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Sachdeva, Kanika, Rajan Kumar Singla, Gurdeep Kalsey, and Preetika Sharma. "Sex Differences in Morphometry of North Indian Acetabula—Forensic and Orthopedic Consideration." National Journal of Clinical Anatomy 08, no. 04 (October 2019): 153–59. http://dx.doi.org/10.1055/s-0039-3400840.
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Abstract Background Acetabulum is a cup-shaped cavity of the hipbone. It constitutes the acetabular part of the hip joint. Its shape and position related to the head of the femur are crucial for the biomechanics of this joint. The knowledge of various acetabular dimensions is essential to diagnose various diseases of hip joint, to monitor patient recovery, to determine stability of the hip joint, to assess acetabular dysplasia, and also to create patient-specific acetabular implants in case of hip arthroplasty. Various parameters of acetabulum differ with respect to age, sex, race, and region. Thus, a region-specific knowledge of the acetabular dimensions will be helpful for surgical reconstruction and sex determination. Materials and Methods The current study was conducted on 100 adult os coxae (male:female = 80:20, right:left = 50:50). The various acetabular dimensions measured were (1) breadth of acetabulum, (2) vertical diameter of acetabulum, (3) maximum depth of acetabulum, (4) linear length of acetabular notch, (5) length of acetabular rim, and (6) total length of acetabular rim with notch. The values were statistically evaluated to find out the sex and side-related differences. Results All the parameters measured were larger in male bones as compared with female bones. Nevertheless, the difference in values was significant only for breadth of acetabulum, vertical diameter of acetabulum, length of acetabular rim, and total length of acetabular rim with notch. Also, the values were more on left side although results were insignificant. Conclusions The results of the present study will provide reference acetabular values for North India region.
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Portinaro, N. M. A., D. Murray, and M. K. D. Benson. "Acetabular Notch." Journal of Pediatric Orthopaedics B 6, no. 1 (January 1997): 48–51. http://dx.doi.org/10.1097/01202412-199701000-00010.
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Pullanna, Bollavaram, Gautham Kamble, and Jayalakshmi P. V. "Study of Morphometric Analysis of Acetabulum and Its Clinical Correlation in South Indian Population." International Journal of Anatomy and Research 10, no. 2 (June 5, 2022): 8352–58. http://dx.doi.org/10.16965/ijar.2022.125.
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Introduction: Acetabulum is a cup shaped cavity on the outer surface of the constricted central part of the hip bone, where three components meet and subsequently fuse. In modern world, orthopaedic surgeons and biomedical engineers are trying to make the best possible prosthesis for planning the total hip replacement. Body proportion and absolute dimension vary widely in respect to age, sex and racial groups. While partially due to variability in muscularity and adiposity, such variations are chiefly in skeletal system. Purpose of study: The main intention of this study was to obtain the morphometric data of acetabulum. This data suffices the mechanics of the hip joint so as to plan for suitable prosthesis and various surgical approaches. Material and method: The study was conducted in the department of Anatomy. Hundred hip bones of both sexes were used. In this study we included only healthy adult bones, deformed and eroded bones were excluded from the study. The osteometric parameters such as diameter, depth and capacity of acetabulum, notch width and shape of the anterior acetabular ridge were measured using digital Vernier calipers and measuring jar. The data was analysed statistically using SPSS software. Results: The mean diameter of acetabulum in males was found to be 5.03 cm and in females it was 4.44 cm, whereas on right side it was 4.70 cm and on left side it was 4.77 cm. The mean depth of acetabulum in males was 2.85 cm and in females it was 2.49 cm, whereas on the right side was 2.71 cm and 2.63 cm on the left. The mean notch width of the acetabulum in males was 2.07 cm and in females it was 1.71 cm, whereas on the right side it was 1.92 cm, and 1.85 cm on the left. Total range for the acetabular capacity was 22-30.68 ml. The curved shape anterior acetabular ridge was the most predominant type (39%) and the least type was irregular shaped (15%). Conclusion: The acetabular parameters such as acetabular diameter, depth, capacity and notch width of the acetabulum was greater in males compared to the females. Statistically the comparison was highly significant. Most common anterior acetabular ridge shape is curved type (39%), least was Irregular type (15%). Morphometric data of acetabulum is essential for clinical correlation and it also helps in the detection of disputed sex by Forensic experts. It also helps the orthopaedic surgeons for planning the total hip replacement KEY WORDS: Hip bone, Acetabular Diameter, Acetabular Depth, anterior ridge, Notch.
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Kabir, C., N. Sandiford, S. K. Muirhead-Allwood, and T. Nuthall. "A Displaced Acetabular Component Causing Femoral Neck Notching following Hip Resurfacing." HIP International 18, no. 4 (October 2008): 321–23. http://dx.doi.org/10.1177/112070000801800409.
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We describe the case of a patient who developed a notch on the femoral neck following a hip resurfacing operation as a result of a displaced acetabular component. The acetabular cup displaced in the coronal plane and impinged on the femoral neck leading to a large notch in the inferior femoral neck.
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Portinaro, NM, SJ Matthews, and MK Benson. "The acetabular notch in hip dysplasia." Journal of Bone and Joint Surgery. British volume 76-B, no. 2 (March 1994): 271–73. http://dx.doi.org/10.1302/0301-620x.76b2.8113290.
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Kalairajah, Yega, Jim M. Gray, Thomas O. Boerger, Lionel G. Ripley, and David M. Ricketts. "Sealing the Acetabular Notch: Does It Improve Cement Penetration in the Acetabulum?" Orthopedics 31, no. 5 (May 1, 2008): 463–66. http://dx.doi.org/10.3928/01477447-20110414-06.
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Yoo, Jeong Joon, Hee Joong Kim, Young Min Kim, Kang Sup Yoon, Kyung Hoi Koo, Kwang Woo Nam, and Yong Lae Kim. "Medial Placement of a Cementless Acetabular Component in a Modern Alumina-on-Alumina THA." Key Engineering Materials 330-332 (February 2007): 1243–46. http://dx.doi.org/10.4028/www.scientific.net/kem.330-332.1243.
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Medial placement of a cementless acetabular component into or beyond the medial wall of a shallow, dysplastic acetabulum is a technique to enhance its coverage during difficult total hip arthroplasty (THA). Dysplastic hips almost always need small size of acetabular component, so an accelerated polyethylene wear can occur when a conventional bearing surface is used. Modern alumina-on-alumina couplings can be an alternative for these patients. We evaluated the clinical results of 43 medially placed cementless acetabular components (PLASMACUP®SC) incorporating a modern alumina bearing surface (BIOLOX® forte). Acetabular components were inserted medially beyond the ilioischial line and, therefore, beyond the level of the cortical bone of the cotyloid notch, and followed up for more than 5 years (range, 60 – 93 months). In 14 hips, the medial acetabular wall was perforated purposefully and the medial aspect of the cup was placed beyond both the ilioischial and the iliopubic line on radiographs. The mean Harris hip score improved from 55.3 points preoperatively to 94.5 points postoperatively. Postoperatively, the hip center migrated 12.1 mm medially and 1.5 mm inferiorly. The average amount of cup protrusion beyond the ilioischial and the iliopubic line was 3.1 mm and 1.9 mm, respectively. The average superolateral coverage of the cup was 98.5 percent. During follow-up, no osteolysis or loosening of acetabular components was observed and no revision was required. Medial placement of a cementless acetabular component into or beyond the medial acetabular wall offers predictable clinical results and durable fixation in modern alumina-on-alumina THA.
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Meng, Huai, Zixue Guo, Lili Hou, Qin Liu, Chanyue Wang, and Ximing Zhou. "USING ACETABULAR NOTCH FOR ACETABULAR COMPONENT PLACEMENT INTRAOPERATIVELY IN TOTAL HIP ARTHOPLASTY." Journal of Biomechanics 40 (January 2007): S571. http://dx.doi.org/10.1016/s0021-9290(07)70561-4.
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DeFroda, Steven F., Thomas D. Alter, Floor Lambers, Philip Malloy, Ian M. Clapp, Jorge Chahla, and Shane J. Nho. "Quantification of Acetabular Coverage on 3-Dimensional Reconstructed Computed Tomography Scan Bone Models in Patients With Femoroacetabular Impingement Syndrome: A Descriptive Study." Orthopaedic Journal of Sports Medicine 9, no. 11 (November 1, 2021): 232596712110494. http://dx.doi.org/10.1177/23259671211049457.
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Background: Accurate assessment of osseous morphology is imperative in the evaluation of patients with femoroacetabular impingement syndrome (FAIS) and hip dysplasia. Through use of computed tomography (CT), 3-dimensional (3D) reconstructed hip models may provide a more precise measurement for overcoverage and undercoverage and aid in the interpretation of 2-dimensional radiographs obtained in the clinical setting. Purpose: To describe new measures of acetabular coverage based on 3D-reconstructed CT scan bone models. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Preoperative CT scans were acquired on the bilateral hips and pelvises of 30 patients before arthroscopic surgical intervention for FAIS. Custom software was used for semiautomated segmentation to generate 3D osseous models of the femur and acetabulum that were aligned to a standard coordinate system. This software calculated percentage of total acetabular coverage, which was defined as the surface area projected onto the superior aspect of the femoral head. The percentage of coverage was also quantified regionally in the anteromedial, anterolateral, posteromedial, and posterolateral quadrants of the femoral head. The acetabular clockface was established by defining 6 o’clock as the inferior aspect of the acetabular notch. Radial coverage was then calculated along the clockface from the 9-o’clock to 5-o’clock positions. Results: The study included 20 female and 10 male patients with a mean age of 33.6 ± 11.7 years and mean body mass index of 27.8 ± 6.3. The average percentage of total acetabular coverage for the sample was 57% ± 6%. Acetabular coverages by region were as follows: anteromedial, 78% ± 7%; anterolateral, 18% ± 7%, posterolateral, 33% ± 13%, and posteromedial, 99% ± 1%. The acetabular coverage ranged from 23% to 69% along the radial clockface from 9 to 5 o’clock. Conclusion: This study demonstrated new 3D measurements to characterize acetabular coverage in patients with FAIS and elucidated the distribution of acetabular coverage according to these measurements.
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Mikula, Jacob D., Erik L. Slette, Jorge Chahla, Alex W. Brady, Renato Locks, Christiano A. C. Trindade, Matthew T. Rasmussen, Robert F. LaPrade, and Marc J. Philippon. "Quantitative Anatomic Analysis of the Native Ligamentum Teres." Orthopaedic Journal of Sports Medicine 5, no. 2 (February 1, 2017): 232596711769148. http://dx.doi.org/10.1177/2325967117691480.
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Background: While recent studies have addressed the biomechanical function of the ligamentum teres and provided descriptions of ligamentum teres reconstruction techniques, its detailed quantitative anatomy remains relatively undocumented. Moreover, there is a lack of consensus in the literature regarding the number and morphology of the acetabular attachments of the ligamentum teres. Purpose: To provide a clinically relevant quantitative anatomic description of the native human ligamentum teres. Study Design: Descriptive laboratory study. Methods: Ten human cadaveric hemipelvises, complete with femurs (mean age, 59.6 years; range, 47-65 years), were dissected free of all extra-articular soft tissues to isolate the ligamentum teres and its attachments. A coordinate measuring device was used to quantify the attachment areas and their relationships to pertinent open and arthroscopic landmarks on both the acetabulum and the femur. The clock face reference system was utilized to describe acetabular anatomy, and all anatomic relationships were described using the mean and 95% confidence intervals. Results: There were 6 distinct attachments to the acetabulum and 1 to the femur. The areas of the acetabular and femoral attachment footprints of the ligamentum teres were 434 mm2 (95% CI, 320-549 mm2) and 84 mm2 (95% CI, 65-104 mm2), respectively. The 6 acetabular clock face locations were as follows: anterior attachment, 4:53 o’clock (95% CI, 4:45-5:02); posterior attachment, 6:33 o’clock (95% CI, 6:23-6:43); ischial attachment, 8:07 o’clock (95% CI, 7:47-8:26); iliac attachment, 1:49 o’clock (95% CI, 1:04-2:34); and a smaller pubic attachment that was located at 3:50 o’clock (95% CI, 3:41-4:00). The ischial attachment possessed the largest cross-sectional attachment area (127.3 mm2; 95% CI, 103.0-151.7 mm2) of all the acetabular attachments of the ligamentum teres. Conclusion: The most important finding of this study was that the human ligamentum teres had 6 distinct points of attachment on the acetabulum (transverse, anterior, and posterior margins of the acetabular notch and cotyloid fossa attachments: ilium, ischium, and pubis) and 1 on the femur. On the acetabulum, the anterior attachment was substantially larger than the posterior attachment and was located at a mean clock face position of 4:53 o’clock. Clinical Relevance: These quantitative descriptions of the ligamentum teres can be used by clinicians to arthroscopically identify the attachments of the ligamentum teres, guiding arthroscopic surgical interventions designed to address ligamentum teres pathology.
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van der Merwe, Johan Francois, Lourens Jacobus Erasmus, Werner van der Merwe, and Johan Arthur Ellis. "Obtaining optimum screw placement for revision acetabular prostheses using the sciatic notch as reference." Translational Research in Anatomy 24 (September 2021): 100133. http://dx.doi.org/10.1016/j.tria.2021.100133.
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MacLaughlin, Susan M., and Margaret F. Bruce. "The Sciatic Notch/Acetabular Index as a Discriminator of Sex in European Skeletal Remains." Journal of Forensic Sciences 31, no. 4 (October 1, 1986): 11916J. http://dx.doi.org/10.1520/jfs11916j.
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Bebej, Ryan M., Iyad S. Zalmout, Ahmed A. Abed El-Aziz, Mohammed Sameh M. Antar, and Philip D. Gingerich. "First remingtonocetid archaeocete (Mammalia, Cetacea) from the middle Eocene of Egypt with implications for biogeography and locomotion in early cetacean evolution." Journal of Paleontology 89, no. 5 (September 2015): 882–93. http://dx.doi.org/10.1017/jpa.2015.57.
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AbstractRemingtonocetidae are Eocene archaeocetes that represent a unique experiment in cetacean evolution. They possess long narrow skulls, long necks, fused sacra, and robust hind limbs. Previously described remingtonocetids are known from middle Eocene Lutetian strata in Pakistan and India. Here we describe a new remingtonocetid, Rayanistes afer, n. gen. n. sp., recovered from a middle to late Lutetian interval of the Midawara Formation in Egypt. The holotype preserves a sacrum with four vertebral centra; several lumbar and caudal vertebrae; an innominate with a complete ilium, ischium, and acetabulum; and a nearly complete femur. The ilium and ischium of Rayanistes are bladelike, rising sharply from the body of the innominate anterior and posterior to the acetabulum, and the acetabular notch is narrow. These features are diagnostic of Remingtonocetidae, but their development also shows that Rayanistes had a specialized mode of locomotion. The expanded ischium is larger than that of any other archaeocete, supporting musculature for powerful retraction of the hind limbs during swimming. Posteriorly angled neural spines on lumbar vertebrae and other features indicate increased passive flexibility of the lumbus. Rayanistes probably used its enhanced lumbar flexibility to increase the length of the power stroke during pelvic paddling. Recovery of a remingtonocetid in Egypt broadens the distribution of Remingtonocetidae and shows that protocetids were not the only semiaquatic archaeocetes capable of dispersal across the southern Tethys Sea.
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Feng, Xiaoreng, Huijie Fan, Frankie Leung, and Bin Chen. "How to obtain and identify the acetabular anterior column axial view projection in patients?" Journal of Orthopaedic Surgery 25, no. 1 (January 1, 2017): 230949901668501. http://dx.doi.org/10.1177/2309499016685012.
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Purpose: This study aims at sharing our experience as how to obtain and identify axial view image of the acetabular anterior column in patients. Methods: Pelvic computed tomography data of six normal adults were used to reconstruct three-dimensional (3D) models. The transparency of each 3D model was downgraded at the view perpendicular to the cross section of the anterior column axis to simulate the anterior column axial view image. Fluoroscopy was performed in all patients to obtain the anterior column axial view image in the operating room. Each fluoroscopic image was compared with the corresponding simulation image to analyze potential anatomic landmarks that were helpful to identify the translucent area (projection of the screw path) in the patients. Results and Conclusions: To obtain ideal anterior column axial fluoroscopic image, the patient should be positioned supine with the leg of “abnormal side” straight and contralateral side flexion, abduction, and external rotation; the C-arm machine should be placed at the caudal end of the operation table with the C-arm fluoroscopic intensifier first positioned at the pelvic lateral view and then tilted approximately 30° toward the “abnormal side” and rotated approximately 45° toward the caudal end of the operation table. To identify the translucent area on the anterior column axial view fluoroscopic image obtained from the patient, the greater sciatic notch, the true pelvis edge, and the acetabulum should be identified first and the translucent area is located in the area surrounded by these three anatomic landmarks.
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Naal, Florian-Dominique. "Von der Fehlform zur Coxarthrose – Beispiel Hüftimpingement." Praxis 109, no. 6 (April 2020): 459–64. http://dx.doi.org/10.1024/1661-8157/a003432.
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Zusammenfassung. Das femoroacetabuläre Impingement (FAI) beschreibt einen deformitätsbedingten, pathomechanischen Konflikt zwischen Femurkopf-Hals-Übergang und Acetabulum, der bei Bewegung auftritt und zu Schäden im Hüftgelenk führen kann. Mittlerweile ist nachgewiesen, dass insbesondere das Cam-FAI mit der Entstehung einer Coxarthrose korreliert. Für das Pincer-FAI, bei dem primär das Labrum und erst sekundär der acetabuläre Gelenkknorpel geschädigt werden, ist dieser Zusammenhang noch nicht eindeutig belegt. Hüftgelenke mit einer klaren Deformität und einer beginnenden Gelenkschädigung sollten operativ behandelt werden, wobei in 80–90 % der Fälle ein arthroskopisches Vorgehen möglich ist. Ein FAI-Patient ist zum Zeitpunkt einer Operation durchschnittlich 30 Jahre alt. Bei korrekter Indikationsstellung und sorgfältig durchgeführtem Eingriff lässt sich in über 80 % der Fälle ein gutes kurz- bis mittelfristiges Ergebnis erreichen.
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Nagla, Ashok, Abhay Manchanda, Anand Gupta, Vinay Tantuway, Viral Patel, and Noor Arshad. "Study to evaluate the outcomes of surgical stabilization of distal 1/3rd fracture shaft femur with retrograde nailing." International Journal of Research in Orthopaedics 3, no. 1 (December 29, 2016): 96. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20164784.
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<p class="abstract"><strong>Background:</strong> Distal femur is a complex fractures and most of times a personalized approach is needed for these fractures. Over a period of time variety of approaches and implants have been used for these fractures. The use of retrograde femur nail for fixing femur fracture, using entry from inter-condylar notch of femur, is a known method of treatment, but most surgeons are apprehensive of making an entry from the knee joint because of possible complications like knee pain, arthro-fibrosis, infections etc .The aim of this study was to investigate its effectiveness in fixation of distal 1/3<sup>rd </sup>fracture of femur with special emphasis on the outcome and inherent surgical challenges<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> A prospective study of 40 patients with fracture femur diaphysial distal one third were treated by retrograde nailing, from July 2010 to January 2016, after obtaining required approval from the Institutional ethical & research committee. All the patients were followed till fracture union and evaluated on the basis of demography, duration of healing, complications and surgical challenges.<strong></strong></p><p class="abstract"><strong>Results:</strong> We observed that mean age of patients was 35.8 years (18 years to 62 years) where 87.5% were male and 12.5% were female. Average duration of healing was 17.75 weeks (ranging from 10 weeks to 36 weeks) with 100% healing achieved. Mean knee range of motion was 124.5 degree (70 to 140 degree), rate of knee pain 10% (4/40), re-operation rate 5% (2/40), infection rate 2.5% (1/40), and fat embolism 2.5% (1/40)<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Retrograde femoral nailing is a reliable alternative to antegrade nailing or plate fixation for diaphyseal fracture distal one third femur, and may be in some situations even advantageous when antegrade nail entry is challenging like ipsilateral hip fractures, previous implant in hip & proximal femur, ipsilateral pelvi-acetabular injury, bilateral femoral shaft fracture, floating Knee injuries, poly-trauma and obese patients<span lang="EN-IN">.</span></p>
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Okay, Erhan, Feyza Ozkan, Zilan Karadag, Emre Koraman, Tarik Sari, Burak Ozturan, Maria Spinelli, and Korhan Ozkan. "The clinical outcomes after surgical treatment of mass lesions causing sciatica - a single-center retrospective study." Srpski arhiv za celokupno lekarstvo, no. 00 (2021): 68. http://dx.doi.org/10.2298/sarh210113068o.
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Introduction/Objective Sciatica is a disabling pathology with variable etiologies. The most common pathologies arise from discogenic or non-discogenic causes. Mass lesions are a rare cause of extraspinal sciatica, which have been commonly overlooked, leading to unnecessary spinal surgeries, delay in diagnosis or inadequate treatment. There is no standard surgical approach and functional outcomes after surgical treatment of these lesions are not well-known. The aim of this study is to evaluate clinical outcomes after surgical treatment of mass lesions causing sciatica in different locations. Methods Data were obtained by a retrospective review from 2015-2020. The mean duration of symptoms at the time of surgery was 10.3 months (3-48 months). The mean age of patients at the time of surgery was 43.8 years (14-73 years). The mean follow-up was 19.5 months (4-50 months). In total, 14 cases had an extrapelvic localization distal to sciatic notch. The other three cases had lesions in the intrapelvic area, including left sciatic notch (1), right acetabulum (1), sacroiliac and lumbosacral region (1). None of the patients had palpable masses. Transgluteal, infragluteal, lateral, and posteromedial approach were used depending on location and size of the lesion. Results At the final follow-up, all patients recovered pain relief. The median musculoskeletal tumor society score was 90% (70-100). There was no recurrence at the latest follow-up. Conclusion Our study demonstrated that early detection by neurological examination and radiological work-up can avoid unnecessary surgeries, enable early surgical treatment of tumoral mass with satisfactory clinical outcomes. The surgical approach should be individualized according to location and size of the lesion.
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Andresen, Julian Ramin, Anna Schrum, Ruth Thiemann, Sebastian Radmer, and Reimer Andresen. "Osteopoikilie – ein posttraumatischer Zufallsbefund mit Literaturübersicht." Osteologie 29, no. 01 (February 2020): 39–44. http://dx.doi.org/10.1055/a-1023-5032.
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Zusammenfassung Einleitung Bei der Osteopoikilie handelt es sich um eine seltene, meist erbliche Knochenstrukturstörung mit überwiegend gelenknahen Spongiosaverdichtungen. Fallbeschreibung und Ergebnisse Bei einem 50-jährigen Mann, der sich bei einem Leitersturz eine Claviculafraktur zuzog, fanden sich in der konventionellen a. p. - Schulteraufnahme multiple, weitgehend scharf begrenzte, rundlich-ovaläre Sklerosierungen in den gelenknahen Skelettanteilen von Skapula und Humerus. In einer zusätzlich erstellten Beckenübersichtsaufnahme sah man unzählige scharf begrenzte, rundliche bis strichförmige spongiöse Verdichtungen mit einer besonderen Häufung im Caput und Collum femoris, dem Acetabulum sowie den gelenknahen Anteilen der Sakroiliakalgelenke beidseits, wobei ein symmetrischer Befall imponierte. Die einzelnen Sklerosierungsherde wiesen eine Größe von 2–10 mm auf und ordneten sich insbesondere im Caput und Collum femoris entlang der Trajektoren in der Spongiosa an. Im Ganzkörper-CT fanden sich typische Herdbefunde im gesamten Skelettbereich. In der Becken-MRT fanden sich korrespondierende Herde ohne perifokale Ödemzonen. Eine 3-Phasenskelettszintigraphie zeigte keine Aktivitätsanreicherungen. Aus der Familienanamnese wurde bekannt, dass seine Schwester ähnliche Veränderungen aufwies. Der Patient und die Schwester waren hinsichtlich der spongiösen Verdichtungen vollkommen beschwerdefrei. In der Familie fand sich anamnestisch kein Anhalt für ein Tumorgeschehen oder für Hautveränderungen. Die Laborwerte waren unauffällig. Im Verlauf kam es zu einer zeitgerechten Ausheilung der Claviculafraktur. Diskussion Bei der Osteopoikilie zeigen sich meist zufällig detektierte, multiple clusterartige, rundliche bis ovaläre, epi- und metaphysäre Skleroseherde im spongiösen Knochen, welche sich vermehrt entlang den Trajektoren des Knochens anordnen. Die Größe der einzelnen Herde liegt in der Regel bei 1–2 mm, in seltenen Fällen können sie bis 25 mm erreichen. Es findet sich ein überwiegend symmetrischer Befall, am häufigsten in den Finger-, Handwurzel-, Oberarm-, Fußwurzel-, Oberschenkel- und Beckenknochen, wobei das Achsenskelett und der Schädel seltener betroffen sind, was sich jedoch bei unserem Patienten fand. Ein sporadisches Auftreten erscheint möglich, eine familiäre Häufung mit einem autosomal-dominanten Erbgang wie bei unserem Patienten überwiegt wahrscheinlich. Es wird eine Prävalenz von 1:50.000 vermutet, wobei das männliche Geschlecht etwas häufiger betroffen zu sein scheint. Differentialdiagnostisch lässt sich die Osteopoikilie mittels radiologischer Bildgebung meist von der Osteopathia striata und Melorheostose diskriminieren. Vom Erscheinungsbild werden für die Osteopoikilie eine lentikuläre, eine striäre und eine Mischform unterschieden, wobei bei unserem Patienten mindestens im Becken eine Mischform vorliegen dürfte. Bei größeren Osteopoikilieherden wäre differenzialdiagnostisch noch an osteoplastische Metastasen zu denken, hier ist die Skelettszintigrafie sehr hilfreich, da osteopoikilotische Herde, wie bei unserem Patienten, typischerweise stumm sind. Wie in unserem Fall zeigen sich in der Regel unauffällige Laborwerte und kein negativer Effekt auf den Verlauf der Knochenheilung. Bei Festlegung der Diagnose Osteopoikilie sind weitere Untersuchungen nicht notwendig.
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Hapa, Onur, Onur Gürsan, Osman Nuri Eroğlu, Hakan Özgül, Efe Kemal Akdoğan, Vadym Zhamilov, Ali Balcı, and Hasan Havitçioğlu. "Bony landmarks, distances and their correlations to each other, which can be used during periacetabular osteotomy: a CT study performed on dysplastic hips." Journal of Hip Preservation Surgery, May 19, 2021. http://dx.doi.org/10.1093/jhps/hnab045.
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Abstract As a surgical technique for hip dysplasia, Bernese periacetabular osteotomy (PAO) still poses technical difficulties and unclear surgical steps like the depth of the first ‘ischial’ cut, the start of the iliac cut and the width of the retroacetabular cut to prevent either iatrogenic joint entrance or posterior column fracture. Twenty-seven dysplastic hips (CE < 25°) were randomly matched with nondysplastic hips (n: 27, CE > 25°). 3D CT sections of the hips were evaluated and the width of the ischium, the distance from the infra-acetabular groove to the ischial spine, from the anterior superior iliac spine (ASIS) to the joint or sciatic notch or the sciatic spine, from the most medial point at the acetabulum to the posterior column, ischial spine or sciatic notch were measured for each group and correlated. The distances (mm) from the infra-acetabular groove to the ischial spine (42 ± 4, 44 ± 4, P: 0.03), the anterior superior iliac spine to the joint (52 ± 6, 60 ± 3, P: 0.03), the most medial point at the acetabulum to the posterior column (34 ± 2, 36 ± 2, P: 0.005) were shorter in the dysplastic group. The distance from the ASIS to the sciatic notch was correlated with the distance from the infra-acetabular groove to the ischial spine, from the ASIS to the joint and the most medial point at the acetabulum to the posterior column. The distance from the ASIS to the sciatic notch can be used intraoperatively to guess the X-ray guided or blindly osteotomized stages to predict the width or depth of the osteotomy to prevent intraarticular extension or posterior column fracture.
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Zhang, Heng, Jiansheng Zhou, Jianzhong Guan, Hai Ding, Zhiyan Wang, and Qirong Dong. "How to restore rotation center in total hip arthroplasty for developmental dysplasia of the hip by recognizing the pathomorphology of acetabulum and Harris fossa?" Journal of Orthopaedic Surgery and Research 14, no. 1 (October 29, 2019). http://dx.doi.org/10.1186/s13018-019-1373-9.
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Abstract Purpose To restore rotation center exactly in total hip arthroplasty (THA) is technically challenging for patients with end-stage osteoarthritis due to developmental dysplasia of the hip (DDH). The technical difficulty is attributable to the complex acetabular changes. In this study, we investigated the pathomorphology of acetabulum and Harris fossa of Crowe types I to IV and discussed the method of restoring rotation center of the hip. Methods This study retrospectively reviewed 56 patients (59 hips) who underwent cementless THA due to end-stage osteoarthritis of DDH. The pathomorphology of acetabulum and Harris fossa was observed during operations. Using the preoperative and postoperative pelvic radiographs, the vertical and the horizontal distances of hip rotation center were measured in order to evaluate the effects of restoring rotation center of the hip. Results Adult DDH acetabulum could be classified into four basic pathological types which include the shallow cup shape, the dish shape, the shell shape, and the triangular shape. Adult DDH Harris fossa could be classified into four pathological types, including the crack shape, the closed shape, the triangle shape, and the shallow shape, in accordance with the osteophyte coverage. The vertical and horizontal distances of hip rotation center on the pelvic radiographs before and after operations were as follows: the preoperative vertical distance of hip rotation center was (39.96 ± 5.65) mm, and the postoperative one was (13.83 ± 2.66) mm; the preoperative horizontal distance of hip rotation center was (42.15 ± 6.42) mm, and the postoperative one was (28.12 ± 4.56) mm. Conclusions The acetabulum and Harris fossa can display different pathological types on account of different degrees of dislocation and osteophyte hyperplasia in the end-stage osteoarthritis of adult DDH. The hip rotation center can be accurately restored by locating the acetabular center with Harris fossa and acetabular notch as the marks.
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Yu, Kequan, Runtao Zhou, Shichang Gao, Anlin Liang, Mingming Yang, and Haitao Yang. "The placement of percutaneous retrograde acetabular posterior column screw based on imaging anatomical study of acetabular posterior column corridor." Journal of Orthopaedic Surgery and Research 17, no. 1 (November 16, 2022). http://dx.doi.org/10.1186/s13018-022-03347-3.
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Abstract Objective To explore the entry point, orientation, and fixation range of retrograde acetabular posterior column screw. Method The computed tomography data of 100 normal adult pelvises (50 males and 50 females, respectively) were collected and pelvis three-dimensional (3D) reconstruction was performed by using Mimics software and the 3D model was imported into Geomagic Studio software. The perspective of acetabular posterior column was carried out orienting from ischial tuberosity to iliac fossa in the Mimics software. Virtual screw was inserted perpendicular to the transverse section of acetabular posterior column corridor, and the maximum screw diameter, entry point, orientation, exit point were measured. The screw fixation range, the easy-to-penetrate sites, and intraoperative optimal fluoroscopic views were assessed. Results The acetabular posterior column corridor showed a triangular-prism shape. The virtual screw entry point was located at the midline between the medial and lateral edges of the ischial tuberosity. The distance between the entry point and the distal ischial tuberosity was around 13 mm. The distances between the exit point and the true pelvis rim, and ipsilateral anterior sacroiliac joint line were (19.33 ± 2.60) mm and (23.65 ± 2.42) mm in males, respectively. As for females, those two data were (17.63 ± 2.00) mm and (24.94 ± 2.39) mm, respectively. The maximum diameters of screws were (17.21 ± 1.41) mm in males and (15.54 ± 1.51) mm in females. The angle between the retrograde posterior column screw and the sagittal plane was lateral inclination (10.52 ± 3.04)° in males, and that was lateral inclination (7.72 ± 2.99)° in females. Correspondingly, the angle between the screw and the coronal plane was anterior inclination (15.00 ± 4.92)° in males, and that was anterior inclination (12.94 ± 4.72)° in females. Retrograde acetabular posterior column screw through ischial tuberosity can fix the acetabular posterior column fractures which were not 4 cm above the femoral head center. The easy-to-penetrate sites were located at the transition between the posterior acetabular wall and the ischium, the middle of the acetabulum, and 1 cm below the greater sciatic notch, respectively. The iliac oblique 10°, iliac oblique 60°, and obturator oblique 60° views were the intraoperative optimal fluoroscopic views to assess whether the screw was safely inserted. Conclusion Retrograde acetabular posterior column screw entry point is located at the midline between the medial and lateral edges of the ischial tuberosity, which is 1.3 cm far from the distal ischial tuberosity. The screw direction is about 10° lateral inclination and 15° anterior inclination, which can fix the acetabular posterior column fractures which were not 4 cm above the femoral head center.
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Dehn, George, N. Hammer, M. C. Wyatt, S. J. Soltani, and D. C. Kieser. "Relative position of the supra-acetabular bone to the crestal plane: a radiological analysis." Journal of the Royal Army Medical Corps, July 19, 2019, jramc—2019–001251. http://dx.doi.org/10.1136/jramc-2019-001251.
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IntroductionDisplaced unstable pelvic injuries are life threatening and require rapid reduction and stabilisation, typically achieved with an external fixator. Recently, the benefits of supra-acetabular pins have been proven; however, these are usually inserted under fluoroscopic guidance. In austere environments and in extremis, this facility is limited and fixation using anatomical landmarks is required. Thus, the aim of this study is to determine the relative position of the supra-acetabular bone to the crestal plane and examine its consistency in military-aged European personnel.MethodsA radiological review of 50 randomised pelvic CT scans in European patients aged 18–30 years from a Level 1 trauma centre was performed. The CT scans were analysed using 3D rendering software. The relative position of the supra-acetabular bone to the crestal plane was determined.ResultsThe supra-acetabular bone relative to the crestal plane was approximately 28° caudal and 24° medial to the crestal plane. The mean minimum distance from the pin’s entry point to the sciatic notch was approximately 73 mm. There were no differences noted between genders or hemipelvic side.ConclusionsThe supra-acetabular bone maintains a consistent relative position to the crestal plane. Thus, with the surgeon’s thumb on the anterior superior iliac spine (ASIS) and index finger on the iliac tubercle, defining the crestal plane, a supra-acetabular pin can be inserted into the anterior inferior iliac spine, which lies 3 cm inferior and 2 cm medial to the ASIS, and advanced along the supra-acetabular bone by angling the pin 30° caudal and 25° medial to the crestal plane.
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Yang, Fan, Hong-Jie Huang, Zi-Yi He, Yan Xu, Xin Zhang, and Jian-Quan Wang. "Central acetabular osteophytes (CAO) are more prevalent in the borderline developmental dysplastic hip (BDDH) patients: a propensity-score matched CT study." Journal of Orthopaedic Surgery and Research 17, no. 1 (March 12, 2022). http://dx.doi.org/10.1186/s13018-022-03056-x.
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Abstract Background The acetabular fossa often showing the first signs of degeneration, Central acetabular osteophytes (CAO) have been increasingly recognized during hip arthroscopy. The purpose of this study was to investigate the condition of CAO in BDDH hips and compare cotyloid fossa size between the BDDH and the non-BDDH hips on CT images. Methods We performed a retrospective analysis of prospectively collected data of hip CT images of FAI or labral injury patients. A 1:2 propensity-score matched observational study comparing the linear length of cotyloid fossa was analyzed. Cotyloid fossa width (CFW) and cotyloid notch width (CNW) were measured on axial images, cotyloid fossa height (CFH) and cotyloid fossa depth (CFD) were measured on coronal images. Within the CAO patients, we performed central acetabular decompression (CAD) and then observed the morphology change in fossa. Results Propensity-score matching yielded 61 BDDH hips and 122 non-BDDH hips. BDDH hips had a higher prevalence of CAO and a decreased linear length of cotyloid fossa (CFW, CFH and CNW). In the BDDH group, 33 hips underwent CAD, postoperative CFW, CFH and CNW were significantly increased (p < .001 for all), and had no statistical difference compared with the non-BDDH hips (p = .193, p = .132, p = .421, respectively). Conclusion BDDH hips had a significantly higher prevalence of CAO than adequate acetabular coverage hips. After the procedure of CAD, BDDH hips were found to have acetabular parameters (CFW, CFH, CNW) and were restored to that of the control hips.
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Thiagarajah, Shankar, Joshua S. Bingham, George Grammatopoulos, and Johan Witt. "A minimally invasive periacetabular osteotomy technique: minimizing intraoperative risks." Journal of Hip Preservation Surgery, November 10, 2020. http://dx.doi.org/10.1093/jhps/hnaa040.
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Abstract The periacetabular osteotomy (PAO) is an extensive surgical procedure associated with potential risk to the adjacent neurovascular structures. A steep learning curve exists, with surgeon experience an important factor in outcome. Little detail exists of the osteotomies themselves, and how to make them safe and reproducible. This article describes our PAO technique with emphasis on specific safety steps. When performing the posterior column cut, migration of the osteotome beyond the lateral pelvis may lead to damage of the sciatic nerve. The safety features detailed include novel measurement of the posterior column width and the use of specific-width osteotomes to complete this osteotomy. To plan the cut, several computerized tomography-based measurements are taken starting just above the greater sciatic notch and continuing down to the inferior part of the acetabulum. The angle of this cut is determined by acetabular morphology and the width of the posterior column. These posterior column width measurements will determine the width of the osteotomes used to perform the cut with little risk that an osteotome will penetrate too far on the lateral side of the pelvis. To ensure the lateral cortex has been cut completely proximally, an osteotome with pre-measured depths may be used from a medial to a direct lateral trajectory. The senior author has been performing this modified approach since 2010 (n = 530 PAOs) and has witnessed no vascular injuries and no nerve injuries aside from minor lateral femoral cutaneous nerve issues. Utilization of these techniques has prevented any major nerve injury without the need for intraoperative electromyography.
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Chumchuen, Sukanis, Wissarut Lertpullpol, and Adinun Apivatgaroon. "Open technique for supra-acetabular pin placement in pelvic external fixation: a cadaveric study." Journal of Orthopaedics and Traumatology 23, no. 1 (March 14, 2022). http://dx.doi.org/10.1186/s10195-022-00635-w.
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Abstract Background Standard supra-acetabular pin placement still needs fluoroscopic guidance, which is technically demanding for an untrained surgeon due to the unfamiliar fluoroscopic view and the risk of damaging some structures. The risks associated with the open technique without fluoroscopy have not yet been investigated, despite the palpable entry point and large bony corridor for rapid insertion in the limited time available for the management of unstable pelvic fracture patients. The aim of this study was to compare the open technique without fluoroscopy to the fluoroscopically assisted percutaneous technique for the positioning of supra-acetabular screws in cadavers without pelvic instability. Materials and methods The open technique for half-pin placement was compared to standard fluoroscopic guidance in 16 hemipelves (8 cadavers). The open technique was first performed on one side in each cadaver after simple randomization, followed by standard fluoroscopic guidance on the other side. In the open technique group, a Schanz pin 5 mm in diameter and 200 mm in length was inserted in the area just above the anteroinferior iliac spine (AIIS) and aimed with a medial inclination of 20° and a cephalad inclination of 10–20° after a 2 cm pilot drill hole had been established. Standard fluoroscopically guided pin placement was performed on the other side. Fluoroscopic assessment was conducted after final pin placement on both sides. The lateral femoral cutaneous nerve of the thigh (LFCN) and the hip capsule were identified via the Smith–Peterson approach. After complete dissection of soft tissue, it was clearly apparent that pin penetration was conducted outside the bony corridor. Results The LFCN was found to be in a risk zone near the pin (mean distance, 15 mm; range, 0–30 mm). One LFCN may have been injured in the fluoroscopic guidance group. The mean medial inclination of the pin was 19.8° (range, 5–40°) and the mean cephalad inclination was 11.5° (range 0–20°) in the open technique group. The mean medial inclination of the pin was 30.4° (range, 20–45°) and the mean cephalad inclination was 19.3° (range, 2–35°) in the fluoroscopic guidance group. The mean distance of the pin entry point from the AIIS was 11.1 mm (range, 0–35 mm) in the open technique group. The mean distance of the entry point of the pin from the AIIS was 15.1 mm (range, 0–25 mm) in the fluoroscopic guidance group. The mean hip joint capsule distance was 12 mm (range, 8–25 mm). No joint penetration was observed in the open technique group, compared to one joint penetration in the fluoroscopic guidance group. No sciatic notch penetration was found in either group, but pin penetration outside the external cortex of the ilium was found only in the open technique group, in 4 hemipelves. Conclusions This study shows that the freehand technique performed by experienced trauma surgeons may be as acceptable as controlled pin insertion under image intensification for selecting the proper entry point and stabilizing the anterior pelvic ring.
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Ziebarth, Kai, Nadine Kaiser, and Theddy Slongo. "Tripleosteotomie bei Morbus Perthes." Operative Orthopädie und Traumatologie, September 16, 2022. http://dx.doi.org/10.1007/s00064-022-00784-5.
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Zusammenfassung Operationsziel Durch die Osteotomie des Ischium‑, Pubis- und Iliumknochens kann das Acetabulum über den Hüftkopf geschwenkt werden, sodass der meist anterolateral vorstehende Anteil des Hüftkopfes wieder überdacht wird. Das Ziel ist der Erhalt des Containments der Hüfte, hiermit ist die Wiederherstellung der Kongruenz zwischen dem lateralisierten Hüftkopf und dem Acetabulum gemeint. Das Acetabulum wirkt so als eine Art Schablone für den Hüftkopf, um eine möglichst sphärische Ausheilung des Hüftkopfes zu erreichen. Indikationen Schwere Morbus-Perthes-Erkrankung mit radiologisch sichtbarer Lateralisation des Hüftkopfes und Head-at-risk-Zeichen. Voraussetzung ist, dass der Hüftkopf sich konzentrisch reponieren lässt (Abduktionsaufnahme oder Arthrographie). Kontraindikationen „Hinged abduction“. Keine konzentrische Reposition des Hüftkopfes möglich. Operationstechnik Arthrographie des Hüftgelenkes zur Bestätigung der Operationsindikation. Darstellung und Osteotomie des Ischiums über einen modifizierten Ludloff-Zugang, Osteotomie des Iliums und Pubis über einen modifizierten Smith-Petersen-Zugang. Verbesserung der Hüftkopfüberdachung durch Schwenken des Acetabulums über den Hüftkopf. Fixation des azetabulären Fragmentes mit Vollgewinde-Kirschner-Drähten oder 3,5-mm-Kortikalisschrauben. Weiterbehandlung Mobilisation an Gehstöcken (kleine Kinder im Rollstuhl). Abstellen des Fußes erlaubt. Teilbelastung für 4 bis 6 Wochen (je nach Alter des Patienten). Danach bei im Röntgen guten Konsolidationszeichen Belastungsaufbau innerhalb 1 bis 2 Wochen. Ergebnisse Sehr gute Ergebnisse hinsichtlich Operationstechnik und Ausheilung in der eigenen Klinik. In einer eigenen noch nicht veröffentlichten Studie mit einem durchschnittlichen Untersuchungszeitraum von 5 Jahren zeigten sich bei 30 Patienten sehr gute klinische und radiologische Ergebnisse nach Tripleosteotomie bei Morbus Perthes.
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Slongo, Theddy, and Kai Ziebarth. "Femurkopfreduktionsosteotomie zur Verbesserung des femoroazetabulären Containments bei Morbus Perthes." Operative Orthopädie und Traumatologie, July 21, 2022. http://dx.doi.org/10.1007/s00064-022-00779-2.
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Zusammenfassung Operationsziel Wiederherstellung der Hüftkongruenz und des Containments durch zentrale Hüftkopfresektion/Reduktion über eine erweiterte chirurgische Hüftluxation unter Erhaltung/Respektierung der Hüftkopfdurchblutung. Eine gleichzeitige oder spätere Reorientierung des Acetabulums durch Triple-Osteotomie oder PAO bei instabiler Hüfte kann in speziellen Fällen notwendig werden. Indikationen Die Indikation zur chirurgischen Hüftkopfreduktion ist praktisch unabhängig vom Alter bei jeglicher inkongruenten, asphärischen Hüftkopfsituation mit „hinged abduction“ (zu erwartende Endsituation wie Stulberg IV und V) gegeben. Dies kann noch bei aktivem wie auch bei bereits ausgeheiltem Morbus Perthes der Fall sein. Zudem kann bei einer Stulberg-V-Situation selbst im adulten Alter noch eine Verbesserung erziel werden. Nach Resektion muss noch ein tragfähiger Resthüftkopf vorhanden bleiben, d. h. mindestens noch 50 % des ausgeweiteten Hüftkopfes. Die dafür beste Planung erfolgt in der „vergleichenden“ 3‑D-Rekonstruktion. Kontraindikationen Völlig zerstörter Knorpel oder Hüftkopf. Operationstechnik Identisches Operationsvorgehen wie für die klassische chirurgische Hüftluxation. Präparation der retinakulären Flaps. Unter Respektierung und in Kenntnis der Gefäßversorgung Spaltung des Hüftkopfes gemäß dem zu entfernenden, nekrotischen Kopfanteil. Bildung eines möglichst sphärischen Hüftkopfes und Verschraubung der beiden Kopfanteile auf Schenkelhalsniveau. Distalisation und Fixierung des großen Trochanters. Je nach Kongruenz und Stabilität des Hüftkopfs in der Hüftpfanne kann eine primäre oder sekundäre Triple-OT oder PAO notwendig werden. Weiterbehandlung Die intraoperative Stabilität des Femurkopfes im Acetabulum muss erzielt worden sein, um eine beckengipsfreie, funktionelle Nachbehandlung zu gewährleisten: Stockentlastung mit Bodenkontakt ist erlaubt; keine aktive Rotation; Flexion aktiv und passiv bis 90 Grad ist erlaubt; vorerst keine spezifische Physiotherapie; je nach Heilungsverlauf sind diese Maßnahmen 8 bis 10 Wochen einzuhalten. Ergebnisse Gemäß unseren publizierten Nachuntersuchungen (aktuell 21 Jahre) sehen wir bei technisch korrekt durchgeführter Operation und korrekter Indikation sowie adäquater Nachbehandlung durchwegs gute Ergebnisse. Nekrosen des reduzierten Hüftkopfs haben wir nie beobachtet. Alle gespaltenen Hüftköpfe, respektive Schenkelhälse sind primär geheilt.
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Wu, Bing, Kai Song, Junyao Cheng, Pengfei Chi, Zhaohan Wang, and Zheng Wang. "Second sacral sacralalar‐iliac (S2AI) screw placement in adult degenerative scoliosis (ADS) patients: an imaging study." BMC Surgery 21, no. 1 (April 6, 2021). http://dx.doi.org/10.1186/s12893-021-01139-w.
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Abstract Background The imaging characteristics of sacral sacralalar-iliac (S2AI) screw trajectory in adult degenerative scoliosis (ADS) patients will be determined. Methods S2AI screw trajectories were mapped on three-dimensional computed tomography (3DCT) reconstructions of 40 ADS patients. The starting point, placement plane, screw template, and a circle centered at the lowest point of the ilium inner cortex were set on these images. A tangent line from the starting point to the outer diameter of the circle was selected as the axis of the screw trajectory. The related parameters in different populations were analyzed and compared. Results The trajectory length of S2AI screws in ADS patients was 12.00 ± 0.99 cm, the lateral angle was 41.24 ± 3.92°, the caudal angle was 27.73 ± 6.45°, the distance from the axis of the screw trajectory to the iliosciatic notch was 1.05 ± 0.81 cm, the distance from the axis of the screw trajectory to the upper edge of the acetabulum was 1.85 ± 0.33 cm, and the iliac width was 2.12 ± 1.65 cm. Compared with females, the lateral angle of male ADS patients was decreased, but the trajectory length was increased (P < 0.05). Compared to patients without ADS in previous studies, the lateral angle of male patients was larger, the lateral angle of female patients was increased, and the caudal angle was decreased (P < 0.05). Conclusions There is an ideal trajectory of S2AI screws in ADS patients. A different direction should be noticed in the placement of S2AI screws, especially in female patients.