Acetabular Teaching Module
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Minimally Invasive Surgical Treatment Using 'Iliac Pillar' Screw for Isolated
European Journal of Trauma and Emergency Surgery (2019) 45:213–219 https://doi.org/10.1007/s00068-018-1046-0 ORIGINAL ARTICLE Minimally invasive surgical treatment using ‘iliac pillar’ screw for isolated iliac wing fractures in geriatric patients: a new challenge Weon‑Yoo Kim1,2 · Se‑Won Lee1,3 · Ki‑Won Kim1,3 · Soon‑Yong Kwon1,4 · Yeon‑Ho Choi5 Received: 1 May 2018 / Accepted: 29 October 2018 / Published online: 1 November 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract Purpose There have been no prior case series of isolated iliac wing fracture (IIWF) due to low-energy trauma in geriatric patients in the literature. The aim of this study was to describe the characteristics of IIWF in geriatric patients, and to pre- sent a case series of IIWF in geriatric patients who underwent our minimally invasive screw fixation technique named ‘iliac pillar screw fixation’. Materials and methods We retrospectively reviewed six geriatric patients over 65 years old who had isolated iliac wing fracture treated with minimally invasive screw fixation technique between January 2006 and April 2016. Results Six geriatric patients received iliac pillar screw fixation for acute IIWFs. The incidence of IIWFs was approximately 3.5% of geriatric patients with any pelvic bone fractures. The main fracture line exists in common; it extends from a point between the anterosuperior iliac spine and the anteroinferior iliac spine to a point located at the dorsal 1/3 of the iliac crest whether fracture was comminuted or not. Regarding the Koval walking ability, patients who underwent iliac pillar screw fixation technique tended to regain their pre-injury walking including one patient in a previously bedridden state. -
Pelvic Anatomyanatomy
PelvicPelvic AnatomyAnatomy RobertRobert E.E. Gutman,Gutman, MDMD ObjectivesObjectives UnderstandUnderstand pelvicpelvic anatomyanatomy Organs and structures of the female pelvis Vascular Supply Neurologic supply Pelvic and retroperitoneal contents and spaces Bony structures Connective tissue (fascia, ligaments) Pelvic floor and abdominal musculature DescribeDescribe functionalfunctional anatomyanatomy andand relevantrelevant pathophysiologypathophysiology Pelvic support Urinary continence Fecal continence AbdominalAbdominal WallWall RectusRectus FasciaFascia LayersLayers WhatWhat areare thethe layerslayers ofof thethe rectusrectus fasciafascia AboveAbove thethe arcuatearcuate line?line? BelowBelow thethe arcuatearcuate line?line? MedianMedial umbilicalumbilical fold Lateralligaments umbilical & folds folds BonyBony AnatomyAnatomy andand LigamentsLigaments BonyBony PelvisPelvis TheThe bonybony pelvispelvis isis comprisedcomprised ofof 22 innominateinnominate bones,bones, thethe sacrum,sacrum, andand thethe coccyx.coccyx. WhatWhat 33 piecespieces fusefuse toto makemake thethe InnominateInnominate bone?bone? PubisPubis IschiumIschium IliumIlium ClinicalClinical PelvimetryPelvimetry WhichWhich measurementsmeasurements thatthat cancan bebe mademade onon exam?exam? InletInlet DiagonalDiagonal ConjugateConjugate MidplaneMidplane InterspinousInterspinous diameterdiameter OutletOutlet TransverseTransverse diameterdiameter ((intertuberousintertuberous)) andand APAP diameterdiameter ((symphysissymphysis toto coccyx)coccyx) -
Femur Pelvis HIP JOINT Femoral Head in Acetabulum Acetabular
Anatomy of the Hip Joint Overview The hip joint is one of the largest weight-bearing HIP JOINT joints in the body. This ball-and-socket joint allows the leg to move and rotate while keeping the body Femoral head in stable and balanced. Let's take a closer look at the acetabulum main parts of the hip joint's anatomy. Pelvis Bones Two bones meet at the hip joint, the femur and the pelvis. The femur, commonly called the "thighbone," is the longest and heaviest bone of the body. At the top of the femur, positioned on the femoral neck, is the femoral head. This is the "ball" of the hip joint. The other part of the joint – the Femur "socket" – is found in the pelvis. The pelvis is a bone made of three sections: the ilium, the ischium and the pubis. The socket is located where these three sections fuse. The proper name of the socket is the "acetabulum." The head of the femur fits tightly into this cup-shaped cavity. Articular Cartilage The femoral head and the acetabulum are covered Acetabular with a layer of articular cartilage. This tough, smooth tissue protects the bones. It allows them to labrum glide smoothly against each other as the ball moves in the socket. Soft Tissues Several soft tissue structures work together to hold the femoral head securely in place. The acetabulum is surrounded by a ring of cartilage called the "acetabular labrum." This deepens the socket and helps keep the ball from slipping out of alignment. It also acts as a shock absorber. -
Lab #23 Anal Triangle
THE BONY PELVIS AND ANAL TRIANGLE (Grant's Dissector [16th Ed.] pp. 141-145) TODAY’S GOALS: 1. Identify relevant bony features/landmarks on skeletal materials or pelvic models. 2. Identify the sacrotuberous and sacrospinous ligaments. 3. Describe the organization and divisions of the perineum into two triangles: anal triangle and urogenital triangle 4. Dissect the ischiorectal (ischioanal) fossa and define its boundaries. 5. Identify the inferior rectal nerve and artery, the pudendal (Alcock’s) canal and the external anal sphincter. DISSECTION NOTES: The perineum is the diamond-shaped area between the upper thighs and below the inferior pelvic aperture and pelvic diaphragm. It is divided anatomically into 2 triangles: the anal triangle and the urogenital (UG) triangle (Dissector p. 142, Fig. 5.2). The anal triangle is bounded by the tip of the coccyx, sacrotuberous ligaments, and a line connecting the right and left ischial tuberosities. It contains the anal canal, which pierced the levator ani muscle portion of the pelvic diaphragm. The urogenital triangle is bounded by the ischiopubic rami to the inferior surface of the pubic symphysis and a line connecting the right and left ischial tuberosities. This triangular space contains the urogenital (UG) diaphragm that transmits the urethra (in male) and urethra and vagina (in female). A. Anal Triangle Turn the cadaver into the prone position. Make skin incisions as on page 144, Fig. 5.4 of the Dissector. Reflect skin and superficial fascia of the gluteal region in one flap to expose the large gluteus maximus muscle. This muscle has proximal attachments to the posteromedial surface of the ilium, posterior surfaces of the sacrum and coccyx, and the sacrotuberous ligament. -
Surgical Approaches to Fractures of the Acetabulum and Pelvis Joel M
Surgical Approaches to Fractures of the Acetabulum and Pelvis Joel M. Matta, M.D. Sponsored by Mizuho OSI APPROACHES TO THE The table will also stably position the ACETABULUM limb in a number of different positions. No one surgical approach is applicable for all acetabulum fractures. KOCHER-LANGENBECK After examination of the plain films as well as the CT scan the surgeon should APPROACH be knowledgeable of the precise anatomy of the fracture he or she is The Kocher-Langenbeck approach is dealing with. A surgical approach will primarily an approach to the posterior be selected with the expectation that column of the Acetabulum. There is the entire reduction and fixation can excellent exposure of the be performed through the surgical retroacetabular surface from the approach. A precise knowledge of the ischial tuberosity to the inferior portion capabilities of each surgical approach of the iliac wing. The quadrilateral is also necessary. In order to maximize surface is accessible by palpation the capabilities of each surgical through the greater or lesser sciatic approach it is advantageous to operate notch. A less effective though often the patient on the PROfx® Pelvic very useful approach to the anterior Reconstruction Orthopedic Fracture column is available by manipulation Table which can apply traction in a through the greater sciatic notch or by distal and/or lateral direction during intra-articular manipulation through the operation. the Acetabulum (Figure 1). Figure 2. Fractures operated through the Kocher-Langenbeck approach. Figure 3. Positioning of the patient on the PROfx® surgical table for operations through the Kocher-Lagenbeck approach. -
The Association of Iliac and Sacral Insufficiency Fractures and Implications for Treatment: the Role of Bone Scans in Three Different Cases
Open Access Case Report DOI: 10.7759/cureus.3861 The Association of Iliac and Sacral Insufficiency Fractures and Implications for Treatment: The Role of Bone Scans in Three Different Cases Sandeep Kola 1 , Michelle Granville 2 , Robert E. Jacobson 2 1. Physical Medicine and Rehabilitation, Larkin Community Hospital, Miami, USA 2. Neurological Surgery, University of Miami Hospital, Miami, USA Corresponding author: Michelle Granville, [email protected] Abstract Iliac wing fractures are under-diagnosed fractures often associated with sacral insufficiency fractures in osteoporotic patients. They are rarely seen alone. Insufficiency fractures of the iliac bone can often be missed on computerized tomography (CT) and magnetic resonance imaging (MRI) yet identified on radioisotope bone scans. Symptomatic iliac fractures present with more lateralized pain in the hip and groin compared to patients with only sacral insufficiency fractures. Since the acetabulum is the key weight- bearing articulation between the sacrum and pelvis and the femoral head and leg, worsening of iliac stress fractures can have major effects on weight bearing and should be a consideration in patients with persistent pain in this area. The anatomy of the ilium and relationship to other pelvic insufficiency fractures is reviewed as well as treatment options. Typical cases are presented where the iliac fractures were found on bone scan either in addition to the more common sacral fracture or due to the persistence of symptoms of hip and thigh pain. Categories: Physical Medicine & Rehabilitation, Radiology, Neurosurgery Keywords: insufficency fractures, ilium, sacral fractures, sacroplasty, acetabulum rim fractures, osteoporosis Introduction The iliac bone composes part of the pelvic ring and can be affected by both traumatic and osteoporotic sacral and pelvic fractures [1-2]. -
The Pelvis Structure the Pelvic Region Is the Lower Part of the Trunk
The pelvis Structure The pelvic region is the lower part of the trunk, between the abdomen and the thighs. It includes several structures: the bony pelvis (or pelvic skeleton) is the skeleton embedded in the pelvic region of the trunk, subdivided into: the pelvic girdle (i.e., the two hip bones, which are part of the appendicular skeleton), which connects the spine to the lower limbs, and the pelvic region of the spine (i.e., sacrum, and coccyx, which are part of the axial skeleton) the pelvic cavity, is defined as the whole space enclosed by the pelvic skeleton, subdivided into: the greater (or false) pelvis, above the pelvic brim , the lesser (or true) pelvis, below the pelvic brim delimited inferiorly by the pelvic floor(or pelvic diaphragm), which is composed of muscle fibers of the levator ani, the coccygeus muscle, and associated connective tissue which span the area underneath the pelvis. Pelvic floor separate the pelvic cavity above from the perineum below. The pelvic skeleton is formed posteriorly (in the area of the back), by the sacrum and the coccyx and laterally and anteriorly (forward and to the sides), by a pair of hip bones. Each hip bone consists of 3 sections, ilium, ischium, and pubis. During childhood, these sections are separate bones, joined by the triradiate hyaline cartilage. They join each other in a Y-shaped portion of cartilage in the acetabulum. By the end of puberty the three bones will have fused together, and by the age of 25 they will have ossified. The two hip bones join each other at the pubic symphysis. -
The Axial Skeleton – Hyoid Bone
Marieb’s Human Anatomy and Physiology Ninth Edition Marieb Hoehn Chapter 7 The Axial and Appendicular Skeleton Lecture 14 1 Lecture Overview • Axial Skeleton – Hyoid bone – Bones of the orbit – Paranasal sinuses – Infantile skull – Vertebral column • Curves • Intervertebral disks –Ribs 2 The Axial Skeleton – Hyoid Bone Figure from: Saladin, Anatomy & Physiology, McGraw Hill, 2007 Suspended from the styloid processes of the temporal bones by ligaments and muscles The hyoid bone supports the larynx and is the site of attachment for the muscles of the larynx, pharynx, and tongue 3 1 Axial Skeleton – the Orbit See Fig. 7.6.1 in Martini and Fig. 7.20 in Figure: Martini, Right Hole’s Textbook Anatomy & Physiology, Optic canal – Optic nerve; Prentice Hall, 2001 opthalmic artery Superior orbital fissure – Oculomotor nerve, trochlear nerve, opthalmic branch of trigeminal nerve, abducens nerve; opthalmic vein F Inferior orbital fissure – Maxillary branch of trigeminal nerve E Z S L Infraorbital groove – M N Infraorbital nerve, maxillary branch of trigeminal nerve, M infraorbital artery Lacrimal sulcus – Lacrimal sac and tearduct *Be able to label a diagram of the orbit for lecture exam 4 Nasal Cavities and Sinuses Paranasal sinuses are air-filled, Figure: Martini, mucous membrane-lined Anatomy & Physiology, chambers connected to the nasal Prentice Hall, 2001 cavity. Superior wall of nasal cavities is formed by frontal, ethmoid, and sphenoid bones Lateral wall of nasal cavities formed by maxillary and lacrimal bones and the conchae Functions of conchae are to create swirls, turbulence, and eddies that: - direct particles against mucus - slow air movement so it can be warmed and humidified - direct air to superior nasal cavity to olfactory receptors 5 Axial Skeleton - Sinuses Sinuses are lined with mucus membranes. -
Medial Acetabular Wall Breach in Total Hip Arthroplasty – Is Full-Weight Bearing Possible?
Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2018 Medial Acetabular Wall Breach in Total Hip Arthroplasty - Is Full-Weight Bearing Possible? Mandelli, Filippo ; Tiziani, Simon ; Schmitt, Jürgen ; Werner, Clément M L ; Simmen, Hans-Peter ; Osterhoff, Georg Abstract: BACKGROUND A breach of the medial acetabular wall is a phenomenon seen frequently due to over-reaming during total hip arthroplasty (THA). The consequences of this issue are not fully understood particularly in cementless THA. A retrospective study was performed to answer whether: 1) immediate postoperative full-weight bearing in the presence of a medial acetabular wall breach after THA results in more short-term revisions of the acetabular component, 2) increases the risk for migration of the acetabular component? HYPOTHESIS Immediate full-weight bearing in the presence of a medial breach is not associated with an increased likelihood for acetabular-related revision surgery or migration of the cup. PATIENTS AND METHODS In this retrospective cohort study, consecutive patients (n=95; mean age 68±13 years; 67 female) who underwent THA with an uncemented acetabular component were identified and a retrospective chart review was performed (follow up 23±17 months, range6to79 months). The presence of a postoperative radiographic medial acetabular breach was documented and the need for revision surgery and the rate of acetabular component migration were assessed during follow-up. RESULTS Some extent of radiographic medial acetabular wall breach was seen in 26/95 patients (27%). With regard to the primary outcome, 2/95 patients (2%) required revision surgery during follow up. -
Investigation of Front Seat Occupants' Acetabulum Injury in Front Impact
Investigation of front seat occupants' acetabulum injury in front impact Shinichi Hayashi Ryuuji Ootani Tsuyoshi Matsunaga Taisuke Watanabe Chinmoy Pal Shigeru Hirayama Nissan Motor Co., Ltd. Japan Paper Number 17-0207 ABSTRACT Among the proposed amendments to the US-NCAP announced on Dec. 2015, a new acetabulum injury evaluation along with the next-generation THOR dummy has been included [1]. In relation to this topic, numerous research tests and studies are already being conducted by NHTSA. However, 29% of those tests showed that acetabulum injury has occurred due to tensile load rather than a compressive load from the femur. Therefore, in this research, we investigated whether similar injury mechanism actually occurred in real world accidents using NASS-CDS (CY2000-10) data. It is observed that 95% of acetabulum injuries in real world accidents were injuries accompanied by fractures, and 82% of these injuries were related to interaction with the instrument panel. This suggests that most of the acetabulum injuries occur by a compressive load and they are far less likely to occur with tensile load. In addition, by analyzing the mechanism of injury occurrence of the research tests, there are the two influential factors for the difference between the crash test results and real world accidents. They are i) the difference between the THOR dummy and the human body around the hip joint and ii) the problem of acetabulum injury criterion. In the future, further research is necessary in order to propose a more appropriate injury risk evaluation. INTRODUCTION Related to the injuries at and around the hip joint of vehicle occupants during a frontal crash, a number of research reports were already published. -
Sacrum and Pelvic Lecture 7
Sacrum and Pelvic Lecture 7 Please check our Editing File. َ َّ َ َ وََمنْ َيتوَكلْ عَلى اَّّللْه ْفوُهوَْ } هذا العمل ﻻ يغني عن المصدر اﻷساسي للمذاكرة {حَس بووهْ Objectives ● Describe the bony structures of the pelvis. ● Describe in detail the hip bone, the sacrum, and the coccyx. ● Describe the boundaries of the pelvic inlet and outlet. ● Identify the structures forming the Pelvic Wall. ● Identify the articulations of the bony pelvis. ● List the major differences between the male and female pelvis. ● List the different types of female pelvis. ● Text in BLUE was found only in the boys’ slides ● Text in PINK was found only in the girls’ slides ● Text in RED is considered important ● Text in GREY is considered extra notes Bony Pelvis From team 436 Bony Pelvis, Functions: ❖ The skeleton of the pelvis is a basin- shaped ring of bones with holes in its walls that connect the vertebral column (Trunk) to both femora (lower extremities). ❖ Its Primary Functions are: ➢ Bears the weight of the upper body when sitting and standing “the most important function”. ➢ Transfers that weight from the axial skeleton to the lower appendicular skeleton when standing and walking. ➢ Provides attachments and withstands the forces of the powerful muscles of locomotion (movement) and posture. ❖ Its Secondary Functions are: ➢ Contains and Protects the pelvic and abdominopelvic viscera (inferior parts of the urinary tracts, internal reproductive organs) ➢ Provides attachment for external reproductive organs and associated muscles and membranes. Pelvic Girdle : Hip Bone : ❖ Compared to the ❖ Each one is a large irregular Pectoral Girdle, the bone. pelvic girdle is Larger, ❖ Formed of three bones: heavier, and stronger. -
Pelvic Implants and Instruments. a Dedicated System for Reconstructive Pelvic and Acetabular Surgery
Pelvic Implants and Instruments. A dedicated system for reconstructive pelvic and acetabular surgery. Surgical Technique This publication is not intended for distribution in the USA. Instruments and implants approved by the AO Foundation. Image intensifier control This description alone does not provide sufficient background for direct use of DePuy Synthes products. Instruction by a surgeon experienced in handling these products is highly recommended. Processing, Reprocessing, Care and Maintenance For general guidelines, function control and dismantling of multi-part instruments, as well as processing guidelines for implants, please contact your local sales representative or refer to: http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance For general information about reprocessing, care and maintenance of Synthes reusable devices, instrument trays and cases, as well as processing of Synthes non-sterile implants, please consult the Important Information leaflet (SE_023827) or refer to: http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance Table of Contents Introduction Implant Specifications 4 AO Principles 6 Intended Use, Indications and Contraindications 7 Instruments 8 – Standard 8 – Retractors 10 – Reduction 12 Surgical Technique Plate Contouring 14 – In-situ Plate Contouring 16 Fracture Fixation 18 – A. Pubic Symphysis Fractures 18 – B. Iliac Fractures 22 – C. Acetabulum Two Column Fractures 28 Implant Removal 38 Product Information Plates 39 Screws 44 Instruments 45 Optional Implants 52 Optional Screws 54 Optional