Iliac Spine Research Articles

Surgical anatomy of the feline sacroiliac joint for lag screw fixation of sacroiliac fracture-luxation

Twenty-eight feline pelves (56 hemipelves) were examined in order to identify the location for optimal sacroiliac screw placement in sacroiliac fracture-luxation repair. A drill hole was started on the median plane of the hemipelvis in the centre of the body of the first sacral segment until it penetrated the lateral cortex of the ilial wing, thus providing optimal drill hole placement. The position of the drill hole on the articular surface of the sacral wing and on the lateral surface of the ilial wing was measured. The distance of the drill hole from the cranial margin of the sacral wing was 51% of sacral wing length, just cranial to the crescent shaped hyaline cartilage. The distance from the dorsal margin was 47% of sacral wing height. The drill bit direction has to be adjusted to the cranio-caudal inclination (range 10° to 29°) and dorso-ventral inclination (range 2° to 25°) of the sacral wing. A notch in the cranial edge of the sacral wing was present, with variable position, in 34% of the specimens and is consequently not a useful landmark for sacroiliac screw placement. The drill hole on the lateral surface of the ilium was located in craniocaudal direction at a distance of 69% of sacral tuber length, measured from the cranial dorsal iliac spine. The dorso-ventral position of the drill hole was at a distance of 52% of ilial wing height measured from the sacral tuber. The ventral gluteal line, present in 93% of the cases, is a useful landmark to locate optimal screw hole position on the ilial wing.

Digital anatomical analysis of transiliac-transsacral screw insertion pathway in Chinese adults

Objective To investigate the transiliac-transsacral screw insertion pathway (TSIP) so as to provide an anatomical basis for clinical surgical practice. Methods CT scanning data of normal pelvis in 90 Chinese adults were selected by random number table. There were 45 males and 45 females, aged from 21 to 82 years (mean, 53.88 years). After computed tomography scan, pelvic data of the 90 subjects were entered into Mimics software 16.0 for three-dimensional reconstruction. The outer frames of sacrum and ilium at sagittal plane were depicted. Maximum inscribed circle method was applied to determine the screw insertion pathways which traversed 1st (S1) and 2nd (S2) sacral segments, respectively. The diameters and lengths of screw pathways, the distances from screw insertion points to both anterior superior iliac spine and posterior superior iliac spine, as well as the angles between pathways and anatomic surface were measured. Results Most subjects had the condition of a trans-S1 TSIP (male 78%, female 76%), and all the tested pelvis had the condition of trans-S2 TSIP. There was no statistically significant difference between the left and right side parameters in male group, and so was in female group (P>0.05). TSIP radius: there was no statistically significant difference among male S1 [(5.52±1.91)mm], male S2[(5.35±1.05)mm], and female S1 [(5.49±1.34)mm](P>0.05), but each of them was greater than female S2 [(4.79±1.40)mm] (P<0.05). TSIP length: male S1 [(158.25±9.84) mm] was larger than male S2 [(138.94±9.75)mm], and female S1 [(154.91±9.40) mm] was larger than female S2 [(141.01±8.60)mm]. The screw insertion point was located at the outer ilium side. The distances from S1 to anterior superior iliac spine and to posterior superior iliac spine were (96.49±6.91)mm and (68.22±6.35)mm in males but (100.48±8.15)mm and (61.57±6.84)mm in females. The distances from S2 to anterior superior iliac spine and to posterior superior iliac spine were (114.43±8.77)mm and (49.62±8.54)mm in males but (114.75±10.19)mm and (44.52±8.36)mm in females. Compared with those with a condition of TSIP in S1, a pelvis without a condition of an S1 TSIP had larger S2 TSIP radius. The S2 TSIP radius in one with such condition in male was (5.10±0.84)mm and that in one without such condition in male was (6.22±1.27)mm. The corresponding female data was (4.37±0.92)mm and (6.11±1.84)mm (P<0.05). Both S1 and S2 TSIP were almost vertical to sagittal plane and parallel to coronal plane. Conclusions Anatomically, a S1 or S2 transiliac-transsacral screw is available in most Chinese adults for sacroiliac joint fixation on both sides. Mimics software can be helpful to ensure the pathway of screw fixation, which provides reference for transiliac-transsacral screw fixation technique. Key words: Sacroiliac joint; Fracture fixation, internal; Dislocation; Screw

Recovery of Donor Hematopoiesis after Graft Failure and Second Hematopoietic Stem Cell Transplantation with Intraosseous Administration of Mesenchymal Stromal Cells.

Multipotent mesenchymal stromal cells (MSCs) participate in the formation of bone marrow niches for hematopoietic stem cells. Donor MSCs can serve as a source of recovery for niches in patients with graft failure (GF) after allogeneic bone marrow (BM) transplantation. Since only few MSCs reach the BM after intravenous injection, MSCs were implanted into the iliac spine. For 8 patients with GF after allo-BMT, another hematopoietic stem cell transplantation with simultaneous implantation of MSCs from their respective donors into cancellous bone was performed. BM was aspirated from the iliac crest of these patients at 1-2, 4-5, and 9 months after the intraosseous injection of donor MSCs. Patients' MSCs were cultivated, and chimerism was determined. In 6 out of 8 patients, donor hematopoiesis was restored. Donor cells (9.4 ± 3.3%) were detected among MSCs. Thus, implanted MSCs remain localized at the site of administration and do not lose the ability to proliferate. These results suggest that MSCs could participate in the restoration of niches for donor hematopoietic cells or have an immunomodulatory effect, preventing repeated rejection of the graft. Perhaps, intraosseous implantation of MSCs contributes to the success of the second transplantation of hematopoietic stem cells and patient survival.

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

Sources of error in measurement of minimal residual disease in childhood acute lymphoblastic leukemia.

IntroductionThe level of minimal residual disease (MRD) in marrow predicts outcome and guides treatment in childhood acute lymphoblastic leukemia (ALL) but accurate prediction depends on accurate measurement.MethodsForty-one children with ALL were studied at the end of induction. Two samples were obtained from each iliac spine and each sample was assayed twice. Assay, sample and side-to-side variation were quantified by analysis of variance and presumptively incorrect decisions related to high-risk disease were determined using the result from each MRD assay, the mean MRD in the patient as the measure of the true value, and each of 3 different MRD cut-off levels which have been used for making decisions on treatment.ResultsVariation between assays, samples and sides each differed significantly from zero and the overall standard deviation for a single MRD estimation was 0.60 logs. Multifocal residual disease seemed to be at least partly responsible for the variation between samples. Decision errors occurred at a frequency of 13–14% when the mean patient MRD was between 10−2 and 10−5. Decision errors were observed only for an MRD result within 1 log of the cut-off value used for assessing high risk. Depending on the cut-off used, 31–40% of MRD results were within 1 log of the cut-off value and 21–16% of such results would have resulted in a decision error.ConclusionWhen the result obtained for the level of MRD is within 1 log of the cut-off value used for making decisions, variation in the assay and/or sampling may result in a misleading assessment of the true level of marrow MRD. This may lead to an incorrect decision on treatment.

Assessment of body parameters' symmetry in child violinists.

Playing violin may lead to overload of the locomotor system. The aim of this study was to assess body parameters for trunk symmetry in child violinists and compare with the control group. We analyzed body posture of 101 children aged 7-12 years, mean age 11.09 ± 9.46, 49 child violinists and control group of 52 children. We found statistically significant differences for the difference in depth of the lower corners of scapulae and upper posterior spina iliaca, though greater asymmetries were found in the clinical control group. The remaining parameter values are close to significance, which may suggest that the process of postural change among the children had just started and that the existing asymmetries were easy to correct. We found positive correlation between body height and the difference in distance of the lower corners of scapulae from the spine: OL (p= 0.029, correlation coefficient value was 0.167) and the Thales triangle height: (p= 0.018, correlation coefficient was 0.214). Position maintained while playing the violin changed some parameters characterizing the curvature of the spine in frontal plane. We found the importance of detailed analysis of children body posture and its critical assessment.

Eccentric Training after a Traumatic Apophysis Fracture atthe Spina Iliaca Anterior Inferior: Case Study of a Junior Football Player

Eccentric training is an established training method in competitive sports. It has been used effectively to improve muscle strength during rehabilitation after cruciate ligament reconstruction. However, it is still uncertain whether or not eccentric training contributes to successful rehabilitation after apophysis fractures. A fourteen-year-old soccer player, forward position, presents with an apophysis avulsion located at the right spina iliaca anterior inferior. After completing an early rehabilitation phase and isokinetic concentric strength development, the patient starts an eccentric training programme eight weeks after the injury, including training on an isokinetic dynamometer (Biodex) for four weeks, followed by a four-week eccentric ergometer training (Eccentron). Before and after each eccentric training phase, isokinetic maximum strength tests of the knee extensors and flexors are performed with angular velocities of 60 degrees per second (°/sec.), 180°/sec. and 240°/sec. In response to the eight-week eccentric rehabilitation program, maximum torque increases in all angular velocities in the injured (60°/sec. + 14.4 %; 180°/sec. + 8.8 %; 240°/sec. + 6.3 %) and the uninjured leg (60°/sec. + 15.6 %; 180°/sec. + 1.9 %; 240°/sec. + 8.1 %) between the first and the last test. Furthermore, neuromuscular coordination has improved during the eccentric training sessions. This case study demonstrates that controlled eccentric training in the open and closed kinetic chain increases coordination and strength of the trained muscles and therefore should be regarded as a valuable contribution toward a safe return to sport after apophysis fractures.

First case of robotic laparoendoscopic single-site radical prostatectomy with single-site VesPa platform

This study aimed at reporting our first experience with robotic laparoendoscopic single-site radical prostatectomy (R-LESS-RP) with single-site VesPa platform (Intuitive Surgical Inc.).A 68-year-old-man presenting with a cT1c adenocarcinoma Gleason Score 3+4=7 in 4/12 bilateral cores underwent a transperitoneal robotic LESS-RP with a single-site Vespa platform. Initial PSA, prostate weight, and body mass index (BMI) were 4.4ng/ml, 45g, and 25, respectively. Instruments and camera cross within the Single-Site port; the da Vinci System software detects and reassigns the user's hands with the instruments position. The single-site port is inserted through a 2-cm intraumbilical incision. The robotic 8.5mm scope and two surgical curved instruments (fenestrated bipolar forceps and cautery hook) are introduced through the ports and used for most of the procedure, whereas a wristed needle driver on the right hand is used for the reconstructive steps. An additional 12mm port (Air Seal, SurgiQuest) is placed in a midline between the umbilicus and the right iliac spine in order to facilitate table assistance during surgery and to place a drain at the end of the procedure.Operative time and blood loss were 300min and 400mL, respectively. The postoperative course was uneventful. The drain and the catheter were removed on days 1 and 6, respectively. The patient experienced a temporary mild stress incontinence (one pad at sixth month) and erectile dysfunction.Our first robotic laparoendoscopic single-site radical prostatectomy (R-LESS-RP) with the single-site VesPa platform was associated with acceptable operative times and perioperative outcome. This procedure is feasible without complications, provided that a proper patient selection has occurred. Limited movements together with the lack of the fourth robotic arm require a considerable expertise in robotic surgery. Some tricks can help overcome technical limitations. The Robotic LESS-RP reduces in some measure the limitations of conventional LESS RP, although further refinement of the robotic instruments is necessary.

Novel Measurement Technique for the Sagittal Vertical Axis and Its Clinical Application in Adult Spinal Deformity.

Study DesignProspective physical measurement of the sagittal vertical axis (SVA).PurposeTo evaluate a simple method for measuring SVA by analyzing its relationship with radiographic measurements and clinical appearance.Overview of LiteratureNo studies have examined physical measurements using the cranial center of gravity (CCG) in a relaxed standing position.MethodsThe physical measurement of the horizontal distance between CCG and spina iliaca posterior superior (CCG-SIPS) was measured using a straight ruler in 252 healthy volunteers and 56 patients with adult spinal deformity. Health-related quality of life (HRQOL) was evaluated using the Oswestry disability index (ODI), and clinical symptoms were assessed according to standing status and the presence of gastroesophageal reflux disease (GERD).ResultsCCG-SIPS increased with age in the volunteer group and strongly correlated with radiographic SVA in the patient group (r=0.984). Differences increased between CCG-SIPS in patients in the relaxed position and radiographic SVA with an increase in sagittal malalignment (r=0.692, p<0.001). ODI with high sagittal malalignment (CCG-SIPS>120 mm) was significantly larger in the patient group than in the group with low sagittal malalignment (59.9±18.8 vs. 45.1±17.0; p=0.004); these patients (CCG-SIPS>120 mm) needed crutches or walkers for standing. The patient group with GERD had significantly larger sagittal malalignment than the group without GERD (160.3 mm vs. 81.0 mm).ConclusionsThe CCG-SIPS correlated with age and strongly reflected radiographic SVA and HRQOL in the patients. Moreover, it reflects a relaxed posture without a backward shift in the radiographic position even in patients with severe sagittal malalignment. The critical limit of CCG-SIPS can be relevant to clinical appearance, including standing assistance (>120 mm) and the existence of GERD (>150 mm). Thus, it will be a useful predictor of true SVA in clinical practice before radiographic evaluation.

A novel complete retroperitoneal laparoscopic nephroureterectomy via modified three ports approach

Objective To assess the clinical efficacy of a modified complete retroperitoneal laparoscopic nephroureterectomy via 3 port approach. Methods From August 2013 to February 2016, 23 patients with complete retroperitoneal laparoscopic renal and ureteral sleeve resection were treated with modified three port approach, including 15 males and 8 females. The average age was 67 years old (ranging 44-83 years old). All patients had complained about the hematuria before operation and urine exfoliated cells showed moderate to severe nuclear atypia. All patients accepted the abdominal CT and urography CTU examination, pre-operatively. All of them was diagnosed localized upper urinary tract malignant tumors based on those images, including 13 cases in the pelvis, and 10 cases in the upper segment of the ureter. No chemotherapy, radiotherapy or immunotherapy was performed before surgery. No patients have the history of severe basic disease or upper urinary procedure.The operations were performed under general anesthesia, patients take the contralateral back 30 degrees slope, low elevation head foot, waist bridge, side waist stretch. In the anterior superior iliac spine perpendicular to the line 2 cm parallel to the lower intersection of the rib border were disposed into the 12 mm trocar. Above the anterior superior iliac spine two cross finger level with the intersection of the anterior axillary node, we placed into the 10 mm trocar placement lens. Laparoscopic placement of third casing form an isosceles triangle with the first two casing. The renal fascia was incised with an ultrasonic knife from the renal dorsal side, and the renal hilum was isolated from the kidney by suction aspirator. The renal artery and vein were separated and closed by hem-o-lok. Along the psoas muscle surface to ureter, ureteral clipping by hem-o-lok but not to cut off the free distal ureteral, the lens is composed of first casing into, using ultrasonic knife to free ureter to the bladder wall segment, with 30 mm endoscopic stapler ureter and bladder wall cut off part. Operation time, blood loss and postoperative recovery were recorded in 23 cases. Results All 23 cases were successfully operated without related the operative complication. The operative duration ranged from 3.5 to 6.1 h (mean 4.8 h), the blood loss was 30-880 ml (mean 304 ml), and the postoperative stay was 8-30 d (mean 17.8 d). There are 3 cases of positive lymph node by postoperative pathological reports. Within 2 to 30 months following up, 2 patients died of tumor progression in 6 months after surgery. 4 patients were diagnosed with bladder cancer in 15 months, 15 months, 21 months, 24 months after surgery, respectively. And the transurethral resection of bladder tumor was performed. Conclusion The modified complete retroperitoneal laparoscopic nephroureterectomy via three ports is safe and reliable. Key words: Retroperitoneoscopic; Nephroureterectomy; Via three ports

Paget's disease in Senegal: Two cases of a rare disease in black African populations

Mr. MD is a 72-years-old man, admitted for spontaneous, permanent, crushing type pain on the pelvis above the right hip evolving for two years, without night or morning stiffness but increasing with hearing loss, temporal and parietal headache. Physical examination showed a painful hip in active and passive mobilization. Pressure on iliac spines and lower lumbar and sacrococcygeal bones was painful. The patient showed no inflammatory syndrome. Serum calcium was normal. We noted an isolated increase in alkaline phosphatase levels to 401 IU/l. Radiographs showed bilateral heterogeneous sclerosis of the iliac bone with thickening lines and and almost disappearance of the right hip joint space. There was a marked thickening of the cortex on the femoral proximal third and thickening of the cranial vault. MRI showed cortical thickening of the right pelvic bone, a T1 hyper signal, and an intermediate T2 signal with fat/sat. This was pathognomonic of Paget's disease. The second patient is a 72-year-old man with no history, having intense pain on the right side of the lower limb. Physical examination showed no musculoskeletal deformity, but pain on palpation and mobilization of the right hip. Serum alkaline phosphatase (ALP) was raised to 4 times the normal range. Radiography showed cortical thickening of the ischial pubic branch, a heterogeneous sclerosis gypsy moth of the iliac wing, a steady narrowing of the femoral hip-spaced lines and thickening of the iliac ischial pubic. This aspect is pathognomonic of Paget’s disease, the patient underwent treatment with zoledronic acid intravenously at 5 mg. The outcome was favorable up to 10 months with reduced pain (VAS = 2/10) and normal PAL.

Effects of seat height on muscular pattern and interlimb coordination in cycling

Effects of seat height on muscular pattern and interlimb coordination in cycling

A pilot study of SPECT/CT-based mixed-reality navigation towards the sentinel node in patients with melanoma or Merkel cell carcinoma of a lower extremity.

To explore the feasibility of an intraoperative navigation technology based on preoperatively acquired single photon emission computed tomography combined with computed tomography (SPECT/CT) images during sentinel node (SN) biopsy in patients with melanoma or Merkel cell carcinoma. Patients with a melanoma (n=4) or Merkel cell carcinoma (n=1) of a lower extremity scheduled for wide re-excision of the primary lesion site and SN biopsy were studied. Following a Tc-nanocolloid injection and lymphoscintigraphy, SPECT/CT images were acquired with a reference target (ReTp) fixed on the leg or the iliac spine. Intraoperatively, a sterile ReTp was placed at the same site to enable SPECT/CT-based mixed-reality navigation of a gamma ray detection probe also containing a reference target (ReTgp).The accuracy of the navigation procedure was determined in the coronal plane (x, y-axis) by measuring the discrepancy between standard gamma probe-based SN localization and mixed-reality-based navigation to the SN. To determine the depth accuracy (z-axis), the depth estimation provided by the navigation system was compared to the skin surface-to-node distance measured in the computed tomography component of the SPECT/CT images. In four of five patients, it was possible to navigate towards the preoperatively defined SN. The average navigational error was 8.0 mm in the sagittal direction and 8.5 mm in the coronal direction. Intraoperative sterile ReTp positioning and tissue movement during surgery exerted a distinct influence on the accuracy of navigation. Intraoperative navigation during melanoma or Merkel cell carcinoma surgery is feasible and can provide the surgeon with an interactive 3D roadmap towards the SN or SNs in the groin. However, further technical optimization of the modality is required before this technology can become routine practice.

Efeitos do método isostretching na função respiratória e postura de respiradores bucal

Introdução: A respiração bucal interfe na tonicidade, na postura, na mobilidade e na sensibilidade de órgãos fonoarticulatórios, podendo gerar hábitos orais viciosos. Objetivo: Avaliar a capacidade respiratória e a postura de respiradores bucais submetidos à técnica de isostretching. Métodos: Estudo prospectivo e quasi-experimental, em que a postura de 17 crianças foi avaliada por fotogrametria e os parâmetros respiratórios avaliados pela cirtometria; pela manovacuometria, e por peak flow. As crianças foram avaliadas inicialmente e ao final de 12 sessões da técnica isostretching. Resultados: Houve mudança nos ângulos esternoclavicular (Inicial: 3,571,54; Final 2,080,93, p= 0,003); espinha ilíaca ântero-superior (Inicial: 3,312,51; Final: 2,001,26, p= 0,001) e posterosuperior (Inicial: 2,992,22; Final 1,621,92, p= 0,009) e na pressão expiratória máxima (PEmáx) (Inicial: 79,2916,11; Final 91,1717,80, p= 0,001) e Peak Flow (Inicial: 279,4172,92; Final 310,9166,65, p= 0,01). Conclusão: O tratamento com isostretching foi eficaz para melhorar a capacidade respiratória e para alterar ângulos posturais.

Surgical treatment in unstable sacral fractures associated with lumbosacral junction injuries

Objective To summarize the clinical features of unstable sacral fractures (USF) associated with lumbosacral junction injuries (LSJIs) and discuss the operative outcomes of lumbopelvic fixation. Methods From March 2009 to April 2014, data of 38 patients of USF associated with LSJIs surgically treated in Tianjin Hospital were retrospectively analyzed. There were 24 males and 14 females with an average age of 37.2 years (range, 18-57 years). 30 patients were multiple injuries including thoracic, abdominal, head, soft tissue, musculoskeletal and nerve injuries. Sacral fractures were classified according to Denis classification, and there were 25 cases with type II and 13 cases type III. According to Isler and Oransky classification of LSJIs, there were type I in 9 cases, type II in 17 cases, type III in 11 cases and type IV in one case. Primary neurological impairments were existed in 19 cases, in which there were 2 cases with L5 nerve damage. The neurological impairments of lumbosacral plexus were classified by Gibbons as type II, III and IV with 8, 6 and 5 cases. All the 38 patients were surgically treated with lumbopelvic fixations and bone graft fusions in lumbosacral junction in necessity. Decompressed sacral plexus were conducted in 7 cases with neurological impairments. Results All the patients were followed up for an average of 22.6 months (range, 18-48 months). All the patients were examined with computer tomography 12 to 18 months after surgery. Twenty-two cases achieved osseous fusion in lumbosacral injunction and sixteen not. Thirty-four sacral fractures were union and 4 fractures were nonunion or incomplete union. According to Majeed' s pelvic injury evaluation, clinical outcomes were rated with in 24 cases, in 9 cases, fair in 5 cases. The excellent and good rate was 86.8% (33/38). According to Mears evaluation criterion, there were 29 cases with anatomical reduction, 8 cases with satisfactory reduction and one case with unsatisfactory reduction. Deep infection of the wound occurred in 3 cases 5-10 days after surgery and the incisions healed after an intravenous drip of sensitive antibiotics and thorough debridement. Fat liquefaction necrosis of the incision occurred in one case and the wound healed after clean dressings. Irritation and pain in iliac spine caused by prominent screws occurred in 5 cases and lumboscaral stiffness in 4 cases, in which the symptom relieved and disappeared after implants removal. Implants breakage occurred in 2 cases. Conclusion USF associated with LSJIs are easily ignored, which can lead spinopelvic instability. It is important to obtain satisfactory reduction and fixation by surgery. The lumbopelvic fixation is an effective method to stabilize the spinopelvic area. Key words: Sacrum; Fractures, bone; Fracture fixation, internal; Treatment outcome

Assessment of Pelvic Shape by a Newly Developed Posture Analyzer in Young Women in Japan

Background: Body composition has been changing along with change in the life style environment but there have been no studies on pelvic size by objective anthropometric assessment in young Japanese women. The objective was to examine pelvic shape by measuring the angle of inclination (AOI) and the distance between right and left anterior superior (AS) iliac spines. We also investigated associations of these measurements with physical symptoms related to distortion of the pelvis in young Japanese women. Methods: The AOI and the distance between right and left AS iliac spines in 92 female undergraduate students were measured by using a newly developed posture analyzer with a self-administered questionnaire. Results: The mean values of AOI and distance between right and left AS iliac spines were 0.31 radian and 270.1 mm, respectively. The distance between right and left AS iliac spines showed significant positive associations with body weight and height. According to tertiles of AOI, a large percentage of the subjects with a large AOI responded positively to the item “Heights of the fingers of the right and left hands being different when the upper limbs are raised”. According to tertiles of distance between right and left AS iliac spines, a large percentage of the subjects with a large distance responded positively to the item “Unhealed past injury in lower legs” and the item “Sitting with one’s legs folded sideways”. Conclusion: Increase in body weight and height were shown to be associated with pelvic shape. It has also shown that change in pelvic size can be estimated by the item “Heights of the fingers of the right and left hands being different when the upper limbs are raised”.

Is mesenchymal stem cell helpful in early osteoarthritis knee?

Event Abstract Back to Event Is mesenchymal stem cell helpful in early osteoarthritis knee? Aditya Aggarwal1, Sreekanth R. Rajoli1, Vivekanand Jha1 and Mahesh Prakash1 1 Post Graduate Institute of Medical Education & Research, Orthopaedics, Stem Cell Research Facility, Radiodiagnosis, India Introduction: There is no effective therapy available today that alters the pathobiologic course of osteoarthritis. Recent advances have shown Mesenchymal stem cells to be a potential disease modifying treatment. Considering the tissue differentiation property and vast paracrine effects of MSCs we proposed the present study to find out the safety and efficacy of MSCs in osteoarthritis of knee joint. Methods: 12 patients with grade 1and2 bilateral osteoarthritis knee (Ahlbacks radiological grading) were selected. 8-10 ml of bone marrow was aspirated under strict aseptic precautions from the iliac spine. After the stem cell culture and expansion for 4-6 weeks the MSC suspension in 10xPBS was injected directly into the 24 knees by lateral approach. The outcome was evaluated by modified VAS score, WOMAC score, KOOS and MRI measurement of knee articular cartilage integrity by the modified WORMS score. Results: Statistically significant improvement in VAS score, total WOMAC score and total KOOS score was observed from pre injection to 1st follow up at 6 weeks, 2nd follow up at 6 months and final follow up of mean 26.7 months. There was also a significant improvement from 1st follow up to 2nd and final follow up. The modified WORMS score showed a statistically significant decrease of 1.49 %. Conclusion: Intra-articular injection of autologous bone marrow derived culture-expanded MSCs can be considered a potential treatment of early osteoarthritis knee which relieves pain, stiffness, improves physical functions, and improves the articular cartilage integrity.

Attritional rupture of extensor pollicis longus by migration of Kirschner wires fixed in non-union scaphoid fracture: A case report

We report a rare complication of internal fixation induced extensor pollicis longus (EPL) rupture. A 34-year-old male sustained a rupture of EPL tendon after the operation of open-reduction internal fixation of the non-union scaphoid fracture by means of two Kirschner wires and autogenous bone grafting from ipsilateral anterior superior iliac spine. He was successfully treated with palmaris longus tendon graft. Attrition of the extensor pollicis longus tendon by migration of Kirschner wires was the major mechanism.

Anterior subcutaneous internal fixation of unstable pelvic ring fracture

Objective To determine the curative effect of stabilizing unstable pelvic ring fracture using the anterior subcutaneous internal fixator (INFIX). Methods From July 2013 to June 2014, 15 cases who suffered from anterior pelvic ring fracture were treated with the device. There were 11 males and 4 females, with mean age of 38. 5 years (range, 23-65 years). Eight cases sustained fracture in traffic accidents, 4 in high falls, and 3 in crush injury. According to the Young-Burgess and AO/OTA classification systems, type APC2 or 61-B1 was noted in one case, LC1 or 61-B2.1 in 4 cases, LC2 or 61-B2. 2/61-B2. 3 in 6 cases, and VS or 61-C1/61-C2 in 4 cases. Basic method in anterior ring fixation was one pedicle screw was respectively inserted into the area between the anterior superior iliac spine and anterior inferior iliac spine of both sides. The precontoured rod was then tunneled subcutaneously from one screw to the other. For the stable posterior injury in pelvic ring fracture, the anterior pelvic ring was stabilized only using the technique. For the unstable posterior injury in pelvic ring fracture, the anterior and posterior ring were both fixed using the technique.During follow-up visits, patients' tolerance to the device, wound infection, myositis ossificans, internal fixation lessening, and lateral femoral cutaneous nerve injury were evaluated. Results Follow-up ranged from 6-12 months (mean, 7. 5 months). The device was well tolerated by the patients for comfort. None had surgical site infection and internal fixation loosening. Injuries healed without loss of reduction at the 3-month follow-up. Injury of the lateral femoral cutaneous nerve at the both side was reported in 4 cases and at one side in 2 cases, but all restored 3 month after operation. Conclusion The reported technique is minimally invasive with few complications and reliable results, hinting an ideal method to stabilize the anterior pelvic ring fracture. Key words: Pelvis; Fracture fixation, internal; Surgical procedures, minimally invasive

Treatment of mono-segmental thoracic spine tuberculosis with one-stage posterior focus debridement and internal fixation of inter-centrum non-structural bone grafting

Objective To evaluate the clinical efficacy and feasibility of treatment of mono-segmental thoracic spine tuberculosis with one-stage posterior focus debridement and internal fixation of inter-centrum non-structural bone grafting. Methods Retrospective study of patients with mono-segmental thoracic spine tuberculosis who underwent surgery in our hospital from January 2010 to January 2013 was conducted. 27 patients were involved in the study, including 16 male patients and 11 female patients. The age of patients is from 23 to 69 (average age 40.3). 22 patients suffered from combined spinal cord dysfunction. For the classification of ASIA, 2 cases were of Grade B, 8 cases were of Grade C and 12 cases were of Grade D. All patients had obvious bone destruction in thoracic spine shown on CT and MRI before the operation. All patients were given anti-tuberculosis drugs (Isoniazid, Rifampicin, Ethambutol, Streptomycin) for 2-3 weeks, preoperatively. And all patients underwent one-stage posterior focus debridement, and bone particles gained from partial decompression and spina iliaca posterior superior bone particles were planted among the centrum. Pedicle screw fixation was conducted internally. Thoracic vertebra X-ray film and CT were rechecked per 3 months after the operation. Bone grafting fusion and physiological curvature change of thoracic vertebra were evaluated. Results All patients were followed up for 12-24 months with the average time of 21.7±2.3 months. The operating time was 110-190 min (average time 167±35 min) and the bleeding amount during the surgery was 350-700 ml (490±160 ml on the average). The bone grafted in centrum achieved bone fusion with the average fusion time of 6.5±2.4 months. The neurological function was improved for all patients, including 19 cases (Grade 1 improvement) and 3 cases (Grade 2 improvement). The preoperative and postoperative Cobb angles of thoracic vertebra were 47°±11° and 41°±9°, respectively. And it was 43°±10° at the final followup period. Conclusion Based on the standardized treatment of antituberculosis drugs and strong fixation with pedicle screw and rod, one-stage posterior focus debridement and internal fixation of inter-centrum non-structural bone grafting are effective and feasible to treat mono-segmental thoracic spine tuberculosis. Key words: Thoracic vertebrae; Tuberculosis; Internal fixators