Relationship between Femoroacetabular Impingement and Pubalgia in Professional Soccer Players / Relação do impacto femoroacetabular e pubalgia em jogadores profissionais de futebol de campo

Abstract Objective To analyze the relationship between pubalgia and femoroacetabular impingement (FAI) in professional athletes of a soccer club, defining the prevalence of these conditions in the sample studied. Methods It is an epidemiological, cross-sectional, and analytical study including 90 professional soccer players active from 2019 to 2021. We accessed the medical records of the subjects to retrieve information from the modified Pre-Competition Medical Assessment (PCMA) protocol, orthopedic physical examination, and anteroposterior pelvic radiographs to assess pubalgia and FAI, respectively. Inclusion criteria were athletes playing in the professional soccer club in the 2019 to 2021 season, who underwent a modified PCMA upon admission, and who signed an informed consent form. Results FAI was highly prevalent (85.6%) in the sample. This prevalence may occur because, in Brazil, people start playing sports early, not always in suitable fields, or with no proper equipment and supervision. In addition, the CAM-type impingement was the most frequent (62.2%). These injuries are related to high-intensity movements, including those associated with soccer. Furthermore, there is no dependency correlation between pubalgia and FAI. FAI was present in only 20% of athletes with pubalgia complaints. Conclusion There was a high prevalence of FAI in professional soccer players in the studied population (85.6%) but with no relationship between FAI and pubalgia.

Resumo Objetivo Analisar a relação entre a pubalgia e o impacto femoroacetabular (IFA) em atletas profissionais de um clube de futebol, definindo a prevalência de pubalgia e de impacto femoroacetabular na casuística estudada. Métodos É um estudo epidemiológico, transversal e analítico. Foram selecionados 90 atletas profissionais de futebol atuantes no período de 2019-2021. Foram acessados os prontuários para obtenção do protocolo PCMA modificado, além de exame físico ortopédico e de radiografias da bacia com incidência anteroposterior para avaliação de pubalgia e IFA, respectivamente. Critérios de Inclusão: Atletas que atuaram no clube de futebol de campo profissional na temporada de 2019 a 2021, que foram submetidos a aplicação do PCMA modificado na admissão e que assinaram o TCLE. Resultados O IFA apresentou elevada prevalência na amostra (85.6%), o que pode ocorrer pois, no Brasil, os jovens iniciam a prática esportiva em idade muito precoce, além do fato de os jogadores nem sempre praticarem o esporte em campos adequados ou com equipamentos e supervisão adequada. Ademais, o impacto tipo CAM foi o mais frequente (62.2%). O surgimento dessas lesões é relacionado a movimentos de alta intensidade, como os vistos no futebol. Outrossim, observou-se que não há correlação de dependência entre a pubalgia e o IFA. Foi visto que o IFA estava presente em apenas 20% dos atletas queixosos de pubalgia. Conclusão Há elevada prevalência de IFA em atletas de futebol profissional na população estudada (85.6%) e não houve relação entre o IFA e a presença de pubalgia.

Anatomic and clinical application of lateral-perineal approach for inferior ramus of pubis-ischium ramus / 中华骨科杂志

Objective:To explore the anatomical and clinical effects of lateral-perineal approach in treating the fracture of inferior ramus of pubis-ischium ramus.Methods:The lateral approach of the perineum was simulated on 10 side of 5 intact wet adult cadavers to determine the surface symbols of incision design and to expose the operative field of the approach and to observe the anatomical characteristics of the perineal branch of the posterior femoral cutaneous nerve and the incision of the surgical approach. Five points were selected at the incision of the approach. The distance (L 1-L 5) between each point and the body surface projection of the perineal branch of the posterior femoral cutaneous nerve was measured. A total of 11 patients, including 5 males and 6 females with an average age of 41.55±14.32 years, ranging from 18 to 62 years, were treated by this approach in clinical practice. All patients had a reduction and fixation to the fracture of inferior ramus of pubis-ischium ramus. The operation duration, incision length, intraoperative blood loss and surgical complications were recorded. The quality of fracture reduction was evaluated according to Matta radiographic criteria. The strength of the adductor was measured. The pelvic function was evaluated according to Majeed Pelvic Score at the last follow-up. Results:Anatomical studies shown that the line between the two points. One point was 4 cm lateral to the level of the apex of the pubic arch. Another point was 4 cm from the ischial tubercle on the line from the ischial tuberosity to the point that 4 cm lateral to the level of the apex of the pubic arch was the axis of the approach lateral of the perineum. Anatomical studies showed that the lateral-perineal approach could expose the range from pubic symphysis to sciatic tuberculum. The distance between the points selected at the incision of the approach and the body surface projection of the perineal branch of the posterior femoral cutaneous nerve: L 1 was 19.40±1.17 mm, ranging from 18 to 21 mm; L 2 was 16.60±2.76 mm, ranging from 10 to 20 mm; L 3 was 18.30±1.89 mm, ranging from 16 to 21 mm; L 4 was 19.20±1.93 mm, ranging from 16 to 22 mm; L 5 was 14.70±1.83 mm, ranging from 13 to 18 mm. All patients were followed up for 17.91±4.09 months, ranging from 13 to 26 months. The incision length was 8.18±0.98 cm, ranging from 7 to 10 cm. The operation duration was 59.64±12.17 min, ranging from 43 to 85 min. The intraoperative blood loss was 100 ml, ranging from 50 to 130 ml. All incisions were healed in all patients. The fractures were healed in 13.36±2.06 weeks, ranging from 10 to 16 weeks. According to Matta radiographic criteria, the quality of fracture reduction was excellent in 6 cases, good in 4 cases and fair in 1 case. At the last follow-up, the adductor muscle strength reached grade 4 in 4 patients and grade 5 in 7 patients. Furthermore, according to the Majeed Pelvic Score, the score of every patient was 86.55±9.59, ranging from 66 to 100, and 8 cases were excellent, 3 cases were good at the last follow-up. The heterotopic ossification occurred in 2 patients, the pain during intercourse occurred in 2 patients. No patient had sensory disturbance or pain in the perineal area. Conclusion:A certain safe distance is between the lateral to the perineum and the perineal branch of the posterior femoral cutaneous nerve with limited risk of injuring posterior femoral cutaneous nerve via the lateral approach of the perineum. The advantages in treating the fracture of inferior ramus of pubis-ischium ramus by this approach have concealed incision, short operation duration and less bleeding with satisfied short-term clinical effects.

Finite element analysis of different intramedullary fixation methods for the treatment of senile pubic ramus fractures / 中国骨伤

OBJECTIVE@#To evaluate the biomechanical stability of elastic intramedullary nail in the treatment of pubic ramus fractures by finite element analysis, and to compare the stability of elastic intramedullary nail with cannulated screw intramedullary fixation.@*METHODS@#The CT data of the pelvis of a volunteer were selected, and the three-dimensional model of the pelvis was reconstructed by reverse engineering software and the fracture of the pubic ramus fractures was simulated by osteotomy. The hollow nail model, single elastic nail model and double elastic nailmodel were assembled with different implants respectively. The mesh division, material assignment loading and other steps were carried out in the ANSYS software, and then the calculation was submitted.@*RESULTS@#The overall displacement of the pelvis of the elastic nail model was smaller than that of the cannulated screw model, in which the double elastic nail model had the smallest overall displacement, but the cannulated screw model had the smallest plant displacement and the single elastic nail model had the largest plant displacement. Although the stress of cannulated screw was small, there was obvious stress concentration, the stress of elastic nail was large, but there was no obvious stress concentration, especially the stress distribution of double elastic nail was more uniform and the overall stress of pelvis was the smallest.@*CONCLUSION@#All the three fixation methods can effectively improve the stability of the anterior ring of the pelvis. Among them, there is no significant difference in the overall biomechanical propertiesof hollow nail fixation and double elastic nail fixation, which is better than that of single elastic nail fixation. Elastic nail fixation has the advantages of minimally invasive surgery and good biomechanical stability, so it can be used as a better surgical method for the treatment of pubic ramus fractures.

Case series of pubic bone diastasis causing severe pelvic girdle pain in pregnancy

Pelvic girdle pain (PGP) is a pregnancy discomfort that causes pain and limitation of mobility and functioning in any of the three pelvic joints. The patient usually presents antenatally with persistent suprapubic pain which is exaggerated during moving, walking or climbing stairs. Intrapartum, this could be associated with disruption of sacroiliac joint, hematuria and bladder dysfunction in severe cases. Pelvic X-rays, ultrasound, and magnetic resonance imaging aid in confirmation of diagnosis by measuring the degree of separation of symphysis. Treatment modalities range from conservative management to orthopedic interventions in form of pelvic strapping, open reduction and internal fixation. Postpartum pain often masks clinicians to make the diagnosis of pubic symphysis diastasis. A case series of three cases which were diagnosed and confirmed with ultrasound and managed with orthopedic consultation. till their delivery and in post-partum period till recovery. Although there is still no specific consensus on treatment guideline, management generally of conservative management to surgical in the form of pelvic bracing or strapping. Awareness of this rare condition can help in management of pain and associated disability which improves post-delivery.

Solitary osteochondroma in the body of the pubic bone: a cadaveric case report / 대한해부학회지

Osteochondromas develop as cartilaginous nodules in the periosteum of bones. They are the commonest benign tumors of the skeleton, generally observed in the long bones. Rarely, they are also found in the axial skeleton, flat bones of skull and facial bones. During a regular dissection, we came across a solitary osteochondroma in posterior surface of the body of the right pubic bone. Histopathology of the bony projection confirmed the typical features of the osteochondroma. The symptomatic osteochondromas are usually evaluated during radiographic examination. Though, the observed osteochondroma is relatively smaller its unusual location is remarkable and knowledge of occurrence of such nodules is clinically important during the diagnosis and planning of treatment.

Modified transobturator tape for female stress urinary incontinence / 中华泌尿外科杂志

Objective To explore the efficacy and safety of modified transobturator tape (TOT) for female stress urinary incontinence (SUI).Methods From June 2015 to June 2017,a total of 87 SUI patients,including 35 patients underwent standard TOT operation (standard TOT group) and 52 patients underwent modified TOT operation (modified TOT group),were retrospectively reviewed.There was no statistical difference of age [(59.7 ± 10.3) yea~ vs.(56.3 ± 9.1) years],BMI [(24.I ± 9.7) kg/m2 vs.(24.6 ± 9.3) kg/m2],diabetes history [31.4％ (11/35) vs.26.9％ (14/52)],mixed urinary incontinence [45.7％ (16/35) vs.48.1％ (25/52)] and the daily amount of urine pad [(4.3 ±2.7) vs.(3.9 ± 2.1)] between the two groups (P ＞ 0.05).The operative time,intraoperative complications,and postoperative complications were collecteded in two groups.Patients were followed up at 3 months,6 months,and 1 year after surgery.Results There was no significant difference in operation time [(21.1 ± 4.3) min vs.(20.5 ± 5.7) min],intraoperative hemorrhage [(18.3 ± 9.1) ml vs.(25.7 ± 8.3) ml] and postoperative incidence of urinary retention [2.9％ (1/35) vs.3.8％ (2/52)] between the two groups (P ＞ 0.05).The incidence of postoperative leg pain was significantly lower in modified TOT group than in TOT group[1.9％ (1/52) vs.20.0％ (7/35),P ＜ 0.05].There was no significant difference in subjective cure rate and objective cure rate between the two groups at 3 months,6 months and 1 year after surgery (P ＞ 0.05).Conclusions Compared with the standard TOT,the modified TOT of modified puncture port has a similar cure rate and efficiency.However,the use of modified TOT can significantly reduce the incidence of postoperative short-term leg pain,but the long-term efficacy still needs to be further followed-up.

Efficacy and safety of TVT-EXACT procedure for treatment of ISD female stress urinary incontinence / 中国医师杂志

Objective To investigate the efficacy and complication of Tension-free Vaginal Tape (TVT)-Exact for the treatment of type-Ⅲ female stress urinary incontinence (SUI).Methods A total of 20 type-Ⅲ SUI patients enrolled from November 2013 to June 2016 were retrospectively analyzed.The efficacy and complication of the surgery were evaluated.Results The mean operation time was (20.7 ± 1.60)min (range,19-25 min).The blood loss was 20-50 ml.There were no intraoperative bladder or urethral injury,and no vessel or nerve damage.2 cases with mixed SUI were relieved by medicine.No case had urethral or vaginal erosion.Therapeutic efficacy:15 cases were cured (75％),5 cases were improved (25％),and no case was ineffective.Conclusions TVT-E is a simple,min-invasive,safe and effective surgery for type-Ⅲ SUI.While the long-term efficacy needs great amount of clinical data and long-term follow-up to prove.

Ischio-Pubic-Patella Syndrome.

Abstracts: It has been stated that regulation of the development of the iliac bone is different from that of the ischium and pubis. There are well-known clinical syndromes concerned with hypoplasia of ischiopubic bone, such as small patella syndrome, nail-patella syndrome, ischiopubic-patellar hypoplasia, and ischiopubic hypoplasia. A 3 year male child presented with right knee pain since 2 weeks. She sought advice from an orthopedic surgeon and was advised for x-ray right knee. On reviewing the X-ray patella were absent and then further X-rays of left knee , pelvis , spine, elbow and foot were taken on suspicion of ischio pubic patellar dysplasia (IPD) or small patella syndrome. Patient had absent patella on left side and bilateral defective ischio pubic ossification with no spinal, elbow or foot abnormalities.Bilateral inferior ischiopubic hypoplasia along with bilateral patellar aplasia with no spinal, elbow or foot abnormalities probably constitutes a new syndrome. To the best of the author's knowledge, this finding has not been described previously.

Corona mortis: importancia anatomo ­ clínica y ocurrencia en una muestra de la población colombiana / Corona mortis: anatomical and clinical relevance and occurrence in a sample of the Colombian population

Corona mortis es una variación anatómica referida a la anastomosis de los vasos iliacos externos e internos, mediante vasos que se arquean por encima y por detrás del ramo superior del pubis. En caso de resultar lesionados iatrogénicamente, se pueden presentar hemorragias de difícil manejo. El objetivo del estudio fue caracterizar los vasos obturatrices en una muestra cadavérica de la población colombiana, para determinar su morfometría y la frecuencia con que se presentan los diferentes patrones venosos y arteriales. Se estudiaron hemipelvis de 14 cadáveres, pertenecientes al anfiteatro del Departamento de Morfología de la Universidad del Valle en Cali, Colombia. Tras acceder a la cavidad pélvica y completar la disección de todos los vasos que se relacionaban con el canal obturador y la cara pélvica del ramo superior del pubis, se determinaron sus características morfológicas y sus dimensiones. Las variaciones arteriales, corona mortis y arteria obturatriz aberrante, se presentaron en el 35,7% de las hemipelvis y las variaciones venosas en el 82,1%. La arteria corona mortis sólo se presentó en el 3,6% de las hemipelvis y el 32,1% presentaron arteria obturatriz aberrante. La moda de las frecuencias absolutas de los patrones venosos fue la vena corona mortis que se presentó en el 75,0% de las hemipelvis. El conocimiento de los patrones arteriales y venosos de los vasos obturatrices y de sus variaciones anatómicas para la población colombiana es indispensable para evitar lesionarlos durante procedimientos clínico - quirúrgicos que comprometan el anillo pélvico anterior y la región inguinal.

The corona mortis is an anatomical variation related to the anastomosis between the internal and external iliac blood vessels, through certain arteries and veins that form arches above and behind the superior pubic ramous. Serious hemorrhages can result from iatrogenic injury of these vessels. The study objective was to characterize the obturator vessels in a sample of Colombian cadavers, to determine their morphometric features and the frequencies in which the arterial and venous patterns are present. Hemipelvises of 14 cadavers from the dissection room of the Department of Morphology at the Universidad del Valle, in Cali, Colombia, were taken as sample. Once the dissection of the vessels related with the obturator canal and the pelvic surface of the superior pubic ramous was completed, their morphological features were determined and measurements were taken of their diameters and lengths. The arterial variations, corona mortis and aberrant obturator artery, were present in 35.7% of the hemipelvises and the venous variations in 82.1%. The corona mortis artery was only present in 3.6% of the hemipelvises and 32.1% presented an aberrant obturator artery. The mode of the absolute frequencies of the venous patterns was the corona mortis vein, present in 75.0% of the hemipelvises. The knowledge of the arterial and venous patterns of the obturator vessels and their anatomical variations for the Colombian population is very important in order to avoid causing any injury to them in the course of clinical and surgical procedures that have to do with the anterior pelvic ring and the inguinal region.

Minimally invasive plate osteosynthesis for anterior pelvic ring fractures: a finite element analysis and clinical study / 中华创伤杂志

Objective To investigate the mechanical stability and clinical outcome of minimally invasive plate osteosynthesis of pubic ramus fractures.Methods Stability of minimally invasive plate osteosynthesis and traditional open fixation of pubic ramus fractures was compared in finite element analysis.A retrospective analysis was performed on fractures of pubic rami (126 sides) in 101 consecutive patients treated with minimally invasive plate osteosynthesis from 2005 to 2012.Operation time,intraoperative blood loss and follow-up of fracture healing were evaluated.Results In finite element analysis,traditional open fixation and minimally invasive plate osteosynthesis resulted in the maximum pelvic force of 7.35 MPa and 5.59 MPa,maximum fracture displacement of 4.31 mm and 4.38 mm and relative fracture gap displacement of 0.029 mm and 0.012 mm.Displacement of fracture gap after minimally invasive plate osteosynthesis and traditional open fixation was reduced 26％ and 59％ respectively.In the clinical study,the surgery acquired for pubic ramus fractures averaged 65 minutes with mean blood loss of 94 ml.Follow-up duration was 5-50 months (mean,24.3 months).Reduction of the fracture as assessed using Matta' s criteria was excellent in 118 sides (93.7％),good in eight sides (6.3％).Totally,the fracture was healed within postoperative 12 weeks in 117 sides and within postoperative 6 months in 9 sides.No iatrogenic nerve or vascular injury occurred.Conclusions Minimally invasive plate osteosynthesis is a safe and effective technique for fixation of pubic ramus fractures.Moreover,satisfactory results can be achieved together with less trauma and better cosmetic effect.

Lifting do púbis após grande perda ponderal / Lifting of the mons pubis after massive weigth loss

This article describes the surgical planning, conducts pre and post operatively, results in the Lifting Pubic ex-obese patients submitted to gastroplasty or not, that feature large sagging skin and excess fat from the pubis. Method: Two hundred and eighteen patients underwent surgery from May 2005 to August 2012. The pubic lifting was held in conjunction with the Anchor Adbominoplasty. The pubis was raised through points positioned 2-3 cm above its original position in the aponeurosis of the muscles rectus abdominis. Traction lines were directed from the center to up and the sides of the pubis and abdominal flaps were pulled to the midline of the abdomen No significant complication was observed, which could compromise the final result. Results: The elevation of the pubis, the correct shape and resection of excess adipocutâneos were achieved in all cases, bringing satisfaction to patients. Conclusion: Considering the pubic deformity after massive weight loss, and the results obtained, the procedures adopted proved to be safe, easily reproducible and stable over the longterm...

O presente artigo descreve o planejamento cirúrgico, as condutasde pré e pós-operatório, e os resultados do lifting púbico em pacientes ex-obesos, submetidos ou não à Gastroplastia, que apresentavam grande flacidez cutânea e excesso adiposo do púbis Método: Duzentos e dezoito pacientes foram submetidos à cirurgia no período de maio de 2005 a agosto de 2012. O Lifting pubiano foi realizado conjuntamente com a Abdominoplastia em ãncora. O púbis foi elevado por meio de pontos posicionados 2 a 3 cm acima de sua posição original, na aponeurose dos retos abdominais. Vetores de tração foram direcionados do centro do púbis para cima e para os flancos e os retalhos abdominais foram tracionados para a linha média do abdome. Nenhuma complicação significativa foi observada que pudesse comprometer o resultado final. Resultados: A elevação do púbis, a correção do formato e a ressecção, dos excessos adipocutâneos, foram alcançadas em todos os casos, trazendo satisfação aos pacientes. Conclusão: Considerando-se a deformidade pubiana após grandes perdas ponderais e os resultados obtidos, os procedimentos adotados mostraram-se seguros, facilmente reproduzíveis e estáveis a longo prazo...

Plástica do púbis e da genitália externa: duas décadas de experiência / Plastic of the pubis and external genitalia: two decades of experience

Este artigo registra a experiência de duas décadas de cirurgias realizadas na região do púbis e da genitália externa em pacientes de ambos os sexos. A literatura apresenta limitadas contribuições sobre as alterações morfológicas que têm levado seus portadores a se submeterem a cirurgias para retornarem à normalidade anatômica, ao equilíbrio emocional e a recuperarem a autoestima. Método: Foram operados 513 pacientes com diferentes tipos de patologias nos genitais externos e no púbis, num período de vinte anos, sendo 469 (91,42%) do sexo feminino e 44(8,58%) do sexo masculino. A idade variou de 17 a 70 anos. No sexo feminino, as deformidades mais frequentes foram as distrofias do púbis, grandes e pequenos lábios, prepúcio sobre o clitóris, além das distorções secundárias decorrentes de cirurgias realizadas previamente nestas regiões. No sexo masculino, as afecções mais frequentes envolveram a região pubiana, hipotrofias penianas, sinéquias e ausência de testículos. Deformidades congênitas, além das descritas, não foram incluídas no presente artigo. Resultados: Durante o período de 1989 a 2010, os procedimentos aplicados nas disformias pubianas e nas genitálias beneficiaram pacientes física e psicologicamente, pela qualidade dos resultados e pelo baixo índice de complicações (2,31%). Conclusões: Apesar da limitada divulgação científica nas revistas da especialidade e nos eventos científicos, a importância destas patologias não tem limite nos seus portadores. Uma das razões da presente publicação baseia-se na experiência adquirida e a necessária divulgação aos especialistas que realizam estas cirurgias, face às consequências que determinam quando não executadas dentro da necessária realidade.

This article is the result of two decades of surgical experience in the pubic region for patients of both genders with the external genitalia dimorphic aspects. The literature presents limited contributions regarding the morphologic alterations of these regions, responsible for the patients be submitted to these surgeries to return to their normal anatomic aspects, to the emotional equilibrium and to the self-esteem. Methods: Patients of both genders, in a total of 513, with different types of pathologies of the external genitalia and the pubic regions were submitted to specific surgeries, where 469 (91.42%) were female and 44 (8.58%) were male. The age range was from 17 to 70 year old. In the female patients were included: dystrophies of the pubis, labia majora and minora, skin excess of the clitoris, and the treatment of other types of unacceptable results after previous surgical procedures. The male deformities included in this study were: penis hypotrophy, skin penis synechia, local angioma and the absence of congenital testicular glands. Congenital or acquired deformities out of the described were not included. Results: From 1989 to 2010, the procedures used in the genitalia and in the pubis dimorphisms brought psychological and physic benefic to the patients combined with low complication rate (2.31%). Conclusions: Despite of the limited scientific publications in the journals of the specialty and in the scientific meetings, the importance of these messages has no limits to their holders. One of reasons of this publicationis based in acquired experience and the necessary diffusion for those that perform these surgeries but still with negative results when not performed within the necessary level.

Fratura de estresse do púbis em atleta de futebol de 15 anos de idade / Pubis stress fracture in a 15-year-old soccer player

Este relato de caso apresenta um atleta de futebol de 15 anos de idade diagnosticado com fratura de estresse do púbis e tratado conservadoramente, com resultados satisfatórios. Uma vez realizada revisão da literatura, os autores descreveram quadro clínico, diagnóstico e tratamento. A importância desta publicação reside no fato de a lesão descrita ser raramente encontrada na literatura.

This case report presents a 15-year-old football player who was diagnosed with a pubis stress fracture and underwent conservative treatment with satisfactory results. After a review of the literature, the clinical picture, diagnosis and treatment are described. The importance of this paper comes from the rarity of finding reports about this kind of injury in the literature.

Tratamento da região pubiana na abdominoplastia de pacientes após grande perda ponderal / Pubic region’s treatment in abdominoplasty of patients with great loss of weight

Introdução: Com base na angústia dos pacientes com grande perda ponderal em relação aoseu corpo, desenvolvemos uma nova tática para tratamento da ptose da região pubiana.Objetivos: Demonstrar tática cirúrgica para tratamento da região pubiana de pacientes comgrande perda ponderal e ptose importante dessa região. Método: Faz-se a marcaçãoconvencional da abdominoplastia com incisão pubiana mais baixa, a 5 cm da fúrcula vulvar,tracionando-se a pele para cima. Realiza-se a fixação mais cranial da fáscia de Scarpa naaponeurose com pontos simétricos em “U”, após seu descolamento, observando-seimediata melhora do aspecto dessa região. Resultados: Obtivemos satisfação de 100%entre os pacientes, por conseguirmos melhorar o aspecto da região pubiana sem aumentara cicatriz resultante e realizar uma retirada efetiva da redundância de pele e de tecido celularsubcutâneo. Conclusão: Trata-se de uma nova solução para melhora da região pubiana edo contorno corporal dos pacientes pós grande perda ponderal, apresentando baixamorbidade, sendo pouco invasiva, de fácil execução e de resultados agradáveis, comnenhuma cicatriz adicional ao paciente.

Introduction: Thinking about the affliction of the patients with great weight loss becauseof their bodies, we developed a new procedure to treat the pubic area in these patients.Objectives: To describe a new way to treat the pubic area in patients with great loss ofweight with an important pubic ptosis. Methods: The incision of the abdominoplasty isperformed a little bit lower in the pubic region, about 5cm from the vulvar fissure with theskin pulled up. Then, the Scarpa fascia is fixed more cranial in the aponeurosis after itsundermining, with symmetric nots. You can see a great improvement in this region as soonas you treat it. Results: We had an 100% satisfaction range among our patients, once wecould improve substantially the looking of this region without increasing the size of thescar, and could also make an effective resection of the excess of skin and fat tissue.Conclusion: This is a new solution to treat the ptotic pubic region in patients with greatloss of weight, improving their body contour. It showed to be a low morbidity technique,easy to performed, less invasive, giving great results and with no additional scars for thepatient.

CLINICAL ANALYSIS OF STRESS FRACTURE OF THE PUBIC RAMUS CAUSED BY MILITARY TRAINING: A REPORT OF 66 CASES / 解放军医学杂志

To investigate the clinical diagnosis and treatment of stress fracture of the pubic ramus caused by military training, clinical data of 66 cases (18 males and 48 females, ranging from 18～21 years, mean age 19 6 years ) with stress fracture of the pubic ramus were retrospectively analysed. 55 cases were military recruits undergoing basic training, 11 army veterans undergoing intensive goose step training. 66 cases complained of chronic groin pain which increased in activity and relieved while at rest. The symptom occurred 3～10 weeks after the training began. The pain often lasted 1 week ～14 months. 22 cases who sought medical advice in medical team were mistaken for muscular injury. There were 76 stress fractures of the pubic ramus in 66 soldiers. 56 had stress fractures of one inferior pubic ramus, 6 both inferior pubic rami, and four had ipsilateral inferior and superior pubic rami fractures. Stress fracture of the pubic ramus is not rare, but it's quite easy to be neglected or misdiagnosed. The key to its diagnosis is getting a deeper understanding and making an adequate and early imaging examination in light of the clinical data.

X-ray diagnosis of stress fracture of the pubic ramus / 中华放射学杂志

Objective To study the X-ray findings and evaluate the value of X-ray in diagnosis of stress fracture of the pubic ramus. Methods The X-ray findings of 66 cases (18 males and 48 females, ranging in age from 18-21 years, mean age 19.6 years) with stress fracture of the pubic ramus were retrospectively analyzed. Fifty-five cases were military recruits undergoing basic training, and 11 army veterans were undergoing intensive goose step training. Results Sixty-two cases had stress fractures of the inferior pubic ramus including right-sided in 26, left-sided in 30, and bilateral in 6. Four had ipsilateral inferior and superior pubic rami fractures. With 2 weeks after onset, the radiographs were normal in 3 cases. The 66 cases had either a slight transverse fissure (34 cases) or a small dense callus (65 cases) or both during the examination period of 4 weeks to 8 months. Then the calcium resorbed at the margins of the fracture and at the same time the callus increased and surrounded the bone. Finally, the resorptive zone disappeared and the callus became homogeneous. This callus formation persisted for several months and disappeared gradually. Conclusion X-ray examination is the first imaging method of choice for detecting stress fracture of the pubic ramus. With combining clinical data, correct diagnosis can be made in the majority.

Anterior Vaginal Wall Sling Operation with Bone Fixation using Self-made Titanium Screw for Stress Urinary Incontinence Associated with Intrinsic Sphincter Deficiency / 대한비뇨기과학회지

PURPOSE: Anterior vaginal wall sling operation (by Raz`s method )for the treatment of stress urinary incontinence(SUI) associated with intrinsic sphincter dysfunction(ISD) may produce postoperative suprapubic discomfort and suture related problem such as pull-through and loosening. Stabilization of the bladder neck to the pubic bone decreases the tension placed on the anterior rectus fascia and lessens the possibility of suture-related pain and the risk of entrapment of ilioinguinal neve branches. At present, bone anchoring system is available in Korea but its cost sometimes limit the use of the kit. Therfore, we developed self-made titanium screw which is anchored to pubic bone at the time of anterior vaginal wall sling operation and acquired good short-term results. MATERIALS AND METHODS: Total 16 women who had SUI with ISD were treated by in-situ anterior vaginal wall sling using self-made titanium screw anchored to pubic bone to support the bladder neck and midurethra. Postoperative results were analyzed for 16 patients who has been followed up for more than 3 months after surgery. RESULTS: Overall cure rate was 100% at 3 months of follow-up. Complication included anemia in 2 patients, mild dysuria in 2 patients and osteitis pubis in 1 patient. After resting and antibiotic therapy, complications were subsided. CONCLUSIONS: In short term follow-up, anterior vaginal wall sling using self-made titanium screw was shown to be very effective treatment of SUI with ISD with simple technique and had relatively low cost, low complication rates. Long-term followup will be necessary to define the efficacy of this method.

Transcatheter arterial embolization of Aneurysmal Bone Cyst in Pubic Bone: A Case Report / 대한정형외과학회잡지

Aneurysmal bone cyst uncommonly involves the pubic bone and tends to grow eccentrically and thin out overlying cortex. In the following case report, a 19-year-old male patient visited out hospital, because of dull pain in his left groin. He was diagnosed as aneurysmal bone cyst originated from the superior pubic ramus by CT guided needle biopsy. Transcatheter arterial embolization was effective in the treatment of this lesion such as complete consolidation after the procedure. At present, 2 years follow-up, no problem was noted at weight bearing as well as hip function or recurrence.

Aneurysamal Bone Cyst in Pubic Bone: A Case Report / 대한정형외과학회잡지

The pubic bone is an unusual site for an aneurysmal bone cyst. This case, a 15year old male patient, was diagnosed as an aneurysmal bone cyst in the superior ramus of the right pubic bone. He was treated by complete excision of the superior ramus and on five years follow up no problems were noted in terms of weight bearing as well as hip function or evidence of recurrence.

Stress Fractures in Pubic Bone: Report of 3 Cases / 대한정형외과학회잡지

The occurence of stress fracturea at sites such as the metatarsal, tibia, fibula, and femur in military trainee and certain other very physically active groups has been reported frequently, but literature regarding stress fractures of the inferior pubic ramus has been very sparse. Authors spresent 3cases of stress fracture which was found in inferior pubic ramus in the newly recruited soldier in training corps; 1 case unilaterally and 2 cases bilaterally.