Left Hip Bone Research Articles

9342 Managing Osteoporosis In Patients With Phocomelia: Challenges And Strategies

Abstract Disclosure: M. Renzu: None. C. Hubers: None. V. Mehta: None. A.M. Qazi: None. A.M. Satei: None. D.K. Yerasuri: None. Introduction: Phocomelia, a rare congenital limb malformation, often results from disruptions in limb bud formation during embryonic stage, due to genetic mutations, teratogens, or environmental factors like thalidomide embryopathy. These disruptions pose unique challenges in bone health management, including an increased risk of osteoporosis.We present a case report of a 52-year-old patient with phocomelia who developed an early onset severe osteoporosis. This case stresses the need for specific measures and care to tackle bone health in individuals with congenital limb anomalies. Case Presentation: A 52-year-old white female with phocomelia, had absence of the left forearm and hand, as well as a transverse tibial deficiency with a prosthetic left lower leg since the age of 1. Osteoporosis was diagnosed after follow-up, with initial osteopenia noted at age 49. DEXA scan showed lumbar osteopenia, radial osteoporosis, and bilateral femoral neck osteopenia. FRAX score showed an 11.9% risk of osteoporotic fracture and 3.1% risk of a hip fracture.Risk factors to her osteoporosis included late menarche, early menopause due to hysterectomy, and a history of hormone replacement therapy without pregnancies. Also, chronic colitis and diarrhea caused malabsorption issues. Her left hip bone mineral density was disproportionately low due to chronic prosthesis use, necessitating close monitoring and treatment initiation with Denosumab, along with vitamin D3 and calcium supplementation.As of the latest follow-up, the patient is closely monitored, and improvement is noted in her condition. She has incorporated daily gym sessions into her routine, indicating proactive engagement in her well-being. Discussion: Managing osteoporosis in patients with phocomelia needs a personalized approach, considering the patient's unique anatomical challenges and the limitations of traditional osteoporosis management strategies. Bone tissue adapts its structure based on mechanical loading, with reduced loading in deformed limbs leading to increased resorption and elevated osteoporosis risk. Tailored treatment plans, including Denosumab, which is known as an effective pharmacological option for managing osteoporosis, complemented by dietary adjustments to enhance vitamin D and calcium intake. Physical therapy programs play a vital role in muscle strengthening and balance improvement, reducing fracture risk.Another challenge that patients with phocomelia face is barriers to accessing healthcare services, like limited specialized care providers, financial constraints, and transportation difficulties, leading to increased morbidity. Hence early screening and intervention are essential to prevent osteoporotic complications. Overall, a comprehensive approach to osteoporosis management in phocomelia patients is crucial for optimizing outcomes and enhancing quality of life. Presentation: 6/3/2024

Biomechanical evaluation of a healed acetabulum with internal fixators: finite element analysis

BackgroundTreatment of complicated acetabular fracture with internal fixation usually has high risk of failure because of unbefitting fixation. However, evaluation of the biomechanical effect of internal fixation under physiological loading for fracture healing is still generally rarely performed. The purpose of this study is to analyze the biomechanical characteristics of a healed acetabulum with designed internal fixators under gait and to explore the biomechanical relationship between the healed bone and the internal fixator.MethodsA patient-specific finite element model of whole pelvis with designed internal fixators was constructed based on the tomographic digital images, in which the spring element was used to simulate the main ligaments of the pelvis. And the finite element analysis under both the combination loading of different phases and the individual loading of each phase during the gait cycle was carried out. The displacement, von Mises stress, and strain energy of both the healed bone and the fixation were calculated to evaluate the biomechanical characteristics of the healed pelvis.ResultsUnder the combination loading of gait, the maximum difference of displacement between the left hip bone with serious injury and the right hip bone with minor injury is 0.122 mm, and the maximum stress of the left and right hemi-pelvis is 115.5 MPa and 124.28 MPa, respectively. Moreover, the differences of average stress between the bone and internal fixators are in the range of 2.3–13.7 MPa. During the eight phases of gait, the stress distribution of the left and right hip bone is similar. Meanwhile, based on the acetabular three-column theory, the strain energy ratio of the central column is relatively large in stance phases, while the anterior column and posterior column of the acetabular three-column increase in swing phases.ConclusionsThe acetabular internal fixators designed by according to the anatomical feature of the acetabulum are integrated into the normal physiological stress conduction of the pelvis. The design and placement of the acetabular internal fixation conforming to the biomechanical characteristics of the bone is beneficial to the anatomical reduction and effective fixation of the fracture, especially for complex acetabular fracture.

Unilateral Coxalgia Revealing Acute Leukemia: One Case Report and Review of Clinical Literature

Introduction: The osteoarticular manifestations revealing acute leukemia in children are diverse and can be source of diagnostic delay, especially in the absence of other signs that point to a malignant origin. Case Report: We report through this case of a 4-year-old boy without any medical history and who consulted in our department for isolated severe pain in the left hip bone causing sleep deprivation, occurred after a minimal trauma and causing lameness, all symptoms dated back to 15 days before admission. Clinical examination was normal. Radiological assessment was normal as well. Mild anemia with neutropenia was noted on the blood count with no inflammatory signs. The blood smear was normal. The bone marrow aspiration confirmed the diagnosis of acute B-cell lymphoblastic leukemia. Discussion: Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. Osteoarticular manifestations of ALL in children are rare, they are revealing ALL in 14% of cases.The musculoskeletal symptoms can be so prominent or even the only presenting sign that sometimes the diagnosis of leukemia is delayed. Conclusion: Knowledge of orthopedic manifestation of leukemia is important in the diagnosis, supportive treatment and follow up of patients in order to improve their survival.

CLINICAL RELEVANCE OF HETEROTOPIC OSSIFICATION OF HIP AND PELVIC BONES MUSCLES AND LIGAMENTS

Objectives: Heterotopic ossification is a formation of bone at unusual sites. The present study is aimed to observe the ossification of transverse acetabular ligament, obturator membrane and gluteus maximus muscle in hip bones and fibrous capsule of hip joints and ossification of sacrotuberous and sacrospinous ligaments, erector spinae aponeurosis in pelves, and bilateral ankylosis of sacroiliac joints. Methods: The study was performed on 128 dried human hip bones and six pelves of unidentified sex and age, in the Department of Anatomy. An ossified muscles and ligaments of hip and pelvic bones were observed and their measurements were recorded using Vernier calipers. Results: The present study showed the incidence of completely ossified transverse acetabular ligament in four hip bones, that is, 3.12% with completely ossified fibrous capsule of hip joint on the left side. The incidence of bony spurs along the margin of Obturator Foramen in four left hip bones is 6.25% along with the ossification of the gluteus maximus muscle on dorsal aspect of ilium. Out of six pelves, one pelvis presented complete ossification of erector spinae aponeurosis bilaterally on the dorsal surface of the sacrum along with complete ossification of sacrotuberous ligament of the right side and sacrospinous ligament of the left side along with bilateral ankylosed sacroiliac joint of pelvis. Conclusions: The knowledge of these abnormal ossifications of hip bones and pelvis may be of immense help to orthopedicians, surgeons, neurosurgeons, and radiologists to come to differential diagnosis and plan treatment accordingly.

P-012: Automatic bone marrow segmentation in whole-body magnetic resonance imaging: towards comprehensive, objective MRI-phenotypic bone marrow characterization in multiple myeloma

<h3>Background</h3> Whole-body magnetic resonance imaging (wb-MRI) is an important diagnostic tool for staging, risk assessment and response evaluation in myeloma. Wb-MRIs contain approximately 110 million voxels per sequence, and only a limited amount of this information can be processed and reported by radiologists to date. Deep learning has brought striking advances in biomedical image segmentation in recent years. The goal of this work was to establish an automatic whole-body bone marrow (BM) segmentation algorithm for T1-weighted MRI sequence, and to use these segmentations for comprehensive MRI-phenotypic characterization of the BM by subsequent radiomics analysis, bone by bone. <h3>Methods</h3> For 66 patients with smoldering multiple myeloma (SMM), BM was manually segmented on T1-w images. Thirty different BM compartments were individually labelled: right and left humerus, second to seventh vertebral bodies of the cervical spine (C2-C7), all vertebral bodies of the thoracic (T1-T12) and lumbar (L1-L5) spine, sacrum, right and left hip bone and right and left femur. Data was split by date by a 3:1 ratio into training-set and independent test-set. A nnU-Net, which is state of the art deep learning framework for medical image segmentation, was trained on the 52 training cases for segmentation of BM compartments, and postprocessing was used to distinguish sides of paired bones (humeri, hip bones, femora). Mean Dice scores report accuracy of automatic segmentations on the test-cases and interrater variability between two radiologists. This study was approved by the institutional review board. <h3>Results</h3> The mean Dice scores of the nnU-Net segmentation on the 14 test-cases for BM of right and left humerus, C2-C7, T1-T12, L1-L5, sacrum, right and left hip bone, right and left femur were 0.95, 0.94, 0.87, 0.86, 0.84, 0.80, 0.82, 0.84, 0.86, 0.87, 0.88, 0.91, 0.85, 0.85, 0.83, 0.83, 0.87, 0.91, 0.93, 0.93, 0.89, 0.85, 0.85, 0.81, 0.76, 0.88, 0.93, 0.93, 0.97 and 0.97, respectively. The mean Dice scores between segmentations from 2 radiologists on 2 cases for these BM compartments in the same order were 0.94, 0.95, 0.79, 0.86, 0.88, 0.81, 0.78, 0.79, 0.84, 0.81, 0.91, 0.85, 0.89, 0.90, 0.91, 0.91, 0.92, 0.90, 0.90, 0.89, 0.88, 0.92, 0.93, 0.88, 0.88, 0.81, 0.89, 0.89, 0.95, 0.94, respectively. On a descriptive level, we found differences in radiomics signatures between vertebrae with physiological bone marrow, vertebrae with focal lesions and vertebrae with diffuse infiltration in exemplary cases. <h3>Conclusion</h3> We established automatic, bone by bone BM segmentation in SMM patients with accuracy only slightly worse compared to the interrater variability of radiologists, mostly due to lumbosacral transitional vertebra. In exemplary cases we found different radiomics-signatures between physiological BM and different pathologies, indicating that such BM segmentations can be used for in depth BM characterization from wb-MRI when combined with subsequent radiomics analysis.

Virtual reconstruction of the Kebara 2 Neanderthal pelvis

The paucity of well-preserved pelvises in the hominin fossil record has hindered robust analyses of shifts in critical biological processes throughout human evolution. The Kebara 2 pelvis remains one of the best preserved hominin pelvises, providing a rare opportunity to assess Neanderthal pelvic morphology and function. Here, we present two new reconstructions of the Kebara 2 pelvis created from CT scans of the right hip bone and sacrum. For both reconstructions, we proceeded as follows. First, we virtually reconstructed the right hip bone and the sacrum by repositioning the fragments of the hip bone and sacrum. Then, we created a mirrored copy of the right hip bone to act as the left hip bone. Next, we 3D printed the three bones and physically articulated them. Finally, we used fiducial points collected from the physically articulated models to articulate the hip bones and sacrum in virtual space. Our objectives were to (1) reposition misaligned fragments, particularly the ischiopubic ramus; (2) create a 3D model of a complete pelvis; and (3) assess interobserver reconstruction variation. These new reconstructions show that, in comparison with previous measurements, Kebara 2 possessed a higher shape index (maximum anteroposterior length/maximum mediolateral width) for the pelvic inlet and perhaps the outlet and a more anteriorly positioned sacral promontory and pubic symphysis relative to the acetabula. The latter differences result in a lower ratio between the distances anterior and posterior to the anterior margins of the acetabula. Generally, the new reconstructions tend to accentuate features of the Kebara 2 pelvis––the long superior pubic ramus and anteriorly positioned pelvic inlet––that have already been discussed for Kebara 2 and other Neanderthals.

Anthropometric Study of Human Hip Bones of Southern Brazilians by Rabbi Method

Forensic anthropology is a branch of forensic sciences that deals with research and aims to determine the identity of an individual by means of the origin of remains, general patterns of identification and individualizing characteristics. Currently, as Brazil has a significant percentage of homicides, serious accidents and natural disasters, it is necessary to use more precise anthropometric techniques to search for victim identification. Therefore, this study proposes to measure human hip bones using bone anthropometry technique, more specifically pelvimetry in order to determine standard measures for this bone for people of the south region of Minas Gerais. The measures obtained were as follows: VDA data was 49.74 ± 3.49 for right hip bone (RHB) and 51.06 for left hip bone (LHB). GSND data was 33.18 ± 3.08 for RHB and 32.96 ± 3.35 for LHB. Regarding CGSN measure, the values were 81.23 ± 6.74 for RHB and 82.87 ± 6.77 for LHB. DASIS results were 114.1 ± 6.62 for RHB and 112.4 ± 5.90 for LHB. OFD measures were 45.95 ± 4.21 for RHB and 47 ± 3.98 for LHB while OFL data were 31.34 ± 3.56 for RHB 30.42 ± 2.82 for LHB. the results above, one could conclude that there were significant differences in the measure of the hip bone when compared with data published for other ethnic groups. It is suggested that such differences may be related to the multiple genetic miscegenation that occurred in this region of Brazil during 500 years or more after colonization.

A radiotherapy refractory brain lesion among breast cancer metastases diagnosed postoperatively as glioblastoma multiforme: A case report

BackgroundBreast cancer is the most common cancer among women. The association between breast cancer and glioblastoma multiforme has not been investigated thoroughly. This case presents a case of glioblastoma multiforme (GBM) which was found concurrently with breast cancer metastases. Case SummaryThe patient is a 53 years old right-handed female with a history of breast cancer, metastatic to bone and liver, who had undergone stereotactic ablative radiotherapy to manage metastases to T10 vertebra, right acetabulum and left hip bone 2 years earlier. Six months prior to the current presentation, the patient was diagnosed with four apparent metastatic lesions to the brain (left cerebellum, right frontal, left parieto-occipital, and left temporal). The patient received Stereotactic Radiation Therapy (SRT). A follow-up MRI 4 months later revealed that all three smaller lesions responded well to SRT except for a mild increase in the size of the larger left temporal lesion with surrounding edema. The patient underwent a craniotomy for resection of the temporal lesion. Pathology revealed that the lesion was glioblastoma multiforme (GBM) rather than being another brain metastatic tumor. ConclusionAlthoughmost brain tumors are metastases, primary brain tumors should be considered a possibility even in the presence of another source of metastases; especially if there is a lesion refractory to treatment.

Does obstetric protection apply to small-bodied females?: A comparison between small-bodied Jomon foragers and large-bodied Yayoi agriculturalists in the prehistoric Japanese archipelago.

This study examined the relationship between maternal pelvic and body size in the transition from the Middle-Final Jomon period (c. 5000-3000 BC) to the Middle Yayoi period (c. 400~200 BC to around AD 1) in Japan. Eight measurements, including the left hip bone, articulated pelvis, and femur, were taken from Jomon (females: 37, males: 26) and Yayoi skeletal remains (females: 32, males: 29). A statistically significant decrease in the anterior diameter of the true pelvic inlet was demonstrated in females from the Jomon to the Yayoi period, but not in males. While significant increases in stature from the Jomon to the Yayoi period were found in both males and females, no significant changes in body mass were seen. The correlation coefficients between true and false pelvic measurements (maximum pelvic height and maximum pelvic breadth) and body size (stature and body mass) suggested few significant relationships between true and false pelvic measurements or body size among the samples, but no significant correlations in small-bodied Jomon females. Results of principal component analysis using the log-size and log-shape variables suggested that the true pelvic size in Jomon and Yayoi females was not correlated with their general pelvic or body size, and there were correlations between sexually dimorphic aspects of true pelvis shape and either the false pelvis or body size in males but not females. These results suggest that the obstetrical dimensions in small-bodied Jomon females were maintained for obstetric needs.

Correlation of Bone Mineral Density Scores and Proton Pump Inhibitors Use in the Elderly.

We aimed to identify any correlation between long-term proton pump inhibitor use and low bone mineral density in the elderly. This is a retrospective cohort study looking at PPI usage and bone mineral density scores of patients age 65 and above within a period of two years. Lumbar spine, right hip, and left hip bone mineral density t-scores were reviewed in PPI users and non-users. A total of 1,016 patients who had bone mineral density scans within that period were identified. Non-adjusted data showed no statistically significant association between PPI users and non-users in lumbar spine (p = 0.903), right hip (p = 0.775) and left hip (p = 0.407) bone mineral density scores. After adjusting for age and gender, PPI use was still not associated with low bone mineral density at the lumbar spine (p = 0.957), right hip (p = 0.440), or left hip (p = 0.691). The logistic regression did not show a statistically significant difference in low bone mineral density scores in lumbar spine (p = 0.162), right hip (p = 0.796), and left hip (p = 0.196) when length of use was considered. Among adults 65 years and older proton pump inhibitors users; there appears to be no correlation between PPI use and low bone mineral density and/or the length of PPI use.

Morphometric study of acetabulum in adult dry human pelvic bone

Background: The knowledge of normal anatomical features and morphometry of the acetabulum is vital to understand the mechanics of hip joint. Present study was aimed for morphometric study of acetabulum in adult dry human pelvic bone. Material and Methods: Present study was prospective, observational study, conducted in hip bones which were dry, complete and showing normal anatomical features. Results: In present study, 100 Indian adult dry hip bones of known sex (50 male and 50 female) (50 right & 50 left) were studied. In male hip bones, mean acetabular Diameter was 5.13 ± 0.4 mm, mean acetabular depth was 2.82 ± 0.3 mm, mean notch width 2.17 ± 0.9 mm & mean acetabular capacity was 30.83 ± 4.6 mm. while in female, mean acetabular diameter was 4.34 ± 0.3 mm, mean acetabular depth was 2.59 ± 0.5 mm, mean notch width 1.61 ± 0.8 mm & mean acetabular capacity was 22.12 ± 4.2 mm. Difference between all parameters was statistically significant. In right hip bones, mean acetabular Diameter was 4.67 ± 0.4 mm, mean acetabular depth was 2.72 ± 0.3 mm, mean notch width 1.9 ± 0.5 mm & mean acetabular capacity was 27.74 ± 6.2 mm. while in left hip bone, mean acetabular diameter was 4.71 ± 0.4 mm, mean acetabular depth was 2.63 ± 0.3 mm, mean notch width 1.89 ± 0.4 mm & mean acetabular capacity was 26.86 ± 6.4 mm. Difference between all parameters was statistically not significant. Conclusion: The morphometric assessment of the acetabulum has a myriad of utilities for Anatomists, anthropologists, experts in forensic medicine and Orthopaedic surgeons for better alignment of acetabular cup placement during total hip Arthroplasty.

A geometric morphometric analysis of acetabular shape of the primate hip joint in relation to locomotor behaviour

The description of acetabular shape variation among primates is essential for our understanding of the locomotor behaviour and ecology of both extant and fossil species. In this study, we use two-dimensional geometric morphometrics to examine variation in acetabular shape in human and non-human primates and to determine the degree to which it co-varies with locomotor behaviour, while taking both intra and inter-specific variation into account. To these ends, we examined the acetabulum of 303 left hip bones of 27 extant genera of primates (including humans) with different locomotor behaviours. After accounting for shape variation due to sex, size, and phylogeny, the results confirm that acetabular shape varies significantly across locomotor groups. The two most differentiated locomotor groups are leapers and slow-climbing quadrupeds, which exhibit a unique acetabular shape. Furthermore, the acetabulum of humans differed significantly from all other groups, while no significant differences existed between chimpanzees and gorillas. The most noticeable differences are detected in both cranial and dorsal areas and around the acetabular horns. This variation in acetabular morphology may have biomechanical implications at the level of the hip joint, potentially determining joint range motion and load distribution during locomotion. Given the increasing number of published studies on fossil pelves, our results are widely applicable to fossil analyses, with critical implications for paleoanthropological analyses about the complex locomotor behaviour of fossil specimens and their classification into locomotor groups, which may enhance our understanding of their ecological habits.

Asymmetries in Hip Mineralization in Mobile Cellular Phone Users

A number of potential effects of mobile cellular phones on human health have been pinpointed, but the question of whether they affect bone mineralization has rarely been addressed. This study assessed differences in bone mineralization in the right and left hip of healthy male adult volunteers who were either nonusers of mobile phones (n=24) or users who carried the phone close to the right hip, for at least 1 year (n=24). Dual-energy x-ray absorptiometry (GE Lunar Prodigy) was performed in dual femur mode for each subject. Right and left hip bone mineral density (BMD) and bone mineral content (BMC) were compared. No difference in mean BMDs and BMCs between groups was found. Nonusers had higher BMC in the right femoral neck (P=0.0044), a difference absent in mobile phone users (P=0.028 for the right-left difference in nonusers vs users). Mobile phone users, but not nonusers, had lower BMD at the right trochanter (P=0.027) and lower BMC at the right trochanter (P=0.014) and right total hip (P=0.039). Linear regression showed a correlation between estimated cumulative hours carrying a cell phone on the right hip and differences between right and left trochanter BMD (r=0.434; P=0.034). The different asymmetries between right and left hip dual-energy x-ray absorptiometry values in nonusers and mobile phone users suggest that these devices may adversely affect bone mineralization.

Geometric morphometric approach to sex estimation of human pelvis

Sex estimation of skeletal remains is an important issue in both forensics and bioarchaeology. The chance of attaining a high level of accuracy regarding sex allocations is related to the skeletal component analyzed and the ability of the techniques employed to describe shape and size differences among the sexes. Current opinion regards the hip bone as the most reliable sex indicator because it is the most dimorphic bone, particularly in adult individuals. The aim of this study was therefore to analyze the greater sciatic notch and the ischiopubic complex morphology by employing geometric morphometric techniques, based on semilandmark and multivariate statistical methods, in order to develop a reliable and accurate technique for adult sex estimation. The sample analyzed consisted of 121 adult left hip bones randomly selected from the collection of documented skeletons housed at the Museu Antropologico de Coimbra. Morphometric analysis was based on coordinates of landmarks and semilandmarks of the ilium and ischiopubic regions that were digitized on 2D photographic images. Discriminant analysis with leave-one-out cross-validation and k-means clustering of shape and shape-size variables were used in order to classify individuals by sex. For the greater sciatic notch, average accuracy of 90.9% was achieved with both multivariate analyses based on shape variables. For the ischiopubic complex, the values obtained with shape variables were 93.4% and 90.1% for discriminant and k-means, respectively. Females were misclassified more frequently than males, especially for the ischiopubic complex. When multivariate statistical analyses were performed using shape-size variables, the percentages of correct classifications were lower than those obtained with shape variables. We conclude that the use of geometric morphometrics and multivariate statistics is a reliable method to quantify pelvic shape differences between the sexes and could be applied to discriminate between females and males.

Anatomische Grundlagen zur Innervation des m�nnlichen Beckens

To reach an optimal outcome after radical prostatectomy or cystoprostatectomy, minimal bleeding from the dorsal vein complex, meticulous apical dissection without distraction of the rhabosphincter and preservation of the cavernous nerves are necessary.A total of 19 male cadavers were used, ranging in age from 52-78 years and including 8 fetuses. Fourteen complete pelves and five tissue blocks of prostate, rectum, membranous urethra and the rhabdosphincter were investigated. Besides anatomical preparations, the lower urinary tract was studied by means of serial histological sections. The cavernous nerves and the pudendal nerves as well as their branches were dissected. For this reason, the pubic symphysis was severed. Subsequently the right or left hip bone was removed, whereas the pelvic organs were left intact to achieve a complete exposure of the lower urinary tract and the pudendal nerves. The rhabdosphincter presents as a vertical structure extending from the bulb of the penis to the region of the bladder neck along the prostate and the membranous urethra. It is supplied by branches of the pudendal nerve after leaving the pudendal canal. The membranous urethra is innervated by branches of the autonomic pelvic plexus. The nervous branches that are responsible for erection travel along the lateral aspects of the prostate in the so called "neurovascular bundle" and traverse through the urogenital hiatus to reach the corpora cavernosa.

The symmetry of hip bone mineral density. A dual photon absorptiometry approach.

Dual photon absorptiometry studies were performed on the hips of 23 patients to determine whether bone mineral density values obtained from one hip were indicative of the values in the contralateral hip of the ambulatory patient. The femoral neck, trochanteric, and Ward's triangle areas of both hips were analyzed. There were no significant differences between the right and left hip bone mineral density measurements in any of these three areas. Since the right and left hip readings were highly correlated, either hip may be used to evaluate osseous status.

On the Antiquity of Mummification in Egypt—A Correction

IN a recent article on the history of embalming, which was published in the Cairo Scientific Journal, I stated that a friend had told me there were two left hip-bones and no right in the remains of the so-called mummy of King Mykerinus in the British Museum.