Iliac Spine Research Articles

1071 Initial Experience Using an Augmented Reality Head-Mounted Display System During Surgical Management of Thoracolumbar Spinal Trauma

INTRODUCTION: Advancements in trauma medicine can improve the speed and accuracy of care response with a major impact on downstream operative outcomes. Augmented reality using a head-mounted-display (AR-HMD) is a novel technology that may be applied to spine surgery to provide surgeons with a real-time CT-guided 3-dimensional reconstruction of a patient’s spinal anatomy. METHODS: We retrospectively reviewed trauma patients who underwent pedicle screw placement guided by AR-HMD or robotic-assisted platforms at an academic tertiary care center between January 1, 2021 and December 31, 2022. Demographic, clinical, cost, and perioperative outcome information was analyzed and outcome profiles were compared using a U test. RESULTS: The AR cohort (4 females, 5 males) had a mean age of 66.0 years, BMI of 29.4 kg/m2, Charlson Comorbidity Index (CCI) of 4.11, and Surgical Invasiveness Index (SII) of 8.78. Pedicle screws (77) were placed in the thoracic (51%), lumbar (39%), and sacral spine (10%). Intraoperatively, there was a mean blood loss of 377.78 ml, 0.78 units transfused, 398.33 minutes spent in the operating room, and a 20.00 day LOS. The average 3-month, 6-month, and 12-month ODI scores were 14.25 (n = 8), 15.40 (n = 5), and 12.66 (n = 3). The robotic cohort (5 females, 8 males) had a mean age of 55.6 years, BMI of 27.1 kg/m2, CCI of 3.77, and SII of 14.23. Pedicle screws (128) were placed in the thoracic (59%), lumbar (37%), sacral spine (2%), iliac spine (2%), and pelvis (2%). Intra-operatively, there was a mean blood loss of 431.54 ml, 0.46 units transfused, 330.61 minutes spent in the operating room, and a 10.38 day LOS. The average 3-month, 6-month, and 12-month ODI scores were 22.67 (n = 9), 18.60 (n = 5), and 29.50 (n = 2). CONCLUSIONS: This case series demonstrates the utility of AR-HMD in surgical spinal trauma cases by showing operative outcomes comparable to those observed in robotic-assisted surgery.

Free iliac crest grafting technology for the management of critical-sized tibial bone defect

ObjectiveTo introduce the method and experience of treating critical-sized tibial bone defect by taking large iliac crest bone graft.MethodsFrom January 2020 to January 2022, iliac crest bone grafting was performed in 20 patients (10 men and 10 women) with critical-sized tibial bone defect. The mean length of bone defect was 13.59 ± 3.41. Bilateral iliac crest grafts were harvested, including the inner and outer plates of the iliac crest and iliac spine. The cortical bone screw was used to integrate two iliac bone blocks into one complex. Locking plate was used to fix the graft-host complex, supplemented with reconstruction plate to increase stability when necessary. Bone healing was evaluated by cortical bone fusion on radiographs at follow-up, iliac pain was assessed by VAS score, and lower limb function was assessed by ODI score. Complications were also taken into consideration.ResultsThe average follow-up time was 27.4 ± 5.6 (Range 24–33 months), the mean VAS score was 8.8 ± 1.9, the mean ODI score was 11.1 ± 1.8, and the number of cortical bone fusion in the bone graft area was 3.5 ± 0.5. Satisfactory fusion was obtained in all cases of iliac bone transplant-host site. No nonunion, shift or fracture was found in all cases. No infection and bone resorption were observed that need secondary surgery. One patient had dorsiflexion weakness of the great toe. Hypoesthesia of the dorsal foot was observed in 2 patients. Ankle stiffness and edema occurred in 3 patients. Complications were significantly improved by physical therapy and rehabilitation training.ConclusionFor the cases of critical-sized tibial bone defect, the treatment methods are various. In this paper, we have obtained satisfactory results by using large iliac bone graft to treat bone defect. This approach can not only restore the integrity of the tibia, but also obtain good stability with internal fixation, and operation skills are more acceptable for surgeons. Therefore, it provides an alternative surgical method for clinicians.

Anatomical leg length discrepancy in children: Can it be accurately determined using 3-D motion capturing?

BackgroundLeg length discrepancy (LLD) is common in youth and is cause by several conditions. Long leg X-rays is the gold standard technique of measuring LLD. It is highly accurate and reliable compared to clinical method, but expose the subject to radiation. Instrumented Gait Analysis (IGA) serves not only as a means to measure joint kinematics during gait but also as a valuable tool for assessing Leg Length Discrepancy (LLD) while standing.Research Question.The purpose of this study was to compare different methods of determining the LLD in paediatric population. We hypothesize that IGA using joint centres is more accurate and precise than the tape measurement. MethodsThirty-one patients with mean age 12.3 (SD=2.4) years were retrospectively included in the study. Their LLD varied between 0 and 36 mm. Three methods for determining LLD were compared to radiography using Bland-Altman analysis: 1. Tape measurement, 2. IGA, summarizing the distance from the spina iliaca anterior superior to the medial malleolus marker via the medial knee condyle marker. 3. IGA, summarizing distances between ankle, knee, and hip joints centres where the latter is calculated with different equations. ResultsThe IGA joints method performed better than the tape measurement or IGA markers method. The equations of Davis calculating the hip joint centre had the highest accuracy with mean difference to radiography of 0.7 mm (SD=6.3). The simple Harrington method resulted in a slightly reduced accuracy but higher precision 0.9 mm (SD=6.2). The Harrington method with leg length as input was less accurate 1.0 mm (SD=6.7), but was still considerably better than the tape measurement 1.8 mm (SD=7.0) or IGA markers method 1.1 mm (SD=11.5).Significance.Determining LLD with IGA using the distances between ankle, knee and hip joints centres is a feasible method that can be applied in clinical practice to calculate LLD.

Deep Circumflex Iliac Artery-vascularized Iliac Bone Graft for Femoral Head Osteonecrosis: Computed Tomography Anatomical Study.

Deep circumflex iliac artery (DCIA)-vascularized iliac graft transposition is a method for treating femoral head osteonecrosis but with inconsistent efficacy. We aim to improve the method of this surgery by recommending the optimal location of the iliac pedicle to satisfy the vascular length for transposition and the blood supply of the vascularized iliac graft. The DCIA and its surrounding tissues were assessed on computed tomography angiography images for 100 sides (left and right) of 50 patients. The length of the vascular pedicle required for transposition and the length of the pedicle at different iliac spine positions were compared. The diameter and cross-sectional area of the DCIA and the distance between the DCIA and iliac spine were measured at different points to assess blood supply. We also compared differences in sex and left-right position. The diameter and cross-sectional area of the DCIA gradually decreased after crossing the anterior superior iliac spine (ASIS), and it approached the iliac bone. However, when the DCIA was 4 cm behind the ASIS (54 sides, 54%), it coursed posteriorly and superiorly away from the iliac spine. The vascular length of the pedicle was insufficient to transpose the vascularized iliac graft to the desired position when it was within 1 cm of the ASIS. The vascular length requirement was satisfied, and the blood supply was sufficient when the pedicle was positioned at 2 or 3 cm. To obtain a satisfactory pedicle length and sufficient blood supply, the DCIA pedicle of the vascularized iliac graft should be placed 2 to 3 cm behind the ASIS. The dissection of DCIA has slight differences in sex and left-right position due to anatomical differences.

V-002 Robotic suprapubic eTEP retrorectus repair for incisional hernia

Abstract Aim A retrorectus mesh position is often considered the most suitable for the repair of a midline incisional hernia. The minimal invasive extraperitoneal approach is gaining popularity. Material & Methods A 56-year-old female patient, who had a laparoscopic deroofing of a bile cyst in her history, presented with an incisional midline hernia (EHS M2-M3, width 6.6 cm). Preoperative optimization via dietary instructions reduced her BMI from 40 kg/m2 to a BMI of 35 kg/m2. Results A robotic extraperitoneal approach via suprapubic docking was performed. The patient is positioned supine and flexed for 15° at the level of the spina iliaca. An intraperitoneal trocar is placed to explore the abdomen for adhesions. Three trocars are placed in the suprapubic position in the extraperitoneal plane whereafter the robot is docked. A dissection in the cranial direction is performed in the retrorectus plane by incising both posterior rectus fascia in a symmetric way. A preperitoneal plane behind the linea alba is created. At the level of the hernia defect the hernia sac is opened, and adhesions are freed. Once the retrorectus space is dissected up to the xyphoid, the linea alba is reconstructed with a barbed suture size 0. A self-fixating mesh is placed in the retrorectus position. The posterior layer of the peritoneum is closed. The postoperative course was uneventful. Conclusions We present an extraperitoneal minimal invasive approach to the retrorectus plane allowing for an adequate retrorectus dissection and mesh placement like in a classical Rives-Stoppa repair.

Acupuncture relieves pain by inhibiting expression of Cx43 in astrocytes and release of interfe-ron-γ in neurons of trigeminal spinal nucleus in rats with migraine

To observe the effect of acupuncture on the expression of connexin 43 (Cx43), glial fibrillary acidic protein (GFAP), interferon-γ (IFN-γ) in the trigeminal spinal nucleus (TNC) of rats with migraine, so as to explore its mechanisms underlying amelioration of migraine. A total of 44 SD rats were randomly divided into control, model, acu-puncture, and sham acupuncture groups (n=11 in each group). Acupuncture was applied to bilateral "Shuaigu"(GB8) and "Yanglingquan"(GB34) or non-acupoint Ⅰ (the spot about 10 mm superior to the iliac spine and 20 mm lateral to the post-median line) and non-acupoint Ⅱ (behind the iliac spine, the ending-spot of the posterior superior iliac spine at the muscles) on both sides for 20 min, once daily for 9 days. Paw withdrawal latency (mechanical pain threshold,PWMT) and thermal tail flick latency (TFL) were measured using a VonFrey detector and photothermal tail pain meter, respectively. The content of IFN-γ of TNC tissue was detected by ELISA. The expression levels of Cx43 and IFN-γ proteins of TNC tissue were detected by Western blot. The immunofluorescence dual labeling method was used to detect the positive expression of GFAP and Cx43, IFN-γR and NeuN in TNC tissue, for displaying the activity of Cx43 in astrocytes and IFN-γ in neurons, respectively. Compared with the control group, both PWMT and TFL at 3, 5, 7 and 9 days after modeling were significantly decreased (P<0.01), while the expression of Cx43 and IFN-γ proteins, the immunofluorescence intensity of GFAP, Cx43, IFN-γR, and the content of IFN-γ were considerably up-regulated in the model group (P<0.01). In comparison with the model group, both PWMT and TFL at 3, 5, 7 and 9 days after modeling were obviously increased (P<0.01), whereas the expression of Cx43 and IFN-γ proteins, the immunofluorescence intensity of GFAP, Cx43, IFN-γR, and the content of IFN-γ in the acupuncture group, as well as the protein expression of IFN-γR in the sham acupuncture group were also remarkably decreased (P<0.05, P<0.01). The effect of acupuncture was significantly superior to that of sham acupuncture in down-regulating the expression of Cx43 and IFN-γ proteins, and the immunofluorescence intensity of GFAP, Cx43, and IFN-γR (P<0.05, P<0.01). Immunofluorescence dual labeling outcomes showed that in the model group, a large number of GFAP and Cx43 co-expressed astrocytes were found, and the cell body and protrusion of GFAP-labelled astrocytes were evidently increased, and Cx43 was mainly expressed on the surface of astrocyte membrane and the protrusion site, and the proportion of IFN-γR and NeuN co-expressing neurons in the model group was significantly increased, suggesting an activation of astrocytes and neurons after modeling. Whereas in the acupuncture group, the bright green clustered particles on the cell membrane and protrusion of astrocytes, and the proportion of IFN-γR and NeuN co-expressing neurons were significantly reduced, suggesting a suppression of activities of Cx43, astrocytes and neurons and IFN-γ release from TNC after acupuncture intervention. Acupuncture can relieve the pain response in rats with migraine, which may be associa-ted with its functions in inhibiting the expression of Cx43 and activation of astrocytes and neurons, and reducing release of pro-inflammatory factor IFN-γ in TNC.

APOPHYSEAL AVULSION FRACTURES OF ANTERIOR INFERIOR ILIAC SPINE

We aim to present diagnostic approach and results from surgical treatment in avulsion fractures of the apophysis of Spina Iliaca Anterior Inferior (SIAI).&#x0D; Material and methods. During the period 2011 – 2021, seven(7) children with acute traumatic apophysiolysis of SIAI, were operated on, 61 A1.2 fracture by AO/OTA classification. All of the patients are boys with average age 14,1±1,35 years. In all cases the right SIAI is affected and the mechanism of the injury is sports trauma. The diagnostic methods used by us are complete orthopedic clinical examination, AP radiographs of the pelvis and lateral radiographic projections of the hip joint by modified Dunlap technique and also CT scan with 3D reconstruction of the pelvic bones (3cases). In four (4) cases the apophysiolyses are Salter-Harris type I and in three cases – SH type II. The average size of the avulsed bone fragment is 3cm/1cm measured on CT scan and 29,66±3,14 mm on AP radiographic view. Dislocation of the fractured fragment is greater than 1,5cm. In four children the diagnosis from the outpatient care is neglected or primary wrong. This fact procrastinated the treatment for between 15 and 30 days. In the rest of the cases the treatment is prompt in an urgent matter. For all patients open reduction and internal fixation with screw osteosynthesis is performed by using one (4 cases) or two (2 cases) 3,5mm cannulated titanium screws. Consolidation of the fracture and the functional condition by Lower Extremity Functional Scale (LEFS) have been followed.&#x0D;

A computer vision-based mobile tool for assessing human posture: A validation study

Background and Objective: Non-invasive methods for postural assessment are tools used for tracking and monitoring the progression of postural deviations. Different computer-based methods have been used to assess human posture, including mobile applications based on images and sensors. However, such solutions still require manual identification of anatomical points. This study aims to present and validate the NLMeasurer, a mobile application for postural assessment. This application takes advantage of the PoseNet, a solution based on computer vision and machine learning used to estimate human pose and identify anatomical points. From the identified points, NLMeasurer calculates postural measures. Methods: Twenty participants were photographed in front view while using surface markers over anatomical landmarks. Then, the surface markers were removed, and new photos were taken. The photos were analyzed by two examiners, and six postural measurements were computed with NLMeasurer and a validated biophotogrammetry software. One-sample t-test and Bland Altman procedure were used to assess agreement between the methods, and Intraclass Correlation Coefficient (ICC) was used to assess inter- and intra-rater reliability. Results: Postural measurements calculated using the NLMeasurer were in agreement with the biophotogrammetry software. Furthermore, there was good inter- and intra-rater reliability for most photos without surface markers. Conclusions: NLMeasurer demonstrated to be a valid tool method to assess postural measurements in the frontal view. The use of surface markers on specific anatomical landmarks (i.e., ears, iliac spines and ankles) can facilitate the digital identification of these landmarks and improve the reliability of the postural measurements performed with NLMeasurer.

Comparison of USG-guided or landmark approach fascia iliaca compartment block for positioning in elderly hip fracture patients with spinal anesthesia: a randomized controlled observational study.

Currently, the elderly population in the world is rapidly increasing due to technological developments and convenient access to health services. Due to comorbidities in elderly patients, hip fractures are frequently observed after exposure to environmental trauma. To reduce pain during positioning in spinal anesthesia, fascia iliaca compartment block (FICB) can be applied easily and reliably. In our study, we aimed to compare the analgesic effects and duration of fascia iliaca compartment blocks performed with USG guidance or the landmark approach methods for relieving spinal anesthesia position pain. Our study included 100 patients undergoing operations due to hip fracture and administered spinal anesthesia after FICB. The group with USG-guided FICB (USG) had the blockage needle advanced to the compartment under the fascia iliaca, and 15 mL bupivacaine + 10 mL 2% lidocaine was administered. They were placed in sitting position for spinal anesthesia 20 min later and procedure duration and numerical rating scale (NRS) scores were recorded. In the group with landmark approach FICB (LAND), the spina iliaca anterior superior (SIAS) and pubic tubercle were connected with a line. The same amount of local anesthetic was administered to the external 1/3 portion of this line with the double pop technique. Procedure duration and NRS scores were recorded. There was no statistically significant difference between the two groups in terms of NRS scores (p: 0.073). There was a statistically significant difference in duration of FICB administration between the two groups (p < 0.001). Both USG-guided and landmark approach FICB methods provide adequate and similar analgesia for positioning in spinal anesthesia. However, in cases where there is no problem with access to the ultrasound device or time, safer blockage can be provided by imaging neurovascular structures with ultrasound.

Вплив болю на функцію м’язів-стабілізаторів крижово-клубового суглоба в пацієнтів із дисфункцією цього суглоба

Мета: вивчити вплив сторони локалізації болю на біоелектричну активність (БЕА) м’язів, що забезпечують стабільність крижово­клубового суглоба (ККС) під час утримування вертикальної пози при двохопорному й одноопорному стоянні у хворих із дисфункцією ККС залежно від рентгенометричних параметрів крижів та таза. Матеріали та методи. Було досліджено 50 пацієнтів із дисфункцією ККС. Критеріями включення були: локалізація болі в ділянці posterior spinae iliaca superior, що іррадіює в пах, сідниці та стегно; анамнез болю більше ніж 3 місяці; безуспішність попереднього консервативного лікування; позитивні мінімум 4 із 6 провокаційних тестів. Критерієм виключення була наявність тільки 1 або 2 позитивних провокаційних тестів. Пацієнтам проводили електроміографічне дослідження м’язів, підтримуючих стабільність ККС при двохопорному та одноопорному стоянні (Stork тест). Усі пацієнти були обстежені рентгенологічно. На отриманих рентгенограмах вимірювали: кут нахилу краніальної пластинки крижі; кут нахилу таза; кут ротації крижі; ширину суглобових щілин крижово­клубового суглоба в трьох відділах: вентральному, медіальному та дорсальному. Отримані результати були оброблені статистично. Результати. У результаті кластерного аналізу рентгенометричних параметрів всі пацієнти були розподілені на 4 кластери. У пацієнтів 1­го рентгенометричного кластера при двохопорному стоянні було підвищення біоелектричної активності m. Obliques abdominis externus на стороні, контрлатеральній стороні локалізації болю. У положенні стоячи на одній нозі при локалізації болю на опорній стороні це викликало підвищення БЕА m. Gluteus medius на контрлатеральній стороні. БЕА m. Biceps femoris, m. Rectus femoris підвищувалась на стороні локалізації болю. У пацієнтів 2­го кластера вірогідно змінилась БЕА m. Erector spinae, m. Gluteus medius. Локалізація болю на опорній стороні вірогідно підвищує БЕА цих м’язів на цій стороні. Висновки. БЕА м’язів­стабілізаторів ККС і вертикального положення залежала від сторони локалізації болю в пацієнтів із дисфункцією ККС найбільш сприятливих 1­го та 2­го рентгенометричних кластерів. Локалізація болю вірогідно впливала на показники БЕА m. Obliquus abdominis externus, m.m. Gluteus medius, m. Biceps femoris, m. Rectus femoris у пацієнтів 1­го рентгенометричного кластера и m. Gluteus, m. Erector spinae в пацієнтів 2­го рентгенометричного кластера. У всіх пацієнтів була асиметрична рухомість ККС. БЕА м’язів­стабілізаторів ККС и вертикального положення не залежала від сторони локалізації болю в пацієнтів із дисфункцією ККС найбільш несприятливих 3­го і 4­го рентгенометричних кластерів.

MRI Assessment of Extra-axial Findings at Pelvic Sites in a Group of Axial-SpA Patients.

IntroductionMRI allows a better evaluation of inflammatory and structural lesions of the sacroiliac joints and spine in patients with axial spondyloarthritis (axial SpA), so MRI plays an important role in the classification and diagnosis of axial SpA. The aim of our study was to assess extra-axial MRI findings at pelvic sites and their possible associations with clinical indices in patients with axial SpA.MethodsAxial-SpA patients who were classified according to the ASAS criteria and consecutively attended our clinic were assessed with pelvic MRI. The main clinical and demographic characteristics of all patients, including age, sex, BMI, presence of HLA-B27 and type of axial SpA (radiographic or nonradiographic), were evaluated. The main indices of disease activity and joint function were assessed, including BASDAI, ASDAS-PCR, BASMI and BASFI. Finally, the presence/absence of inflammatory/structural lesions at extra-axial structures (the hip joints, pubic symphysis, greater and lesser trochanters, ischial tuberosity, iliac spines and iliac crest) was evaluated.Results35 patients (21 males and 14 females) with a mean age (SD) of 47 (12.7) years and a mean duration of symptoms of 5 (2.1) years were enrolled. Hip abnormalities were found in 14 (40%) patients. Trochanteric enthesopathy/bursitis and pubic osteitis were found in 2 patients (5.7%) and 1 patient (2.8%), respectively. No other abnormalities were found at other sites. We found significant associations between the presence of extra-axial alterations, disease activity and joint function.ConclusionsOur study demonstrated the presence of extra-axial abnormalities in more than one-third of patients with axial SpA, suggesting that MRI evaluation should be extended to the entire pelvis.

Characteristics of hematopoiesis in primary and recurrent ovarian cancer

Introduction. An important aspect of cancer treatment today is the concept of immuno-targeted therapy, which requires a deep understanding of the characteristics of immune reactions in the body of a cancer patient. Bone marrow is the central organ of immunopoiesis, therefore, along with the study of tumor characteristics, attention is paid to the bone marrow. The study of the cellular composition of the bone marrow in some types of cancer revealed a number of features of hematopoiesis, which requires further deeper analysis.Purpose. To study the parameters of hematopoiesis in patients with primary and recurrent ovarian cancer.Materials and methods. The paper presents data from 68 patients with a verified diagnosis of primary (n = 43) and recurrent (n = 25) ovarian cancer. The study was dominated by serous adenocarcinoma of high grade. Stage I was established in 13.2 % of cases, II – in 5.9 %, III – in 60.3 %, IV – in 20.6 %. The bone marrow was harvested by puncture of the posterior iliac spine (spina iliaca posterior superior). Parameter assessment and myelogram calculation were performed by two physicians, morphologists. The content of myelokaryocytes, indicators of granulocyte, erythroid lineage, the content of lymphocytes, monocytes were analyzed, and myelogram indices were assessed. In all patients microscopy of bone marrow samples excluded metastatic lesions. Statistical data processing was performed using the SPSS Statistics v. 21 package.Results. The analysis of bone marrow samples from patients with ovarian cancer revealed differences with the norm for both primary and recurrent ovarian cancer. Most punctates were normocellular, but average myelokaryocyte count in both groups was below normal. With recurrent ovarian cancer, a reduced content of promyelocytes and metamyelocytes was noted, whereas with primary cancer, all young forms of neutrophils was below normal. An increase in segmented neutrophils without a change in the percentage of cells of the granulocytic lineage was observed in primary ovarian cancer, and in one third of the samples of bone marrow an increased number lymphocytes and monocytes were noted. With recurrent ovarian cancer lymphocytes were increased in 2/3 of samples, monocyte – in 48 %. A change in the proportion of cells of the erythroid lineage was observed in both recurrent and primary cancers: depletion of the pool of basophilic normoblasts and polychromatophils with an unchanged number of erythrokaryocytes, an increase in oxyphilic forms were noted.Conclusion. The revealed changes in hematopoiesis in ovarian cancer reflect the aggressive course of high-grade tumors, which can be considered as a result of the systemic influence of the tumor, and the obtained data can serve as the basis for a detailed immunophenotypic study of bone marrow in ovarian cancer.

Optimal pin position in supraacetabular external fixation.

This study focuses on (i) the length of the intraosseous part of the supraacetabular pin using the insertion technique from the spina iliaca anterior inferior to the cortical part of the incisura ischiadica major, (ii) the angle of insertion of the supraacetabular pin in the transversal plane and (iii) gender-specific differences of the measured results. Images of uninjured pelves from 49 patients (64-line computed tomography scanner) were evaluated, and virtual external fixator pins were positioned using a three-dimensional reconstructions of computed tomography scans. The length of the pins and the insertion angle were investigated. Descriptive statistics were used, and gender-specific differences were calculated. A P-value of <0.05 was considered statistically significant. The results showed significant differences between male and female pelves concerning both pin length and insertion angel. For male pelves, the mean screw length was 82.7 mm (SD 5.1; range 72.9-94.3). For females, this was statistically significantly shorter (P ≤ 0.001), with an average of 74.1 mm (SD 5.0; range 63.1-81.9). In the male subgroup, the insertion angle was a mean of 22.6° (SD 3.4; range 12.4-31.8), and the female pelves had an average angle of 19.7° (SD 4.0; range 11.7-24.5). These values differed statistically significantly (P = 0.0032). Based on our measurements, we can confirm that both the length of the Schanz screws and the angle of insertion for the supraacetabular external fixator show a statistically significant difference between males and females.

Comparison of USG-guided or landmark approach fascia iliaca compartment block for positioning in elderly hip fracture patients with spinal anesthesia: a randomized controlled observational study

Currently, the elderly population in the world is rapidly increasing due to technological developments and convenient access to health services. Due to comorbidities in elderly patients, hip fractures are frequently observed after exposure to environmental trauma. To reduce pain during positioning in spinal anesthesia, fascia iliaca compartment block (FICB) can be applied easily and reliably. In our study, we aimed to compare the analgesic effects and duration of fascia iliaca compartment blocks performed with USG guidance or the landmark approach methods for relieving spinal anesthesia position pain. Our study included 100 patients undergoing operations due to hip fracture and administered spinal anesthesia after FICB. The group with USG-guided FICB (USG) had the blockage needle advanced to the compartment under the fascia iliaca, and 15 mL bupivacaine + 10 mL 2% lidocaine was administered. They were placed in sitting position for spinal anesthesia 20 min later and procedure duration and numerical rating scale (NRS) scores were recorded. In the group with landmark approach FICB (LAND), the spina iliaca anterior superior (SIAS) and pubic tubercle were connected with a line. The same amount of local anesthetic was administered to the external 1/3 portion of this line with the double pop technique. Procedure duration and NRS scores were recorded. There was no statistically significant difference between the two groups in terms of NRS scores (p: 0.073). There was a statistically significant difference in duration of FICB administration between the two groups (p < 0.001). Both USG-guided and landmark approach FICB methods provide adequate and similar analgesia for positioning in spinal anesthesia. However, in cases where there is no problem with access to the ultrasound device or time, safer blockage can be provided by imaging neurovascular structures with ultrasound.

Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for large medial talar osteochondral defects : Operative technique.

ObjectiveProvision of a natural scaffold, good quality cells, and growth factors in order to facilitate the replacement of the complete osteochondral unit with matching talar curvature for large medial primary and secondary osteochondral defects of the talus.IndicationsSymptomatic primary and secondary medial osteochondral defects of the talus not responding to conservative treatment; anterior–posterior or medial–lateral diameter >10 mm on computed tomography (CT); closed distal tibial physis in young patients.ContraindicationsTibiotalar osteoarthritis grade III; multiple osteochondral defects on the medial, central, and lateral talar dome; malignancy; active infectious ankle joint pathology.Surgical techniqueA medial distal tibial osteotomy is performed, after which the osteochondral defect is excised in toto from the talar dome. The recipient site is microdrilled in order to disrupt subchondral bone vessels. Then, the autograft is harvested from the ipsilateral iliac crest with an oscillating saw, after which the graft is adjusted to an exact fitting shape to match the extracted osteochondral defect and the talar morphology as well as curvature. The graft is implanted with a press-fit technique after which the osteotomy is reduced with two 3.5 mm lag screws and the incision layers are closed. In cases of a large osteotomy, an additional third tubular buttress plate is added, or a third screw at the apex of the osteotomy.Postoperative managementNon-weight bearing cast for 6 weeks, followed by another 6 weeks with a walking boot. After 12 weeks, a CT scan is performed to assess consolidation of the osteotomy and the inserted autograft. The patient is referred to a physiotherapist.ResultsTen cases underwent the TOPIC procedure, and at 1 year follow-up all clinical scores improved. Radiological outcomes showed consolidation of all osteotomies and all inserted grafts showed consolidation. Complications included one spina iliaca anterior avulsion and one hypaesthesia of the saphenous nerve; in two patients the fixation screws of the medial malleolar osteotomy were removed.

Statistical Shape Modeling to Determine the Anterior Pelvic Plane for Total Hip Arthroplasty.

The anterior pelvic plane (APP) defined by both iliac spines and the pubic symphysis, is essential in total hip arthroplasty (THA) for the orientation of the prosthetic cup. However, the APP is nowadays still difficult to determine in computer assisted orthopedic surgery (CAOS). We propose to use a statistical shape model (SSM) of the pelvis to estimate the APP from ipsilateral anatomical landmarks, more easily accessible during surgery in computer assisted THA with the patient in lateral decubitus position. A SSM of the pelvis has been built from 40 male pelvises. Various ipsilateral anatomical landmarks have been extracted from these data and used to deform the SSM. Fitting the SSM to several combinations of these landmarks, we were able to reconstruct the pelvis with an accuracy between 2.8mm and 4.4mm, and estimate the APP inclination with an angular error between 1.3° and 2.8°, depending on the landmarks fitted. Results are promising and show that the APP could be acquired during the intervention from ipsilateral landmarks only.

Morphometrıc evaluatıon of acetabulum

Amaç: Kalça kemiğinin dış yüzünde bulunan ve femur başı ile eklem yapan çukura acetabulum denir. Acetabulum os ilium, os ischii, os pubis olmak üzere üç kemikten oluşur. Bu üç kemiğin birleşmesi 14–16 yaşlarında başlar ve 23 yaşına kadar devam eder. Bu çalışmanın amacı, acetabulum'un morfometrik ölçümlerini yaparak, kalça operasyonlarında klinisyenlere yardımcı olmaktır.Yöntemler: Bu gözlemsel çalışmada Erciyes Üniversitesi Anatomi Anabilim Dalındaki 96 adet os coxae (50 sağ, 46 sol) kullanıldı. Kuru kemik üzerinde dijital kumpas yardımı ile sağ ve sol ayrı ayrı olmak üzere, corpus ischii acetabulum kenarı ile acetabulum ön kenarı arası uzunluğu (CİAK-AÖK) ortalama, incisura acetabulum’un transvers çapı (ATÇ), incisura acetabuli (IAU) uzunluğu, acetabulum’un derinliği (AD) ortalama, spina iliaca anterior inferior tarafındaki acetabulum kenarı ile acetabulum arka kenarı arası uzunluk ortalama (SİAİ), facies lunata alanı, limbus acetabuli uzunluğu, incisura acetabuli orta noktası ile limbus orta noktası arası mesafe ortalama, acetabulum’un şekli hesaplanarak 9 parametre değerlendirildi. Kuru kemik üzerinden alınan görüntüler bilgisayar ortamına aktarıldı ve ImageJ programı ile facies lunata’nın alanı ve limbus acetabuli’nin uzunluğu hesaplandı.Bulgular: Yapılan ölçümler sonucunda ortalama değerleri, sağ-sol olarak CİAK-AÖK 53,04-54,67 mm, ATÇ 50,57-51.44 mm, IAU 18,08-20,25 mm, AD 24,87-22,85 mm, SİAİ mesafe 52,38-45,63 mm, facies lunata alanı ortalama 13,25-13,65 cm2, limbus acetabuli uzunluğu 13,65-3,61 cm (ortalama 13,63 cm), incisura acetabuli orta noktası ile limbus orta noktası arası mesafe ortalama 56,45-57,12 mm hesaplandı. Acetabulum’un şekli ise 41 kemikte düz şekilli, 8 kemikte düzensiz, 27 kemikte eğimli ve 20 kemikte açısal şekilde hesaplandı.Sonuç: Elde ettiğimiz acetabulum’a ait bu indeks değerlerininin kalça dislokasyonu ve total kalça ameliyatlarında klinisyenlere ve aynı zamanda literatüre katkı sağlayacağını düşünmekteyiz.

Condicionamento Cardiorrespiratório de idosos: há diferença em praticante de exercício físico e não praticantes?

INTRODUÇÃO: As mudanças no sistema cardiorrespiratório são evidentes durante o processo de envelhecimento. A aptidão cardiorrespiratória (ACR) tem sido considerada um dos principais fatores responsáveis pela perda de independência em idosos. OBJETIVO: verificar a capacidade cardiorrespiratória em idosos praticantes e não praticantes de atividade física sistematizada. MÉTODOS: Trata-se de um estudo com delineamento transversal. A amostra foi composta por 30 idosas, do sexo feminino com idade entre 65 a 75 anos independentes, divididas em praticantes e não praticantes de exercício físico. Definiu-se como critério de exclusão da pesquisa ausência das participantes durante o período de coleta dos dados. Como instrumento de coleta utilizou-se o teste de marcha estacionária para a avaliação cardiorrespiratória. O avaliador conta uma passada de cada vez, sendo que só foram computadas as passadas em que o joelho atinja a altura correta ao nível ponto médio entre a patela e a espinha ilíaca ântero-superior. RESULTADOS: obteve como resultado média de 43,40 ± 10,08 para indivíduos não praticantes de exercício físico, com peso corporal de 59,26 ± 10, 09kg. No entanto, para indivíduos praticantes de exercício físico com peso corporal de 69,73 ± 11,48kg obteve-se média de 43,73 ± 9,29 ciclos completos. CONCLUSÃO: Nessa amostra não houve uma diferença da aptidão cardiorrespiratória em idosos praticantes e não praticantes de exercício físico.

Comparison of two reinforcement rings for primary total hip arthroplasty addressing displaced acetabular fractures: a biomechanical analysis

IntroductionAim of this study was to biomechanically compare two different acetabular cup fixation constructs in terms of fracture fixation for displaced acetabular fractures involving the anterior column with hemitransverse fracture under partial and full weight-bearing conditions.MethodsTwo different reinforcement rings designed as cages for primary THA were biomechanically tested in terms of managing a complex acetabular fracture. Single-leg stance cyclic loading was performed to assess fracture gap movement and fragment rotation. Twelve hemi pelvis Sawbones were divided into two groups: primary THA with acetabulum roof reinforcement plate (ARRP) (n = 6) and primary THA with Burch–Schneider reinforcement cage (BSRC) (n = 6).ResultsDuring loading under partial weight-bearing (250 N) fracture gap movement tended to be larger in the BSRC group as compared to the ARRP group. Under full weight-bearing conditions, the ARRP showed 60% significantly less motion (p = 0.035) of the os ilium to os ischii gap compared to BSRC. Fracture gap movements between the os ilium and spina iliaca fragments were significantly reduced by 76% (p = 0.048) for ARRP in contrast to BSRC. The ARRP group also demonstrated significantly less movement in the fracture gaps os ischii to quadrilateral plate (62% reduction, p = 0.009) and quadrilateral plate to spina iliaca (87% reduction, p < 0.001). Significantly less rotational movement of the quadrilateral plate to the os ilium was exhibited by the ARRP group (p = 0.015).ConclusionsThe presented acetabulum roof-reinforcement plate (ARRP) provides stable conditions at the acetabular component with adequate stabilization of a displaced acetabular fracture.

Comparison of thoracic paravertebral nerve block and transverse abdominal plane block for multiple costal margins in anal-gesia after open liver surgery

Objective To evaluate the analgesic application of thoracic paravertebral blockade (TPVB) and transverse abdom-inal plane block (TAPB) for multiple costal margins after open liver surgery. Methods A total of sixty patients [American Society Anesthesiologists (ASA) Ⅰ-Ⅲ ]who were scheduled for open liver surgery (with a classical reverse L-shaped incision) were enrolled. The patients were divided into two groups according to the random number table method (n=30): a TPAB group (group TP) and a group of TAPB for multiple costal margins (group TA). Both groups received ultrasound guided nerve block before surgery. Group TP under-went bilateral TPVB at T7-T8 and T8-T9, while group TA underwent TAPB under bilateral costal margins and the classical site between the costal margin and the anterior inferior iliac spine, with a total of four block points. Then, both groups were compared and recorded for the duration of block procedures; the mean arterial pressure (MAP) and heart rate before incision (T0), after incision (T1), and at the times of block of the superior vena cava (T2), liver removal (T3) and stitching (T4); surgical duration, the inflow of liquid during surgery, the consumption of remifentanil, and the length of post-anesthesia care unit (PACU) stay after surgery; the Visual Analogue Scale (VAS) scores at resting and during movement immediately after surgery (when patients were awaken after extubation and able to communicate normally), and 2 h and 6 h after surgery; and the number of patients requiring opioids within 6 h after surgery and the time when opioids were first given after surgery. Results Group TA presented shorter duration of block procedures than group TP (P 0.05). Conclusions During open liver surgery, compared with TAPB for multiple costal margins, TPVB can maintain more stable hemody-namics, require less doses of opioids and improve perioperative analgesia. Key words: Open liver surgery; Thoracic paravertebral nerve block; Transverse abdominal plane block; Postoperative analgesia