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Six boys with traumatic ischial apophysis are reported. Two cases were diagnosed as stress apophysis and four as apophyseolysis. Two of our patients were referred to the hospital as malignant bone tumours--Ewing sarcoma and osteosarcoma.
14 cases of rare, primary iliac, pubic and ischial bone tumours or tumorous conditions are reported. These include aneurysmal bone cyst, eosinophilic granuloma, cavernous haemangioma, osteoid osteoma, fibrous dysplasia, fibrous dysplasia with sarcomatous degeneration, chondrosarcoma, lymphoma and atypical malignant histiocytosis. The possibilities to be considered in the accurate radiographic recognition of primary tumours of iliac, pelvic and ischial bones are discussed.
Differences in size and shape of ischiopubic synchondrosis in childhood may present problems in diagnosis and differential diagnosis. Whereas asymptomatic swollen ischiopubic synchondrosis represents a normal ossification process, painful swelling is a symptom of underlying pathology. Five children are described with symptomatic ischiopubic synchondrosis swelling, four representing stress reaction and one with osteomyelitis. Radiologists should be careful when reporting on swollen ischiopubic synchondrosis in symptomatic children.
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The obturator foramen bypass graft remains an excellent option for revascularizing the lower extremity when dealing with an infected prosthetic vascular graft in the groin. In this series, six obturator foramen bypass grafts were performed in five patients for infectious groin complications following vascular surgery. Conservative measures such as local antibiotic irrigation and abscess drainage designed to preserve the graft in situ had failed to eradicate the infection in all instances and was complicated by suture-line haemorrhage in three instances. An aggressive approach should be adopted, aimed at excision of the infected graft. The obturator foramen bypass graft remains a durable graft for limb salvage. Five out of six obturator foramen bypass grafts were patent after 11-26 months follow up.
Avulsion of the ischial apophysis is a rare injury. We report the successful treatment of an avulsion of the ischial apophysis by open reduction and internal fixation.
Analgesia of the pudendal nerve is used in patients undergoing gynecologic, obstetric and penile surgery. Stimulation techniques are used to determine the functions of the nerve. In these interventions, different landmarks are used to describe the localization of this nerve. Although some authors use perineal approaches, others prefer a transvaginal (rectal in males) approach. Knowledge regarding the anatomy of the pudendal nerve and its blockade allows an easy approach to the clinical problems like perineal neuralgia, neurogenic bladder dysfunction and penile implant operations. However, in the descriptions of these different approaches, there is no clear information regarding the depth of the nerve and the branches of the pudendal nerve that are blocked. The aim of the present study was to determine the depth and location of the pudendal nerve and, thus, describe certain and easily identified surface landmarks for clinical use. According to our examinations, the distance between the ischial tuberosity and the coccyx (the base of a triangle defined by the ischial tuberosity, coccyx and ischial spine) was 8.62 +/- 0.92 cm (range 6.74-9.77 cm). The distance between the ischial tuberosity and the ischial spine was 5.23 +/- 0.33 cm (range 4.76-5.81 cm) and the distance from the ischial spine to the coccyx was 5.42 +/- 0.52 cm (range 4.02-6.32 cm). Because the pudendal nerve intersected the distance between the posterior superior iliac spine and the ischial tuberosity, the distance between these two landmarks was also measured and found to be 13.31 +/- 0.91 cm (range 10.58-15.13 cm); the depth of the nerve was 4.14 +/- 0.83 cm (range 3.13-5.25 cm).
Patients were X-rayed in supine and squatting positions in order to measure any increase in pelvic outlet diameters. An increase of less than 2% was found. Previous estimates of 20-30% increases in pelvic outlet area were not duplicated.
Bilateral sacroiliac fracture-luxations in four dogs and four cats weighing 3.5 kg to 30.9 kg were reduced and stabilized with a single 3.5 mm, 4.5 mm, or 6.5 mm transsacral screw. Alignment of the drill bit was visual in six cases and assisted by the use of an aiming device in two cases. Seven animals were reevaluated at months 3 to 6. No significant screw loosening or loss of reduction had occurred. Although no intraoperative complications were encountered with visual drill bit alignment, use of an aiming device for transsacral drilling is strongly recommended.
A ventral approach to the pelvic canal by bilateral pubic and ischial osteotomy was performed in five female dogs. The entire urogenital tract could be exposed and easily manipulated through this approach. All animals were ambulatory within 24 hours. Clinical union had formed in three of the four osteotomies by the time of euthanasia (months 2-4) in all animals. Incomplete union in some osteotomies indicated that exercise should be restricted for at least 4 months after the procedure. The procedure was determined to be clinically useful when wide exposure of the entire female urogenital tract is desired.
The functional results of partial or total hemipelvectomy in seven dogs and two cats with sarcomas involving the pelvis were excellent, and the cosmetic outcome was acceptable to all owners. Tumors in two dogs were inoperable. Locally recurrent cancer occurred in two animals and metastases occurred in three animals. Three dogs survived longer than 2.5 years and the overall and disease-free survival at 12 months was 62%. It appears that osteosarcoma of the pelvis is at least as aggressive as osteosarcoma of limbs and, unless effective adjuvant therapy is used, poorer survival results are likely in dogs with osteosarcoma than with other sarcomas of the pelvis. Hemipelvectomy is an aggressive surgical procedure that can be used successfully in selected dogs and cats with cancer involving the pelvis.
Unilateral triple pelvic osteotomy was performed with three variations in technique on canine cadaver pelves. The following variables were studied: the angle of the ilial osteotomy (perpendicular to the long axis of the ilium and 10 degrees, 20 degrees, and 30 degrees off perpendicular); the degree of axial rotation (20 degrees, 30 degrees, and 45 degrees); and the type of fixation (canine pelvic osteotomy plate [CPOP] or a 2.7-mm dynamic compression plate [DCP]). Structural changes measured were the pelvic inlet and acetabular area, interischiatic tuberosity distance, and degree of acetabular version. Means and standard error of the means were determined for all pelvic measurements and were analyzed by three-way analysis of variance (P < .05). As the axial rotation increased from 20 degrees to 45 degrees an ilial osteotomy angled 10 degrees, 20 degrees, or 30 degrees resulted in a significantly greater decrease in the pelvic inlet area and significantly less deviation of the interischiatic tuberosity distance and degree of acetabular version from normal than an osteotomy directed perpendicular to the long axis of the ilium. Compared with the CPOP, as the axial rotation increased from 20 degrees to 45 degrees, the DCP resulted in a significantly greater decrease in the pelvic inlet area, an increase in the interischiatic tuberosity distance and degree of acetabular version, and less of an increase in the acetabular area. The results of this study suggest that to maximize dorsal acetabular coverage, while minimizing disruption of normal pelvic architecture, a CPOP and an ilial osteotomy angled 10 degrees to 30 degrees are preferred for all degrees of axial rotation.
The aim of the study was to compare the long-term stability of membranous and endochondral autogenous bone grafts with or without combined application of guided bone regeneration (GBR). Twenty-five, male, 6-month old, albino rats were used in the study. The animals were divided into four groups (A5, A11, B5 and B11). Group A5 (control): The inferior border of the mandible was exposed in both sides. At one side of the jaw, a calvarial bone graft (baseline -3 x 4 x 0.64 mm) was placed at the inferior border of the mandible and was fixed with a standardized screw-type titanium microimplant. At the contralateral side, an ischiac bone graft (baseline -3 x 4 x 0.87) was transplanted. The healing period was 5 months. Group A11 (control): The animals were treated in the same manner as in Group A5 with the difference that the healing period was 11 months. Group B5 (test): The animals were treated in the same manner as in Group A5 with the difference that an e-PTFE membrane was adapted over the bone graft on each side of the jaw. Group B11 (test): The animals were treated in the same manner as in Group B5 with the difference that 5 months following transplantation the animals were subjected to a second operation and the membranes were removed. The healing period was 11 months. The animals were killed at 5 (Groups A5 and B5) or at 11 months (Groups A11 and B11) following mandibular augmentation and the jaws were defleshed. The width, the length and the thickness/height of the bone graft were evaluated by means of a stereomicroscope. At 5 months, both types of the membrane-treated bone grafts presented increase in all dimensions compared with baseline. However at 11 months, both types of the membrane-treated bone grafts exhibited a decrease in their dimensions which were similar to the baseline measurements. In the control groups, both types of bone graft presented significant resorption both at 5 and at 11 months with the ischiac bone grafts presenting more resorption in width and length than the calvarial bone grafts. It can be concluded that the long-term volume stability of autogenous endochondral and membranous onlay bone grafts combined with GBR is superior to that of autogenous endochondral and membranous onlay bone grafts alone.
Obtaining high-quality radiographs of the proximal aspect of equine limbs is difficult because of the large muscles in these regions. The use of scintigraphy may provide further information. Abnormal bone scan findings of the ischial tuberosity or the third trochanter were found in 29 adult horses with obscure hind limb lameness between 1986 and 1996 at the Large Animal Clinic of the University of Bern. Each had abnormal radiopharmaceutical uptake but not all had radiographic changes. Radiopharmaceutical uptake ratios between the ischial tuberosity and the greater trochanter were calculated. The uptake ratio in a control group of 11 clinically sound horses was lower than in 11 lame horses with subjectively enhanced radiopharmaceutical uptake.
In the llama, signs of colic are obscure and may be exhibited as persistent sternal recumbency and anorexia even in the presence of a surgical lesion. Diagnostic methods for evaluation of abdominal disorders are limited. As a result, surgical intervention may be prolonged and increase the risk of mortality and postoperative complications. The objective of this study was to determine the feasibility of computed tomography to evaluate the llama intestinal tract. Eighteen hours prior to the computed tomography scan, six llamas were given barium sulfate (15%) via an orogastric tube. Following induction of general anesthesia, the llamas were positioned in sternal recumbency, and 10 mm contiguous slices were obtained from the diaphragm to the tuber ischiadicum. Structures that were consistently identified included the first, second, and third compartments (C1, 2, and 3), small intestine, spiral colon, and ascending colon. C1 was easily identified in the cranial aspect of the abdomen due to its large size relative to the other compartments and characteristic saccules. C2 was located cranial, ventral, and to the right of C1, while C3 was visualized as a tubular structure to the right and ventral to C1 and C2, C3 was traced caudally until it turned dorsally and continued cranially to a dilated ampulla in the right cranial abdomen delineating the entrance to the small intestine. The spiral colon was identified consistently in the left ventral caudal abdomen. Structures that could not be conclusively identified included the cecum and mesenteric lymph nodes. Computed tomography allowed a consistent evaluation of the major intestinal structures associated with colic in the llama. Thus, computed tomography is a potentially valuable noninvasive diagnostic tool to effectively evaluate the abdominal cavity and differentiate medical from surgical lesions in the llama.
Three cases of osteoid osteoma and one of benign osteoblastoma in children are described. The main complaint was severe pain which was worse at night; it was relieved by aspirin or other analgesics. The diagnosis was made on clinical and radiological grounds and was confirmed on histological examination of the central nidus removed at operation. The pain was relieved in the patients with osteoid osteoma, and it was very much less after operative removal of the benign osteoblastoma. Both conditions are probably variations of the same disease process, depending on the anatomical site and the type of bone affected.
A case is reported of an adolescent sprinter who was chronically disabled by pain after non-operative management for an acute hamstring injury. He had sustained an avulsion fracture of the ischial apophysis with displacement of 2.5 cm. Avulsion fractures of the ischial apophysis with displacement of 2 cm or more are unusual, but they frequently result in a symptomatic non-union, and early diagnosis, open reduction, and internal fixation is to be encouraged.
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