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At least 253 records · Page 14Linked to original sources
PubMed2004

The current role of structural grafts and cages in revision arthroplasty of the hip.

Treating large segmental acetabular defects that comprise more than 50% of the acetabulum is one of the most difficult challenges in revision arthroplasty of the hip. One of the surgical options is a structural acetabular allograft. Unless these allografts are protected by a cage that extends from ilium to ischium, there is an unacceptable incidence of graft failure. The cage allows reconstruction at the correct anatomic level. It provides a scaffold for bone grafting (structural and morsellized). The use of cement to stabilize the cup allows the surgeon to adjust the cup position independent of the cage. The current generation of cages does not provide biologic fixation and with time may loosen or fracture. Recent experience with a combination of a trabecular metal shell protected by a cage may offer a more favorable environment for bone grafting with permanent biologic fixation of the cup cage construct.

Acetabulum↗
PubMed2004

Use of custom triflanged acetabular components in revision total hip arthroplasty.

Difficulty persists in consistently treating massive acetabular defects in revision total hip arthroplasty. A relatively new treatment option for these complex cases is a custom triflanged acetabular component created from anatomic data derived from a computed tomography scan of the pelvis. The custom triflanged acetabular component achieves fixation on the remaining ilium, ischium, and pubis with multiple fixation screws while the acetabular defect is filled with cancellous allograft bone. A retrospective review was done of 26 hips (26 patients) with massive periacetabular bone loss (Paprosky Type 3B) reconstructed with a custom triflanged acetabular component. Twenty-three of 26 patients (88.5%) were considered clinically successful at short-term followup (average, 54 months; range, 24 to 85 months), with stable fixation and reconstruction of periacetabular bone. Three failures occurred from loss of ischial fixation in two patients with a preoperative pelvic discontinuity and one patient with severe osteopenia. These devices should be used with caution in patients with a preoperative pelvic discontinuity unless additional column plating is done.

Acetabulum↗
PubMed2005

A new modified technique of triple osteotomy of the innominate bone for acetabular dysplasia.

A new modified technique of triple osteotomy of the innominate bone has been devised and implemented for the treatment of residual acetabular dysplasia in children with developmental dysplasia of the hip. The procedure is done through a two-incision approach. The ischium, pubis, and iliac bones are osteotomized, with resection of a triangular wedge of bone from the outer cortex of the proximal part of the ilium. The resection of the triangular wedge of bone from the outer cortex alone creates a slot with the intact inner cortex serving as a stabilizing abutment where the distal posterior aspect of the ilium fits. This osteotomy allows for extensive coverage of the femoral head with greater stability. The stable construct of the osteotomy and pelvic fixation facilitates early weight bearing and obviates the need for hip spica cast immobilization. Since its conception the new triple osteotomy has been done in 11 children (13 hips). The preoperative vertical center edge angle of Weiberg was 8.9 degrees (range, 5 degrees -17 degrees ). The postoperative vertical center edge angle was a mean of 45.6 degrees (range, 31 degrees -58 degrees ). The last followup vertical center edge angle was a mean of 44.9 degrees (range, 29 degrees -58 degrees ). The mean preoperative acetabular angle of Sharp was 53 degrees (range, 48 degrees -61 degrees ). The postoperative acetabular angle was a mean of 25.4 degrees (range, 19 degrees -40 degrees ). The last followup acetabular angle was a mean of 28 degrees (range, 18 degrees -41 degrees ). All patients went on to have bony unions on their innominate bone. We describe the technique for the osteotomy and presents preliminary results of all patients who had the procedure.

Acetabulum↗
PubMed2007

Quadruple and juxta-articular pelvic osteotomy in children using anterior approach: technique and results.

The traditional indications of pelvic osteotomy in children are Salter's osteotomy in young patients and triple osteotomy in older patients. We performed the juxta-articular pelvic osteotomy with a single anterior approach. Our population included a group of young children necessitating a high degree of reorientation. In elder children a quadruple osteotomy of the ischium, pubis, ilium and ischial spine was achieved to release the sacrospinal ligament. Between 1993 and 2003, 30 osteotomies have been carried out on 26 patients. The mean age was 6.7 years, 10 patients were younger than 5 years, with 6 years of follow-up. The indications included acetabular dysplasia (15 cases), Perthes disease (14 cases) and one caput valgum. When compared with preoperative clinical examination, the postoperative flexion was decreased by 14 degrees, extension increased by 7 degrees, external rotation increased by 5 degrees, internal rotation decreased by 5 degrees. Radiographic assessment demonstrated an average angle of correction by 20 degrees for the acetabular angle of Sharp, 32 degrees for the center edge angle and 18 degrees for the slope of sourcil. We concluded that lateral coverage must be achieved in a frontal plan, avoiding the figure-of-four maneuvers and displacement in a transverse plan. Despite the significant reorientation of the acetabulum, we did not observe excessive external rotation. The quadruple osteotomy allowed important acetabular displacement in older patients. The single approach avoided prone position and permitted a simpler postoperative management.

Acetabulum↗
PubMed2005

Complete bilateral agenesis of the ilium in a 7-year-old ambulatory girl: case report.

STUDY DESIGN: A 7-year-old ambulatory girl with complete bilateral agenesis of the ilium is reported. OBJECTIVE: To document the clinical evolution and the spino-pelvic balance of a girl with bilateral agenesis of the ilium. SUMMARY OF BACKGROUND DATA: Scapuloiliac dysostosis is a rare focal skeletal dysplasia consisting in hypoplasia of ilium and scapula. METHODS: A 7-year-old girl with a short stature was referred to our clinic at 35 months of age for an asymptomatic lumbar hyperlordosis. She presented a waddling gait, and normal range of motion of her upper and lower limbs. The neurologic examination was within normal limits. RESULTS: Initial radiographs at 35 months of age showed complete bilateral agenesis of the ilium with preservation of the pubis, ischium, and sacrum, associated with a bilateral high hip dislocation. The lumbar lordosis and sacral slope were 89 degrees and 84 degrees, respectively. A radiographic skeletal survey also showed hypoplasia of both scapulae. At 7 years old, the girl was fully ambulatory, with a waddling gait and had no pain. The sacral slope and lumbar lordosis have increased to 97 degrees and 97 degrees, respectively. There was no evidence of spondylolisthesis. So far, the patient has required no treatment for her condition. CONCLUSION: This article reports a unique case of scapuloiliac dysostosis with complete bilateral agenesis of the ilium in an ambulatory girl. This case indicates that a functional gait is possible with bilateral congenital absence of the ilium, provided that there is adequate muscular support and normal neurologic function.

Child↗
PubMedDate not supplied

Radiologic pelvic asymmetry in unilateral late-diagnosed developmental dysplasia of the hip.

Eighty-three cases of unilateral late-diagnosed (older than 4 months of age) developmental dysplasia of the hip (DDH) were studied to evaluate pelvic shape and innominate bone relationships in the initial anteroposterior radiograph. To be included, each initial radiograph had to have no lumbar pedicle rotation, lumbar scoliosis, gas shadows, or metallic protectors. Measurements were done using as reference a medial pelvic line, which divides the pelvis into two innominate bones. Lineal parameters were defined to assess pelvic radiologic shape; angular parameters defined the relationship between the ilium, ischium and pubis, and sacrum. Statistically significant differences were observed in most cases, and pelvis asymmetry was evident. The asymmetry was more obvious in cases in which the teardrop had a negative value and in low dislocations. Similar changes have been observed in experimental dislocation of the hip secondary to a triplane pelvic deformity. We suggest that similar alterations of pelvic shape occur in DDH, possibly secondary to growth disturbance in the triradiate cartilage.

Age Factors↗
PubMedDate not supplied

Lameness associated with coxofemoral soft tissue masses in six dogs.

Six cases of mechanical lameness involving the coxofemoral joint are presented. All dogs had a history of chronic rear leg pain and lameness, and decreased range of motion of the hip. On physical examination, ventral subluxation of the coxofemoral joint during extension was present in three dogs. A radiographic diagnosis of subluxation was made in five dogs. In each dog, surgical exploration of the area caudal to the coxofemoral joint revealed a fibrous mass between the lesser or third trochanters and the ischium, diagnosed as a nonneoplastic fibrous reaction by microscopic examination. The clinical, radiographic, and histopathologic signs were similar to previously described cases of myositis ossificans. Five dogs returned to normal function after excision of the soft tissue mass, and one dog was normal when lost to follow-up 4 weeks postoperatively.

Animals↗
PubMedDate not supplied

Transpelvic urethrostomy in 11 cats using an ischial ostectomy.

OBJECTIVE: To investigate the feasibility and long-term outcome of a modified subpubic urethrostomy technique termed transpelvic urethrostomy (TPU) in cats. STUDY DESIGN: Prospective clinical study. ANIMALS: Eleven male cats with obstructive lower urinary tract disease that could not be relieved, and requiring a surgical urinary diversion, were selected for TPU. METHODS: With the cat in dorsal recumbency, the penis was exposed and the ventral pelvis was denuded by median adductor muscle elevation. An approximately 12 mm x 15 mm area of ischium was removed. The pelvic urethra, 8-20 mm cranial to the bulbourethral glands, was incised longitudinally and sutured to the skin to create a urethrostomy. RESULTS: All cats were neutered males (2-9 years); none were uremic or hyperkalemic at admission. Urine was cultured if there was leukocyturia, nitrituria, and/or bacteriua. Bacteria were isolated from 2 specimens. A patent urethrostomy was created in all cats without operative complications. Except for 1 cat without associated clinical signs, stricture was not evident between 9 and 42 months after urethrostomy. One cat had postoperative urinary incontinence (UI) that resolved within 4 weeks. Two cats each had 1 episode of idiopathic lower urinary tract disease after 6-month follow-up; both responded to medical therapy. CONCLUSIONS: TPU was used as a successful urinary diversion procedure relieving signs of urinary tract obstruction and preventing further obstruction, with few complications. The incidence of UI after TPU remains minimal. CLINICAL RELEVANCE: TPU should be considered as a salvage urinary diversion procedure in cats (as an alternative to prepubic and subpubic techniques). TPU may also be considered as a possible primary urinary diversion solution (an alternative to perineal urethrostomy) for obstructive lower urinary tract disease in cats.

Animals↗
PubMed2002

Verification of prostate treatment setup using computed radiography for portal imaging.

A non-film-based system was used to obtain high quality portal film images. Digital portal images were obtained with a computed radiography (CR) system, in which the film is replaced with a photostimulable phosphor plate. Digital processing of portal images enhanced the display contrast using regional histogram equalization. The images were compared to images on radiographic film, exposed in the same cassette. The contrast-enhanced CR images of prostate treatment fields facilitated identification of the entire contour of the ischium, the location of the pubic symphysis, and the ischial tuberosity to determine the anterior and inferior locations of the prostate and bladder. Identifying the coccyx on the processed portal images permits the physician to locate accurately the posterior wall of the rectum. In each case the quality of the CR image was judged by the clinician to be superior to conventional portal film. The identification of these anatomical structures on the portal images is clinically important for verifying 3D conformal therapy of the prostate. With the same CR system one may acquire digital treatment portal and simulation images. This provides a foundation for a picture archival communication system for radiation oncology. Existing software can be used to register these digital portal and simulation images to facilitate verification of treatment setup.

Databases as Topic↗
PubMed1992

Pediatric pelvis: radiographic appearance in various congenital disorders.

This article presents the spectrum of pelvic abnormalities in developmental diseases of bone. The pelvis comprises the ilium, ischium and pubis, and the sacrum. Knowledge of pelvic embryology and normal development is essential in recognizing pelvic abnormalities and disorders, which involve the number of bone elements, rate of ossification, density, and size or shape. Anarchic development of bone and dysplasias identifiable at birth must also be considered. The pelvis is important in the evaluation of such disorders because of the frequent, varied, and often specific radiologic abnormalities. The pelvis may also be the first evidence for a congenital malformation syndrome because it is often included in routine radiographic examinations.

Bone Diseases, Developmental↗
PubMed1982

The teardrop shadow of the pelvis; anatomy and clinical significance.

The teardrop shadow of the pelvis is poorly understood and as a result its clinical significance is not appreciated. The structure responsible for this shadow was pinpointed by removing sections from the hemipelvis of an anatomic specimen with an electric saw. This structure is located in the anteroinferior portion of the acetabular fossa at the acetabular notch and consists of cortical and medullary bone contributed primarily from the ischium with a much smaller contribution from the superior pubic ramus. The normal and abnormal appearances of the teardrop shadow of the acetabulum of three patients were demonstrated on both plain radiographs and computed tomographic (CT) scans.

Acetabulum↗
PubMed1984

Concentric reduction of the dislocated hip. Computed-tomographic evaluation.

Concentric reduction of a dislocated hip can be evaluated by anteroposterior views or linear tomography. Anterior relationships, however, may be difficult to evaluate from a frontal radiograph despite good visibility. Computed tomography (CT), because of its cross-sectional imaging capabilities, is superior in demonstrating these relationships. The CT appearance of two types of dislocations (posterior and lateral) is described. A posterior dislocation should be suspected if the femoral metaphysis approximates the acetabulum, a mass projects behind the ischium, or the fat plane anterior to the gluteus maximus is deformed or displaced posteriorly.

Female↗
PubMed1985

Bursae and abscess cavities communicating with the hip. Diagnosis using arthrography and CT.

Bursae or abscess cavities communicating with the hip joint were demonstrated by hip arthrography or by computed tomography (CT) in 40 cases. The bursae or abscess cavities were associated with underlying abnormalities in the hip, including painful hip prostheses, infection, and inflammatory or degenerative arthritis. Structures communicating with the joint capsule included iliopsoas bursae (13 cases), bursae associated with the greater trochanter (21 cases), ischiotrochanteric bursae created by abnormal articulation between the ischium and lesser trochanter (two cases), and abscess cavities not associated with a bursa (four cases). Symptoms may be produced directly as a result of infection or indirectly as a result of inflammation or pressure on adjacent structures. In cases of suspected infection, direct puncture and aspiration of the bursa or abscess cavity, in addition to joint aspiration, may be necessary to obtain organisms for culture as joint aspiration may not yield fluid. Hip arthrography can confirm a diagnosis of bursae and abscess cavities communicating with the hip joint in patients with hip pain or soft-tissue masses around the groin. Differentiation of enlarged bursae from other abnormalities is important to avoid unnecessary or incorrect surgery.

Abscess↗
PubMed1987

Leakage through the crural edge of corpus cavernosum. Diagnosis and treatment.

Blood drainage of the corpora cavernosa is made by the deep dorsal vein and by the deep crural veins. The root of the corpora can be compressed against the ischium during papaverine test or cavernometry. In a series of patients with cavernosal leakage, this maneuver demonstrated that the crural edge of the corpora is the point of leakage in many of them. Exclusion of the crural edge by ligation of the corpora proximal to the entrance of the arterial supply caused improvement of erections in 7 of 8 patients.

Erectile Dysfunction↗
PubMed1985

Canine diffuse idiopathic skeletal hyperostosis.

The radiographic and necropsy findings in a case of canine diffuse idiopathic skeletal hyperostosis are reported. Radiographically, the disease was characterized by progressive development of para-articular mineral densities along joint surfaces of the appendicular skeleton; progressive osseous fusion of the ilium, pubis, femur, and ischium; and progressive flowing ossification of the dorsal spinous processes of cervical and thoracic vertebrae. The para-articular lesions were considered to develop as a consequence of fibrocartilaginous proliferation followed by endochondral ossification. Progression of the ossification process led to para-articular joint fusion and almost complete ossification of the metaplastic cartilage. A distinguishing feature was the sparing of intra-articular structures.

Animals↗
PubMedDate not supplied

Surgical repair of chronic complete hamstring tendon rupture in the adult patient.

Complete rupture of the hamstring tendons in the adult is a rare injury. This report discusses complete rupture of the hamstring tendons in nine patients treated by late operative repair. All patients were referred from outside centers for a second opinion after failed nonoperative treatment. The diagnosis was made quite easily on clinical grounds and was confirmed at surgery. Surgical treatment in all cases consisted of reattachment of the hamstring tendons to the origin on the ischium, and in all cases it was necessary to perform neurolysis of the sciatic nerve. Good results were achieved in all cases, at follow-up all patients were satisfied with the surgery.

Adult↗
PubMed2006

Persistent umbilical discharge in infants and children.

BACKGROUND: Umbilical discharge is not an unusual presentation in infants and children. However, the evaluation and management are rarely discussed. METHOD: A retrospective review of 18 patients presenting with persistent umbilical discharge over a period of 22 years, excluding neonates with omphalitis. RESULTS: The patients' ages ranged between 11 days and 9 years. Presentation was usually discharge of clear, serous or purulent fluid or faecal matter from the umbilicus, sometimes dating back to the neonatal period. Evaluation consisted of bacteriology, fistulogram (one patient) and histopathology. The cause of discharge was patent vitello-intestinal duct in 11 patients, umbilical granuloma in three, umbilical sinus in two and patent urachus and osteomyelitis of the ischium in one each. Definitive treatment was exploration and complete excision of the lesion and antibiotics. Two patients with patent vitello-intestinal duct died, one before surgery from hypokalaemia and sepsis, and the other from anaesthetic complications. CONCLUSION: There is a need for early referral and treatment in patients with persistent umbilical discharge. Conservative treatment is usually not successful as the common causes would normally require complete excision.

Child↗
PubMed1997

Biomechanics of the Gazi type pelvis external skeletal fixator.

External skeletal fixation is an alternative method of treatment to conventional therapy and open surgical procedures in pelvis fractures. The appropriate type of frame and the configuration of the connecting bars of these fixators are under investigation. In the Gazi type pelvis external fixator (GPEF) which has been developed, a 70 degree angulation is applied to the connecting bars of the anterior quadrangular frame. This configuration, which is expected to improve the stability of the posterior column of the pelvis, was evaluated biomechanically on a phantom with various types of pelvic fractures and separations. The results suggest that the GPEF effectively controls anterior column pelvis fractures such as unilateral pubic ramus fractures, unilateral ischium pubis rami fractures and symphysis pubis separations under vertical loads. The fixator is partially capable of stabilizing the posterior column; however, loads above 700 N cause separation at the fracture site. Further studies and clinical trials are essential to determine the GPEF's effectiveness in reducing blood loss and in providing stability at the posterior column.

Adult↗