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.

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.

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.

Proposta de tratamento preventivo de pubalgia em jogadores juniores de futsal / Proposal for preventive treatment of pubic pain in junior futsal players

A pubalgia é uma síndrome caracterizada por processo inflamatório da sínfise púbica, predominante em esportes que envolvem esforços repetitivos com freqüentes mudanças de direção e arranques, como o futebol e o tênis. Os sintomas são freqüentemente inespecíficos e de difícil diagnóstico. Desta forma, proporcionam longos períodos de afastamento de atividades físicas e esportivas, perpetuando os desequilíbrios funcionais e dificultando o tratamento. A pubalgia pode ser tratada de três formas: preventiva, conservadora, ou cirúrgica. O estudo teve como objetivo propor um protocolo de tratamento preventivo de pubalgia, para prevenir desequilíbrios da musculatura da cintura pélvica. Participaram do presente estudo 13 atletas de futsal do sexo masculino, com idade média de 18 anos, da equipe sub-20 do Sport Club Corinthians Paulista. Todos foram submetidos a duas avaliações, inicial e final, e ao protocolo de tratamento preventivo realizado duas vezes por semana por período de dois meses. Os resultados demonstraram uma melhora de flexibilidade e do fortalecimento da musculatura abdominal nos jogadores. Assim, pode-se concluir que o protocolo se mostrou eficaz na melhora da flexibilidade e do fortalecimento da musculatura abdominal.

The pubic pain is a syndrome characterized by an inflammatory process of pubic symphysis. It is predominant in sports that use repetitive efforts with different changes in direction such as football and tennis. The symptoms are not frequently specific and the disease is difficult to diagnose. Therefore, long periods of absence from physical activities imply in difficulties in treatment. The pubic pain can be treated in three different ways: preventive, conservative or surgical. This study aimed at conducting a treatment and preventive protocol for preventing imbalances of pelvic muscles. Thirteen male athletes of futsal, average age 18 years, from the sub –20 team from the Sport Club Corinthians Paulista participated to the study. All of them were submitted to two evaluations, at the beginning and at the end, and to treatment and preventive protocol carried out twice a week for two months. The results showed improving in flexibility and stretching of players abdominal muscles. We can conclude that the protocol was effective to improve flexibility and abdominal muscles strengthening.

Evaluation of functional results of fixation of unstable open-book pelvic fractures by external and internal fixation

This study was performed to evaluate the functional results of unstable open-book pelvic fractures in adults by external fixator and internal fixation. 15 patients were included in the study, 12 males and 3 females who were admitted to the Suez Canal university hospital. The average age was 45 years [22-63]. The mechanism of injury was motor car accident in 10 patients and 5 were pedestrians. Adult patients with recent unstable open-book pelvic ring injuries with diastasis at the symphysis pubis more than 2.5 cm were included with exclusion of open fractures and fractures of lower extremities. For each patient, history taking for mechanism of injury, clinical examination, and radiological evaluation as a preoperative assessment was done. Radiographic assessment through anteroposterior view, inlet view and outlet views were done for every patient to identify pelvic ring injuries. Also CT was done for every patient to identify any posterior pelvic ring injuries. In most of the cases the symphysis pubis was fixed first using Pfannenstiel's approach followed by applications of the esternal fixator frame. The patient's average hospital stay was 14 days]10-18 days]. The different methods of fixation were evaluated according to a system of functional scoring by Majeed. Anatomical results of patients post-operatively at one year revealed excellent results in 10 patients [67%] and good results in 4 patients [27%], and one patient has fair results [6%] due to displacement at the sacroiliac joint. The functional results were excellent in 12 patients [80%] good in 2 patients [14%] and fair results in one patient [6%]. Post-operative local complications in two patients [14%] as pin tract superficial infection. The technique of combined external fixation of the posterior ring and anterior fixation by a single-plate for unstable open-book pelvic fractures is an easy method and gives satisfactory anatomical and functional results

Tratamento cirúrgico de fratura pélvica em gestante: relato de caso / Surgical treatment of pelvic fracture in pregnancy: a case report

The authors report the case of a 16-year-old woman in her 21st week of twin pregnancy who had an acetabular fracture and pelvis disruption after being overrun by a car. Open reduction and internal fixation were performed without affecting the pregnancy. On the 35th week, she was submitted to a cesarean section and gave birth to two healthy children. After 3 years, the patient had a pain-free hip with full range of motion. The authors conclude that surgical treatment was a good therapeutic approach in this case since it offered functional recovery with good long-term result.

Fratura de Malgaigne em grávidas: relato de 2 casos / Malgaigne fracture in pregnant women: report of 2 cases

Os autores apresentam dois casos de fraturas instáveis da pelve em pacientes grávidas tratadas no Serviço de Ortopedia e Traumatologia da Santa Casa de Porto Alegre. A revisäo dsa literatura näo revelou descriçäo similar