The prevalence and risk factors of pubic bone marrow edema in femoroacetabular impingement and hip dysplasia

ABSTRACT Femoroacetabular impingement syndrome (FAIS) has been associated with osteitis pubis; however, it is still unclear whether hip dysplasia is associated with osteitis pubis. This study aimed to investigate (i) the incidence of pubic bone marrow edema (BME) on magnetic resonance imaging in symptomatic patients with FAIS, borderline developmental dysplasia of the hip (BDDH) and developmental dysplasia of the hip (DDH) undergoing hip arthroscopic surgery with labral preservation and (ii) the demographic and radiographic factors associated with pubic BME. A total of 259 symptomatic patients undergoing hip arthroscopic surgery between July 2016 and April 2019 were retrospectively reviewed and divided into three groups: FAIS (180 patients), BDDH (29 patients) and DDH (50 patients). Diffuse changes in the pubic bone adjacent to the pubic symphysis were labeled pubic BME, and the prevalence of their occurrence was examined. Multivariate logistic regression analysis was performed to identify factors involved in pubic BME, and odds ratios (ORs) for relevant factors were calculated. There was no significant difference in the prevalence of pubic BME among the three groups (20 [11.1%] of 180 FAIS patients, 6 [20.6%] of 29 BDDH patients and 7 [14%] of 50 DDH patients, P = 0.325). Multivariate logistic regression analysis showed that acetabular coverage was not associated with pubic BME, whereas younger age and greater alpha angle were still independent associated factors [age ≤26 years (OR, 65.7) and alpha angle ≥73.5° (OR, 4.79)]. Determining the possible association of osteitis pubis with cam impingement in dysplastic hips may provide insights toward a more accurate understanding of its pathophysiology.

Sex Estimation Using Geometric Morphometrics

Creating and testing efficient techniques for the sex estimation of modern human skeletal remains has been a significant focus in biological anthropology. It is well established that the innominate, particularly the pubic bone, is a sexually dimorphic part of the human skeleton, but prone to fragmentation. Using modern pubic bones of known age and sex, this study aims to capture shape differences using geometric morphometrics (GMM) to test classification accuracy of segments of the pubic bone. The sample consists of 70 left adult pubic bones from the William M. Bass Donated Skeletal Collection, with 35 males and 35 females of mixed age and population affinity. Landmarks were placed on the dorsal surface of the pubic body and ischiopubic ramus to capture their overall shape in two dimensions, so the study is easily replicable and applicable. The scans were separately run through a generalized Procrustes, principal components (PCA), and canonical linear discriminant function analysis (DFA). The DFA results show high classification accuracy for the pubic body (94% males, 100% females) and the ischiopubic ramus (100% females, 97% males), with the PCA DFA allowing a researcher to explore specific shape changes driving the differentiation between groups. GMM was able to quantify and successfully discriminant the shape changes between males and females for small elements of the pubis, which can be applied to fragmentary remains and future morphological methods.

Description and Quantification of Sexual Dimorphism of Pubic Body Shape in Hispanic Populations Using Elliptic Fourier Analysis

Sex estimation is important in the creation of a biological profile for unidentified human remains, as positive identification cannot occur until the decedent’s biological traits have been determined and the range of possible matches has been narrowed. The pubic bone is cited as one of the best indicators of sex due to the constraints of childbirth. Current methods that use the pubic bone for sex estimation, however, rely on poorly defined and subjective observations that are susceptible to inter-and intraobserver error. Additionally, many of the methods currently in use are based on North American populations and thus may not necessarily model the variation seen in other populations around the globe. The aim of this study is to gain a better understanding of variation in pubic bone shape in Hispanic populations by separating the influences of sex, ancestry, and age at death. A total of 164 pubic bones from North American Hispanic and Chilean individuals were compared to 287 pubic bones from individuals of Euro-American ancestry from North American collections, using Elliptic Fourier analysis (EFA) of photographs, principal component analysis, and ANCOVA. EFA generated five effective principal components that collectively describe approximately 95% of the variation in the shape of the pubic body. Sex, age at death, and ancestry were all found to significantly influence shape but explained only 25% of the overall variation. The remaining 75% is likely influenced by variables that cannot be controlled for in anthropological analysis, underscoring how little variance in skeletal morphology is actually explainable.

Intraosseous schwannoma of inferior pubic ramus – A rare benign osseous neoplasm

Intraosseous schwannomas are a very rare subgroup of schwannomas. They account for <1% of all primary bone neoplasms. The mandible is the most commonly involved bone followed by the sacrum. We herein report a case of intraosseous schwannoma involving the inferior ramus and body of the pubic bone in a 43-year-old male who presented with a swelling in the right groin. On radiographs and computed tomography, it appeared as a mildly expansile, lytic, multiloculated lesion in the right pubic bone with a narrow zone of transition, sclerotic margins with areas of cortical breach, and a significant intra and extrapelvic soft-tissue component which did not show any areas of calcification. On magnetic resonance imaging, it appeared isointense to skeletal muscle on T1-weighted images, mildly hyperintense on T2-weighted images, and markedly hyperintense on short-tau inversion recovery images. The differentials considered on imaging were chondroid neoplasms such as chondromyxoid fibroma or low-grade chondrosarcoma, giant cell tumor, and plasmacytoma. However, biopsy and histopathology revealed an intraosseous schwannoma. The patient was operated and the lesion was excised in toto. Intraoperatively, the origin of the lesion was identified as the right obturator nerve. Post-operative, the patient recovery was uneventful and he was discharged.

Application of computer stabilometric technologies with biofeedback in patients with lumbosacral pain

Introduction. Low back pain is one of the most common sufferings of modern humans. In developed countries, such manifestations are a serious medical and economic problem. Lumbosacral pain in many cases is caused by the occurrence of somatic dysfunction of the bones of the pelvis and sacrum. The main methods of treatment are prescribing drug therapy and non-drug treatment. Today, osteopathic techniques are highly effective for the diagnosis and correction of somatic dysfunctions of the pelvic region. Such treatment in patients with pain in the lower back helps to reduce pain and restore the functional state of patients. Equally important are computer technologies with biofeedback (BFB) with the possibility of effective correction of proprioceptive innervation and muscle-tonic syndromes. The stabilometric platform allows you to register the parameters of the static-dynamic function of support and balance maintenance. The resulting changes in the position of the sacrum and pelvic bones create a distortion of proprioceptive somatosensory afferentation, postural tonic reflexes of the axial skeleton and limbs are blocked, the sequence of activation of the motor units of the locomotor apparatus is disrupted, the mechanisms for maintaining support and walking change. The aim — to study the effectiveness of using a stabiloplatform with biofeedback in the diagnostic mode of coordinating and static-dynamic disorders in patients with somatic dysfunctions of the pelvic and sacral bones in a training mode in combination with osteopathic correction for pain in the lumbosacral region. Materials and methods. In a prospective controlled study in patients with lumbosacral pain with somatic dysfunctions of the pelvic bones, the results of treatment were analyzed in 66 patients aged 23–56 years. Diagnosis of dysfunctions of the iliac bones was carried out according to the generally accepted rules of osteopathic examination — osteopathic examination and determination of the position of bone landmarks. The observed patients were divided into groups and subgroups depending on the type of dysfunction. The main group consisted of patients with clinical and osteopathic signs of somatic dysfunctions of the pubic bone and ilium. The patients were followed up for 14 days. The observation and treatment program included: osteopathic correction of diagnosed somatic dysfunction and stabilometric examination (3 control points) with a training regimen (3 sessions). Stabilometric testing was carried out at the stage of diagnosis and selection of patients for inclusion in the study. Re-examination was carried out 14 days after the moment of treatment. The clinical effect was compared with the results of stabilometric tests. In addition, the intensity of the pain syndrome and the severity of muscle-tonic reactions were analyzed. According to the results of the test regime, the stability in the «eyes open» and «eyes closed» modes was assessed. Results. A decrease in the intensity of pain is achieved, normalization of the balance in axial parameters with an improvement in the function of coordination of movements is noted. The Romberg coefficient decreases most significantly in somatic dysfunctions of the iliac bones in the position of anterior rotation without a significant difference in lateralization: on the right, a decrease from 570 ± 12% to 295 ± 23% and on the left from 550 ± 22 to 260 ± 25% (p <0.05). Conclusion. In the event of somatic dysfunctions of the pelvic bones with lumbosacralgia, the combined use of osteopathic correction and physiotherapy exercises on a stabiloplatform in a training mode with biofeedback has a significant effect. The training regimen promotes pain regression in acute and chronic pain. The best results have been achieved in patients with dysfunction in the anterior rotation of the ilium. Stabilometric testing in the diagnostic mode allows you to obtain objective data on the nature of imbalance and imbalance. The training regime ensures the achievement of a therapeutic result in 3 sessions and can be used in inpatient and outpatient conditions of medical institutions.

Resection and Reconstruction of Acetabular Tumors involving Ischium and Inferior pubic bone with a Total Hip Replacement Using Posterior K-L Approach

Background: To explore the feasibility and short-term effect of posterior K-L (Kocher Langenbeek) approach in treating pelvic acetabular tumors involving ishium, inferior ramus of pubis. Methods: We retrospectively reviewed patients with acetabular tumors involving ishium, inferior ramus of pubis underwent surgery in Shanghai General Hospital from January 2016 to June 2020 with modified K-L approach, including 8 women and 12 men, patients aged from 19-76 years, including 6 chondrosarcomas, 6 osteosarcomas, 3 metastatic pelvic tumors, 2 epithelioid sarcomas, 3 giant cell tumor of bone. 20 patients were defined as pelvic Ennecking zone II + pelvic zone III involvement. All patients were followed up regularly in clinic, operation time, intraoperative bleeding, methods of reconstruction, duration of hospitalization, perioperative complications were recorded, and MSTS functional score was used to evaluate the patients' functional status.Results: All patients were followed up regularly in clinic with a mean 32 months (20-48 months). No patient died in the perioperative period, the average intraoperative bleeding was 1250 ml (800-2400 ml) in 10 patients, the mean operation duration was 2.6 hours (2-3.5 hours), no wound infection and delayed healing, the average duration of hospital stay was 12 days (10-16 days), the main complications during the follow-up included nervus cutaneus femoris posterior paralysis, 2 tumor recurrence, MSTS score was 22.5 points. 4 patients died during follow-up. Conclusions: The posterior K-L approach can be employed to effectively resect and reconstruction pelvic acetabular tumors invoving ishium, inferior ramus of pubis and reconstruct them properly. It is mainly suitable for malignant pelvic tumors involving the pelvic III and II + III regions. It also can often be available for biological reconstruction by using the acetabulum tantalum metal block, acetabulum reinforcing ring or autograft femur head. It is of highly safety and few perioperative complications, which is worth popularizing.

Karakteristik Kuantitatif dan Jarak Genetik Beberapa Galur Ayam Lokal

The research of this study aims to know quantitative characteristics and genetic distance of several local chicken strains. The research material is Super chicken, KUB chicken, and Kampung chicken. The method used was an experiment with a sample of 82 chickens from each strain. Retrieval of BW and AVG data are collected every month until the age of 2 months, while body measurements are taken at the age of 2 months. The data collected are quantitative characteristics includes body weight, weight gain, beak length, beak width, head length, head circumference, head height, neck length, neck circumference, wing length, back length, back height, back height, chest length, chest width, shank length, shank circumference, tibia length, tibia circumference, third finger length and pubic bone distance. Data collected were analyzed using t-test to see the difference in BB, PBB, and body measurements using Minitab statistical software 18. Mahalanobis distance approach with a matrix of variance between variables based on chicken strains was arranged into a matrix to determine the discriminant function and then form phylogenetic trees by using the MEGA X program via the UPGMA method. Body weight, average daily gain, and body sizes of Super chickens are bigger than other strains of chickens, while the smallest is owned by Kampung chickens. The closest genetic distance matrix was shown by Super chickens to KUB chickens (4.08) and the farthest genetic distance was shown by KUB chickens to Kampung chickens (13.87). Keywords: Genetic distance; Local chicken; Quantitatif characteristic Abstrak Tujuan penelitian ini untuk mengetahui karakteristik kuantitatif dan jarak genetik beberapa galur ayam lokal. Materi penelitian ini adalah ayam Super, ayam KUB, dan ayam Kampung. Metode yang digunakan adalah eksperimen dengan sampel 82 ekor ayam jantan/betina yang dipelihara umur 1 hari sampai umur 2 bulan pada masing-masing galur. Pengambilan data BB dan PBB diambil pada setiap bulan hingga ayam berumur 2 bulan, sedangkan ukuran-ukuran tubuh diambil pada umur 2 bulan. Data yang dihimpun adalah karakteristik kuantitatif meliputi bobot badan, pertambahan bobot badan, panjang paruh, lebar paruh, panjang kepala, lingkar kepala, tinggi kepala, panjang leher, lingkar leher, panjang sayap, panjang punggung, tinggi punggung, panjang dada, lebar dada, panjang shank, lingkar shank, panjang tibia, lingkar tibia, panjang jari ketiga dan jarak tulang pubis. Data yang dikumpulkan dianalisis menggunakan uji-t untuk melihat perbedaan BB, PBB, dan ukuran-ukuran tubuh menggunakan perangkat lunak statistika Minitab 18. Pendekatan jarak Mahalanobis dengan matriks peragam antara peubah berdasarkan galur ayam disusun menjadi sebuah matriks untuk mengetahui fungsi diskriminan kemudian membentuk pohon filogenetik dengan menggunakan program MEGA X melalui metode UPGMA. BB, PBB, dan ukuran-ukuran tubuh ayam Super lebih besar dibandingkan dengan galur ayam lainnya, sedangkan yang paling kecil dimiliki oleh ayam Kampung. Nilai matrik jarak genetik terdekat ditunjukkan oleh ayam Super dengan ayam KUB (4,08) dan jarak genetik terjauh ditunjukkan oleh ayam KUB dengan ayam Kampung (13,87). Kata Kunci: Ayam lokal; Jarak genetik; Karakteristik kuantiatif

Anatomical Reasoning for Atraumatic Trocar Placement during Implantation of a Transobturator Suburethral Sling

The aimof this research was to study the variant anatomy of the obturator complex in terms of surgical treatment of stress urinary incontinence, as well as to determine the most atraumatic technique for conducting a surgical trocar for a transobturator suburethral sling.Material and methods.A suburethral sling was implanted on 40 sagittally dissected samples of the female pelvis with preserved soft tissues using two techniques: the conventional one based on the use of external landmarks and the technique of the trocar rotation around the lower branch of the pubic bone developed at the University Clinic of St. Petersburg. After implantation of a transobturator suburethral sling, the probability of injury to the branches of the obturator nerve was assessed by precision preparation for each of the presented techniques using 40 samples. It was also suggested to develop a protocol for atraumatic placement ofa sling for stress urinary incontinence.Results. Based on the results obtained and study of the topographic relationships of the trocar and branches of the obturator nerve, it is concluded that the obturator complex has significant anatomical variability. This relates to both the muscular component –the internal and external obturator muscles, and neurovascular structures. The obturator nerve has two types of branching: joint and separate. The latter is a risk factor for intraoperative nerve injury. The technique of suburethral sling implantation by rotating the surgical trocar around the inferior branch of the pubic bone is atraumatic and safe.Conclusions.Variant anatomy of the obturator complex influences the probability of trauma in a transobturator suburethral sling implantation. In particular, the separate branching of the obturator nerve is a risk factor for its intraoperative injury. Further clinical studies are required to assess the outcomes of surgical t reatment of stress urinary incontinence taking into account the variant anatomy of the true pelvis.

Anatomical premises for the variability of the results of transobturator mid-urethral sling

Introduction. The implantation of a synthetic sub-urethral sling is the main method of surgical correction of stress urinary incontinence (SUI). However, the investigation results of long-term effectiveness indicate the ambiguity of the surgery outcomes. In addition, the problem of pain in the perineum remains relevant for everyday practice. One of the important aspects in this matter may be a variant technique for installing a suburethral sling, including based on the anatomical variability of the small pelvis.Purpose of the study. To identify key anatomical factors that can negatively affect the effectiveness and safety of the environment of suburethral sling surgery for urinary incontinence in women.Materials and methods. The study consisted of 2 parts - anatomical and clinical. In the anatomical part of the study, a suburethral sling was implanted on 20 preparations of a female pelvis with a lower limb and preserved soft tissues. The clinical part of the study involved 50 patients with stress urinary incontinence. These patients underwent installation of a transobturator suburethral sling in two ways using the “inside-out” technique: using the standard “external landmarks” technique and using the proposed anatomical technique developed in the first part of the study. After visualization of the suburethral sling using the original method, the outcomes of the operations were assessed depending on the location of the sling in the patient's tissues.Results. In the anatomical part of the study, the most atraumatic method of suburethral sling implantation was determined by rotating the tool around the lower branch of the pubic bone. In the clinical part of the study, this method demonstrated a higher efficiency of the operation at a follow-up of 1 year, presumably due to the U-shaped angle of the «hammock» for the urethra, which is characteristic of the retropubic sling.Conclusion. Outcomes of operations for SUI depend, among other things, on the method of the suburethral sling implantation.