Embarazo y ortopedia / Pregnancy and Orthopaedics

Introducción: Son múltiples las afecciones ortopédicas que sufre una mujer embarazada, por ello las demandas de atención por esta causa van en ascenso. Objetivo: Actualizar el tratamiento de las lesiones traumáticas y ortopédicas en la paciente embarazada y coordinar las indicaciones de la cesárea. Métodos: Se utilizan métodos teóricos y empíricos para realizar análisis del conocimiento actualizado sobre estas. Resultados: Se determinó que el parto normal es posible después de una fractura pélvica, siempre que no existan secuelas que dañen el canal del parto. El dolor de espalda fue un síntoma común en las mujeres embarazadas, pero en las que presentaron escoliosis las molestias fueron más frecuentes. La diastasis de la sínfisis del pubis se asoció con la maniobra de McRoberts; y la indicación de cesárea se sugirió a partir de criterios puramente obstétricos, aunque se respetaron las afecciones ortopédicas y traumáticas presentes en las pacientes. Conclusiones: Incrementar los conocimientos del personal que trabaja con la embarazada, a partir de sus factores de riesgo y las posibilidades de mitigación de daño por estas causas.

Introduction: pregnant women suffer from multiple orthopaedic conditions; therefore, care demands for this cause are on the rise. Objective: to update the treatment of traumatic and orthopaedic injuries in pregnant patients and coordinate the indications for cesarean section. Methods: theoretical and empirical methods were used to carry out the analysis of updated knowledge regarding these affections. Results: we determined that normal delivery is possible after a pelvic fracture, as long as there are no sequelae that damage the birth canal. Back pain was a common symptom in pregnant women but in those with scoliosis the discomfort was more frequent. Symphysis pubis diastasis was associated with the McRobert's maneuver; and the indication for cesarean section was suggested based on purely obstetric criteria, although the orthopaedic and traumatic conditions present in the patients were respected. Conclusions: to increase the knowledge of the personnel, who work with the pregnant women, based on their risk factors and the possibilities of mitigating damage due to these causes.

Mid-term follow-up of superior pubic ramus osteotomy in locked symphysis pubis with urethral injury: A case report / 中华创伤杂志(英文版)

A locked pubic ramus body is an unusual variant of lateral compression injury. Till date, there have been only 25 cases reported in the published literature. We herein described a case where the right pubic ramus was entrapped within the opposite obturator foramen with an overlap of greater than 4 cm, with associated urethral injury. When all maneuvers of closed and instrumented reduction failed, we performed a superior pubic ramus osteotomy on the left side and unlocked the incarcerated right pubic ramus. The osteotomy site was stabilized with a 6-hole recon plate. The patient underwent delayed urethral repair 10 weeks after the index surgery. At 3-year follow-up, the patient has sexual dysfunction especially difficulty in maintaining erection, secondary urethral stricture, heterotopic ossification, and breakage of implants.

Research progress of pubic symphysis diastasis / 中国修复重建外科杂志

OBJECTIVE@#To review the research progress of pubic symphysis diastasis and provide effective reference for orthopedic surgeons in the diagnosis and treatment of pubic symphysis diastasis.@*METHODS@#The anatomy, injury mechanism, treatment, and other aspects of pubic symphysis diastasis were summarized and analyzed by reviewing the relevant research literature at domestically and internationally in recent years.@*RESULTS@#The incidence of pubic symphysis diastasis is high in pelvic fractures, which is caused by the injury of the ligaments and fibrocartilage disc around the pubic symphysis by external force. The treatment plan should be individualized according to the pelvic stability and the needs of patients, aiming to restore the stability and integrity of the pelvis and improve the quality of life of patients after surgery.@*CONCLUSION@#At present, the research on pubic symphysis diastasis still needs to be improved. In the future, high-quality, multi-center, and large-sample studies are of great significance for the selection of treatment methods and the evaluation of effectiveness for patients with pubic symphysis diastasis.

Value of ultrasonic measurement of pubic symphysis distance during labor / 中华超声影像学杂志

Objective:To explore the application value of ultrasonic measurement of the pubic symphysis distance in predicting pubic symphysis diastasis(PSD) during delivery.Methods:A total of 262 pregnant women from June 2021 to July 2022 who delivered at Suzhou Wuzhong People′s Hospital and Jiangyin People′s Hospital were retrospectively analyzed. The patients were divided into PSD group of 26 cases and normal pregnant women group (control group) of 234 cases according to whether or not PSD was confirmed during postpartum follow-up. Relevant data of the two groups were collected, including the biparietal diameter and femoral length of the fetus within 7 days before delivery, the pubic symphysis distance of pregnant women when the cervix was not dilated, pubic symphysis distance when the cervix dilated to 5 cm during the first stage of delivery, and the pubic symphysis distance after delivery, the age of the pregnant woman, the gestational week, the number of pregnancies, and the birth weight of the fetus. The differences of the above relevant data between the two groups were compared.Spearman correlation analysis was used to analyze the correlation between various parameters. The occurrence of postpartum PSD, and Logistic regression was used to analyze the predictive value of various parameters on the occurrence of postpartum PSD. ROC curve was used to analyze the diagnostic efficacy of each parameters to predict PSD.Results:The fetal birth weight, number of pregnancies, pubic symphysis distance in three time points in the PSD group were significantly higher than those in the control group (all P<0.05). The age of the pregnant women was negatively correlated with the occurrence of postpartum PSD ( rs=-0.152, P=0.014). The fetal birth weight, the number of pregnancies, the pubic symphysis distance in the cervix no-dilated and the first stage of labor were positively correlated with the occurrence of postpartum PSD( rs=0.160, 0.166, 0.678, 0.581, all P<0.05). Logistic regression analysis showed that the increase of pubic symphysis distance before labor would increase the risk of postpartum PSD, and the difference was statistically significant ( OR=2 506.028, 95% CI=14.293-439 402.630, P=0.003). The increase of pubic symphysis distance at the first stage of labor increased the risk of postpartum PSD, with a statistically significant difference ( OR=10 704.027, 95% CI=33.830-3 386 803.429, P=0.002). The ROC curve analysis showed that the area under the curve of the pubic symphysis distance in the cervix no-dilated and the first stage of labor for the diagnosis of PSD were 0.896 and 0.917 respectively, the sensitivity were 0.731 and 0.885, the specificity were 0.940 and 0.829, and the corresponding critical values were 0.87 cm and 1.06 cm respectively. The area under the curve of the combination of the two parameters for the diagnosis of PSD was 0.930, the sensitivity was 0.885, and the specificity was 0.876. Conclusions:Ultrasonic measurement of pubic symphysis distance during delivery can predict the occurrence of postpartum PSD in pregnant women and can provide a basis for the occurrence and treatment of postpartum pubic symphysis separation in pregnant women.

The pubic symphysis orthotic compression anatomic plate for treatment of fractures and dislocations around the pubic symphysis / 中华创伤骨科杂志

Objective:To evaluate our self-designed pubic symphysis orthotic compression anatomic plate (PSOCAP) in the treatment of fractures and dislocations around the pubic symphysis.Methods:A retrospective study was conducted to analyze the 16 patients with fracture or dislocation around the pubic symphysis who had been treated by our self-designed PSOCAP at Department of Traumatic Surgery, Center for Orthopaedic Surgery, The Third Hospital Affiliated to Southern Medical University from January 2021 to June 2022. There were 8 males and 8 females with an age of (41±19) years. According to the Tile classification for pelvic fractures, there were 3 cases of type B1, 2 cases of type B3, 1 case of type C1.2, 4 cases of type C1.3, 3 cases of type C2, and 3 cases of type C3. There were 8 cases of pubic symphysis separation and 8 fractures of the pubic ramus (2 ones at Nakatani zone Ⅰ and 6 ones at Nakatani zone Ⅱ). Time from injury to surgery was 16 (11, 53) days, ranging from 4 to 348 days. The fractures or dislocations around the pubic symphysis were exposed by the modified Stoppa approach, reduced with the assistance of PSOCAP and fixated with PSOCAP; the posterior pelvic ring was reduced and fixated by corresponding surgical methods. Recorded were the surgical time, intraoperative bleeding, postoperative quality of fracture reduction, surgical complications, and functional recovery at the last follow-up concerning the pelvic anterior ring.Results:Surgery went on successfully in the 16 patients. Their surgical time was (58±15) min, ranging from 40 to 90 min, and their intraoperative bleeding 85 (63, 150) mL, ranging from 50 to 250 mL. According to the Matta scoring, the fracture reduction was evaluated as excellent in 10 cases, as good in 3 cases and as fair in 3 cases. The (10±3)-month follow-up for the 16 patients revealed complete fracture union for all after (12±2) weeks. According to the Majeed scoring at the last follow-up, the pelvic function was evaluated as excellent in 5 cases, as good in 7 cases, and as fair in 4 cases. No such postoperative complications as fracture displacement or internal fixation failure occurred.Conclusion:Owing to the biplane and integrated structure, our self-designed PSOCAP can help reduce the fractures or dislocations around the pubic symphysis to achieve anatomical reduction and strong internal fixation, leading to good clinical efficacy.

Pelvic incidence and osteitis pubis in professional soccer players / Incidência pélvica e osteíte púbica em jogadores profissionais de futebol

ABSTRACT Introduction. Osteitis pubis is a common inflammatory disease of the pubic symphysis, defined as a chronic pain syndrome caused by repetitive microtrauma. Since adaptative changes are necessary in the pelvis to adjust the equilibrium of the myotendinous structures, the aim of this study was to evaluate the correlation between pelvic incidence and osteitis pubis among professional soccer players. Materials and Methods. An observational, cross-sectional study was performed with professional soccer players from five teams during pre-season. Athletes with previous congenital pelvic abnormalities or a history of surgery were excluded. Radiographs of the pelvis were analyzed by two radiologists and assessed for findings consistent with osteitis pubis, and the following parameters were measured: pelvic incidence (PI), sacral inclination (SI), and pelvic version (PV). Results. A total of 107 subjects were included in the study, with a mean age of 25.6 ± 3.1 years. Findings compatible with osteitis pubis were present in 74.8% of the subjects (80/107). There was no statistical correlation between osteitis pubis and PI (52.3°±12.7° vs. 48.4°±10.8°; p=0.156), SI (43.1°±9.8° vs. 39.9°±10.1°; p=0.146), or PV (9.2°± 6.3° vs 8.6°± 7.5°; p=0.649). Agreement between readers was excellent (p<0.0001). Conclusion. There was no significant correlation between pelvic parameters and radiographic diagnosis of osteitis pubis. Leve of Evidence II; Diagnostic study.

RESUMO Introdução. A osteíte púbica é uma doença inflamatória comum da sínfise púbica, definida como síndrome de dor crônica causada por microtraumas de repetição. Uma vez que são necessárias mudanças adaptativas na pelve para adequar o equilíbrio das estruturas miotendíneas, o objetivo deste estudo foi avaliar a correlação entre e a incidência pélvica e a osteíte púbica em jogadores profissionais de futebol. Materiais e Métodos. Estudo transversal, observacional, conduzido com jogadores profissionais de futebol de cinco times profissionais durante a pré-temporada. Foram excluídos do estudo atletas com anormalidades congênitas prévias ou com história de cirurgia. As radiografias de pelve foram avaliadas por dois médicos radiologistas quanto aos achados compatíveis com osteíte púbica, e os seguintes parâmetros foram medidos: incidência pélvica (PI), inclinação sacral (SI) e versão pélvica (PV). Resultados. Foram incluídos 107 participantes, com média de idade de 25,6 ± 3,1 anos. Achados compatíveis com osteíte púbica estavam presentes em 74,8% dos indivíduos (80/107). Não houve correlação estatística entre osteíte púbica e PI (52,3°± 12,7° vs. 48,4° ± 10,8°; p = 0,156), SI (43,1° ± 9,8° vs. 39,9° ± 10,1°; p = 0,146) ou PV (9,2° ± 6,3° vs. 8,6° ± 7,5°; p = 0,649). A concordância entre os médicos radiologistas foi excelente (p < 0,0001). Conclusões. Não houve correlação significativa entre os parâmetros pélvicos e o diagnóstico radiográfico de osteíte púbica. Nível de Evidência II; Estudo diagnóstico.

Infix plus cannulated screws for the treatment of pelvic injuries caused by pubic symphysis separation in middle-aged and elderly patients / 中华老年医学杂志

Objective:To investigate the clinical effect of Infix combined with hollow screws for the treatment of pelvic injuries with pubic symphysis separation in middle-aged and elderly patients.Methods:Data of 8 middle-aged and elderly patients with pelvic injuries due to pubic symphysis separation undergone treatment from January 2017 to December 2020 were retrospectively analyzed.Results:The average operating time of 8 patients was (46.0±6.2)min(range: 40-62min); the average intraoperative blood loss was (32.0±5.6)ml(range: 25-50 ml); the average length of incisions at the iliac screw was(2.6±0.4)cm(range: 2.0-3.5 cm); the average length of incisions at the hollow screw was (1.1±0.3)cm(range: 0.8-1.5 cm); and the average times of fluoroscopy were (36.0±6.0)times(range: 28-52 times). Postoperative X-ray and CT examinations showed that the reduction of the pubic symphysis was good, the inserted iliac screws and cannulated screws were positioned accurately, and the incision healed well.Based on Matta's criteria, postoperative radiological outcomes were evaluated, with 7 cases rated as excellent and 1 as good, giving an excellent to good rate of 100%(8/8). The average followed up time for all 8 patients was (15.0±4.2)months(range: 6-24 months). Pelvic X-ray and CT examinations at the last follow-up showed that the fractures healed well and the pubic symphysis reduction did not fail.Infix and cannulated screws in the pubic symphysis were removed 10-12 weeks after surgery[average: (10.5±0.5)weeks]. According to the Majeed Pelvic Score, 5 cases were rated as excellent, 2 cases as good and 1 as fair, with an excellent to good rate of 87.5%(7/8). One patient had symptoms related to the lateral femoral cutaneous nerve that disappeared after 3 months.One patient developed deep venous thrombosis after surgery, and the filter was placed and removed 10 weeks later.Conclusions:Using Infix plus cannulated screws for the treatment of pelvic injuries in middle-aged and elderly patients with pubic symphysis separation has the advantages of limited trauma and intraoperative blood loss, good fixation and few complications.

Comparison of Three Methods for Skeleton Age Estimation / 法医学杂志

OBJECTIVES@#To find the appropriate method for age estimation for different ages and sexes.@*METHODS@#The costal cartilage, sternum and pubic symphysis of 91 unknowns from 2000 to 2020 from the Forensic Department of the Criminal Investigation Team of Shanghai Public Security Bureau were collected. Costal cartilage, sternal and pubic symphysis inferences were used to estimate the age, and the consistency between the estimated results and the actual physiological age of the unknowns was tested. The accuracy of age estimation of different samples was compared, and the relationship between accuracy and age and sex was analyzed.@*RESULTS@#Using the costal cartilage method, the inference errors of males, females and the whole population under 40 years old were (0.608±2.298) years, (0.429±1.867) years and (0.493±2.040) years, while those over 40 years old were (-1.707±3.770) years, (-3.286±4.078) years and (-2.625±4.029) years. The differences between different age groups in these three populations were statistically significant (P<0.05). Using the sternum method, the inference errors of males and females under the age of 40 were (0.921±3.019) years and (0.452±1.451) years, while those over the age of 40 were (-5.903±5.088) years and (-1.429±2.227) years. The differences between different age groups in males and females were statistically significant (P<0.05). Using the pubic symphysis method, the inference errors of males and females under 40 years old were (-0.204±1.876) years and (0.238±2.477) years, while those over 40 years old were (1.500±2.156) years and (-2.643±4.270) years. The differences between different age groups in males and females were statistically significant (P<0.05). Using the sternum method and pubic symphysis method for age estimation of over 40 years old, the difference between different sexes was statistically significant (P<0.05).@*CONCLUSIONS@#All three methods of age estimation are stable and effective and more accurate for people under 40 years old. For age estimation of unknowns over 40 years old, the pubic symphysis method is preferred in males and the sternum method is preferred in females.

Septic Arthritis of the Pubic Symphysis in Adult: A Case Report / Artrite séptica da sínfise pubiana em adultos: Relato de caso

Abstract Septic arthritis of the pubic symphysis is a rare condition. Risk factors include trauma, low-grade infection, urological or gynecological procedures, malignant tumors of the pelvis, sports, and intravenous drug abuse. This report describes a case of septic arthritis of the pubic symphysis in a 23-year-old male patient with no history of pelvic surgery, previous infections, or intense physical activity. Arthritis was diagnosed by blood culture positive for Enterococcus spp. and yeasts, and the patient was treated with antibiotics. This case emphasizes the importance of complementary exams to aid the treatment of septic arthritis of the pubic symphysis and shows that an invasive procedure, such as pubic symphysis puncture biopsy, may not be required.

Resumo A artrite séptica da sínfise púbica é uma condição rara. Os fatores de risco são trauma, infecção de baixo grau, procedimentos urológicos ou ginecológicos, tumores malignos da pelve, prática de esportes e uso de drogas intravenosas. O presente relato descreve um caso de artrite séptica da sínfise púbica em um paciente do sexo masculino, de 23 anos, sem história de cirurgias pélvicas, infecções prévias ou atividade física intensa. A artrite foi diagnosticada pela hemocultura que revelou crescimento de Enterococcus sp + leveduras, e o paciente foi tratado com antibioticoterapia. Este caso enfatiza a importância de exames complementares no auxílio do tratamento da artrite séptica da sínfise púbica, e demonstra que procedimentos invasivos, tais como a punção da sínfise púbica, podem não ser necessários.

No clinical advantage of locking over nonlocking plate fixation of symphyseal disruptions / Nenhuma vantagem clínica do uso de placas bloqueadas sobre não bloqueadas na disjunção da sínfise púbica

ABSTRACT Purpose: although locking plates have led to important changes in fracture management, becoming important tools in the orthopedic surgeon's arsenal, the benefits of locking plates for traumatic diastasis of the pubic symphysis have not been established. This study was conducted to assess the quality of life in its different domains among patients with traumatic diastasis of the pubic symphysis managed either with locking or nonlocking plate. Methods: a prospective cohort study was undertaken at 3 level 1 trauma centres in Brazil. Patients presenting traumatic diastasis of the pubic symphysis treated with plate fixation with a minimum follow-up of 12 months were eligible for inclusion. Through a Pfannenstiel approach, the pubic symphysis was reduced and fixed with a superiorly positioned 4.5mm four to six hole reconstruction locked plate or 3.5mm four to six hole reconstruction nonlocked plate. Posterior injury was managed during the same procedure. Outcome measures were adequate healing of the pelvic injuries, return to pre-injury level on daily activities, and quality of life at the last follow-up visit. Complications and modes of failure were summarized and reviewed. Bivariate linear regression was used to assess individual factors affecting patients' health-related quality of life. A p value of <5% was considered significant. Results: a total of 31 adult patients (29 males and 2 females) were eligible for the study. Thirteen patients were managed with a reconstruction locked plate and 18 patients with a nonlocked reconstruction plate. Average postoperative follow-up time was 24 months. Adequate healing of the pelvic injuries was achieved in 61.5% of patients treated with locking plates and 94.4% of patients treated with nonlocking plates (p=0.003). Radiographic failure of fixation with minor complications occurred in 46.1% of patients after locked plating versus 11.1% of patients in the nonlocking plate group (p=0.0003). In bivariate analysis, abnormal gait (p=0.007) was associated with a reduced long-term quality of life as measured with the EQ-5D-3L. Conclusion: internal fixation of traumatic diastasis of the pubic symphysis with locking plates has no clinical advantage when compared to nonlocked plating. Mechanical failure and inadequate healing are significantly increased after locked plating of the pubic symphysis. Therefore, we do not recommend routine use of locking plates for managing patients presenting traumatic diastasis of the pubic symphysis. Level of evidence: II (prospective, cohort study).

RESUMO Justificativa e Objetivo: embora as placas bloqueadas tenham levado a mudanças importantes no tratamento de fraturas, tornando-se ferramentas importantes no arsenal do cirurgião ortopédico, os benefícios para a fixação da lesão da sínfise púbica não foram adequadamente estabelecidos. Este estudo foi realizado para avaliar a qualidade de vida em diferentes domínios de pacientes com disjunção traumática da sínfise púbica tratados com placas bloqueadas e não bloqueadas. Métodos: trata-se de estudo de coorte prospectivo, realizado em três centros de trauma nível 1, no Brasil. Foram elegíveis para inclusão no estudo pacientes com disjunção traumática da sínfise púbica tratados com redução aberta e fixação interna com placa, com seguimento mínimo de 12 meses. Por meio de abordagem de Pfannenstiel, a sínfise púbica foi reduzida e fixada com uma placa bloqueada de reconstrução de 4,5mm de quatro a seis orifícios posicionada superiormente ou com uma placa não bloqueada de reconstrução de 3,5mm de quatro a seis orifícios. A lesão pélvica posterior foi tratada durante o mesmo procedimento. Os desfechos analisados na última visita de acompanhamento foram cicatrização da lesão pélvica, retorno às atividades diárias para nível pré-lesional e qualidade de vida. Complicações e modos de falha foram observados e descritos. Foi utilizada regressão linear bivariada na avaliação dos fatores individuais que afetaram a qualidade de vida relacionada à saúde dos pacientes, com valor p <5% considerado significativo. Resultados: foram incluídos no estudo 31 pacientes adultos (29 homens e 2 mulheres). Treze pacientes foram tratados com placa de reconstrução bloqueada e 18 com placa de reconstrução não bloqueada. O tempo médio de seguimento pós-operatório foi de 24 meses. A cicatrização adequada da lesão do anel pélvico foi alcançada em 61,5% dos pacientes tratados com placas bloqueadas e em 94,4% dos pacientes tratados com placas não bloqueadas (p=0,003). Falha radiográfica de fixação com complicações menores ocorreu em 46,1% dos pacientes tratados com placa bloqueada contra 11,1% dos pacientes no grupo de placas não bloqueadas (p=0,0003). Na análise bivariada, marcha anormal (p=0,007) foi associada à redução da qualidade de vida em longo prazo, medida com o EQ-5D-3L, embora não tenha sido observada relação direta destas com os implantes utilizados. Conclusão: a fixação interna da disjunção traumática da sínfise púbica com placas bloqueadas não apresenta vantagem clínica quando comparada com placas não bloqueadas. Falha mecânica e cicatrização inadequada aumentam significativamente após o uso de placas bloqueadas na sínfise púbica. Portanto, não recomendamos o uso rotineiro de placas bloqueadas para o tratamento de pacientes com disjunção traumática da sínfise púbica. Nível de evidência: II (estudo de coorte prospectivo).

Holistic Pelvic Ring Concept in Treatment of Postpartum Pubic Symphysis Diastasis / 中国康复理论与实践

Objective:To observe the effect of pelvic band fixation with three-dimensional adjustment of suspended pelvis on patients with pubic symphysis diastasis under the holistic pelvic ring concept. Methods:From February, 2018 to February, 2020, 30 parturients with pubic symphysis diastasis were evaluated pelvic ring. They accepted three-dimensional adjustment of pelvis with suspension to restore the anatomical reduction of sacroiliac joint and the symphysis pubis according to the evaluation, and were fixed with pelvic band for six to eight weeks. The pubic symphysis union was monitored with color ultrasonography. They were reviewed with pelvic X-ray two weeks after removal of pelvic band, and assessed with Visual Analogue Scale (VAS) for pain and modified Barthel Index (MBI) before treatment, immediately after removal of the pelvic band and two weeks after removal of the pelvic band, while the pelvic ring structure was measured. Results:The scores of VAS and MBI improved two weeks after pelvic band removal compared with those before treatment, as well as distance of pubic symphysis separation, upper margin difference of pubic symphysis, width difference of iliac wings, transverse and longitudinal diameter difference of obturator foramens (t > 2.509, P < 0.05). However, the scores of VAS and MBI improved two weeks after pelvic band removal compared with those immediately after removal of the pelvic band (|t| > 2.854, P < 0.05), while the distance of pubic symphysis separation increased (t = 2.319, P < 0.05), still in the normal reference value. Conclusion:Correcting the post-partum pubic symphysis diastasis under the holistic pelvic ring concept can restore the anatomical structure of the pelvis, avoid the compensatory movement pattern, and improve the daily living in the later time.

Anatomic progress of pubic symphysis and biomechanical characteristics of internal fixation / 中国组织工程研究

BACKGROUND: The separation injury of pubic symphysis is most commonly associated with severe pelvic fracture injuries. Because the anatomical position of the pubic symphysis is deep, and the curative effect is often unsatisfactory. Anatomical and biomechanical studies are necessary to better guide clinical diagnosis and treatment. OBJECTIVE: To summarize and analyze the anatomical characteristics and biomechanical research status of pubic symphysis, and to provide some benefits for the clinical treatment of pubic symphysis separation. METHODS: The authors retrieved CNKI, VIP, and PubMed with the key words of “separation of pubic symphysis” and “biomechanics” for articles published from April 1984 to February 2020. Relevant literature was selected by title and abstract, and the titles and abstracts of the references were read. The related literatures were selected again and the duplicate literatures were eliminated. RESULTS AND CONCLUSION: There were 57 eligible literatures, and 33 were finally included. (1) The present anatomical study mainly focuses on the structure of pubic symphysis and its adjacent ligaments. (2) Because of the position of pubic symphysis, no further study was carried out. The precise distribution of the starting and ending points of the peripheral ligaments and muscles, and the precise nerve and blood distribution need further study. (3) There have been relatively few studies of pubic symphysis biomechanics, and they vary widely. It needs to be deeply studied and agreed upon. (4) With the development of finite element, the biomechanics focus on the treatment of pubic symphysis. (5) Due to good mechanical stability, the reconstructed plate and the hollow screw are used as common fixation for pubic symphysis separation. However, percutaneous hollow screw fixation has become the trend in the future because of its minimal invasion.

Biomechanical Properties of the Modified Memory Alloy Internal Fixator for Separation of Pubic Symphysis / 医用生物力学

Objective To investigate biomechanical characteristics of the modified memory alloy internal fixator for separation of pubic symphysis. Methods The model of pubic symphysis separation injury was established based on 10 pelvic specimens. The control group was fixed with the dynamic compression plate after reduction, and the experimental group was fixed with the modified memory alloy internal fixator for separation of pubic symphysis after reduction. The biomechanical stability for two kinds of internal fixation was compared. Results There were no loosening and fracture of internal fixation in both groups. The displacement of pubic symphysis in horizontal, anterio-posterior and vertical direction in the experimental group was obviously reduced compared with the control group (P＜0.05). Conclusions Compared with the dynamic compression plate, the modified memory alloy internal fixator for separation of pubic symphysis shows better resistance to the tensile force against horizontal and anterio-posterior direction, as well as better resistance to the vertical shear force.

Diástasis de la sínfisis púbica posparto: Reporte de caso

Pubic symphysis diastasis is rare in normal vaginal delivery. Etiology is not clear but it is associated with multiparity, macrosomia, physiological joint loosening and excessive force on the pubic area. Symptoms include pain around the pubic symphysis, hips, groin, lower abdomen and inner thighs, as well as tenderness over the area. Imaging shows distance between pubic bones. Management varies from case to case and outcomes are scarcely known. Delayed diagnosis has health implications for the woman in the short and long term. We report a case of postpartum pubic symphysis diastasis. An 18-year-old woman presented lacerating pain in the pubic area in the second day of the postpartum period, after a pregnancy of normal evolution and a spontaneous vaginal delivery, with a term live newborn and no apparent complications. On physical examination, we found moderate pain in the pubic region, which interfered with walking and active movements of the lower limbs. A supine anteroposterior x-ray of the pelvic area showed abnormal diastasis of the pubic symphysis of approximately 25 millimeters long, without bone nor congenital anomalies. Conservative treatment led to recovery three months later.

La disrupción de la sínfisis púbica después de un parto vaginal normal es rara. La etiología no es clara, pero se asocia con multiparidad, macrosomía, debilitamiento fisiológico de la articulación y fuerza excesiva en el área púbica. Los síntomas incluyen dolor cerca de la articulación púbica, caderas, ingle, parte inferior del abdomen y parte interna de los muslos, acompañada de sensibilidad del área. Los estudios por imágenes muestran la distancia entre los huesos púbicos. El manejo médico es variable y los resultados potenciales todavía son poco conocidos. Sin embargo, el retraso en el diagnóstico tiene graves consecuencias para la salud de la mujer en forma aguda y a largo plazo. Se presenta un caso de diástasis de la sínfisis púbica posparto. Se trata de mujer de 18 años que presentó dolor lacerante en el área púbica durante el segundo día del puerperio. Tuvo embarazo de evolución normal y parto vaginal espontáneo, a término, con recién nacido vivo y sin complicaciones. En el examen físico se encontró dolor moderado en la región del pubis que interfería con la marcha y los movimientos activos de los miembros inferiores. La radiografía pélvica anteroposterior en posición supina mostró diástasis anormal de la sínfisis púbica de aproximadamente 25 milímetros de extensión, sin otras anomalías óseas o congénitas. Se recomendó tratamiento conservador, con recuperación a los 3 meses.

Imaging Assessment of the Pubis in Soccer Players / Avaliação por imagem do púbis em jogadores de futebol

Abstract Objective To compare the accuracy of ultrasound (US) with that of magnetic resonance imaging (MRI) in the detection of aponeurosis lesions of the rectus abdominis/adductor longus muscles, to study the characteristics of the athletes and imaging findings associated with pubalgia, and to demonstrate the importance of each method in evaluating this condition. Materials and methods The present study was conducted from 2011 to 2016 with 39 professional soccer players: 15 with pubalgia and 24 without pubalgia. Age, field position, bodymass index (BMI), weekly training load, career length, and history of thigh/knee injury and lower back pain were recorded. The following tests were performed: radiographs (anteroposterior view of the pelvis in standing and flamingo positions) to evaluate hip impingement, sacroiliac joint, and pubic symphysis instability; US to analyze the common aponeurosis of the rectus abdominis/adductor longus muscles and inguinal hernias; and MRI for pubic bone degenerative alterations and edema, and lesions in the adductor and rectus abdominis muscles and their aponeurosis. Results There was an association between pubalgia, high BMI (p = 0.032) andmuscle alterations (p < 0.001). Two patients with pubalgia had inguinal hernias and one patient with pubalgia and two controls had sports hernias. Pubic degenerative changes were frequent in both groups. Aponeurosis lesions weremore frequent in patients with pain. The US detection had 44.4% sensitivity and 100% specificity. Conclusion The evaluation of athletic pubalgia should be performed with radiography, US, and MRI. High BMI, muscle injuries, geodes, and osteophytes are findings associated with pubalgia; US has low sensitivity to detect injuries of the common aponeurosis of the rectus abdominis/adductor longus muscles.

Resumo Objetivo Comparar a acurácia da ultrassonografia em relação à ressonância magnética na detecção de lesões da aponeurose do reto abdominal/adutor longo, estudar características dos jogadores e achados de imagem associados à pubalgia e demonstrar a importância de cada método. Materiais e métodos Estudo realizado de 2011 a 2016 com 39 jogadores profissionais de futebol, 15 deles com e 24 sem pubalgia. Foram registrados idade, posição, índice de massa corporal (IMC), carga de treino semanal, tempo de profissão e lesão prévia na coxa/joelho e lombalgia. Os seguintes exames de imagem foram realizados: radiografias (anteroposterior da bacia e flamingo) para avaliar sinais de impacto do quadril, articulações sacroilíacas e instabilidade da sínfise púbica; ultrassonografia para analisar a aponeurose comum do reto abdominal/adutor longo e hérnias inguinais e do esporte; ressonância magnética buscando alterações degenerativas e edema no púbis, lesões musculares dos adutores e retos abdominais e na sua aponeurose. Resultados Observou-se uma associação entre pubalgia e IMC elevado (p = 0,032) e alterações musculares (p < 0,001). Hérnia inguinal foi encontrada em dois casos e hérnia do esporte, em um caso e dois controles. Alterações degenerativas do púbis foram frequentes nos dois grupos. Lesões da aponeurose foram mais comuns nos pacientes com dor e a ultrassonografia teve sensibilidade de 44,4% e especificidade de 100% na detecção. Conclusão A avaliação da pubalgia atlética deve ser realizada com radiografias, ultrassonografia e ressonância magnética. Índice de massa corporal elevado, lesões musculares, geodos e osteófitos são achados associados à pubalgia; a ultrassonografia tem baixa sensibilidade para detectar lesões da aponeurose comum do reto abdominal/ adutor longo.

Location of the umbilicus in Korean women and its changes after breast reconstruction with an ipsilateral pedicled rectus abdominis musculocutaneous flap

BACKGROUND: The umbilicus makes an important contribution to the natural appearance of the abdomen. To date, studies on its position in Korean women are lacking, and no standards have been established. The purpose of this study was to investigate the position of umbilicus in Korean women and to review changes in its position after ipsilateral pedicled rectus abdominis musculocutaneous (IP-RAM) flap. METHODS: This research consisted of two studies. In first study, 100 females who visited the emergency department with gastroenteritis between 2007 and 2011 were included. In second study, 40 women who underwent IP-RAM flap in the same period were included. Using abdominal computed tomography, we measured the distance between xiphoid process and umbilicus, represented by value a, and the distance between umbilicus and symphysis pubis, represented by value b. Thus, the location of the umbilicus was represented by the ratio a/b. The data were analyzed using Pearson correlation test and paired t-test. RESULTS: In study 1, the mean value of a/b was 1.07. Pearson correlation test revealed a significant correlation between age and a/b. In study 2, the mean value of a/b was 1.16 in preoperative measurements and 1.01 in postoperative measurements. The paired t-test showed a significant difference between preoperative and postoperative measurements, indicating cephalic migration of the umbilicus after surgery. CONCLUSIONS: The natural position of the umbilicus showed caudal migration with aging. Additionally, in a comparison of preoperative and postoperative measurements in patients who underwent IP-RAM flap, cephalic migration of the umbilicus was observed after surgery.

LOCKED PUBIC SYMPHYSIS: A CASE REPORT AND REVIEW OF LITERATURE

@#Locked pubic symphysis is a rare form of pelvic injury that usually occurs after a lateral compression injury to the pelvis, where the intact pubis is trapped behind the contralateral pubis. To the best of our knowledge, there were 25 similar cases reported in the English literature since it was first described in 1952. We present a case of locked pubic symphysis with a left iliac wing fracture and a left femur shaft fracture requiring open reduction and internal fixation. We also reviewed previous reported cases of locked pubic symphysis and analysed the pattern of presentation and guide to management of such injuries. We propose a classification system for grading overlapping pubic symphysis that will provide a better guide to the management of such injuries

Age Estimation of Adult Living Donor by Pubic MSCT Three-dimensional Recon-struction / 法医学杂志

Objective To establish a method for the age estimation of adult living donor based on pubic MSCT three-dimensional reconstruction and verify its accuracy and reliability. Methods The volume ren-dering (VR) image data of pubic symphysis surface were collected from 300 volunteers aged over 17 years old. According to different age groups, the age estimation of these volunteers was performed by the method and formula of pubic symphysis surface. Results In the 300 volunteers, the difference between biological age and actual age was <1 year in 117 cases, >1-2 years in 178 cases, >2 years in 5 cases. Conclusion MSCT three-dimensional reconstruction technology of pubic symphysis surface can be used to estimate the age of adult living donor, which can provide a high accurate and reliable result.

Case-control study on clinical effects of squeezing and clapping manipulation for treating the postpartum pubic symphysis separation / 中国骨伤

<p><b>OBJECTIVE</b>To study the clinical effect of squeezing and clapping bone setting manipulation in treating the postpartum pubis symphysis separation.</p><p><b>METHODS</b>From June 2015 to March 2017, 80 patients with postpartum pubic symphysis separation were randomly divided into treatment group and control group, 40 patients in each group. In treatment group, the patients' reproductive age ranged from 26 to 40 years old with an average of (30.61±5.94) years old and the neonatal weight ranged from 3.2 to 4.52 kg with an average of (3.59±0.13) kg. In control group, patients' reproductive age ranged from 22 to 37 years old with an average age of (27.51±4.57) years old and the neonatal weight ranged from 3 to 5.8 kg with an average of (3.81±0.63) kg. The patients in the treatment group were treated with the squeezing and clapping manipulation, once a week for 3 weeks. The patients in the control group were treated with pelvic bandage immobilization, and the immobilization of the pelvis was not less than 8 hours per day, 3 weeks for 1 course. The VAS pain score, Oswestry dysfunction index (ODI) and separation distance of pubis were clinical observed and evaluated on the first day of treatment, 1, 2, 3 weeks and 1 months after treatment.</p><p><b>RESULTS</b>The pubic symphysis VAS score was compared with that before treatment, in the treatment group, the difference was statistically significant at 1 week(0.013); the difference was statistically significant in the control group for 1 month (0.042). The two groups were less than those of the control group after treatment (<0.05). The ODI score was compared with that before the treatment, in the treatment group, the difference was statistically significant at 1 week (0.009), the difference was statistically significant in the control group for 1 month(0.013), the two groups were less than those before treatment(<0.05). The pubic symphysis distance was compared with that before treatment, the treatment group decreased significantly after treatment (<0.05), there was no significant difference in the control group after treatment (>0.05), the two groups were compared, the difference was statistically significant at first weeks(0.042) and third weeks (0.005).</p><p><b>CONCLUSIONS</b>The "squeezing and clapping" manipulation can quickly restore the distance between pubic symphysis separation, relieve local pain and improve lumbosacral function, and is better than pelvic bandage fixation treatment.</p>

Revisitando a puboplastia pós-bariátrica / Revisiting Postbariatric Monsplasty

INTRODUÇÃO: O tratamento da região pubiana é parte integrante do reajuste corporal inferior nos pacientes pós-bariátricos, tendo em vista a fisiopatologia e o caráter generalizado das deformidades de contorno após grandes emagrecimentos. O objetivo é apresentar nossa experiência no tratamento de pacientes pós-bariátricos, exclusivamente pela marcação baixa da abdominoplastia com vetores adequados de mobilização tecidual, sem a necessidade de cicatrizes verticais ou oblíquas na região do púbis. MÉTODOS: Foram avaliados retrospectivamente prontuários médicos e registros fotográficos de pacientes submetidos a diferentes abordagens abdominais, com aplicação dos princípios descritos acima no tratamento associado da região pubiana. Incisão cutânea anterior baixa, descolamento cranial angulado em direção ao plano aponeurótico (bisel preservando gordura profunda superior), e manutenção um excedente gorduroso nos bordos superiores para a facilitar a fixação dos retalhos através do Sistema Fascial Superficial. Uma avaliação subjetiva da qualidade dos resultados foi caracterizada por observador único. RESULTADOS: Numa casuística de 126 pacientes consecutivos, a tática empregada possibilitou restabelecer a melhor posição, tônus e formato do púbis em 100% dos casos, cujos resultados foram subjetivamente classificados como bom (40%) ou ótimo (60%). As intercorrências mais frequentemente encontradas na evolução pós-operatória foram pequenas deiscências da sutura (23,8%) e seromas (19%), com boa evolução pelos curativos e punções seriadas. CONCLUSÃO: A tática cirúrgica apresentada, com posicionamento baixo da incisão anterior e aproximação dos retalhos por fixação no sistema fascial superficial e pele, possibilita o tratamento adequado da região pubiana durante as abdominoplastias pós-bariátricas, sem a necessidade de ressecções e cicatrizes adicionais.

INTRODUCTION: The treatment of the pubic region is an integral part of lower body readjustment in post-bariatric patients, considering the pathophysiology and generalized characteristics of contour deformities after a considerable weight loss. The objective is to present our experience in the treatment of post-bariatric patients, exclusively by low marking of abdominoplasty with appropriate tissue mobilization vectors, without the necessity to leave vertical or oblique scars in the pubic region. METHODS: The medical and photographic records of patients subjected to different abdominal approaches were retrospectively evaluated, applying the principles described above in the combined treatment of the pubic region. A low anterior skin incision was created, and angled cranial detachment towards the aponeurotic plane (with the bevel preserving the deep upper fat) and maintenance of excess fat on the upper edges to facilitate the fixation of the flaps through the superficial fascial system were performed. The outcomes' quality was subjectively evaluated by a single observer. RESULTS: In the case series of 126 consecutive patients, the strategy used restored the best position, tone, and shape of the pubis in 100% of the cases; the results were subjectively classified as good (40%) or very good (60%). The complications more frequently found in the post-operative period were small suture dehiscence (23.8%) and seroma formation (19%), with good evolution provided by dressings and serial punctures. CONCLUSION: The surgical strategy presented involving low positioning of the anterior incision and flap alignment in the superficial fascial system and skin by fixation allows the proper treatment of the pubic region during post-bariatric abdominoplasty procedures, without the need for additional resections and scars.