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At least 1,531 records · Page 85Linked to original sources
PubMed1996

Epidemiology of pelvic ring injuries.

3260 patients with pelvic and acetabular fractures were assessed using a standardized documentation form by collating the data on 1905 patients treated at the Department of Traumatology of the Hannover Medical School together with those patients treated between 1991 and 1993 in the German Multicentre Study Group (Pelvis) of the German Trauma Society and the German Section of the AO International. 2551 patients had pelvic ring injuries. 61.7% of the patients were multiply injured. 12.2% were suffering a complex pelvic trauma defined as a pelvic injury with concomitant soft tissue injury. The pelvic ring fracture was classified as stable in 54.8% (type A injury), as rotationally unstable in 24.7% (type B injury), and as unstable in translation in 20.5% (type C injury). There were concomitant acetabular fractures in 15.7%. The most frequent single lesions affecting the pelvic girdle were fractures of the ischiopubic bones (transpubic instability), injuries involving the sacroiliac joint (transiliosacral instability), and sacral fractures (transsacral instability). The overall rate of operative stabilizations was 21.6%. Type B injuries were stabilized in 28.9% and type C injuries in 46.7%. The overall mortality rate was 13.4%, depending significantly on the associated extrapelvic trauma. In complex pelvic injuries, the mortality rate was 31.1% whereas for pelvic fractures without concomitant soft tissue injury the rate was only 10.8%.

Accidents, Traffic↗
PubMed1995

Complications associated with harvesting autogenous iliac bone graft.

The harvesting of an autogenous iliac bone graft is a frequently performed orthopedic procedure. Although often regarded as the simple or routine part of bone graft requiring surgery, complications are not necessarily uncommon. Documented donor-site complications include nerve, arterial, or urethral injury; chronic donor-site pain; cosmetic deformity; herniation of abdominal contents; sacroiliac joint instability; pelvic fractures; gait disturbances; hematoma; infection; peritoneal perforation; and hip subluxation. Most of these complications are avoidable when the surgeon is aware of their possibility and is familiar with the involved anatomy and preferred surgical approaches.

Aged↗
PubMed1996

Radiological evaluation of S1 dorsal screw placement.

Twelve bony pelves were used in this study. S1 dorsal screws were inserted in the anteromedial, anterior, anterolateral, and anteroinferior directions. When the screws were inserted within 5-10 mm beyond the anterior sacral cortex, radiographs were obtained in the anteroposterior, modified inlet, modified outlet, and lateral projections to evaluate the position of the screws and penetration of the anterior cortex. In addition, 30 dried sacral were obtained for anatomic evaluation focused on the anterior and superior aspect of the sacral alae and its relationship to the anterior aspect of the sacrum. The results showed that a screw penetration of the anterior cortex of the S1 vertebral body or ala is best detected in the modified inlet view. A misdirected screw into the S1 anterior foramen is best seen in the modified outlet view. The lateral view also is useful in determining the extraosseous penetration. The average distance from the anteriormost limit of the ala to the anterior sacral cortex was approximately 11 mm. The average sagittal angle between the superior surface of the ala and S1 dorsal aspect was approximately 51 degrees. This study suggested that the modified inlet and lateral radiograph views are most useful for detecting screw penetration of the anterior cortex of the sacrum. The modified outlet projection is the best for determination of a screw violating the S1 anterior foramen. Also, the modified inlet projection will show the screw orientation relative to the mediolateral plane (the sacral canal and sacroiliac joint), and the lateral view will show the screw direction relative to the superoinferior plane.

Adult↗
PubMed1997

Posttraumatic posterior urethral strictures in children: a 20-year experience.

PURPOSE: We attempted to identify the particular features of strictures complicating pelvic fracture urethral injuries in children. MATERIALS AND METHODS: A total of 68 boys 3 to 15 years old who had sustained pelvic fracture urethral disruption underwent 78 urethroplasties performed by bulboprostatic anastomosis through the perineum in 42, transpubically in 23 and by 2-stage urethroscrotal inlay in 13. RESULTS: Perineal and transurethral urethroplasty was successful in 93 and 91% of cases respectively. There was a 54% failure rate after urethroscrotal inlay. CONCLUSIONS: Urethral strictures were most commonly associated with Malgaigne's fracture (35% of cases) and straddle fracture with or without diastasis of the sacroiliac joint (26%). Strictures were almost invariably inferior to the verumontanum with prostatic displacement in 44% of cases. Length of the strictured segment may be overestimated or underestimated on urethrography as a result of incomplete filling of the prostatic urethra or a urinoma cavity connected with the proximal segment, respectively. Perineal or transpubic bulboprostatic anastomosis is the best treatment for posttraumatic strictures, while internal urethrotomy should be avoided since it may compromise the chance of subsequent anastomotic urethroplasty. Repair of associated bladder neck incompetence may be deferred until the resumption of urethral voiding after urethroplasty, when incontinence can be documented.

Adolescent↗
PubMed1997

[Recurrent chronic multifocal bone infection].

We present a 9-year-old girl who had chronic recurrent multifocal osteomyelitis. The bones involved were: right clavicle, distal fibula (bilateral), left sacroiliac and right wrist. After 10 years of follow-up; she is asymptomatic but presents radiological evidence of lesions in the right clavicle and left sacroiliac joint. The diagnosis was made by exclusion criteria. The biopsy and results of cultures from various bones were negative 4 times. Although chronic recurrent multifocal osteomyelitis is rare, it should be considered in the differential diagnosis of acute or chronic osteomyelitis and neoplasma. Its recognition avoids unnecessary laboratory tests and antibiotic therapy.

Acute Disease↗
PubMedDate not supplied

The biomechanics of the normal and dysplastic hip.

The author describes a simple method to highlight forces, by extrapolating on x-rays of normal and dysplastic hips the direction of the skeletal lamellae of the pelvis and that of the proximal femoral metaepiphysis. In the pelvis is described a tridimensional structure, made of two basic lamellar systems: one that begins from the "lamina quadrilatera" and one from the lateral border of the "sourcil." They move in the opposite direction: the first towards the Waldayer tuberosity, the anterosuperior and inferior iliac spine; the second towards the sacroiliac joint. They form a structure similar in shape to an hourglass, the inferior cone of which underlines the "sourcil" and looks like a Gothic arch. In the normal hip the "sourcil" is slightly oblique (3-4 degrees) in bipodalic support. It becomes horizontal in monopodalic support. From the direction of the lamellae of the Gothic arch the author obtains the direction of the forces acting in the static and dynamic phase of the normal hip. In the dysplastic hip the "sourcil" may be oblique in an anterocraniolateral or posterocraniomedial direction. Consequently, the lamellae of the hour-glass and of the Gothic arch undergo a different orientation. From these altered orientations the author visualizes the direction of the pathologic forces. Based on the shape of the Gothic arch and of the angle of inclination of the femoral neck the author describes the forces acting on the pelvis and on the femoral head when there is either valgus or varus in the neck; according to the degrees of inclination of the femoral neck he describes the variation of magnitude of loading on the support surfaces.

Biomechanical Phenomena↗
PubMed1997

[An echocardiographic study of the aortic root in ankylosing spondylitis].

The inflammatory condition in ankylosing spondylitis (AS) may affect cardiac structures, being the aortic valve mostly studied. Several studies regard the existence of a subaortic ridging as specific for AS. Our objective was to assess abnormalities in the aortic root in AS using echocardiography and its relation to HLA B-27 and clinical parameters of the disease. Thirty patients with no clinical, radiographic or electrocardiographic evidence of cardiovascular disease were studied by monodimensional, bidimensional and Doppler echocardiography. After an initial ultrasound examination to detect subclinical cardiac abnormalities, aortic root dimensions were measured at the aortic annulus, at the tip of the cusps and 1 cm above the cusps. The existence of subaortic ridging was assessed using bidimensional echocardiography. As clinical parameters were estimated duration of AS, sacroiliac joint X-ray involvement and activity of disease. The results are compared with those in a control group of thirty healthy people with same age, sex and corporal surface. No statistical differences were observed in the mean values of aortic root dimensions between the two groups; in patients with AS were not seen significant differences in the echocardiographic measurements related to clinical parameters or HLA B-27. Only in one patient was observed the characteristic subaortic ridging (4%, NS compared to control group). We conclude, in contrast to other authors, that in patients with AS without cardiovascular disease echocardiographic examination of aortic root does not detect significant abnormalities.

Adult↗
PubMedDate not supplied

[Reiter's syndrome--analysis of 187 patients].

The study included 187 patients with positive diagnosis of Reiter's syndrome (RS) examined and treated in the Clinic of Rheumatology of Military Medical Academy in the period of 26 years (1970-1995). There were 176 males and 11 females (16:1) aged from 12 to 65 (average age 28.5) years. The disease diagnosis was made upon the clinical finding of at least two of four RS main features: acute urogenital or enteral infection, arthritis, ophthalmic and mucocutaneous changes. Family disease occurrence was noticed in 5, and juvenile type in 6 patients. HLA-B27 antigen was present in 81.5% patients. In 74.3% patients the urogenital disease type was determined, in 18.2% enterocolitic and in 7.5% initial causative agent was not discovered. Three or two RS main signs were present in approximately same number of patients (42.2% and 42.6%) while all the four disease signs were found in 15% patients. Acute or subacute course was found in 43.8%, recurrent in 34.2% and chronic in 22% patients. Clinically, the disease was revealed in locomotor system, most frequently as the asymmetric oligoartritis localized in lower extremities. Sacroiliac arthritis, partial or more frequently asymmetric mutual, radiologically confirmed, was present in 18.2% patients. Only one patient was with sacroiliitis without peripheral arthritis, pain in heel was present in 31.5%, and dactilitis, more frequently in the feet, in 13.9% patients. Radiological changes were found in 51.8% patients, most frequently in sacroiliac joints and heel bone. Chlamydia trachomatis or genital mycoplasma were isolated in synovial fluid of 33.3% (6/18) patients. The most frequent urogenital change was urethritis (56.7), ophthalmic--conjunctivitis (46.5), and mucocutaneous--balanitis (12.3). Positive damage of heart and kidneys by primary disease was found in 2, i.e. 4 patients, and possible in 7, i.e. 14 patients. No differences in RS clinical demonstration among sexes were observed. Besides conventional therapy, in only 26 (13.9%) patients were applied drugs out of the basic group, so as the radiation synovectomy and surgical methods of treatment.

Adolescent↗
PubMed1998

[Dysphagia caused by ossification of the anterior longitudinal ligament associated with diffuse idiopathic skeletal hyperostosis: report of 2 cases].

Two cases of ossification of the anterior longitudinal ligament (OALL) associated with diffuse idiopathic skeletal hyperostosis (DISH) presenting as dysphagia are reported. DISH has long been regarded as a radiological entity manifesting flowing ossification adjacent to the anterior and lateral borders of at least four contiguous vertebral bodies, maintenance of disc spaces, and a dearth of bony ankylosis and erosion of the apophyseal and sacroiliac joints. In the majority of cases, this entity shows an innocuous clinical course, but the dysphagia shown in our cases has also been documented in previous literature. Case 1 was a 63-year-old male developing progressive dysphagia and rhinolalia. Cervical X-rays and CT showed flowing OALL in the entire cervical spine. MRI demonstrated displacement of the trachea and esophagus by this mass. There was OALL in the thoracic and lumbar spine. Case 2 was a 62-year-old male who had undergone removal of ossification of the posterior longitudinal ligament (OPLL) from C2 to C5. He developed dysphagia and myelopathy. Cervical X-rays and CT demonstrated projection of OALL as well as posterior osteophytes at C5/6. MRI suggested that OALL had caused dysphagia, and osteophytes deteriorated myelopathy. Removal of OALL was carried out in these two cases. In case 2, removal of the osteophytes and herniated disc was carried out at the same time. Postoperative course was unremarkable with improvement of symptoms. Treatment of dysphagia due to OALL is considered to be conservative. However, surgical decompression should be considered in cases of marked projection of OALL obstructing the esophagus as shown in our cases.

Deglutition Disorders↗
PubMed1998

[Method for measuring the comparative stability of osteosynthesis in the dorsal pelvic ring].

In the past, biomechanical investigations on the dorsal pelvic ring have generally been performed on a small number of cadaveric pelves in various non-standardized procedures. Significant differences in stability between different internal fixation methods of unstable pelvic ring fractures were not found. The experimental design presented here was based as closely as possible on the physiological loading of the pelvis in one-leg stance. This method made it possible to carry out standardized, reproducible tests on different osteosytheses of the sacroiliac joint. Furthermore, the suitability of artificial bones for such investigations can be assessed on the basis of a larger number of similar experiments on artificial and human pelves and the number of human pelves required for such studies could be reduced.

Biomechanical Phenomena↗
PubMed1998

[Silent axial arthropathy in inflammatory bowel disease. Clinical, radiological and genetic characteristics].

OBJECTIVES: To evaluate the prevalence, clinical and radiological characteristics, association with HLA B27 in a subgroup of patients with inflammatory bowel disease (IBD) and subclinical sacroileitis. The sensitivity of the diagnostic criteria for spondyloarthropathy in this group of patients is evaluated. MATERIALS AND METHODS: All patients with inflammatory bowel disease attending an outpatient gastroenterology unit from January 1994 to June 1994 were recruited. A total of 62 patients with IBD and without clinical evidence of axial involvement were included in the study. The demographic, clinical, and radiological characteristics were collected. The radiological examination included PA and lateral views for the dorso-lumbar, and three views (Ferguson, right and left oblique views) for the sacroiliac joints. Films were interpreted by three independent readers. The HLA B27 allele distribution was analyzed in the 62 patients and in 80 healthy controls. The modified New York criteria, Amor criteria, and European Spondyloarthropathy Study Group criteria were evaluated. Patients were prospectively followed for two years with the same initial protocol. The statistical management of data was performed with the information program SPSS/PC. RESULTS: Fifteen cases of silent sacroileitis were detected, and most of them were grade 2 unilateral sacroileitis. There was no correlation between sacroileitis and IBP type, extradigestive symptoms, disease duration, sex, or peripheral arthritis. The frequency of HLA B27 in the sacroileitis group was 20% (p < 0.05). During the two-year follow-up period none of these cases has changed from diagnostic category. The sensitivity of diagnostic the criteria for spondyloarthropathy was low in these patients (40%-53%). CONCLUSIONS: A high frequency of asymptomatic sacroileitis in patients with IBD was detected. We propose the term Silent Axial Arthropathy to define this category of patients and, as with other authors, we consider this is a third form of rheumatic syndrome in IBD, different from the classical forms of peripheral arthritis and ankylosing spondylitis.

Adult↗
PubMed1998

Hindquarter amputation for pelvic tumors. The importance of patient selection.

Twenty-two patients underwent hindquarter amputation with curative intent for malignant or locally aggressive tumors of the pelvis (21 cases) or proximal thigh (one case). In all cases, the ilium was resected, and in seven cases an osteotomy of the sacrum was done to achieve negative surgical margins. Only six wounds healed without complications. The worst wound problems occurred in patients requiring ligation of the common iliac vessels and in those requiring a sacral osteotomy. Twelve patients have died of disease, two are alive with extensive pulmonary metastases, and one remains well after excision of a local tumor recurrence. Thirteen of 14 patients with high grade sarcoma had metastases develop, compared with only one of eight patients with low grade sarcoma. Eight patients (all with high grade sarcoma) died within 1 year of surgery. Seven patients have remained disease free at a mean of 39 months after surgery. Given the poor prognosis and high morbidity after amputation in high grade sarcoma, the authors think that consideration should be given to pursuing nonoperative management in patients with large, high grade sarcomas and significant medical extension to the sacroiliac joint or sacrum.

Adolescent↗
PubMed1998

[Giants schwannoma of the sacrum. Apropos of 3 cases and review of the literature].

Giant sacral schwannoma is a very rare tumor (25 cases reported). The authors report 3 cases of giant sacral schwannoma treated by curettage through posterior approach and discuss symptoms and treatment. These tumors were characterized by their minimal symptoms compared to radiographic findings. Magnetic resonance imaging must be performed in order to detect extraosseous tissue component and intradural invasion. A biopsy was performed to confirm the diagnosis before definitive treatment. Wide resection was proposed by many authors because of the high recurrence rate. We believe that a wide resection is too sever as it causes neurologic sacrifices. A curettage through posterior approach preserves nerve function, and if a local recurrence occurs it remains possible to perform a wide resection. When sacroiliac joint instability is detected, a lumboiliac arthrodesis is indicated. Osteosynthesis could be performed with spine device (using pedicular and iliac screws).

Adult↗
PubMed1998

Long-term radiographic follow-up in a patient with osteosclerotic sarcoidosis of the spine and pelvis.

Eight-year clinical and radiographic data in a patient with sarcoidosis manifesting as pelvic and spinal osteosclerosis and as mediastinal lymphadenopathy are described, extending the initial report of this case written after three years of follow-up. The osteosclerotic lesions involved the right iliac and sacral wings, as well as two lumbar vertebras, which had an ivory appearance. There was also evidence of right sacroiliitis, pubic symphysitis and T7-T8 discitis. The diagnosis was established by bone and mediastinal lymph node biopsies. Follow-up was eight years at the time of this writing. The osteosclerotic lesions improved, disappearing almost completely at the lumbar spine, and fusion occurred at the right sacroiliac joint, pubic symphysis, and T7-T8 intervertebral disk. A review of the literature found 13 similar cases, with noticeably shorter follow-ups. The characteristics of axial osteosclerotic sarcoidosis are reviewed, and the indications of corticosteroid therapy are discussed.

Female↗
PubMed1998

[Air in the bone? Diagnosis and treatment of a pneumatocyst of the ilium. Apropos of a case].

We present a case of symptomatic pneumatocyst of the ilium observed in a professional scuba diver exposed to pressure variations. Pneumatocysts are rare and except for one case reported in a clavicular localization, are always found in subchondral bone of the iliac or sacral side of the sacroiliac joint. Undoubtedly, air fills an intraosseous node. We report here the first case of efficient treatment achieved by filling the cyst via percutaneous access under scopic control.

Adult↗