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At least 127 records · Page 7Linked to original sources
PubMed1987

[Dangers of ischiectomy in ulcers in the paraplegic patient. Review of 236 records].

Two hundred and thirty-six paraplegics were operated on for unilateral or bilateral ischial ulceration between 1956 and 1981. A study was made of the long-term results, of the development of recurrences or bilateral involvement in unilateral lesions, of secondary complications and of their treatment and consequences. A distinction was made between procedures involving removal of the ischium and those with preservation of bone. The results, with a follow-up of one to 28 years were less satisfactory after extensive bony resection. Recurrence reached 50 per cent and a contralateral ulcer developed in up to 50 per cent. In contrast, when the ischium was preserved, these figures were respectively 20 per cent and 10 per cent. Complications such as the appearance of other pressure sores, or of perineal or urethral lesions occurred in 50 per cent of cases in which both ischia were resected but did not reach 15 per cent if the ischia were preserved. The analysis of these complications, their etiology and their outcome, with eleven deaths and two disarticulated hips implies the need to treat these ulcerations without removing the ischium. Infection and osteomyelitis can be healed without sacrifice of bone with at most one or two procedures preceding a plastic procedure. Myocutaneous flaps can be used to fill the lesions and to cover the bone with the help of proximal mobilisation of the hamstring muscles.

Adolescent↗
PubMed1989

Morphometric analysis of the development of sexual dimorphism of the mouse pelvis.

Sex differences in the innominate bone of C57BL/Tw mice were studied morphometrically from the day of birth to 120 days of age. In neonatal male and female mice, a small cartilaginous spine was found on the basal part of ischium. This process disappeared in males within 24 hours after birth, whereas in females it remained until at least 30 days. Other sexual differences in the pubis and the ischium appeared at 30 and 120 days, respectively. The pubis in female mice was longer and thinner than that in the males, and the ischium in male mice was shorter and thicker than that in the females. Thirty-day-old female mice treated neonatally with testosterone or 5 alpha-dihydrotestosterone possessed pubic bones shorter and thicker than those of the age-matched untreated females. Pubes in male mice castrated at the day of birth were thinner than those in intact males. These findings suggest that the shape of the innominate bone is transformed to the male type under the influence of early postnatal androgen.

Aging↗
PubMed2002

Anatomical study of the blood supply of the coxal bone: radiological and clinical application.

The aim of this work was to study the arterial blood supply of the coxal bone in order to optimize radiological embolization and to minimize the risk of postoperative osteonecrosis. Ten fresh cadavers were dissected after intra-arterial injection of colored resin. All the collateral vessels running to this bone were described and counted. On 25 dry bones, the vascular foramina were measured with the aid of a millimetric gauge and a vascular map was created. The posterior part of the ilium appears to be twice as well vascularized as the anterior part. Fractures of the posterior arch of the pelvis are theoretically more hemorrhagic. The presence of the iliolumbar artery in contact with the sacroiliac joint increases the risk with open book or shearing fractures. The artery of the ischium, a collateral of the pudendal artery, supplies the posterior and lateral parts of the acetabulum and the artery of the roof of the acetabulum, its superior and lateral parts. The branches of the anterior and posterior divisions of the obturator artery supply the superior part of the surroundings of the obturator foramen and the antero-inferior and postero-inferior parts of the acetabulum. The Kocher approach may injure the artery of the ischium. Letournel's extended lateral approach and Mears' triradiate approach may injure the artery of the ischium and the artery of the roof of the acetabulum. The risk of osteonecrosis appears to be theoretically increased if one adds an endopelvic approach. The anterior approach to the acetabulum appears to be that which theoretically leads to the least devascularization. The French version of this article is available in the form of electronic supplementary material and can be obtained by using the Springer Link server located at http://dx.doi.org/10.1007/s00276-002-0029-2.

Arteries↗
PubMed1991

Screw-augmented fixation of acetabular components. A mechanical model to determine optimal screw placement.

Sixteen embalmed hemipelves were used to determine the optimal acetabular screw placement to provide maximal screw pull-out strength in unicortical and bicortical screw fixation. The anterior column, superior ilium, posterior column, ischium, and pubis regions of the pelvis were tested using 6.5-mm titanium alloy screws and a hydraulic servo-controlled 1321 Instron testing machine. Force vs displacement data were acquired. Bicortical fixation was stronger than unicortical fixation in the four zones compared. This difference was significant in the superior ilium, posterior column, and ischium. The anterior column could not accept unicortical screws due to inadequate bone depth, which ranged between only 6 mm and 10 mm. Bicortical fixation was significantly greater in the superior ilium, posterior column, and ischium than in the anterior column or pubis. Unicortical fixation was greatest in the superior ilium. This information may aid decisions concerning the positioning of screws to augment acetabular component fixation.

Acetabulum↗
PubMed1998

Comparison of supine and lateral positioning on various clinically used support surfaces.

In this study, interface pressures, transcutaneous oxygen tension (TcPO2), and blood flow were compared with the classic pressure ulcer-prone areas in the supine and lateral position on six different high- and low-air-loss support surfaces. Interface pressures were substantially higher in the lateral decubitus than in the supine position. Consistent with this, mean TcPO2 and blood flow readings over the trochanter in the lateral position were lower than over the sacrum and ischium in the supine position. With weighting, the average TcPO2 readings decreased from 78.6 mmHg to 11.9 mmHg on the trochanter and from 65.4 mmHg to 45.7 mmHg on the sacrum and ischium. In parallel, average laser Doppler readings decreased from 2.3 to 0.7 laser Doppler flow units over the trochanter, but did not change significantly over the sacrum and ischium. These data support the clinical suggestion that the lateral decubitus position should not be maintained for long periods of time, not even on many special support surfaces.

Adult↗
PubMed1999

[New instruments for preparation of the prosthesis socket and primary stability of the acetabular Press-fit cups].

The aim of the present study was to develop surgical instruments necessary to achieve a precisely reamed surface and stable initial fixation. The instruments used to prepare the socket were a gauge-drill guide, a liner for the spigot hole and two spigotted reamers of different design and indentation intended to achieve a precisely reamed surface while preserving subchondral bone. For each reamer we implanted in a synthetic hip model 10 uncemented cups with 2 mm press-fit and loaded at 2.4 kN in the physiological axis (Mod. 8501, Instron, Canton, MA, USA). The micromotion between implant and bone socket was measured using an inductive micrometric measuring system (MultiNCDT-500, Micro-Epsilon, Ortenburg, Germany) and compared with that seen after using conventional instruments. The use of the new reamer of elliptical design significantly reduced the standard deviations of the measured values (p < 0.01 at the ischium and pubis) and also reduced maximum movement (p < 0.01 at the ischium); at the same time, all the components showed overall limited movement (< 150 microns at the ischium, pubis and ilium) under maximum loading (2.4 kN). Manufacturing tolerances, the quality and wear of the instruments, acetabular bone stock and surgical technique all impact on the degree of press-fit obtainable at surgery. The results of our study show that press-fit and initial stability can be optimized by using adequate instruments to prepare the socket.

Acetabulum↗
PubMed1997

Hip pain in an adolescent.

We have described a case of osteomyelitis of the ischium with extension into the adjacent soft tissues and abscess formation. Diagnosis and treatment were initially delayed due to the assumption that edema in the thigh muscles seen on initial MRI represented polymyositis. Subsequent radiographs demonstrated a destructive lesion containing a sequestrum within the ischium, indicative of osteomyelitis. It was, however, the MRI imaging that dramatically demonstrated the full extent of the complicating abscess which extended downward to mid-thigh and upward under the gluteal muscles almost to the top of the iliac crest. This proved to be an invaluable guide for the surgeon.

Adolescent↗
PubMed1979

Detachment of the ischial tuberosity sows.

The clinical and pathological features of five cases of detachment of the ischial tuberosity are described. In two cases, the detachment occurred unilaterally; one was a gilt showing severe lameness which precluded mating and the other was a uniparous sow which showed only slight lameness. Three gilts which were affected bilaterally developed progressive lameness during pregnancy and were unable to stand after farrowing. One of these gilts died and two had to be slaughtered. The diagnostic features of the epiphyseal detachment were shortening of the caudal extremity of the ischium, palpation of the displaced ischial tuberosity and crepitation elicited by pressing the displace tuberosity against the ischium.

Animals↗
PubMed1998

Anatomic basis of Tönnis' triple pelvic osteotomy for acetabular dysplasia.

Dysplasia of the hip in adults can be treated by a pelvic osteotomy. In order to assess pelvic anatomy in relation to surgical approach and osteotomy sites, 12 cadaver hips were studied. A triple pelvic osteotomy as described by Tönnis [6] through ilium, pubis and ischium was performed, followed by an intrapelvic and anterior and posterior dissection of the hip. At the ischium, the pudendal and inferior gluteal neurovascular bundles are most at risk medially and proximally respectively. Much less in danger is the sciatic n. as it runs 1 to 3 cm lateral to the osteotomy site. At the pubis osteotomy the femoral v. lies close on the bone and is prone to damage. The artery lies further off the bone. The ilium osteotomy starts just proximal to the anterior inferior iliac spine and exits posteriorly at the sciatic notch. Here the sciatic n. and the superior gluteal neurovascular bundle may be damaged. The practical surgical implications of these three osteotomies are discussed, especially with respect to the requirement of meticulous subperiostal dissection and accurate placement of retractors.

Acetabulum↗
PubMed1997

Flap selection as a determinant of success in pressure sore coverage.

OBJECTIVE: To establish a treatment algorithm for the long-term surgical management of pressure sores. DESIGN: Retrospective case series. SETTING: University-based teaching hospital. PATIENTS: From March 1979 to July 1995, 280 unselected pressure sore reconstructions (113 ischial, 94 sacral, and 73 trochanteric sores) were performed in 201 patients (130 men and 71 women; age range, 16-90 years; mean, 50 years). Of the patients, 90% had severe spinal cord injuries (paraplegia or quadriplegia). Forty-one percent of the wounds were chronic (present longer than 3 months). MAIN OUTCOME MEASURES: Length of stay, postoperative morbidity and mortality, and flap success (defined as a completely healed wound). RESULTS: Overall, 89% of the flaps healed primarily (ischium, 83% [94/113]; sacrum, 91% [86/94]; trochanter, 93% [68/73]). Three fourths of cases were treated in a single stage (debridement and reconstruction). The inferior gluteus maximus island flap (ischium) (94% [32/ 34]), the V-Y gluteus maximus advancement flap (sacrum) (97% [36/37]), and the tensor fascia lata flap (trochanter) (95% [42/44]) had the highest success rates. Flap success was not significantly affected by the size of the pressure sore or the number of previous flaps used. Postoperative hospital stays averaged 20 days. The overall complication rate was 28%, most commonly from a slight wound edge dehiscence. CONCLUSIONS: Flap selection and the appropriate short- and long-term sequence of flap use significantly improve success rates for pressure sore coverage. Reconstruction can be reliably performed in a single stage with a relatively short hospitalization.

Adolescent↗
PubMed1995

Natural selection and developmental sexual variation in the human pelvis.

This research examines ontological patterns of change in variation of the human pelvis as a means of identifying regions of differential growth, growth canalization and evidence of selection. Data were derived from pelvic radiogrammetry of 180 8-year-olds and 89 subjects at age 18 who were part of the Fels Longitudinal Growth Study. Coefficients of variation (CVs) and total growth increments were compared between sexes and between ages 8 and 18 for 14 pelvic measures. Sex-specific comparisons of mean size were tested per age using Student's t, whereas coefficients of variation were calculated and compared using the methods suggested by Sokal and Braumann ([1980] Syst. Zool. 29:50-66). The Mann-Whitney U-test was used to test median growth increments between ages 8 and 18. Results of these comparisons show significant sex differences in breadth of the ischium and acetabular regions among 8-year-olds. Most of the sexual dimorphism in the pelvis at age 18, however, develops during the adolescent growth period, during which both male and female pelves undergo growth remodeling of the pelvic cavity. Over the same time period, males show significantly greater incremental growth in the acetabulum, and females show differentially greater growth in the pelvic cavity. At age 18, the pelvis demonstrates a posterior-to-anterior gradient of increasing dimorphism within the inlet and midplane of the pelvic birth canal. As a means of interpreting the effects of natural selection on the pelvis, it is argued that appropriate comparisons are within-sample comparisons of CVs over time, rather than comparisons between sexes of adult coefficients as has been argued by others (Meindl et al. [1985] Am. J. Phys. Anthropol. 68:79-85). Analyses of change in coefficients of variation over time show evidence of concordantly reduced within-sample variation in 7 pelvic dimensions indicating canalization of growth. These results are attributed to the effects of stabilizing selection operating on both males and females and include transverse diameters of the sacrum, inlet, anterior inferior iliac spines, and breadths of the ilium and ischium. Six pelvic dimensions show evidence of increased total sample CVs and discordant change in within-sex comparisons of CVs as well as differential growth between sexes over time. This pattern is indicative of the effects of disruptive selection on the pelvis for interacetabular diameter, breadths of the anterior superior and posterior inferior iliac spines, public length, and ilium height.

Adolescent↗
PubMedDate not supplied

Interactive effects of ethanol intake and maternal nutritional status on skeletal development of fetal rats.

Skeletal development on gestation day 21 was examined in fetuses of alcohol-consuming (A), pair-fed (PF) and ad lib-fed (C) Sprague-Dawley females. Ethanol (36% ethanol-derived calories) was administered in liquid diets that were marginal (Diet A1) or optimal (Diet A2) in terms of pregnancy requirements (18% vs. 25% total calories as protein, respectively). For each bone studied, a lengthwise measurement was made of the whole bone and of the ossified portion(s), and percent ossification was calculated. Number of sternebral ossification centers present was also determined. Alcohol-exposed fetuses showed retarded ossification of the tibia and radius, regardless of maternal protein intake. Increasing the protein content of the alcohol diet from 18% (Diet A1) to 25% (Diet A2) significantly increased ossification of the ulna, sternum, humerus and ilium-ischium. For the ulna, A2 fetuses showed greater ossification than A1 fetuses but were still retarded compared to PF and C fetuses. For the sternum, humerus and ilium-ischium, however, ossification in A2 fetuses increased to the levels observed in the PF and C groups. In addition, number of sternebral ossification centers present was significantly increased in A2 compared to A1 fetuses. These data indicate that skeletal development provides a sensitive index of ethanol-induced developmental delay as well as interactive effects of ethanol and nutrition.

Animals↗
PubMed2002

Computer assisted screw insertion into real 3D rapid prototyping pelvis models.

OBJECTIVE: Show the use of computer navigation in exact screw positioning in the different pelvic bones. BACKGROUND: Computer assisted pedicle screw insertion in the spine is an established procedure. Screw fixation is also used in highly difficult pelvic and hip surgery (arthroplasty revision surgery and tumor surgery). DESIGN: Insert as long screws as possible with computer navigation into the different bones of the pelvis and compare these results with a non-computer controlled method. METHODS: The computer navigation was done with the system of Medivision (Oberdorf, Switzerland), the software was SurgiGATE 2.1. Optically controlled spine instruments and a special calibrated drill were used. The screw insertion with and without computer navigation took place in seven real rapid prototyping pelvis models matched by pairs. Three screws were inserted into the Os ileum, one into the Os pubis and one into the Os ischium. The length of the inserted screws were measured and compared using routine statistic methods. RESULTS: The mean screw length with vs. without computer navigation was 8.9 vs. 5.7 cm in the Os ileum (P=0.0001), 6.0 vs. 4.2 cm in the Os pubis (P=0.01) and 4.3 vs. 3.9 cm in the Os ischium (not significant). CONCLUSIONS: The use of computer navigation allows for the insertion of longer screws into the bones of the pelvis (more exact positioning), which requires a more precise original point of entry and direction of the drill (vector). RELEVANCE: The insertion of fixation screws in highly difficult pelvic and hip surgery (revision arthroplasty, tumor surgery) are another field for the use of computer navigation.

Arthroplasty, Replacement, Hip↗
PubMed2001

Hip arthroscopy. The lateral approach.

The lateral approach provides an easy and safe access to the hip joint. The line from skin to the joint itself is a straight, downward drop (Fig. 18). The vital arteries and nerves are a safe distance from the portal sites. The potential problems that can arise from this procedure are from the traction applying a compression force on the branches of the pudendal nerve as they cross the ischium (Fig. 19) and traction force on the sciatic nerve. I have always maintained that traction should be treated like a tourniquet; that is, it should be applied for no more then 2 hours. [figure: see text] Furthermore, the amount of traction should not exceed 75 pounds. I use a tensiometer, but it is not mandatory because the major issue with traction is the duration of application. I have monitored the sciatic nerve using both evoke potentials and, in some cases, motor potentials in over 50 cases in the past year, and the poundage and time limits of the traction (75 pounds and 2 hours) were verified. In addition, if the fracture [figure: see text] table has a vertical post as well as a peroneal post, set the vertical post in the back of the patient, and not in the front. Flexing the hip around that post will greatly increase the traction and at the same time will place an extreme stretch on the sciatic nerve, setting up the chance of a significant sciatic nerve neuropraxia. To protect the pudendal nerve, Lyon et al suggest that the perineal post be at least 9 cm in diameter to distribute the forces in a wide area on the ischium and make sure that the pelvis is well supported so the pressure of the post is not placed directly on the this nerve. The perineal posts on most fracture tables are only 3 cm in diameter. These can be made larger by wrapping them with padding. In some fracture tables, the slats that support the lower leg can be removed, and consequently the support on the pelvis is lost. For hip arthroscopy, the slats do not have to be removed. The lateral approach provides a safe and simple way of performing hip arthroscopy. The instruments can be manipulated easily so that the entire confines of the joint can be visualized with the arthroscope and reached with operative instruments.

Arthroscopes↗
PubMed1985

[Recurrent stress incontinence].

The results of urethrocystography in 193 patients with urodynamically and clinically confirmed recurrent incontinence were analyzed. Severe displacement of the vesical cervix and the proximal section of the urethra predisposes the patient to recurrent stress incontinence. The roentgenological findings (difference of over 30 mm in the distance between the vesical cervix and the ischium, outflow of contrast medium next to the catheter under stress with differential values between 20 and 40 mm, angle of inclination of the proximal urethra of over 45 degrees) are significantly more frequent in cases of recurrent stress incontinence than in cases of first occurrence (132 patients). Of the 193 patients 164 (84%) had previously undergone a vaginal operation. In 60% of these 164 patients the difference in the distance between the vesical cervix and the ischium was 30 mm or more under "resting" stress, and in a further 19% it was between 26 and 30 mm, often with outflow of contrast medium during "pressing". Stress incontinence has a damaging effect on the supporting apparatus of the urethra and the bladder, and also on the ureter and the kidneys. Ureteral drainage disorders and chronic pyelonephritis are the changes most commonly diagnosed in roentgenograms. No statistically significant differences between recurrent and first-time stress incontinence were found. Urethrocystographic findings facilitate selection of the surgical procedure. It appears possible to reduce the frequency of recurrence if preoperative roentgenological findings are taken into account.

Adult↗
PubMed1981

[A new technique of triple osteotomy for turning dysplastic acetabula in adolescents and adults (author's transl)].

A new form of triple-osteotomy of the pelvis is described. The ischium is osteotomized from a dorsal approach, immediately behind the hip joint. The ischium is left in place, the ligaments giving stability to the sacrum remain in tension. After turning the patient a small medial incision is done for the osteotomy of the pubis. The The ilium is cut through with a Gigli saw from a small incision laterally. It should descend medially in a distance of 2-2,5 cm apart from the joint. The possibilities to turn the acetabulum are very good and correspond to the amount of abduction before operation. Injuries to the sciatic nerve are avoided by the dorsal approach. The evaluations of 32 patients with different degrees of dislocations are reported. The osteotomy may be done even in flat-shaped femoral heads, where the acetabulum is still congruent as long as it is possible to abduct the leg and turn the femoral head into the acetabulum. It has been done in high dislocations with secondary acetabulae as well. The operation may be used in children above 8 years, where the osteotomy of Salter and acetabuloplasties are not efficient any more. In contrary to Chiari's osteotomy the acetabulum is covered by cartilage and the angle of inclination usually normal. It can be used in adults and beginning arthrosis as long as the abduction is not limited.

Acetabulum↗
PubMed1989

Broken bones in domestic fowl: handling and processing damage in end-of-lay battery hens.

1. 3115 end-of-lay battery hens and carcases were sampled at set points in the sequence of events that occurred between depopulation of the battery cages at the layer farms and the end of the evisceration line in two processing plants. Live birds were killed in a convulsion-free manner and carcases were dissected to determine the incidence of broken bones. 2. Of the live battery birds 29% had broken bones by the time they reached the waterbath stunner, with on average 0.5 broken bones per bird. Removing birds from the battery cages and hanging them on the slaughter line were identified as causes of broken bones. 3. By the time birds left the end of the eviscerating line, 98% of carcases had broken bones, with on average 6 broken bones each. The stunning, plucking and eviscerating processes caused most of this damage. In particular, stunning broke the furculum, coracoid and scapula, plucking broke the ischium, pubis and ribs, and evisceration damaged the ischium and pubis.

Abattoirs↗
PubMedDate not supplied

Reconstructive surgery in the myelomeningocele hip.

In 17 myelomeningocele patients with subluxating or dislocated hips, 31 posterolateral iliopsoas were treated by transfers, as described by Sharrard, in addition to complimentary procedures to balance muscle power and center the hip joint. Surgical goals are to stablize the hips within the acetabulum and prevent the occurrence of severe fixed flexion and adduction contractures of the hip and secondary lumbar lordosis. Surgery is performed at about 1 year of age with bilateral adductor transfer to the ischium, followed in 2 weeks by the posterolateral transfer of the iliopsoas muscle, first on one hip and 2 weeks later following with the other hip. Adductor transfer to the ischium reduces the adductor and secondary flexor power of the adductor longus and anterior fibers of the adductor brevis. After transfer it provides some extensor power. The range of abduction is increased. The transferred iliopsoas muscle has a better mechanical advantage in its new function as an abductor and extensor, and the hips were better centered radiographically than the cases with iliopsoas transfer alone. Fewer bony procedures were required to center the hips when the iliopsoas transfer was performed in children before the age of 1 1/2 years.

Braces↗