Search Results (11)

Background/Objectives: The growing incidence of acetabular revisions has highlighted the importance of achieving reliable fixation to the remaining bone. Proximal transiliac fixation (TIF) of pelvic implants is becoming an increasingly common approach for managing extensive bone defects. This study seeks to provide guidance on TIF implantation by analyzing the optimal screw placement in partial pelvic replacements for acetabular defects. Methods: Between 2014 and 2024, a cohort of 96 consecutive patients (65 females and 31 males) who underwent customized partial pelvic replacement (PPR) with transiliac fixation (TIF) were examined. The angle and entry point of the ideal TIF were determined using preoperative three-dimensional planning and compared with potential influencing factors. Results: All PPRs were successfully implanted, with an average TIF length of 77 mm. The mean anteroposterior angle for TIF was 18° medially and 27° dorsally. Conclusions: Analysis of the entry point showed concentration around the second radius and between the eleven o’clock and one o’clock positions. The AP angle is notably affected by gender and height. Considering the precision of human judgment, a recommendation for TIF placement would be 20° medial and 30° dorsal deviation, with the entry point around the twelve o’clock position and the second ring from the center of the cup. Full article

Introduction: Sacral fractures are rare but are increasing in incidence among trauma patients. They are associated with a wide variety of complications, most commonly neurologic defects. Case Report: A 59-year old woman initially underwent open reduction internal fixation (ORIF) for a sacral fracture, after which the patient developed an infection, wound complications, and hardware failure. The revision of the iliosacral screws proved challenging in that the standard screw and washer could not achieve sufficient compression of the fracture. Therefore, a modified midfoot mesh plate was cut to size and used as a washer to gain more surface area, achieving fixation. The plate was applied laterally and cut to cover as much surface area as possible without unnecessary bony overhang. A trans-iliac trans-sacral screw was then inserted in the standard fashion, thus allowing the plate to act as a washer. This resulted in an excellent outcome with appropriate fracture healing. Conclusion: We describe the case of an iliosacral screw revision in which a modified midfoot mesh plate was used as a washer. This resulted in appropriate fixation in the revision settings. The principles described to achieve this fixation can be broadly applied in the setting of orthopedic fractures. Full article

Secondary aortoesophageal fistula (AEF) is defined as a communication between the aorta and the esophagus, occurring after aortic disease treatment or esophageal procedures, associating very high mortality rates with treatment and being fatal without it. Several treatment strategies have been described in the literature, combining open surgery or endovascular aortic repair with surgical or endoscopic management of the esophageal lesion. We present the case of a 53-year-old patient with a history of open aortic surgery for a giant descending thoracic aortic pseudoaneurysm complicated with secondary AEF, successfully managed using emergency transiliac TEVAR (thoracic endovascular aortic repair), extensive antibiotic therapy associated with nutritional replenishment, and rehabilitation therapy. Novel endovascular and endoscopic devices have been developed, offering less invasive treatment strategies with improved outcomes, especially for high risk surgical patients. This case highlights the importance of a multidisciplinary approach to personalized medicine to manage such complex situations. Full article

Epidemiological evidence suggests existing comorbidity between postmenopausal osteoporosis (OP) and cardiovascular disease (CVD), but identification of possible shared genes is lacking. The skeletal global transcriptomes were analyzed in trans-iliac bone biopsies (n = 84) from clinically well-characterized postmenopausal women (50 to 86 years) without clinical CVD using microchips and RNA sequencing. One thousand transcripts highly correlated with areal bone mineral density (aBMD) were further analyzed using bioinformatics, and common genes overlapping with CVD and associated biological mechanisms, pathways and functions were identified. Fifty genes (45 mRNAs, 5 miRNAs) were discovered with established roles in oxidative stress, inflammatory response, endothelial function, fibrosis, dyslipidemia and osteoblastogenesis/calcification. These pleiotropic genes with possible CVD comorbidity functions were also present in transcriptomes of microvascular endothelial cells and cardiomyocytes and were differentially expressed between healthy and osteoporotic women with fragility fractures. The results were supported by a genetic pleiotropy-informed conditional False Discovery Rate approach identifying any overlap in single nucleotide polymorphisms (SNPs) within several genes encoding aBMD- and CVD-associated transcripts. The study provides transcriptional and genomic evidence for genes of importance for both BMD regulation and CVD risk in a large collection of postmenopausal bone biopsies. Most of the transcripts identified in the CVD risk categories have no previously recognized roles in OP pathogenesis and provide novel avenues for exploring the mechanistic basis for the biological association between CVD and OP. Full article

Background Context: Pelvic ring fractures are becoming more common in the aging population and can prove to be fatal, having mortality rates between 10% and 16%. Stabilization of these fractures is challenging and often require immediate internal fixation. Therefore, it is necessary to have a biomechanical understanding of the different fixation techniques for pelvic ring fractures. Methods: A previously validated three-dimensional finite element model of the lumbar spine, pelvis, and femur was used for this study. A unilateral pelvic ring fracture was simulated by resecting the left side of the sacrum and pelvis. Five different fixation techniques were used to stabilize the fracture. A compressive follower load and pure moment was applied to compare different biomechanical parameters including range of motion (contralateral sacroiliac joint, L1-S1 segment, L5-S1 segment), and stresses (L5-S1 nucleus stresses, instrument stresses) between different fixation techniques. Results: Trans-iliac–trans-sacral screw fixation at S1 and S2 showed the highest stabilization for horizontal and vertical displacement at the sacral fracture site and reduction of contralateral sacroiliac joint for bending and flexion range of motion by 165% and 121%, respectively. DTSF (Double transiliac rod and screw fixation) model showed highest stabilization in horizontal displacement at the pubic rami fracture site, while the L5_PF_W_CC (L5-Ilium posterior screw fixation with cross connectors) and L5_PF_WO_CC (L5-Ilium posterior screw fixation without cross connectors) showed higher rod stresses, reduced L1-S1 (approximately 28%), and L5-S1 (approximately 90%) range of motion. Conclusions: Longer sacral screw fixations were superior in stabilizing sacral and contralateral sacroiliac joint range of motion. Lumbopelvic fixations displayed a higher degree of stabilization in the horizontal displacement compared to vertical displacement of pubic rami fracture, while also indicating the highest rod stresses. When determining the surgical approach for pelvic ring fractures, patient-specific factors should be accounted for to weigh the advantages and disadvantages for each technique. Full article

Sacral insufficiency fractures commonly affect elderly women with osteoporosis and can cause debilitating lower back pain. First line management is often with conservative measures such as early mobilization, multimodal pain management, and osteoporosis management. If non-operative management fails, sacroplasty is a minimally invasive intervention that may be pursued. Candidates for sacroplasty are patients with persistent pain, inability to tolerate immobilization, or patients with low bone mineral density. Before undergoing sacroplasty, patients’ bone health should be optimized with pharmacotherapy. Anabolic agents prior to or in conjunction with sacroplasty have been shown to improve patient outcomes. Sacroplasty can be safely performed through a number of techniques: short-axis, long-axis, coaxial, transiliac, interpedicular, and balloon-assisted. The procedure has been demonstrated to rapidly and durably reduce pain and improve mobility, with little risk of complications. This article aims to provide a narrative literature review of sacroplasty including, patient selection and optimization, the various technical approaches, and short and long-term outcomes. Full article

Introduction: The Pericapsular Nerve Group (PENG) block is a novel technique that allows for analgesia of the anterior hip capsule via the articular branches of the accessory obturator nerve and femoral nerve, which have a significant role in the innervation of the hip capsule. A PENG (Pericapsular Nerves Group) blockade is effective in both adult and pediatric patients. However, no studies on patients under five are available in the literature. Herein, we describe our experience with two pediatric patients with hip dysplasia. Purpose: This study aimed to evaluate the analgesic effect of the pericapsular nerves group (PENG) in preschool children undergoing hip surgery. Patients and methods: This study included two patients, aged 4 and 2 years old, who were qualified for hip surgery. Spinal or general anesthesia with the addition of a PENG block was performed. During the procedure, the basic hemodynamic parameters were monitored. The pain was assessed using the FALCC (Face, Legs, Activity, Cry, Consolability scale) score. A dose of 15 mg/kg⁻¹ of metamizole was administered if the FLACC score was 3. In the case of a score of 4 on the FLACC scale, the application of 0.2 mg/kg⁻¹ of nalbuphine was ordered. Results: After the surgery, the patients received 15 mg/kg⁻¹ IV paracetamol every 6 h to prevent rebound pain. The patient’s hemodynamic parameters were stable and within normal range. In the first 24 h period, the FLACC scores from all patients ranged from 0 to 3. One patient required metamizole 12 h after surgery. No evidence of block complications was observed. Conclusions: This case series showed that the PENG block assured opioid-free pain management and provided adequate postoperative analgesia. However, we are convinced that future randomized, controlled trials are needed in this field. Full article

Pain originating in the sacroiliac joint (SIJ) is a contributor to chronic lower back pain. Studies on minimally invasive SIJ fusion for chronic pain have been performed in Western populations. Given the shorter stature of Asian populations compared with Western populations, questions can be raised regarding the suitability of the procedure in Asian patients. This study investigated the differences in 12 measurements of sacral and SIJ anatomy between two ethnic populations by analyzing computed tomography scans of 86 patients with SIJ pain. Univariate linear regression was performed to evaluate the correlations of body height with sacral and SIJ measurements. Multivariate regression analysis was used to evaluate systematic differences across populations. Most sacral and SIJ measurements were moderately correlated with body height. The anterior–posterior thickness of the sacral ala at the level of the S1 body was significantly smaller in the Asian patients compared with the Western patients. Most measurements were above standard surgical thresholds for safe transiliac placement of devices (1026 of 1032, 99.4%); all the measurements below these surgical thresholds were found in the anterior–posterior distance of the sacral ala at the S2 foramen level. Overall, safe placement of implants was allowed in 84 of 86 (97.7%) patients. Sacral and SIJ anatomy relevant to transiliac device placement is variable and correlates moderately with body height, and the cross-ethnic variations are not significant. Our findings raise a few concerns regarding sacral and SIJ anatomy variation that would prevent safe placement of fusion implants in Asian patients. However, considering the observed S2-related anatomic variation that could affect placement strategy, sacral and SIJ anatomy should still be preoperatively evaluated. Full article

Osteocytes are terminally differentiated osteoblasts embedded within the bone matrix and key orchestrators of bone metabolism. However, they are generally not characterized by conventional bone histomorphometry because of their location and the limited resolution of light microscopy. OI is characterized by disturbed bone homeostasis, matrix abnormalities and elevated bone matrix mineralization density. To gain further insights into osteocyte characteristics and bone metabolism in OI, we evaluated 2D osteocyte lacunae sections (OLS) based on quantitative backscattered electron imaging in transiliac bone biopsy samples from children with OI type I (n = 19) and age-matched controls (n = 24). The OLS characteristics were related to previously obtained, re-visited histomorphometric parameters. Moreover, we present pediatric bone mineralization density distribution reference data in OI type I (n = 19) and controls (n = 50) obtained with a field emission scanning electron microscope. Compared to controls, OI has highly increased OLS density in cortical and trabecular bone (+50.66%, +61.73%; both p < 0.001), whereas OLS area is slightly decreased in trabecular bone (−10.28%; p = 0.015). Correlation analyses show a low to moderate, positive association of OLS density with surface-based bone formation parameters and negative association with indices of osteoblast function. In conclusion, hyperosteocytosis of the hypermineralized OI bone matrix associates with abnormal bone cell metabolism and might further impact the mechanical competence of the bone tissue. Full article

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. Full article

Accurate clinical evaluation of renal osteodystrophy (ROD) is currently accomplished using invasive in vivo transiliac bone biopsy, followed by in vitro histomorphometry. In this study, we demonstrate that an alternative method for ROD assessment is through a fast, label-free Raman recording of multiple biomarkers combined with computational analysis for predicting the minimally required number of spectra for sample classification at defined accuracies. Four clinically relevant biomarkers: the mineral-to-matrix ratio, the carbonate-to-matrix ratio, phenylalanine, and calcium contents were experimentally determined and simultaneously considered as input to a linear discriminant analysis (LDA). Additionally, sample evaluation was performed with a linear support vector machine (LSVM) algorithm, with a 300 variable input. The computed probabilities based on a single spectrum were only marginally different (~80% from LDA and ~87% from LSVM), both providing an unacceptable classification power for a correct sample assignment. However, the Type I and Type II assignment errors confirm that a relatively small number of independent spectra (7 spectra for Type I and 5 spectra for Type II) is necessary for a p < 0.05 error probability. This low number of spectra supports the practicality of future in vivo Raman translation for a fast and accurate ROD detection in clinical settings. Full article