Ischial Tuberosity Research Articles

The Utilization of Diagnostic Musculoskeletal Ultrasound in the Evaluation for Ischiofemoral Impingement: A Perspective for Rehabilitation Providers

Ischiofemoral impingement (IFI) is a significant but often underdiagnosed source of deep posterior hip pain and functional impairment, frequently associated with narrowing of the ischiofemoral space (IFS) between the ischial tuberosity and the lesser trochanter of the femur. Traditionally, diagnostic approaches for IFI have relied on clinical examination and magnetic resonance imaging (MRI). However, the advent of diagnostic musculoskeletal ultrasound (MSKUS) has transformed the evaluation process. MSKUS offers a non-invasive, cost-effective, and dynamic method for assessing the IFS and associated musculature in real time, allowing for high-resolution visualization of soft tissues, bones, and neurovascular structures. For rehabilitation providers, understanding the application, strengths, and limitations of MSKUS can enhance diagnostic accuracy, guide targeted therapeutic interventions, and potentially expedite recovery. This article reviews the anatomy of the IFS, the pathophysiology of IFI, and the use of MSKUS in diagnosing IFI, equipping rehabilitation professionals with the knowledge to integrate this valuable diagnostic tool into clinical practice.

Systemic investigation of pelvimetric profile in three strains of Deoni cattle

The present research work was designed to establish baseline data of the pelvimetric profile in Deoni Cattle. Deoni cattle (270) of three strains, i.e. Wannera, Balankya and Shevera were selected and divided into six age groups: Group I (12 to 24 months), II (25 to 36 months), III (37 to 48 months), IV (49 to 60 months), V (61 to 72 months) and VI (73 to 84 months) with 45 animals in each group. Body weight along with different pelvimetric parameters such as distance between two angles of haunch (A), distance between two ischial tuberosities (B), distance between level of croup and hip joint (C) and distance between tuber coxae and tuber ischia (D) were measured to determine the transverse and vertical diameter of pelvic inlet and outlet which were used to calculate pelvic area of inlet and outlet. The pelvic area values for both inlet and outlet showed highly significant differences within groups, but no significant difference was observed between the three strains of each group. From the results of the study, it can be concluded that the pelvic area of Deoni cattle increases with the age and it has significant positive correlation with the parity and body weight. Thus, pelvimetric profile can be used as a marker for selection of young Deoni heifers and cows for breeding purposes to lower dystocia incidences.

Accuracy of pelvic bone segmentation for 3d printing: a study of segmentation accuracy based on anatomic landmarks to evaluate the influence of the observer.

3D printing has a wide range of applications and has brought significant change to many medical fields. However, ensuring quality assurance (QA) is essential for patient safety and requires a QA program that encompasses the entire production process. This process begins with imaging and continues on with segmentation, which is the conversion of Digital Imaging and Communications in Medicine (DICOM) data into virtual 3D-models. Since segmentation is highly influenced by manual intervention the influence of the users background on segmentation accuracy should be thoroughly investigated. Seventeen computed tomography (CT) scans of the pelvis with physiological bony structures were identified, anonymized, exported as DICOM data sets, and pelvic bones were segmented by four observers with different backgrounds. Landmarks were measured on DICOM images and in the segmentations. Intraclass correlation coefficients (ICCs) were calculated to assess inter-observer agreement, and the trueness of the segmentation results was analyzed by comparing the DICOM landmark measurements with the measurements of the segmentation results. The correlation between segmentation trueness and segmentation time was analyzed. The lower limits of the 95% confidence intervals of the ICCs for the seven landmarks analyzed ranged from 0.511 to 0.986. The distance between the iliac crests showed the highest agreement between observers, while the distance between the ischial tuberosities showed the lowest. The distance between the upper edge of the symphysis and the promontory showed the lowest deviation between DICOM measurements and segmentation measurements (mean deviations < 1mm), while the intertuberous distance showed the highest deviation (mean deviations 14.5-18.2mm). Investigators with diverse backgrounds in segmentation and varying experience with slice images achieved pelvic bone segmentations with landmark measurements of mostly high agreement in a setup with high realism. In contrast, high variability was observed in the segmentation of the coccyx. In general, interobserver agreement was high, but due to measurement inaccuracies, landmark-based approaches cannot conclusively show that segmentation accuracy is within a clinically tolerable range of 2mm for the pelvis. If the segmentation is performed by a very inexperienced user, the result should be reviewed critically by the clinician in charge.

Using calcaneal plates in fixation of comminuted posterior wall acetabular fractures with cranial or posterior extension: a prospective case series and novel technique.

This study aims to evaluate the outcomes of using calcaneal plate in fixation of comminuted posterior wall (PW) acetabular fractures especially that have cranial (dome) or posterior extension (posterior column edge), and to evaluate its safety. To our knowledge, this is the first study that utilizes this off label implant technique in fixation of such fracture. Twenty-two patients enrolled in the study with a minimum follow up of one year. After reducing the PW fragments sequentially, calcaneal plate was applied, fixing its distal part at ischial tuberosity upper ends using 3 screws in a triangular fashion, while its proximal part and radial wings were firmly fixed along the acetabular rim together with the classic longitudinal anchorage. Any fixation failure or head subluxation was recorded. Radiological outcome showed 18 cases scored as excellent, 2 were good, and 2 were poor. The functional outcome revealed 2 patients were excellent, 6 were very good and 14 were good. There was no loss of reduction or fixation failures throughout the follow up period. Calcaneal plate may offer an alternative method of fixation of comminuted PW fractures with acceptable radiological and functional results. Our study result may encourage the comprehensibility and replicability of this practice, however randomized multicentered studies should be conducted to validate this assumption. This method provides valuable trick strategy, stable and soft-tissue-friendly fracture fixation where modern implantations may be unavailable or of high cost. Calcaneal plates show some fascinating features that allow using them outside their field being flexible with large footprint area for fracture buttressing beside numerous hole choices with diverse paths providing suitable fixation, articular stability and wide zone of coverage in PW comminuted fracture patterns with cranial or posterior extensions. The plate proximal triangular configuration together with distal triangular screw fixation gives a stiff rigid anchorage and buttressing similar to a metal mesh covering and fixing any fragment numbers up to dome level.

Case series of genital lymphaticovenous anastomosis for genital lymphatic vesicles

BackgroundThe management of lymphatic vesicles is challenging. This study aimed to clarify the lymphatic flow around the genitals and the effect of genital LVA on genital lymphatic vesicles. MethodsWe performed a retrospective study of 34 patients who underwent resection for lymphatic vesicle and LVA. In patients with genital lymphedema, two types of lymphatic inflow existed around the genital area; from the lower extremities (type 1) and from the buttocks (type 2). Lymphoscintigraphy was performed to detect type 1 lymphatics injecting isotope into the first interdigital area. ICG lymphography was performed to detect type 2 lymphatics injecting ICG into the ischial tuberosity. We performed resection of lymphatic vesicles and LVA in the legs and/or in the genitals. Postoperative recurrence rate of lymphatic vesicles and the frequency of cellulitis were evaluated. ResultsType 1 lymphatics were observed in 38.2% of the patients. In ICG lymphography, there was linear inflow to the genitals in 40.9% and DB inflow in 24.2%. In 10 patients (29.4%), both type 1 and 2 lymphatic vessels were observed. Genital LVA was performed in 31 patients and lower extremity LVA was performed in 15 patients. The average follow-up period was 332 days, and recurrence was observed in 8 (25.8%) of 31 patients who underwent total resection. The average number of cellulitis episodes decreased significantly from 2.8 times before surgery to 0.31 times after surgery (p<0.01). ConclusionLVA in the genital area and lower limbs was effective in preventing postoperative recurrence of lymphatic vesicles after resection.

A METHOD OF SIMULATING SEAT LOAD FOR NUMERICAL ANALYSIS OF WOOD CHAIR STRUCTURE

This study aimed to investigate the characteristic values of the human-seat interface in a normal sitting posture, and to numerically mode the load on the chair seat for the structural design of chairs. The stress distributions and the characteristic values of seat were measured under normal sitting posture by using a human body pressure distribution measurement system considering the effects of gender and body mass index (BMI). The stress distribution on the seat was then numerically modeled using three modeling methods. The observed results and the numerical analysisresults were compared. The results showed that an inverted U-shaped pressure distribution was observed in normal sitting posture. The stress was concentrated on the ischial tuberosity with a maximum value of 0.066 MPa. The ratio of the load on the seat to the gravity of the human body weight was about 65.3%. The numerical model established using the body pressure mapping method was superior to those of the uniform load method and the standard loading pad method in terms of stress distribution, maximum stress, and contact area.

The Measurement of the Lateral Center-Edge Angle Is Underestimated on Radiographs Compared With 3-Dimensional Computed Tomography

PurposeTo determine if there is a significant difference using Femoral Heads (FH) as anatomical horizon when measuring the LCEA compared to Floor (F), Acetabular Teardrops (AT), and Ischial Tuberosities (IT) and to determine their accuracy by comparing to CT scan with commercially available software. MethodsBetween June 2019 and May 2020, patients with preoperative supine anteroposterior (AP) pelvis radiographs and CT scans were included and retrospectively analyzed. The LCEA was measured on all preoperative supine AP pelvis radiographs four times per hip, using the four methods. The four anatomical horizons used to measure LCEA were compared to each other to determine statistically significant difference. The LCEA measured in the CT scan at the 12 o’clock position was used to compare and determine radiographs’ LCEA accuracy. ResultsNinety-six patients (100 hips) met the inclusion criteria. Sixty-two were females (65%), and the mean age was 35.2 ± 15 years. The mean value for LCEA in CT was 32.2 and 31.1 for the four anatomical horizons in X-ray (P < 0.001). The lowest mean difference between CT scan and X-ray was obtained using the FH (2.3 ± 2.4). Less mean difference was obtained between FH and IT (1.0 ± 0.8). ConclusionIn this study, radiographic measurements underestimated LCEA compared with those from CT scans. Using the FH as an anatomic horizon on radiographs was a more accurate method to measure LCEA than using AT, IT, or F. While this difference is statistically significant, it is not likely to be clinically significant.

Osteopathic Approach to Proximal Hamstring Tendinopathy-related Sciatic Nerve Entrapment (PHTrSNE): Case Report

Abstract Proximal Hamstring Tendinopathy (PHT) provides a challenging diagnosis for clinicians due to limited evidence-based research. Presenting as chronic pain originating at the ischial tuberosity, PHT can progress to entrap the sciatic nerve, resulting in proximal hamstring tendinopathy-related sciatic nerve entrapment (PHTrSNE). This case expands the understanding of PHT by describing the osteopathic assessment and treatment of a runner with PHTrSNE. A 24-year-old female marathoner presented to the neurology clinic with a unique running gait: a left leg circumduction, or “leg whip,” that presented only when running. She also reported constantly dull hamstring pain, which occasionally elicited a sharp, shooting pain from her lower gluteal muscles to mid-hamstrings. Activities such as prolonged sitting and intense running exacerbated the sharp pain. On examination, the patient displayed ischial tuberosity tenderness and positive tests for hamstring tendinopathy. Evaluation with EMG/NCS showed mild chronic denervation of the left tibialis anterior muscle. A treatment plan for the patient’s PHTrSNE was created based on the principles of the neurological model of osteopathic medicine. Patients presenting with chronic hamstring discomfort accompanied by sharp, shooting pain may benefit from the diagnostic and therapeutic approach outlined in this study.

Hip Injuries in the Pediatric Athlete—Pelvic Apophyseal Avulsions

Pelvic apophyseal avulsion fractures have been occurring more commonly in young athletes in the context of increased intensive year-round training and early specialization in youth sports, and this diagnosis must be considered in the pediatric patient presenting with hip pain. An understanding of the relevant anatomy can guide the history and physical exam to arrive at the diagnosis, which is usually confirmed with plain radiographs. Although non-operative management remains the mainstay of treatment for these patients, surgery may be warranted for ischial tuberosity fractures displaced > 2 cm and for symptomatic nonunions The objective of this review is to provide a comprehensive overview of pelvic apophyseal avulsion injuries.

Surgically Treated Ischial Tuberosity Avulsion Fractures in Adolescents: Risks and Outcomes of 3 Fixation Constructs.

Avulsion fractures of the ischial tuberosity (AFIT) are uncommon injuries that sometimes require operative fixation with screws, suture anchors, or cortical suspensory buttons. This study reviewed a series of surgically managed AFITs at a single institution and compared outcomes among fixation strategies. We hypothesized there would be no difference in outcomes between fixation types. We conducted a retrospective review of all patients treated operatively at a single institution from 2010 to 2022 for AFIT identified by CPT code (27215). We collected patient demographics, injury characteristics, Revised Modified Oxford Bone Score, radiographic measures, fracture classification (type 1-lateral vs. type 2-complete), surgical fixation technique, postoperative complications (Modified Clavien-Dindo-Sink [M-CDS] Complication Classification), and time to return to sport (RTS). Descriptive statistics and univariate analyses were performed. Study criteria identified 16 patients with surgically treated AFITs during the study period. Patients were predominantly male (88%) with a mean age of 14.8±0.8 years. Injured patients most commonly participated in soccer (38%), with the most common mechanism of injury being running/sprinting (50%). The avulsed fracture fragments were a mean of 42.6mm in size, with an average maximal displacement of 21.1mm and predominantly type 1-lateral (75%). Surgical constructs included: screws (4), suture anchors (5), cortical suspensory buttons (6), and combined (1, screw and suture anchor). Postoperative complications occurred in 8 patients (50%) including 7 type 1 and 1 type 3 M-CDS. No statistically significant difference was found between fixation types among the studied outcome variables; however, re-fracture (1 case [M-CDS type 3]) was only observed with a combined (screw and suture anchor) construct. This retrospective cohort study demonstrated that postoperative complications after ORIF for AFIT were not infrequent but were largely low in severity. Refracture occurred only with a combined screw and suture anchor construct. Consistent return to sport was achieved across all fixation types, with no significant difference in complication rate between constructs, although the available study sample limited robust analysis. This study is also, of note, one of the first to report outcomes from cortical suspensory buttons (CSB)-a relatively novel intervention for AFIT. Findings from this retrospective case series of multiple surgical techniques serve to bolster the limited literature base regarding the operative treatment of AFITs in adolescents.

The anatomical course of the sciatic nerve in relation to different approaches in total hip arthroplasty.

Although sciatic nerve (SN) injury is relatively rare, it is a devastating complication after primary and revision total hip arthroplasty (THA). Therefore, precise localization of the SN is essential for arthroplasty surgeons. We dissected 50 hemipelves from formalin-fixed cadavers. The course and location of the sciatic nerve were investigated in relation to different approaches for THA with the help of anatomical landmarks like the greater trochanter (GT), the iliac tubercle, the ischial tuberosity (IschT), the infrapiriform foramen, and the suprapiriform foramen. We found and exposed the sciatic nerve in all 50 specimens with no sex-specific differences. No SN was encountered up to 22mm posterior from the GT. The zone affording the highest probability of finding the nerve was posterior to the GT between 32 and 55mm in 39 (78%) cases, thus defining a danger zone for different approaches for the THA. Special care should be taken with posterior and deep instrument placement between the GT and IschT during THA. Moreover, manipulations in the proximal third of the posterior approach reaching deep and posteriorly should be performed with the utmost care.

A new insight for investigating the prenatal and postnatal ossification centers of pelvic and femur bones in white New Zealand rabbits (Oryctolagus cuniculus) using 3D CT, double stain technique, and morphometry

BackgroundThe ossification centers in rabbit limbs are related to fetal age and bone maturation. Objective: To address the limited studies on ossification in the hind limbs of New Zealand rabbits, we investigated the prenatal and postnatal development of the pelvic and femur bones. MethodsDouble staining with Alcian Blue and Alizarin Red, computed tomography (CT), and 3D reconstruction were employed to visualize and analyze ossification centers in detail. ResultsUsing double staining, we observed these patterns: At prenatal days 18 and 21, ossification centers appeared in the ilium. By prenatal days 23 and 25, ossification began in the ischium. On postnatal day 1, ilium ossification centers spread across most of the ilium wings, except for the iliac crest, and new centers appeared in the pubis and cotyloid bones. Most bones had ossified by the third week and one month postnatal, except for the iliac crest and ischial tuberosity. At 1.5 months, both were fully ossified. On day 18 post coitum, an ossification center was visible in the middle of the femur shaft. By day 28 post coitum, ossification extended through the shaft, and postnatally, new ossification spots appeared at the extremities by day one and week one. By the third week, complete ossification of the femur head, lesser trochanter, third trochanter, medial condyle, and lateral condyle was observed. At 1.5 months, the entire proximal extremity was ossified. Conclusion3D CT provided clear imaging of ossification progression in the pelvic and femur bones. This study enhances our understanding of vertebrate skeletal development.

Beaton and Anson Type A Classification of the Sciatic Nerve and Piriformis Complex: Clinical Considerations for Sex and Laterality

Variations of the sciatic nerve and piriformis muscle (SN-PM) relationship must be considered when discussing orthopedic procedures within the region as they may cause increased risk of SN injuries. Thirty-one formalin-embalmed, prosected donors were evaluated using the Beaton and Anson (B&amp;A) classification system (1939). Major landmarks of the SN-PM relationship were identified, including the posterior superior iliac spine (PSIS), ischial tuberosity (IT), greater trochanter (GT), and the middle of the SN as it exits under the PM (S1). Distances measured included: PSIS-IT, PSIS-GT, IT-GT, PSIS-S1, IT-S1, GT-S1, S1-Q (distance of perpendicular line connecting S1 to PSIS-IT), and S1-R (distance of perpendicular line connecting S1 to PSIS-GT). Measurements from 49 lower extremities were evaluated using a two-tailed t-test to compare by sex and laterality; a one-tailed t-test was utilized to compare groups based on anatomical sex. Six donors displayed asymmetric B&amp;A classifications, demonstrating gross anatomical differences within a single individual; however, no measurements were significant when comparing extremities. Seven measurements were statistically significant (p &lt; 0.05) between sexes, indicating notable sex-based differences. These data highlight sex-based differences in the SN-PM relationship, as well as consistencies within measurements among extremities, which can be utilized by clinicians when treating male and female patients needing unilateral or bilateral orthopedic procedures or injections within the gluteal region.

Developmental three-dimensional examination of the pelvic cavity of Hamdani crossbred sheep fetuses (Ovis aries) in the last two periods of gestation.

Türkiye is a country in the world ranking in terms of sheep breeding. Hamdani crossbred sheep breed is one of the sheep breeds that can adapt to the difficult conditions in our country. In addition, the sentence may be corrected as 'Especially in the southeastern part of the Türkiye, crossbreeding is preferred by breeders to increase the yield characteristics of sheep'. In our study, it was aimed to perform a pelvimetric analysis of Hamdani crossbred sheep fetuses in the second and third trimesters by three-dimensional modelling method. For this purpose, a total of 40 second-trimester (10 females, 10 males) and third-trimester (10 females, 10 males) fetuses were used. The pelvises of the fetuses were imaged with CT and 3D models were created. Sixteen pelvimetric measurements were performed from the models. The results obtained were evaluated statistically. The study found statistically significant differences between male and female fetuses in terms of vertical diameter (VD) and foramen obturatum width (FOW) measurement parameters in the second trimester. In the third trimester, there were statistically significant differences between genders in acetabulum (AC) (p < 0.01), medial ischial tuberosities (MIT), and ischiatic arch (IA) (p < 0.05) parameters. As a result of the correlation analysis, it was determined that the pelvis length (PL) measurement parameter was positively correlated with different parameters in varying degrees in both periods, while the IA parameter did not show significant correlations with the other parameter in the last two periods of pregnancy. In conclusion, the data obtained will be useful in pelvimetric evaluations of human and animal fetuses, anatomy education, zooarchaeology and taxonomy studies.

Exploring the effects of lateral pressure to the soft tissue of the buttocks during seating to preserve tissue perfusion

AimPressure-ulcer occurrence in the seated patient is understudied. Preventative devices have been developed and are prescribed commonly, but there is little quantitative evidence of their effectiveness. This study explores the concept of a lateral pressure device, a prevention device that applies pressure to the sides of the seated buttocks, to reduce the amount of tissue distortion and blood-vessel occlusion. It is hypothesized that this device will reduce deep tissue injury by reducing the pressure at the bone-muscle interface, as demonstrated computationally in previous research. This study aimed to use oximetry to investigate the efficacy of the device in maintaining transcutaneous gas tensions of the tissue as close to baseline as possible. MethodsOximetry electrodes were attached to participants' ischial tuberosity and greater trochanter for different amounts of lateral pressure. The amount of lateral pressure is a given percentage of the pressure due to the participants’ underbody pressure. ResultsThe results show that 50 % lateral pressure is sufficient to produce an improvement in participants’ gas tensions at their ischial tuberosity, without negatively impacting the tissue at their greater trochanter, relative to the control of sitting with no application of lateral pressure. ConclusionDespite a rudimentary prototype device design, and that participants each placed their own oximetry sensors, results support the application of lateral pressure as a method to maintain transcutaneous gas tensions. Further work should be carried out on a larger sample to consolidate these findings.

Management of Proximal Hamstring Injuries: Non-operative and Operative Treatment.

To evaluate the current evidence and literature on treatment options for proximal hamstring injuries. Patients with 3-tendon complete tears with greater than 2cm of retraction have worse outcomes and higher complication rates compared to those with less severe injuries. Endoscopic and open proximal hamstring repair both have favorable patient reported outcomes at 5-year follow up. Proximal hamstring repair in patients who are male, with isolated semimembranosus injury, and have proximal hamstring free tendon rupture are more likely to have earlier return to sports. The Parisian Hamstring Avulsion Score (PHAS) is a validated patient-reported outcome measure to predict return to sports. Proximal hamstring injuries may occur in both elite and recreational athletes and may present with varying degrees of chronicity and severity. Injuries occur most commonly during forceful eccentric contraction of the hamstrings and often present with ischial tuberosity tenderness, ecchymosis, and hamstring weakness. Treatment decision-making is dictated by the tendons involved and chronicity. Many proximal hamstring injuries can be successfully treated with non-surgical measures. However, operative treatment of appropriately indicated proximal hamstring tendon injuries can result in significantly better functional outcomes and faster and more reliable return to sports compared to nonoperative treatment. Both endoscopic and open surgical repair techniques show high satisfaction levels and excellent patient-reported outcomes at short- and mid-term follow-up. Postoperative rehabilitation protocols vary across the literature and ongoing study is needed to clarify the optimal program, though emphasis on eccentric hamstring strengthening may be beneficial.

Reparation with moving least squares sampling and extraction of body sizes of beef cattle from unilateral point clouds

Body measurements of beef cattle at various growth stages are crucial for assessing breeding quality. To decrease the stress responses of live cattle during measurement, noncontact body size measurement using a deep sensor is conducted. After directly obtaining the point cloud data (PCD) of a unilateral surface, novel point cloud repair and body measurement are proposed. The PCD of beef cattle are first preprocessed using Euclidean clustering, conditional filtering, and Random Sample Consensus. To merge the unilateral PCD into the entire contour, a Euclidean transformation matrix and moving least squares are applied. To address holes caused by stitching due to camera angle restrictions, various upsampling techniques based on least squares deformation are investigated to repair holes in different surfaces with varying growth stages. Finally, polynomial fitting is chosen to be in accordance with the feature point distribution of the body height (BH), chest girth (CG), back height (AH), waist height (WH), ischial tuberosity, and shoulder end of beef cattle. Using the formulas of Euclidean distance and cubic B–spline curve fitting, the values of BH, AH, WH, CG, and body length are obtained and then compared with manual measurement data. The predicted values of the five body sizes of 100 beef cattle had a mean absolute error and mean absolute percentage error of 7.77 cm and 5.42 %, respectively. The largest absolute error was 12.05 cm, and the smallest absolute error was 4.12 cm. A series of PCD processing and repair methods provides a new method for the noncontact automated measurement of beef cattle. This approach promotes more effective practices in livestock welfare and trait assessment compared with traditional management.

Ultrasound-guided gluteal nerves electrical stimulation to enhance strength and power in individuals with chronic knee pain: a randomized controlled pilot trial.

Various pathophysiological contexts can be accompanied by weakness, arthrogenic muscle inhibition, and even disability. In this scenario, peripheral nerve stimulation has been studied not only for pain management but also for the improvement of neuromuscular parameters. For this purpose, the use of Transcutaneous Electrical Nerve Stimulation (TENS) has typically been investigated, but recently, the use of ultrasound-guided percutaneous peripheral nerve stimulation (pPNS) has gained popularity. In this regard, electrical stimulation has a predisposition to activate Type II muscle fibers and has been shown to be capable of generating short-term potentiation by increasing calcium sensitivity. However, the evidence of pPNS applied in humans investigating such variables is rather limited. This pilot study aimed to assess the feasibility of the methodology and explore the potential of pPNS in enhancing hip extension performance in individuals suffering from knee pain, comparing it with TENS. Twelve participants were divided into pPNS and TENS groups, undergoing pre- and post-intervention assessments of peak concentric power (W), strength (N), execution speed (m/s), and one-repetition maximum (1RM) (kg) estimation. For pPNS, two needles were positioned adjacent to the superior and inferior gluteal nerves under ultrasound guidance. For TENS, electrodes were positioned between the posterosuperior iliac spine and the ischial tuberosity, and halfway between the posterosuperior iliac spine and the greater trochanter. The interventions consisted of 10 stimulations of 10 s at a frequency of 10 Hz with a pulse width of 240 μs, with rest intervals of 10 s between stimulations. Peripheral nerve stimulation significantly improved concentric power at 30% (p = 0.03) and 50% (p = 0.03) of 1RM, surpassing TENS, which showed minimal changes. No significant strength differences were observed post-intervention in either group. This work presents evidence where pPNS applied to the gluteal nerves results in an enhanced performance of hip extension at submaximal loads. However, this improvement does not seem to be reflected in short-term changes in the estimation of the 1RM by the force-velocity profile.

Poster 212: Ischial Tuberosity Avulsion Fractures: Treatment and Return to Sport in Athletes with Displaced Fragments

Objectives: Ischial tuberosity avulsion fractures are relatively rare injuries that typically occur in young athletes during activity. Some of these patients may experience significant morbidity, often through chronic pain and changes in sports participation. The influence of fragment displacement on optimal treatment and proper return to sport protocol has not been well investigated. This study sought to evaluate the relationship between displacement and both choice of treatment and time to return to sport. Methods: Retrospective analysis of ischial tuberosity avulsion fractures in pediatric patients between 2010-2021 at Boston Children’s Hospital was completed. Information regarding demographics, treatment, and recovery were extracted from individual patient charts. Plain radiographs and magnetic resonance imaging (MRI) were analyzed in order to measure fragment displacement at the ischial apophysis. Treatment protocol, return to sport (RTS) time, and complications were analyzed. Results: Eighty-eight patients with a diagnosis of an ischial tuberosity avulsion fracture were identified. Of these, 64 (73%) were treated non-operatively, 8 (9%) were treated acute operatively (within 6 weeks), and 16 (18%) were treated chronic operatively (&gt;6 weeks). Imaging for measurement of fragment displacement was available for 86 (98%) of patients. The median displacement was 0.2cm for the non-operative group, 2.2cm for the acute operative group, and 1.5 for the chronic operative group. Of the 86 patients with available imaging, 67 (78%) had a RTS time. The median RTS was 3.6 months in the non-operative group, 5.5 months in the acute operative group, and 13.3 months in the chronic operative group. Conclusions: In this retrospective cohort study, nearly all fractures with displacement &gt;= 1.0cm were surgically treated, either acutely or at a delayed time point. All patients that underwent acute operation had displacement &gt; 1.0cm, while 87% of those undergoing delayed operation had displacements &gt; 1.0cm. Those treated non-operatively returned to sport about 1 month earlier than those undergoing acute operation, and several months prior to those who underwent delayed surgical intervention. This data suggests that patients with displacement less than 1.0cm may be successfully treated through non-operative treatment and those with displacement greater than this should undergo operative treatment in the acute period to optimize outcome and return to sport.

An alternative method for measuring patient’s sagittal balance parameters in sitting and standing positions

Introduction The understanding of the biomechanics of movements in the spinopelvic segment plays an important role in the successful treatment of patients with hip-spine syndrome. Analysis of the biomechanical processes occurring in the biokinematic chain of the spine–pelvis–hip during the transition from standing position to sitting position allows us to conclude that the acetabular axis of rotation of the pelvis in space is not the only one. Classical methods for measuring PI, PT, overhang S1 are applicable for patients in a standing position and use the hip joint as a starting point, since it is the point of rotation of the pelvis in space in a standing position. Previously, using mathematical modeling, we described spatial changes in the pelvis during a given change in the body position and showed the presence of a second point of pelvis rotation in space, which appears in a sitting position. We assumed that in a sitting position, it is necessary to use other methods for calculating indicators of spinopelvic relationships for their determination.Purpose of the study was to evaluate the parameters of patients’ sagittal balance using the proposed alternative method in standing and sitting positions.Materials and methods Medical documentation and the results of X-ray examination of 20 patients with unilateral idiopathic coxarthrosis who underwent total hip replacement surgery were analyzed. The radiographic parameters were calculated: PI, PT, overhang S1 in standing and sitting positions, anterior inclination of the acetabular component; parameters PI ischial, PT ischial, deviation of the ischial tuberosities in standing and sitting positions were proposed and calculated.Results The study shows that there is no statistical difference in the values of the angles PI standard for a standing position and PI ischial for a sitting position. It corresponds to objective data and is generally accepted. Examples of changes in radiographic parameters of the sacral slope and the deviation of the ischial tuberosities were shown reflecting the rotation of the pelvis in space through the second, ischial axis, that confirm the biaxial concept of pelvic rotation.Discussion The calculations demonstrated the possibility of using alternative indicators of spinopelvic relationships (PT, distance of overhang of the sacrum (overhang S1), deviation of the ischial tuberosities). They enabled assessment of the spatial transformation of the pelvis and the ability to predict the spatial position of the acetabulum, which is an important factor for successful treatment of patients with combined pathology of the hip joint and spine.Conclusion Our findings complement the biaxial concept of pelvic rotation. An alternative method for measuring sagittal balance parameters in a sitting position has been proposed. Further research is required to assess the practical significance of this method.