Orthopedic implications of the corona mortis: a case report / Implicaciones ortopédicas de la corona mortis: reporte de un caso

SUMMARY: Corona mortis is classified as a connection between the inferior epigastric and obturator vessels over the superior pubic ramus. Its incidence varies among different studies. The corona mortis is an extremely important anatomical variation as it can be injured in a great number of procedures. Moreover, it can also be injured during pelvic or acetabular fractures. A male cadaver fixed in a 10 % formalin solution had its pelvic region dissected and an arterial corona mortis was observed on its right side. The left hemipelvis presented no variations whatsoever. This vessel was measured with the aid of a digital caliper. We aim to report this variation and address - from an orthopedic point of view - the clinical and surgical significance of the corona mortis.

RESUMEN: La corona mortis es clasificada como una conexión entre los vasos epigástricos inferiores y obturadores sobre la rama superior del pubis. Su incidencia varía según los diferentes estudios. La corona mortis es una variación anatómica extremadamente importante, ya que se es posible dañarla en un número significativo de procedimientos. Además, también puede resultar lesionada durante las fracturas pélvicas o acetabulares. Durante la disección de un cadáver de sexo masculino fijado en solución de formalina al 10 %, se observó la corona mortis arterial en el lado derecho de la región pélvica. El lado izquierdo de la pelvis no presentó ninguna variación. Se midió la corona mortis con ayuda de un calibre digital. Nuestro objetivo fue informar sobre esta variación y abordar - desde el punto de vista ortopédico - la importancia clínica y quirúrgica de la corona mortis.

Effect of Arterial Deprivation on Growing Femoral Epiphysis: Quantitative Magnetic Resonance Imaging Using a Piglet Model

OBJECTIVE: To investigate the usefulness of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion MRI for the evaluation of femoral head ischemia. MATERIALS AND METHODS: Unilateral femoral head ischemia was induced by selective embolization of the medial circumflex femoral artery in 10 piglets. All MRIs were performed immediately (1 hour) and after embolization (1, 2, and 4 weeks). Apparent diffusion coefficients (ADCs) were calculated for the femoral head. The estimated pharmacokinetic parameters (Kep and Ve from two-compartment model) and semi-quantitative parameters including peak enhancement, time-to-peak (TTP), and contrast washout were evaluated. RESULTS: The epiphyseal ADC values of the ischemic hip decreased immediately (1 hour) after embolization. However, they increased rapidly at 1 week after embolization and remained elevated until 4 weeks after embolization. Perfusion MRI of ischemic hips showed decreased epiphyseal perfusion with decreased Kep immediately after embolization. Signal intensity-time curves showed delayed TTP with limited contrast washout immediately post-embolization. At 1-2 weeks after embolization, spontaneous reperfusion was observed in ischemic epiphyses. The change of ADC (p = 0.043) and Kep (p = 0.043) were significantly different between immediate (1 hour) after embolization and 1 week post-embolization. CONCLUSION: Diffusion MRI and pharmacokinetic model obtained from the DCE-MRI are useful in depicting early changes of perfusion and tissue damage using the model of femoral head ischemia in skeletally immature piglets.

Packing pelviano retroperitoneal en fracturas inestables de pelvis: reporte de un caso y descripción de la técnica / Retroperitoneal packing in unstable pelvic fractures: case report and description of the technique

Pelvic fractures in hemodynamically unstable patients are associated with high rates of morbidity and mortality. The optimal management strategy for hemorrhage control remains controversial. We present a clinical case that was successfully treated with retroperitoneal pelvic packing. The technique is described and discussed.

Las fracturas de pelvis con inestabilidad hemodinámica se asocian a altas tasas de morbilidad y mortalidad. No existe consenso sobre la mejor manera de controlar hemorragia asociada. Se presenta un caso manejado exitosamente mediante la realización de un packing pelviano retroperitoneal. Se describe la técnica quirúrgica y se discuten sus alcances.