scholarly journals Iliac Bone Corridors to Host the Transiliac Internal Fixator—An Experimental CT Based Analysis

2021 ◽  
Vol 10 (7) ◽  
pp. 1500
Author(s):  
Paul Schmitz ◽  
Maximilian Kerschbaum ◽  
Philipp Lamby ◽  
Siegmund Lang ◽  
Volker Alt ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
Pelvic Ring ◽  
Axial Plane ◽  
Internal Fixator ◽  
Reference Plane ◽  
Posterior Pelvic Ring ◽  
Optimal Position ◽  
Iliac Wing ◽  
Minimally Invasive Surgical Procedure ◽  
The Mean

Background: The transiliac internal fixator (TIFI) is a novel minimally invasive surgical procedure to stabilize posterior pelvic ring fractures. Two bone corridors with different lengths, widths, and angulations are suitable to host screws in the posterior iliac wing. While the length and the width have been described previously, the angulation has not been determined yet. Methods: We created a computer tomography-based 3D-model of 40 patients (20 women, 20 men). The possible bone corridors to host the ilium screws for the TIFIcc (cranio-caudal) and the TIFIdv (dorso-ventral) procedure were identified. After reaching the optimal position, the angles in relation to the sagittal and axial plane were measured. The anterior pelvic plane was chosen as the reference plane. Results: The mean angle of the TIFIcc screws related to the axial plane was 63.4° (±1.8°) and to the sagittal plane was 12.3° (±1.5°). The mean angle of the TIFIdv screws related to the axial plane was 16.1° (±1.2°) and to the sagittal plane was 20.1° (±2.0°). In each group, a high constancy was apparent irrespective of the age or physical dimension of the patient, although a significant gender-dependent difference was observed”. Conclusions: Due to a high inter-individual constancy in length, width, and angulation, bone corridors in the posterior iliac wing are reliable to host screws for posterior pelvic ring fixation irrespective of each individual patient’s anatomy.

scholarly journals A systematic review of the transiliac internal fixator (TIFI) for posterior pelvic injuries

SICOT-J ◽  
2021 ◽  
Vol 7 ◽  
pp. 40
Author(s):  
Franz Müller ◽  
Bernd Füchtmeier
Keyword(s):  
Clinical Studies ◽  
Pelvic Ring ◽  
Randomized Study ◽  
Case Series ◽  
Operation Time ◽  
Fragility Fractures ◽  
Internal Fixator ◽  
Posterior Pelvic Ring ◽  
Pelvic Ring Injuries ◽  
Pelvic Injuries

Objective: To summarize the literature on transiliac internal fixator (TIFI) indications and outcomes for treating posterior pelvic ring injuries. Methods: We searched databases for original publications in journals. Biomechanical and clinical studies using a TIFI for posterior pelvic ring injuries were considered for inclusion. The dates of publications that were included ranged from January 2000 until December 2020. Results: A total of 13 articles were reviewed, including eight clinical studies and five biomechanical tests. We found only case series and no multicenter or randomized study. The clinical studies contained data for a total of 186 cases, including indications, treatments, complications, and outcomes, with a minimum follow-up time of 12 months. All studies reported superior results according to operation time, blood loss, complication, dislocation, and union. One biomechanical test evaluated inferior results. Conclusions: The TIFI is a user-friendly and safe device to treat posterior pelvic injuries. It can also be used for acute, high-impact injuries, and fragility fractures. Nevertheless, there is no evidence concerning which types of pelvic fractures are most beneficial. Therefore, further biomechanical and clinical studies are necessary to resolve this question.

The Kaplan Fibers of the Iliotibial Band Can Be Identified on Routine Knee Magnetic Resonance Imaging

2019 ◽  
Vol 47 (12) ◽  
pp. 2895-2903 ◽  
Author(s):  
Lachlan Batty ◽  
Jerome Murgier ◽  
Richard O’Sullivan ◽  
Kate E. Webster ◽  
Julian A. Feller ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Sagittal Plane ◽  
Interobserver Reliability ◽  
Joint Line ◽  
Coronal Plane ◽  
Iliotibial Band ◽  
Resonance Imaging ◽  
Lateral Gastrocnemius ◽  
The Mean

Background: The Kaplan fibers (KFs) of the iliotibial band have been suggested to play a role in anterolateral rotational instability of the knee, particularly in the setting of an anterior cruciate ligament (ACL) rupture. Description of the normal magnetic resonance imaging (MRI) anatomy of the KFs may facilitate subsequent investigation into the MRI signs of injury. Purpose: To assess if the KF complex can be identified on 3-T MRI using standard knee protocols. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: 3-T MRI scans of 50 ACL-intact knees were reviewed independently by a musculoskeletal radiologist and 2 orthopaedic surgeons. Identification of the KFs was based on radiological diagnostic criteria developed a priori. Identification of the KFs in the sagittal, coronal, and axial planes was recorded. Interobserver reliability was assessed using the Kappa statistic. Detailed anatomy including distance to the joint line and relationship to adjacent structures was recorded. Results: The mean patient age was 43 years (range, 15-81 years), 58% were male, and 50% were right knees. The KFs were identified by at least 2 reviewers on the sagittal images in 96% of cases, on the axial images in 76% of cases, and on the coronal images in 4% of cases. The mean distance from the KF distal femoral insertion to the lateral joint line was 50.1 mm (SD, 6.6 mm) and the mean distance to the lateral gastrocnemius tendon origin was 10.8 mm (SD, 8.6 mm). The KFs were consistently identified immediately anterior to the superior lateral geniculate artery on sagittal imaging. Interobserver reliability for identification was best in the sagittal plane (Kappa 0.5) and worst in the coronal plane (Kappa 0.1). Conclusion: The KF complex can be identified on routine MRI sequences in the ACL-intact knee; however, there is low to moderate interobserver reliability. Imaging in the sagittal plane had the highest rate of identification and the coronal plane the lowest. There is a consistent relationship between the most distal KF femoral attachment and the lateral joint line, lateral gastrocnemius tendon, and superior lateral geniculate artery.

scholarly journals Plate fixation of the anterior pelvic ring in patients with fragility fractures of the pelvis

2021 ◽  
Author(s):  
Michiel Herteleer ◽  
Mehdi Boudissa ◽  
Alexander Hofmann ◽  
Daniel Wagner ◽  
Pol Maria Rommens
Keyword(s):  
Pelvic Ring ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Weight Bearing ◽  
Fragility Fractures ◽  
Pubic Symphysis ◽  
Osteoporotic Bone ◽  
Screw Loosening ◽  
Posterior Pelvic Ring ◽  
Pelvic Brim

Abstract Introduction In fragility fractures of the pelvis (FFP), fractures of the posterior pelvic ring are nearly always combined with fractures of the anterior pelvic ring. When a surgical stabilization of the posterior pelvis is performed, a stabilization of the anterior pelvis is recommended as well. In this study, we aim at finding out whether conventional plate osteosynthesis is a valid option in patients with osteoporotic bone. Materials and methods We retrospectively reviewed medical charts and radiographs of all patients with a FFP, who underwent a plate osteosynthesis of the anterior pelvic ring between 2009 and 2019. Patient demographics, fracture characteristics, properties of the osteosynthesis, complications and revision surgeries were documented. Single plate osteosynthesis (SPO) at the pelvic brim was compared with double plate osteosynthesis (DPO) with one plate at the pelvic brim and one plate anteriorly. We hypothesized that the number and severity of screw loosening (SL) or plate breakage in DPO are lower than in SPO. Results 48 patients with a mean age of 76.8 years were reviewed. In 37 cases, SPO was performed, in 11 cases DPO. Eight out of 11 DPO were performed in patients with FFP type III or FFP type IV. We performed significantly more DPO when the instability was located at the level of the pubic symphysis (p = 0.025). More patients with a chronic FFP (surgery more than one month after diagnosis) were treated with DPO (p = 0.07). Infra-acetabular screws were more often inserted in DPO (p = 0.056). Screw loosening (SL) was seen in the superior plate in 45% of patients. There was no SL in the anterior plate. There was SL in 19 of 37 patients with SPO and in 3 of 11 patients with DPO (p = 0.16). SL was localized near to the pubic symphysis in 19 of 22 patients after SPO and in all three patients after DPO. There was no SL in DPO within the first month postoperatively. We performed revision osteosynthesis in six patients (6/48), all belonged to the SPO group (6/37). The presence of a bone defect, unilateral or bilateral anterior pelvic ring fracture, post-operative weight-bearing restrictions, osteosynthesis of the posterior pelvic ring, and the presence of infra- or supra-acetabular screws did not significantly influence screw loosening in SPO or DPO. Conclusion There is a high rate of SL in plate fixation of the anterior pelvic ring in FFP. In the vast majority, SL is located near to the pubic symphysis. DPO is associated with a lower rate of SL, less severe SL and a later onset of SL. Revision surgery is less likely in DPO. In FFP, we recommend DPO instead of SPO for fixation of fractures of the anterior pelvic ring, which are located in or near to the pubic symphysis.

scholarly journals Two-Dimensional Visualization of the Three-Dimensional Planned Sacroiliac Screw Corridor with the Slice Fusion Method

2021 ◽  
Vol 10 (2) ◽  
pp. 184
Author(s):  
Maximilian Kerschbaum ◽  
Siegmund Lang ◽  
Florian Baumann ◽  
Volker Alt ◽  
Michael Worlicek
Keyword(s):  
Pelvic Ring ◽  
Three Dimensional ◽  
Fusion Method ◽  
Two Dimensional ◽  
Posterior Pelvic Ring ◽  
Simple Method ◽  
Sacroiliac Screw ◽  
Screw Insertion ◽  
Multiplanar Reconstructions ◽  
Screw Position

Insertion of sacro-iliac (SI) screws for stabilization of the posterior pelvic ring without intraoperative navigation or three-dimensional imaging can be challenging. The aim of this study was to develop a simple method to visualize the ideal SI screw corridor, on lateral two-dimensional images, corresponding to the lateral fluoroscopic view, used intraoperatively while screw insertion, to prevent neurovascular injury. We used multiplanar reconstructions of pre- and postoperative computed tomography scans (CT) to determine the position of the SI corridor. Then, we processed the dataset into a lateral two-dimensional slice fusion image (SFI) matching head and tip of the screw. Comparison of the preoperative SFI planning and the screw position in the postoperative SFI showed reproducible results. In conclusion, the slice fusion method is a simple technique for translation of three-dimensional planned SI screw positioning into a two-dimensional strict lateral fluoroscopic-like view.

Factors affecting lateral mass screw placement at C-7

2011 ◽  
Vol 14 (3) ◽  
pp. 405-411 ◽  
Author(s):  
Kalil G. Abdullah ◽  
Amy S. Nowacki ◽  
Michael P. Steinmetz ◽  
Jeffrey C. Wang ◽  
Thomas E. Mroz
Keyword(s):  
Sagittal Plane ◽  
Anatomical Variation ◽  
Axial Plane ◽  
Screw Placement ◽  
Lateral Mass ◽  
Lateral Mass Screw ◽  
Modified Technique ◽  
Modified Method ◽  
Starting Point ◽  
Lateral Mass Screws

Object The C-7 lateral mass has been considered difficult to fit with instrumentation because of its unique anatomy. Of the methods that exist for placing lateral mass screws, none particularly accommodates this anatomical variation. The authors have related 12 distinct morphological measures of the C-7 lateral mass to the ability to place a lateral mass screw using the Magerl, Roy-Camille, and a modified Roy-Camille method. Methods Using CT scans, the authors performed virtual screw placement of lateral mass screws at the C-7 level in 25 male and 25 female patients. Complications recorded included foraminal and articular process violations, inability to achieve bony purchase, and inability to place a screw longer than 6 mm. Violations were monitored in the coronal, axial, and sagittal planes. The Roy-Camille technique was applied starting directly in the middle of the lateral mass, as defined by Pait's quadrants, with an axial angle of 15° lateral and a sagittal angle of 90°. The Magerl technique was performed by starting in the inferior portion of the top right square of Pait's quadrants and angling 25° laterally in the axial plane with a 45° cephalad angle in the sagittal plane. In a modified method, the starting point is similar to the Magerl technique in the top right square of Pait's quadrant and then angling 15° laterally in the axial plane. In the sagittal plane, a 90° angle is taken perpendicular to the dorsal portion of the lateral mass, as in the traditional Roy-Camille technique. Results Of all the morphological methods analyzed, only a combined measure of intrusion of the T-1 facet and the overall length of the C-7 lateral mass was statistically associated with screw placement, and only in the Roy-Camille technique. Use of the Magerl technique allowed screw placement in 28 patients; use of the Roy-Camille technique allowed placement in 24 patients; and use of the modified technique allowed placement in 46 patients. No screw placement by any method was possible in 4 patients. Conclusions There is only one distinct anatomical ratio that was shown to affect lateral mass screw placement at C-7. This ratio incorporates the overall length of the lateral mass and the amount of space occupied by the T-1 facet at C-7. Based on this virtual study, a modified Roy-Camille technique that utilizes a higher starting point may decrease the complication rate at C-7 by avoiding placement of the lateral mass screw into the T1 facet.

scholarly journals Comparison of One-Year Functional Outcomes and Quality of Life between Posterior Pelvic Ring Fixation and Combined Anterior-Posterior Pelvic Ring Fixation after Lateral Compression (B2 Type) Pelvic Fracture

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 204
Author(s):  
Giedrius Petryla ◽  
Valentinas Uvarovas ◽  
Rokas Bobina ◽  
Jaunius Kurtinaitis ◽  
Roma Puronaitė ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pelvic Fracture ◽  
Functional Outcomes ◽  
Pelvic Ring ◽  
Pelvic Fractures ◽  
Posterior Pelvic Ring ◽  
Sf 36 ◽  
One Year ◽  
Anterior Posterior

Background and Objectives: The treatment algorithm of lateral compression B2 type pelvic fractures are still under debate. Some authors advocate conservative treatment, while others recommend surgical approach. The clear indications for isolated anterior or posterior ring fixation or combined anterior-posterior pelvic ring fixation of B2 type fractures remain unclear. The aim of this study was to compare the functional outcomes and quality of life after isolated posterior pelvic ring fixation and combined anterior-posterior pelvic ring fixation for the treatment of B2 pelvic fractures. Materials and Methods: Patients aged 18 to 65 years with B2 type pelvic fracture hospitalized in a single trauma centre over a period of 3 years were included in the research. Based on the attending surgeon’s preference, patients were treated with isolated posterior or combined anterior-posterior pelvic fixation. The quality of life and pelvic function were assessed using SF-36 and Majeed questionnaires, respectively. Patients filled in the questionnaires twice: during the first hospitalization (concerning their pre-trauma state—timepoint I) and one-year after the injury (timepoint II). Results: A cohort of 32 patients with B2 type pelvic fracture was enrolled in the analysis: 23 (72%) were female and 9 (28%) were male. The mean age was 35.3 ± 11.9 years. In this cohort 13 (41%) patients underwent isolated posterior pelvic ring fixation (group I) and 19 (59%) patients underwent combined anterior-posterior pelvic ring fixation (group II). No statistically significant differences were observed between the groups in both timepoints concerning Majeed, SF-36 PCS and MCS scores. However, in both groups Majeed and SF-36 PCS scores were statistically significantly lower one year after pelvic fracture compared with pre-trauma state, while SF-36 MCS scores did not differ. Conclusions: No differences were found in quality of life and functional outcomes between isolated posterior pelvic ring fixation and combined anterior-posterior fixation for the treatment of B2 type pelvic fractures.

scholarly journals PARAMETERS FOR THE EVALUATION OF CERVICAL SAGITTAL BALANCE IN IDIOPATHIC SCOLIOSIS

2017 ◽  
Vol 16 (1) ◽  
pp. 38-41
Author(s):  
MAURICIO COELHO LIMA ◽  
MARCELO ITALO RISSO NETO ◽  
GUILHERME REBECHI ZUIANI ◽  
IVAN GUIDOLIN VEIGA ◽  
MARCOS ANTONIO TEBET ◽  
...  
Keyword(s):  
Idiopathic Scoliosis ◽  
Sagittal Balance ◽  
Sagittal Plane ◽  
Lateral View ◽  
Plumb Line ◽  
Cervical Lordosis ◽  
Thoracic Inlet ◽  
Mean Values ◽  
Cervical Sagittal Balance ◽  
The Mean

ABSTRACT Objective: There are no values defined as standard in the literature for the parameters of assessment of cervical sagittal balance in patients with idiopathic scoliosis. This study describes the sagittal cervical parameters in patients with idiopathic scoliosis. Methods: Study carried out in a tertiary public hospital in patients with adolescent idiopathic scoliosis, through the evaluation of panoramic radiographs in lateral view. The Cobb method was used to evaluate cervical lordosis from C2 to C7, distance from the center of gravity (COG) of the skull to C7, measurement of T1 slope, thoracic inlet angle (TIA), neck tilt, and plumb line from C7 to S1 (SVA C7-S1). A statistical analysis was performed, to demonstrate the relationship between the alignment of the thoracic spine in the sagittal plane and the cervical sagittal balance of patients with scoliosis. Results: Thirty-four patients were female (69.4%) and 15 male (30.6%). The mean values for COG-C7 were 0.71 mm (median 0.8 mm/standard deviation [SD]= 0.51 mm). For Cobb C2-C7, the mean was -11.7° (median -10°/SD= 20.4°). The mean slope of T1 was 23.5° (median 25°/SD= 9.5°). The mean cervical version was 58.8° (median 60°/DP= 15.4°). The mean TIA was 81.8° (median 85°/SD= 16.7°). The mean plumb line C7-S1 was -0.28 (-0.3/SD= 1.0). Conclusion: The analysis of the results showed that the mean values for the cervical lordosis are lower than the values described as normal in the literature, suggesting a loss of sagittal cervical balance in these patients.

scholarly journals Physiological in vitro sacroiliac joint motion: a study on three‐dimensional posterior pelvic ring kinematics

2018 ◽  
Vol 234 (3) ◽  
pp. 346-358 ◽  
Author(s):  
Niels Hammer ◽  
Mario Scholze ◽  
Thomas Kibsgård ◽  
Stefan Klima ◽  
Stefan Schleifenbaum ◽  
...  
Keyword(s):  
Sacroiliac Joint ◽  
Pelvic Ring ◽  
Three Dimensional ◽  
Joint Motion ◽  
Posterior Pelvic Ring
Sign in / Sign up

Export Citation Format

Share Document