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At least 433 records · Page 24Linked to original sources
PubMed2001

Bone density adjacent to press-fit acetabular components. A prospective analysis with quantitative computed tomography.

BACKGROUND: The status of periprosthetic bone stock is an important concern when revision total hip arthroplasty is undertaken. Remodeling of periprosthetic femoral bone after total hip arthroplasty has been studied extensively, and the phenomenon of femoral stress-shielding has been well characterized. Finite element analysis and computer-simulated remodeling theory have predicted that retroacetabular bone-mineral density decreases after total hip arthroplasty; however, remodeling of periprosthetic pelvic bone in this setting has yet to be well defined. This study was conducted to evaluate the short-term natural history of periacetabular bone-mineral density following primary total hip arthroplasty. METHODS: Periacetabular bone-mineral density was studied prospectively in a group of twenty-six patients who underwent primary hybrid total hip arthroplasty for the treatment of advanced osteoarthritis. Density within the central part of the ilium (directly cephalad to a press-fit acetabular component) was assessed with serial quantitative computed tomography. Baseline density was measured within the first five days following the total hip arthroplasty. Ipsilateral density measurements were repeated at an average of 1.28 years postoperatively. Density values at corresponding levels of the contralateral ilium were obtained at both time-points in all patients to serve as internal controls. RESULTS: Bone-mineral density decreased significantly (p< or =0.001) between the two time-points on the side of the operation. The mean absolute magnitude of the interval density reduction (75 mg/cc) was greatest immediately adjacent to the implant (p<0.001), but it was also significantly reduced (by 35 mg/cc) at a distance of 10 mm cephalad to the implant (p = 0.001). Relative declines in mean density ranged from 33% to 20% of the baseline values. No focal bone resorption (osteolysis) was detected at the time of this short-term follow-up study. With the numbers available, no significant interval alteration in bone-mineral density was found on the untreated (internal control) side (p> or =0.07). CONCLUSIONS: We suggest that the observed decline in bone-mineral density represents a remodeling response to an altered stress pattern within the pelvis that was induced by the presence of the acetabular implant. This finding corroborates the predictions of finite element analysis and computer-simulated remodeling theory. It remains to be seen whether this trend of atrophy of retroacetabular bone stock will continue with longer follow-up or will ultimately affect the long-term stability of press-fit acetabular components.

Acetabulum↗
PubMed1992

Comparison of histomorphometry and 85Sr uptake in induced heterotopic bone in rats.

Heterotopic bone formation in the abdominal muscle of 45 male 8-week-old Wistar rats induced by implantation of 5, 10, or 15 mg demineralized bone (DBM) powder was evaluated at 4 weeks by 85Sr uptake of the implants and area histomorphometry of the induced bone. Two indices of 85Sr uptake were calculated: the osteogenic index [(counts/min/mg implant)/(counts/min/mg os ilium)] and an index that we have called the osteoquantum index in which the weight of the implant is disregarded [(counts/min implant)/(counts/min/mg os ilium)]. The osteoquantum index showed a linear relationship to the area of the induced bone with a correlation coefficient (r) of 0.90. Only weak linear relationships were found between the osteogenic index and the area of the bone (r = 0.32) and between the osteogenic index and the osteoquantum index (r = 0.33). The osteoquantum index and the area of the induced bone both increased with increasing mass of implanted DBM, whereas the osteogenic index did not change.

Analysis of Variance↗
PubMedDate not supplied

Osteosarcoma at the site of a triple pelvic osteotomy in a dog.

An osteosarcoma (OSA) involving the right pelvis was diagnosed in a 12-year-old golden retriever 11 years after triple pelvic osteotomy (TPO) surgery. The dog was presented with a 12-week history of nonweight-bearing lameness of the right hind limb. Radiographs demonstrated an aggressive bone lesion of the right ilium with profound periosteal proliferation and punctate lysis that extended along the ilium caudally and into the right ischium, with its epicenter at the level of the right TPO plate. Necropsy revealed that the entire right hemipelvis, especially the ischium, was markedly thickened and firm with irregular margins. Histopathology was consistent with a diagnosis of OSA.

Animals↗
PubMed1999

[CD30-positive anaplastic large cell lymphoma of bone treated with autologous peripheral blood stem cell transplantation].

A 30-year-old man was admitted to our hospital with the chief complaints of fever and pain in the right shoulder, axilla, and inguinocrural region. Computed tomography, magnetic resonance imaging, 67Ga-scintigraphy, and bone-scintigraphy revealed osteolytic lesions in the ribs and right ilium. Biopsy specimens from lesions in the right ilium confirmed the diagnosis of CD 30-positive anaplastic large cell lymphoma. The patient was treated with 6 courses of CHOP therapy followed by high-dose chemotherapy and autologous peripheral blood stem cell transplantation. He achieved and remained in remission with no evidence of relapse 14 months later.

Adult↗
PubMedDate not supplied

Comparison of radiological and gross examination for detection of cancer in de-fleshed skeletons.

The reliability of visual examination of de-fleshed bones was assessed for detection of postcranial metastatic disease in individuals known to have had cancer. This was compared with standard clinical radiological techniques. The skeletons of 128 diagnosed cancer patients from an early 20th century autopsied skeletal collection (Hamann-Todd Collection) were examined. Radiological examination detected evidence of metastatic disease in 33 individuals, compared to 11 by visual examination of the postcranial skeletons. Four of these cases were detected by both techniques. Blastic lesions were most commonly overlooked on visual examination, because they were localized to trabecular (internal bone) structures. The ilium was the most commonly affected bone, with lytic or blastic lesions detected in 30 out of 33 individuals. While the proximal femur was affected in only nine individuals, X-ray of the proximal femur and ilium detected all individuals with postcranial evidence of metastatic disease. Skeletal distribution of metastases provides no clue to the location of origin or histological subtype of the cancer. A survey of archeological human remains for metastatic cancer requires radiological examination. Such skeletal surveys should X-ray at least the ilia and femora.

Autopsy↗
PubMed1991

Predictors of abdominal injury in children with pelvic fracture.

During a 48-month period, 2,248 children (aged less than 15 years) were consecutively admitted to a regional pediatric trauma center with blunt trauma (ICD-9-CM code greater than or equal to 800). Fifty-four children (2.4%) had injury to the pelvic circle, as diagnosed by radiographic examination; 13 of these children had concomitant abdominal or genitourinary (GU) injury. Contingency table analysis and stepwise logistic regression were used to determine the best predictors of abdominal injury. The mean age of the children was 8.6 years. Eighty-nine percent of the injuries were motor-vehicle related (59% pedestrian; 30% crash occupant). Nine children (17%) required transfusions of packed red blood cells; 9 children (17%) required surgery. There were 6 deaths in this group, a mortality rate of 11.1%. The most common fracture sites in the pelvis were the pubic rami (59%), ilium or pelvic rim (17%), and the sacrum (6%). Ten children (19%) had multiple pelvic fractures. Location of fracture was strongly associated with the probability of abdominal injury: 80% of children with multiple pelvic fractures had concomitant abdominal or GU injury, compared with 33% with fracture of the ilium or pelvic rim, and 6% with isolated pubic fractures (p less than 0.001). The variables that best predicted abdominal or GU injury using a backward-elimination, stepwise logistic model were the presence of multiple pelvic fractures (p less than 0.002) and unweighted Revised Trauma Score (p less than 0.05); age of child, systolic blood pressure, respiration rate, Glasgow Coma Scale score, and mechanism of injury were not predictive.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed1989

[Transiliac postero-lateral approach to the bodies of 2 lower lumbar vertebrae and the upper segment of the sacral vertebrae].

The author has described in detail the surgical procedure of a modification of the postero-lateral approach to the lumbar spine, which enables a wide access to the lower lumbar vertebrae and the upper sacral segment. The modification consists in osteotomy of a fragment of the lateral part of the ilium covering this region together with the origins of the dorsal muscles, isolating it from the sacral-pelvic ligaments and removing it posteriorly. This gives a good view into lateral parts of the arches and bodies. This approach has been used by the author--starting from 1964--in 78 operations in such diseases as: spondylolisthesis, spondylitis, stenosis of the root canals, disorders of growth of the sacral-lumbar junction, and tumors. The operation was tolerated well by the patients and no complications connected with osteotomy of the ilium were recorded.

Humans↗
PubMed1978

Review of bone grafting for reconstruction of discontinuity defects of the mandible.

Thirty-eight patients with discontinuity defects of the mandible were hospitalized at Iwate Medical University School of Dentistry during the 12-year period from 1965 to 1976. Treatment consisted of grafting autogenous ilium and rib in 35 patients and isologous ilium and Kiel bone in three patients. No bony union was noted in four of 28 cases involving benign tumors, three of eight cases involving malignant tumors, and one of two cases involving old fractures. Postoperative infection was the main cause for lack of union.

Bone Transplantation↗
PubMed1983

Intracapsular and intraosseous vascular supply to the mature dog's coxofemoral joint.

The intracapsular and intraosseous arterial supply to the mature dog's coxofemoral joint was investigated using a vascular injection, tissue-clearing technique in 6 mixed-breed dogs. Ascending arteries of the femoral neck, arising from an extracapsular vascular ring at the base of the femoral neck, penetrated the articular capsule and traveled subsynovially over the surface of the femoral neck. These intracapsular arteries formed an incomplete intracapsular vascular ring at the junction of the femoral head and neck. Bony components of the acetabulum, ie, ilium, ischium, and acetabular bones, received intraosseous vascular supply from the nutrient artery of the ilium and minute vessels entering nutrient foramina around the rim of the acetabulum. The femoral head received branches (epiphyseal arteries) from the ascending arteries of the femoral neck at the intracapsular vascular ring. Epiphyseal arteries formed anastomosing vascular arches of decreasing caliber up to the subchondral bone of the femoral head. The proximal femoral metaphysis, particularly the femoral neck, received vascular supply from 4 sources: (i) branches from the epiphyseal arteries on the surface of the physeal scar which descended, penetrating the physeal scar, (ii) distally directed branches from the intracapsular vascular ring, (iii) ascending nutrient vessels from the trochanteric fossa, and (iv) terminal branches of the ascending nutrient artery of the femur.

Acetabulum↗
PubMed1978

Growth and development of the acetabulum in the normal child. Anatomical, histological, and roentgenographic studies.

Postmortem studies of ten normal full-term infants and of three children, seven, nine, and fourteen years old, showed that the acetabular cartilage complex is a unit that is triradiate medially and cup-shaped laterally and is interposed between the ilium, ischium, and pubis. This complex is composed of epiphyseal growth-plate cartilage adjacent to these bones, of articular cartilage adjacent to these bones, of articular cartilage around the acetabular cavity, and, for the most part, of hyaline carilage. Interstitial growth within the triradiate part of the cartilage complex causes the hip socket to expand during growth. The concavity of the acetabulum develops in response to the presence of the spherical femoral head. The depth of the acetabulum increased during development as the result of interstitial growth in the acetabular cartilage, of appositional growth at the periphery of this cartilage, and of periosteal new-bone formation at the acetabular margin. At puberty, three secondary centers of ossification appear in the hyaline cartilage surrounding the acetabular cavity. These centers are homologous with other epiphyses in the skeleton. The os acetabuli, which is the epiphysis of the os pubis, forms the anterior wall of the acetabulum. The epiphysis of the ilium, which has been called the acetabular epiphysis, forms a good part of the superior wall of the acetabulum. A small epiphysis of the ischium was seen in the oldest patient, who was fourteen years old. The bone in these epiphyses expands toward the periphery of the acetabulum and thus contributes to its increase in depth.

Acetabulum↗
PubMed1981

[A study on the stress analysis of the pelvis by means of the three-dimensional photoelastic experiments (author's transl)].

The processes are as follows: 1) Life-sized photoelastic models molded from a cadaver pelvis are made of Epoxy resin. 2) In order to practice the stress freezing process, the models are set to our original loading apparatus in the electric heater. The forces exerted on the hip models are both body weight and four kinds of muscular forces, those of the abductor, adductor, rectus femoris and gluteus maximus. 3) After the stresses are frozen in the models, they are cut off into slices to observe isochromatic and isoclinic lines. 4) In the stress analysis both the shear difference method and the double slice method are utilized to obtain more accurate stress distributions. And the results have been summarized as follows: 1) In the ring-shaped slices large stresses are observed especially at four areas; namely the central area of the iliac bone, the acetabulum proximal to the ilium, the pubic ramus and the area adjacent to the sacroiliac joint. The specific areas where hydrostatic pressure works are seen at two points in the deep acetabular cavity. 2) The principal stress lines of almost all slices tend to flow smoothly and monotonously along the ilium, the sacrum and the pubic bone, but as they approach the acetabulum they run in complex patterns and make some singular points. 3) Around the acetabulum the principal stress lines of one group run in concentric circles and those of the other group radiate in all directions from the center of the acetabulum at the upper half of the dome which supports the load. The stress here was 5 to 6 times greater than in the lower half of the dome. 4) The acetabulum is stretched vertically and deformed into an oval shape. The horse shoe-shaped articular facet is deformed as both beaks approach each other. 5) As for the slices of the pelvic ring the normal acetabulum tends to be obviously deformed as it holds or embraces the femoral head. As a result of this deformity the stability between the acetabulum and the head increases. On the other hand the dysplastic acetabulum shows none of those phenomena. 6) The iliac bone of the pelvic ring is deformed into the "S" shape and the pubic ramus the "C" shape, the "S" shape, or the "Z" shape depending on the limb position. The pelvic ring tends to be deformed into a heart shape during abduction.

Acetabulum↗
PubMed1995

Bone pathologic correlation of multimodality imaging in Paget's disease.

The pagetic bones in the active phase of the disease with brisk lysis and sclerosis manifest intense tracer uptake on planar bone and SPECT images. Intense tracer uptake, however, can occur also in infections, dysplasias and metastases. Pinhole bone scintigraphy has been shown to portray specific diagnostic signs in a number of skeletal diseases. In an effort to identify useful bone scan signs, we prospectively carried out 99mTc-oxidronate pinhole bone scintigraphy of the skull, vertebrae, ribs, humerus, sacrum and ilium in two patients with Paget's disease of the bone. The pinhole bone scintigraphy findings correlated with radiographic, CT and MRI findings and in the vertebra with the pathological study. Interestingly enough, pinhole bone scintigraphy revealed intense tracer uptake preferentially in the bone cortex and the rim of the affected bones. Thus, the cranial inner table, humeral cortex and vertebral endplates and rims were the seats of characteristic tracer uptake, respectively creating a scintigraphic version of the radiographic "cotton wool" sign, "casket" sign and "picture frame" sign. The pagetic lesions in the sacrum and ilium also showed intense cortical and rim uptake. Correlation of pinhole bone scintigraphy with radiography, CT and MRI indicated that such cortical or rim uptake is characteristic of Paget's disease.

Bone and Bones↗
PubMed1995

[Intraoperative localization of metastases with a hand-held gamma probe].

A 50-y-old male patient with prostate cancer showed two suspicious lesions in bone scintigrams. They were assessed to be bone metastases by biopsy of the os ilium. After i.v. injection of 99mTc-HMDP a probe-guided localization permitted optimal surgical treatment. A bone metastasis in the os ilium was confirmed. The intraoperative detection with a hand-held gamma probe permitted accurate and complete excision of the tumour; the bone defect could thus be reduced to a minimum.

Bone Neoplasms↗
PubMed1995

Comparison of the holding power of 3.5-mm cortical versus 4.0-mm cancellous orthopedic screws in the pelvis of immature dogs (cadavers).

A 3.5-mm cortical orthopedic screw was compared with a 4.0-mm cancellous screw for maximal load to failure in the pelvis of immature dogs. The pelvis from young cadavers (7 to 13 months old) was divided into hemipelves and used for testing of the 2 screw types. Two sites in each hemipelvis were used, mid-shaft of the ilium and mid-sacrum, including the wing of the ilium. The screws were extracted, and maximal load to failure and mode of failure were recorded. Maximal load to failure per millimeter of engaged thread was calculated. In either pelvic site, the 4.0-mm cancellous screw required a significantly (P < 0.05) higher pullout force per millimeter of engaged screw threads than did the 3.5-mm cortical bone screw.

Animals↗
PubMed1977

The conservative hemipelvectomy.

Conservative hemipelvectomy is the resection of the ischium, ilium and subjacent extremity. It differs from the orthodox hemipelvectomy method by retaining the ilium, which permits the patient to have normal balance, Sarcomas of the soft tissue extend toward the attachment of the pelvis. The operation has been performed upon ten patients, and the entire operative procedure can be done using the anterior approach, thus minimizing the need to turn the patient. This technique is less traumatic than either disarticulation of the hip joint or hemipelvectomy and can be performed in approximately one and one-half hours, blood loss being limited to an amount varying from 500 milliliters to 1 liter. No postoperative deaths have been recorded. Of the ten patients operated upon, none have had a local recurrence. One obese elderly woman with a liposarcoma died two years after operation from diffuse metastases. The other nine patients are alive and well from two to six years after amputation. The balance of these patients is manifested by the fact that two of them are excellent amputee-skiers.

Amputation, Surgical↗
PubMed1993

[Anterior approaches to the spinal column: considerations of the surgical technic].

The anterior approach to the vertebral column is indicated in the tumors or traumas of the vertebral body with prevalent anterior expression. This method allows to control easily all the structures in front of the rachis. Furthermore, the current reconstructive techniques require the exposure of a long tract of the vertebral column. The Authors report their experience with the anterior approach in 22 patients (9 males, 13 females) affected by different pathologies: 10 primary tumors divided as follows: 4 sacral chordomas, 1 L1 chordoma, 2 sacral neurinomas, 1 L5 malignant melanotic schwannoma, 1 D9 osteoblastoma, 1 D6 intraspinal cavernoma, and 1 D3 myeloma; 4 metastatic tumors (2 D10, 1 L4 and 1 L5); 5 fractures of the vertebral body (1 L1, 1 L1-L2, 2 L4 and 1 L5); 2 echinococcal cysts respectively arising from the D11 body, the sacrum and ilium. The Authors overall performed 8 thoracotomies, 6 for dorsal location; in 1 case of L1-L2 fracture a thoracophrenolaparotomy was performed; in 7 cases involving the L3-L5 segment an abdominal anterolateral extraperitoneal approach was followed; finally in 6 cases a transperitoneal laparotomy to approach the sacrum and ilium was performed.

Female↗
PubMed1998

Iliosacral screw insertion using computer-assisted CT image guidance: a laboratory study.

Procedures were performed to evaluate the efficacy of using a computer-assisted image-guided system to improve the accuracy of inserting iliosacral screws for posterior pelvic ring injuries. The fluoroscopic method currently in use has shortcomings that do not eliminate the risk to the L5 and sacral nerve roots and iliac vessels. The procedure was performed on embalmed cadaver pelvis specimens with intact soft tissues. Iliosacral screws were inserted across each sacroiliac joint after registering the opposite ilium to simulate a clinical situation. Two trials were performed. The first was necessary to become familiar with the system and test the basic methods of registration. In the second trial, deficiencies were corrected by using spherical-headed fiducial screws for fiducials and a better reference frame clamp, and by better spacing of more fiducials. Results were evaluated by inlet and outlet X-ray views and dissection. All eight S-1 iliosacral 7.0-mm cannulated screws were entirely inside bone. Of the eight S-2 screws, five were inside bone, two infringed upon an S-1 foramen, and one had threads out of the sacral body anteriorly and intruding into an S-1 foramen. This system was felt to be effective and sufficiently safe to warrant clinical trials.

Bone Screws↗
PubMed1979

Internal hemipelvectomy--excision of the hemipelvis with limb preservation. An alternative to hemipelvectomy.

Our results indicate that it is technically possible to resect the hemipelvis and maintain a viable extremity. Functional results are remarkably good and tumor control has been equivalent to standard hemipelvectomy. Excision of the ilium with preservation of the extremity in selected cases would appear to be a reasonable alternative to the standard hemipelvectomy, which involves amputation of the extremity.

Adolescent↗