Pelvic Stability Research Articles

Management of Pelvic Trauma Orthopedic Management of Pelvic Trauma

Patients with a suspected pelvic fracture should be managed according to the principles of Advanced Trauma Life Support. The mechanism of trauma determines the pattern of pelvic lesions and the likelihood of associated injuries. The most common classification to describe pelvic lesions is the Young–Burgess system. This classification describes the radiographic images by analyzing the mechanism of injury that leads to predictable patterns of injury and displacement. It is useful in describing injuries and in helping guide both initial treatment and definitive fixation. The initial treatment in case of pelvic lesion is the application of a pelvic binder. An external fixator is recommended in hemodynamically unstable patients with unstable pelvic lesions to prevent further bleeding and to support measures of hemorrhage control. Definitive treatment of pelvic ring lesions requires anterior stabilization or a posterior fixation, or both, depending on the type of injury.

Round ligament management during minimally invasive groin hernia repair in women: a systematic review and meta-analysis.

Female sex has been associated with worse outcomes after groin hernia repair (GHR), including a higher rate of chronic pain and recurrence. Most of the studies in GHR are performed in males, and the recommendations for females extrapolate from these studies, even though females have anatomy intricacies. The round ligament of the uterus (RLU) is associated with pelvic stabilization and plays a role in sensory function. Transection of the RLU during GHR is controversial as it can allow easier mesh placement but can favor genitourinary complications and chronic pain. As no previous meta-analysis compared preserving versus transecting the RLU during minimally invasive (MIS) GHR, we aim to perform a systematic review and meta-analysis evaluating surgical outcomes comparing the approaches. Cochrane Central, Embase, and PubMed databases were systematically searched for studies comparing transection versus preservation of the RLU in MIS groin hernia surgeries. Outcomes assessed were operative time, bleeding, surgical site events, hospital stay, chronic pain, paresthesia, recurrence rates, and genital prolapse rates. Statistical analysis was performed using RevMan 5.4.1. Heterogeneity was assessed with I2 statistics. A review protocol for this meta-analysis was registered at PROSPERO (CRD 42023467146). 1738 studies were screened. A total of six studies, comprising 1131 women, were included, of whom 652 (57.6%) had preservation of the RLU during MIS groin hernia repair. We found no statistical difference regarding chronic pain, paresthesia, recurrence rates, and postoperative complications. We found a longer operative time for the preservation group (MD 6.84min; 95% CI 3.0-10.68; P = 0.0005; I2 = 74%). Transecting the RLU reduces the operative time during MIS GHR with no difference regarding postoperative complication rates. Although transection appears safe, further prospective randomized studies with long-term follow-up and patient-reported outcomes are necessary to define the optimal management of RLU during MIS GHR.

A Prospective Study of the IlluminOss Photodynamic Nail System for Pelvic Stabilization: Treatment of Impending and Actual Fractures from Metastatic Bone Disease, Multiple Myeloma, and Primary Bone Lymphoma.

The stabilization of metastatic lesions in the periacetabular region can be successfully performed using percutaneous techniques. Photodynamic nails (PDNs) are among the available tools for stabilization. Data on postoperative complications and functional outcomes are, however, scarce. Patients undergoing percutaneous stabilization using PDNs (IlluminOss Medical) for impending or actual minimally displaced pathological fractures of the pelvis from metastatic bone disease, multiple myeloma, or primary bone lymphoma were enrolled prospectively. Outcomes were assessed preoperatively and postoperatively at the 2-day, 2-week, 6-week, 3-month, 6-month, and 1-year time points. Functional outcomes assessed included the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function, PROMIS Pain Interference, Combined Pain and Ambulatory Function (CPAF), EuroQol-Visual Analogue Scale (EQ-VAS), and Musculoskeletal Tumor Society (MSTS) scores. Pain was assessed using a VAS. A total of 30 patients treated with PDNs were included. The median VAS pain score dropped from 60 points preoperatively to 30 at 6 weeks postoperatively (p = 0.004). The median CPAF score improved from 6 preoperatively to 7 postoperatively at the 6-week mark. The median EQ-VAS score showed significant improvement at 6 weeks (70 versus 50; p = 0.006). The median 2-week PROMIS Pain Interference score was significantly lower than preoperatively (64.1 versus 66.9; p = 0.03). An improvement in the median PROMIS Physical Function score was seen at 6 weeks following surgery compared with preoperatively (37 versus 30.1; p = 0.001). A significant improvement in the MSTS score was seen as soon as 2 days after surgery (77% versus 40%; p < 0.0001). Among patients with pelvic bone metastases, multiple myeloma, or primary bone lymphoma, we found that treatment using PDNs resulted in immediate return to ambulation and rapid functional outcome improvement, with low complication rates. In this population, this technique represents a safe alternative to open surgery. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Review article: Pre-hospital trauma guidelines and access to lifesaving interventions in Australia and Aotearoa/New Zealand.

The centralisation of trauma services in western countries has led to an improvement in patient outcomes. Effective trauma systems include a pre-hospital trauma system. Delivery of high-level pre-hospital trauma care must include identification of potential major trauma patients, access and correct application of lifesaving interventions (LSIs) and timely transport to definitive care. Globally, many nations endorse nationwide pre-hospital major trauma triage guidelines, to ensure a universal approach to patient care. This paper examined clinical guidelines from all 10 EMS in Australia and Aotearoa/New Zealand. All relevant trauma guidelines were included, and key information was extracted. Authors compared major trauma triage criteria, all LSI included in guidelines, and guidelines for transport to definitive care. The identification of major trauma patients varied between all 10 EMS, with no universal criteria. The most common approach to trauma triage included a three-step assessment process: physiological criteria, identified injuries and mechanism of injury. Disparity between physiological criteria, injuries and mechanism was found when comparing guidelines. All 10 EMS had fundamental LSI included in their trauma guidelines. Fundamental LSI included haemorrhage control (arterial tourniquets, pelvic binders), non-invasive airway management (face mask ventilation, supraglottic airway devices) and pleural wall needle decompression. Variation in more advanced LSI was evident between EMS. Optimising trauma triage guidelines is an important aspect of a robust and evidence driven trauma system. The lack of consensus in trauma triage identified in the present study makes benchmarking and comparison of trauma systems difficult.

Imposter or knight in shining armor? Pelvic circumferential compression devices (PCCD) for severe pelvic injuries in patients with multiple trauma: a trauma-registry analysis

BackgroundPelvic Circumferential Compression Devices (PCCD) are standard in hemorrhage-control of unstable pelvic ring fractures (UPF). Controversial data on their usefulness exists. Aim of the study was to investigate whether prehospital application of PCCD can reduce mortality and transfusion requirements in UPF.MethodsRetrospective cohort study. From 2016 until 2021, 63,371 adult severely injured patients were included into TraumaRegister DGU® of the German Trauma Society (TR-DGU). We analyzed PCCD use over time and compared patients with multiple trauma patients and UPF, who received prehospital PCCD to those who did not (noPCCD). Groups were adjusted for risk of prehospital PCCD application by propensity score matching. Primary endpoints were hospital mortality, standardized mortality rate (SMR) and transfusion requirements.ResultsOverall UPF incidence was 9% (N = 5880) and PCCD use increased over time (7.5% to 20.4%). Of all cases with UPF, 40.2% received PCCD and of all cases with PCCD application, 61% had no pelvic injury at all. PCCD patients were more severely injured and had higher rates of shock or transfusion. 24-h.-mortality and hospital mortality were higher with PCCD (10.9% vs. 9.3%; p = 0.033; 17.9% vs. 16.1%, p = 0.070). Hospital mortality with PCCD was 1% lower than predicted. SMR was in favor of PCCD but failed statistical significance (0.95 vs. 1.04, p = 0.101). 1,860 propensity score matched pairs were analyzed: NoPCCD-patients received more often catecholamines (19.6% vs. 18.5%, p = 0.043) but required less surgical pelvic stabilization in the emergency room (28.6% vs. 36.8%, p < 0.001). There was no difference in mortality or transfusion requirements.ConclusionWe observed PCCD overuse in general and underuse in UPF. Prehospital PCCD appears to be more a marker of injury severity and less triggered by presence of UPF. We found no salutary effect on survival or transfusion requirements. Inappropriate indication and technical flaw may have biased our results. TR-DGU does not contain data on these aspects. Further studies are necessary. Modular add-on questioners to the registry could offer one possible solution to overcome this limitation. We are concerned that PCCD use may be unfairly discredited by misinterpretation of the available evidence and strongly vote for a prospective trial.

Exploring Axillary Vein Central Cannulation in Critically Ill Trauma Patients: A Focus on Infraclavicular Techniques

Managing major trauma in hospital settings, especially in emergency departments, presents significant challenges. Hypovolemic shock, often resulting from hemorrhage, is commonly due to bleeding in non-compressible areas like the abdomen and thoracic cavities, complicating intravenous access. Central vein cannulation is typically performed for effective volume resuscitation and blood transfusions prior to surgery, with common sites including the internal jugular, subclavian, and femoral vessels. However, in acutely bleeding trauma patients, early pre-hospital interventions such as cervical collars and pelvic binders can impede the cannulation of these veins and limit access to traditional central venous sites. This article explores the cannulation of central axillary veins, an underutilized yet advantageous route. Central axillary veins are readily accessible and provide a viable alternative for resuscitation in major trauma patients in emergency settings, offering a practical solution when other central venous access points are compromised.

Concentric and eccentric hip musculotendon work depends on backpack loads and walking slopes

Hip muscle weakness is associated with low back and leg injuries. In addition, hiking with heavy loads is linked to high incidence of overuse injuries. Walking with heavy loads on slopes alters hip biomechanics compared to unloaded walking, but individual muscle mechanical work in these challenging conditions is unknown. Using movement simulations, we quantified hip muscle concentric and eccentric work during walking on 0° and ±10° slopes with, and without 40% bodyweight added loads, and with and without a hip belt. For gluteus maximus, psoas, iliacus, gluteus medius, and biceps femoris long head, both concentric and eccentric work were greatest during uphill walking. For rectus femoris and semimembranosus, concentric work was greatest during uphill and eccentric work was greatest during downhill walking. Loaded walking had greater concentric and eccentric work from rectus femoris, biceps femoris long head, and gluteus maximus. Psoas concentric work was greatest while carrying loads regardless of hip belt usage, but eccentric work was only greater than unloaded walking when using a hip belt. Loaded and uphill walking had high concentric work from gluteus maximus, and high eccentric work from gluteus medius and biceps femoris long head. Carrying heavy loads uphill may lead to excessive hip muscle fatigue and heightened injury risk. Effects of the greater eccentric work from hip flexors when wearing a hip belt on lumbar spine forces and pelvic stability should be investigated. Military and other occupational groups who carry heavy backpacks with hip belts should maintain eccentric strength of hip flexors and hamstrings.

Evaluation of the electromyography activity of hindlimb muscles during core exercises in horses

IntroductionTherapeutic exercise is key in rehabilitation programs, so they must be specific, individualised, and reasoned. Biomechanical studies using surface electromyography have allowed us to make an evidence-based selection of the most appropriate exercises for each patient. The literature describes different electromyography activities in many muscles during different exercises, including walking, trotting, galloping, poles, and slopes, among others, but research on exercises performed in standing horses is lacking. Inclusion in rehabilitation programs of these exercises is based on an effect extrapolated from an anatomical and biomechanical concept of the muscles and not on surface electromyography evidence. This study evaluated the effect of six therapeutic exercises commonly used in horse rehabilitation programs on four muscles (m. gluteus medius, m. tensor fasciae latae, m. biceps femoris, and m. gracilis), to objectively measure the activity they generate by surface electromyography. Material and methodsSix horses performed six selected core exercises: axial tail traction, lateral tail traction, lateral tail traction to the contralateral side, lumbosacral flexion, lumbosacral extension, and caudal weight displacement. The activity was recorded by surface electromyography in four hindlimb muscles, including the m. gluteus medius, m. tensor fasciae latae, m. biceps femoris, and m. gracilis, and the signal registered was rectified and smoothed using the root mean square (RMS) algorithm. Finally, the data obtained was subjected to a statistical analysis using an ANOVA for the differential voltage factor followed by a Duncan multiple range analysis to determine which muscles activated each exercise. ResultsMaximum activity was observed for m. gluteus medius with lateral tail traction (41.55 μV) and lumbosacral flexion (46.72 μV); m. tensor fasciae with lateral tail traction (40.63 μV); m. biceps femoris with lumbosacral flexion (22.22 μV); and m. gracilis with axial tail traction (39.48 μV), lateral tail traction to the contralateral side (56.43 μV), lumbosacral flexion (68.72 μV), and caudal weight displacement (41.12 μV). ConclusionsM. biceps femoris was moderately activated during lumbar flexion, indicating it is not as relevant in pelvic stability as previously assumed. M. gluteus medius, m. biceps femoris, and m. gracilis activity during lumbar flexion suggests their potential involvement in the stability of the lumbosacral region. m. gracilis exhibited more activity than expected, indicating a significant role in pelvis and hip stability.

Clinical Associated Factors of Tile B/C Type of Pelvic Ring Fractures; a Retrospective Cross-sectional study.

Pelvic ring fractures categorized under Tile Categories B and C denote partially and fully unstable fractures, respectively. This study aimed to identify the clinically associated factors of Tile B/C pelvic ring fractures. This retrospective cross-sectional study reviewed medical records from the Emergency Medicine department at Ramathibodi Hospital in Bangkok, Thailand. The study included individuals aged ≥ 15 who experienced accidents from 2012 to 2021. To investigate the associations between the clinical variables and three critical outcomes, including Tile B/C pelvic ring fractures, major vascular injuries, and the necessity for surgical or radiological interventions, multivariable logistic regression analysis was employed. A total of 198 patients were included in the study, among whom 34.8% were diagnosed with Tile B/C pelvic ring fractures. The analysis revealed several significant predictors of Tile B/C fractures, including the presence of pelvic tenderness (adjusted odds ratio [aOR] = 15.25, 95% confidence interval [CI] = 5.86-39.66, p < 0.001), and a shock index (SI) ≥1 (aOR = 4.2, 95% CI = 1.24-14.22, p = 0.021). Moreover, Tile B/C pelvic ring fractures were associated with an increased incidence of major vascular events and the imperative requirement for surgical or radiological interventions. Clinical findings of pelvic tenderness and an SI ≥1 are strong predictive clinical factors associated with Tile B/C pelvic fractures. Early diagnosis, application of an pelvic binder, provision of initial resuscitation, and prompt transportation to a definitive care facility are crucial components of management.

Remodeling of murine vaginal smooth muscle function with reproductive age and elastic fiber disruption

Advanced maternal age during pregnancy is associated with increased risk of vaginal tearing during delivery and maladaptive postpartum healing. Although the underlying mechanisms of age-related vaginal injuries are not fully elucidated, changes in vaginal microstructure may contribute. Smooth muscle cells promote the contractile nature of the vagina and contribute to pelvic floor stability. While menopause is associated with decreased vaginal smooth muscle content, whether contractile changes occur before the onset of menopause remains unknown. Therefore, the first objective of this study was to quantify the active mechanical behavior of the murine vagina with age. Further, aging is associated with decreased vaginal elastin content. As such, the second objective was to determine if elastic fiber disruption alters vaginal contractility. Vaginal samples from mice aged 2–14 months were used in maximum contractility experiments and biaxial extension-inflation protocols. To evaluate the role of elastic fibers with age, half of the vaginal samples were randomly allocated to enzymatic elastic fiber disruption. Contractile potential decreased and vaginal material stiffness increased with age. These age-related changes in smooth muscle function may be due, in part, to changes in microstructural composition or contractile gene expression. Furthermore, elastic fiber disruption had a diminished effect on smooth muscle contractility in older mice. This suggests a decreased functional role of elastic fibers with age. Quantifying the age-dependent mechanical contribution of smooth muscle cells and elastic fibers to vaginal properties provides a first step towards better understanding how age-related changes in vaginal structure may contribute to tissue integrity and healing. Statement of significanceAdvanced maternal age at the time of pregnancy is linked to increased risks of vaginal tearing during delivery, postpartum hemorrhaging, and the development of pelvic floor disorders. While the underlying causes of increased vaginal injuries with age and associated pathologies remain unclear, changes in vaginal microstructure, such as elastic fibers and smooth muscle cells, may contribute. Menopause is associated with fragmented elastic fibers and decreased smooth muscle content; however, how reproductive aging affects changes in the vaginal composition and the mechanical properties remains unknown. Quantifying the mechanical contribution of smooth muscle cells and elastic fibers to vaginal properties with age will advance understanding of the potential structural causes of age-related changes to tissue integrity and healing.

Midline Sacral Fractures: Review of the Literature

INTRODUCTION Sacral fractures are an important consideration in high-energy traumas associated with injuries to the pelvic ring that confer much of pelvic stability. A midline longitudinal sacral fracture (MLS) is a relatively rare fracture pattern, with only 23 cases of MLS fractures reported in the literature to date. This systematic review evaluates overall mechanisms of MLS injury, associated injuries, complications, management, and fracture prognosis. METHODS A 1952-2021 PubMed literature search yielded 11 publications reporting the outcomes of a total of 23 MLS fracture cases. RESULTS Of the 23 MLS patients, 15 (65%) were male and eight (35%) were female, with an average age of 37.25. Ten (43.5%) MLS fractures occurred during motor vehicle collisions and eight (34.7%) because of motorcycle accidents. The most common pelvic ring injuries associated with MLS were pubic symphysis diastasis (n = 12, 57%) and pubic ramus fractures (n = 11, 48%). Patients most frequently suffered intra-pelvic organ dysfunction such as sexual dysfunction or bowel/bladder/urethral injuries. Fractures were treated both operatively or non-operatively and generally showed clinical meaningful resolution at 10 weeks post-injury. CONCLUSIONS MLS injuries most often occur in high-energy trauma due to motor vehicle or motorcycle accidents as well as crush injuries, leg splitting, direct perineal/perianal impacts. Pre-trauma sacral abnormalities could be potentially predisposing factors correlated with MLS fractures. Careful review of x-rays and CT scans may help reveal MLS fractures, which can go initially undiagnosed. Operative and nonoperative management strategies includes bedrest, transsacral transiliac screw, decompressive laminotomies, and/or pelvic external fixation. The outcomes reported to date have been generally favorable, with most patients healing at approximately 10 weeks. Keywords: Midline sacral fracture; vertical sacral fracture; sacrum; pelvic ring injury

How to Correctly Place the Pelvic Binder – A Life-Saving Technique

How to Correctly Place the Pelvic Binder – A Life-Saving Technique

From tradition to innovation: a comparison of the traditional 4-step approach versus a blended learning modification for technical skills teaching

BackgroundThis experimental study was performed to evaluate the role of blended learning for technical skill teaching on the European Trauma Course (ETC). While online modules are extensively used for theoretical teaching, their role in skills training remains less well explored. The ETC currently relies on the established 4-step technique for teaching technical skills. However, the required large cohort of skilled instructors and the time intensity prove increasingly challenging in a current climate of staff shortages and funding constraints. This study assesses if blended learning, combining pre-course online elements with face-to-face training matches the effectiveness of the traditional 4-step approach whilst being more time-efficient.MethodsIn a randomised, multi-centre trial, the conventional face-to-face 4-step technique for teaching a skill of medium complexity, the application of a pelvic binder, was compared with an innovative blended approach. It was hypothesised that the blended approach was non-inferior for skill performance measured after the teaching session and after two days (skill retention) with the time needed for teaching and student/teacher satisfaction as secondary outcomes.ResultsNinety participants, divided into 44 traditional and 46 blended method students, were analysed. Independent-samples t-test showed no significant difference in performance scores and non-inferiority of the blended approach with a half of one standard deviation margin. A statistically significant difference in mean retention scores favored the blended approach. A Mann–Whitney U Test revealed no significant difference in candidate satisfaction levels but a statistically significant difference in instructors' satisfaction levels in favour of the blended approach. Analysis with Welch' t-test demonstrated that the face-to-face teaching time needed for the blended approach was significantly shorter (by 6 min).ConclusionsThe integration of a blended approach with the 4-step technique for teaching pelvic binder application in the ETC streamlined teaching without compromising skill acquisition quality. This innovative approach addresses traditional limitations and shows promise in adapting medical education to modern learning and teaching demands. We suggest that blended learning could also be applied for other skills taught on life support courses.Trial registration: University of Dundee (Schools of Medicine and Life sciences Research Ethics Committee, REC number 22/59, 28th June 2022).

OFF-LOADING PRESSURE RELIEF WITH FOAM CUT OUT CUSHIONS: EXPERIENCES FROM RANCHO LOS AMIGOS NATIONAL REHABILITATION CENTER.

This paper explores the efficacy of the cushion fitting technique using foam cut out cushions for off-loading bony prominences in the sitting position, with a particular focus on reducing the high risk of developing pressure injuries among aging wheelchair users. This technique, historically employed at Rancho Los Amigos National Rehabilitation Center, has shown promising results in reducing pressure injuries for patients with spinal cord injuries. However, its widespread adoption remains limited. This manuscript aims to raise awareness about foam cut out cushions, its historical context, and its contemporary relevance by presenting customized solutions for individual patients with specific deformities. Key clinical points are highlighted, emphasizing the importance of skilled clinicians in the fitting process and the need to consider foam cut out cushions alongside other preventive measures. Case examples illustrate successful outcomes, demonstrating improved pelvic stability, posture, and off-loading of bony prominences. By promoting foam cut out cushions as a valuable cushioning option, this manuscript equips clinicians with knowledge to utilize this technique effectively.

Gluteal Muscle Fatty Atrophy: An Independent Risk Factor for Surgical Treatment in Elderly Patients Diagnosed with Type-III Fragility Fractures of the Pelvis.

Gluteal muscle fatty atrophy (gMFA) might impair pelvic stability and negatively influence remobilization in patients with fragility fractures of the pelvis (FFP). This study aimed to investigate the association between gMFA and surgical indication in patients with FFP. A retrospective analysis of 429 patients (age ≥80) diagnosed with FFP was performed. gMFA of the gluteus maximus, medius, and minimus was evaluated using a standard scoring system based on computer tomography images. No significant difference was found in gMFA between genders or among FFP types. The severity of gMFA did not correlate with age. The severity of gMFA in the gluteus medius was significantly greater than in the gluteus maximus, whereas the most profound gMFA was found in the gluteus minimus. gMFA was significantly more severe in patients who underwent an operation than in conservatively treated patients with type-III FFP, and an independent correlation to surgical indication was found using logistic regression. Our findings imply that gMFA is an independent factor for surgical treatment in patients with type-III FFP. Besides focusing on the fracture pattern, the further evaluation of gMFA could be a feasible parameter for decision making toward either conservative or surgical treatment of type-III FFP.

Availability and use of resources for emergency fracture care of pelvic trauma associated with haemorrhagic shock in Latin America: A cross-sectional study

Determining the true availability of resources and understanding the level of training of surgeons involved in the treatment of patients with pelvic fractures and haemorrhagic shock is critical. In the herein study, the availability of technical, technological, and human resources for the care of this injury in Latin America region was analysed, and the preferences of orthopaedic trauma surgeons when performing interventions for the diagnosis and treatment of patients with pelvic trauma and associated haemorrhagic shock was described. A cross sectional web-based survey containing questions on knowledge, attitudes, and practices with respect to imaging resources, emergency pelvic stabilization methods, and interventions used for bleeding control was sent to 948 Latin America orthopaedic trauma surgeons treating pelvic fractures in the emergency department. Differences between regional clusters, level of training, type of hospital, and pelvic surgery volume were assessed. 368 responses were obtained, with 37.5% of respondents reporting formal training in pelvic surgery and 36.0% having available protocol for managing these patients. The most frequently used interventions were the supra-acetabular pelvic external fixator and pelvic packing. Limited hospital and imaging resources are available for the care of patients with pelvic trauma and associated haemorrhagic shock throughout Latin America. In addition, the training of orthopaedic trauma surgeons dealing with this type of injury and the volume of pelvic surgeries per year is heterogeneous. It should be urgently considered to develop management protocols adapted to Latin America according to the availability of resources, as well as to promote training in this severe life-threatening traumatic condition.

The importance of gluteal muscle strength in dynamic pelvic stability of fatigued female endurance road runners

BACKGROUND: Recently there has been a rise in female participation in running yet the female population is under-researched in sport specific research. Locally, many female athletes annually compete in numerous ultra-marathons (&gt; 42 km). OBJECTIVE: This study investigated the importance of Gluteal muscle strength in dynamic pelvic stability of fatigued female endurance road runners. METHODS: Fourteen female endurance runners (age: 38.0 ± 10.12 years, BMI: 21.99 ± 2.37 kg/m2, and VO2max: 40 ± 5.34 ml/min/kg) volunteered for the participation of this study. Through isokinetic testing, muscle strength and fatigability of the Gluteus Maximus, Medius and Minimus was determined. Sign tests compared pelvis stability (unilateral Trendelenburg, Pelvic Bridge test and pelvic stability through a gait analysis) before and after an endurance run on a cambered and flat surface. Participants were divided into two groups based on change in pelvic stability after the fatigue intervention. RESULTS: The unaffected group was moderately younger; lighter in weight and had a lower BMI. Additionally, this group was largely more experienced (p= 0.61, d= 1.341); aerobically fit and ran significantly longer weekly distances (p= 0.002, d= 3.4). There was no statistical difference in isokinetic testing of strength and endurance hip flexion/extension and abduction/adduction between the two groups (p&gt; 0.05). CONCLUSION: In conclusion, the group that was more experienced and ran longer weekly distances showed no change in pelvic stability after an endurance run. However, the group that showed changes in pelvic stability suggests that fatigue could be a contributing factor to pelvic compensation. It is recommended that female endurance runners incorporate strength training to strengthen the Gluteal and Hip Flexor muscle groups to reduce pelvic compensation.

Lower-Extremity Fillet Flap for Reconstruction of Complex Stage IV Pressure Sores and Plantar Flap for Lumbosacral Padding.

The lower-extremity fillet flap is a suitable option for the repair of complex (multiple or complicated with osteomyelitis) stage IV pressure sores. If prepared from a nonfunctional extremity, it can close complex wounds and avoid the unnecessary burden of a nonfunctional organ that restricts patient movement, thereby improving quality of life. We used a lower extremity fillet flap for reconstruction in 5 patients with complex stage IV pressure sores. The flaps were prepared from the nonfunctional lower extremity with multiple lesions by using iliofemoral disarticulation. The mean age of the patients was 60 years old, and the mean follow-up period was 18 months. A plantar flap was used in 1 patient for prophylactic padding of the lumbosacral region. In another patient, the plantar flap was used as a sensate flap. No major complications, such as total or partial flap loss, occurred in these patients. In 1 patient, a hematoma developed under the flap that led to dehiscence; however, it healed uneventfully without flap loss. Patients developed minimal pelvic stability and balance loss because of iliofemoral disarticulation, but it did not affect their sitting ability and mobility. After the operation, all patients became increasingly active and mobile because of the absence of excess weight on their nonfunctional legs, allowing them to easily perform daily activities such as turning in bed, using a wheelchair, eating, and dressing. Pressure sores did not develop in any of the patients during the postoperative follow-up period. The patient who underwent lumbosacral padding with a sensate plantar flap began to perceive touch over the flap in the fifth postoperative month. These results suggest that a lower-extremity fillet flap can be a good repair option in complex stage IV pressure sores because it prevents recurrence and enables patients to perform daily activities more easily. Furthermore, plantar flaps can provide prophylactic padding in the lumbosacral region.

Pelvic binder radiography detects occult instability in cadaveric simulated lateral compression type I (LC1) pelvic fractures

ObjectivesOccult instability in minimally displaced lateral compression (LC) pelvic ring injuries may have clinical relevance for treatment. We describe two novel LC pelvis fracture stress examinations – pelvic binder stress radiography (PBR) and pelvic binder stress bladder manometry (PBM) – which do not require sedation, anesthesia, patient transport, or radiation of personnel. MethodsA biomechanical study was performed with five fresh elderly cadavers. Sequential osteotomies of the pelvis simulated increasingly unstable LC pelvis fracture patterns (OTA/AO 61A2.2, 61B1.1a, 61B1.1b, 61B2.1). Compressive force was quantitatively applied using a pelvic binder and scale. Pelvis fracture displacement was measured on AP and inlet fluoroscopic views. Pelvic bladder pressure (PBM) was measured using a Foley catheter as a water column. ResultsFracture displacement strongly correlated with force applied (R2=0.600-0.963). PBR discriminated between simulated LC injuries. Mean displacement of 61B1.1b injuries >1cm was observed at 3.8kg on AP view and 5kg on inlet view. Mean displacement of 61B1.1a injuries >1cm was observed at 8.2kg on AP view and 9.3kg on inlet view. 61A2.2 injuries did not displace >1cm at forces up to 10kg. >95% of 61B1.1a and 61B1.1b injuries displaced >1cm at 10kg. PBM moderately correlated with force applied (R2=0.517-0.842) but did not discriminate between LC injuries. ConclusionsPBR is feasible, precisely quantified occult mechanical instability in simulated LC pelvis fractures in response to reproducible applied force, and discriminated between simulated LC pelvis fractures. PBM did not discriminate between simulated LC fractures. A clinical trial to validate the safety and efficacy of PBR for assessing occult instability in LC pelvis fracture is warranted.

Analysis of Differences in FIB, D-D, and Inflammatory Factor Levels between Patients Undergoing Pelvic Fracture Surgery through the Pararectus Abdominis Approach and Traditional Ilioinguinal Approach

Background: Pelvic fractures require surgery to restore pelvic stability and ensure the restoration of normal physiological structure and function. In pelvic fracture surgery, the choice of surgical approach may have a significant impact on the postoperative recovery and prognosis of patients. This study compared the postoperative recovery effect, coagulation function, and inflammatory indicators of patients through two different surgical approaches: the pararectus abdominis approach and the traditional ilioinguinal approach, aiming to provide more evidence and guidance for clinical practice. Objectives: To observe the differences in fibrinogen (FIB), D-dimer (D-D), and inflammatory factor levels between patients undergoing pelvic fracture surgery through the Pararectus abdominis approach and traditional ilioinguinal approach. Methods: A total of 86 patients with pelvic fractures were divided into a control group (n=43) and an observation group (n=43). The control group received traditional ilioinguinal approach surgery, while the observation group underwent surgery through the Pararectus abdominis approach. Comparisons were between the two groups for the postoperative coagulation function level, inflammatory factor level, and postoperative hip joint function scores. Results: Before surgery, there was no difference in FIB and D-D levels between the two groups (P&gt;0.05). At 3 days and 7 days after the surgery, the levels of FIB and D-D in the two groups increased compared to before the surgery; however, the observation group was lower in this regard than the control group at the same time (P&lt;0.05). The results of the repeated analysis of variance showed that there were group, time, and interaction effects between the two groups (P&lt;0.05). One week after the operation, the scores of hip joint function were compared between the two groups (P&gt;0.05). The hip joint function scores of the two groups were higher at 1 month and 3 months postoperatively than at 1 week, and the observation group was higher than the control group at the same time. Conclusion: Compared with traditional ilioinguinal approach surgery, surgery through the Pararectus abdominis approach can reduce surgical stimulation, decrease coagulation factor secretion, and alleviate systemic inflammatory reactions after the surgery, promoting the recovery of hip joint function.