Anterior Superior Spine Research Articles

Ethnicity-related differences in inguinal canal dimensions between African and Caucasian populations and their potential impact on the mesh size for open and laparoscopic groin hernia repair in low-resource countries in Africa.

IntroductionAccess to surgery in Africa is significantly limited. Treatment outcomes in Africa differ significantly compared to those achieved in Europe or the US. Therefore, to popularise tension-free repair, it is essential to determine the economically justified mesh size for the African population.AimTo conduct anthropometric evaluation of the inguinal canal in African and European patients to determine its potential consequences for the mesh size for open and laparoscopic hernia repair.Material and methodsThe measurements were made in 44 adult males in Africa (group I) and were compared to measurements in 45 consecutive Caucasian males (group II). The mean age of patients was respectively 48.3 and 51.2 years.ResultsThere was no statistically significant difference in the internal ring diameter between groups (2.2 vs. 2.1 cm; p = 0.58). The distance between the pubic tubercle and the inferomedial border of the internal inguinal ring was significantly shorter in group I (3.8 vs. 5.1 cm; p < 0.001). A similar difference was found in the length of transverse arch aponeurosis (2.9 vs. 4.0 cm; p < 0.001). The distance between the pubic tubercle and anterior superior iliac spine in group I was approximately 2 cm shorter on each side (10.0 vs. 11.8 cm; p < 0.001).ConclusionsThe anatomical differences in inguinal dimensions between Central African and European populations support the potential need to adjust the standard size of synthetic mesh used for hernia repair to the needs of local populations. The significantly smaller dimensions of the inguinal canal in African males may allow the use of smaller meshes.

Distal major pedicle of sartorius muscle flap: Anatomical study and its clinical implications.

Background:Reconstruction of the popliteal region has limited option in terms of muscle flaps or myocutaneous flaps. Gastrocnemius muscle or the myocutaneous flaps are the option for majority of cases. However, reach of Gastrocnemius is limited if the wound is on the distal one-third thigh or the lateral aspect of knee region. Similarly, if the wound injures the muscle, then coverage becomes all the more difficult. Although inferiorly based fasciocutaneous flaps can cover the wound in case of bony injuries, muscle flaps are beneficial as they help in fracture healing. However, in cases with direct gastrocnemius muscle injury or if the wound on the distal one-third thigh or the lateral aspect then the options of muscle flaps is limited. An inferiorly based sartorius muscle can be one suitable alternative to cover this region.Aims and Objective:The aim is to devise an inferiorly based sartorius muscle flap for coverage of lower thigh, popliteal and upper one-third leg region.Objectives:(1) To identify the location of distal major (largest diameter) pedicle in cadavers and its clinical application. (2) To determine the arc of rotation with distal major pedicle as pivot point.Methods:Ten Cadavers and 20 sartorius muscle dissected out. Prior silicone injection onto the femoral vessels was done to identify the location of the perforators for the sartorius muscle. The distance of perforators from anterior superior iliac spine (ASIS) measured and the diameter of each perforator by transverse cut measured using callipers. In clinical cases, the arc of rotation was measured by keeping the distal perforator intact as pedicle (detaching the muscle from the ASIS without detaching from the insertion and then rotating it).Results:Out of the 10 cadavers analysed, 6 were male and 4 were female. The mean location of the distal major pedicle was at 35.25 cm from ASIS and range was between 30.4 cm to 38.3 cm. There was no significant variation between right and left limbs in individual cadaver (range 0.2 cm–1.6 cm). The mean diameter of the arterial component of distal major pedicle was 1.54 mm. In three clinical cases where this flap was harvested the arc of rotation were 95°, 110°, 125°. In one of the cases where flap was used to cover the tibial plateau (arc of rotation 155°), distal end of the muscle necrosed.Conclusion:This cadaver study supported by various other studies show that it has sizeable distal pedicle based on which whole muscle can be harvested as flap. In our study, the usual location of this pedicle is at 35 cm from ASIS. The mean diameter of the widest pedicle in distal one-third was 1.54 mm which along with other small diameter pedicle can support the entire muscle. This flap reached up to the infrapatellar region without any vascular compromise.

Positioning the Umbilicus in African Newborns with Large Anterior Abdominal Wall Defects.

Objective:We tried to determine the normal position of the umbilicus in African newborns with a potential application in aesthetically acceptable umbilical reconstruction.Subjects and Methods:The study involves a cross-sectional study of 896 healthy neonates who underwent clinical abdominal examination and measurement of the distances between the xiphoid process and the umbilicus (XU), xiphoid process and the pubis (XP), umbilicus and the pubis (UP), umbilicus and the anterior superior iliac spine (UASIS), abdominal girth (AG), and inter anterior superior iliac spines (IASIS) distance. The gestational age at delivery, age at measurement, sex, AG measured across the umbilicus, birth weight (BW), body length, and body mass index of the newborns were recorded. The measurements were used to determine the location of the umbilicus and Pearson's correlation analysis performed to determine the relationships of the recorded neonatal parameters with the measurements.Results:The mean XP was 11.97 ± 2.09 cm, XU = 7.94 ± 2.74 cm, UP = 4.26 ± 1.21 cm, UASIS = 5.79 ± 1.04 cm, and IASIS = 10.25 ± 1.54 cm. The BW, length, and AG significantly correlated with the distance between the XU, umbilicus and pubis, umbilicus and anterior superior iliac spine as well as the distance between the two anterior superior iliac spines.Conclusion:The position of the umbilicus is dependent on the selected participants' characteristics. We suggest that a UP: XU ratio of 0.55 should be used to position the umbilicus during umbilical reconstruction in African neonates.

Robotic lower pelvic port placement for optimal upper paraaortic lymph node dissection

ObjectiveUpper paraaortic lymph node dissection (UPALD) to the infrarenal level is one of the most challenging robotic procedures. Because robotic system has the limitation in robotic arm mobility. This surgical video introduces a novel robotic approach, lower pelvic port placement (LP3), to perform optimally and simultaneously both UPALD and pelvic procedures in gynecologic cancer patients using da Vinci Xi system.MethodsThe patient presented with high-grade endometrial cancer. She underwent robotic surgical staging operation. For the setup of the LP3, a line was drown between both anterior superior iliac spines. At 3 cm below this line, another line was drown and four robotic ports were placed on this line.ResultsAfter paraaortic lymph node dissection (PALD) was completed, the boom of robotic system was rotated 180° to retarget for the pelvic lateral displacement. Robotic ports were placed and docked again. The operation was completed robotically without any complication.ConclusionThe LP3 was feasible for performing simultaneously optimal PALD as well as procedures in pelvic cavity in gynecologic cancer patients. The advantage of LP3 technique is the robotic port placement that affords for multi-quadrant surgery, abdominal and pelvic dissection. The LP3 is facilitated by utilizing advanced technology of Xi system, including the patient clearance function, the rotating boom, and ‘port hopping’ that allows using every ports for a camera. The LP3 will enable surgeons to extend the surgical indication of robotic surgical system in the gynecologic oncologic field.

Muscle tone evaluation of the internal oblique muscle transverse fibers by measurement of the distance between the anterior superior iliac spines

Muscle tone evaluation of the internal oblique muscle transverse fibers by measurement of the distance between the anterior superior iliac spines

Apophyseal avulsion fractures of the pelvis. A review.

Background and aim of the work: Fractures of the pelvis classically occur in adolescent during sports activities with forceful and repetitive contractions or passive lengthening acting on not yet ossified growth plates. Their misdiagnosis lead to disability, chronic pain and decrease of performances. Evidence based treatment guidelines do not exist; aim of this paper is to point out clinical outcomes, return to sport rates and complications of surgical and conservative approach. Methods: A systematic search based on MEDLINE database was performed in August 2017 to identify all published articles from 2010 to 2017 reporting outcomes, return to sport and complications rates after surgical and non-operative treatment of avulsion fractures of the pelvis. Results: Mean age was 14,5 years with anterior inferior iliac spine avulsion representing the most common injury (46%), followed by anterior superior iliac spine avulsion (32%), ischial tuberosity avulsion (12%) and iliac crest avulsion (11%). Rates of excellent outcome and return to sports at pre-injury levels were higher after surgical treatment; surgery has a higher risk of heterotopic ossification (9%) compared to conservative treatment (1,8%), whereas the risk of non-unions is lower (0% versus 2,5%). Conclusions: Surgery is preferred for major dislocations and fragment sizes, providing a faster return to pre-injury level of activity, decreasing the risk of pseudoarthrosis. Conservative treatment is advisable for minimally displaced fractures when a rapid recovery is not required; patient and his family should be informed on the risk of non-unions and the eventuality of a delayed surgical approach. (www.actabiomedica.it)

For accurate placement of a socket navigation should be used. If not available, a socket should be placed with reference to bilateral anterior superior iliac spines of a patient in the supine position should be used for reference

For accurate placement of a socket navigation should be used. If not available, a socket should be placed with reference to bilateral anterior superior iliac spines of a patient in the supine position should be used for reference

Unique Duo of Clinical Variants of Calcinosis Cutis: Report of 2 Cases

Calcinosis cutis is a condition of calcium hydroxide deposition in the skin and subcutaneous tissue. Literature divides calcinosis in to 4 major types with description of sites and causes. But here we are reporting the unique presentation of calcinosis cutis in atypical presentation. Usually present over the surgical scar, keloid, periarticulararea, heel, as nodule [1]. Here our 1st patient is presenting with non specific whitish plaque bilaterally symmetrical over the face and 2nd patient present over anterior superior iliac spine with tender swelling. There were not much cases reported with calcinosis over these atypical sites. So this will be interesting cases to practitioners.

Operative treatment of pelvic apophyseal avulsions in adolescent and young adult athletes: a follow-up study.

Pelvic apophyseal avulsion can limit young athletes' performance for months and may result in permanent disability. Nonoperative treatment is most commonly preferred, while surgical management with reduction and fixation is reserved for selected cases. Our aim was to evaluate outcomes of operative management of pelvic apophyseal avulsions in a series of adolescents and young adult athletes. Operative room registries and medical records were reviewed to identify patients who received surgical treatment for pelvic apophyseal avulsions who were younger than 24years and with a minimum of 12month follow-up. Thirty-two patients (16.8years±2.6) were identified. The most common avulsion sites were anterior inferior iliac spine (34.4%, N=11) and ischial tuberosity (34.4%, N=11). Other avulsions were five cases (15.6%) of the pubic apophysis, four cases (12.5%) of the anterior superior iliac spine apophysis and one case of the iliac crest apophysis. Seventeen cases (53.1%) underwent surgery early, i.e., during the first 3months after the acute injury. Twenty-two cases (68.8%) involved reduction with internal fixation, and six cases (18.8%) involved resection of the fragment. Twenty-six athletes (81.3%, N=26) reported good outcomes and were able to return to preinjury sports level. Six patients (18.8%) had moderate outcome and reported activity limitations during high-level sports. Large displacement (>20mm) or delayed (>3months) surgery was not associated with inferior outcomes (P=0.690 and P=0.392, respectively). Injury side (P=0.61) or gender (P=0.345) did not affect outcomes. Operative management of pelvic apophyseal avulsion results in return to the preinjury sports level in more than 80% of the cases. However, while both acute surgery for large displacement and delayed intervention for failed nonoperative treatment are generally successful in improving sports function in these cases, comparative studies are required to refine criteria for surgery. Case series, IV.

Increased Anterior Column Exposure Using the Anterior Intrapelvic Approach Combined With an Anterior Superior Iliac Spine Osteotomy: A Cadaveric Study.

To determine whether the addition of an anterior superior iliac spine (ASIS) osteotomy to the lateral window, when combined with the anterior intrapelvic (AIP) surgical approach, would improve visualization of the iliopectineal eminence and allow for predictable and safe clamp application. Ten lateral window approaches to the iliac fossa were developed in conjunction with the AIP approach on 10 fresh-frozen cadaveric pelvi. A calibrated digital image was taken from the surgeon's optimal viewing angle to capture the visualized osseous surface of the false pelvis with emphasis on the iliopectineal eminence. An ASIS osteotomy was then performed and an additional calibrated image was obtained to identify any increased visualization of the iliopectineal eminence. Using ImageJ software (NIH, Bethesda, MD), the additional surface area afforded to the surgeon was calculated. An AIP approach was then performed to confirm complete exposure of the anterior column and whether a Weber clamp could safely be placed across the iliopectineal eminence. The lateral window, osteotomy, and AIP approach were successfully accomplished in all 10 specimens. Before performing an ASIS osteotomy, a mean of 20.3 cm (range: 14.5-25.6 cm) of the false pelvis adjacent to the pelvic brim was visualized. After completion of the osteotomy, the mean visualized surface area increased significantly to 28.4 cm (range: 14.6-45.6 cm) (P < 0.0168). Clamp placement through the lateral window was unsuccessful in all 10 specimens. After completion of the AIP approach, complete visualization of the iliopectineal eminence was confirmed and safe clamp application through the lateral window possible in all 10 specimens. ASIS osteotomy through the lateral window significantly improved visualization and access to the iliopectineal eminence in this cadaveric model, which suggests that it may be a suitable alternative to the traditional ilioinguinal approach for select fracture patterns when combined with an AIP approach.

Medial approach for minimally-invasive harvesting of a deep circumflex iliac artery flap for reconstruction of the jaw using virtual surgical planning and CAD/CAM technology

Donor site morbidity is the most common limitation of the deep circumflex iliac artery (DCIA) flap, so the purpose of this paper is to describe a new, minimally-invasive, approach to its harvest using virtual surgical planning and CAD/CAM technology to reduce functional and aesthetic morbidity at the donor site. Virtual surgical planning was based on preoperative computed tomographic data. A newly-designed surgical guide made using CAD/CAM technology was used to transfer the virtual surgical plan to the site of operation. This enabled us to raise a bicortical flap from the pelvis with preservation of the anterior superior iliac crest from the medial side with minimal muscular stripping. The guide, designed at slightly less than 90° to the lateral cortex, allowed the cut segment of bone to be raised medially. The new virtual surgical planning guide allowed a medial approach with reduced stripping of muscle and lower morbidity. No complications were encountered during the operation or the healing phase. Patients treated in this way had a shorter recovery period, with minimal complaints about walking or loss of profile of the hip. We conclude that virtual surgical planning can aid a minimally-invasive approach with predictable results. This allows a medial approach to the harvest of DCIA with preservation of important anatomical structures, and a reduction in donor site morbidity.

One-stage minimally invasive surgery for femoral and ipsilateral tibial plateau fractures with a rapid reductor

Objective To investigate the fixation sequence, key points and clinical value of a new minimally invasive surgery for one-stage treatment of femoral and ipsilateral tibial plateau fractures with a rapid reductor. Methods From October 2015 to January 2017, 5 patients with femoral and ipsilateral tibial plateau fractures received surgery at our department. They were 4 men and one woman, aged from 23 to 65 years (mean, 45.5 years). The femoral fractures were type A in 2 cases, type B in 2 cases and type C in one case according to AO/OTA classification. The tibial plateau fractures were type Ⅴ in 2 cases and type Ⅵ in 3 according to Schatzker classification. After the tibial plateau fractures were first fixated, Kirschner wires were inserted via the femoral condyle and distal tibia. A rapid reductor was used to reduce the tibial plateau and dual plates were implanted by percutaneous minimally invasive internal fixation. Then the same set of rapid reductor was used to treat femoral fractures by antegrade femoral nailing. The bone traction was completed via the femoral condyle and anterior superior iliac spine. The operative time, bone union time, knee functional recovery and hospital stay were recorded. Results The 5 patients were followed up for an average of 10 months (from 7 to 17 months). No delayed union, nonunion or malunion happened of either femoral or tibial plateau fractures. The healing time for femoral fractures ranged from 4 to 8 months, averaging 5.5 months; the union time for tibial plateau fractures ranged from 10 to 14 weeks, averaging 12.0 weeks. The knee flexion averaged 110° (from 95° to 130°). The overall functional recovery was rated as excellent in 2 cases and good in 3 according to the Karlstrom & Olerud criteria. The average hospital stay was 18 days(from 13 to 32 days). Conclusion Minimally invasive surgery with a rapid reductor can treat femoral and ipsilateral tibial plateau fractures at one stage, leading to fine functional recovery of the knee and greatly reduced hospital stay in particular. Key words: Femur; Tibia; Fractures fixation, internal; One stage; Minimally invasive

Three-axis displacement classification of pelvic fracture and its reduction principles

Based on images of pelvic CT three-dimensional reconstruction, to establish three-dimensional coordinate system of pelvis and investigate the three-axis displacement classification of pelvic fracture and its reduction principles. Between June 2015 and May 2016, 21 cases of normal pelvic CT data were included in the study, and the mean pelvic three-dimensional model was established. The pelvic three-dimensional axis was established by defining the origin as the midpoint of the anterior superior iliac spine. Based on this coordinate system, a three-axis displacement classification of pelvic fracture were built. To assess the clinical guidance value of the three-axis classification, 55 cases (29 males and 26 females, aged 11-66 years with an average of 35.6 years) of pelvic fractures were analyzed by this classification, and replaced and fixed according to the principles of the reverse reduction. According to the theory of three-axis, pelvic fractures were divided into x-axis positive displacement/negative displacement, positive rotation/negative rotation; y-axis positive displacement/negative displacement, positive rotation/negative rotation; z-axis positive displacement/negative displacement, positive rotation/negative rotation. The average incision of included patients with pelvic fractures was 7.1 cm. The average reduction time was 12.2 minutes and the average radiation time was 55.3 s. The average time of screw implantation was 27.2 minutes. Postoperative pelvic X-ray films or three-dimensional CT showed all pelvic fracture was reducted well and the screw or plate was implanted correctly. The average intraoperative blood loss was 96.5 mL, the average operation time was 2.1 hours, and the average hospitalization time was 18.7 days. All patients were followed up 6-53 months (mean, 16.7 months). At last follow-up, according to Matta standard by pelvic radiography evaluation, there were excellent in 39 cases, good in 13 cases, and fair in 3 cases, the excellent and good rate was 94.55%. Based on three-dimensional coordinate system, three-axis displacement classification of pelvic fracture can illustrate the displacement mode of patient simply and accurately, and can also guide the intraoperative reduction precisely.

The deep layer of the tractus iliotibialis and its relevance when using the direct anterior approach in total hip arthroplasty: a cadaver study

IntroductionSurgical approaches through smaller incisions reveal less of the underlying anatomy, and therefore, detailed knowledge of the local anatomy and its variations is important in minimally invasive surgery. The aim of this study was to determine the location, extension, and histomorphology of the deep layer of the iliotibial band during minimally invasive hip surgery using the direct anterior approach (DAA).Materials and methodsThe morphology of the iliotibial tract was determined in this cadaver study on 40 hips with reference to the anterior superior iliac spine and the tibia. The deep layer of the tractus iliotibialis was exposed up to the hip-joint capsule and length and width measurements taken. Sections of the profound iliotibial tract were removed from the hips and the thickness of the sections was determined microscopically after staining.ResultsThe superficial tractus iliotibialis had a length of 50.1 (SD 3.8) cm, while tensor fasciae latae total length was 18 (SD 2) cm [unattached 15 (SD 2.5) cm]. Length and width of the deep layer of the tractus iliotibialis were 10.4 (SD 1.3) × 3.3 (SD 0.6) cm. The deep iliotibial band always extended from the distal part of the tensor fascia latae (TFL) muscle to the lateral part of the hip capsule (mean maximum thickness 584 μm). Tractus iliotibialis deep layer morphology did not correlate to other measurements taken (body length, thigh length, and TFL length).ConclusionsThe length of the deep layer is dependent on the TFL, since the profound part of the iliotibial band reaches from the TFL to the hip-joint capsule. The deep layer covers the hip-joint capsule, rectus, and lateral vastus muscles in the DAA interval. To access the precapsular fat pad and the hip-joint capsule, the deep layer has to be split in all approaches that use the direct anterior interval.

Verification of an improved hip joint center prediction method

In motion analysis, the hip joint center (HJC) is used to define the proximal location of the thigh segment and is also the point about which hip moments are calculated. The HJC cannot be palpated; its location must be calculated. Functional methods have been proposed but are difficult to perform by some clinical populations. Therefore, regression methods are utilized, but yield large errors in estimating the HJC location. These prediction methods typically utilize the anterior and posterior superior iliac spines, where excessive adipose tissue makes correctly locating difficult. A new regression method (Hara) utilizes leg length and has been shown to improve HJC location in cadavers and less error than previous pelvic based regression methods, such as those proposed by Harrington et al. This study compared the accuracy of the HJC location calculated with both of the Harrington methods and the Hara method. The coronal knee angle was calculated for each method using a static motion analysis trial, and compared to the tibiofemoral angle measured on a gold standard digital full-leg coronal radiograph. This study demonstrated that the Hara method was more accurate than either of the Harrington methods. The mean error between the gold standard x-ray measurement and the motion analysis calculation for the Harrington (stepwise and LOOCV), the Harrington (linear regression), and Hara regression methods, respectively were 6.0°, 4.0°, and 1.8°. Accurately modeling the HJC is critical for data interpretation and patient care. This study confirmed that the Hara HJC regression method is valid in an in-vivo setting.

Numerical expression of volume status using the bioimpedance ratio in continuous ambulatory peritoneal dialysis patients: A pilot study.

BackgroundVolume overload results in higher mortality rates in patients on continuous ambulatory peritoneal dialysis (CAPD). The ratio of bioimpedance (RBI) might be a helpful parameter in adjusting dry body weight in CAPD patients. This study examined whether it is possible to distinguish between non-hypervolemic status and hypervolemic status in CAPD patients by using only RBI.MethodsRBI was calculated as follows: RBI = impedance at 50 kHz/impedance at 500 kHz. Based on the experts’ judgements, a total of 64 CAPD patients were divided into two groups, a non-hypervolemic group and a hypervolemic group. The RBI was measured from right wrist to right ankle (rw-raRBI) by bioimpedance spectroscopy (BCM®, Fresenius Medical Care) before and after the peritosol was emptied. Other RBIs were measured from the right side of the anterior superior iliac spine to the ipsilateral ankle (rasis-raRBI) to control for the electro-physiological effects of peritoneal dialysate.ResultsThe mean rw-raRBI of non-hypervolemic patients was higher than that of hypervolemic patients in the presence (1.141 ± 0.022 vs. 1.121 ± 0.021, P < 0.001) of a peritosol. Likewise, the mean rasis-raRBI of non-hypervolemic patients was higher than that of hypervolemic patients (presence of peritosol: 1.136 ± 0.026 vs. 1.109 ± 0.022, P < 0.001; absence of peritosol: 1.131 ± 0.022 vs. 1.107 ± 0.022, P < 0.001).ConclusionThe volume status of CAPD patients was able to be simply expressed by RBI. Therefore, this study suggests that when patients cannot be analyzed using BCM, RBI could be an alternative.

Clinical Implications of Hand Position and Lower Limb Length Measurement Method on Y-Balance Test Scores and Interpretations.

The Lower Quarter Y-Balance Test (LQ-YBT) was developed to provide an effective and efficient screen for injury risk in sports. Earlier protocol recommendations for the LQ-YBT involved the athlete placing the hands on the hips and the clinician normalizing scores to lower limb length measured from the anterior-superior iliac spine to the lateral malleolus. The updated LQ-YBT protocol recommends the athlete's hands be free moving and the clinician measure lower limb length to the medial malleolus. To investigate the effect of hand position and lower limb length measurement method on LQ-YBT scores and their interpretation. Cross-sectional study. National Sports Institute of Malaysia. A total of 46 volunteers, consisting of 23 men (age = 25.7 ± 4.6 years, height = 1.70 ± 0.05 m, mass = 69.3 ± 9.2 kg) and 23 women (age = 23.5 ± 2.5 years, height = 1.59 ± 0.07 m, mass = 55.7 ± 10.6 kg). Participants performed the LQ-YBT with hands on hips and hands free to move on both lower limbs. In a single-legged stance, participants reached with the contralateral limb in each of the anterior, posteromedial, and posterolateral directions 3 times. Maximal reach distances in each direction were normalized to lower limb length measured from the anterior-superior iliac spine to the lateral and medial malleoli. Composite scores (average of the 3 normalized reach distances) and anterior-reach differences (in raw units) were extracted and used to identify participants at risk for injury (ie, anterior-reach difference ≥4 cm or composite score ≤94%). Data were analyzed using paired t tests, Fisher exact tests, and magnitude-based inferences (effect size [ES], ±90% confidence limits [CLs]). Differences between hand positions in normalized anterior-reach distances were trivial (t91 = -2.075, P = .041; ES = 0.12, 90% CL = ±0.10). In contrast, reach distances were greater when the hands moved freely for the normalized posteromedial (t91 = -6.404, P < .001; ES = 0.42, 90% CL = ±0.11), posterolateral (t91 = -6.052, P < .001; ES = 0.58, 90% CL = ±0.16), and composite (t91 = -7.296, P < .001; ES = 0.47, 90% CL = ±0.11) scores. A similar proportion of the cohort was classified as at risk with the hands on the hips (35% [n = 16]) and the hands free to move (43% [n = 20]; P = .52). However, the participants classified as at risk with the hands on the hips were not all categorized as at risk with the hands free to move and vice versa. The lower limb length measurement method exerted trivial effects on LQ-YBT outcomes. Hand position exerted nontrivial effects on LQ-YBT outcomes and interpretation, whereas the lower limb length measurement method had trivial effects.

Can Anatomic Measurements of Stem Anteversion Angle Be Considered as the Functional Anteversion Angle?

BackgroundStem anteversion angle is important in the combined anteversion theory to avoid implant impingement after total hip arthroplasty (THA). However, anatomic measurements of stem anteversion angle may not represent functional anteversion of the femur if the femur undergoes axial rotation. Herein, the femoral rotational angle (FRA) was measured in supine and standing positions before and after THA to evaluate the difference between anatomic and functional measurements. MethodsA total of 191 hips (174 patients) treated with THA for osteoarthritis were analyzed in this retrospective, case-controlled study. The FRA was measured as the angle between the posterior condylar line and the line through the bilateral anterior superior iliac spines (positive for external rotation) and was measured preoperatively and postoperatively in supine and standing positions with computed tomography segmentation and landmark localization of the pelvis and the femur followed by intensity-based 2D-3D registration. The number of cases in which the absolute FRA remained <15° in both positions was also calculated. ResultsThe average ± standard deviation preoperative FRA was 0.3° ± 8.3° in the supine position and −4.5° ± 8.8° during standing; the postoperative FRA was −3.8° ± 9.0° in supine and −14.3° ± 8.3° during standing. There were 134 cases (70%) in which the preoperative absolute FRA remained <15° in both positions while only 85 hips (45%) remained <15°, postoperatively. ConclusionSubstantial variability was seen in the FRA, especially during the postoperative period. These results suggest that the anatomic stem anteversion angle may not represent the functional anteversion of the femur.

Redefining the abdominal seatbelt sign: Enhanced CT imaging metrics improve injury prediction

IntroductionThe abdominal seatbelt sign (ASBS) has an established association with abdominal injury, yet its definition remains ill-defined. We hypothesize specific imaging characteristics associated with the ASBS such as location above the pelvic brim and depth of abdominal wall contusion would better predict underlying injury and need for operative intervention. MethodsWe performed a retrospective chart review of subjects suffering from restrained motor vehicle collisions (MVC) evaluated at a level one trauma facility from 2010 to 2015. CT imaging was reviewed for the presence of a transverse abdominal wall contusion consistent with lap belt use. Contusion location was determined in relation to the anterior superior iliac spine (ASIS). Abdominal wall thickness as well as contusion depth were measured at the contusion level and an abdominal seatbelt sign depth index (ASBSI) was calculated. ResultsSample size for the cohort was 551 subjects. Operative need was 19.73% in those with ASBS on CT (CT ASBS) above the ASIS and 4.05% (p-value < 0.01) in those with only clinical evidence of ASBS (CL ASBS). CT ASBS above the ASIS was associated with higher incidence of intra-abdominal injuries (31.97% vs 16.45%; p = 0.01) and a higher rate of abdominal operations (19.73% vs. 7.59%; p < 0.01) compared to below the ASIS. In contrast, CT ASBS below the ASIS was associated with a higher incidence of pelvic fractures (17.72% vs. 8.16%; p = 0.01) with fractures being an independent risk factor for abdominal injury requiring intervention. Logistic regression analyses and receiver-operator characteristic curves demonstrated ASBSI was significantly associated with abdominal injury requiring operative intervention. ConclusionCharacteristics of abdominal wall injury on imaging such as location and contusion depth (ASBSI) are better predictors of abdominal operative need than standard clinical measures. This analysis substantiates a novel diagnostic tool which may have the potential to facilitate clinical diagnosis and management decisions in patients with abdominal seatbelt sign.

Abstract: A Study on the Length of Flap in the Thigh for Abdominal Wall Reconstruction

INTRODUCTION: A pedicled or free tissue thigh flap has been used for large abdominal wall defect reconstruction.1, 2 Anterolateral thigh flaps, tensor fascia lata musculocutaneous flaps, and their combination are reliable and are often used.3, 4 Despite the reported efficacy, it is unclear how large an abdominal defect can be closed with a single thigh flap. The objective of this study was to compare the length of the abdomen and thigh, and to determine whether a thigh flap is suitable for all abdominal wall reconstruction procedures. METHODS: A total of 100 adult Japanese subjects (men: 50, women: 50) with no medical history of musculoskeletal disease or injury were recruited. The length from the xiphoid process to the pubic tubercle was defined as the length of the abdomen (AL). The length of the thigh (TL) was defined as the distance from the anterior superior iliac spine to the upper lateral edge of the ipsilateral patella. The height of each subject and the difference between the TL and AL (TL – AL) were recorded. Statistical analysis was performed. RESULTS: The average age was 42.6 years in men and 41.8 years in women. The average height and standard deviation was 172.65 ± 6.53 cm in men and 158.00 ± 5.14 cm in women. The averages and standard deviations of the TL, AL, and TL – AL were 45.26 ± 3.20 cm, 32.70 ± 2.78 cm, and 12.57 ± 3.73 cm in men, and 40..82 ± 1.68 cm, 32.69 ± 2.93 cm, and 7.91 ± 3.17 cm in women, respectively. The height showed no correlation with AL in female subjects. AL showed no correlation between the male and female subjects. A height of less than 170 cm in males showed a clear correlation with TL – AL. CONCLUSION: Since the TL was larger than the AL in all subjects, a thigh flap is suitable for abdominal wall reconstruction in most cases. AL was consistent according to height in female subjects. In female and male subjects less than 170 cm in height, the thigh flap may be too short for abdominal wall reconstruction. Reference Citations: 1. Kimata Y, Uchiyama K, Sekido M, et al. Anterolateral thigh flap for abdominal wall reconstruction. Plast Reconstr Surg. 1999; 103: 1191–1197. 2. Williams JK, Carlson GW, Howell RL, Wagner JD. The tensor fascia lata free flap in abdominal-wall reconstruction. J Reconstr Microsurg. 1997; 13: 83–90. 3. Lv Y, Cao D, Guo F, Qian Y. Abdominal wall reconstruction using a combination of free tensor fasciae lata and anterolateral thigh myocutaneous flap: a prospective study in 16 patients. Am J Surg. 2015; 210: 365–373. 4. Sasaki K, Nozaki K, Nakazawa H, Kukuchi Y. Reconstruction of a large abdominal wall defect using combined free tensor fasciae lata musculocutaneous flap and anterolateral thigh flap. Plast Reconstr Surg. 1998; 102: 2244–2252.