Pelvic Asymmetry Research Articles

30 An investigation into the relationship between rider pelvic asymmetry and equine pelvic asymmetry in relation to the use of physical therapy

There is increasing use of physical therapy for both horse and rider but limited scientific research linking the horse, the rider and their symmetry together. Pelvic asymmetry can indicate musculoskeletal imbalance and affect performance. Therapy may have an impact on the pelvic asymmetry of both the horse and the rider as independent parties. This study aimed to investigate the hypothesis that single horse/rider combinations who both have regular (4 or more times per year) physical therapy will have improved pelvic symmetry rather than horse/rider combinations that have no physical therapy. Fifty single horse (age 6–14yrs) and rider (age 18–45yrs) combinations (minimum 6-mo partners) were selected with inclusion/exclusion criteria. Treatment group (n = 25) horse and rider received regular physical therapy (chiropractic, osteopathy, physiotherapy or sports massage therapy). Control group (n = 25) pairs received no therapy ever or over 1 year prior. Data collection was blinded to groups. On level ground, triplicate measurements of horse tuber coxae (TC) heights (stood square) and rider anterior superior iliac spine (ASIS) (feet@30cm) to floor were taken using a plumb line. Symmetry indices (SI) were calculated from raw data. Data were tested for normality (Shapiro Wilk test) and Mann Whitney test, regression analysis tests used with level of statistical significance at P < 0.05. There was a significant difference between treatment and control groups of pelvic symmetry values for horses (mean SI ± SD: control 4.69 ± 2.48, treatment 2.35 ± 0.61, P = 0.00001) and riders (mean SI ± SD: control 3.4 ± 1.25, treatment 2.11 ± 0.88, P = 0.00003). There was no significant correlation between horse TC and rider ASIS asymmetry means for treatment group (r 2 = 0.04, F = 0.95, P = 0.34) or control group (r 2 = 0.01, F = 0.29, P = 0.6). This study provides positive evidence that regular use of physical therapy for horses and riders may improve pelvic asymmetry of the horse and rider individually. This is a positive basis for further research into the casual effect of relationships between the horse and rider and their use of physical therapy.

Prepubic tendon rupture in Santa Inês ewe – case report

Prepubic tendon rupture may lead to the loss of pelvic floorsupport. A four-year-old Santa Inês ewe had been reported suffering fromapathy, progressive weight loss throughout ten days, and prolongedpregnancy. Physical exams showed an excessive pendulous abdomen, amild ventral edema between the udder and the umbilical scar (xiphoidregion). Also, the udder was cranially displaced and with hematomas.Other symptoms noticed were walking reluctance, pelvic asymmetry,tachycardia, and tachypnea. The urinalysis findings indicated the presenceof ketone bodies. The ultrasound examination confirmed the presence offetuses with normal development, and a potential rupture of theabdominal muscles was excluded. Eight days following its hospitalization,labor induction was carried out using dexamethasone (20mg, IM, singleapplication). She went into labor three days after the initial dose ofcorticosteroid. The ewe had difficulty expelling the lambs, making theirtraction necessary. Although the animal has recovered from its injuries,the clinical picture shows prepubic tendon rupture, and in order to preventfuture complications, the ewe is not going to breed anymore. The report ofthis case works as an alert to the possibility of the occurrence of thisaffection in ewes and demonstrates the need of parturition assistance inanimals with this condition, which can be diagnosed through clinicalevaluation and ultrasound examination.

Upper body movement analysis of multiple limb asymmetry in 367 clinically lame horses

Compensatory lameness is common in horses and evaluation can be challenging. To investigate patterns of compensatory movements in clinical cases with fore- or hindlimb lameness before and after diagnostic analgesia. Retrospective clinical study. Multiple limb lameness of 367 horses was characterised by type (push-off, impact or mixed), limb (fore- or hindlimb in predominant lameness) and side (ipsi- or contralateral in concurrent lameness) using a body-mounted inertial sensor (BMIS). Diagnostic analgesia was performed until the percentage improvement of the vector sum in forelimb lameness and the mean difference of the maximum or minimum pelvic height (PDmax or PDmin ) in hindlimb lameness was ≥50%. Linear mixed model and post-estimation of effects were performed by contrast command with multiple comparisons adjusted by Bonferroni method. Correlation of pre- and post-analgesia of all head and pelvis asymmetry parameters was tested with Spearman's rank correlation. Improvement in vector sum per mm after diagnostic analgesia in forelimb impact lameness positively correlated with decrease in PDmax in contralateral mixed lameness (0.187mm, r=.58, P<.05). Improvement in PDmin per mm after diagnostic analgesia in hindlimb mixed and PDmax in hindlimb push-off lameness decreased vector sum in ipsilateral forelimb impact lameness by 0.570 and 0.696mm, respectively (P<.05), with no positive correlation. A variety of cases with inhomogeneous distribution of lameness patterns was investigated retrospectively, therefore, it is impossible to distinguish between true multiple limb lameness and compensatory lameness in this clinical material. Various asymmetry patterns of concurrent lameness were seen in horses with naturally occurring primary forelimb impact lameness with contralateral compensatory hindlimb lameness with a mixed component being the most common. In horses with hindlimb lameness, compensatory movements were seen in ipsilateral forelimbs, mostly as an ipsilateral impact lameness during straight line trot.

Smartphone‐based pelvic movement asymmetry measures for clinical decision making in equine lameness

Smartphone‐based pelvic movement asymmetry measures for clinical decision making in equine lameness

Is acetabular dysplasia and pelvic deformity properly interpreted in patients with congenital femoral deficiency? A 3D analysis of pelvic computed tomography.

PurposeThe aim of this study is to assess the pelvis’s morphology and spatial orientation of the acetabulum, and their relation to the severity of Congenital Femoral Deficiency (CFD) using 3D imaging. Defining these pathologies is crucial for adequate surgical correction.MethodsThe shape and structure of the acetabulum and pelvis were evaluated in 14 children with unilateral CFD via 3D computed tomography (CT) scans, and then analysed with geometric morphometrics (Procrustes ANOVA). The association between pelvic directional asymmetry and CFD classifications (Aitken, Paley) was assessed. The affected acetabulum’s orientation was compared to the non-affected side, and the variability of orientation in different CFD types was evaluated (bivariate correlation).ResultsThe hemipelvis with CFD is characterized by a smaller acetabulum, a laterally curved ischium and a less upright ilium (p < 0.001). Multivariate regressions revealed a greater level of pelvis asymmetry in more severe types of CFD (p < 0.001). The acetabulum orientation assessment showed a significant decrease in mean anteversion (1.3°) and inclination (9.6°) angle, when compared to the non-affected side (26°and 17.1° respectively; p < 0.001).ConclusionsThe affected side of the pelvis is considerably smaller and more deformed, and this should be considered during limb lengthening. The acetabulum presents with significant dysplasia due to its severe retroversion and steepness (superoposterior distortion). This should not be interpreted as a simple wall deficit, but as a complete acetabular misalignment (often misinterpreted in 2D imagery). Using transiliac osteotomies (e.g. Dega, Salter) is debatable due to abnormal acetabular orientation (superoposterior malalignment). Therefore, alternative options, e.g. San Diego or triple pelvic osteotomy, should be considered.

The association between pelvic asymmetry and non-specific chronic low back pain as assessed by the global postural system

BackgroundEmpirical evidence that demonstrates the relationship between pelvic asymmetry and non-specific chronic low back pain (NCLBP) is currently lacking.ObjectiveTo establish the reliability of the Global Postural System (GPS) in assessing pelvic asymmetry and identify the association between pelvic asymmetry parameters and the occurrence of NCLBP in young adults.DesignA cross-sectional, regression study.MethodsPeople who were aged between 18 and 30 and were diagnosed with NCLBP were recruited. Healthy individuals who were matched for age, sex, and education level were recruited as controls. Global Postural System (GPS) was employed to assess pelvic asymmetry. Prior to exploring the association, the reliability of GPS was assessed by the ICC (2, k) for interrater reliability, ICC (3, k) for intra-rater reliability, standard error and minimal detectable difference. Bivariate correlation analysis and logistic regression analysis were used to determine the relationship between pelvic asymmetry and the occurrence of NCLBP.ResultsTwenty-eight healthy participants and 28 people with NCLBP were recruited. Moderate to excellent ICCs were observed for the inter-rater and intra-rater reliability of most postural parameters. The bivariate correlation analysis indicated that age, body mass index and pelvic asymmetry parameters were related to the occurrence of NCLBP. Pelvic angle asymmetry (odds ratio = 1.17), and asymmetry of the distance between the posterior superior iliac spine and the floor (odds ratio = 1.21) were associated with NCLBP.LimitationsThis study did not explore the causal relationship between pelvic asymmetry in the sagittal plane/pelvic asymmetry in the transverse plane and the occurrence of NCLBP. The interpretation of the results may not be generalized beyond the sample population.ConclusionsThe GPS is a reliable method to assess pelvic asymmetry in a clinical setting. Two pelvic parameters were associated with the presence of NLBP. Measurement of pelvic asymmetry may assist in the early identification of potential occurrence of NCLBP but further work is required.

Outcome of bilateral hip reconstruction in unilateral hip subluxation in cerebral palsy: Comparison to unilateral hip reconstruction

ObjectiveTo evaluate the post-operative outcomes of the hips in CP patients with unilateral hip subluxation treated with bilateral and unilateral hip reconstruction. MethodsA retrospective review was performed of all diplegic and quadriplegic patients with unilateral hip displacement treated with either bilateral or unilateral hip reconstructive surgery. Radiographic parameters [migration percentage (MP), pelvic obliquity angle (POA) and migration percentage difference (MPD)] and changes in functional ability (sitting, standing and walking) were evaluated and compared between the 2 groups. Failure was defined as post-operative MP>40%, POA>5° and MPD>30%. ResultsEighteen patients had unilateral hip reconstruction and 42 patients had bilateral hip reconstruction. Mean age of 87 months and 90 months and means follow-up of 38 months and 40 months respectively. Post-operative MP was significant in both groups. However, of 18 patients in unilateral hip reconstruction group, 33.3% of patients had contralateral hip subluxation and 22.2% of patients had hip failure on the operated hip; compared to only one of 42 patients had hip failure and no contralateral hip problem in the other group. For assessment of pelvic symmetry, MPD was significantly improved in both group but POA was only significant in bilateral group. Overall functional improvement was significant in patients with bilateral hip reconstruction compared to unilateral group. ConclusionBilateral hip reconstruction in unilateral displacement had shown to have better outcome in correcting unstable hip and pelvic asymmetry, thus provide good sitting balance and improvement in overall functional outcome.

Canonical correlation between body-posture deviations and gait disorders in children with cerebral palsy.

Children with Cerebral Palsy (CP) show the postural constraints while standing, and gait disorders, resulting from both primary and secondary impairments of brain injury. In our previous studies, several characteristic postural and gait patterns in children with unilateral as well as with bilateral CP were defined, and the relationship between these patterns was demonstrated. The purpose of present study was to identify which features of body posture deviation during standing were strongly related to gait deviations in independently ambulatory children with CP. For this aim we explored the cross—relationship between features of body posture while standing examined by surface topography and the selected gait parameters from three-dimensional instrumented gait analysis in one hundred twenty children with cerebral palsy, aged between 7 and 13 years, who were able to walk independently. First, our study documented that that sagittal misalignment of the spine curvature was significantly related to kinematic deviations such as deviations of pelvic tilt, inadequate swing phase and knee flexion, and peak dorsiflexion in stance. Second, the study shows that the static asymmetry of pelvis and trunk was significantly associated with kinematic deviations during gait cycle such as pelvic rotation, hip abduction in swing, ROM of knee flexion, peak dorsiflexion in stance. Based on obtained results and referring to our previous findings it can be assumed that the first model of the relationship between postural deviation and gait disturbances, called ‘postural and gait complex of disorders in sagittal plane’, is related to children with bilateral CP, whereas the second model ‘postural and gait complex of disorders in coronal plane’ to children with unilateral CP. The clinical applications of this study relate to the early recognition of particular features of postural deviation using surface topography, instead of more difficult and demanding expensive tools 3-D gait analysis.

Back pain in adolescents with idiopathic scoliosis: the contribution of morphological and psychological factors.

To define the relationship between 3D radiological features, psychological factors, and back pain prevalence and intensity in patients with adolescent idiopathic scoliosis (AIS). Consecutive AIS patients answered self-reported questionnaires and underwent simultaneous posterior-anterior and lateral scans of the spine (EOS Imaging, Paris, France). 3D reconstructions of the spine and pelvis reported 18 parameters in the coronal, sagittal, and axial plane. Hundred and twenty-four patients with AIS were included in the study. Overall, 90% of AIS patients reported having some back pain over the last 6months and 85.8% over the last 30days. Pain intensity in the last month was reported to be mild in 37.5%, moderate in 31.8%, moderate to severe in 24.3%, and severe in 6.54% of cases. Location of back pain was associated with location of main curve (P = 0.036). Low back pain was associated with higher lumbar apical AVR and lower lumbar lordosis (P < 0.05). Independent risk factors for back pain in AIS were pain catastrophizing (B = 0.061, P = 0.035), poorer self-reported state of mental health (B = - 0.872, P = 0.023), decreased thoracic kyphosis (B = - 0.033, P = 0.044) and greater pelvic asymmetry (B = 0.146, P = 0.047). There was a significant association between self-reported pain intensity in the last 24h and levels of catastrophizing. Pain catastrophizing level influenced the relationship between deformity severity and pain intensity. In low catastrophizers, there was a significant association between greater deformity severity and higher pain levels. Back pain in AIS is multifactorial and associated with psychological and morphological parameters. Pain catastrophizing is an important construct in AIS-related pain and should be taken into consideration when evaluating these patients.

The application of lateral-rectus approach on toddlers\u2019 unstable pelvic fractures

BackgroundPelvic fractures are rare in toddlers but are often associated with other injuries that make treatment difficult. Conservative treatment has been used with moderate success, but it is unclear if surgical correction could confer additional benefits and improve patient outcomes. The purpose of this study was to report authors’ experience using the lateral-rectus approach (LRA) for surgical correction of unstable pelvic fractures in two toddlers.MethodsWe retrospectively analyzed the cases of two toddlers with unstable pelvic fractures who underwent surgery through the LRA between April 2016 and October 2018. Patients’ characteristics, fracture type, mechanism of injury, Injury Severity Score (ISS), operative time, intra-operative blood loss, and post-operative complications were assessed. Pelvic asymmetry, degree of deformity, Cole scoring criteria and modified Barthel Index (MBI) were used to evaluate radiographic and functional outcomes.ResultsSuccessful surgical treatment was performed using the LRA, external fixation, and sacroiliac screw fixation. Surgery duration was 180 min on average, with an average intra-operative bleeding of 250 ml. There were no iatrogenic nerve injuries or infections. Pelvic asymmetry a week after surgery was 0.5 cm on average and dropped to 0.3 cm on average at the end of the follow-up period. The deformity index of the pelvis dropped from an average of 0.035 a week after surgery to 0.02 at the end of the follow-up period. The mean MBI was 100 in the last follow-up, and Cole scoring criteria categorized both patients as being in excellent condition. All patients achieved radiological bone union without discrepancy in length of the lower limbs. Neither patient had loss of reduction nor evidence of low back pain during the mean follow-up period of 22 months.ConclusionsPelvic fracture in toddlers is rare, and surgical treatment requires careful consideration. The lateral-rectus approach was proven as a viable alternative for managing unstable pelvic fractures in toddlers, with minimal blood loss and risk of nerve injury. Furthermore, anterior external fixation and posterior sacroiliac screw fixation would be adequate for this population, with excellent final outcome.

Effects of Active Release Technique on Pain, Oswestry Disability Index and Pelvic Asymmetry in Chronic Low Back Pain Patients

Effects of Active Release Technique on Pain, Oswestry Disability Index and Pelvic Asymmetry in Chronic Low Back Pain Patients

The SpinalMeter biometrical assessment to improve posture diagnosis in school-age girls: a validation study

Introduction: Assessing spinal deformities using an X-ray radiation is the method of choice for posture diagnosis. It is also used for the evaluation of the degree of correction, brace fit, and spinal balance as well as for further management decisions. However, multiple X-ray exposures during control visits could be too burdensome for children. Aim: The aim of this study was to investigate the precision and repeatability of measurement of the variables obtained by a fast, simple postural evaluation in children by the SpinalMeter. Material and methods: The measurements of the angle of trunk rotation (ATR) and SpinalMeter posture assessments were performed 8 to 10 times in a short period of time (6 s). The overall of 300 photos (SpinalMeter) and 1020 measurements (asymmetry, distance between anthropometric points as well as ATR) were obtained from 6 girls (8–15 years old). The validation study comprised of the repeatability, interclass correlation coefficient (Qw) and relative standard deviation (rSD) measurements. Results and discussion: The measurements of the distance between acromion–popliteal fossa, acromion–iliac crest, and acromion–posterior superior iliac spine obtained by SpinalMeter were clearly repeatable (Qw &gt; 0.9). The scapular and pelvic asymmetry in standing and sitting positions were highly repeatable and had low rSD (e.g. for scapular asymmetry 5.6%–80.3%; Qw &gt; 0.8). Conclusions: The precise and reliable postural biometrical measurements were performed by SpinalMeter in the case of the distance between anthropometric points and asymmetry of pelvis and scapula. These measurements could be useful in the assessment of girl’s posture when visiting the pediatrician.

Pelvic alignment changes during the perinatal period.

BackgroundThe function of the pelvic bones is to transfer load generated by body weight. Proper function of the pelvic bones can be disturbed by alignment changes that occur during pregnancy. Further, misalignment of the pelvic bones can lead to pain, urinary incontinence, and other complications. An understanding of the timing and nature of pelvic alignment changes during pregnancy may aid in preventing and treating these complications.ObjectiveTo investigate the changes in pelvic alignment during pregnancy and one month after childbirth.MethodsThis is a prospective, longitudinal cohort study. Pelvic measurements were obtained for 201 women at 12, 24, 30, and 36 weeks of pregnancy, and 1 month after childbirth. The anterior and posterior width of the pelvis (the distance between the bilateral anterior superior iliac spines and the bilateral posterior superior iliac spines), the anterior pelvic tilt, and pelvic asymmetry (the mean left and right pelvic tilt degrees and the bilateral difference of the anterior pelvic tilt) were measured. For the change in pelvic alignment, a Friedman test was conducted to determine any significant difference in the measurements over time.ResultsThe anterior and posterior width of the pelvis became significantly wider with pregnancy progress and the anterior width of the pelvis at 1 month after childbirth remained wider than that at 12 weeks of pregnancy (p < 0.001). The anterior pelvic tilt increased during pregnancy and decreased after childbirth (p < 0.05).ConclusionSome changes in pelvic alignment occur continuously during the perinatal period. Changes in the anterior width of the pelvis are not recovered at one month post-childbirth. Understanding these perinatal changes may help clinicians avert complications due to pelvic misalignment.

Comparative Study of Sacroiliac Joint Dysfunction and Lumbar Flexibility between Normal Subjects and Sacroiliac Joint Dysfunction Patients

AbstractBackground: Low Back Pain (LBP) is a symptom rather than a disease diagnosis. Pathology in the low back might affect the pattern of movement rather than only the range of movement ROM. Approximately 10% with LBP do not respond to treatment and develop chronic LBP. The cause for this non-response to treatment is lack of specific diagnosis and inability to distinguish, in some people, pain arising from the Sacroiliac Joints (SIJs) or the lumbar spine.Aim of Study: This study was conducted to identify the relationship between Sacroiliac joint dysfunction SIJD and lumbar spine movement in sagittal and frontal plan.Subjects and Methods: Forty participants aging 20:40 years divided into 2 groups. Group (A) consisted of 20 healthy participants, Group (B) SIJD consisted of 20 subjects were positive of at least 3 SIJ provocative test. All the participants on the study, pelvic asymmetry was measured by PALM device also spinal flexibilityof lumbar spine was assessed in sagittal and frontal plan.Results: There was negative weak significant correlation between mean difference of pelvic inclination and Extension-Flexion E-F of lumbar (r=–0.405, p=0.014*). While, no significant correlation between mean difference of pelvic inclination and lumbar flexion, left side bending, right side bending, and over all side bending L-R of lumbar.Conclusion: There was change of lumbar spine mobility in sagittal plan on extension and overall sagittal ROM with SIJD patients, though in comparison between groups it showed that patient with SIJD had less overall frontal plan ROM.

The effects of pelvic belt use on pelvic alignment during and after pregnancy: a prospective longitudinal cohort study

BackgroundPelvic alignment changes during pregnancy and post-childbirth. Pelvic belts exert external forces that compress and stabilize the joints, and therefore, could influence pelvic alignment. However, limited information is available regarding this potential effect. Therefore, the purpose of this study is to investigate the influence of pelvic belt use on pelvic alignment during and after pregnancy.MethodsData of 201 pregnant women in late pregnancy and 1 month after childbirth were used. Pelvic alignment measurements, including anterior and posterior pelvic width, pelvic asymmetry, and pelvic belt use during and after pregnancy were investigated. Participants were divided into four groups according to pelvic belt use: before and after childbirth (BAC), before childbirth only (BC), after childbirth only (AC), and non-use (NU). Then, an initial one-way ANOVA was conducted to compare the amount of change in pelvic alignment from late pregnancy to post-childbirth between the groups. After the initial analysis, a multivariate regression analysis was performed to determine the statistically significant differences between the groups to consider other factors that influenced pelvic alignment such as age, BMI, number of previous childbirths, vaginal delivery and pelvic asymmetry in late pregnancy. Next, a cutoff point for subgroup stratification based on the weekly duration of pelvic belt use and inter-group changes in pelvic alignment were compared.ResultsAs the result of the initial one-way ANOVA, the decrease in pelvic asymmetry from during pregnancy to postpartum for BAC was greater than that for AC. Moreover, multiple regression analysis showed that the effect of pelvic belt that was revealed in the initial analysis was statistical significance even after adjustment for other factors. Moreover, pelvic asymmetry in the BAC group decreased, compared to being increased or unchanged in the NU and AC groups when the group cutoff time was 7 h per week.ConclusionsContinuous and extended use of pelvic belts during and after pregnancy might be related to modifications of pelvic asymmetry in the perinatal period. Therefore, the instruction of correct and comfortable usage and the recommendation of continuous use of pelvic belt especially during pregnancy are required for prevention of some discomforts related to pelvic malalignment.

INFLUENCE OF CUSTOMIZED FOOT ORTHOTICS ON GAIT BALANCE FOR PELVIC ASYMMETRY PATIENTS

Gait is one of the most common and important factor of human movements in daily life. Pelvis is closely connected with the gait due to it allows maintain stable posture by supporting the spine and lower extremities against the gravity. Therefore, pelvic asymmetry, which is caused by biomechanical stress and muscle imbalance, has been associated with postural imbalance and abnormal walking pattern. The purpose of this study was to manufacture customized foot orthotics for improving gait balance and evaluate the effectiveness of customized foot orthotics during walking by measuring lower extremity muscle activity and plantar pressure distribution. All subjects with pelvic asymmetry were asked to walk on a treadmill under three conditions: walking without foot orthotics, walking with customized foot orthotics and walking with non-customized foot orthotics. Root mean square (RMS) value of the electromyography signals, force and peak pressure of the plantar pressure distribution was analyzed based on the gait cycle. The results showed that excessive tension of the muscles and high pressure of the foot that was induced by pelvic asymmetry were more reduced when walking with custom-made foot orthotics than walking without foot orthotics and walking with non-customized foot orthotics. This paper suggest that custom-made orthotics for patients with pelvic asymmetry could be helpful to relieve the excessive loading of the foot and maintain balanced gait pattern.

The effects of domestic mechanical knee joints on pelvic motion in transfemoral amputees

Purpose Pelvic asymmetry in the sagittal and horizontal planes among prosthesis users is related to the strength of the abdominal and back muscles. Considering that lumbosacral pathologies and pain in long-term transfemoral prosthesis users can cause asymmetric pelvic motion, it is necessary to investigate pelvic asymmetry caused by prosthetic components. The aim was to compare the gait symmetry of the pelvis of active transfemoral amputees using different types of prosthetic knee joints (Non-microprocessor-controlled prostheses (NMCPs) and microprocessor-controlled prostheses (MCP) knees). Methods The two patient groups comprised eight transfemoral amputees: four patients had NMCP joints (Turkish products), and four patients had MCP knees. The reference group consisted of ten normal volunteers. In this work, the 3-D motion of the pelvis, hip, knee and ankle was assessed using the VICON system. Results The results revealed that during stance, the kinematics of pelvic movement in the amputee group differed from those of the control group in terms of the total excursion anterior pelvic tilt (APT) and maximum and minimum degrees of APT (p < .05). We evaluated the graphics of the NMCP and MCP knee joints and found that the prosthesis-side APT was closer to that of the control group during the stance phase among the NMCP users, while the APT of the MCP users was closer to that of the control group during the swing phase. Conclusion The investigated MCP benefitted the patients considerably. The NMCP did not provide as much walking as the MCP but produced less APT. Implications for Rehabilitation The MCP may not provide symmetrical pelvic motion during all phases of the gait cycle. In transfemoral amputees using MCP, focusing on pelvis in walking training will contribute to pre-prosthetic and post-prosthetics rehabilitation. The NMCP knee joint may be closer in terms of APT.

The long-term outcome of pelvic asymmetry during gait in children with cerebral palsy following unilateral femoral derotation osteotomy

In this retrospective study, children with cerebral palsy underwent a unilateral femoral derotation osteotomy and had a preoperative (PO), short-term postoperative (1-3 years), and a long-term postoperative (≥5 years) gait analysis. Patients were subdivided into groups by the PO pelvic presentation and Gross Motor Function Classification System level. In children with PO pelvic external rotation, femoral derotation osteotomy decreased the hip internal rotation and decreased the pelvic external rotation. These results could influence surgical planning to achieve long-term pelvic asymmetry.

Manipulation Effect on Lumbar Kinematics in Patients with Unilateral Innominate Rotation and Comparison with Asymptomatic Subjects

Background: Lumbar motion analysis is used as a clinical method in the diagnosis and treatment of low back pain (LBP). So far, no studies have shown if manipulating the sacroiliac joint (SIJ) will change spinal kinematics.Objective: The main objectives of this study were to investigate the effects of SIJ manipulation on the lumbar kinematics in subjects with innominate rotation and to compare lumbar kinematics among experiment and control groups.Material and Methods: This study was a quasi-experiment-control trial study. 21 LBP patients with anterior or posterior innominate rotations in experiment group and 22 asymptomatic subjects in control group were evaluated. Lumbar kinematic variables (LKV) include lumbar range of motion (ROM) and speed, lumbar lateral flexion and rotation asymmetry were evaluated using Qualysis Track Manager (QTM) twice within two days in control group, and these parameters with pelvic asymmetry and disability were tested before and after intervention in the experiment group.Results: While pre-intervention experiment group exhibited significantly lower lumbar lateral flexion (p=0.0001), rotation (p=0.008) ROM and lower lateral flexion speed (p=0.014), post-intervention experiment group exhibited significantly lower lumbar lateral flexion (p=0.01) ROM in comparison with control group. Pelvic asymmetry (p=0.049) and disability (p=0.01) significantly decreased in the experiment group after manipulation, but LKV did not change significantly after the intervention (p˃0.05).Conclusion: Experiment groups had different lumbar kinematics in comparison with control group before and after SIJ manipulation. Despite the changes in pelvic asymmetry and disability, intervention had no effect on lumbar kinematics.

Quality of reduction correlates with clinical outcome in pelvic ring fractures

IntroductionPosttraumatic pelvic deformity is associated with pain and loss of function. This study aimed to test the correlation of functional outcome in patients with pelvic fractures with the postoperative radiographic quality of reduction. MethodsConsecutive patients with an isolated traumatic pelvic fracture that required closed or open reduction between 07/2015 and 07/2017 and had a completed follow-up of at least 6 months were included (N = 31, mean age 50 years, SD 21 years, range, 16 to 88 years). Majeed and Timed Up & Go were obtained from a prospective outcome database at 6 months and last follow-up (mean 10 months, SD 5 months). Quality of pelvic ring reduction was determined on postoperative radiographs as described by Matta, Sagi and Keshishyan/Lefaivre. ResultsClinical outcome at 6 months as measured by the Majeed and the Timed Up & Go correlated moderately with Keshishyan/Lefaivre’s pelvic asymmetry value (Pearson R: −0.520 and 0.585, p ≤ 0.003) and the pelvic deformity index (−0.527 and 0.503, p ≤ 0.004). There was a weak correlation between the Timed Up & Go and the radiographic grading system as described by Matta/Tournetta at 6 months (0.408, p = 0.023) and at last follow-up (0.380, p = 0.035). ConclusionsThis study showed a moderate correlation of the clinical outcome at 6 months with postoperative quality of radiographic reduction when measured with the method described by Keshishyan and Lefaivre. Although having only descriptive value due to the small cohort, our findings underline the importance of anatomic reduction and restoration of pelvic symmetry in patients with pelvic trauma. Future studies with more patients and more investigators are required and reliability and validity of functional outcome scores needs to be further assessed to predict outcome in patient with fractures of the pelvic ring.Level of evidence: Level IV (case series).