JBJS 2005 Managing Bone Loss in Acetabular Revision
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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. -
Applied Anatomy of the Hip RICARDO A
Applied Anatomy of the Hip RICARDO A. FERNANDEZ, MHS, PT, OCS, CSCS • Northwestern University The hip joint is more than just a ball-and- bones fuse in adults to form the easily recog- socket joint. It supports the weight of the nized “hip” bone. The pelvis, meaning bowl head, arms, and trunk, and it is the primary in Latin, is composed of three structures: the joint that distributes the forces between the innominates, the sacrum, and the coccyx pelvis and lower extremities.1 This joint is (Figure 1). formed from the articu- The ilium has a large flare, or iliac crest, Key PointsPoints lation of the proximal superiorly, with the easily palpable anterior femur with the innomi- superior iliac spine (ASIS) anterior with the The hip joint is structurally composed of nate at the acetabulum. anterior inferior iliac spine (AIIS) just inferior strong ligamentous and capsular compo- The joint is considered to it. Posteriorly, the crest of the ilium ends nents. important because it to form the posterior superior iliac spine can affect the spine and (PSIS). With respect to surface anatomy, Postural alignment of the bones and joints pelvis proximally and the PSIS is often marked as a dimple in the of the hip plays a role in determining the femur and patella skin. Clinicians attempting to identify pelvic functional gait patterns and forces associ- distally. The biomechan- or hip subluxations, leg-length discrepancies, ated with various supporting structures. ics of this joint are often or postural faults during examinations use There is a relationship between the hip misunderstood, and the these landmarks. -
Surgical Management of Pelvic Ewing's Sarcoma in Children and Adolescents
ONCOLOGY LETTERS 14: 3917-3926, 2017 Surgical management of pelvic Ewing's sarcoma in children and adolescents HONGBIN FAN, ZHENG GUO, JUN FU, XIANGDONG LI, JING LI and ZHEN WANG Department of Orthopedic Surgery, Xi-Jing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China Received June 16, 2016; Accepted March 9, 2017 DOI: 10.3892/ol.2017.6677 Abstract. The present study describes a novel surgical strategy of life, with the median age at diagnosis ranging from 13 to used to treat immature pelvic Ewing's sarcoma (ES), one made 19 years (3). Pelvic ES accounted for 19.9% of cases in the possible owing to the intrinsic structure of the skeletally imma- Mayo Clinic series (4) and 21% in the chapter written by ture pelvis. A total of 12 children and adolescents with open Ginsberg et al (5), who discussed the principles and practice triradiate cartilage received limb-salvage surgeries following of ES. The numerous advances made in diagnostic imaging a diagnosis of pelvic ES. In total, 3 patients with iliac lesions and multimodality therapy over the past few decades mean (2 lesions with extension into the sacrum) received surgical that the overall 5-year survival rate of ES has increased from tumor excisions and allograft reconstructions. Another 10% in the 1970s (6) to 55-75% at the turn of the century (7). 8 patients with periacetabular lesions received trans-acetabular Studies have demonstrated that 5-year survival is improved osteotomies and allograft reconstructions. No reconstruction in patients treated with surgical resection and chemotherapy was performed on 1 patient following excision of a pubic lesion. -
Evaluation and Treatment of Selected Sacral Somatic Dysfunctions
Evaluation and Treatment of Selected Sacral Somatic Dysfunctions Using Direct and HVLA Techniques including Counterstrain and Muscle Energy AND Counterstrain Treatment of the Pelvis and Sacrum F. P. Wedel, D.O. Associate Adjunct Professor in Osteopathic Principles and Practice A.T. Still University School of Osteopathic Medicine in Arizona, and private practice in Family Medicine in Tucson, Arizona Learning Objectives HOURS 1 AND 2 Review the following diagnostic and treatment techniques related to sacral torsion Lumbosacral spring test Sacral palpation Seated flexion test HOURS 3 AND 4 Counterstrain treatments of various low back pathologies Sacral Techniques Covered : 1. Prone, direct, muscle energy, for sacral rotation on both same and opposite axes 2. HVLA treatment for sacral rotation on both same and opposite axes 3. Counterstain treatment of sacral tender points and of sacral torsion Counterstrain Multifidi and Rotatores : UP5L Gluteii – maximus: HFO-SI, HI, P 3L- P 4L ,medius, minimus Piriformis Background and Basis The 4 Osteopathic Tenets (Principles) 1. The body is a unit; the person is a unit of body, mind, and spirit. 2. Structure and function are reciprocally inter-related. 3. The body is capable of self- regulation, self-healing, and health maintenance. 4. Rational treatment is based upon an understanding of these basic principles. Somatic Dysfunction - Defined • “Impaired or altered function of related components of the somatic (body framework) system: • Skeletal, arthrodial, and myofascial structures, • And… • Related vascular, lymphatic, and neural elements” Treatment Options for Somatic Dysfunctions All somatic dysfunctions have a restrictive barrier which are considered “pathologic” This restriction inhibits movement in one direction which causes asymmetry within the joint: The goal of osteopathic treament is to eliminate the restrictive barrier thus restoring symmetry…. -
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. -
Alt Ekstremite Eklemleri
The Lower Limb Sevda LAFCI FAHRİOĞLU, MD.PhD. The Lower Limb • The bones of the lower limb form the inferior part of the appendicular skeleton • the organ of locomotion • for bearing the weight of body – stronger and heavier than the upper limb • for maintaining equilibrium The Lower Limb • 4 parts: – The pelvic girdle (coxae) – The thigh – The leg (crus) – The foot (pes) The Lower Limb • The pelvic girdle: • formed by the hip bones (innominate bones-ossa coxae) • Connection: the skeleton of the lower limb to the vertebral column The Lower Limb • The thigh • the femur • connecting the hip and knee The Lower Limb • The leg • the tibia and fibula • connecting the knee and ankle The Lower Limb • The foot – distal part of the ankle – the tarsal bones, metatarsal bones, phalanges The Lower Limb • 4 parts: – The pelvic girdle – The thigh – The leg – The foot The pelvic girdle Hip • the area from the iliac crest to the thigh • the region between the iliac crest and the head of the femur • formed by the innominate bones-ossa coxae The hip bone os coxae • large and irregular shaped • consists of three bones in childhood: – ilium – ischium •fuse at 15-17 years •joined in adult – pubis The hip bone 1.The ilium • forms the superior 2/3 of the hip bone • has ala (wing), is fan-shaped • its body representing the handle • iliac crest: superior margin of ilium The hip bone the ilium • iliac crest – internal lip (labium internum) – external lips (labium externum) The hip bone the ilium • iliac crest end posteriorly “posterior superior iliac spine” at the level of the fourth lumbar vertebra bilat.* • iliac crest end anteriorly “anterior superior iliac spine – easily felt – visible if you are not fatty • *: it is important for lumbar puncture The hip bone the ilium • Tubercle of the crest is located 5cm posterior to the anterior superior iliac spine • ant. -
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]. -
Stress Fractures Stress Fractures in the Pelvis Typically Occur in the Ilium, Most Commonly in the Which Are a Common Cause of Hind Limb Lameness
function of the pelvis is to connect the hind limbs of the horse to the axial Ilial wing skeleton. The ilium is the largest bone of If Only They Could Talk the pelvis. The wing of the ilium is covered by the gluteal muscles with a narrow shaft extending back to form part of the hip joint. The ischium forms the back of the pelvic floor and can be palpated on both sides at the base of the Ilial shaft tail. The pubis is the smallest bone of the Pubis Our regular focus on equine health. This month MJR vet pelvis and forms another part of the hip joint and the pelvic floor. JOHN MARTIN discusses two types of stress fractures Stress fractures in the pelvis typically occur in the ilium, most commonly in the which are a common cause of hind limb lameness. wing of the ilium but can also be seen in Hip socket the narrow ilial shaft. These stress John Martin fractures can be present with an acute onset of lameness but can equally present with vague signs of ‘poor movement’ Ischium RACTURES of the pelvis are of hind limb lameness. maintaining healthy bone as the skeleton and stiffness, particularly if present on a common cause of hind limb The pathology of stress fractures has responds to stresses and changes. When a both sides of the pelvis. lameness in the young racing been discussed numerous times in this horse’s bones are subjected to repetitive Diagnosis of these stress fractures can thoroughbred. The severity of section of the Kingsley Klarion, but loading, as is the case with horses in sometimes be difficult, particularly in theseF fractures can range from minor basically in normal bone there is a training, this normal balance of osteoblast mild cases with subtle clinical signs. -
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. -
An Isolated Iliac Wing Stress Fracture in a Marathon Runner
A Case Report & Literature Review An Isolated Iliac Wing Stress Fracture in a Marathon Runner Louis F. Amorosa, MD, Alana C. Serota, MD, Nathaniel Berman, MD, Dean G. Lorich, MD, and David L. Helfet, MD To our knowledge, there has been only 1 reported case in Abstract the English language literature of an isolated stress fracture of Iliac stress fractures are uncommon and are usually the iliac wing not extending into the sacroiliac joint. In 2003, insufficiency fractures related to osteoporosis. Only Atlihan and colleagues7 reported on a 35-year-old woman who 2 previous case reports of iliac stress fractures in had experienced 2 and a half months of activity-related lateral- runners that extended into the sacroiliac joint, and 1 sided hip pain that became acutely more severe while running previous case of an isolated iliac wing stress fracture a marathon. Magnetic resonance imaging (MRI) showed a not involving the sacroiliac joint were found in the horizontal fracture of the ilium 4 cm cephalad to the hip joint English language literature. with surrounding soft-tissue and muscle edema. The patient We report on a second case of an isolated stress was treated with rest and restricted activity, and the fracture fracture of the iliac wing in a female marathon runner healed. and the associated diagnosis of the female athlete triad. We report a second case of an isolated iliac wing stress Iliac stress fractures can be an occult cause of hip fracture, also in a woman marathon runner, which was as- pain in athletes and should be included in the differ- sociated with the female athlete triad.