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PubMed1994

False-positive Meckel's imaging and true-positive imaging of a gastrointestinal bleed and surgical lesion.

A 76-year-old woman presented after 1 day of melena and anemia. A Meckel's scan revealed an upper mid abdominal focus of activity that paralleled stomach activity. Later, the surgeon removed the corresponding lesion in the mid ilium. Pathology confirmed that the lesion was a carcinoid tumor, not ectopic gastric mucosa. The false-positive Meckel's scan had revealed the true source of gastrointestinal bleeding and an unsuspected solitary carcinoid tumor. This is the third published case of a carcinoid tumor discovered by a false-positive Meckel's scan.

Aged↗

PubMed1994

Sarcoidosis of the axial skeleton.

Sarcoidosis of the bones in the hands and feet is not uncommon. However, sarcoidosis involving the axial skeleton is unusual. The authors present the case of a 37-year-old man with sarcoidosis who developed low-back pain. Radionuclide bone scan demonstrated abnormalities in the pelvis, spine, and scapulae. A bone scan directed open biopsy of an abnormality in diagnostic tissue from the ilium.

Adult↗

PubMed1975

Intrapelvic protrusion of the acetabular component following total hip replacement.

Protrusion of the acetabular component into the true pelvis following total hip replacement has occurred in 5 patients, 4 with severe rheumatoid arthritis and 1 with a destructive type of degenerative hip disease. Preoperatively all hips had severe protrusio acetabuli, a markedly thin acetabular medial wall and advanced osteoporosis. Four had a McKee-Farrar prosthesis, a metal-to-metal device with high frictional torque, particularly when the contact is equatorial, and no damping capacity against marginal impingement in the extreme range of motion. In order to reduce the incidence of intrapelvic protrusion, extreme care should be given to preserve the medial bone stock of the acetabulum, more so when it is already damaged or defective. If anchoring holes are used they should be restricted to the superior ilium, pubis and ischium and should not perforate the medial wall. Once loosening is present, reoperation is indicated to avoid progressive bone reabsorption by the abrasive motion of the loosened prosthesis, that might lead to irreparable bone loss. To reduce the stress transmitted to an already weakened acetabulum, select a total prosthetic device with low friction; fix it with acrylic cement in order to distribute the stress over a large surface; carefully orient both components to avoid marginal impingement; be certain to preserve the medial wall as much as possible and if it is already defective reinforce it by bone grafting and/or wire mesh.

Acetabulum↗

PubMed1996

Internal fixation for the transforaminal sacral fracture.

The mechanical stability of alternate forms of internal fixation of the transforaminal sacral fracture were compared. A transforaminal sacral fracture was made in each of 6 fresh-frozen cadaveric pelvic specimens. Implants compared for fixation included: a single and 2 fully threaded iliosacral screws inserted through the posterior ilium and anchored into the first sacral vertebral body both with and without the addition of a posterior tension band plate; and 2 transiliac bars inserted through the posterior tubercles. The femora of each specimen were potted and fixed to the table of a materials tester. The pelvis was restrained only from flexing and extending, and a compressive load was applied through the lumbar spine, representing a standing loading condition. Flexion of the sacrum and displacement at the fracture site were measured during loading. Although creation of the injury increased motion considerably, there was no measurable increase in stability provided by any of the implants or combination of implants in this model when an anatomic reduction was obtained.

Aged↗

PubMed1999

Revision arthroplasty of the acetabulum with restoration of bone stock.

Bone defects on the acetabular side are defined as contained (cavitary) and uncontained (segmental). Contained (cavitary) defects can be treated by morselized allograft bone with an uncemented cup if contact can be made with 50% host bone. If contact cannot be made with 50% host bone, the author prefers to use a ring and a cemented cup. Defining success as a stable implant, no additional surgery, and improvement in hip score of at least 20 points, the success rate was 90% in 51 hips in 51 patients at an average followup of 7 years. Segmental defects involving between 30% and 50% of the acetabulum are treated by minor column allografts (shelf graft), and a cemented or an uncemented cup. In 29 hips in 28 patients with an average followup of 7 years the success rate was 86%. Segmental defects involving more than 50% of the acetabulum are treated by major column allografts. These grafts are fixed by cancellous screws and protected by a reconstruction ring that extends from ilium to ischium. In 33 hips in 32 patients with an average followup of 7 years, the success rate was 76%.

Acetabulum↗

PubMedDate not supplied

Transiliac exposure of the sacrum: a new surgical approach.

Biopsy or surgical approach of the midsacrum is difficult from the anterior, posterior, or superior approaches. I describe a lateral approach removing a piece of posterior ilium and entering the midsacrum through the sacroiliac joint. The approach was successfully used in an 8-year 7-month-old girl for the removal of an osteoid osteoma. The patient was monitored for 9 years 6 months until skeletally mature (age 18 years 1 month). This approach is applicable for biopsy or removal of benign tumors in the midsacrum in adults. Some developmental asymmetry of the pelvis may develop if it is used in children.

Bone Neoplasms↗

PubMedDate not supplied

MR imaging of septic sacroiliitis.

Septic sacroiliitis is difficult to diagnose, causing delayed treatment and increased morbidity. The traditional imaging techniques for diagnosis have been CT and nuclear medicine. Our purpose was to determine the ability of MR imaging to detect septic sacroiliitis, to evaluate the features of septic sacroiliitis with MR, and to compare the relative detection rate of MR, CT, and nuclear medicine. All patients with a discharge diagnosis of septic sacroiliitis who were evaluated by MR imaging of the pelvis were retrospectively evaluated. Five patients were collected with six septic sacroiliac joints, which were also evaluated with CT, 99mTc-methylene diphosphonate bone scans, and 67Ga-citrate scans. Abnormalities consistent with sacroiliitis were seen in all sacroiliac joints both prospectively (impression from the initial report) and retrospectively on MR. In addition to the nonspecific MR findings of inflammation and/or fluid in the sacroiliac joint space, bone marrow of the sacrum and/or ilium, and iliopsoas muscle, fluid/inflammation was uniquely identified tracking posterior to the iliopsoas muscle in each of these patients with septic sacroiliitis. Even in retrospect, a definite diagnosis of sacroiliitis could be made in only five of six joints by 67Ga-citrate scans, three of six joints by CT scans, and one of six joints by 99mTc-methylene diphosphonate bone scans. These results suggest MR imaging may be a sensitive modality in the early diagnosis of septic sacroiliitis.

Adult↗

PubMed2003

Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads.

OBJECTIVE: To conduct a biomechanical comparison of a new triangular osteosynthesis and the standard iliosacral screw osteosynthesis for unstable transforaminal sacral fractures in the immediate postoperative situation as well as in the early postoperative weight-bearing period. DESIGN: Twelve preserved human cadaveric lumbopelvic specimens were cyclicly tested in a single-limb-stance model. A transforaminal sacral fracture combined with ipsilateral superior and inferior pubic rami fractures were created and stabilized. Loads simulating muscle forces and body weight were applied. Fracture site displacement in three dimensions was evaluated using an electromagnetic motion sensor system. INTERVENTION: Specimens were randomly assigned to either an iliosacral and superior pubic ramus screw fixation or to a triangular osteosynthesis consisting of lumbopelvic stabilization (between L5 pedicle and posterior ilium) combined with iliosacral and superior pubic ramus screw fixation. MAIN OUTCOME MEASURES: Peak loaded displacement at the fracture site was measured for assessment of initial stability. Macroscopic fracture behavior through 10,000 cycles of loading, simulating the early postoperative weight-bearing period, was classified into type 1 with minimal motion at the fracture site, type 2 with complete displacement of the inferior pubic ramus, or type 3 with catastrophic failure. RESULTS: The triangular osteosynthesis had a statistically significantly smaller displacement under initial peak loads (mean +/- standard deviation [SD], 0.163 +/- 0.073 cm) and therefore greater initial stability than specimens with the standard iliosacral screw fixation (mean +/- SD, 0.611 +/- 0.453 cm) ( = 0.0104), independent of specimen age or sex. All specimens with the triangular osteosynthesis demonstrated type 1 fracture behavior, whereas iliosacral screw fixation resulted in one type 1, two type 2, and three type 3 fracture behaviors before or at 10,000 cycles of loading. CONCLUSION: Triangular osteosynthesis for unstable transforaminal sacral fractures provides significantly greater stability than iliosacral screw fixation under in vitro cyclic loading conditions. In vitro cyclic loading, as a limited simulation of early stages of patient mobilization in the postoperative period, allows for a time-dependent evaluation of any fracture fixation system.

Biomechanical Phenomena↗

PubMed1998

Nonunion of pelvic fractures.

Nonunion of the pelvic bones is uncommon. It may be under-diagnosed because of the difficulty in visualization of the fracture and interpretation with conventional radiography. The authors report four cases of nonunion involving the pelvic bones. Nonunion of the posterior ilium was occult in two patients and was not apparent on routine radiographs. The two patients with nonunion of the anterior iliac crest had major displacement caused by muscle pull. Pain on weight-bearing and awkward gait were common symptoms. All patients required surgical management for symptomatic relief.

Accidents, Traffic↗

PubMed1998

99Tcm-labelled chimeric human/mouse anti-granulocyte antibody bone marrow scintigraphy: a preliminary clinical study.

Bone marrow scintigraphy using 99Tcm-labelled chimeric anti-granulocyte antibody (anti-NCA-95) was performed in 17 patients with haematological disorders and skeletal metastases. Chimeric anti-NCA-95 antibody (chNCA95 Ab, 0.2 mg) labelled with 444 MBq 99Tcm was administered to obtain bone marrow images 4 h post-injection. One week later, an 111In-chloride bone marrow scan was performed on nine patients with haematological disorders. Lumbar bone marrow-to-background (L/B) and ilium-to-background (I/B) uptake ratios were calculated for each scan. In six patients with suspected skeletal metastases, 99Tcm-HMDP bone scans were performed. No patient had any adverse reaction or any immune reaction over 20 weeks. In the patients with haematological disorders, the L/B and I/B ratios of the 99Tcm-chNCA95 Ab scan were 3.41 +/- 0.90 and 1.23 +/- 0.31, whereas those of the 111In-chloride scan were 1.58 +/- 0.32 and 1.00 +/- 0.32, respectively. In assessing findings of irregular central bone marrow uptake and peripheral expansion of the bone marrow, the 99Tcm-chNCA95 Ab scan was much better than the 111In-chloride scan. In the six patients with suspected skeletal bone metastases, three true-positive and two true-negative results were observed. This preliminary study has revealed that 99Tcm-chNCA95 Ab scanning is safe and useful in the diagnosis of haematological disorders and skeletal metastases.

Adult↗

PubMed1978

Placement of the umbilicus in an abdominoplasty.

The location of the umbilicus was measured in 100 randomly selected non-obese subjects. It was found that a line drawn from the highest level of the crest of one ilium to the same point on the other side will transect the umbilicus in 96 percent of the subjects. This relationship can be of use during an abdominoplasty, when determining the location for the umbilicus.

Abdomen↗

PubMed1991

Free bone graft reconstruction of irradiated facial tissue: experimental effects of basic fibroblast growth factor stimulation.

A study was undertaken to evaluate the potential utility of basic fibroblast growth factor in the induction of angiogenesis and osseous healing in bone previously exposed to high doses of irradiation. Thirty New Zealand rabbits were evaluated by introducing basic fibroblast growth factor into irradiated mandibular resection sites either prior to or simultaneous with reconstruction by corticocancellous autografts harvested from the ilium. The fate of the free bone grafts was then evaluated at 90 days postoperatively by microangiographic, histologic, and fluorochrome bone-labeling techniques. Sequestration, necrosis, and failure to heal to recipient osseous margins was observed both clinically and histologically in all nontreated irradiated graft sites as well as those receiving simultaneous angiogenic stimulation at the time of graft placement. No fluorescent activity was seen in these graft groups. In the recipient sites pretreated with basic fibroblast growth factor prior to placement of the graft, healing and reestablishment of mandibular contour occurred in nearly 50 percent of the animals. Active bone formation was evident at cortical margins adjacent to the recipient sites but was absent in the more central cancellous regions of the grafts.

Animals↗

PubMed1998

The current role of preoperative arteriography in free fibula flaps.

The free fibula flap has become a "workhorse" flap for reconstructive surgeons, yet the indications for preoperative arteriography for the donor extremity remain unclear. Therefore, a retrospective review of all free fibula candidates over a 4-year period was conducted to clarify the need for preoperative arteriography. One hundred consecutive patients were evaluated as potential candidates for free fibula reconstruction. Twenty-one patients were deemed unsuitable because of associated comorbid conditions (15) or unusable limbs (6). The remaining 79 patients were candidates for fibula free flap reconstruction. Eight patients (10 percent) who had an abnormal lower extremity vascular physical examination (diminished or absent pedal pulses) underwent arteriography to evaluate the fibula donor site. Free fibula transfer was performed in 77 patients (mean age, 41; range, 3 to 80 years) to the following sites: mandible (65), upper limb (4), lower limb (6), and trunk (2). The overall free flap success rate was 99 percent. Results of arteriography included: normal three-vessel runoff (6), bilateral peroneal arteria magna (1), and bilateral posterior tibial artery occlusion with reconstitution via the peroneal artery (1). Two patients with unusable fibula donor sites (determination based on arteriographic findings) were reconstructed with ilium and radius. All others underwent uncomplicated free fibula transfer. Ischemic complications at the fibula donor site did not occur in any patient. This study supports the use of lower extremity vascular physical examination as the primary means of evaluating the fibula donor site. Routine preoperative arteriography is unnecessary and should be reserved for those patients with abnormal vascular examinations.

Adolescent↗

PubMed2003

Acute hematogenous osteomyelitis of the pelvis in childhood: Diagnostic clues and pitfalls.

Acute hematogenous osteomyelitis (AHOM) of the pelvis is a rare form of childhood osteomyelitis. Prompted by a recent case, we reviewed the 146 reported cases of pelvic AHOM published since 1966. Classical childhood AHOM of tubular bones usually occurs in older children (mean age, 8.1 y) as opposed to younger children (aged 2-5 y). It is more common in boys than in girls (male to female ratio = 1.5:1). The most common site is the ilium (40%), followed by the ischium (28%) and the pubis (15%). In contrast to AHOM of the long bones, trauma is an uncommon antecedent event in pelvic AHOM. The pain in pelvic AHOM may be referred to the hip, thigh, or abdomen, often leading to misdiagnosis. On average, the correct diagnosis is delayed for 12 days. Such delays have resulted in a permanent disability in 3.4% of the cases. If diagnosed and treated promptly, uneventful recovery can be anticipated in all patients. This case history and review of the literature may facilitate early recognition of pelvic AHOM by primary care physicians, as well as by pediatric or orthopedic specialists.

Acute Disease↗

PubMed1978

High amputation of the sacrum for extirpation of tumors. Principles and technique.

A detailed description is given of the principles and surgical technique for extensive resection of the sacrum, including an adjacent part of each ilium, for radical removal of tumor. Two levels of sacral amputation are discussed: between S1 and S2 (through the canals of the S1 nerves) and through S1 (above the canals of the S1 nerves), with or without inclusion of the rectum in the specimen. The former level permits the preservation of the S1 nerves; the latter does not. Important pathoanatomic facts are discussed. The effects of these operations on the urogenital and anorectal function and on the stability of the pelvic girdle are briefly reviewed. Five illustrative cases are reported with comments on the results.

Anal Canal↗

PubMedDate not supplied

The application of pelvic pins in halo-pelvic distraction. An anatomic study.

The application of the pelvic hoop for halo-pelvic distraction, as described by O'Brien, has led to serious abdominal complications. A study of mature Caucasian pelves as compared to the smaller East Indian pelves has shown that in the larger pelvis, when the gluteal tubercle and posterior superior iliac spine are used as landmarks, as advocated by O'Brien, the pins will invariably pass within the soft tissue elements of the inner pelvis instead of being entirely within the bony ilium, as O'Brien noted in the Chinese pelves. On the basis of pelvic measurements and observations, the authors recommend an open technique for passage of the pins.

Adult↗

PubMed1984

The applied anatomy of the thoracolumbar fascia.

The thoracolumbar fascia was studied by dissection in ten adult human cadavers. The posterior layer of this fascia was found to consist of two laminae. The superficial lamina is formed by the aponeurosis of latissimus dorsi. The deep lamina consists of bands of fibers passing caudolaterally from the midline. Both laminae form a retinaculum over the back muscles, and the deep lamina constitutes a series of accessory posterior ligaments that anchor the L2 to L5 spinous processes to the ilium and resist flexion of the lumbar spine. The function of these ligaments is enhanced by the contraction of the back muscles and the action of certain, restricted portions of the abdominal muscles.

Adult↗

PubMed1985

Technique for achievement and maintenance of reduction for severe spondylolisthesis using spinous process traction wiring and external fixation of the pelvis.

A technique is described for achievement and maintenance of reduction for severe spondylolisthesis in conjunction with reconstructive surgery. Spinous-process traction wires exert a posterior and cephalad force on the lumbar spine, while Hoffman pins anchored to the ilium rotate the sacrum in an anterior and caudad direction. Once maximum reduction is achieved, the patient is kept supine for 3 months with pins and traction wires incorporated in a plaster cast. At follow-up, two patients demonstrated excellent correction of slip angle and a solid fusion.

Adult↗