SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Insufficiency fractures are fractures in bones with nontumorous disease (e.g., osteoporosis, rheumatoid arthritis or following radiation) at normal load. Two cases of insufficiency fracture of the ilium and sacrum are presented. Predisposing factors, clinical picture, imaging procedure and therapy are outlined.
Human imnmunodeficiency virus (HIV) infection is one of the possible serious complications associated with bone allografts. In order to prevent infection, grafted bone is sterilized by various treatments. Heat treatment has attracted attention as a simple and practical method. We carried out a histological study of the influence of heat treatment on autogenic bone grafts. To eliminate the problem of antigenicity of grafted bone, we used autografts, not allografts. Three types of heat-treated autografts were employed: heat-treated at 60 degrees C for 30 min, at 80 degrees C for 10 min, and at 100 degrees C for 5 min; as a control, fresh autografts were replaced in the rabbits' ilium. One, 2, 4 and 8 weeks after grafting, we performed microangiography and prepared two types of samples: transparent and haematoxylin-eosin (H&E) stained. Then, using an image analyzer, we quantitatively measured revascularization and new bone formation in the grafted bone. The grafts heat-treated at 60 degrees C showed early and good revascularization and new bone formation, from 1 to 8 weeks. The grafts heat-treated at 80 degrees C showed relatively good revascularization and new bone formation. However, the grafts heat-treated at 100 degrees C showed unsatisfactory revascularization and bone formation, less than 40% of control 8 weeks after grafting. Therefore, heat treatment at 60-80 degrees C does not seriously affect revascularization and new bone formation.
Although limb development has been a subject of intense research over the last decades, development of the girdles has been poorly investigated. Particularly, a detailed analysis of pelvic girdle development including functional data is not available to date. Here, we describe the early steps of the formation of mesenchymal and cartilaginous anlagen of the pelvic elements using alcian blue staining in whole mount embryos and serial histological sections, and the expression pattern of several marker genes to provide an operative basis for further research in pelvis development. Moreover, we describe pelvis development after unilateral hindlimb bud amputation and somatopleural ectoderm extirpation. We show for the first time, that ectodermal signals at pre-limb bud stages are required for pelvis formation. We present evidence suggesting that the regulation of ilium development is different from the development of ischium and pubis.
A model of sacroiliac joint (SIJ) function postulates that SIJ shear is prevented by friction, dynamically influenced by muscle force and ligament tension. Thus, SIJ stability can be accommodated to specific loading situations. The purpose of this study was to examine, in vivo, whether muscles contribute to force closure of the SIJ. SIJ stiffness was measured using a verified method combining color Doppler imaging with induced oscillation of the ilium relative to the sacrum in six healthy women. SIJ stiffness was measured both in a relaxed situation and during isometric voluntary contractions (electromyographically recorded). The biceps femoris, gluteus maximus, erector spinae, and contralateral latissimus dorsi were included in this study. Results were statistically analyzed. The study showed that SIJ stiffness significantly increased when the individual muscles were activated. This held especially true for activation of the erector spinae, the biceps femoris and the gluteus maximus muscles. During some tests significant co-contraction of other muscles occurred. The finding that SIJ stiffness increased even with slight muscle activity supports the notion that effectiveness of load transfer from spine to legs is improved when muscle forces actively compress the SIJ, preventing shear. When joints are manually tested, the influence of muscle activation patterns must be considered, since both inter- and intra-tester reliability of the test can be affected by muscle activity. In this respect, the relation between emotional states, muscle activity and joint stiffness deserves further exploration.
Recurrent low back pain (LBP) is a common pain condition in elderly workers in a variety of occupations, but little is known about its origin and the mechanisms leading to an often disabling sensation of pain that may be persistent or intermittent. In the present study we evaluated the pressure pain thresholds (PPTs) in subjects suffering from recurrent LBP, as well as in healthy controls, to investigate if recurrent LBP is associated with an increased sensitivity of the muscular and ligamentous structures located on the lower back. One hundred and six female workers, aged between 45 and 62 years and working either in administrative or nursing professions were examined. The subjects were classified into LBP cases and controls based on the Nordic questionnaire. Subjects indicating 8-30 or more days with LBP during the past 12 months were graded as cases. PPTs were measured on 12 points (six on each side of the body) expected to be relevant for LBP (paravertebral muscles, musculus quadratus lumborum, os ilium, iliolumbar ligament, musculus piriformis and greater trochanter), as well as on a reference point (middle of the forehead) using a digital dolorimeter. The PPTs on all points on the lower back highly correlated with each other and a high internal consistency was found with a Cronbach alpha coefficient > 0.95. There was a moderate and significant correlation of the PPT on the forehead with the PPT on the lower back with correlation coefficients ranging from 0.36 to 0.49. In LBP cases from administrative professions, the PPT on the forehead was significantly decreased (P < 0.05). The PPT on the lower back did not significantly differ between the four groups studied, namely nurses and administrative workers with and without recurrent LBP. These results give evidence that recurrent LBP is not associated with an altered sensitivity of the muscular and myofascial tissues in the lumbar region. Furthermore, they raise questions about the value of reference point measurements in recurrent LBP.
The literature reports that traumatic spondylolisthesis of L5 is an uncommon lesion. The authors report their experience of three cases of this particular fracture-dislocation of the lumbosacral spine. They stress the importance of certain radiographic signs in the diagnosis: namely, the presence of unilateral multiple fracture of the transverse lumbar apophysis. As far as the treatment is concerned, they state the need for an open reduction and an internal segmental fixation by posterior approach. A preoperative MRI study appears mandatory in order to evaluate the integrity of the L5-S1 disc. In the event of a traumatic disruption of the disc, they state the importance of posterior interbody fusion by means of a strut graft carved from the ilium or, in case of iliac wing fracture (which is not uncommon in these patients), by means of interbody cages.
We compared the long-term clinical and radiographic results of two methods of open reduction for congenital dislocation of the hip; a wide exposure method (360-degree circumferential capsulotomy) versus Ludloff's method (limited capsulotomy via the medial approach). Thirty-one hips in 24 patients assigned to group A received the wide exposure method and 32 hips in 27 patients assigned to group B had the Ludloff reduction. All patients were surgically reduced at less than 3 years of age. The follow-up averaged 16 years. None of the hips in group A required additional operations; however, 34.4% of the hips in group B did. At the latest review, 26 (83.9%) of the hips in group A were rated as Severin class I or II. Except for one patient, none had pain or a limp. Of the hips in group B, 18 (56.3%) were rated as Severin class I or II. Three patients had pain or Trendelenburg gait. Avascular necrosis occurred in 3.2% of hips in group A and in 21.9% of hips in group B. The wide exposure method is capable of completely releasing the posterosuperior tightness resulting from capsular adhesion to the ilium and the contracted short external rotators. Releasing the posterosuperior tightness from these structures seemed to provide a better chance of achieving an anatomically and functionally satisfactory hip.
We assessed coverage over the femoral head, using three-dimensional computed tomography (CT) imaging on 20 hips in 18 patients before rotational acetabular osteotomy, and on 18 normal hips as control. In particular, we introduced a "top view of the hip" in three-dimensional CT evaluation in order to detect posterolateral deficiency, which needs special attention in regard to rotational transfer of the acetabular fragment. We determined the horizontal plane passing through 5 mm cranial to the top of the femoral head on the coronal view of a multiplanar reconstruction image. Then, we erased the images of the ilium that were more cranial than this horizontal plane from the conventional cranial view of the pelvis and the proximal femur, and defined this view as the "top view of the hip". This top view clearly showed any uncovered area on the femoral head. Of the 20 hips, 6 were deficient anterolaterally (anterolateral type), 9 were deficient laterally (lateral type), and 5 were deficient posterolaterally (posterolateral type). On plain anteroposterior radiographs, 7 of the 20 hips had the cross-over sign of Reynolds. Five of these 7 hips with the cross-over sign were the posterolateral type in top view, while none of the 13 hips without the cross-over sign was the posterolateral type. We recommend preoperative evaluation using a top-view on three-dimensional CT images in patients who have the cross-over sign on an anteroposterior radiograph.
Microvascular free flap transfer currently represents one of the most popular methods for mandibular reconstruction. With the various free flap options now available, there is a general consensus that no single kind of osseous or osteocutaneous flap can resolve the entire spectrum of mandibular defects. A suitable flap, therefore, should be selected according to the specific type of bone and soft tissue defect. We have developed an algorithm for mandibular reconstruction, in which the bony defect is termed as either "lateral" or "anterior" and the soft-tissue defect is classified as "none," "skin or mucosal," or "through-and-through." For proper flap selection, the bony defect condition should be considered first, followed by the soft-tissue defect condition. When the bony defect is "lateral" and the soft tissue is not defective, the ilium is the best choice. When the bony defect is "lateral" and a small "skin or mucosal" soft-tissue defect is present, the fibula represents the optimal choice. When the bony defect is "lateral" and an extensive "skin or mucosal" or "through-and-through" soft-tissue defect exists, the scapula should be selected. When the bony defect is "anterior," the fibula should always be selected. However, when an "anterior" bone defect also displays an "extensive" or "through-and-through" soft-tissue defect, the fibula should be used with other soft-tissue flaps. Flaps such as a forearm flap, anterior thigh flap, or rectus abdominis musculocutaneous flap are suitable, depending on the size of the soft-tissue defect.
The purpose of this study was to compare the frequency of degenerative changes in the sacroiliac joint by age, sex, laterality, body mass index, and childbearing experience, based on computed tomography (CT) images obtained from the lower back of symptom-free subjects in different age groups. These data were used to trace the development of the sacroiliac joint until the occurrence of osteoarthritis with aging. CT transverse and coronal images were examined for the presence of the following degenerative signs: joint space narrowing, sclerosis, osteophytes, cysts, and erosion. The results indicated that joint degeneration begins in the 20s and tends to progress with age. Each form of degeneration was markedly more frequent in the 40s or older, and some type of degeneration was observed in the joints of all subjects aged 50 years or older. In terms of the localization of the joint degeneration, sclerosis was common on the upper and middle anterior of the articular surface of the ilium, and osteophytes were common on the anterior surface of the sacrum. Degeneration had progressed further in women than in men in every age group, and tended to progress faster in parous than in nulliparous women. It was presumed that the birth of the first child, rather than subsequent births had the greatest effect on the sacroiliac joint.
A patient with renal cell carcinoma, recurrent in the renal bed and metastatic to the lung parenchyma, hilar lymph nodes, and ilium bone, showed a complete response to 12 months of treatment with human diploid fibroblast interferon. However, concurrently with clinical and pathologic resolution of the metastatic and recurrent tumor at known sites, a brain metastasis developed, which was not clinically or radiologically apparent during his lifetime. At autopsy, there was no evidence of metastatic renal cell carcinoma at the known sites of disease. In the brain, there was a massive fresh intracerebral hemorrhage originating in a small focus of metastatic renal cell carcinoma. Possible explanations for these mixed responses to interferon and this curious phenomenon are discussed.
These cases are presented in detail from a series of fifteen cases treated in the described manner, with follow-up orthodontic documentation 2 to 5 years after PMCB grafts. The long-term results in all of the cases were excellent. Late or secondary bony reconstruction of the osseous alveolar and anterior palatal clefts may be accomplished with either an essentially nonviable autogenous graft or an autogenous particulate marrow and cancellous bone graft. The differences essentially are as follows: 1. In the nonviable graft, orthodontic movement of teeth adjacent to the cleft is undertaken at some time prior to the grafting procedure. This is opposed to the use of the autogenous PMCB graft in which active orthodontic treatment may be undertaken within 2 months after the osseous grafting procedure. 2. In the use of nonviable autogenous bone, presurgical orthopedic treatment to expand the arch is usually essential since extensive arch expansion is not usually possible after grafting. With PMCB grafts , postsurgical arch expansion may be routinely undertaken. 3. It is thought that the use of rib, solid one-piece grafts from the ilium, and other types of nonviable graft is warrented only after major growth and development of the premaxillary region has occurred. This is due to lack of ability of such a grafted area to keep pace with the growth of adjacent bone segments. This would mean that secondary grafting with such grafts would be restricted to patients over 15 years of age. This is opposed to the PMCB technique, in which the next procedure may be undertaken at any time from the age of mixed dentition to adulthood but preferably earlier than the age of 7, before the lateral incisor has erupted and been lost through exfoliation into the cleft area. Thus with these two techniques, there is a marked difference in the philosophy of grafting and a marked difference in the overall results. There is, in addition, an altered philosophical effect upon the total maxillofacial cleft palate team, with a marked difference in the type of treatment and prognosis which can be offered in terms of social rehabilitation of the patient. While the team approcah to the treatment of the cleft palate patient has done much to advance rehabilitation in terms of social and psychological problem areas, speech correction, and soft-palate and cosmetic lip restoration, much needs to be done to rehabilitate the patient completely from a dental standpoint. We believe that the prognosis of dental rehabilitation without appropraite bone-grafting procedures of the alvolar and prepalatal cleft is unfavorable. The use of the PMCB procedure in conjunction with orthondotic therapy opens new avenues to the total rehabilitation of the patient with an anterior maxillary cleft.
Replacement of skeletal support after extensive intraoral resection demands the use of a vascularized bone graft. This can be provided by microvascular free transfer using the ilium or metatarsal bones or by using muscle as a vascular carrier, employing the rib, the spine of the scapula, or the clavicle. Over a 5 year period, 27 patients underwent mandibular reconstruction with a vascularized segment of the outer table of sternum transposed together with a skin island on the pectoralis major muscle. Loss of bone occurred in two patients. A 93 percent survival rate was achieved. An earlier, smaller series of six patients using rib for reconstruction resulted in an unacceptably high complication rate. Success in survival of the bone graft, however, is not enough to procure a satisfactory result. Specific aspects of surgical technique are described that create an alveolar ridge with a sulcus on either side that can accept a denture; a diaphragm to replace the floor of the mouth and eliminate dead space; and an esthetically acceptable appearance, with definition of the jawline and a properly supported lower lip.
The choice of which decision to use for open reduction and internal fixation of complex acetabulum fractures depends on several variables. We report on 26 patients in whom a lateral extension of the ilioinguinal incision was used to achieve fracture reduction and stabilization. The lateral extension allowed visualization of the lateral ilium, in some cases passage of cerclage wires around the anterior and posterior columns, and in some cases placement of lateral to medial lag screws above the dome of the acetabulum. Reduction with a step of 1 mm or less and a gap of 3 mm or less with joint congruence was achieved in 21 patients (81 per cent). No patients had clinically significant heterotopic ossification. One patient had a transient postoperative femoral neuropathy, one a superficial infection, and one a deep infection. We recommend this lateral extension as an option during surgery of complex acetabular fractures through the ilioinguinal incision.
A two-dimensional finite element study was undertaken to establish the stresses in the acetabular region after total joint replacement. The influence of cement thickness and the effect of metal backing on the polyethylene cup were explored. Increasing cement thickness (from 1 to 3 to 5 mm) caused a decrease in the von Mises' equivalent stresses in the cement and surrounding cancellous bone. A more dramatic reduction in these stresses was found when a 2 mm thick cobalt-chromium alloy backing was added to the cup. The results indicate that increasing the stiffness of the composite implant by either method is helpful but that the metal backing causes a more efficient transfer of the stresses to the walls of the ilium. The finding strongly suggests that the use of a metal-backed acetabular component will help to delay or prevent cup loosening and migration in total hip replacement patients.
Four human pelves were dissected of soft tissues and instrumented with rosette strain gages. The pelves were left intact (not separated at the pubic symphysis or sacroiliac joints) although each of the eight hemipelves was tested separately. The pelves were loaded to simulate single leg stance with use of a wire mesh cemented to the wing of the ilium, representing the abductor muscles. Loading was carried out with the intact hip joint and 1 mm undersized, correct sized, and 1 mm oversized hemiarthroplasty. The correct sized component produced a strain pattern closet to normal. The oversized component was associated with an increase in strain at the medial acetabular dome.
In an adult male rhesus monkey, a large pelvic mass causing lysis of the ilium and destruction of pelvic musculature was diagnosed as a spontaneous rhabdomyosarcoma by the use of histological, ultrastructural and immunohistochemical techniques.
Restoration of the mandibular compromised ridge requires various treatment modalities. The simplest approach often is to extend the denture base adequately for proper use of all available supporting tissues. If the patient is incapable of wearing a conventional denture, the surgical approach becomes necessary. Surgical avenues include vestibular extension procedures that increase vestibular depth and augmentation procedures, which include (1) overlay grafts of rib or the crest of the ilium, (2) osteotomy grafts to include the visor osteotomy and the interpositional bone graft, (3) alloplastic grafts of which hydroxyapatite augmentation is the most common, and (4) various types of implants to restore the compromised ridge. The ultimate goal, regardless of the treatment modality chosen, is to restore the patient to a level of masticatory function.