Left Sacroiliac Joint Research Articles

Epidural Analgesia for Palliative Pain Management for A Patient with An Advanced Stage Prostate Cancer: A Case Report

Introduction: Patients with advanced-stage cancer should be able to stay at home with their families without suffering from pain. This case report aims to discuss challenges in pain management of a patient with bone metastasis of prostate cancer who received epidural analgesia at home. Challenges were related to the patients, health professionals, and system. Understanding each factor will bring insights to develop a workable pain management program in the palliative setting. Case Presentation: A 66-year-old male was diagnosed with left sacroiliac joint pain due to metastatic prostate cancer. After a three-year history of prostate cancer and ineffective chemotherapy, the patient complained of pain in the left hip that did not improve with conventional medications (paracetamol, tramadol, and Morphine Sustained Release/MST). In response, the consideration of an epidural implant emerged as a potential solution, offering the prospect of home-based care and autonomous medication administration through an epidural continuous block with intermittent drug injection. Conclusions: This case highlights home-based interventional pain management for cancer, addressing challenges at the patient, health professional, and system level. Overcoming these challenges requires a multidisciplinary approach and robust institutional policies. The insights gained offer valuable lessons for hospitals aiming to enhance the competence of pain and palliative care teams and establish comprehensive support systems in hospital and home settings.

Comparison Of Three Methods for Calculation of Sacroiliac Joint Index in Different Age Groups in Bone Scintigraphy

Objective: The aim of this study is to evaluate three techniques for calculating the sacroiliac joint (SIJ) index by bone scintigraphy in patients. Materials and Methods: Patients (n:160) who did not exhibit abnormalities on bone scan were analyzed and were divided into 4 groups; 3-20 years, 21-40 years, 41-60 years, 61-86 years, respectively. Irregular and rectangular region of interest (ROI) were used for first and second methods, respectively. Horizontal rectangular ROI was selected for the last technique. The SIJ index was calculated by the following formula: SIJ count/sacrum count. Results: There was no difference between the averages of all three methods according to right and left SIJ index (p>0.05). The averages of all SIJ values differed for three methods (p

The relationship between sacroiliac joint MRI scores and central sensitization in axial spondyloarthritis: A cross-sectional study

ABSTRACT Objective: To investigate the relationship between sacroiliac joint (SIJ) involvement and central sensitization (CS) in patients with axial spondyloarthritis (axSpA). Patients and Methods: Twenty-four patients with axSpA were included in this study. CS was investigated via pressure pain threshold (PPT), temporal summation (TS), conditional pain modulation (CPM), and the central sensitization inventory (CSI). Sacroiliac joint involvement was assessed using the magnetic resonance imaging (MRI)-based Canadian Spondyloarthritis Research Consortium (SPARCC) scoring system. CS-related parameters and SPARCC score correlations were analyzed. Results: The median (IQR) sacroiliac PPT score for the right SIJ was calculated as 17.47 (4.43) and 17.67 (4.57) for the left SIJ. In the TS measurement, the right SIJ TS median (IQR) value was calculated as 4.0 (3.5) and 4.0 (2.75) for the left side. The median (IQR) value was 149.67 (107.5) for CPM and 45.0 (27.75) for CSI. The median (IQR) sacroiliac inflammation score was calculated as 3.0 (8.75), and the median (IQR) structural score was calculated as 7.0 (11.5). No correlation was found between SPARCC scores and PPT, TS, CPM, and CSI values. Conclusion: In axSpA patients, there was no association observed between pain sensitivity measures and sacroiliac involvement. Further comprehensive studies are required, taking into account the complex nature of CS.

Unravelling a Case of Coronary Vasculitis

Background Coronary vasculitis is a rare cause of myocardial infarction through varied mechanisms. We report the case of a 32-year-old female found to have diffuse coronary microaneurysms during treatment for an Inferior ST Elevation Myocardial Infarction (STEMI), with challenges in pinpointing the underlying aetiology. Results Our patient has been diagnosed with a seronegative arthritis and had been initiated on regular Golimumab 4 months prior. She presented with prolonged fever for 4 weeks and inflammatory oligoarthritis with left sacroiliac joint pain. During this admission, Antinuclear antibody was 1:2560 and anti ds DNA was 1:80. She had highly positive Rickettsia conorii IgG titres of 1:128, suggestive of acute infection with Orientia tsustsugamushi. Meropenem and doxycyclin for presumed typhus had no impact on her fever spikes. In the 10th week of the illness, she developed ischaemic chest pain with electrocardiographic changes of inferior STEMI and was thrombolysed. Invasive coronary angiography revealed numerous coronary microaneurysms affecting all major myocardial vessels, with minimal coronary artery disease. Following multidisciplinary discussion, she was treated with intravenous methylprednisolone, antiplatelets, a statin and warfarin for a diagnosis of coronary vasculitis. Repeat angiography showed complete resolution of the microaneurysms. She continues on anticoagulation and has since had no coronary events. Conclusion Typhus and medium vessel vasculitis such as Kawasaki and Polyarteritis Nodosa were potential diagnoses for this presentation. A diagnosis of SLE was established due to the highly specific immunological profile. As there are reports of high Rickettsial titres in autoimmune disease, which alongside the lack of response to doxycyclin makes Typhus unlikely. The possibility of golimumab induced SLE was briefly entertained due to similar reports, but the positivity of ds DNA and major organ involvement made this possibility unlikely. We highlight the cardiac involvement in this case due to its high morbidity on young patients, and the current paucity of knowledge on SLE-related endothelial dysfunction and immune-mediated vascular damage. The role of anticoagulation in this inflammatory milieu too, is controversial. This case highlights a rare presentation of SLE, with an emphasis on coronary vasculitis. It adds to the current knowledge on the complex cardiovascular risk in SLE and highlights ambiguous areas in current management strategies to prompt further research.

Comparison of Sacroiliitis Grade Readings on the Same Plain Radiographs by the Same Observer at Different Periods.

This study aimed to investigate whether there is a difference between the readings of plain sacroiliac radiographs of patients with sacroiliitis by the same observer. In the study, we included patients diagnosed with sacroiliitis through sacroiliac MRI who had undergone plain radiographs at our center between 2015 and 2022. The radiographic grading of patients was conducted by transferring their demographic and clinical information into a computerized environmentso that these details would not be identifiable. The plain radiographs were numbered, and the responses were graded as grade 0, 1, 2, 3, or 4 for the right and left sacroiliac joints. The next day, using the same procedure, the same clinician re-evaluated the same plain radiographs in a different order without viewing the previous responses. This method was employed to prevent bias. The results (kappa value) were evaluated (0.00-0.20: slight agreement, 0.21-0.40: fair agreement, 0.41-0.60: moderate agreement, 0.61-0.80: substantial agreement, 0.81-1.00: perfect agreement). The study population included 478 patients and 956 sacroiliac joints from plain radiographs, both on the right and left. Following the observer's classification of the sacroiliac joints into 0, 1, 2, 3, and 4, a moderate level of agreement was found in the second evaluation of the same observer a day later with the same grades (p<0.001, kappa: 0.576). When categorized as grade0-1 and grade2-4, there was moderate agreement (p<0.001, kappa: 0.519), and categorization into grades 0-2 and 3-4 showed substantial agreement (p<0.001, kappa: 0.715). Analyzing the categorization into grades 0-3 and grade 4 revealed a higher kappa value, indicating substantial agreement (p<0.001, kappa: 0.766). Intraobserver interpretation of radiographs may be more accurate than the interpretation of different specialists. While interpreting plain radiographs, we observed variability between adjacent grades but less variability between distant grades. However, these results need to be validated.

The effects of topping-off instrumentation on biomechanics of sacroiliac joint after lumbosacral fusion

BackgroundLumbar/lumbosacral fusion supplemented with topping-off devices has been proposed with the aim of avoiding adjacent segment degeneration proximal to the fusion construct. However, it remains unclear how the biomechanics of the sacroiliac joint (SIJ) are altered after topping-off surgery. The objective of this study was to investigate the biomechanical effects of topping-off instrumentation on SIJ after lumbosacral fusion. MethodsThe validated finite element model of an intact lumbar spine–pelvis segment was modified to simulate L5–S1 interbody fusion fixed with a pedicle screw system. An interspinous spacer, Device for Intervertebral Assisted Motion (DIAM), was used as a topping-off device and placed between interspinous processes of the L4 and L5 segments. Range of motion (ROM), von-Mises stress distribution, and ligament strain at SIJ were compared between fusion (without DIAM) and topping-off (fusion with DIAM) models under moments of four physiological motions. ResultsROM at the left and right SIJs in the topping-off model was higher by 26.9% and 27.5% in flexion, 16.8% and 16.1% in extension, 18.8% and 15.8% in lateral bending, and 3.7% and 7.4% in axial rotation, respectively, compared to those in the fusion model. The predicted stress and strain data showed that under all physiological loads, the topping-off model exhibited higher stress and ligament strain at the SIJs than the fusion model. ConclusionsMotion, stress, and ligament strain at SIJ increase when supplementing lumbosacral fusion with topping-off devices, suggesting that topping-off surgery may be associated with higher risks of SIJ degeneration and pain than fusion alone.

Investigation of Potential Injury Patterns and Occupant Kinematicsin Frontal Impact with PMHS in Reclined Postures.

The reality of the autonomous vehicle in a near future is growing and is expected to induce significant change inthe occupant posture with respect to a standard driving posture. The delegated driving would allow sleeping and/or resting in a seatwith a reclined posture. However, the data in the literature are rare on the body kinematics, human tolerance, and injury types insuch reclined postures. The current study aims at increasing the knowledge in the domain and providing useful data to assess therelevance of the standard injury assessment tools such as anthropomorphic test devices or finite element human body models. For that purpose, a test series of three male Post-Mortem Human Subjects (PMHS) were performed in frontal impact at a 13.4 m/sdelta V. The backseat inclination was 58 degrees with respect to the vertical axis. The semi-rigid seat developed by Uriot et al.(2015) was used with a stiffer seat ramp. The restraint was composed of a lap belt equipped with two 3.5 kN load limiters, and ofa shoulder belt equipped of a 4 kN load limiter on the upper anchorage placed in the vicinity of the shoulder. The belts, the semi-rigid seat, and the footrest were equipped with force sensors. The rotations of the seat pan and of the seat ramp were also measured. The PMHS were instrumented with multi-axis accelerometers and Y angular velocity sensors attached to the head, thorax (T1 andT12 vertebrae), and sacrum. Strain gauges were glued onto the anterior face of the L1 to L5 lumbar vertebrae and onto the anteriorface of the iliac wings. To estimate the pelvis kinematics, a rigid support equipped with targets was fixed onto the femur shaft. Prior to test, X-ray imagery was performed to exhibit the initial curvature of the lumbar spine. After the tests, an in-depth necropsywas done, with a specific attention to the lumbar spine. In the chosen test conditions, no lap-belt submarining was observed for the three PMHS. One PMHS sustained an AIS2 pelvic ringfracture and another one sustained an AIS4 injury with complete separation of the left and right sacroiliac joints. Lumbar discruptures and vertebral fractures were observed for the three PMHS (AIS 2 and AIS3 coding). The number of separated rib fractureswere very different from one PMHS to another (0, 6 and 33). Response corridors for the external forces and kinematics were builtand are presented in the paper. The results are discussed by comparing with existing data for which the backseat was in standardposture.

Successful treatment of pustulotic arthro-osteitis with amoxicillin: A case report and review of the literature.

Palmoplantar pustulosis (PPP) is a chronic skin inflammatory disease characterized by sterile pustules on the palms and soles. Pustulotic arthro-osteitis (PAO) is a major comorbidity of PPP, frequently affecting the anterior chest wall. PPP and PAO are thought to be closely associated with focal infection. We report a female in her 40s who developed pustules on her palms and soles with tenderness of both sternoclavicular and left sacroiliac joints, which were not improved with non-steroidal anti-inflammatory drugs. Of note, she showed a great response to amoxicillin, resulting in the almost complete resolution of her skin lesions and arthralgia. We also reviewed previous reports to learn more about the potential therapeutic options of antibiotics for PAO.

Success of the pain relief drug injections in management of the bertolloti syndrome: case report and review of the literature

Introduction: Low back pain accompanied by the lumbosacral transitional vertebra (LSTV) is called the Bertolotti syndrome. This report discussed a case treated with combined corticosteroid and local anesthetic injections based on the literature. Case report: A 35-year-old female patient was admitted to the hospital suffering from low back pain. On neurological exam, her left sacroiliac joint was painful on palpation. Her muscle strength was full, but the left patella reflex was hypoactive. X-ray images revealed “Castellvi Type IIa” LSTV on the left side; therefore, it was considered that the patient might have Bertolotti Syndrome. Because şhedid not accept surgical intervention, “betamethasone dipropionate+betamethasone sodium” and “bupivacaine hydrochloride” were injected into her bilateral sacroiliac joints, bilateral L3-4, and L4-5 facets, and left LSVT joint under fluoroscopy. Her low back pain vanished immediately after the procedure, and she was discharged from the hospital with a full recovery. With an interval of about six months, she was hospitalized 5 more times with complaints of recurrent low back pain, and at each hospitalization, "local anesthetic" (LA) alone or "local anesthetic+corticosteroid" (LA+S) combination was injected into the primary trigger zones. During long-term follow-up, she continued his daily life without any problems. Discussion: This case report showed that sequential LA and LA+S administrations could be curative for patients with Bertolotti syndrome who do not accept surgical treatment, or who cannot undergo surgical intervention. Thus, it was concluded that it would be beneficial to conduct studies with larger samples to obtain more precise information about this method.

An In Vitro Biomechanical Analysis of Contralateral Sacroiliac Joint Motion Following Unilateral Sacroiliac Stabilization with and without Lumbosacral Fixation.

Cadaveric biomechanics study. This study investigated the effects of unilateral sacroiliac joint (SIJ) fixation for fusion with/without L5-S1 fixation on contralateral SIJ range of motion (ROM). SIJ fusion raises concerns that unilateral SIJ stabilization for fusion may increase contralateral SIJ mobility, leading to accelerated SIJ degeneration. Also, prior lumbosacral fixation may lead to accelerated SIJ degeneration, due to adjacent level effects. SIJ fixation biomechanics have been evaluated, showing a reduced-ROM, but SIJ fixation effects on contralateral nonfixated SIJ remain unknown. Seven human lumbopelvic spines were used, each affixed to six-degrees-of-freedom testing apparatus; 8.5-Nm pure unconstrained bending moments applied in flexion-extension, lateral bending, and axial rotation. The ROM of left and right SIJ was measured using a motion analysis system. Each specimen tested as (1) intact, (2) injury (left), (3) L5-S1 fixation, (4) unilateral stabilization (left), (5) unilateral stabilization+L5-S1 fixation, (6) bilateral stabilization, and (7) bilateral stabilization+L5-S1 fixation. Both left-sided iliosacral and posterior ligaments were cut for injury condition to model SIJ instability before surgery. There were no statistical differences between fixated and contralateral nonfixated SIJ ROM following unilateral stabilization with/without L5-S1 fixation for all loading directions (p>0.930). Injured condition and L5-S1 fixation provided the largest motion increases across both joints; no significant differences were recorded between SIJs in any loading direction (p>0.850). Unilateral and bilateral stabilization with/without L5-S1 fixation reduced ROM compared with the injured condition for both SIJs, with bilateral stabilization providing maximum stability. In the cadaveric model, unilateral SIJ stabilization with/without lumbosacral fixation did not lead to significant contralateral SIJ hypermobility; long-term changes and in vivo response may differ.

Ectopic parathyroid adenoma with severe osteoporosis in premenopausal woman

Abstract Introduction Primary hyperparathyroidism (PHPT) is defined as unsuppressed secretion of parathyroid hormone leading to a dysregulated bone and mineral metabolism and ultimately causing hypercalcemia. The main reasons for its development are parathyroid adenomas (PAs) with an estimated prevalence of 1–4/1.000 in the general population, predominant in postmenopausal women. Ectopic location of the parathyroid glad occurs in 6–16%.1 The most common location of ectopia is thymus, the next retroesophageal region and thyroid gland. We present a case of ectopic thymic parathyroid adenoma with severe clinical manifestations. Clinical Case A 43 years old woman patient applied to the clinic with complaint of bone pain, especially at the waist and hip. She had also difficulty in walking. Her laboratory tests were as follows; Ca: 9.65 mg/dl, albumin:45 g/dl, corrected Ca:9.25 mg/dl, phosphorus: 0.55 mmol/l (0.81–1.45), thyroid stimulating hormone (Tsh) 5.8 miu/l,Alp: 369 u/l, Pth: 442 pg/ml, vitamin D: 13 ng/mL, Mg:0.84 mmol/l. In radiologic findings; Hip and knee MRI revealed T1 hypointense, STIR and T2 hyperintense cystic lesion on the iliac wing of the left sacroiliac joint 36×13 mm in size, intraosseous cystic lesion on the right knee cap 16×26×27 mm in size. And cystic lesion was observed in the diaphysis region of the upper 1/3 of the right tibia 8×7×22 mm in size. The patient was found to be osteoporotic on dual energy X-ray absorptiometry (DEXA) scanning (Z score =−6.3 at the lumbar spine; Z score =-6.4 at the femur neck and Z score =-5.8 at the total femur). Neck ultrasound revealed an incidental thyroid nodule but no lesion suggestive of parathyroid adenoma was observed in ultrasonography. Vitamin D replacement therapy was started. After 4 weeks, laboratory tests were as follows; vitamin D:21 ng/ml, Pth:364 pg/ml, Ca: 10.65 mg/dl, albumin: 3.8 g/dl corrected Ca: 10.81, phosphorus: 0.73 mmol/l Alp:392 u/l, renal function tests were in the normal range. And 24-hour urinary calcium was 652 mg/day, fractional excretion of calcium (FeCa): 0.023. 24-hour urinary phosphorus: 29 mmol/day (normal). The patient was started on bisphosphonate therapy. Parathyroid sintigraphy was taken for localization purposes in the patient with hyperparathyroidism. In the early and late imaging of the anterior mediastinum, MIBI collection was detected behind the manubrium sterni with a size of 15×10 mm consistent with a parathyroid adenoma. The patient was consulted with thoracic surgery and the operation was performed. In the post-examination assays, Ca: 8.64 albumin: 3.8 g/dl corrected Ca: 8.75 mg/dl phosphorus: 2.54 mg/dl Pth: 41 pg/ml. Pathology resulted as ectopic thymic parathyroid adenoma. Conclusion Although ectopic parathyroid adenoma is not common in premenopausal women, it should be considered as a cause of severe osteoporosis.

Manipulations of Oblique Pulling Affect Sacroiliac Joint Displacements and Ligament Strains: A Finite Element Analysis.

Clinical studies have found that manipulation of oblique pulling has a good clinical effect on sacroiliac joint pain. However, there is no uniform standard for manipulation of oblique pulling at present. The purpose of this study was to investigate the effects of four manipulations of oblique pulling on sacroiliac joint and surrounding ligaments. A three-dimensional finite element model of the pelvis was established. Four manipulations of oblique pulling were simulated. The stresses and displacements of sacroiliac joint and the strains of surrounding ligaments were analyzed under four manipulations of oblique pulling. Manipulation of oblique pulling F2 and F3 caused the highest and lowest stress on the pelvis, at 85.0 and 52.6 MPa, respectively. Manipulation of oblique pulling F3 and F1 produced the highest and lowest stress on the left sacroiliac joint, at 6.6 and 5.6 MPa, respectively. The four manipulations of oblique pulling mainly produced anterior-posterior displacement. The maximum value was 1.21 mm, produced by manipulation of oblique pulling F2, while the minimal value was 0.96 mm, produced by manipulation of oblique pulling F3. The four manipulations of oblique pulling could all cause different degrees of ligament strain, and manipulation of oblique pulling F2 produced the greatest ligament strain. The four manipulations of oblique pulling all produced small displacements of sacroiliac joint. However, they produced different degrees of ligament strain. Manipulation of oblique pulling F2 produced the largest displacement of sacroiliac joint and the greatest ligament strain, which could provide a certain reference for physiotherapists.

Sacral Multifidus Plane Block – A Way Forward to Provide Perioperative Analgesia for Spinopelvic Fixation Surgery

Sacral Multifidus Plane Block – A Way Forward to Provide Perioperative Analgesia for Spinopelvic Fixation Surgery

Avulsion of the gluteus maximus associated with a Morell Lavellè lesion in a pelvic ring fracture

Morell Lavellè injury is associated with high-energy trauma. By itself, avulsion of the gluteus maximus is an extremely rare injury, and their association is extremely rare.Case report: A 21-year-old was victim of a car accident. On admission, he presented pelvic instability and a large hematoma in the right gluteal region. X-rays and computerized axial tomography (CT) were performed. He was diagnosed with a bilateral sacral wing fracture with dislocation of the left sacroiliac joint and underwent fixation of the sacroiliac joint with cannulated screws on the left. After discharge, he recurred due to fever with inflammatory signs on the posterior surface of the right buttock, with palpation of a gap. Faced with this situation, a CT scan was repeated where an extensive degloving lesion of the soft parts was identified, opting for debridement and surgical cleaning. During the surgery, detachment of the gluteus maximus from its ileal insertion was verified. After adequate mobilization and release, transosseous reinsertion was performed with a multifilament suture. To date, no incidents to report, with good clinical and imaging evolution. Discussion: The gluteus maximus is one of the external rotators and the most important extensor of the hip, playing a preponderant role in gait. In addition, it has functions as a global stabilizer of the pelvic ring. Diagnose is not easy, it might even go unnoticed. Form of repair is not consensual: we performed a transosseous reinsertion with Ethibond® and Vicryl®. With this case we intend to highlight the importance of soft tissue degloving injuries in the context of polytraumatized patients.

Long‐term outcome of infectious sacroiliitis due to Pasteurella multocida in a dog

AbstractA 6‐month‐old, male German shepherd dog was presented with a 2‐week history of left pelvic limb lameness. Physical examination revealed severe left pelvic limb lameness, lumbosacral and left pelvic limb pain. Magnetic resonance imaging showed heterogeneous T2‐weighted hyperintensity, T1‐weighted hypointense with marked contrast enhancement in the left sacroiliac joint, consistent with unilateral sacroiliitis. Computed tomography was used to perform image‐guided arthrocentesis and also revealed an irregular left sacroiliac joint. Infectious sacroiliitis, caused by Pasteurella multocida, was confirmed by culture of the synovial fluid of the sacroiliac joint. Infectious sacroiliitis should be considered as a differential diagnosis for young dogs presented with pelvic limb lameness and pain.

Surgical correction of the pelvis after malunited pelvic fracture.

Mal-union and non-union of the pelvic bones is a complicationof the treatment of its injuries, which mostly occur with 61C fracturesaccording to the AO/OTA classification. Objective. To analyzethe results of surgical treatment of a female patient with a pelvic fracturethat has healed with residual deformity (shortening, posteriordisplacement, internal rotation to the right and external rotation tothe left) and to demonstrate the importance of careful planning withthe involvement of 3D modeling in cases of reconstructive surgeryafter a pelvic fracture. Methods. The study has the form of a clinicalcase description. The results of the treatment were evaluated accordingto the IPS score. During the examination, multiple fracturesof the pelvic bones and dislocations corresponding to type 61 C3 accordingto the AO/OTA classification were revealed. After a CT scanof the pelvis with 3D reconstruction, a 3-stage surgical interventionwas planned and performed. The first stage: 2 K-wires were percutaneouslyinserted through the left sacroiliac joint at the SI-SII level tothe area of the planned osteotomy of the sacrum; through a paramedianaccess, a longitudinal osteotomy of the sacrum was performedon the right through the area of the previous fracture with mobilizationof the lateral fragment. The second: transection of the symphysis,osteotomy of the pubic bone at the site of improper fusion, repositioning,fixation with a simulated reconstructive plate and standardscrews; reposition of the right pelvic semiring. The third: adequateclosure of the posterior wound. For control, a CT scan of the pelvisand a comparative evaluation of the main projections and images on3D reconstruction and frontal sections were performed. 4 months afterthe operation, the patient carries out a full axial load with no painsyndrome and continues rehabilitation aimed at returning the correctstereotype of gait. The functional result was estimated at 90 pointson the IPS scale. Conclusions. Late surgical correction is difficultto perform and is associated with a large number of possible severecomplications. Careful preoperative planning is the key for the pelvicfractures treatment and their consequences. The best method of preventionof late reconstructions is the correct initial definitive treatment.This requires the presence of specialized medical centers withexperts specializing in the treatment of pelvic fractures, the necessaryequipment and a defined protocol

Primary Tuberculosis Presenting as a Soft Tissue Mass in the Sacroiliac Joint of an Immunocompetent Patient: A Case Report

A 46-year-old immunocompetent Somali female immigrant presented with a 2-year history of progressive left hip pain refractory to conservative management. Magnetic resonance imaging revealed a large mass arising from her left sacroiliac joint and extending into her left gluteus maximus. Biopsy and culture identified an abscess of unknown etiology, prompting an incision and drainage. This abscess was later identified as primary tuberculosis, for which she was placed on an antitubercular regimen and had complete resolution of her symptoms. Primary tuberculosis, while extremely rare, should be considered on the differential for a complex sacroiliac abscess, particularly in patients from endemic countries.

Mechanical evaluation of canine sacroiliac joint stabilization using two short screws.

To assess the feasibility and mechanical stability of sacroiliac (SI) joint stabilization using 2 short 3.5 mm cortical screws, each spanning an average of 23% of the width of the sacral body. Cadaveric experimental study. Twenty-four canine pelvis specimens. Pelvis specimens were prepared by disarticulation of the left SI joint and osteotomy of the left pubis and left ischium, and stabilized using a single long lag screw (LLS), 2 short lag screws (SLS) or 2 short positional screws (SPS). Computed tomography (CT) imaging was used to determine standardized screw lengths for each group and was repeated following implant insertion. Specimens were secured within a servohydraulic test frame and loaded through the acetabulum to simulate weight bearing under displacement control at 4 mm/min for 20 mm total displacement. Group mechanical testing data were compared. Peak load, yield load, and stiffness were more than 2 times greater in both the SLS and SPS groups when compared with the LLS group. No mechanical difference was identified between the short-screw groups. Sacroiliac luxation fixation using 2 short screws created a stronger, stiffer construct when compared with fixation using a single lag screw spanning 60% of the width of the sacral body. No mechanical advantage was observed between short screws inserted in positional vs. lag fashion. Sacroiliac luxation fixation using 2 short screws creates a mechanically superior construct with a larger region of acceptable implant positioning and potentially reduced risk of iatrogenic injury compared with conventional fixation.

Progression of sacroiliitis in men and women according to the cohort of early axial spondyloarthritis (CORSAR) over 3 years of follow-up

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease with predominant involvement of the sacroiliac joints (SIJ) and/or the spine. Despite the fact that the prevalence of axSpA is almost the same in men and women, there is evidence of a delay in diagnosis and a more severe course of the disease in females. The available reports on the progression of structural changes in the SIJ in men and women with early axSpA are contradictory. Meanwhile, the analysis of radiographic progression in the SIJ has fundamental importance both for timely diagnosis and for assessing the effectiveness of therapy in axSpA. Such studies have not yet been carried out in the Russian Federation.Objective: to assess the radiographic progression of sacroiliitis (SI) over 3 years in men and women with early axSpA.Material and methods. The study included patients from the cohort of early axSpA CORSAR, formed at the V.A. Nasonova Research Institute of Rheumatology. Currently, it includes 175 patients with axSpA. We analyzed the data of 64 patients, followed for at least 3 years. To assess the radiographic progression of the disease at baseline and after 3 years, the sum of X-ray stages of SI in the left and right SIJ was determined (the total stage of SI). Progression was assessed by the change in the total stage of SI in the right and left SIJ (0-8) during the observation period. We also calculated the proportion of patients with deterioration (increase in the total stage of SI by at least 1 stage), with improvement (decrease in the total stage of SI by at least 1 stage) and without progression. In order to fully exclude the error in measuring the radiographic progression of SI, we counted patients with “net” progression, that is, the proportion of patients with improvement was subtracted from the proportion of patients with deterioration.Results. Among 64 patients with early axSpA, there were 37 (57.8%) men and 27 (42.2%) women. For 3 years, the median of the total stage SI in men was 0 [0; 1], in women - 0 [0; 2] (p&gt;0.05). When assessing the progression of the total stage SI over 3 years, no significant differences were found between the number of men and women with improvement, with deterioration, “net” progression and without progression. Men with early axSpA showed a higher level of C-reactive protein (CRP) at baseline, women had higher BASDAI and ASDAS CRP values after 3 years. In 8% of patients, there was a regression of X-ray signs of SI.Conclusion. The radiographic progression of SI in patients with early axSpA does not depend on gender and disease activity. In some patients with early axSpA, reverse development of structural damage to the SIJ is possible.

Treatment of Unstable Injury of Pelvic Bones in Pregnant (Case Report)

Summary. There is no doubt in the relevance of the problem of treatment of patients with unstable fractures of pelvic bones, since these injuries involve a threat to the patient's life in the early period and often lead to disability in the future. This article presents a rare case of treatment of a patient with an unstable pelvis injury, while being 16 weeks pregnant. Patient A., born 1993, was admitted after a road accident injury. The examinations included: X-ray, CT, ultrasound, and gynecologist consultation. The patient was diagnosed with closed bilateral fracture of the pubic and ischial bones with displacement; rupture of the left sacroiliac joint with the boundary fracture of the sacrum (61-С1.3 by the Tile-AO-ASIF classification). The patient was 16 weeks pregnant. The surgery – open reduction and extramedullary metalosteosynthesis – was performed at the 9th day after the injury. The patient was discharged to outpatient treatment at the 12th day after the surgery. She started walking on crutches 3 weeks after the surgery; no additional support was needed since 1.5 months after the surgery. The patient gave birth at 39 weeks by surgical intervention (caesarean section). The baby's condition was assessed as 8 according to the Apgar scale. At the control examination 10 months after the surgery, musculoskeletal function of the patient was fully restored.