Relative position of the supra-acetabular bone to the crestal plane: a radiological analysis.

INTRODUCTION: Displaced unstable pelvic injuries are life threatening and require rapid reduction and stabilisation, typically achieved with an external fixator. Recently, the benefits of supra-acetabular pins have been proven; however, these are usually inserted under fluoroscopic guidance. In austere environments and in extremis, this facility is limited and fixation using anatomical landmarks is required. Thus, the aim of this study is to determine the relative position of the supra-acetabular bone to the crestal plane and examine its consistency in military-aged European personnel. METHODS: A radiological review of 50 randomised pelvic CT scans in European patients aged 18-30 years from a Level 1 trauma centre was performed. The CT scans were analysed using 3D rendering software. The relative position of the supra-acetabular bone to the crestal plane was determined. RESULTS: The supra-acetabular bone relative to the crestal plane was approximately 28° caudal and 24° medial to the crestal plane. The mean minimum distance from the pin's entry point to the sciatic notch was approximately 73 mm. There were no differences noted between genders or hemipelvic side. CONCLUSIONS: The supra-acetabular bone maintains a consistent relative position to the crestal plane. Thus, with the surgeon's thumb on the anterior superior iliac spine (ASIS) and index finger on the iliac tubercle, defining the crestal plane, a supra-acetabular pin can be inserted into the anterior inferior iliac spine, which lies 3 cm inferior and 2 cm medial to the ASIS, and advanced along the supra-acetabular bone by angling the pin 30° caudal and 25° medial to the crestal plane.

Hypofractionated radiation treatment in early breast cancer: Results in a New Zealand setting.

AIMS: High-quality evidence supports that hypofractionated radiation treatment (HFRT) is as effective and safe in early breast cancer as conventionally fractionated radiation treatment. HFRT with fewer treatments has potential benefits for both patients and radiation departments. Despite this, concerns about local control and toxicity with HFRT persist, such that many eligible patients do not receive HFRT. The local recurrence rates and acute toxicity after HFRT was analyzed in our center in Christchurch, New Zealand. METHODS: An audit was undertaken of all early breast cancer (T1-2 and N0-1) patients treated with HFRT from Jan 21, 2004, to December 31, 2006, dating from the adoption of HFRT in our department. Sixty-eight percent of the patients during this time received HFRT (274/402). Acute toxicity was prospectively recorded and local, regional and distant recurrences were documented. RESULTS: A total of 274 patients were analyzed with a median follow-up of 7 years (range 0.55-9.5 years). Eleven of 274 patients had local recurrence only. The local recurrence-free survival was 97.2% and 95.8% at 7 years. The skin, lethargy and breast pain acute toxicity was less than grade 3, except for one patient experiencing grade 3 breast pain. CONCLUSION: Low local recurrence rates and acceptably low acute toxicity were achieved in a local setting with HFRT, comparable to results achieved in large randomized controlled trials. HFRT is a valid option for eligible patients and its use should be encouraged.