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At least 541 records · Page 30Linked to original sources
PubMed2006

Comprehensive analysis of cantilever, translational, and modular corrective techniques in adults with scoliosis treated with surgery to the sacropelvis.

BACKGROUND: The treatment of adults with scoliosis has been the source of debate over the last several decades. Pain associated with curve progression and decompensation is the most common presenting scenario and surgical management is often indicated. Correction of these deformities may involve long segment fusions to the sacrum and pelvis. Most authors have reported high rates of complications associated with this procedure. There remains little consensus with regard to the treatment of this challenging condition. PURPOSE: The purpose of this study was to evaluate the clinical and radiographic outcomes of patients treated with long fusions to the sacrum and pelvis using third generation instrumentation techniques. These included the use of cantilever, translational, and modular corrective techniques. METHODS: Inpatient and outpatient charts were reviewed for 97 patients (89 women and 8 men). The average age was 55 years (27 to 78 y). The information obtained included patient age, sex, comorbidities, perioperative complications, and long-term clinical outcome. Standing radiographic coronal and sagittal measurements were recorded preoperatively, immediately postoperatively, and at the most recent follow-up visit. RESULTS: Eighty-nine patients underwent combined anterior and posterior surgery, whereas 8 patients were treated with posterior-only procedures. Two patients had fixation to the sacrum without extension into the ilium. Structural curves averaged 53 degrees preoperatively, 32 degrees postoperatively, and 33 degrees at follow-up. Thoracic kyphosis averaged +36 degrees preoperatively, +39 degrees postoperatively, and +46 degrees at follow-up. Lumbar lordosis averaged -41 degrees preoperatively, -48 degrees postoperatively, and -48 degrees at follow-up. Coronal imbalance averaged 2.9 cm preoperatively, 2.4 cm postoperatively, and 2.3 cm at follow-up. Sagittal imbalance averaged 6.8 cm preoperatively, 2.9 cm postoperatively, and 3.6 cm at follow-up. Major complications included pseudarthrosis (10%), deep infection (13%), painful iliac fixation (20%), neurologic injury (6%), need for some form of revision surgery (39%), chronic severe pain (2%), pulmonary embolism (2%), and deep venous thrombosis (2%). There were no permanent neurologic injuries or deaths related to the surgery.

Adult↗
PubMed2006

Reconstruction of internal orbital wall fracture with iliac crest free bone graft: clinical, computed tomography, and magnetic resonance imaging follow-up study.

BACKGROUND: The purpose of this study was to clinically and radiologically assess the outcome of internal orbital reconstruction with an iliac bone graft. METHODS: Twenty-four consecutive patients with unilateral orbital wall fractures were enrolled in this prospective study. A medial cortical wall from the anterior ilium was used for reconstruction. At each follow-up visit, globe posture, diplopia, and eye movements were assessed. Coronal and sagittal computed tomography and magnetic resonance imaging were used to observe graft posture, bone defects, and intraorbital soft-tissue changes. RESULTS: Most fractures (46 percent) were pure orbital floor fractures. The mean follow-up was 7.8 months. One patient with medial wall and floor fractures required reoperation because of insufficient bone graft. At the last follow-up, this was the only patient (4 percent) with both enophthalmos (2 mm) and hypophthalmos (3 mm). Five patients (21 percent) had hypophthalmos (> 1 mm) at the end of the study. Resorption and remodeling were detected in all grafts, but no grafts were totally resorbed. Sagittal or coronal bone graft postures were assessed as good in 18 orbits (75 percent). Bone defects (> 10 mm) at reconstructed areas were detected in 13 orbits (54 percent). Scar tissue was observed only in three reconstructed orbits (13 percent). Diplopia in central field of vision was registered in seven patients preoperatively but in none at the end of the study. CONCLUSIONS: The resorption rate was high, but most of it was advantageous remodeling. Overall outcome was good. Secondary operations led to poor outcomes. Thin computed tomography and magnetic resonance imaging sections (< or = 2 mm) are needed to evaluate accurately bone graft placement and posture and orbital volume.

Adult↗
PubMed1982

Cylindrically modeled bone grafts.

A technique of autogenous grafting for repair of large defects in long bones is presented. Quadrangular grafts, taken from the external table of the posterior ilium, are modeled by bending them into cylindrical form, which has higher mechanical resistance as compared to flat struts. Cancellous chips are added. The original shape of the bone is immediately restored, and heavy internal fixation is avoided. combination of cortical and cancellous bone grafts provides both strength and rapid bone healing. There is no risk of fracture at the donor site. Of eight consecutive cases operated on, seven were successful. One failed because of relapsing infection. The procedure is suitable in children, adolescents, and young adults, for difficult cases of large defects in long bones left after resection of tumors and tumor-like conditions, as well as after diaphyseal distraction for leg lengthening.

Adult↗
PubMedDate not supplied

Acquired vitamin D-resistant rickets caused by aggressive osteoblastoma in the pelvis: a case report with ten years' follow-up and review of the literature.

Rickets or osteomalacia secondary to tumor in either bone or soft tissue is rare and interesting in that it can be cured after removal of the tumor. The majority of the reported cases occurred in adults older than 30 years, and the most commonly associated types were vascular and fibrous tumors. We present a new case of aggressive osteoblastoma in the ilium, which induced vitamin D-resistant rickets in an 8-year, 9-month-old boy. Radiographs and blood chemistry findings on admission showed typical features of active hypophosphatemic ricketts. He underwent three local excisions of the tumor. At 10-year follow-up, the patient was symptom free but short. When a child has symptoms of rickets that develop relatively later than ordinary vitamin D-resistant rickets, every effort should be made to search out a tumorous lesion before attributing it to a renal origin.

Bone Neoplasms↗
PubMedDate not supplied

Fracture of the superior pelvic quadrant in a child.

We present a case report (with review of the literature) of a 3-year-old child who was struck by an automobile, sustaining a superior quadrant pelvic fracture that involved the sacroiliac joint, the adjacent ilium, and the acetabulum. This was successfully treated by open reduction and fixation with cannulated screws.

Acetabulum↗
PubMed1981

Morphometric studies on mouse bone using a computer-based image-analysis system.

The morphological structure of the ilium, femur, third lumbar vertebra and a central caudal vertebra of the female CBA mouse has been studied using 5 micrometer thick, plastic embedded, transverse and longitudinal sections. The sections were analysed on a Quantimet 720, system 30, image analyser connected on-line to a PDP11 computer. Separate endosteal and periosteal surface to volume ratios were calculated for each position of sampling in each bone. For this calculation the anisotrophy of the bone was estimated from measurements of mean chord lengths in longitudinal sections of the bone using a new analytical technique. Chord length distributions in transverse sections of bone were also measured and the relevance of such measurements to the study of morphological changes in the bone and its included marrow are briefly discussed.

Animals↗
PubMed1991

Bone biopsy in the horse. 3. Normal histomorphometric data according to age and sex.

Histomorphometrical analysis of bone biopsies from the wing of ilium in 35 clinically normal horses are reported according to age. The biopsies were collected from 20 mixed-bred foals (mean age 6 +/- 1 months) and 15 older horses (mean age 73 +/- 62 months). No gender differences were found in the group of foals examined, but a significant difference (p less than 0.001) in a number of the primary measurements occurred between them and the older horses. The parameters which altered with age were the extent of osteoid surface (OS/BS), the extent of resorption (erosion) surface (ES/BS), the osteoid thickness (O. Th), the mineral appositional rate (MAR), which corresponds to the rate of matrix mineralisation and, if no mineralisation defects exist reflects the amount of bone laid down per day, and the extent of labelled surfaces (MS/BS). These data indicate a much greater rate of bone remodelling in the foals. This was also reflected in a number of the derived parameters (i.e. the extent of quiescent surfaces [QS/BS] and the activation frequency [Ac.f]).

Age Factors↗
PubMed1992

Multifocal osteosarcoma with extensive pleural metastatic disease.

An eighteen year old female presented with multifocal synchronous osteosarcoma, with multiple skeletal foci of tumour in long bones, pelvis and spine. The radiographically dominant lesion was in the right ilium, and this was considered to be the primary site. There was an extensive osseous pleural plaque and there were also metastases to lungs, peritoneum, abdominal wall, adrenal gland and lymph nodes. A review of the literature reveals that multifocal osteosarcoma is an uncommon condition and is probably due to metastatic disease and not multiple primary lesions. Pleural metastatic disease in osteosarcoma has been seldom reported.

Adolescent↗
PubMedDate not supplied

Mechanical evaluation of two canine iliac fracture fixation systems.

Twenty-three canine pelves were tested bilaterally to determine the stiffness and strength of intact ilium and stabilized oblique iliac osteotomies that simulated a common clinical fracture. Fixation systems tested were three 4.0 mm cancellous screws inserted ventral to dorsal across the osteotomy site and one laterally placed five hole 3.5 mm dynamic compression plate. Specimens were mechanically tested to failure under torsional, axial, or axial plus bending loads. Lag screw fixation was stiffer and stronger than plate fixation in all testing modes. The differences were statistically significant (p less than .05) in the torsional and axial plus bending loading modes. Fatigue testing was performed on implanted specimens with low-level cyclic loading under axial plus bending loading conditions. Physiologic loading conditions failed to produce mechanical failure of either fixation system after 100,000 cycles.

Animals↗
PubMed1973

Azotaemic renal osteodystrophy: a quantitative study on iliac bone.

The histopathology of bone is described in 60 patients with chronic renal failure due to a variety of renal diseases. Changes of azotaemic renal osteodystrophy included osteitis fibrosa, osteomalacia, and osteosclerosis. Quantitative histology using a point-counting technique revealed a significant increase in total bone, mineralized bone, and osteoid in comparison with a control group of 68 individuals. Osteitis fibrosa due to secondary hyperparathyroidism occurred in 93%, osteomalacia in 40%, and osteosclerosis in 30% of patients. Woven bone formation was a characteristic feature and was related to the severity of osteitis fibrosa. There were significant correlations between the weights of parathyroid glands and the number of osteoclasts, amounts of woven bone, and marrow fibrosis in the ilium. Hyperparathyroidism caused degradation of mineralized bone but the loss was balanced or exceeded by the aggradation of woven mineralized bone. Woven bone formation together with excess osteoid gave rise to osteosclerosis. The histological findings indicate that hyperparathyroidism and osteitis fibrosa usually occur early in chronic renal failure and that osteomalacia develops subsequently.

Adult↗
PubMed1978

Computed tomography of tumors of the musculoskeletal system in children. Clinical applications.

Studies indicate that computed tomography (CT) has several important clinical applications in the evaluation of tumors of the musculoskeletal system. These include (a) diagnosis of lesions involving difficult areas such as the sacrum and ilium, (b) demonstration of soft-tissue components of bone tumors or primary soft-tissue masses, (c) assessment of bone-marrow involvement, and (d) follow-up after irradiation or chemotherapy. Several selected pediatric cases are described in detail.

Adolescent↗
PubMed1994

Pelvic mass: CT-guided interstitial catheter implantation with high-dose-rate remote afterloader.

A technique is presented for computed tomography (CT)-guided interstitial catheter placement and treatment planning for high-dose-rate brachytherapy. In a 66-year-old woman with adenocarcinoma of unknown origin that had metastasized to the right ilium, interstitial brachytherapy catheters were placed by means of CT guidance. With use of a treatment planning system with dose optimization, an excellent dose distribution was obtained with minimal dose being delivered to the surrounding critical tissues. For selected patients, this procedure can provide effective and safe local treatment for solid tumors.

Adenocarcinoma↗
PubMed1996

Dysmorphologic features of the fetal pelvis in Down syndrome: prenatal sonographic depiction and diagnostic implications of the iliac angle.

PURPOSE: To determine whether the axial pelvic profile is morphologically different in fetuses with Down syndrome from those with a normal karyotype. MATERIALS AND METHODS: Pelvic images were selected from ultrasound studies in 27 fetuses with trisomy 21 and in 135 fetuses with a normal karyotype. An observer blinded to study results measured the angle formed by the convergence of lines drawn tangent to the wing of the ilium. This angle was measured prospectively in 20 normal fetuses by four independent observers to estimate variability. RESULTS: The iliac bones could be assessed in 19 fetuses with trisomy 21 and in 87 fetuses with a normal karyotype. Between 15 and 20 weeks of gestation, the mean iliac angle was 60 degrees in normal fetuses and 75 degrees in fetuses with Down syndrome (P < .001). Intra- and interobserver correlation coefficients were .70 and .62, respectively. The greatest variability in results was among fetuses (estimated variance, 72.5); smaller variance was seen with repeat measurements in the same fetus (34.7) and with measurements by different observers (9.1). CONCLUSION: The mean iliac angle in fetuses with Down syndrome is larger than that in fetuses without Down syndrome and may aid in weighing the risks of trisomy 21 against the risks of performing amniocentesis.

Down Syndrome↗
PubMed1988

Spatial distribution of trabeculae in iliac bone from 145 osteoporotic females.

145 women showing clinical and radiological signs of involutional osteoporosis of the spine were biopsed at the ilium for histomorphometric analysis of bone mass including trabecular bone volume and parameters reflecting the spatial distribution of bony elements (mean trabecular plate thickness, density and separation). Results were compared with an age-matched population of 22 healthy females. Postmenopausal osteoporotics (i.e. younger than 75 years) were characterized by a significant reduction in trabecular bone volume, plate density and thickness, while senile osteoporotics (i.e. older than 75 years) did not exhibit any difference with controls. 51% of the osteoporotic patients had a trabecular bone volume higher than the spontaneous vertebral crush threshold defined by Meunier. Osteoporotic patients with trabecular bone volume under the vertebral crush threshold had a significant decrease in all trabecular parameters. On the opposite, patients with trabecular bone volume above the vertebral crush threshold had only a significant decrease in the number of trabeculae. A negative correlation was found between age and plate density in both osteoporotic patients and controls. A linear correlation was found between trabecular bone volume and plate density, but thickness and density of trabecular plates were not correlated. This study confirms that involutional osteoporosis is not only a decreased bone mass disorder. A modified spatial distribution of trabeculae or a mechanically less resistant bone matrix could be additional factors.

Aged↗
PubMed2003

Implantation metastasis in a 13-year-old girl: a case report.

We report a case of a 13-year-old girl with an osteosarcoma of the right humerus, which had been diagnosed as an aneurysmal bone cyst at our institution. She underwent curettage and bone grafting of the lesion, which resulted in implantation metastasis of the tumour to the ilium. She died 15 months after presentation owing to pulmonary metastases. This report highlights the possibility of metastasis occurring by direct implantation to a graft donor site. We strongly recommend that a biopsy be performed in cases of presumed benign lesions before proceeding with the definitive surgery.

Adolescent↗
PubMed2005

Trabecular bone microarchitecture after alendronate treatment of osteoporotic women.

OBJECTIVE: To compare the microarchitecture of iliac crest trabecular bone from women treated for two to three years with alendronate versus that of women treated with placebo. RESEARCH DESIGN AND METHODS: Three-dimensional micro-computed tomography (micro-CT; resolution 20 microm) and two-dimensional histomorphometry (resolution 5-7 microm) were used to examine trabecular bone from single transilial biopsies obtained at the completion of clinical trials. MAIN OUTCOME MEASURES: Microarchitectural variables, including bone volume, trabecular number, trabecular thickness, and trabecular spacing in specimens from alendronate- and placebo-treated women were examined. Three-dimensional images of trabecular bone from both groups were constructed from CT images. Correlations among variables and between techniques were also calculated. RESULTS: Eighty-eight specimens were suitable for evaluation by both techniques. As measured by two-dimensional histomorphometry, bone volume fraction (as a proportion of total volume) and trabecular thickness were significantly greater in alendronate specimens, 17.1 +/- 5.5% vs. 13.4 +/- 5.5% (p = 0.0043) and 127 +/- 29 microm vs. 109 +/- 28 microm (p = 0.0090), respectively, and trabecular spacing was significantly smaller, 729 +/- 227 microm vs. 862 +/- 338 microm (p = 0.005). Micro-CT yielded similar findings: bone volume and trabecular number were significantly greater in alendronate specimens: 19.4 +/- 6.2% vs. 16.2 +/- 6.3% (p = 0.0412) and 1.46(+/-) 0.32 vs. 1.31(+/-) 0.33 per mm (p = 0.0346). Two-dimensional and micro-CT measured characteristics correlated strongly with one another, with Pearson product moment correlation coefficients ranging from 0.60 (for trabecular thickness) to 0.83 (for bone volume). CONCLUSIONS: Trabecular microarchitecture of the ilium, whether studied by two- or three-dimensional methods, is better (greater bone volume, greater trabecular thickness, decreased trabecular spacing) after alendronate treatment than after two to three years of treatment with placebo. Bone volume in a trabecular region is strongly correlated to its microarchitecture, suggesting that bone quantity predicts values for these microarchitectural endpoints.

Aged↗
PubMed1976

The shelf operation for hip dysplasia in adolescence.

Failure of normal acetabular development is inevitable in congenital dislocation of the hip when it is unrecognised until late infancy or early childhood. Numerous stabilising procedures have been described, one of the first being the shelf operation or acetabuloplasty. This procedure fell into disrepute because the shelf was often located too high or was too small to prevent upward migration of the femoral head. The technique described emphasises the importance of resecting the thickened capsule and exposing the lateral margin of the acetabulum to allow a substantial portion of the outer cortex of the ilium to be turned down both laterally and anteriorly over the femoral head. Twenty cases of acetabuloplasty have been followed up for an average period of nine years. The results have been assessed from the point of view of function, relief of pain, and degree of support of the femoral head as demonstrated radiologically. The shelf operation is a simple and safe procedure, and provided it gives adequate support to the subluxated femoral head it will ensure a stable, mobile joint capable of standing up to reasonable use for many years. If deterioration should occur in later life, total hip replacement may be undertaken more easily than if the joint had been allowed to undergo progressive subluxation.

Adolescent↗