A review of the treatment of pelvic discontinuity.
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ABSTRACT:
SUBMITTER: Villanueva M
PROVIDER: S-EPMC2553162 | biostudies-other | 2008 Sep
REPOSITORIES: biostudies-other
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Project description:BackgroundBilateral pelvic discontinuity is characterized by complete dissociation of the superior and inferior pelvis secondary to bone loss or fracture. The end result is a freely mobile inferior pelvis at the level of each discontinuity which presents a significant reconstruction challenge. This clinical entity has not been described previously, and the results of surgical treatment are not known.MethodsWe retrospectively reviewed all identified cases of pelvic discontinuity (PD) treated with revision THA at one institution. We identified 133 pelvic discontinuities. Within this group, 6 patients had bilateral simultaneous PDs. Preoperative, intraoperative, and postoperative data and radiographic imaging were reviewed preoperatively and postoperatively for the characteristics of the dissociation and assessing PD healing and fixation of components after surgery.ResultsThere were no preoperative factors that could distinguish these patients from the rest of the group of discontinuities (3 rheumatoid arthritis, 2 osteonecrosis of the femoral head, 1 developmental dysplasia). The reconstructions performed included 2 cup/cage, 5 posterior plating and uncemented cup, 3 cage alone, and 2 cups only. Ten of 12 hips had at least 1 complication postoperatively. At final follow-up, only 1 patient (17%) had radiographic evidence that both discontinuities had healed (posterior plate with uncemented cup).ConclusionsBilateral pelvic discontinuity is rare but presents the surgeon with a major reconstructive challenge. Only 1 patient went on to radiographic healing with current treatment strategies. Continued motion of the contralateral pelvic dissociation may account for the high failure rates. Surgeons should be aware of the challenges presented by this diagnosis and develop strategies to improve outcomes.
| S-EPMC5247510 | biostudies-literature
Project description:A 74-year-old female patient presented to our clinic with pelvic discontinuity after multiple revision total hip surgeries requiring custom triflange acetabular reconstruction, which we accomplished through a direct anterior approach to the hip. The direct anterior approach to the hip has grown in popularity but still has the reputation of being a minimally invasive approach without the capacity for extensile exposure in the revision setting. We describe the extensile technique and demonstrate through our case the ability to perform the most challenging cases through this approach and discuss the potential benefits of its utilization.
| S-EPMC6920714 | biostudies-literature
Project description:With newer-generation ceramic components used in total hip arthroplasty, component fracture is a rare complication. However rare, when ceramic component fracture does occur, prompt identification and revision is necessary as delay can lead to dramatic failure with resultant metallosis as the extremely hard ceramic debris abrades remaining components. We present a case of a 70-year-old woman with ceramic liner fracture and an estimated 10-year delay in intervention with failure resulting in pelvic discontinuity and massive metallosis with associated cutaneous manifestation. She was treated with a complex revision and reconstruction and is 2 years postrevision without major complication.
| S-EPMC5485230 | biostudies-literature
Project description:BackgroundRegression discontinuity designs are non-randomized study designs that permit strong causal inference with relatively weak assumptions. Interest in these designs is growing but there is limited knowledge of the extent of their application in health. We aimed to conduct a comprehensive systematic review of the use of regression discontinuity designs in health research.MethodsWe included studies that used regression discontinuity designs to investigate the physical or mental health outcomes of any interventions or exposures in any populations. We searched 32 health, social science, and gray literature databases (1 January 1960 to 1 January 2019). We critically appraised studies using eight criteria adapted from the What Works Clearinghouse Standards for regression discontinuity designs. We conducted a narrative synthesis, analyzing the forcing variables and threshold rules used in each study.ResultsThe literature search retrieved 7658 records, producing 325 studies that met the inclusion criteria. A broad range of health topics was represented. The forcing variables used to implement the design were age, socioeconomic measures, date or time of exposure or implementation, environmental measures such as air quality, geographic location, and clinical measures that act as a threshold for treatment. Twelve percent of the studies fully met the eight quality appraisal criteria. Fifteen percent of studies reported a prespecified primary outcome or study protocol.ConclusionsThis systematic review demonstrates that regression discontinuity designs have been widely applied in health research and could be used more widely still. Shortcomings in study quality and reporting suggest that the potential benefits of this method have not yet been fully realized.
| S-EPMC7707156 | biostudies-literature
Project description:BackgroundIntravaginal electrical stimulation (IVES) has been explored as a potential treatment for pelvic floor disorders (PFDs), although its efficacy remains a subject of debate. We aim to conducted a comprehensive meta-analysis of relevant trials.MethodsThis meta-analysis was performed under the PRISMA 2020 guideline. We meticulously searched for randomized controlled trial (RCT) studies in various databases, including PubMed, Cochrane Library, EMBASE, and ClinicalTrials.gov, spanning from inception to March 6, 2023. All studies included one treatment group of intravaginal electrical stimulation and the diseases spectrum of the studies involved different kinds of PFDs, including urinary incontinence, overactive bladder, etc. Risk of bias charts were used to assess the risk of bias in the studies and forest plots were used the demonstrate the overall effects.ResultsOur analysis encompassed a total of 13 RCT studies. In most of the assessed PFD cure outcomes, the results demonstrated positive effects of IVES therapy, as indicated by the following findings: daily voiding frequency (MD = -1.57, 95% CI = -3.08 to -0.06, I 2 = 68%,), nocturia (MD = -1.07, 95% CI = -2.01 to -0.13, I 2 = 71%), Pad test, and Urinary incontinence. Nevertheless, the data concerning the impact of IVES therapy on the quality of life of individuals with PFDs did not confirm these positive results.DiscussionIn light of the insufficiency in both the quality and quantity of the included studies, it is premature to draw a definitive conclusion regarding the efficacy of IVES therapy for treating PFDs. Nonetheless, our study does provide several pieces of evidence in support of the potential therapeutic effects of electrical stimulation therapy in this context. We recommend that further research in this area be conducted to provide more conclusive insights into the efficacy of IVES therapy for PFDs.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42023442171.
| S-EPMC11348806 | biostudies-literature
Project description:RationaleFibrous dysplasia is a rare disorder that results in fractures, pain, and disability and can affect any bone in the body. The treatment of symptomatic fibrous dysplasia is determined based on the affected bones. Although some lesions are often too extensive for surgical procedures, there are currently no effective or recommended medical treatments available for them.Patient concernsA 27-year-old woman developed right buttock pain and was diagnosed with a bone tumor in the right ilium. Clinical images revealed an expansive osteolytic lesion with thinning of the cortex and cystic change from the acetabulum to the sacroiliac joint.DiagnosisAn incisional biopsy was performed, and the lesion was diagnosed as cystic fibrous dysplasia. Occasional osteoclast-like giant cells and woven bone were observed. The patient had no evidence of polyostotic lesions or findings of McCune-Albright syndrome. Biochemical blood test results showed no obvious abnormal values, except for an increase in serum tartrate-resistant acid phosphatase 5b to 459 mU/dL.InterventionsSince surgical treatment appeared to be challenging, she was treated with denosumab with decreased dose-intensity schedules.OutcomesThe administration of denosumab caused osteosclerosis within the lesion, resulting in the elimination of bone pain. The patient received denosumab treatment for 18 months. Pain relief and lesion radiodensity were maintained for 9 months after denosumab discontinuation. The serum level of tartrate-resistant acid phosphatase 5b was measured to monitor the response to denosumab, which was suppressed during denosumab treatment.LessonsWe described successful denosumab treatment in a patient with cystic fibrous dysplasia (FD) who maintained efficacy for 9 months after treatment. Although the use of denosumab in fibrous dysplasia is currently off-label, our experience with this patient supports the potential of denosumab therapy for patients for whom surgical treatment is challenging.
| S-EPMC8663861 | biostudies-literature
Project description:BACKGROUND: Abdomino-pelvic injuries often present a challenge for the emergency department. Although literature reports several protocols on the treatment of abdomino-pelvic injuries aiming at defining the most advisable treatment line, optimal treatment is still controversial. This paper describes a protocol that has been used to treat abdomino-pelvic injuries in our hospital since 2002. MATERIALS AND METHODS: In literature different protocol of abdomino-pelvic injuries are described and comparing them most of the difference are the timing of CT scan, the angiography and the laparotomy when treating a lesion of pelvic ring. If patient is haemodynamically instable and presents a lesion of pelvic ring our protocol suggest the simplest and fastest stabilization (pelvic external fixator) in emergency room and delay exam such as CT scan as second level exam. In the presence of an abdominal injury, with a positive focused assessment with sonography for trauma test, the first step should be a pelvic ring stabilization, as laparotomy decreases the abdominal pressure and reduces the tamponade effect on the retroperitoneum. According to presented protocol the angiography is not be a first choice treatment. This protocol was applied to 58 cases of abdomino-pelvic injury with unstable pelvic lesions from October 2002 to December 2005. Mean injury severity score was 27.2 (CI 24.1-30.3). RESULTS: Five patients (8%) died, three due to haemorrhagic shock and two due to pulmonary embolization. Four patients (6.9%) had a partial or complete cauda equina syndrome, four patients (6.9%) complained of mild incontinence, whilst 1 (1.7%) complained of urinary retention with multiple cystitis. Two patients (3.4%) with retention and multiple cystitis, had a malunion and a painful non-union of the fracture. Seven patients (12.3%) had neurological impairment: 5 (8.6%) sciatic nerve palsy, 1 (1.7%) lumbosacral root lesions in a C2-type fracture and there was one case (1.7%) of inconstant lumbago with sciatic pain. Twelve patients reported different levels of sexual dysfunction (20.7%). CONCLUSIONS: Although validation with a larger cohort is required, our preliminary clinical data are similar to, or better than, those reported in the most recent publications on this question, suggesting that this protocol could well reduce both the mortality rate and the long term complications of abdominopelvic injuries.
| S-EPMC2656964 | biostudies-other
Project description:BackgroundPelvic fractures in children are indicative of significant trauma. Patients will often have associated injuries - some of which require urgent intervention to prevent death and disability. Paediatric and adult pelvises respond to traumatic forces differently and distinct approaches are required for each population. Historically, pelvic fractures have been treated conservatively, but this trend is changing with a better understanding of the pelvis' inability to remodel significant deformity, as well as new techniques for operative fixation.MethodsA comprehensive search of the literature was conducted for articles published between 2000 and 2020 on paediatric pelvic fractures using medical databases including PubMed, Embase and the Cochrane Library.ResultsWe included 143 studies in our literature review and summarized the incidence, pathophysiology, assessment, management and complications associated with paediatric pelvic fractures.ConclusionsThe rarity of paediatric pelvic fractures corresponds with a paucity of randomized clinical trials covering this topic. Trends such as the screening pelvic x-ray are derived from adult populations but are now questioned in children. Other aspects of assessment and management of these children warrant such levels of scrutiny.
| S-EPMC10084350 | biostudies-literature
Project description:BackgroundPelvic inflammatory disease (PID) is the result of infection ascending through the endocervix to the uterus and fallopian tubes. Inflammation driven by infected host cells appears to be central to the development of tissue damage and associated reproductive complications. Nonsteroidal anti-inflammatory agents (NSAIDs) therefore have the potential to reduce the sequelae associated with pelvic infection.MethodsA search of four electronic reference databases, an internet search for relevant grey literature and a review of the bibliographies of identified publications was used to identify studies evaluating NSAIDs in the management of PID. A predefined search strategy was used to identify studies that included women with PID aged over 16 and diagnosed after 1980. Randomized controlled trials, nonrandomized controlled trials, and cohort studies with comparison group data were included without language restriction. Two reviewers independently assessed the studies against agreed criteria and extracted relevant data using a standardized pro forma. A meta-analysis to calculate the relative risk associated with NSAID use was planned if appropriate.ResultsForty-three studies were identified. After reviewing abstracts or full texts, two randomized controlled trials were found to meet the selection criteria for inclusion. The use of NSAIDs was reported to improve tubal patency, reduce pelvic adhesions and reduce suprapubic pain but the studies were of poor quality with a high risk of bias. Meta-analysis of the data was not performed.ConclusionsInsufficient data is available to support or refute the efficacy of NSAIDs in the prevention of short or long-term complications of PID.
| S-EPMC4125595 | biostudies-literature