Obturator Foramen Research Articles

What are the functional results and complications from allograft reconstruction after partial hemipelvectomy of the pubis?

In patients undergoing hemipelvectomies including resection either of a portion of the pubis or the entire pubis from the symphysis to the lateral margin of the obturator foramen while sparing the hip (so-called Dunham Type III hemipelvectomies), reconstructions typically are not performed given the preserved continuity of the weightbearing axis and the potential complications associated with reconstruction. Allograft reconstruction of the pelvic ring may, however, offer benefits for soft tissue reconstruction of the pelvic floor and hip stability, but little is known about these reconstructions. (1) What is the postoperative functional status after allograft reconstruction of Type III pelvic defects? (2) What are the rates of hernia, infection, and hip instability? In this case series, we reviewed all patients with Type III pelvic resections (with or without anterior acetabular wall resections) who underwent allograft reconstruction between 2005 and 2013 at one center (N = 14). During the period in question, reconstruction was the general approach used in patients undergoing these resections; during that time, three other patients were treated without reconstruction as a result of either surgeon preference or the patient choosing to not have reconstruction after a discussion of the risks and benefits. Of the 14 patients treated with reconstruction, complete followup was available at a minimum of 1 year in 11 (other than those who died before the end of the first year; median, 19 months; range 16-70 months among those surviving), one was lost to followup before a year, and two others had partial telephone or email followup. Patient demographics, disease status, functional status, and complications were recorded. For a portion of the cohort (four patients) later in the series, we used a novel technique for anterior acetabular wall reconstruction using the concave cartilaginous surface of a proximal fibula allograft; the others received either a long bone (humerus or femur) or hemipelvis graft. Seven patients died of disease; two had local recurrence, and five died of metastatic disease. All patients remained ambulatory Pain at 12 months after surgery was reported as none in five, mild in two, moderate in two, and severe in one. Operative complications included infection in two, symptomatic hernia in one, hip instability in one, dislocated total hip arthroplasty on the first postoperative day in one, and graft failure in one. Allograft reconstruction after Type III pelvic resections can provide functional reconstruction of the pelvic ring, pelvic floor, and, in certain patients with partial anterior acetabular resections, the resected anterior acetabulum. This has implications in preventing the occurrence of hernia and hip instability in this patient population that is classically not reconstructed, although longer-term outcomes in a larger number of patients would help to better delineate this because infection, hernia, hip instability, and graft nonunion still remain concerns with this approach. The most important unanswered question remains whether, on balance, any benefits that may accrue to these patients as the result of reconstruction are offset by a relatively high likelihood of undergoing secondary or revision surgery.

Autologous Transobturator Urethral Sling Placement for Female Stress Urinary Incontinence

We describe and evaluate a transobturator approach to urethral sling placement using autologous rectus fascia for the management of female stress urinary incontinence. We performed a feasibility study of 10 cases of autologous transobturator mid urethral sling placement for stress urinary incontinence. The procedure includes an anterior vaginal dissection performed in the standard fashion for a mid urethral sling and harvest of a strip of rectus fascia. A trocar is passed through each obturator foramen and the fascial stay sutures are retracted through the skin incisions. The sling is appropriately tensioned and the stay sutures are tied. Patient outcomes were measured by a 24-hour pad weight test and ICIQ-FLUTS score. Median patient age was 57 years (IQR 48, 69.5) and median body mass index was 30.3 kg/m(2) (IQR 25.2, 32.4). Median followup was 4 months (range 3 to 5). All patients demonstrated a reduction in leakage with 80% being completely dry (0 gm on 24-hour pad test and not wearing pads). Overall there was significant improvement in postoperative vs preoperative 24-hour pad weight (p=0.02). Likewise, all subscores of the ICIQ-FLUTS were significantly improved after surgery, including frequency (p=0.006), voiding (p=0.04) and incontinence (p=0.002). Of the 9 eligible cases 6 (67%) were performed on an outpatient basis. One patient performed intermittent self-catheterization for 24 hours after sling placement. No patients experienced severe (Clavien III-V) postoperative complications or required urethrolysis. Autologous transobturator urethral sling placement appears to be technically feasible with excellent short-term outcomes. Longer followup and larger series are needed for validation.

Retrograde lag screw placement in anterior acetabular column with regard to the anterior pelvic plane and midsagittal plane—Virtual mapping of 260 three-dimensional hemipelvises for quantitative anatomic analysis

Percutaneous screw placement can be used for minimally invasive treatment of none or minimally displaced fractures of the anterior column. The complex pelvic geometry can pose a major challenge even for experienced surgeons. The present study examined the preformed bone stock of the anterior column in 260 hemipelvises (130 male and 130 female). Screws were virtually implanted using iPlan® CMF (BrainLAB AG, Feldkirchen, Germany); the maximal implant length and the maximal implant diameter were assessed.The study showed, that 6.5mm can generally be used in men; in women however individual planning is essential in regard to the maximal implant diameter since we found that in 15.4% of women, screws with a diameter less than 6.5mm were necessary.The virtual analysis of the preformed bone stock corridor of the anterior column showed two constrictions of crucial clinical importance. These can be found after 18% and 55% (men) respectively 16% and 55% (women) measured from the entry point along the axis of the implant.The entry point of the retrograde anterior column screw in our collective was located lateral of tuberculum pubicum at the level of the superior-medial margin of foramen obturatum. In female patients, the entry point was located significantly more lateral of symphysis and closer to the cranial margin of ramus superior ossis pubis.The mean angle between the screw trajectory and the anterior pelvic plane in sagittal section was 31.6±5.5°, the mean angle between the screw trajectory and the midsagittal plane in axial section was 55.9±4.6° and the mean angle between the screw trajectory and the midsagittal plane in coronal section was 42.1±3.9° with no significant deviation between both sexes. The individual angles formed by the screw trajectory and the anterior pelvic and midsagittal plane are independent from anthropometric parameters sex, age, body length and weight. Therefore, they can be used for orientation in lag screw placement keeping in mind that the entry point differs in both sexes.

Quantification of Bony Pelvic Exposure Through the Modified Stoppa Approach

Authors previously have described anatomic structures commonly seen through the modified Stoppa approach; however, no study has formally quantified the areas and amount of visual bony exposure that is obtained. This information is important for proper preoperative planning of acetabulum fractures with regard to fracture reduction and fixation. The aim of this study was to quantify and describe the extent of bony pelvis exposed while identifying the limits of exposure from osseous landmarks within the dissection of the modified Stoppa approach. Ten modified Stoppa approaches were performed on cadavers. Specific anatomic landmarks were identified, and the far boundaries of the exposed osseous structures from the surgeon's perspective were marked on each cadaver. All soft tissues were then stripped, and calibrated digital images of the demarcated area of exposure were taken and total viewable osseous surface area was calculated. Additionally, the boundaries of exposure based on various anatomic landmarks were determined. All neurovascular structures at potential risk (external iliac, obturator, corona mortis, and superior gluteal) were identified in each exposure. The entire pelvic brim from the pubic symphysis to beyond the sacroiliac joint was visualized in all exposures, with an average ± SD of 10 ± 5 mm of anterior sacrum exposed. On average, visualization above the pelvic brim was possible 15 ± 5 mm anteriorly over the acetabular roof and 19 ± 5 mm posteriorly above the greater sciatic notch. The viewable area included 51 ± 5 mm below the pelvic brim along the quadrilateral surface, with 41 ± 5 mm of the obturator foramen depth and 29 ± 9 mm of the greater sciatic notch seen on average. Approximately 32% ± 4% of the total surface area of the inner pelvis was able to be visualized, which included 79% ± 5% of the inner true pelvis below the brim and 80% ± 6% of the quadrilateral surface. The modified Stoppa approach allows for exposure of most (79%) of the inner true bony pelvis including the entire pelvic brim and 80% of the quadrilateral surface. On average, visualization is possible 2 cm above the pelvic brim and 5 cm below the pelvic brim along the quadrilateral surface, providing adequate anterior exposure for clamp and implant placement.

Evolution of the auditory ossicles in extant hominids: metric variation in African apes and humans.

The auditory ossicles in primates have proven to be a reliable source of phylogenetic information. Nevertheless, to date, very little data have been published on the metric dimensions of the ear ossicles in African apes and humans. The present study relies on the largest samples of African ape ear ossicles studied to date to address questions of taxonomic differences and the evolutionary transformation of the ossicles in gorillas, chimpanzees and humans. Both African ape taxa show a malleus that is characterized by a long and slender manubrium and relatively short corpus, whereas humans show the opposite constellation of a short and thick manubrium and relatively long corpus. These changes in the manubrium are plausibly linked with changes in the size of the tympanic membrane. The main difference between the incus in African apes and humans seems to be related to changes in the functional length. Compared with chimpanzees, human incudes are larger in nearly all dimensions, except articular facet height, and show a more open angle between the axes. The gorilla incus resembles humans more closely in its metric dimensions, including functional length, perhaps as a result of the dramatically larger body size compared with chimpanzees. The differences between the stapedes of humans and African apes are primarily size-related, with humans being larger in nearly all dimensions. Nevertheless, some distinctions between the African apes were found in the obturator foramen and head height. Although correlations between metric variables in different ossicles were generally lower than those between variables in the same bone, variables of the malleus/incus complex appear to be more strongly correlated than those of the incus/stapes complex, perhaps reflecting the different embryological and evolutionary origins of the ossicles. The middle ear lever ratio for the African apes is similar to other haplorhines, but humans show the lowest lever ratio within primates. Very low levels of sexual dimorphism were found in the ossicles within each taxon, but some relationship with body size and several dimensions of the ear bones was found. Several of the metric distinctions in the incus and stapes imply a slightly different articulation of the ossicular chain within the tympanic cavity in African apes compared with humans. The limited auditory implications of these metric differences in the ossicles are also discussed. Finally, the results of this study suggest that several plesiomorphic features for apes may be retained in the ear bones of the early hominin taxa Australopithecus and Paranthropus as well as in the Neandertals.

Tumor maligno de tritón pélvico: reporte de un caso

Se presenta el caso de una paciente de 29 años con dolor en la región glútea y miembro inferior derecho, portadora de una enfermedad de Von Recklinghausen y que desarrolló dos tumoraciones pélvicas retroperitoneales de crecimiento rápido. En la laparotomía se encontró las tumoraciones adheridas al hueco obturatriz y alerón del hueso iliaco. Se procedió a exéresis de las tumoraciones, la del lado derecho de mayor tamaño, de evolución rápida y compatible con tumor de Tritón, y la izquierda compatible con neurofibroma.

Anatomical feasibility of the anterior obturator nerve transfer to restore bowel and bladder function

Total sacrectomies are radical procedures required to treat tumorigenic processes involving the sacrum. The purpose of our anatomical study was to assess the feasibility of a novel nerve transfer involving the anterior obturator nerve to the pudendal and pelvic nerves to the rectum and bladder. Anterior dissection of the obturator nerve was performed in eight hemipelvis cadaver specimens. The common obturator nerve branched into the anterior and posterior at the level of the obturator foramen. The anterior branch then divided into two separate branches (adductor longus and gracilis). The branch to the gracilis was on average longer and also larger than the branch to the adductor longus (8.7 ± 2.1 cm vs. 6.7 ± 2.6 cm in length and 2.6 ± 0.2 mm vs 1.8 ± 0.4 mm in diameter). Each branch of the anterior obturator was long enough to reach the pelvic nerves. The novel transfer of the anterior branch of the obturator nerve to reinnervate the bladder and bowel is anatomically feasible. This represents a promising option with minimal donor site deficit.

Medial Approach for Drainage of the Obturator Musculature in Children

In a recent study designed to determine the anatomic location of infection in children presenting with acute hip pain, fever, and elevated inflammatory markers, we demonstrated the incidence of infection of the musculature surrounding the hip to be greater than twice that of septic arthritis. Importantly, the obturator musculature was infected in >60% of cases. Situated deep in the pelvis, surrounding the obturator foramen, debridement of these muscles and placement of a drain traditionally requires an extensive ilioinguinal or Pfannenstiel approach, placing significant risk to the surrounding neurovascular structures. We hypothesized that the obturator internus and externus could be successfully debrided using a limited medial approach. An IRB-approved prospective study of children (0 to 18 y) evaluated in the pediatric emergency department by an orthopaedic surgeon to rule out septic hip arthritis at a tertiary care children's hospital (July 1, 2010 to June 30, 2012) was conducted. Infected obturator musculature was identified and confirmed using magnetic resonance imaging. Cadaveric dissection was performed comparing the ilioinguinal, Pfannenstiel, and proposed minimally invasive medial approach. The proposed approach was utilized to debride and place drains in 7 consecutive patients. Anatomic information gained from magnetic resonance images of patients with abscess within the obturator musculature, and from the results of cadaveric studies, allowed for planning of a novel surgical approach. We found that through the surgical approach used to perform an osteotomy of the ischium (Tonnis) the obturator externus could be debrided through the adductor brevis and the obturator internus could be debrided through the obturator foramen. Using our medial approach, resolution of symptoms in all children who underwent surgical drainage resulted without complication. Our medial approach can safely access the obturator musculature for abscess decompression and drain placement with successful results. Advantages to this approach include: lower risk to neurovascular structures within the pelvis, less soft tissue trauma, and similarity to current techniques used for adductor lengthening, medial reduction of the dislocated hip, and osteotomy of the ischium. Level II.

V1-07 ABDOMINOVAGINAL TECHNIQUE FOR COMPLETE REMOVAL OF TRANSOBTURATOR SLINGS

You have accessJournal of UrologyFemale Pelvic Medicine & Reconstructive Surgery1 Apr 2014V1-07 ABDOMINOVAGINAL TECHNIQUE FOR COMPLETE REMOVAL OF TRANSOBTURATOR SLINGS Diana Kang, Judy Choi, Leah Nakamura, Shlomo Raz, Ja-Hong Kim, and Larissa Rodriguez Diana KangDiana Kang More articles by this author , Judy ChoiJudy Choi More articles by this author , Leah NakamuraLeah Nakamura More articles by this author , Shlomo RazShlomo Raz More articles by this author , Ja-Hong KimJa-Hong Kim More articles by this author , and Larissa RodriguezLarissa Rodriguez More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.601AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transobturator vaginal mesh is commonly used for the treatment of female stress urinary incontinence. Complications of transobturator mesh may include hip, groin, or leg pain that can occasionally be debilitating. Total removal of mesh may resolve or improve pain symptoms but can be a challenging or daunting procedure. METHODS In this movie we present complete obturator mesh removal in a 48 year old woman suffering from disabling pelvic pain, dyspareunia and groin pain. Through a transvaginal approach, bilateral oblique distal vaginal incisions are made and the vaginal epithelium is dissected away from the periurethral fascia. The mesh is isolated and anterior and posterior vaginal wall flaps are created. The mesh is transected in the midline and dissected free transvaginally. The obturator fascia is opened and the mesh dissected from the obturator internus muscle, obturator externus and obturator membrane. The cut end of the mesh is secured with a stay suture for later identification. Bilateral incisions are made over the obturator foramen 1 cm lateral to the descending rami of the pubic bone. After opening the adductor longus fascia, dissection is carried through the adductor longus and gracilis muscles. The mesh is carefully passed under finger control from the vagina to the labial incisions and dissected free from the adductor brevis muscle and obturator membrane using a coagulation knife. The mesh is freed from the periosteum of the pubic bone and removed entirely. The urethra is reconstructed by advancing the periurethral fascia with interrupted sutures and a flap of vaginal wall is advance to cover the area of the mesh removal. An indwelling catheter is left in place postoperatively for 5 days. RESULTS From June 2009 to August 2013 we have performed 217 surgeries for the removal of vaginal suburethral slings. Of these, 92 have included the removal of transobturator mesh. 16 patients had more than one mesh removed at the time of surgery. Average surgery time for removal of one transobturator sling was 84 minutes. Complete removal of transobturator mesh may improve or completely resolve symptoms of pain. Dissection of the mesh in the inferior and medial portion of the obturator foramen on the inferior pubic ramus is key to avoid injury to the obturator nerve and artery. None of our patients complained of obturator nerve injury postoperatively. CONCLUSIONS Complete transobturator mesh sling removal is feasible using an abdominovaginal approach. There is minimal perioperative associated morbidity associated. Long term outcome data is still forthcoming. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e293 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Diana Kang More articles by this author Judy Choi More articles by this author Leah Nakamura More articles by this author Shlomo Raz More articles by this author Ja-Hong Kim More articles by this author Larissa Rodriguez More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

V1-02 AUTOLOGOUS TRANSOBTURATOR MID-URETHRAL SLING FOR FEMALE STRESS URINARY INCONTINENCE

You have accessJournal of UrologyFemale Pelvic Medicine & Reconstructive Surgery1 Apr 2014V1-02 AUTOLOGOUS TRANSOBTURATOR MID-URETHRAL SLING FOR FEMALE STRESS URINARY INCONTINENCE Brian Linder and Daniel Elliott Brian LinderBrian Linder More articles by this author and Daniel ElliottDaniel Elliott More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.596AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We present a video of a novel transobturator approach to autologous urethral sling placement. METHODS A 55-year old female presented with worsening pure stress urinary incontinence. She had significant bother from her leakage and after discussion of potential management options preferred an autologous urethral sling, however did not want an intra-abdominal portion of the procedure. Thus, we utilized a transobturator approach to autologous urethral sling placement. Following hydrodissection with injectable saline a midline incision was made in the anterior vaginal wall. Dissection was carried to the obturator foramen bilaterally. Next, a transverse abdominal incision was made and an 8cm x 1cm strip of rectus fascia was harvested and prepared with two stay sutures on each lateral end of the fascial sling. A small incision was made in the medial thigh bilaterally and dissection carried to the obturator foramen. A helical trocar was passed twice through each obturator foramen and the stay sutures retracted through the incision. The sling was secured proximally and distally with interrupted sutures. Careful attention was paid to tensioning the sling, which was left flush with the urethra. The stay sutures were then tied down and cut at the skin level. The anterior vaginal wall and skin incisions were then closed. RESULTS The patient had an uncomplicated postoperative course and was able to spontaneously empty her bladder with low post-void residual. She was seen back 2 weeks following her procedure noting no leakage, requiring zero pads and subjectively pleased with her outcome. CONCLUSIONS Given this result, a transobturator approach to urethral sling placement appears technically feasible in appropriately selected candidates. Longer follow up and larger case series will be needed to validate this finding. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e292 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Brian Linder More articles by this author Daniel Elliott More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Autologous transobturator midurethral sling placement: a novel outpatient procedure for female stress urinary incontinence

We present a novel outpatient transobturator autologous rectus fascia midurethral sling procedure. A 55-year old woman presented with stress urinary incontinence (SUI) as documented by history, physical exam, and 24-h pad test. Conservative and surgical treatment options were discussed. The patient was interested only in outpatient surgical options, however, and was adamantly opposed to any mesh procedures due to concerns regarding complications. Therefore, following an in-depth discussion and informed consent, a transobturator, autologous sling procedure was performed. The vaginal dissection was performed in the standard fashion. A rectus fascial strip measuring 7 × 1cm rectus fascia was harvested. A trocar was passed through each obturator foramen. Fascial stay sutures were retracted through the skin incisions. The sling was then appropriately tensioned and the stay sutures tied together. The patient had an uncomplicated perioperative course. She voided spontaneously with low postvoid residual. At follow-up, she had no urinary leakage. The transobturator autologous midurethral sling procedure is technically feasible and, in the short term, effective. Longer follow-up and larger series are needed to validate this procedure, which, however, may become a suitable option for patients and surgeons concerned with potential mesh complications.

Anatomical study of anterior column screw tunnels through virtual three-dimensional models of the pelvis

We created 66 male and 74 female virtual three-dimensional models of the pelvis based on computed tomography data from 140 patients. Virtual cylindrical bolts (VCBs) were placed in the anterior column (AC), which was then resliced serially along the bolt's long axis. AC screw tunnel mainly comprises two long, narrow triangular prisms [zone III (acetabular fossa) and zone V (obturator foramen)]--forming the III/V angle--linked by a larger, shorter cylinder [zone IV (acetabular notch)]. VCBs' mean length and maximum diameter were 111.13 ± 7.33 and 7.37 ± 1.90 mm, respectively. The models' anatomical zone lengths were similar between the sexes. Zone V's narrowest diameters and the III/V angles were significantly different. VCBs >6.5 mm were accommodated in 65 of 66 male models and 31 of 74 female models. VCBs >5.0 and <6.5 mm were accommodated in one male and 30 female models. Eleven female models accommodated only VCBs >3.5 and <5.0 mm. However, to 13 female pelvic models with maximum VCB accommodation of <5 mm for the anterior column, the maximum diameter of the VCBs was 8.23 ± 1.22 mm in medial passage and 10.3 ± 1.91 mm in lateral passage, respectively. Percutaneous fixation of the AC with screws is a safe technique, even though in Chinese female patients. The narrowest diameters in zone V and the III/V angles are the key factors for application of AC screws. Female patients with a smaller interosseous space at zone V and a large III/V angle can accommodate segmental passage screws.

Morphological Examination of the Obturator Notch and Canal in Cervidae

ABSTRACTThe purpose of this study was to investigate gross findings of the obturator notch (ON) and obturator canal (OC) in Cervidae. A total of 183 pelvic girdles from 26 species of deer were examined, and the obturator canal (OC) was classified into 4 types based on the degree of separation from the obturator foramen (OF). The deep ON was observed primarily in the subfamily Capreolinae (telemetacarpal deer). The small bony OC was frequently observed in Hydropotes inermis, Mazama gouazoubira and Ozotoceros bezoarticus. A canal without a tubercle or bony bridge structure was mainly observed in the subfamily Cervinae (plesiometacarpal deer). These results suggest that the deep ONs or the OCs separated by bony structures are more common in telemetacarpal rather than plesiometacarpal deer.

閉鎖孔バイパスに用いたEPTFE グラフト断裂の1 例

閉鎖孔バイパスに用いたEPTFE グラフト断裂の1 例

Resection of Soft Tissue Tumors Extending Through the Obturator Ring

Pelvic soft tissue sarcomas are rare tumors often presenting larger than other soft tissue sarcomas and can extend into the thigh through various anatomic routes. Surgical resection is the main modality of curative treatment. En bloc tumor excision with wide, negative margins may reduce the risk of local recurrence. Soft tissue sarcomas extending through the obturator foramen create unique challenges to operative management. This case report describes 2 cases of lipomatous lesions that extend through the obturator foramen, presenting as dumbbell-shaped lesions with large intra- and extrapelvis portions. One possible surgical approach performed in both patients is detailed with long-term follow-up. Postoperatively, 1 incidence of infection was reported. Functional outcomes were acceptable, with full restoration of ambulation without assistive devices in both cases and no hernia observed. Oncologic outcomes included locoregional recurrence in 1 patient at 24 months outside the radiation field. The ideal primary treatment for all localized soft tissue sarcomas, including those extending through the obturator foramen, is resection. However, the unique subgroup of obturator ring soft tissue sarcomas has undefined outcomes and complications. The authors' goal was to achieve en bloc resection with wide negative margins while preserving ipsilateral limb function. The surgical approach described in this case study offers a description of feasibility and discussion of theoretical and observed complications.

Effect of suspension method and aging time on meat quality of Chinese fattened cattle M. Longissimus dorsi

Objectives of the present study were to evaluate the effects of suspension method and aging time on quality traits of Chinese fattened cattle M. Longissimus dorsi (LD). At the end of the slaughter line, the right sides of carcasses were re-hung from the pelvic bone obturator foramen, while the left sides remained hung by Achilles tendon suspension (AS). LD muscles were aged for 1, 7, 14 and 21days and were then evaluated for quality index. Pelvic suspension (PS) significantly decreased the WBSF of beef muscle at 1d and 7d postmortem compared with AS. The tenderness with PS at 7d postmortem was similar with that of AS at 14d. Moreover, PS increased sarcomere length and decreased purge loss of LD significantly. In addition, aging time had a significant effect on pH, meat color, Warner–Bratzler shear force, and myofibril fragmentation index of LD muscle. To conclude, PS is valuable to be introduced to the beef industry in China for rapid (within 7days) improvement of beef tenderness and decreased aging time of Chinese fattened cattle.

Closed reduction and fixation of locked symphysis pubis using tubular external fixator: a case report

Locked symphysis pubis is a kind of pelvic injury in which one pubic bone is jammed in the back of the other or opposite the obturator foramen following lateral compression forces. In this article, we present a 31-year-old female case of locked symphysis pubis which was treated by closed reduction using tubular external fixator. We believe that tubular external fixators are useful devices to perform closed reduction maneuvers for locked pelvic injuries and also help to reduce the need for open reduction and internal implant usage.

Measuring Limb Length Discrepancy Using Pelvic Radiographs: The Most Reproducible Method

Leg length inequality following total hip replacement remains common. In an effort to reduce this occurrence, surgeons undertake pre-operative measurements, templating and use various forms of intraoperative measurements, including computer navigation. This study aims to delineate which measurement technique is most appropriate for measuring leg length inequality from a pelvic radiograph. Three observers took a total of 9600 measurements from 100 pelvic radiographs. Four lines were constructed on each of the radiographs, bisecting the acetabular teardrops, ischial spines, inferior sacroiliac joint and inferior obturator foramen. Measurements were taken from these lines to the most prominent medial point on the lesser trochanter and to the tip of the greater trochanter. The effect of pelvic positioning was also assessed using radiographs of a synthetic pelvis and femur. Intra-observer and inter-observer variability were calculated. Measuring from the inferior aspect of the ischial tuberosities to the most prominent medial point on the lesser trochanter appears to be the best method for measuring LLD however large error margin still exist, even when corrected for magnification errors.

A simple nonlinear model for estimating obturator foramen area in young bovines

The aim of this study was to produce a simple and inexpensive technique for estimating the obturator foramen area (OFA) from young calves based on the hypothesis that OFA can be extrapolated from simple linear measurements. Three linear measurements - dorsoventral height, craneocaudal width and total perimeter of obturator foramen - were obtained from 55 bovine hemicoxae. Different algorithms for determining OFA were then produced with a regression analysis (curve fitting) and statistical analysis software. The most simple equation was OFA (mm ) = (3,150.538 + (36.111*CW)) � (147,856.033/DH) (where CW = craneocaudal width and DH = dorsoventral height, both in mm), representing a good nonlinear model with a standard deviation of error for the estimate of 232.44 and a coefficient of multiple determination of 0.846. This formula may be helpful as a repeatable and easily performed estimation of the obturator foramen area in young bovines. The area of the obturator foramen magnum can thus be estimated using this regression formula.

Comment to: First laparoscopic totally extraperitoneal repair of Laugier’s hernia: a case report. Ates M, Dirican A, Kose E, Isik B, Yilmaz S. Hernia 2013; 17:121–123

I read with interest the recent case report of Ates et al. [1] regarding laparoscopic totally extraperitoneal (TEP) repair of Laugier’s hernia and would like to take this opportunity to add few comments. The authors made a very important remark that ‘the surgeon should be alert to the possibility of an atypical femoral hernia when examining patients with inguinal hernias’ and this statement is even more relevant in female patients who carry a significantly higher risk of having a synchronous femoral [2], or less commonly obturator hernia. In a personal prospectively maintained database on 582 patients undergoing TEP repairs for inguinal hernias, out of 540 male patients who had 763 repairs an obturator hernia was incidentally identified in only 3 explored groins (0.4 %), whereas the same combined anomaly was found in 5 out of 52 inguinal hernia repairs (9.6 %) in the remaining 42 female patients. In comparison, I only came across two patients initially consented for a TEP repair of bilateral inguinal hernias that were incidentally found to have an associated Laugier’s hernia at time of surgery. Both repairs were completed laparoscopically and a photographic representation of the first case can be seen in a recently published article [3]. This reinforces the increasing observation that a laparoscopic approach may offer further advantages over traditional inguinal herniorrhaphy as it can also allow simultaneous repair of occult contralateral inguinal [4], synchronous femoral [5] or obturator [6] hernias. It is therefore extremely important to possess a thorough anatomical knowledge of the pelvis and groin regions as viewed through the laparoscope, but also to systematically and carefully expose all potential hernial defects such as the obturator foramen and femoral canal. This only comes at the cost of quite a steep learning curve [7] that will eventually allow the surgeon to master every aspect of this challenging procedure [8]. Once a synchronous groin/pelvic hernia has been identified, it may also become quite convenient to be familiar with few extra technical tricks that could be of significant value for a successful clinical outcome. I would like to illustrate this with the presentation of my second patient, at the time 54 years of age, who was incidentally diagnosed with multiple groin defects. During a standard TEP approach and following reduction of bilateral indirect inguinal hernia sacs and right femoral hernia, a synchronous previously undiagnosed smaller left-sided femoral hernia was identified along with the presence of an additional, quite distinct and substantial defect that had formed through the lacunar ligament on the right side (Laugier’s hernia). The Laugier’s hernia was reduced (Fig. 1a, b) and remaining defect closed using the previously described Endoloop technique (Fig. 1c) [9] in order to minimize the risk of postoperative seroma formation. Similarly, the right femoral canal was plugged using a small size prosthetic mesh (Perfix Plug, Bard, Warwick, RI, USA) that was simply glued in place using fibrin sealant [TISSEEL (Fibrin Sealant), Baxter, Deerfield, IL, USA] (Fig. 1d). Finally, two anatomical meshes of polyester with lateral slit (Parietex Anatomical Mesh 15 9 10 cm, TECT 1510 ADP2, Covidien, Mansfield, MA, USA) were used to cover all defects and also fixed with fibrin sealant as This comment refers to the article available at 10.1007/s10029-011-0820-2.