Retrograde Pubic Rami Screw

SummaryObjectives: The hypothesis of this study was that juvenile pubic symphysiodesis (JPS) results in pelvic changes that can be identified radiographically in adult dogs.Methods: The medical records at the Clinica Veterinaria Vezzoni were searched for standard ventro-dorsal views of the pelvis of adult Labrador and Golden Retrievers that had undergone JPS or had not undergone surgery. The objective assessment of radiographs included the analysis of various pelvic measurements. Subjective evaluation of radiographs was undertaken by 18 specialists and 21 general practitioners and was based on five criteria relating to 1) the acetabular fossae, 2) the pubic symphysis, 3) the margin of the cranial pubic area, 4) the pubic rami, and 5) the obturator foramen.Results: The radiographs of 42 Labrador Retrievers and 16 Golden Retrievers were evaluated. The most useful criteria were the radiographic measurement of the shape of the obturator foramen and two different ratios of length to width of the pubic rami; these values were significantly smaller in dogs after JPS. The pelvic canal width was the same in both groups. All objective measurements were repeatable within and between evaluators. The most reliable subjective criterion was number 4, followed by number 5 in Golden Retrievers and by 2 in Labrador Retrievers.Conclusion: Our objective and subjective evaluations were simple and yielded useful and repeatable results. There was no significant difference between general practitioners and specialists with regard to subjective evaluation, which indicates that these evaluation criteria can be used by small animal clinicians after minimal training.

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Orthopaedic Management of Bladder Exstrophy

Turkish Association of Pediatric Surgeons ◽

10.5222/jtaps.2021.25986 ◽

2021 ◽

Author(s):

R. Özgür Özer

Keyword(s):

Abdominal Wall ◽

Bladder Exstrophy ◽

Pelvic Osteotomy ◽

Orthopedic Procedures ◽

Suture Materials ◽

Cloacal Exstrophy ◽

Surgical Interventions ◽

Pubic Rami ◽

Multi Stage ◽

Pubic Diastasis

Bladder exstrophy is an embryologic malformation that affects urogenital and skeletal systems. Non-operative treatment of this rare problem is impossible. Urogenital reconstructions can be facilitated by orthopedic procedures. These reconstructions can be performed in a single stage as a complete repair or multi-stage approaches. The goal of the treatment is closure of the bladder and abdominal wall for the achievement of continence, preservation of renal functions, and cosmetic and functional reconstruction of genital organs. Orthopedic procedures are performed to decrease the tension that complicates the bladder and abdominal wall closure by approximating the pubic rami to achieve a secure closure and a low recurrence rate. Surgical interventions consist of the approximation of the pubic rami with different materials such as suture materials and plaque or the application of different osteotomy types such as posterior iliac, anterior pelvic (pubic), diagonal iliac, horizontal iliac and posterior pelvic resection osteotomies. The age of the patient, the amount of pubic diastasis and history of previous operations that the patient has undergone should be considered during the operation planning. Pubic rami can be approximated without performing pelvic osteotomy in patients who are operated within the first 72 hours after birth. But, osteotomy is required in children older than 2 years of age with severe pubic diastasis, concomitant cloacal exstrophy and unsuccessful operation history. The surgical team should have enough knowledge and experience to perform different osteotomy types in case of need to combine anterior and posterior iliac osteotomies. With these multidisciplinary approaches, much more successful outcomes could be achieved.

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88 The Truth Behind the Pubic Rami Fracture: Identification of Pelvic Fragility Fractures at A University Teaching Hospital

Age and Ageing ◽

10.1093/ageing/afz193.03 ◽

2020 ◽

Vol 49 (Supplement_1) ◽

pp. i28-i29

Author(s):

D van Berkel ◽

O Herschkovich ◽

R Taylor ◽

T Ong ◽

O Sahota

Keyword(s):

Older People ◽

Pelvic Fracture ◽

Plain Radiograph ◽

Fragility Fractures ◽

University Teaching ◽

Acetabular Fractures ◽

Sacral Fractures ◽

Pubic Rami ◽

Number Of Patients ◽

Pelvic Imaging

Abstract Introduction Older patients presenting with pelvic fragility fractures (PFF) is an increasing epidemic. The most common pelvic fracture identified by plain radiograph is pubic rami fracture. These fractures are painful and often require admission to hospital. However, despite optimal analgesia, many of these patients struggle to mobilise and may have fractures of the posterior pelvic ring, which are overlooked and not visible on plain radiograph imaging. We aimed to quantify the number of patients progressing to further pelvic imaging in the form of computed tomography (CT) or magnetic resonance imaging (MRI) and the presence of concurrent fractures. Methods Prospective screening of pelvic imaging in patients aged over 70 years was undertaken at Nottingham University Hospitals NHS Trust over an 8-month period from October 2018. Results 103 predominantly female (83%) patients were confirmed to have an acute fragility fracture of the pubic rami on plain radiograph. 19% of patients were discharged direct from the Emergency Department, 45% were admitted to Health Care of Older People (HCOP) teams, 30% to Trauma and Orthopaedic (T&O) teams and 6% to other specialities. 25% of the patients admitted underwent further pelvic imaging, which confirmed fragility fractures of the pubic rami in 88%, with 40% showing acetabular fractures and 68% showing sacral fractures of all types. A further 10 patients were diagnosed with pubic rami insufficiency fractures on further imaging, having had a normal initial radiograph, but had been admitted with poor mobility due to groin pain. In these 10 patients, 20% also had an acetabular fracture and 60% sacral fractures. Overall, 59% of patients with pubic rami fractures had an ipsilateral sacral fracture; a Type 1 Lateral Compression pelvic fracture by AO classification. Conclusions Pubic rami fractures are a significant problem in older people and often require admission to hospital. Further imaging confirms these fractures are complex, with co-existing fractures of the acetabulum and sacrum common. However despite this, only a quarter of patients admitted had further imaging. Where pelvic fractures are missed or severity not appreciated, appropriate pain control can be more difficult to achieve. With the potential for minimally invasive surgical options to aid pain management in sacral fractures, it may be prudent for all patients hospitalised with suspected or confirmed pelvic fracture to undergo further imaging.

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Superior pubic rami resection for isolated recurrent uterine cancer

Gynecologic Oncology ◽

10.1016/j.ygyno.2006.10.041 ◽

2007 ◽

Vol 104 (2) ◽

pp. 45-47 ◽

Cited By ~ 1

Author(s):

Aileen Caceres ◽

Dennis S. Chi ◽

Patrick J. Boland ◽

Richard R. Barakat ◽

Nadeem R. Abu-Rustum

Keyword(s):

Uterine Cancer ◽

Pubic Rami

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Fractured Inferior Pubic Ramus with Ipsilateral Total Hip Replacement: A Case Report and Review of the Literature

Case Reports in Orthopedics ◽

10.1155/2013/674732 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3

Author(s):

Sarkhell Radha ◽

Michael Shenouda ◽

Alexandra Hazlerigg ◽

Sujith Konan ◽

Alison Hulme

Keyword(s):

Total Hip Replacement ◽

Hip Replacement ◽

Groin Pain ◽

Occupational Therapists ◽

Early Mobilisation ◽

Review Of The Literature ◽

Pubic Ramus ◽

Total Hip ◽

Pubic Rami ◽

Fracture Of The Acetabulum

Pubic rami fractures are common. They are associated with significant morbidity and mortality. These fractures are usually classified as stable injuries and traditionally receive limited orthopaedic input. Management typically involves hospital admission and early input from physiotherapists and occupational therapists. Early mobilisation is advocated as a central part of managing these patients, with emphasis on secondary prevention. We report a case diagnosed as minimally displaced inferior pubic ramus fracture in a patient with an ipsilateral total hip replacement (THR). The patient was mobilised early and despite analgesia continued to complain of groin pain. Repeat radiographs showed a fracture of the acetabulum with displacement of the acetabular component of the hip replacement. We advocate early orthopaedic input for all pubic rami fractures, particularly in patients with hip arthroplasty, and thorough investigation including a CT scan of the pelvis to exclude acetabular extension prior to mobilisation.

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