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Malignant transformation of fibrous dysplasia to chondrosarcoma is rare. We report a case in which malignancy developed in an area of fibrous dysplasia in the ilium. We believe this to be the second reported case at this site. Treatment was by excision of the hemipelvis including the ala of the sacrum. A review of the literature is presented.
Four patients with injuries of the acetabular triradiate cartilage are presented. In three of them premature fusion of the cartilage occurred; two of these developed acetabular deformity and subluxation of the hip. In all patients the sacroiliac joint also was injured; in two, the joint was completely disrupted, leading to fusion and growth disturbance of the ilium. As injury of the triradiate cartilage is easily missed on the initial radiograph, it is advised that all patients with pelvic trauma should be followed clinically and radiographically for at least one year.
In patients who underwent autogenous iliac bone grafting we studied prospectively injury to the lateral femoral cutaneous nerve (LFCN) in relation to the size (length, depth, width) of the graft. We also examined the neurological deficit, by questioning them about numbness and/or pain in the lateral thigh. The risk of injury was significantly higher in those in whom the depth of the graft was more than 30 mm. With regard to the length of the graft the incidence of nerve injury was 20% when the graft was 45 mm long or more, 16% when it was between 30 mm and 45 mm long, and 8% when it was less than 30 mm long. We should inform patients of the possibility of such injury, and take size into consideration when harvesting grafts from the ilium.
We have evaluated the effect of vacuum aspiration of the iliac wing on the osseointegration of cement into the acetabulum. We entered a total of 40 patients undergoing primary total hip arthroplasty into two consecutive study groups. Group 1 underwent acetabular cement pressurisation for 60 seconds before insertion of the acetabular component. Group 2 had the same pressurisation with simultaneous vacuum suction of the ilium using an iliac-wing aspirator. Standard post-operative radiographs were reviewed blindly to assess the penetration of cement into the iliac wing. Penetration was significantly greater in the group with aspiration of the iliac wing.
In order to clarify individual differences in bone metabolism among colony-raised beagle dogs, histomorphometric values of iliac trabecular bone and values of serum biochemical constituents related to bone were examined in 10 and 17 beagle dogs raised, respectively, under our two breeding systems in which differences in factors such as exercise, ultraviolet rays, and mineral content of the diet affect bone metabolism. At the age of 14 months, all dogs were injected with tetracycline hydrochloride and calcein twice for double bone labeling in order to measure dynamic as well as static parameters by bone histomorphometry and the ilium was later biopsied. The measurement on cancellous bone areas of undecalcified iliac sections was performed with a semiautomatic image analyser. Values of total calcium, phosphorus, alkalinephosphatase activity, parathyroid hormone and calcitonin in serum were also determined. The results showed that there were no significant differences between the two groups in histomorphometric values, except for the osteoid volume (p less than 0.05) and osteoid surface/trabecular surface ratio (p less than 0.01) in females, or in serum biochemical constituents, except for alkalinephosphatase activity (p less than 0.001) in males, indicating there were virtually no individual differences in bone metabolism in normal colony raised beagle dogs.
Changes in histomorphometric values of iliac trabecular bone and serum biochemical constituents related to bone metabolism in normal beagle dogs during growth were examined. A total of 90 dogs (male; 46, female; 44) aged 3, 6, 9, 12 and 24 months, were used. Each dog was injected with tetracycline hydrochloride and calcein for double bone labeling in order to quantitatively measure dynamic as well as static parameters in bone histomorphometry and a part of the ilium was later removed. The measurements on cancellous bone areas of undecalcified iliac sections were performed with a semiautomatic image analyzer. There were no sex significant differences in histomorphometric values except for mineralization lag time at the age of 3 months. In the static parameters, bone volume and mean trabecular thickness increased from 3 to 9 months of age. Bone surface area and mean osteoid thickness increased up to 6 months. Osteoid volume and osteoid surface area decreased up to 6 months of age. As to the dynamic parameters, the mineral apposition and bone formation rates decreased from 3 to 12 months of age. Mineralization lag time increased from 3 to 9 months of age. However, high bone surface area values in both sexes and low osteoid thickness values in females were seen at the ages of 9 and 12 months. Low values of trabecular thickness in both sexes, osteoid thickness and mineralization lag time in males and mineral apposition rate in females were also noted at the age of 12 months. Serum total calcium did not show any specific tendency.(ABSTRACT TRUNCATED AT 250 WORDS)
To characterize the magnitude and location of mineralized bone loss, 40 patients (20 men, 20 women, 29 white, 11 black) with clinically significant renal osteodystrophy who could be unambiguously classified based on histologic criteria as having osteitis fibrosa (OF; 20 cases) or osteomalacia (OM; 20 cases) were studied; they had been on maintenance hemodialysis for 4.6 +/- 3.0 yr. One hundred forty-two healthy women of similar age and ethnic composition served as control subjects. In all subjects, the proportions of mineralized bone, osteoid, and porosity (nonbone soft tissue) were measured separately in cortical and cancellous bone tissue, from intact full-thickness biopsies of the ilium, representative of the axial skeleton. The results were related to the volumes of cortical and cancellous bone tissue separately and to the volume of the entire biopsy core. Approximately three-quarters of the patients had measurements in the appendicular skeleton by single photon absorptiometry of the radius and morphometry of the metacarpal. Disease effects did not differ significantly between ethnic groups. Mineralized cortical bone volume (per unit of core volume) was reduced by approximately 45% in both patient groups. Mineralized cancellous bone volume was significantly increased by 36% in the patients with OF and nonsignificantly reduced by 9% in the patients with OM; however, the reduction in the latter patients was significant in relation to tissue volume. The combined total deficit for both types of iliac bone was approximately 20% in the patients with OF and approximately 40% in the patients with OM. Significant reductions in appendicular cortical bone were demonstrated in both patient groups at both measurement sites. Regardless of the current histologic classification, the major structural abnormality in the skeleton is generalized thinning of cortical bone due to increased net endocortical resorption, the most characteristic effect on bone of hyperparathyroidism. Protection of the skeleton from the adverse consequences of renal failure will require therapeutic intervention in patients with no symptoms of either renal or bone disease.
Since 1961 we have used the Spitzy shelf operation combined with a vertical flap osteotomy of the outer cortex of the ilium for early arthrosis secondary to acetabular dysplasia, subluxation, and dislocation. In 124 hips, followed for 10 (5-25) years, clinical improvement was maintained in 67/85 of patients who were operated on under the age of 30 and in 22/39 of patients treated after 30. However, less than half of the hips in the younger group and only one out of ten in the older group were symptom-free.
OBJECT: Placement of pedicle screws into S-1 is difficult. In cases in which there is a closed posterior superior iliac spine (PSIS), its medial situation prevents lateral oblique placement of the screw inserter sleeve and directing the screw to the anteromedial aspect of S-1. In the present study, the authors discuss anatomical variations of the PSIS and sacrum, and they describe a safe and effective S-1 screw insertion technique. METHODS: The relation of 50 PSISs obtained from 25 dry pelvises (15 male and 10 female cadavers) was examined. The distance from the inferolateral aspect of the S-1 superior articular facet to its promontory was estimated. The relation between the point of anterior penetration of the "screw line" and "safe zone" was analyzed. Penetration of screw lines into the S-1 body was also measured. (An illustrative case of closed PSIS is presented with pre- and postoperative computerized tomography [CT] scan findings.) The authors found that that PSIS was situated in 28% of the specimens. When screws were directed anteromedially, the screw lines failed to penetrate the S-1 body in 24% of the male and in 15% of female specimens. The screw lines deviated from the safe zone anteriorly in 34% of the male and in 20% of the female specimens. When the PSIS was medial to the line that connects the inferolateral aspect of the S-1 superior articular facet to the promontory, a classification of closed PSIS was assigned. CONCLUSIONS: The accuracy of the placement of the screws and their pullout strength are increased when using the present technique. Preoperative CT scanning should be performed to determine the presence of a closed PSIS; in cases in which a closed PSIS is found, the ilium should be resected to enable a greater anteromedial trajectory for placement of S-1 pedicle screws.
Age estimates of the auricular surface (sacro-iliac joint) of the ilium taken from bony specimens, 35 mm slides, and digital images were compared for 29 intact specimens from archaeological contexts. Results demonstrate that age estimates from all photographic and digital images may result in significantly differing estimates of age than those from bony specimens. Of the imaging techniques, 35 mm slides provided estimates most similar to those from bony specimens. Digital images provided age estimates that varied more from bony specimens. In general, photographic and digital images may offer researchers a way of documenting age information that would otherwise be unavailable or delayed. Yet, caution should be used when age estimates are derived solely from images rather than from bony specimens.
In a series of 20 dogs, 23 fractured ilia were reduced and stabilized with a variety of bone plates. The results indicated that fixation was rigid enough for fracture healing and for the patient to be ambulatory soon after surgery. Plate fixation can therefore be recommended as a reliable method of repair in selected fractures of the canine ilium.
The Salter innominate osteotomy is useful in the treatment of congenital dislocation and subluxation of the hip after the age of 18 months. The procedure provides stable reduction of the femur even with weight bearing. In addition, the acetabulum depth is not diminished and the head is covered with hyaline cartilage. Derotation-varization intertrochanteric osteotomy improves hip biomechanics and when done in combination with the innominate osteotomy, the wedge of bone from the femur may be used in the ilium, precluding the necessity for a separate iliac graft. Combined Salter innominate osteotomy, intertrochanteric femoral osteotomy and open reduction as a single operation has produced satisfactory results and has distinct advantages over staged procedures.
Vascularized osteocutaneous free grafts have been successfully applied to maxillofacial reconstruction. Careful planning allows for implant prosthesis fabrication in these cases. The scapula, fibula, and ilium are the donor sites that result in the most favorable application of implant prosthetics. Intraoral soft tissues, although compromised, are manageable with meticulous home oral hygiene practices and frequent recall examinations with professional cleaning. Many patients severely impaired by trauma, neoplasm, or congenital deformity can have restoration of form and function with the amalgamation of microsurgical and osteointegration techniques.
Concerning these six cases, the authors recall the rarity of osseous localization of Hydatidiform disease, isolated as a rule, arising in the adult and preferentially involving the ilium, spinal column, femur, humerus and scapula. Being slowly progressive, the condition is revealed by pain, swelling and above all spontaneous fractures (long bones), or signs of root or medullary compression (spinal column), followed sometimes by fistula formation. Radiological diagnosis is often difficult with an osteolytic appearance without appreciable reactional osteogenesis. As for laboratory investigations, they are only of value in orientation; immunofluorescence being the weakest. The extent of osseous lysis frequently demands extensive surgery. From the anatomical standpoint, the hydatid variety of Echinococcosis has a specific intra-osseous development: beginning in the spongy bone, the architecture is intermediary between the hydatid appearance and the alveolar variety. Some cases however comprise a unilocular appearance with a suspicion of adventitial reaction. Extension into the soft parts frequently adopts a macroscopic appearance identical with that of visceral forms. Bony lysis is dependant on osteoclastic resorption or foci of necrosis while reactional osteogenesis is reduced. Medullary cellular reactions are determinant in the anatomical progress: osteitis or histiocyte and plasmodial reaction to the cuticle fragments.
PURPOSE: The aim of this study was to histologically analyze the bone repair of maxillary areas reconstructed with autogenous bone grafts using 2 different donor sites, the ilium and the chin. MATERIALS AND METHODS: Specimens were retrieved with trephine burs positioned transversely in augmented ridges 4 months after placement of the grafts. To analyze bone conditions, a histomorphometric study of ground sections was performed using a special template to identify 3 specific regions of the specimens: cortical bone, cancellous bone, and the region of transition between the alveolar ridge and the graft. Ten patients, 5 men and 5 women, with a mean age of 47 years (range 28 to 67) were evaluated. RESULTS: Results indicated good incorporation of the grafts in this period, demonstrated by intense osteogenesis indicating an active remodeling process. DISCUSSION: In both groups, the improvement in bone quality of the receptor site was evident, independent of the size of the reconstruction, although chin grafts presented better bone quality. CONCLUSIONS: From this study it was possible to conclude that a period of 4 months is sufficient for the placement of osseointegrated implants in reconstructed areas, where chin or iliac autogenous grafts have been used.
Age at death assessment of adult skeletons is one of the most difficult problems in forensic and physical anthropology. Two fundamental sources of error are described: the complex variability in the process of skeletal aging and methodological bias. Taking into account these limits, we developed a new scoring system for the auricular surface of the ilium and the pubic symphysis. In order to address a large variability, we examine reference samples from Europe, North America, Africa, and Asia. Data were processed using Bayesian prediction in order to classify specimens in age range categories. Results show that combining indicators do not perform better than the auricular surface used as a single indicator. Morphological changes with aging are variable between Asian, African, and European populations, confirming the necessity to use population-specific standards. Bayesian prediction produces reliable classification and is applicable for subjects over 50 years old, a real methodological improvement.
The purpose of this study was to evaluate the results of the authors' modification of Salter innominate osteotomy in Perthes' disease. The operation was performed in 16 hips of 15 Perthes' patients (11 boys and 4 girls). The posterior half of the ilium was cut by a Gigli saw using a conventional method. The anterior half was osteotomized using a reciprocal saw in a direction of 45 degrees obliquely to the coronal plane and 30 degrees to 40 degrees posteroinferiorly to the sagittal plane. Stable interposition of the bone block was achieved within the osteotomy site. Bone union occurred in all cases within 4 months without displacement of the osteotomy. The mean of the center-edge angle improved from a mean 19 degrees preoperatively to 29.4 degrees postoperatively, and the average epiphyseal extrusion improved from 23% to 9.5%. The modified Salter osteotomy provided much better stability by simply changing the direction of osteotomy.
Fusion of the iliac apophyses with the crests of the ilium is of greater prognostic value than completion of excursion of the iliac apophyses. Completion of fusion of the vertebral ring apophyses coincides with fusion of the iliac apophyses to the crests. For accurate evaluation of the progression of the scoliotic curve, patients should be followed a few years after fusion of the iliac apophyses although progression after this stage is rare.