMN) aided technically demanding surgical procedure (PAO), which emphasizes the benefits of PST and EMN use in hip preservation surgery in patients with complex pathoanatomic circumstances.
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Affiliation(s)
- Peter Brumat
- Valdoltra Orthopaedic Hospital, Jadranska cesta 31, Ankaran 6280, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana 1000, Slovenia
| | - Rene Mihalič
- Valdoltra Orthopaedic Hospital, Jadranska cesta 31, Ankaran 6280, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana 1000, Slovenia
| | - Črt Benulič
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana 1000, Slovenia
- Department of Traumatology, Division of Surgery, University Medical Centre Ljubljana, Ljubljana, Zaloška 7, Ljubljana 1000, Slovenia
| | - Anže Kristan
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana 1000, Slovenia
- Department of Traumatology, Division of Surgery, University Medical Centre Ljubljana, Ljubljana, Zaloška 7, Ljubljana 1000, Slovenia
| | - Rihard Trebše
- Valdoltra Orthopaedic Hospital, Jadranska cesta 31, Ankaran 6280, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana 1000, Slovenia
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Agrawal N, Ghuman N, Singh P, Kathuria P, Banerjee S, Garg P, Rai A. Postmenopausal bleeding as a late sequela of pelvic fracture. J Midlife Health 2021; 12:316-318. [PMID: 35264840 PMCID: PMC8849150 DOI: 10.4103/jmh.jmh_99_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/23/2021] [Accepted: 12/05/2021] [Indexed: 11/15/2022] Open
Abstract
Postmenopausal bleeding is one of the common presenting complaints in the gynecological outpatient department. The common causes of which are atrophic endometritis, vaginitis, estrogen therapy, cancer endometrium, and cancer cervix. Hereby, we present a rare case of a 65-year-old female presented with postmenopausal bleeding who had history of trauma 1 year back with pelvic bone fracture. The cause of postmenopausal bleeding, in this case, is abnormal bony protrusion secondary to malunited pelvic fracture causing laceration of the right lateral vaginal wall. The case was managed by local osteotomy and vaginal wall repair.
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