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At least 523 records · Page 29Linked to original sources
PubMed2002

Comparison of two methods of screw fixation in periacetabular osteotomy.

The optimal method of fixation during periacetabular osteotomy is unknown. Periacetabular osteotomies were created on both sides of six whole pelves from fresh cadavers and were fixed randomly either with three long 4.5-mm cortical screws from the iliac crest to the osteotomized fragment (iliac fixation) or with two such screws supplemented by a transverse screw from the acetabular segment to the ilium (transverse fixation). Pelvis loading in simulated push-off phase of the gait cycle was accomplished using a custom-made fixture. Linear potentiometers measured displacements at the pubic and ischial osteotomies. Fracture site stiffness was calculated from actuator force and pubic osteotomy displacement data. Displacement of the pubic osteotomy averaged 12.8 mm in the iliac fixation group and average 12.45 mm in the transverse group fixation. The ultimate loads beyond which catastrophic failure occurred were measured from 531.27 N to 1103.3 N (mean, 741.5 N) and 660.9 N to 1273.9 N (mean, 930.8 N), respectively. Effective stiffness ranged from 38.9 N/mm to 117 N/mm in the iliac fixation group (mean, 77.8 N/mm), and from 99 N/mm to 315 N/mm in the transverse construct (mean, 182 N/mm). Although the transverse screw provided statistically significantly greater local stiffness to the periacetabular construct fixation, neither type of fixation provided enough stability to allow immediate weightbearing after periacetabular osteotomy.

Acetabulum↗
PubMed1989

Cancellous bone donor site regeneration.

Patients requiring cancellous bone grafting of an extensive deficit or multiple grafting procedures often lack a sufficient quantity of autogenous cancellous donor bone. This study was designed to determine the potential for reharvesting autogenous cancellous bone donor sites in a canine model. Fixed-sized cancellous bone grafts were harvested from the ilium of 12 mature, conditioned dogs. Ilia containing the donor sites were removed from groups of 3 dogs at intervals of 6 weeks, 3 months, 6 months, and 1 year. The donor sites were evaluated by roentgenograms, histology, and histomorphometric analysis and were compared to the opposite, nonoperated ilia, which served as controls. The analysis revealed a gradual replacement of the surgical defect with new cancellous bone by 1 year. Donor site reharvesting is a potential alternative to multiple site grafting or the use of allograft material.

Animals↗
PubMed1993

Posterior pelvic fixation using a transiliac 4.5-mm reconstruction plate: a clinical and biomechanical study.

Operative management of unstable pelvic fractures is directed toward stabilization of the posterior lesion. We describe a technique of posterior pelvic fixation that uses a 4.5-mm reconstruction plate as a transiliac tension band. The plate is inserted through the posterior superior iliac spines with screw fixation to the ilium. Our initial clinical experience was gained using this technique in 15 patients who had unstable pelvic ring injuries with sacral fractures. Stable fixation was achieved in all patients with this low-profile plate. There were no infections, no wound complications, and no failures of fixation. Comparative biomechanical testing using cadaveric and artificial pelvises demonstrated that the strength of the transiliac plate method was equal to that of other techniques of posterior pelvic fixation.

Adult↗
PubMed1976

Unstable hemipelvic fractures with internal rotation displacement.

Two cases of unstable hemipelvic fractures with internal rotation displacement successfully treated by outward (external lateral) rotation and continuous skeletal traction by wires passed through the crest of the ilium are described. X-rays show both patients before and 2 years after treatment.

Adult↗
PubMed1984

Donor-site morbidity after harvesting rib and iliac bone.

Morbidity following 104 bone graft harvesting operations (60 iliac, 44 rib) in 72 patients is documented. Early morbidity of iliac donor sites was found, as expected, to be far greater than that of rib donor sites. However, long-term follow-up reveals that while hip symptoms largely resolve, a significant number of chest-wall sites cause persistent, unpleasant pain. Technical ways of minimizing problems are also discussed. When procuring an iliac graft, a lateral skin incision and a medial bony approach are used if possible. If full-thickness ilium is required, the crest should be left intact or raised and replaced as a trapdoor .

Adolescent↗
PubMed1988

Mandibular reconstruction with vascularized iliac crest: a 10-year experience.

Since 1978, 35 patients have undergone mandibular reconstruction with vascularized iliac crest. During this time, the technique of raising and shaping the iliac crest has undergone a series of modifications. Initially, osteocutaneous segments based first on the superficial circumflex iliac system and later on the deep circumflex iliac system were used. More recently, only the inner table of the ilium has been employed, and where intraoral lining is required, an ulnar forearm free flap has been added. Thirty-two patients were reconstructed successfully. Of the three anastomotic failures, one bony segment was able to survive as a free graft. There were no donor-site complications. With continued experience, operative morbidity has been minimized, while the technique has been modified to tailor the reconstruction to the specific requirements of the patient. It is concluded that vascularized iliac crest provides the most appropriate mandibular reconstruction for a range of congenital and acquired defects.

Adolescent↗
PubMed1990

Immediate complications of Cotrel-Dubousset instrumentation to the sacro-pelvis. A clinical and biomechanical study.

The authors reviewed the early complications in all patients fused to the sacro-pelvis using Cotrel-Dubousset instrumentation at the Texas Scottish Rite Hospital. Sixteen patients were studied with an average follow-up of 13 months. Three methods of sacro-pelvis fixation were evaluated: iliosacral screws, sacral screws, and a technique whereby the caudle ends of the Cotrel-Dubousset rods were fashioned and inserted into the posterior iliac crest using the Galveston technique. Seven of the 16 sets of sacral screws (44%) failed during and after surgery. Two of the 7 sets of iliosacral screws failed postoperatively (28%). No failures occurred in the 8 sets of Cotrel-Dubousset rods placed with the Galveston technique. Seven of the nine medical complications observed (77%) occurred in the sacral screw group. Using calf spines, a biomechanical evaluation of each system was undertaken to determine strength of fixation. Each system was failed in flexion 3 times. The sacral screws were the weakest, pulling directly out of the sacrum at 40 N-M. Cotrel-Dubousset rods inserted with the Galveston technique were the strongest, experiencing rod deformities before flexion failure at 70 N-M. Iliosacral screws were of intermediate strength failing by rotation on the axis of the screws or pulling directly out of the ilium at 55 N-M. The authors conclude that using Cotrel-Dubousset rods inserted with the Galveston techniques was the strongest and safest method of sacro-pelvis fixation of the three tested.

Adolescent↗
PubMed1990

The role of the iliolumbar ligament in the lumbosacral junction.

The biomechanical function of the iliolumbar ligament in the human lumbosacral junction was investigated by analyzing the three-dimensional movements of the whole lumbar and lumbo-sacral-ilium specimens. The experiment was repeated in the following three conditions: 1) intact iliolumbar ligament, 2) right iliolumbar ligament transected, and 3) bilateral iliolumbar ligaments transected. The representative values of the increased motions, compared with intact, after transection of the bilateral iliolumbar ligaments were 1.7 degrees (23%) in flexion, 1.1 degrees (20%) in extension, 0.3 degrees (18%) in axial rotation, and 1.2 degrees (29%) in lateral bending. The most restricted motion governed by the iliolumbar ligament in the lumbosacral junction was lateral bending. The bilateral iliolumbar ligament specimen could restrict flexion and extension of the lumbosacral junction, but the unilateral iliolumbar ligament preparation alone could not restrict these motions. The iliolumbar ligament also had the function of restricting the rotational movement of the lumbosacral junction.

Adult↗
PubMed1995

The accuracy of Risser staging.

STUDY DESIGN: This study analyzed the accuracy of Risser sign staging on posteroanterior radiographs. OBJECTIVE: To correlate the Risser sign on a posteroanterior radiograph with that on an anteroposterior radiograph. SUMMARY OF BACKGROUND DATA: On the posteroanterior view of the spine, the full length of iliac apophysis is difficult to interpret. No report has assessed the relation of these findings. METHODS: The staging of the Risser sign was examined in 89 girls. In 52 subjects, the stage of the Risser sign was identical on both views, whereas in 37 (42%) the interpretations were different. RESULTS: On evaluation of the iliac apophysis using a skeletal specimen, the posteroanterior views produced a distorted image of the iliac apophysis, and the medial and lateral aspects of the apophysis were superimposed over the ilium. CONCLUSIONS: As a result of these findings and the fact that the Risser staging was developed for the anteroposterior radiograph, the appearance of the iliac apophysis on the posteroanterior radiograph cannot be used as a reliable indicator of skeletal maturity.

Adolescent↗
PubMed1996

Radiologic evaluation of iliosacral screw placement.

STUDY DESIGN: This study analyzed anteroposterior, lateral, inlet, and outlet radiographic representations of different iliosacral screw orientations and evaluated anatomic features of the superior aspects of the sacral alae. OBJECTIVES: The purpose of this anatomical and radiologic study was to assess the value of anteroposterior, inlet, outlet, and lateral views with regard to the planning of iliosacral screw placement, to determine if screws penetrating the sacral surfaces and foramina can be detected during or after operation, and to evaluate the anatomy of the superior aspects of the sacral ala quantitatively. SUMMARY OF BACKGROUND DATA: Direct iliosacral screw fixation has recently become popular because it provides stable fixation using reasonably small implants and is biomechanically equal or superior to other techniques of internal fixation. However, misinterpretation of the relationship of pelvic radiographs and the position of a screw may result in incorrect screw placement during surgery or misdiagnosis of postoperative neurologic complications. The morphology of the sacrum is complex. No previous data relative to the superior aspect of the sacral alae are available. METHODS: Four bony pelves were used to model the different iliosacral screw orientations possible during iliosacral reconstruction. A drill bit was inserted laterally from the posterior ilium through the sacroiliac joint and into the S1 vertebra. Radiographs were taken from anteroposterior, lateral, inlet, and outlet views for evaluation of placement. Twenty-two dry sacra were obtained for anatomic evaluation of the superior aspects of the sacral alae. All symmetrical structures were measured bilaterally. Measurements included three angular and two linear parameters. RESULTS: The results showed that a misdirected drill bit penetrating the anterior aspect of the ala is best appreciated by the inlet view. A misdirected drill bit penetrating the superior aspect of the ala or the S1 foramen is best represented in the outlet view. The average angle between the coronal plane of the S1 vertebra and the anterior aspect of the ala was 27.1 degrees; between the superior aspect of the S1 vertebral body and superior edge of the ala, 36.9 degrees; and between the superior aspect of the S1 vertebral body and posterosuperior edge of the ala, 24.5 degrees. CONCLUSIONS: The inlet view shows the orientation of screws relative to the coronal plane and extraosseus screws extending anterior to the ala, whereas the outlet view elucidates the placement of screws relative to the transverse plane and extraosseus screw tips extending into the sacral foramina or superior to the ala. Evaluation of preoperative pelvic computed tomography scans may be helpful in understanding the unique morphology of each individual patient and enhancing the safety of iliosacral screw placement.

Bone Screws↗
PubMed1997

Endoscopic transiliac approach to L5-S1 disc and foramen. A cadaver study.

STUDY DESIGN: The toros of fresh cadavers were used to create endoscopic channels through the iliac wings to gain access to the L5-S1 disc and foramen. The spine and pelvis then were dissected out en bloc, and the anatomic relationships were studied. OBJECTIVES: To determine the feasibility of a transiliac approach to the L5-S1 disc and foramen and to assess the safety of this approach by studying the anatomic relationships of the transiliac track. SUMMARY OF BACKGROUND DATA: Because of its location deep in the pelvis, the L5-S1 disc and foramen are not easily accessible via a supra-iliac portal. A laparoscopic approach violates the abdominal cavity, and makes major vessels and viscera at risk for injury. METHODS: A core drill was inserted over a guide wire into the iliac wing under fluoroscopy to obtain a core of bone, which then was removed to create a transiliac channel. An arthroscope was inserted through the channel to perform discoscopy or foraminoscopy. The spine was dissected out en bloc to study the relationships of the track. RESULTS: It was possible to use a transiliac approach to L5-S1 in all the experiments. There was no damage of neural structures in any of the experiments. CONCLUSIONS: The results of this study suggest that it is possible to access the L5-S1 disc and foramen through the ilium without injuring important structures. It would be necessary to conduct a study based on an animal model and to evaluate the results before using this procedure in a clinical situation.

Adult↗
PubMed1999

Complete pelvic ring failure after posterior iliac bone graft harvesting.

STUDY DESIGN: Case report. OBJECTIVE: To present a rare complication of posterior iliac bone graft harvesting. SUMMARY OF BACKGROUND DATA: Although iliac bone graft harvesting is a common procedure in spinal surgery, it is not without complications. One such complication is fracture of the ilium that is seen most often in older women with osteopenia. METHOD: In this case a severe complication of posterior iliac bone graft harvesting was identified in a patient with steroid-induced osteoporosis that led to multiple pelvic fracture, nonunions, and eventual failure of the entire pelvic ring. Imaging studies showed osteoporotic bone and multiple nonunions of the pelvis with structural collapse. RESULTS: Staged sequential platings of the iliac wings were performed to stabilize the pelvis. The initial fixation of the left iliac wing apparently united after hardware failure. The right iliac wing was successfully fixed with plates supplemented with bone cement and allograft. Anterior fixation was planned. CONCLUSIONS: Care should be taken when considering autograft harvesting in patients with risk factors for osteoporosis. The outcome could be debilitating.

Bone Transplantation↗
PubMed2000

Comparison between the outer table and intracortical methods of obtaining autogenous bone graft from the iliac crest.

STUDY DESIGN: A prospective study in two groups of patients selected randomly. OBJECTIVES: To determine whether keeping the outer and inner cortices of the ilium intact, while obtaining bone graft, would result in reduced postoperative bleeding and less postoperative pain. SUMMARY OF BACKGROUND DATA: Donor site complications after harvesting bone from the iliac crest are frequent. They comprise pain and bleeding related to the large bone exposed, injuries to the cluneal nerve, and sacroiliac instability. METHOD: Sixty patients who were admitted for elective fusion of lumbar segments were included in the study. In half of them, the iliac bone graft was taken in the outer Table method (group A), which included the outer cortex and the cancellous bone beneath, and in the remaining 30 patients only the cancellous bone from between the cortices was collected (group B). The amount of bone harvested, and the time taken to obtain it, were measured, as was the blood volume in the drains. At fixed intervals after surgery and up to 2 years thereafter, the patients were asked to grade the severity of pain in their back and at the donor site. RESULTS: Two years after surgery, 22% of the patients in group A and 17% of the patients in group B reported to have significant pain at the donor site. This difference was not found to be statistically significant, nor was the postoperative bleeding. The average amount of bone harvested in group A was 36 grams compared with 25.7 grams in group B, taking 14 minutes and 20.3 minutes, respectively, to harvest it. These differences were found to be statistically significant. CONCLUSIONS: Preserving the iliac cortices, while obtaining bone graft, does not reduce the postoperative bleeding or the severity of pain at the donor site. In the intraosseous method, less bone is harvested and longer duration of surgery is required, compared with that of the outer Table method.

Adult↗
PubMed2000

The visible human anatomy of the lumbar erector spinae.

STUDY DESIGN: Image data of the male and female cadavers from the Visible Human Project were visualized and quantified. OBJECTIVE: To clarify the anatomy of the lumbar part of the human lumbar erector spinae muscles. SUMMARY OF BACKGROUND DATA: Recent studies have shown discrepancies in the description of the anatomy of the lumbar part of the lumbar erector spinae. The main differences concern whether lumbar fascicles of iliocostalis lumborum exist and whether the lumbar fascicles have direct attachments to the ilium or attach via the erector spinae aponeurosis. With the Visible Human Project from the U.S. National Library of Medicine, a new powerful basis for anatomic investigation has become available. METHODS: Software was produced to visualize sections oriented in any direction and with maximum resolution of the Visible Human male and female. Three-dimensional coordinates of anatomic structures in the image space could be marked in the cross-sectional images. The geometry and the physiologic cross-sectional areas of the erector spinae fascicles of lumbar origin were thus derived. RESULTS AND CONCLUSIONS: The study supports a classification of the lateral fascicles of the lumbar part of the lumbar erector spinae as part of iliocostalis lumborum. In both the male and the female, a large part of the erector spinae fibers of lumbar origin attached to the erector spinae aponeurosis. These results are of importance for biomechanical analysis of force transmission in the lumbar spine.

Adult↗
PubMed2003

Metachronous multicentric giant cell tumor: a case report and literature review.

Metachronous multicentric giant cell tumors of bone are rare. The case of a 47-year-old woman who had a giant cell tumor of the ilium develop 24 years after resection of a giant cell tumor of the proximal tibia is reported. The initial and current surgical approaches for this patient are described. A literature review is presented to show that this patient had the longest disease-free interval documented for a patient with metachronous multicentric giant cell tumors.

Adult↗
PubMed2004

Extended total sacrectomy and reconstruction for sacral tumor.

STUDY DESIGN: This case report includes the results of long-term follow-up after extended total sacrectomy in a 13-year-old boy with a sarcoma originating in the sacrum with an extraskeletal extension and infiltration into the left ilium. OBJECTIVE: To report and discuss a case of sacral tumor treated by extended sacrectomy. SUMMARY OF BACKGROUND DATA: Sacral tumors are often at an advanced stage with a large volume at diagnosis. Although total or extended sacrectomy is the only radical means to treat the massive sacral tumor, unavoidable complications in total sacrectomy are serious in the treatment selection. METHODS: Initial histologic findings indicated a synovial sarcoma. Additional genetic analysis redesignated the tumor as an unclassified sarcoma. Preoperative neoadjuvant chemotherapy and radiotherapy were completed. The response to the preoperative treatment appeared as a reduction in tumor size (approximately 50%) on radiographs. After extended sacrectomy, the L5 vertebral body was fixed between the ilia, and the pelvic ring was compressed by the Zielke system. The ISOLA instrumentation system connected the lumbar spine and both ilia. All sacral nerve roots and the L5 root on the left side were cut. RESULTS: At the 5-year follow-up examination, the patient was disease-free, could walk with crutches, and could climb stairs using the handrail and one crutch. CONCLUSIONS: The patient's excellent response to preoperative antitumor treatment was considered crucial to the long-term outcome. But the decision between a radical resection with reconstruction and a less extensive procedure with combined therapy remains controversial.

Adolescent↗
PubMed2005

Spondylolytic spondylolisthesis: a study of pelvic and lumbosacral parameters of possible etiologic effect in two genetically and geographically distinct groups with high occurrence.

STUDY DESIGN: An anatomic and radiographic study of archeological skeletal remains from two genetically and geographically distinct groups with high occurrence rates of spondylolytic spondylolisthesis was done. Specimens were Aleut (27% known occurrence rate, n = 48) and Arikara Plains Indians (9% occurrence, n = 250+ of 1,062). OBJECTIVE: To evaluate three radiographic parameters highly correlated with spondylolisthesis (pelvic incidence [PI], sacral table angle [STA], and lumbar index [LI]) in genetically homogeneous populations to determine which may be etiologic or most predictive for lysis. SUMMARY OF BACKGROUND DATA: LI has been known to vary with the percentage of slip in lytic spondylolisthesis. Recent clinical studies have shown that PI is also significantly higher in high-grade slips, and a possible etiologic effect has been ascribed to this association. STA has also been shown to vary between normals, those with only lysis, and those with lysis and slip. The etiologic significance of STA is unknown. METHODS: Radiographic and direct morphologic measurement of PI, LI, and STA was done on L5 and reassembled sacra and ilia. Statistical analysis of these three parameters among all groups was done. RESULTS: 1) There is a genetically determined difference in the upper sacral tilt (STA) that may be etiologic. 2) Genetically homogeneous groups with a lower STA in normal specimens have an increased occurrence rate of spondylolysis. 3) When there has been pars lysis, changes in the STA occur as well as deformity more caudal in the sacrum. 4) These changes are likely related to remodeling with epiphyseal growth related to changed axial stresses secondary to pars lysis. 5) PI is not a primary etiologic factor in the process. CONCLUSIONS: The STA in the normal population for each genetic group varies and relates significantly to the occurrence rate and is thus probably etiologic. STA is more highly associated with the occurrence of pars defect than is PI. Upper sacral deformities appear due to the growth plate response to the changed pressure gradients across the epiphyseal plate rather than interosseous remodeling of the ilium and acetabular area. Thus, changes in PI would be secondary.

Adult↗
PubMed2005

Pelvic ring reconstruction with a vascularized pedicle iliac bone graft for a large sacral schwannoma.

A case of pelvic ring reconstruction with a vascularized pedicle iliac bone graft for removal of a huge sacral schwannoma is reported. It is necessary to reconstruct a pelvic ring when its integrity is impaired. Spinal instrumentation is essential for a temporary stability of the pelvic ring in the course of complete healing, which at times results in instrumentation failure. Several cases of pelvic ring reconstruction using vascularized fibular bone grafts have also indicated positive results attributable to their good blood circulation, but techniques with them are relatively complicated. We applied a vascularized pedicle iliac bone graft to the pelvic ring reconstruction after resection of a huge sacral schwannoma. When a stable pelvic ring was regained by using a lumbosacral instrumentation technique, a tricortical iliac bone graft with its vascular pedicle was harvested, transported into the dead space, and tied to the right residual sacrum and the left ilium. The vascularized graft healed rapidly, and continuity of the pelvic ring was regained. This method is effective for pelvic ring reconstruction in that it does not require microvascular techniques and rapid bone healing can be obtained.

Bone Transplantation↗