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Management of osteoporotic pelvic fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Pol M. Rommens, Daniel Wagner, Alexander Hofmann
Another minimally invasive technique for bridging the posterior pelvic ring in FFP is posterior transiliac internal fixation (52). The patient is placed in prone position. Two small vertical incisions are made just medial to the posterior superior iliac spines. The medial and posterior aspects of the spines are exposed. One long pedicle screw is placed in the left and one in the right posterior ilium. Their trajectory starts from the posterior superior iliac spine and goes laterally and anteriorly in the direction of the anterior superior iliac spine, passing just above the greater sciatic notch. The screws are located between the inner and outer cortexes of the ilium and have a diameter of up to 7 mm and a length of up to 100 mm. The screw heads are connected with a slightly bowed rod with a diameter of 5 or 6 mm, which has been placed in a subcutaneous tunnel connecting both crests. To avoid protruding hardware, which may lead to wound disturbances, a bone block with the width of a pedicle screw head is removed from the posterior iliac crest before screw insertion. This enables countersinking of the screw head below or at the level of the iliac crest (Figure 20.6a–i). Stiffness of the posterior transiliac internal fixator was higher as in double iliosacral screw osteosynthesis in a transforaminal fracture model (53). Recently, promising clinical data with a cement augmented transiliac internal fixator were published (54). Other outcome data with the posterior transiliac internal fixator in FFP have not yet been published.
Blocks of Nerves of the Sacral Plexus Supplying the Lower Extremities
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand
The posterior femoral cutaneous nerve (Posterior cutaneous nerve of the thigh) is a sensory nerve formed by fibers originating from the ventral rami of S1 to S3 spinal nerves. It issues from the pelvis through the greater sciatic notch and runs deep to the gluteus maximus, within the subgluteal space, accompanied by the inferior gluteal artery, medial or posterior to the sciatic nerve (Figure 2.29). It is enclosed in a fascial canal different from that through which the sciatic nerve runs. It enters the dorsal part of the thigh deep to the fascia lata and runs towards the knee where it gives terminal branches. It supplies the skin covering (1) the lower part of the gluteus maximus (gluteal branches), (2) the medial part of the posterior aspect of the thigh (perineal branches and branches to the back of the thigh), and (3) the popliteal fossa and the upper part of the posterior aspect of the leg (posterior branches of the back of the leg) (Figure 2.30).
Pelvis and perineum
Published in Aida Lai, Essential Concepts in Anatomy and Pathology for Undergraduate Revision, 2018
Ilium– iliac crest: between ant. sup. iliac spine (ASIS) and post. sup. iliac spine (PSIS)– iliac tuberosity– ant. inf. iliac spine, post. inf. iliac spine– greater sciatic notch– lesser sciatic notch– ischial spine separates greater sciatic notch from lesser sciatic notch– sciatic notches are divided into greater and lesser sciatic foramina by sacrotuberous and sacrospinous ligaments
Prediction of pelvic tumour coverage by magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) from referral imaging
Published in International Journal of Hyperthermia, 2020
Ngo Fung Daniel Lam, Ian Rivens, Sharon L. Giles, Emma Harris, Nandita M. deSouza, Gail ter Haar
Internal acoustic obstructions, primarily bone, were segmented by manual contouring of axial slices using OsiriX Lite v10.0.4 [13] (Pixmeo, Geneva, Switzerland) and Horos. For volunteers, pelvic bones were manually segmented from referral imaging datasets. The registered-referral imaging dataset pelvic bone segments were applied to the corresponding treatment imaging dataset in order to reduce the burden of manual contouring. Femora were manually segmented separately from referral and treatment imaging datasets, because of the likelihood of different articulation between datasets (unlike the more rigid pelvis). For patients, the treatment region was considerably smaller and therefore pelvic bones as well as femora close to the target (tumor) could be manually segmented in a realistic time. However, contouring was restricted to ±10 axial slices from the edges of the tumor to reduce the time burden of manual segmentation. The pelvic bones at the greater sciatic notch were always segmented, because the notch defines the superior edge of the sciatic foramen through which the acoustic beam is expected to sonicate the tumor.
The influence of musculoskeletal forces on the growth of the prenatal cortex in the ilium: a finite element study
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Peter J. Watson, Michael J. Fagan, Catherine A. Dobson
The distribution produced when plotting the overall peak von Mises strain in each element arising from the four hip joint movements (Figure 5) (hereafter referred to as peak strain) resembles that associated with flexion and adduction (Figure 4). However strains are observed between the acetabulum and greater sciatic notch on the pelvic surface, which resembles that generated during extension.
Influence of energy absorbers on Malgaigne fracture mechanism in lumbar-pelvic system under vertical impact load
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
K. Arkusz, T. Klekiel, G. Sławiński, R. Będziński
The average strain values measured in six points of the LPC model (Figure 1A) in numerical analysis under a 500 N vertical load are listed in Table 4. The minimal strain value was 11.5e–4 localised in greater sciatic notch. In contrast, the maximum strain value was 54.73e–4 at the first foramina sacralia pelvica.