Sciatic Notch Research Articles

Hydroxychloroquine Mitigates Cytokine Storm and Prevents Critical Illness Neuromyopathy in a Rat Sepsis Model.

Background and Objectives: It is known that critical illness and associated neuromuscular problems begin to appear in patients hospitalized in the intensive care unit (ICU) for more than a week. The goal of this study was to research the role of hydroxychloroquine (HCQ) in the treatment of cytokine storm and critical illness neuromyopathy (CINM) in a rat sepsis model. Materials and Methods: Rats were assigned into three groups, and a feces intraperitoneal-injection group (FIP) procedure was carried out on 30 rats to induce a model of sepsis for critical illness polyneuromyopathy (CINM). The study groups were as follows: Group 1: control (nonoperative and orally fed control, n = 10), Group 2: FIP with 0.9% NaCl saline was given as 1 mL/kg/day by oral gavage (n = 10), and Group 3: FIP with 10 mg/kg/day of hydroxychloroquine (Plaquenil 200 mg) administered by oral gavage (n = 10). Electrophysiological recordings (EMG) were conducted six days after surgery. EMG was carried out three times on the right sciatic nerve, which was stimulated with supramaximal intensity utilizing a bipolar needle electrode at the sciatic notch. Tumor necrosis factor-alpha (TNF-α), malondialdehyde (MDA), lactic acid levels, and interleukin-6 (IL-6) were evaluated. Results: In terms of TNF-α, MDA, lactic acid levels, and IL-6, there was a statistically significant decrease in the CINM + 10 mg/kg HCQ group compared to the CINM and saline group (p < 0.0001, p < 0.05, p < 0.05, and p < 0.05, respectively). Compound muscle action potentials (CMAPs) latency and duration were decreased in the CINM + 10 mg/kg HCQ group compared to other groups (p < 0.01 and p < 0.001). However, CMAP amplitude was significantly higher in the CINM + 10 mg/kg HCQ group unlike the CINM and saline group (p < 0.001). Conclusions: This is the first study to demonstrate the effects of HCQ on CINM in a rat model of sepsis. The findings of our research suggest that hydroxychloroquine may be used as a potential therapeutic agent in the treatment of sepsis. Hydroxychloroquine may have an important effect in the pathogenesis of sepsis-associated CINM by reducing cytokine production and oxidative stress.

Electrode Configurations for Sensitive and Specific Detection of Compound Muscle Action Potentials to the Tibialis Anterior Muscle after Peroneal Nerve Injury in Rats

BackgroundQuantifying peripheral nerve regeneration via electrophysiology is a commonly used technique, but it can be complicated by spurious electrical activity. This study sought tocompare electrode configurations for measuring compound muscle action potential (CMAP) of the tibialis anterior (TA) muscle in a rat model for specific and sensitive detection of regeneration of peroneal nerve to the TA. New method10 Sprague-Dawley rats underwent a peroneal nerve transection with direct microsuture repair. CMAPs were conducted with different placements and types of electrodes. Compound action potentials (CAPs) and gait analysis were regularly collected up to 70 days (d) post operation (PO). Nerve sections were harvested at 49 d (n=4) and 70 d (n=6) PO and stained with toluidine blue to assess nerve morphometry. ResultsOf the tested configurations for CMAPs, a concentric recording/reference electrode in combination with stimulation from the sciatic notch showed the least background and highest sensitivity, while some configurations showed significant noise and did not detect changes in CMAPs within the 70 d recording period following injury. CAPs, gait analysis, morphometry, and muscle mass support the extent of regeneration indicated by CMAPs collected with concentric electrodes. ConclusionCollateral innervation patterns can complicate CMAP recordings as signals from adjacent muscles can be detected and misinterpreted as regeneration. The outcome of this study shows how differences in configurations and electrodes have significant effects on CMAP for the TA. The results identify methods using concentric electrodes that provides high specificity and sensitivity capable of detecting evidence of regeneration early after injury.

Intraneural and Extraneural Ganglion Cysts at the Greater Sciatic Notch Involving the Sciatic Nerve Causing Sciatica: Two Case Reports

Intraneural ganglion cysts (IGCs) are benign mucinous cysts within the epineurium of peripheral nerves. Hip joint-related IGCs are much rarer than those that arise from peripheral nerves around the joints of limbs. The unifying articular synovial theory has been accepted as explaining the pathogenesis of IGCs. Herein, we present two cases of hip joint-related ganglion cysts—one case of an IGC and one case of an extraneural ganglion cyst—that involved the sciatic nerve through the articular branch of the hip joint and caused sciatica. Preoperative and postoperative magnetic resonance imaging (MRI) findings of the articular branch derived from a paralabral cyst of the hip are presented, as well as photographic findings of a ganglion cyst with the articular branch addressed through a transgluteal approach. Despite improvement in postoperative sciatica due to cyst decompression and treatment aimed at addressing the articular branch, the articular branch remained present on postoperative MRI. Unlike IGCs arising from peripheral nerves associated with limb joints, involvement of the sciatic nerve might make it challenging to treat articular branches due to the location of the sciatic nerve over the greater sciatic notch of the deep gluteal region.

Therapeutic Potential of Vitamin B Complex in Peripheral Nerve Injury Recovery: An Experimental Rat Model Study.

Objectives: Vitamin B complexes are frequently used in clinical practice for peripheral nerve trauma. However, there is a lack of scientific data on their effectiveness. This study aims to investigate the impact of the vitamin B complex on nerve recovery in a rat model of peripheral nerve paralysis. Materials and Methods: Sixty male Wistar Albino rats were divided into six groups. Models of nerve injury, including blunt trauma, nerve incision, and autograft, were performed on all rats approximately 1 cm distal to the sciatic notch. B-complex vitamins were injected intraperitoneally at 0.2 mL/day to the treatment groups. The control groups were given 0.2 mL/day saline. After 1 month, the study was terminated, electromyography (EMG) was performed to measure the conduction velocity, and nerve tissue was taken from the repair line. The sciatic function indexes (SFIs) were calculated and analyzed. The histopathological samples were stained with hematoxylin and eosin and Toluidine blue and examined with a light microscope. Pathologically, myelination, fibrosis, edema, and mast cell densities in the nervous tissue were evaluated. Results: The vitamin B treatment groups demonstrated significant improvements in SFI compared to the control groups, indicating functional improvement in nerve damage (p < 0.05). In the nerve graft group, the vitamin B group showed a shorter latency, higher velocity, and larger peak-to-peak compared to the controls (p < 0.05). In the nerve transection group, the vitamin B group had better latency, velocity, and peak-to-peak values than the controls (p < 0.05). In the crush injury group, the vitamin B group exhibited an improved latency, velocity, and peak-to-peak compared to the controls (p < 0.05). Better myelination, less fibrosis, edema, and mast cells were also in the vitamin B group (p < 0.05). Conclusions: Vitamin B treatment significantly improves nerve healing and function in peripheral nerve injuries. It enhances nerve conduction, reduces fibrosis, and promotes myelination, indicating its therapeutic potential in nerve regeneration.

VALIDITY OF ANTHROPOMETRIC STUDY OF ANATOMICAL FEATURES OF GREATER SCIATIC NOTCH FOR GENDER DETERMINATION: A DISTINCT AND VALUABLE TOOL FOR FORENSIC IDENTIFICATION.

Forensic Medicine has challenging dynamics particularly in identification of gender from bones. Pelvic bone is one of them which is commonly used in gender estimation due to variety of its features. The greater sciatic notch is the best part of pelvic bone for gender determination as its location makes it resilience to trauma even for many years. The aim of this study was to validate the various features such as width, depth angles etc. of greater sciatic notch for sex determination of the deceased. This validation study was carried out in department of Forensic Medicine and Anatomy of Ayub Medical College from June 2023 to December 2023. A sample of 70 dry unidentified pelvic bones were studied by measuring the width, depth, anterior and posterior segments, anterior and posterior angles of the greater sciatic notch. Based on these measurements, the bones were then segregated as male and female bones. After initial gender identification, the standard features of the pelvic bones as per Krogman's classification were used for final confirmation of the gender. Result showed width, Anterior segment and posterior angle of greater sciatic notch greater in females while depth of notch deeper, posterior segments, anterior angle greater in males. These parameters and measurements give a unique importance for determining the gender of individual. Our study shows that there is a significant difference between gender on the basis of different mentioned parameters of estimation. By using these parameters of greater sciatic notch anthropometric measurements, investigators can easily conclude important milestones of identity and determine the truth.

Estimating osteological sex using predictive geometric morphometric analyses of the greater sciatic notch

Accurately estimating the biological sex of human skeletal remains is crucial in both forensic and archaeological contexts for constructing biological profiles. Presently, one of the most commonly used methods involves an ordinal scale describing the shape of the greater sciatic notch (GSN). However, this approach is limited by variations influenced by temporal, geographic, and ancestral factors affecting pelvic morphology. Consequently, its reliable applicability is restricted to populations resembling the original reference group. Recent advancements in quantitative analyses offer a promising alternative by enabling detailed measurement of subtle morphological changes, thus enhancing the accuracy of sex estimation using skeletal pelvic remains. In this study, we employ 2D landmark-based geometric morphometrics (GMM) to develop a protocol for pelvic sex estimation by quantifying the curve and angle of the GSN. These techniques are applied to both a contemporary population of adult European-Americans of known biological sexes (33 females, 38 males) and an archaeological population (n = 73) from south-west England. Our analysis reveals that our GMM approach achieves a 90 % accuracy rate in modern populations. Results indicate that both GSN morphology and angle are highly indicative of biological sex, allowing confidence in sex estimations of archaeological remains using these features.

Ankylosing spondylitis and heterotopic calcification: a case from the Prehispanic population of Buenavista del Norte (Tenerife, Canary Islands).

Skeletal remains of an adult (estimated age at death ≈ 27-30 years) Prehispanic male with fusion in the sacroiliac joints showed a heterotopic ossification consisting of a flat, 10 × 5 cm bone formation covering the posterior aspect of the right sacroiliac joint. The bones were recovered from a burial cave containing remains of 4 individuals, located on the side of a ravine, in Buenavista del Norte (NW corner of Tenerife, Canary Islands), at ≈ 450 m altitude. This individual was probably affected by ankylosing spondylitis (AS) that led to bony fusion of the pelvic bones with the sacrum, but several unusual features prompted us to compare the pelvis with those belonging to two modern individuals affected by AS (20th century) housed at the Department of Anatomy of the school of medicine (University of La Laguna, Tenerife). The Prehispanic individual possibly suffered a pelvic fracture that caused a hematoma which underwent ossification. Some features (periosteal reaction, formation of new foramina) may also suggest a superimposed infection. The fracture altered the pelvic structure, severely narrowing the right sciatic notch, possibly causing neural and/or vascular compromise of the lower limbs. Living in a steep mountainous environment, this individual (possibly a goatherder) probably suffered a fall, that caused the fracture complicated by a severe bleeding and pelvic deformation.

Radiographic Alignment Parameters for Lumbosacral Reconstruction in Patients With Altered S1 Morphology.

Retrospective quantitative analysis study. Pelvic incidence has been established as central radiographic marker which determines patient-specific correction goals during surgery for adult spinal deformity. In cases with sacral doming or sacral osteotomy where the PI cannot be calculated, reliable radiographic parameters need to be established to determine surgical goals. We aim to determine multiple radiographic parameters and formulas that can be utilized when the S1 superior endplate is obscured. Retrospective analysis was performed on 68 healthy volunteers without prior spine surgery with full-length radiographs. Pelvic incidence, sacral slope, and pelvic tilt were calculated for each patient. Additional measurements such as L4, L5, and S2 incidence, tilt, and slope were collected. A new radiographic parameter defined as the L4-Sciatic notch angle was measured. Regression analysis was performed on each value to determine its relationship with S1 based incidence, tilt, and slope. Mean values for L5 incidence, L4 incidence, and L4 sciatic notch angle were 21.8° ± 8.9, 4.4° ± 8.1, and 44.4° ± 12, respectively. The linear regression analysis produced the following formulas which can be utilized to determine deformity correction goals when pelvic incidence can be calculated pre-operatively: L5i = .65*S1i-11.4, L4i = .44*S1i-18.6, and L4SNA = -.34*S1i + 66.5. In settings where pelvic incidence cannot be calculated, the following formulas can be utilized: L5i = .66*S2i-32.3 and L4SNA = -.02*S2i2 + 1.1*S2i + 63.5. P-values for all regression analyses were <.001. This study provides target radiographic alignment values that can be utilized for patients with either pre-operative altered S1 endplates or in cases with intraoperative alteration of S1 (sacral osteotomy).

PMCT-based sex determination using posterior segment of greater sciatic notch in North Indian population

BackgroundDigital tools, which offer superior accuracy compared to manual metrics, utilize radiological images for noninvasive data collection, providing a convenient means of obtaining skeletal data. The greater sciatic notch exhibits high sexual dimorphism and resistance to damage, and therefore serves as a viable tool for sex determination in poorly preserved skeletons, particularly in scenarios involving mass disasters, highly putrefied, and skeletonized cases. In addition to the width and depth of the greater sciatic notch, the length and angle of the posterior segment are highly specific parameters. This study aims to obtain accurate and standardized values for determining sex by measuring the posterior segment of the greater sciatic notch using postmortem computed tomography with a 16-slice multidetector row computed tomography scanner.ResultsThe study revealed that except for depth and the distance between the ischial spine and deepest point, all measured variables of the greater sciatic notch were greater for women than men on both sides. The length of the posterior segment and the posterior angle on both sides showed the highest positive correlation and provided highly significant differences between males and females. These findings not only reinforce the utility of the greater sciatic notch in sex determination but also highlight the potential for more accurate and noninvasive methods in forensic investigations.ConclusionsPostmortem computed tomography accurately determines sex by measuring the posterior sciatic notch segment, achieving a 90.9% accuracy rate. This study, the first of its kind in India, utilized postmortem computed tomography ruler measurements for sex determination, specifically evaluating the role of the posterior segment dimensions of the greater sciatic notch in the North Indian population.

Do Iliac Screws Placed Close to the Sciatic Notch Have Greater Pullout Strength?

Optimal iliac screw position in relation to the sciatic notch remains unknown. In 12 cadavers undergoing S2 alar-iliac (S2AI) screw placement, we tested the pullout strength of screws placed in proximity to the sciatic notch (≤5 mm) vs farther away from the sciatic notch (>5 mm). A biomechanical, cadaver-based study was performed on 12 cadavers undergoing bilateral S2AI screw insertion. The position of the S2AI screw regarding the sciatic notch was dichotomized as ≤5 mm from the sciatic notch on the right side and >5 mm on the left side, confirmed using c-arm fluoroscopy. The primary outcome was the pullout strength of the screw (N). Secondary outcomes were stiffness (N/mm), yield force (N), and work to failure (N mm). Ischial tuberosity was embedded into polymethyl methacrylate and secured to a custom 3-axis vise grip mounted to a 14.5-kN load cell. Pullout testing was performed at 5 mm/min. Force and displacement data were collected at 100 Hz and evaluated using MATLAB. The Mann-Whitney test was performed. Of 24 S2AI screws, 3 screws could not be tested because of cement-bone interface failure. A positive though nonsignificant trend of screw pullout strength was found for screws close to the notch compared with those farther from the notch (861.8 ± 340.7 vs 778.7 ± 350.8 N, P = .859). Similarly, screws close to the notch demonstrated a higher trend of stiffness (149.4 ± 145.4 vs 111.34 ± 128.2 N/mm, P = .320) and force to yield (806.9 ± 352.0 vs 618.6 ± 342.9 N, P = .455). Conversely, screws farther from the notch had a higher but similarly nonsignificant area under the force-displacement curve (10 867.0 ± 9565.0 vs 14 196.6 ± 9578.3 N mm, P = .455), which might be due to excess sheer/translation force that could not be reliably quantified. Although placing S2AI screws ≤5 mm of the sciatic notch provided stronger fixation in 3 of 4 biomechanical testing categories, these results were not statistically significant. Therefore, placing S2AI screws ≤5 mm of the sciatic notch did not provide stronger fixation.

Phantom limb pain, traumatic neuroma, or nerve sheath tumor? Illustrative case.

Phantom limb pain and traumatic neuromas are not commonly seen in neurosurgical practice. These conditions can present with similar symptoms; however, management of traumatic neuroma is often surgical, whereas phantom limb pain is treated with conservative measures. A 77-year-old female patient with a long-standing history of an above-the-knee amputation experienced severe pain in her right posterior buttocks area for several years' duration, attributed to phantom limb pain, which radiated down the stump of her leg and was treated with a variety of conservative measures. A recent exacerbation of her pain led to a prolonged hospitalization with magnetic resonance imaging of her leg stump, revealing a mass in the sciatic notch, at a relative distance from the stump. The anatomical location of the mass on the sciatic nerve in the notch led to a presumed radiological diagnosis of nerve sheath tumor, for which she underwent excision. At surgery, a neuroma of the proximal portion of the transected sciatic nerve that had retracted from the amputated stump to the notch was diagnosed. Traumatic neuromas of transected major nerves after limb amputation should be considered in the differential diagnosis of phantom limb pain.

The morphological variability of the piriformis muscle.

The aim of the study is to create several classifications of the piriformis muscle (PM): proximal and distal attachments, potential fusions, and the relationship with the sciatic nerve. It is the first comprehensive anatomical examination of this subject. One hundred and twenty-four lower limbs from 62 cadavers, fixed in 10% formalin, were examined. The piriformis muscle was present in 120 limbs (96.8% of cases). Four types of proximal attachment were described (I-IV). The most common type was Type I, in which the proximal attachment was at the anterior surface of the sacrum, between S2 and S4 (52 lower limbs; 43.3%). The rarest type was Type IV, in which the proximal attachment was at the gluteal surface of the ilium near the margin of the greater sciatic notch and from the gluteus medius (12 cases; 10%). Three types of distal attachment were distinguished. The most common was Type 1, a single tendon. This type comprised two subtypes: A and B (105 lower limbs; 87.5%). The other two types accounted for 12.5% of the total. Fusions were noted between the piriformis muscle and adjacent muscles in 31.7%. Four patterns were observed in which the sciatic nerve ran against the piriformis muscle. The most common variation in the relationship was the common fibular nerve exiting superior to the piriformis muscle and the tibial nerve passing inferior to it (10 cases; 8.3%). The piriformis muscle is highly morphologically variable in both its proximal and distal attachments and its relationship with the sciatic nerve. There are four types of proximal attachment and three types of distal attachment. The piriformis muscle shows numerous fusions with its adjacent muscles: gluteus medius or minimus or superior gemellus. A new (fourth) type of relationship was demonstrated between the piriformis muscle and sciatic nerve. The piriformis muscle was absent in four cases.

Anatomical study of the modified direct posterior gluteal splitting approach for acetabular fractures

BackgroundIn this study, we investigated the area that can be addressed with an approach in which the skin incision is made directly above the dorsal column with Thiel cadaveric specimens. MethodsSix Thiel cadaveric specimens were prepared. A skin incision was made directly above the dorsal column. The accessible proximal end from the proximal part of the greater sciatic notch to the gluteal ridge and the accessible distal end of the ischium were marked with a flat chisel. A molded 8-hole reconstruction plate was placed from the base of the ischium toward the gluteal ridge and fixed with 3 screws proximally and 2 screws distally. The length of the skin incision and the distance from each reference point on the bone to the reachable markings were assessed after the muscles were removed. ResultsMean skin incision length was 9.3 ± 0.7 (range, 8.0–10.0) cm. In 3 of 6 cases, proximal screws were inserted through different spaces between muscle fibers. In all cases, we were able to reach at least the greater sciatic notch, the gluteal ridge at the level of superior border of the acetabulum, and the base of the ischial tuberosity. In all cases, an 8-hole plate could be placed from the gluteal ridge to the base of the ischium. There were no superior gluteal artery or sciatic nerve injuries in any of the cases. ConclusionWe anatomically investigated the area that can be addressed with an approach in which the skin incision was made directly above the dorsal column. In all cases, we were able to access the areas needed to reduce the fracture and place the plates necessary to stabilize the fracture through a 9.3 ± 0.7 cm skin incision. This approach can be a useful minimally invasive posterior approach for acetabular fractures.

Differential Diagnosis of "Foot Drop": Implications for Peripheral Nerve Surgery.

At least 128,000 patients in the United States each year suffer from foot drop. This is a debilitating condition, marked by the inability to dorsiflex and/or evert the affected ankle. Such patients are rendered to a lifetime of relying on an ankle-foot orthosis (AFO) for walking and nighttime to prevent an equinovarus contracture. This narrative review explores the differential diagnosis of foot drop, with a particular focus on clinical presentation and recovery, whether spontaneously or through surgery. Contrary to popular belief, foot drop can be caused by more than just insult to the common peroneal nerve at the fibular head (fibular tunnel). It is a common endpoint for a diverse spectrum of nerve injuries, which may explain its relatively high prevalence. From proximal to distal, these conditions include lumbar spine nerve root damage, sciatic nerve palsy at the sciatic notch, and common peroneal nerve injury at the fibular head. Each nerve condition is marked by a unique clinical presentation, frequency, likelihood for spontaneous recovery, and cadre of peripheral nerve techniques. The ideal surgical technique for treating foot drop, other than neurolysis for compression, remains elusive as traditional peripheral nerve procedures have been marred by a wide spectrum of functional results. Based on a careful understanding of why past techniques have achieved limited success, we can formulate a working set of principles to help guide surgical innovation moving forward, such as fascicular nerve transfer.

Biomechanical characteristics of arteries during pelvic fracture reduction and dynamic simulation analysis

During robot-assisted reduction of pelvic fracture, blood vessels are susceptible to tensile and shear forces, making them prone to injury. Considering the impact of pelvic reduction on the risk of arterial injury, the biomechanical characteristics of arteries during the pelvic fracture reduction process are studied, and a refined coupled composite model of the damaged pelvic structure is established. Dynamic simulations of pelvic fracture reduction are conducted based on the planned reduction path. The simulation results show that during the reduction process, when the affected side is rotated, the stress and strain of the artery are maximum, particularly at the locations of the iliac common artery, internal iliac artery, and the superior gluteal artery arch endure significant stress and strain. After reduction, the maximum stress is observed in the right superior gluteal artery, and the maximum strain occurs at the intersection of the right iliac common artery. The stretch ratio of both the left and right iliac common arteries is considerable. Therefore, it can be concluded that the superior gluteal artery and the internal iliac artery are prone to injury, particularly the segment from the origin of the superior gluteal artery to its passage around the greater sciatic notch. After reduction, substantial traction on the iliac common artery, which makes it more susceptible to deformation, carries a risk of arterial rupture and aneurysm formation. This study provides a reference for planning the safe reduction path of pelvic fracture surgery and improving safety.

Medial surface plating of posterior column through the anterior intrapelvic approach in acetabulum fractures with involvement of both columns.

Posterior column plating through the single anterior approach reduces the morbidity in acetabular fractures that require stabilization of both the columns. The aim of this study is to assess the effectiveness of posterior column plating through the anterior intrapelvic approach (AIP) in the management of acetabular fractures. We retrospectively reviewed the data from R G Kar Medical College, Kolkata, India, from June 2018 to April 2023. Overall, there were 34 acetabulum fractures involving both columns managed by medial buttress plating of posterior column. The posterior column of the acetabular fracture was fixed through the AIP approach with buttress plate on medial surface of posterior column. Mean follow-up was 25 months (13 to 58). Accuracy of reduction and effectiveness of this technique were measured by assessing the Merle d'Aubigné score and Matta's radiological grading at one year and at latest follow-up. Immediate postoperative radiological Matta's reduction accuracy showed anatomical reduction (0 to 1 mm) in 23 cases (67.6%), satisfactory (2 to 3 mm) in nine (26.4%), and unsatisfactory (> 3 mm) in two (6%). Merle d'Aubigné score at the end of one year was calculated to be excellent in 18 cases (52.9%), good in 11 (32.3%), fair in three (8.8%), and poor in two (5.9%). Matta's radiological grading at the end of one year was calculated to be excellent in 16 cases (47%), good in nine (26.4%), six in fair (17.6%), and three in poor (8.8%). Merle d'Aubigné score at latest follow-up deteriorated by one point in some cases, but the grading remained the same; Matta's radiological grading at latest follow-up also remained unchanged. Stabilization of posterior column through AIP by medial surface plate along the sciatic notch gives good stability to posterior column, and at the same time can avoid morbidity of the additional lateral window.

Unrecognized sciatic lipomatosis of the nerve diagnosed by telehealth: illustrative case.

Lipomatosis of the nerve (LN) is a rare congenital hamartoma in which abundant fibroadipose tissue is found within the epineurium of peripheral nerves. It is frequently associated with nerve territory overgrowth affecting bones or soft tissues. The clinicoradiological features are well known and pathognomonic. A 38-year-old female was evaluated via telehealth for worsened sciatica after the resection of a sciatic notch lipoma, after having been evaluated over a decade for symptoms. Virtual physical examination revealed previously unrecognized subtle limb discrepancy (i.e., overgrowth). Although preoperative radiographs were unavailable during the initial evaluation, postoperative magnetic resonance imaging studies showed evidence of sciatic nerve LN. A diagnosis of LN and nerve territory overgrowth was established. Despite its limitations, telehealth can be an effective alternative or adjunct to in-person evaluations in making complex diagnoses. Dedicated examination without clinical suspicion can miss subtle findings. An iterative process prompted by a focused history, knowledge of clinical associations, and pattern recognition can facilitate an accurate diagnosis without obvious face-to-face visual clues. In patients with rare disorders, asynchronous evaluation allows in-person visits to be supplemented by subsequent telehealth virtual physical exam findings. This case illustrates how examination via telehealth can be used to effectively diagnose a rare syndrome.

Assessing the utility of 3D modeling with photogrammetry in assigned sex estimation from the greater sciatic notch

Assigned sex estimation via the greater sciatic notch (GSN) is traditionally performed via physical/visual examination and ordinal scoring; however, this relies on the subjective assessment of morphology for typological classification which may not be reflective of human variation. Three-dimensional (3D) photogrammetry may offer a technologically advanced, low cost, and more objective alternative to assess the complex curvature of anatomical landmarks. This research explores the accuracy of photogrammetry derived 3D models by comparing digital measurements to those obtained from the skeletal elements and to streamline the application of curvature analysis for the estimation of assigned sex from the GSN. This study utilizes the left and right os coxae from 15 skeletal individuals (5 females, 10 males) from the Boston University Chobanian & Avedisian School of Medicine. A Fujifilm X-Pro2 and Fujifilm 35 mm prime lens captured 123 images per element, which were processed in Meshroom by AliceVision® to create a 3D textured mesh. The mesh was exported into Blender for cleanup, scaling, measurement, and curvature analysis. The measurements were between 96.54 % and 99.94 % consistent across methods and observations. The consistency between digital metric observations increased by an average of 0.07 % when compared to the consistency of the dry bone measurements. Additionally, curvature analysis of the GSN correctly estimated the assigned sex of all os coxae in the sample. This study demonstrates that photogrammetry is an accurate and reliable method for the digitization of remains that enables analytical techniques to better capture skeletal variation compared to traditional methods.

Chapter 13 - Piriformis syndrome

Piriformis syndrome is a condition that is proposed to result from compression of the sciatic nerve, either in whole or in part, in the deep gluteal space by the piriformis muscle. The prevalence of piriformis syndrome depends upon the diagnostic criteria being used and the population studied but is estimated by some to be 5%-6% in all cases of low back, buttock, and leg pain and up to 17% of patients with chronic low back pain. While the sciatic nerve may pierce the piriformis muscle in about 16% of healthy individuals, this frequency is no different in those with the syndrome; thus, the relationship to this anatomic finding is unclear. The most common symptoms are buttock pain, external tenderness over the greater sciatic notch, and aggravation of the pain through sitting. Many clinical signs are reported for piriformis syndrome, but the sensitivity and specificity are unclear, in part because of the lack of a uniformly accepted case definition. In the majority of cases in the literature, it appears that the diagnosis is more ascribed to a myofascial condition rather than a focal neuropathy. Electrodiagnostic studies can be useful to exclude other causes of symptoms, but there is no well-accepted test to confirm the presence of piriformis syndrome. Ultrasound imaging may show thickening of the piriformis muscle, but further research is required to confirm that this is correlated with the clinical diagnosis. Magnetic resonance imaging and neurography may hold promise in the future, but there are not yet sufficient data to support adopting these methods as a standard diagnostic tool. The initial treatment of piriformis syndrome is typically conservative management with the general rehabilitation principles similar to other soft tissue musculoskeletal conditions. Local anesthetic, botulinum toxin, and/or corticosteroid injections have been reported by some to be beneficial for diagnostic or treatment purposes. Surgical interventions have also been used with variable success.

Superior gluteal artery injury in pelvic ring injury and acetabular fracture: Single center observational study

BackgroundIntrapelvic hemorrhage following pelvic fractures, including pelvic ring and acetabular fractures, originates from the venous system and the fracture. Arterial injury often causes significant bleeding and hemodynamic instability. The superior gluteal artery (SGA) is a frequently injured artery in patients with pelvic fractures. This study investigated the incidence and pattern of SGA injuries associated with pelvic fractures. MethodsWe retrospectively reviewed the medical records of patients with pelvic fractures who visited our institution between January 2016 and April 2022. Patients who underwent angiography for suspected arterial injury and SGA embolization were identified. Furthermore, the demographics and patterns of pelvic fractures were evaluated. ResultsIn total, 2042 patients with pelvic fractures visited our trauma emergency department and 498 patients (24.4%) underwent embolization for arterial injuries. Of these, 30 patients (1.5% of the total and 6.0% of the patients who underwent procedures) received embolization therapy of the main trunk of the SGA. The mean age of patients was 51.2 (23–85 years), and the injury mechanisms were all high-energy injuries. There were 19 pelvic ring injuries, eight acetabular fractures, and three combined injuries. Acetabular fractures involved mostly both columns. The three combined injuries were lateral compression involving both columns, vertical shear involving both columns, and lateral compression with T-type fractures. Twelve (40.0%) occurred through the sciatic notch of different patterns. ConclusionsSGA injury occurred in 1.5% of all pelvic fractures and was identified in 6% of patients receiving embolization. SGA injury occurs through various injury mechanisms and fracture patterns, even in the absence of a fracture in the sciatic notch. However, no conclusions could be drawn in this study on the association between SGA injuries, injury mechanisms, and fracture patterns. Since the prediction of SGA injury by fracture pattern is limited, angiography should be performed regardless of fracture pattern when an injury is suspected.