pelvic injury and imbalance

The volume of pelvic hematoma at CT has been shown to be the strongest independent predictor of major arterial injury requiring angioembolization in trauma victims with pelvic fractures, and also correlates with transfusion requirement and mortality. Measurement of pelvic hematomas (unopacified extraperitoneal blood accumulated from time of injury) using semi-automated seeded region growing is time-consuming and requires trained experts, precluding routine measurement at the point of care. Pelvic hematomas are markedly variable in shape and location, have irregular ill-defined margins, have low contrast with respect to viscera and muscle, and reside within anatomically distorted pelvises...

OBJECTIVE: Sagittal imbalance and loss of lumbar lordosis are the main drivers of functional disability in adult degenerative scoliosis. The main limitations of the classic posterior lumbar interbody fusion technique are increased risk of neurological injury and suboptimal correction of the segmental lordosis. Here, the authors describe the radiological results of a modified posterior lumbar interbody fusion and compare the results with a historical cohort of patients. METHODS: Eighty-two consecutive patients underwent surgical treatment for degenerative scoliosis/kyphosis in a single tertiary referral center for complex spinal surgery...

The sacrum forms the distal end of the spine and communicates with the pelvis. Fractures involving the sacrum are complex and may disrupt this vital communication. Neglecting these fractures may result in malunion, which often causes significant alteration in the pelvic parameters and sagittal balance. Management of ensuing deformities is complex and poorly described. The authors present a case of sacral malunion with sagittal imbalance treated with a low lumbar osteotomy.

In acute trauma, pelvic ring instability can lead to hemorrhage and hemodynamic instability. Pelvic ring instability and displacement that is not stabilized may lead to chronic pain, sitting imbalance, and limb length inequality. Methods and timing of securing anterior pelvic ring injuries operatively is controversial and debatable. Many orthopaedic trauma surgeons would agree that acceptable methods to treat a disrupted anterior pelvic ring fracture include nonoperative care, external fixation, internal spanning fixators, intramedullary superior ramus screws, and open reduction internal fixation...

This review evaluates the existing level of evidence for efficacy of BoNTs in different pain syndromes using the recommended efficacy criteria from the Assessment and Therapeutic Subcommittee of the American Academy of Neurology. There is a level A evidence (effective) for BoNT therapy in post-herpetic neuralgia, trigeminal neuralgia, and posttraumatic neuralgia. There is a level B evidence (probably effective) for diabetic neuropathy, plantar fasciitis, piriformis syndrome, pain associated with total knee arthroplasty, male pelvic pain syndrome, chronic low back pain, male pelvic pain, and neuropathic pain secondary to traumatic spinal cord injury...

PROBLEM AND HYPOTHESIS: Over time, some patients with unilateral or bilateral lumbosacral injuries experience chronic low back pain. We studied the sagittal and frontal balance in a population with these injuries to determine whether mismatch in the pelvic and lumbar angles are associated with chronic low back pain. PATIENTS AND METHODS: Patients with posterior pelvic ring fractures (Tile C1, C2, C3 and A3.3) that had healed were included. Foreign patients and those with an associated spinal or acetabular fracture or nonunion were excluded...

OBJECTIVES: To examine how spinopelvic morphology changes after traumatic spinopelvic dissociation and whether these changes affect the sagittal balance of the spine. DESIGN: Retrospective analysis. SETTING: Level I trauma center. PATIENTS: Thirty-nine consecutive patients who were diagnosed with traumatic spinopelvic dissociation and had a minimum 2-year radiological follow-up were included. INTERVENTION: Nineteen patients underwent spinopelvic pedicle screw fixation, 11 patients underwent percutaneous iliosacral screw fixation, and 9 patients were treated conservatively...

OBJECTIVE: To discuss the clinical effects of damage control resuscitation (DCR) in treating severe multiple trauma in the pelvic fractures. METHODS: From March 2009 to September 2013, a restrospective analysis was conducted on the clinical data of 28 patients with multiple trauma in the pelvic fractures, including 19 males and 9 females, ranging in age from 21 to 51 years old with an average of 32.5 years old. According to Tile classification of pelvic fractures, 16 cases were type B and 12 cases were type C...

Sacral fractures are generally accompanied by pelvic ring fractures. They rarely develop in an isolated form. Sacroiliac dislocation without sacral fracture is extremely rare. We report a case with a sacroiliac dislocation without sacral fracture, which was treated surgically. Lumbopelvic stabilization was applied using iliac wing plates. The case was evaluated according to his clinical condition and visual analogue score (VAS), American Spinal Injury Association (ASIA) and Oswestry scales. Considering the role of the sacrum, which transmits the load of the entire spine to the pelvis, meticulous care must be given to ensure the mechanic stability of the spine when evaluating patients with sacral and pelvic fractures...

Long-duration exposure to the space environment causes physical adaptations that are deleterious to optimal functioning on Earth. Post-mission rehabilitation traditionally concentrates on regaining general muscle strength, neuromuscular control, and lumbo-pelvic stability. A particular problem is muscle imbalance caused by the hypertrophy of the flexor and atrophy of the extensor and local lumbo-pelvic muscles, increasing the risk of post-mission injury. A method currently used in European human spaceflight to aid post-mission recovery involves a motor control approach, focusing initially on teaching voluntary contraction of specific lumbo-pelvic muscles and optimizing spinal position, progressing to functional retraining in weight bearing positions...

CONTEXT: Pelvic stress fractures, osteitis pubis, and snapping hip syndrome account for a portion of the overuse injuries that can occur in the running athlete. EVIDENCE ACQUISITION: PUBMED SEARCHES WERE PERFORMED FOR EACH ENTITY USING THE FOLLOWING KEYWORDS: snapping hip syndrome, coxa sultans, pelvic stress fracture, and osteitis pubis from 2008 to 2013. Topic reviews, case reports, case series, and randomized trials were included for review. STUDY DESIGN: Clinical review...

The runner who presents with pain in the hip and pelvis, all too often is approached from a one-joint or soft tissue injury concept. Since most injuries to this region are related to overuse and, in particular, overload injury, a biomechanical approach to identify significant muscle imbalances and joint dysfunctions must be sought. In addition, their relationship as predisposing factors to soft tissue injury will be emphasized in this article. A thorough understanding of the relationship between the lumbar spine, pelvis, hip and thigh, and, in particular, dysfunctions and imbalances in the lumbo-pelvic movements, are the most essential...

The "sportsman's hernia" commonly presents as a painful groin in those sports that involve kicking and twisting movements while running, particularly in rugby, football, soccer, and ice hockey players. Moreover, sportsman's hernia can be encountered even in normally physically active people. The pain experienced is recognized at the common point of origin of the rectus abdominis muscle and the adductor longus tendon on the pubic bone and the insertion of the inguinal ligament on the pubic bone. It is accepted that this chronic pain caused by abdominal wall weakness or injury occurs without a palpable hernia...

STUDY DESIGN: Retrospective case series. OBJECTIVES: Introduce and evaluate the safety of a new technique of anterior column realignment (ACR) using a lateral transpsoas approach with release of anterior longitudinal ligament and annulus for correction of focal kyphotic deformity. SUMMARY OF BACKGROUND DATA: Spinal sagittal imbalance can adversely affect the long-term outcomes of patients with spinal deformity. METHODS: Clinical and radiographic review of patients who underwent ACR...

OBJECTIVE: To detail the progress of 2 high-level soccer players and 1 recreational soccer player with chronic groin pain that was exacerbated by participation in sports and relieved by rest. The patients under went a conservative treatment plan featuring manual therapy, therapeutic modalities, and plyometric training. CLINICAL FEATURES: The most important examination findings were palpable tenderness over the internal oblique fascia and anterior pubic tubercle, pain with resisted hip adduction, and pain with a resisted abdominal curl-up...

In summary, LBP is a common problem for the young adult athlete, with discogenic pain being the most common of all etiologies. Although rare, more serious etiologies such as tumor or infection should be included in the differential diagnosis until effectively ruled out. Regardless of the cause, nonoperative and conservative strategies should be the cornerstone of treatment, owing to the favorable natural history of most LBP etiologies. Short-term non-narcotic medications are helpful, and avoidance of bed rest is critical for the athletic population...

Hamstring strain injuries (HSIs) are common in a number of sports and incidence rates have not declined in recent times. Additionally, the high rate of recurrent injuries suggests that our current understanding of HSI and re-injury risk is incomplete. Whilst the multifactoral nature of HSIs is agreed upon by many, often individual risk factors and/or causes of injury are examined in isolation. This review aims to bring together the causes, risk factors and interventions associated with HSIs to better understand why HSIs are so prevalent...

Endometriosis is one of the most frequent benign gynecological diseases that affect women. Little is known about the pathogenesis and etiology of endometriosis, despite the numerous studies performed in this field. Although endometriosis is a benign disease, the endometrial tissue, after attachment to the peritoneum, has the ability to grow and invade the surrounding tissues. Similar to neoplastic growth, local extracellular proteolysis might take place, and therefore, the fibrinolytic system may be involved...

We analyse our experience in performing the wet colostomy, also called urocolostomy and present seven cases treated at our hospital in which this was used. We present: a) three women, one underwent an urocolostomy as a result of a myelomeningocele with urinary and fecal incontinence, another because of a pelvic malignancy, and the third after developing a post radiotherapy cysto-proctitis; b) four men, one underwent this surgical procedure as a result of a traumatic paraplegia with multiple urinary fistulae and neurogenic bladder, the other three were secondary to pelvic malignancies (two bladder and one sigmoid malignacies)...

BACKGROUND: The study was concerned with the secondary functional compromise persons with long-term paraplegia contend with, that has been shown to be associated with wheelchair use. Of particular interest was the relationship between the level of thoracic spinal cord injury (SCI) and factors predisposing to rotator cuff disorders (RCD), one of the most common upper extremity musculoskeletal complications linked with long-term SCI. Disorders of these peri-articular structures have previously been associated with impaired trunk postural control and abnormal muscle strength ratios in both able-bodied groups and in paraplegic athletes...