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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
Optimal indications are superior pubic ramus fractures, situated above the obturator foramen or at the anterior lip of the acetabulum. The retrograde transpubic screw is also called an anterior column screw as it can be inserted antegrade as part of the osteosynthesis of acetabular fractures. Retrograde insertion is done in a percutaneous technique if the fracture is minimally displaced.
Injuries of the pelvis
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
This is the rarest fracture pattern seen. It is very commonly mistaken for a superior pubic ramus fracture that encroaches on the acetabular rim. A true anterior wall fracture is associated with anterior subluxation of the femoral head (Figure 29.24). The injury occurs with the leg in external rotation and radiographs will show the iliopectineal line broken in two places associated with a large trapezoid fragment.
Investigation of pelvic floor disorders
Published in Climacteric, 2019
MRI allows detection of morphologic changes of the pelvic floor which correlate with PFDs53. Significant differences in levator muscle volume, shape, and integrity are observed between asymptomatic women and patients with UI or POP53. The levator muscles can be assessed for areas of asymmetric thickening or atrophy, focal defects, scarring, ballooning, or focal eventration54. In nulliparous women, the puborectalis muscle appears uniformly intact whereas unilateral or bilateral muscle tears may result from vaginal trauma or injury during childbirth55. In primiparous women, around 20% have some degree of structural defect or deviation55. Disruption of the puborectalis at the attachment to the superior pubic ramus has been associated with SUI55.
STAT1 and STAT3 mutations: important lessons for clinical immunologists
Published in Expert Review of Clinical Immunology, 2018
Peter Olbrich, Alexandra F. Freeman
A recently diagnosed case illustrates nicely the above. The patient presented at age 3 years with limps and bone pain. Imaging revealed destructive lesions in the right iliac bone, right superior pubic ramus, left calcaneus, and distal left tibia. Biopsy showed granulomatous osteomyelitis with cultures positive for Mycobacterium kansasii. Combined antimycobacterial treatment resulted in a rapid improvement and antibiotics were stopped after 1 year maintaining azithromycin prophylaxis. Immunologic work-up was normal, and a heterozygous mutation in STAT1 (c.2017A>G) was detected. His asymptomatic identical twin brother was found to also carry this mutation and he was subsequently started on azithromycin prophylaxis (Freeman AF, personal communication).