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Sample records for sustained pelvic injuries

  1. Analysis of pelvic fracture pattern and overall orthopaedic injury burden in children sustaining pelvic fractures based on skeletal maturity.

    Science.gov (United States)

    Shaath, M K; Koury, K L; Gibson, P D; Lelkes, V M; Hwang, J S; Ippolito, J A; Adams, M R; Sirkin, M S; Reilly, M C

    2017-06-01

    The purpose of this study was to review pelvic fractures and concomitant orthopaedic injuries in children who have a patent triradiate cartilage (TRO) compared with children whose triradiate cartilage has closed (TRC). We hypothesise that these injuries will differ, leading to correlated alterations in management. Using a database, we retrospectively reviewed patients aged below 18 years with pelvic fractures presenting to our Level 1 trauma center. Radiographs and CT scans were reviewed to identify orthopaedic injuries and categorise pelvic injuries using the modified Torode classification between the two groups. A total of 178 patients met inclusion criteria (60 TRO and 118 TRC). Mean age ± SD for TRO and TRC groups were 8 ± 4 years and 16 ± 2 years, respectively. TRO patients were more likely to present as a pedestrian struck by a vehicle (odds ratio (OR) 6.0; p < 0.001) and less likely to present after a motor vehicle collision (OR 0.2; p < 0.001). TRO patients were more likely to sustain rami fractures (OR 2.1; p = 0.020) and Torode IIIA injuries (OR 3.6; p < 0.001). They were less likely to sustain acetabular fractures (OR 0.5; p = 0.042), sacral fractures (OR 0.4; p = 0.009), hip dislocations (p = 0.002) and Torode IV injuries (OR 0.4; p = 0.004). TRO patients were less likely to be treated operatively for their pelvic (OR 0.3; p = 0.013) and orthopaedic injuries (OR 0.4; p = 0.006). We suggest that patients with open triradiate cartilage are unique. Their pelvic injuries may be treated more conservatively as they have a greater potential for periosteal healing and bone remodelling. Patients with closed triradiate cartilage should be treated similarly to adults, as they share a similar mechanism of injury and need for operative fixation.

  2. Angioembolization for pelvic hemorrhage control: results from the German pelvic injury register.

    Science.gov (United States)

    Hauschild, Oliver; Aghayev, Emin; von Heyden, Johanna; Strohm, Peter C; Culemann, Ulf; Pohlemann, Tim; Suedkamp, Norbert P; Schmal, Hagen

    2012-09-01

    Hemorrhage from pelvic vessels is a potentially lethal complication of pelvic fractures. There is ongoing controversy on the ideal treatment strategy for patients with pelvic hemorrhage. The aim of the study was to analyze the role of angiography and subsequent embolization in patients with pelvic fractures and computed tomography scan-proven vascular injuries. The data from the prospective multicenter German pelvic injury registry were analyzed. Of 5,040 patients with pelvic fractures, 152 patients with associated vascular injuries were identified. Patients undergoing angioembolization (n = 17) were compared with those undergoing conventional measures for hemorrhage control (n = 135) with regard to demographic and physiologic parameters, fracture type distribution, and treatment measures. Outcome measures were mortality, requirement for blood transfusions, complications, and hospital length of stay. Embolization and nonembolization groups were comparable with regard to age, sex, Injury Severity Score, Hannover Polytrauma Score, initial hemoglobin levels, blood pressure, fracture distribution, and conventional measures. Blood transfusion requirement was significantly prolonged in the embolization group. This resulted in a higher adult respiratory distress syndrome incidence and a tendency toward increased multiple organ failure rate in this group. There was no significant difference in overall mortality rate when compared with the nonembolization group (17.6% vs. 32.6%, respectively; p = 0.27). None of the patients undergoing embolization died from exsanguination when compared with 20.6% in the nonembolization group (p = 0.038). Angioembolization alongside with conventional measures is an effective complementary means for hemorrhage control in patients sustaining pelvic fracture-related vascular lesions. It might prove even more effective when performed early enough to avoid prolonged blood transfusion requirement. Further studies without the mentioned limitations

  3. Severe abdominal injuries sustained in an adult wearing a pelvic seatbelt: a case report and review of the literature.

    LENUS (Irish Health Repository)

    O'Kelly, F

    2008-12-01

    In automobile accidents, the "seatbelt syndrome" (SBS) consists of a constellation of injuries, predominantly involving thoraco-lumbar vertebral fractures and intraabdominal organ injury. A recent amendment to Irish legislation has made the wearing of seatbelts mandatory for all rear seated passengers in an effort to protect children. Whilst rear seatbelts result in a significant reduction in morbidity and mortality following road traffic accidents (RTA), we present a case in which the rear lap seatbelt caused severe abdominal injuries. It is evident that the current rear seat lapbelt system is an inferior design associated with a significant morbidity and mortality when compared to three-point harness system and consideration should be given to replacing them in all motor vehicles.

  4. Epidemiology and outcome of complex pelvic injury

    DEFF Research Database (Denmark)

    Schmal, Hagen; Markmiller, Max; Mehlhorn, Alexander T

    2005-01-01

    with lacerations of branches of the iliac artery was identified as being at high risk for lethal outcome; they represented 4.3% of all patients with pelvic fracture (group II). The overall mortality reached 4.4%; it increased in group I to 15.5%, and in group II to 33.3%. In the subgroup with pelvic arterial...... haemorrhage (group II), the severity of injury, the proportion of multiple injured patients, the prevalence of unstable fractures and the incidence of sepsis were significantly increased. The only predictive factor for outcome was the amount of blood transfused, suggesting that fast elimination...

  5. Genitourinary injuries in pelvic fracture morbidity and mortality using the National Trauma Data Bank.

    Science.gov (United States)

    Bjurlin, Marc A; Fantus, Richard J; Mellett, Michele M; Goble, Sandra M

    2009-11-01

    Pelvic fractures from blunt force trauma place the bladder and urethra at risk for injury, often resulting in significant complications. We sought to compare morbidity, mortality, and health care resource utilization in patients with and without genitourinary injuries (GUI) associated with pelvic fractures. In this retrospective study of patients with blunt force pelvic fractures, the incidence of GUI, initial emergency department data, mechanism of injury, morbidity, health care resource utilization, associated injuries, discharge disposition, and mortality were investigated using chi tests for categorical variables and Student's t test for continuous variables comparing pelvic fractures with and without GUI. Multiple logistic regression analysis was used to detect significant predictors of mortality. Of the 31,380 patients with pelvic fractures, 1,444 had GUI. Men more commonly sustained pelvic fractures with GUI than women (66.14% vs. 33.86%). The incidence of urogenital, bladder, and urethral injuries for men and women was 5.34%, 3.41%, 1.54%, and 3.62%, 3.37%, 0.15%, respectively. Patients with GUI remained hospitalized longer (median 10 vs. 6 d, p GUI. Motor vehicle collisions were the most common mechanism of injury for all pelvic fractures. Spleen and liver were the most commonly injured abdominal organs associated with pelvic fractures as a whole. Pelvic fractures with GUI were more likely to result in associated injuries of the bowel, and reproductive organs. Although GUI was not found to be an independent predictor of mortality, age >or=65 years, initial systolic blood pressure in the emergency department 0 mm Hg to 90 mm Hg, Injury Severity Score >or=25, Glasgow coma score of GUI have an increase in morbidity. Although GUI was not an independent predictor of mortality, patients who sustained a pelvic fracture with GUI had a greater number of concomitant injuries resulting in an increase in overall mortality compared with those without an associated GUI.

  6. Epidemiology of pelvic ring fractures and injuries

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    Gilberto José Cação Pereira

    Full Text Available ABSTRACT OBJECTIVE: This study evaluated the pelvic ring fractures and injuries in patients admitted to and treated at this ward between August, 2012 and January, 2014. METHODS: 66 patients were submitted to treatment protocols according to their age, gender, skin color, injury mechanism, location of the trauma, classification of their injuries, emergency intervention, associated injuries, injured side of the body, treatment, and mortality. The most relevant data were classified according to statistic procedures, such as Goodman's association test. Measures were compared with Student's t-test and analysis of variance associated with Tukey's multiple comparison test. RESULTS: The mean age was 47 years; white race and male gender were most common. Car or truck accident was the most common cause of injuries, which occurred mainly in urban sites. Type A injuries were the most frequent. 16.6% of the cases were submitted to emergency surgery. 42.4% displayed associated injuries. The right side of the body was the most commonly affected side. Non-invasive treatment was most commonly used. Death was the outcome in 3% of the cases, associated to high-energy trauma. CONCLUSIONS: Pelvic ring fractures and injuries are more often verified among males. In general and among younger individuals, traffic accidents are the most common cause of the injury, while among the elderly, ordinary falls are the most commonly verified cause. The majority of those injuries are suffered in urban areas. Type A fractures are more frequent. The majority of cases do not require emergency intervention nor do they feature associated injuries. Non-invasive treatment is most common and death outcomes are associated to high-energy traumas with severe injuries.

  7. Radiodiagnosis of pelvic birth injuries and their consequences

    Energy Technology Data Exchange (ETDEWEB)

    Konycheva, E.A.; Loskutova, L.A. (Bashkirskij Meditsinskij Inst. (USSR))

    A study was made of the changes in the pelvic articulations in women with birth injuries 2-5 years following birth on the basis of the clinicoroentgenological findings. Pathological adhesion of birth injuries of the pelvic bones, that manifested itself in the formation of callus and arthrosis of the public and sacroiliac articulations, was noted. The study confirmed incomplete rehabilitation in this group of women. For prognosis of subsequent parturition roentgenopelvimetry is recommended for women with birth injuries of the pelvic girdle.

  8. Abdominal solid organ injury in trauma patients with pelvic bone fractures.

    Science.gov (United States)

    Kwon, Hyo-Min; Kim, Sun-Hyu; Hong, Jung-Seok; Choi, Wook-Jin; Ahn, Ryeok; Hong, Eun-Seog

    2014-03-01

    We analyzed the clinical progression of trauma patients with pelvic bone fractures so to determine the risk factors associated with sustaining concurrent abdominal solid organ injuries. This study was a retrospective chart review. Subjects were categorized based on injury type: solid organ versus non-solid organ injury groups. These study groups were compared based on demographics, treatments, and clinical outcomes. Potential risk factors that may contribute to the occurrence of abdominal solid organ injury in trauma patients with pelvic bone fractures were evaluated. The solid organ injury group included 17.4% of all the patients in the study (n=69). Fall from height occurred at greater distances in patients that sustained solid organ injuries as opposed to patients with non-solid organ injuries. Initial blood pressure and Revised Trauma Scores were lower in the solid organ injury group. Shock diagnosed immediately upon emergency department arrival was a risk factor for intra-abdominal solid organ injuries in trauma patients with pelvic bone fractures. Clinical prognosis for patients in the solid organ injury group was poorer and more invasive treatments were performed for patients in this group. Traumatic pelvic fracture patient prognosis needs to be improved through early diagnosis and prompt delivery of aggressive treatments based on rapid identification of abdominal solid organ injuries.

  9. A comparison study of pelvic fractures and associated abdominal injuries between pediatric and adult blunt trauma patients.

    Science.gov (United States)

    Swaid, Forat; Peleg, Kobi; Alfici, Ricardo; Olsha, Oded; Givon, Adi; Kessel, Boris

    2017-03-01

    Pelvic fractures are a marker of severe injury, mandating a thorough investigation for the presence of associated injuries. Anatomical and physiological differences between adults and children may lead to a different impact of pelvic fractures on these populations. The purpose of this study is to compare pelvic fractures between pediatric and adult blunt trauma victims, mainly regarding their severity and associated intraabdominal injuries. A retrospective study involving blunt trauma patients suffering pelvic fractures, according to the records of the Israeli National Trauma Registry. Patients included children, aged 0-14years, and adults between 15 and 64years. The presence and severity of associated injuries were assessed. Overall, 7621 patients aged 0-64years were identified with pelvic fractures following blunt trauma. The incidence of pelvic fractures in children was (0.8%), as compared to 4.3% in adults, p 25. Adults sustained significantly more moderate to severe pelvic fractures (AIS≥3) than children (26.7% vs. 17.4%, ptrauma are more likely to sustain pelvic fractures, and these are generally more severe fractures, as compared to children suffering from blunt trauma. Nonetheless, mortality rates were found similar in both groups. The only associated injury with statistically significant difference in incidence among the two groups was rectal injury. In adults, but not in children, higher grade pelvic fractures correlated with more severe concomitant splenic or hepatic injuries. The level of evidence for this study is III (3). Copyright © 2016 Elsevier Inc. All rights reserved.

  10. An approach to urological injuries associated with pelvic surgery ...

    African Journals Online (AJOL)

    Injuries during pelvic floor surgery may involve the ureter, bladder and urethra. Detailed knowledge of the anatomy of these structures and the application of this knowledge during surgery, together with appropriate pre-operative imaging will help to reduce morbidity from urological injuries during pelvic floor surgery.

  11. Pelvic fracture urethral injuries revisited: A systematic review ...

    African Journals Online (AJOL)

    Purpose: We attempted to determine the unresolved controversies about pelvic fracture urethral injuries and to present a treatment plan for this lesion. Materials and methods: A systematic review was conducted on all contemporary pelvic fracture urethral injury articles published in the last 60 years. Studies were eligible ...

  12. Pelvic fracture urethral injuries revisited: A systematic review

    African Journals Online (AJOL)

    Mamdouh M. Koraitim

    2011-07-12

    Jul 12, 2011 ... Abstract Purpose: We attempted to determine the unresolved controversies about pelvic fracture urethral injuries and to present a treatment plan for this lesion. Materials and methods: A systematic review was conducted on all contemporary pelvic fracture urethral injury articles published in the last 60 years ...

  13. Immediate Revascularization of A Traumatic Limb Vascular Injury associated with Major Pelvic Injuries

    Directory of Open Access Journals (Sweden)

    Hanifah J

    2015-11-01

    Full Text Available High velocity pelvic injury with limb vascular injury poses difficulties as immediate surgery for limb reperfusion is indicated. However immediate vascular intervention deviates from conventional principles of damage control following major injuries. We present two cases of this rare combination of injuries. In both cases, early limb revascularization is possible despite presented with multiple injuries and pelvic fracture.

  14. Development of Pelvic Abscess Following Water-Skiing Injury

    OpenAIRE

    Pearlman, Mark D.; Lauren Zoschnick

    1993-01-01

    Several descriptions of hydrostatic injuries while water-skilng have been described, including lacerations of the perineum, vagina, and cervix. Salpingitis or pelvic abscess resulting from water-skiing injuries are rare but important complications. A case of a pelvic abscess following a fall while water-skiing is described. The abscess was drained laparoscopically, resulting in a good clinical outcome. The mechanism of injury and recommendations for prevention are also presented. Upper genita...

  15. Spinal and pelvic injuries in airborne sports: a retrospective analysis from a major Swiss trauma centre.

    Science.gov (United States)

    Hasler, Rebecca M; Hüttner, Harald E; Keel, Marius J B; Durrer, Bruno; Zimmermann, Heinz; Exadaktylos, Aristomenis K; Benneker, Lorin M

    2012-04-01

    Adrenalin-seeking airborne sports like BASE-jumping, paragliding, parachuting, delta-gliding, speedflying, and skysurfing are now firmly with us as outdoor lifestyle activities and are associated with a high frequency of severe injuries, especially to the spine. Retrospective analysis of all airborne sports-associated spinal and pelvic injuries admitted to a Level I trauma centre in the Swiss Alps between 1st March 2000 and 31st October 2009. Spinal injuries were classified by the Magerl system and pelvic injuries by the AO/OTA scheme modified by Isler and Ganz. Spino-pelvic dissociation fractures in airborne sports were compared to similar injuries in the general trauma population using multiple logistic regression analysis. 181 patients (11 BASE-jumpers, 144 paragliders, 19 parachuters, 1 speedflyer, 4 deltagliders, 2 skysurfer) were included. 161 (89%) were male. Median age was 37.0 years (IQR=29.0-47.0) and ISS 8 (IQR=4-13). 89 (49.2%) patients sustained spinal fractures. Type A fractures were predominant (91.5%), followed by Type C (5.3%) and Type B (3.2%). The level L1 was most often affected (35.1%). 17 patients (9.4%) had pelvic ring fractures. Most frequent were Type C fractures (41.2%), followed by Types A and B (29.4% each). 8 paragliders (4.4%) suffered spino-pelvic dissociation injuries. The odds ratio for sustaining such fractures in paragliders was 21-fold higher (OR 21.04, 95% CI 7.83-56.57, psporting activities. The thoracolumbar region was most often affected, but the lumbopelvic junction is also especially vulnerable as high impact forces from vertical and horizontal deceleration need to be absorbed. The frequency of spino-pelvic dissociation was very high in paragliding injuries, with a 21-fold higher odds ratio than in the general trauma population. Copyright © 2011 Elsevier Ltd. All rights reserved.

  16. Associated Injuries in Skeletally Immature Children with Pelvic Fractures.

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    Shaath, M Kareem; Koury, Kenneth L; Gibson, Peter D; Adams, Mark R; Sirkin, Michael S; Reilly, Mark C

    2016-09-01

    Pediatric pelvic fractures are rare injuries resulting from high-energy mechanisms that warrant an extensive work-up for associated injuries. We performed a retrospective study to review concomitant injuries in children who suffered a pelvic fracture and have an open triradiate cartilage. Using a database, pediatric pelvic fractures presenting to the authors' institution were extracted. Radiographs and computed tomography scans were reviewed, ensuring that triradiate cartilages were not fused and the pelvic injuries were classified using the Modified Torode Classification. Epidemiologic data extracted included Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and Abbreviated Injury Score (AIS). Sixty patients met the inclusion criteria, and their average age was 8.3 years (range 2-14 years). There were no mortalities. The most common mechanism of injury was a vehicle striking a pedestrian. There were no significant correlations between GCS, ISS, and AIS. All 60 children (100%) suffered extremity injuries. Nineteen patients required surgical orthopedic intervention, and 6 required operative stabilization of the pelvis. Patients who were struck by a motor vehicle were more likely to have multiple pelvic fractures (p fractures were more likely to require orthopaedic surgical intervention and require a blood transfusion (p fractures were more likely to require a transfusion than patients with III-A fracture (p fractures to an immature pelvis are likely to have additional injuries, which may be fatal or disabling if not diagnosed in a timely manner. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. THE ASSOCIATION BETWEEN PELVIC FRACTURES (RING AND ACETABULUM FRACTURES AND OTHER ORGAN SYSTEM INJURIES

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    Igor Kostić

    2015-09-01

    Full Text Available Pelvic fractures are often associated with injuries of intra-abdominal organs and intrathoracic injuries. Between January 1, 2004 and June 31, 2009, at the Clinic for Orthopaedic Surgery and Traumatology, Clinical Center Niš, 216 patients with pelvic disruption were treated. All patients were evaluated according to sex, age, mechanism of injury, anatomical injury scale (AIS, injury severity scale (IIS, type of fracture, method of treatment, associated injuries of visceral organs, duration of hospitalization and monitoring of the patient check-ups. The aim of this work was to determine the frequency of occurrence of intra-abdominal and intrathoracic injuries in patients with pelvic fractures and to study the relationship between different types of fractures. In the analyzed group there were 116 (53.7% male patients and 100 (46.3% female patients. The average age of patients was 45.3 years. In total, there were 139 isolated fractures of the pelvis. In relation to the mechanism of injury, 153 patients had sustained low energy trauma, while 63 patients had sustained high energy trauma. In the group of patients with the fracture of the pelvis sustained under the force of low intensity, 17 patients had fallen from the ladder, whereas 136 patients had fallen at home. In patients with the injury that occurred under the force of high intensity, 49 patients were injured in car accidents, and 14 had fallen from a great height. Combined injuries of intra-abdominal and intrathoracic organs with pelvic fracture were observed in 28 (12.9 % patients.

  18. [Clinical report of traumatic lumbo-sacro-pelvic injuries].

    Science.gov (United States)

    Qi, Lei; Sang, Xi-guang; Li, Mu; Li, Yu-hua

    2009-12-15

    To study the characteristic and surgical treatment of traumatic lumbo-sacro-pelvic injuries. A retrospective study was carried out on 8 cases with traumatic lumbo-sacro-pelvic injuries between August 2005 and February 2008, which included 6 male and 2 female, aged from 21 to 52 years with a mean age of 38.4 years. ISS scores were undertaken to evaluate the injury severity of the cases after admission. Measures were taken to treat the emergency that affected the patients' lives. After the patients' conditions were stable, lumbo-iliac fixation was performed to treat traumatic lumbo-sacro-pelvic injuries. Imaging examinations were made to observe the reduction of fracture after operation. Injury of nerve was evaluated with ASIA score, and ASIA scores of preoperation and the last follow-up were analyzed statistically with paired t test. The group was followed up for 9 to 25 months, averaging 16.9 months. Postoperative imaging examinations showed satisfied reduction of fracture. The preoperative ASIA sensory score and motor score were 35.8+/-5.3 and 31.9+/-6.4 respectively, while the sensory score and motor score were 51.8+/-13.8 and 38.2+/-7.5 at the last follow-up respectively. The sensory and motor functions were improved significantly after operation (Psacro-pelvic injuries is a kind of severe injury of lumbo-sacro-pelvic region. It can be treated with lumbo-iliac internal fixation and fine clinical effect can be gained.

  19. PELVIC INJURY IN CHILDHOOD: WHAT IS ITS CURRENT IMPORTANCE?

    OpenAIRE

    GUERRA, MAR?A ROXANA VIAMONT; BRAGA, SUSANA REIS; AKKARI, MIGUEL; SANTILI, CLAUDIO

    2016-01-01

    ABSTRACT Objective: The purpose of this study was to assess the importance of pelvic fractures in childhood by analyzing epidemiological characteristics and associated injuries. Methods: This is a retrospective study performed between 2002 and 2012 at two trauma referral centers in São Paulo. We identified 25 patients aged 16 years old or younger with pelvic fracture. Results: The main mechanism of trauma was traffic accident (80%), followed by fall from height (16%). At hospital admiss...

  20. PELVIC INJURY IN CHILDHOOD: WHAT IS ITS CURRENT IMPORTANCE?

    Science.gov (United States)

    Guerra, María Roxana Viamont; Braga, Susana Reis; Akkari, Miguel; Santili, Claudio

    2016-01-01

    The purpose of this study was to assess the importance of pelvic fractures in childhood by analyzing epidemiological characteristics and associated injuries. This is a retrospective study performed between 2002 and 2012 at two trauma referral centers in São Paulo. We identified 25 patients aged 16 years old or younger with pelvic fracture. The main mechanism of trauma was traffic accident (80%), followed by fall from height (16%). At hospital admission, 92% had traumatic brain injury and 40% had hemodynamic instability. Besides pelvic fractures, 56% of the children had other associated injuries (genitourinary, abdominal, vascular, chest and neurological), and 79% of them required operative treatment. According to the Torode and Zieg classification, the majority of cases were types III and IV. Seventy-two percent of all pelvic fractures were treated by surgery; 52% involved external fixation and 20% involved open reduction and internal fixation. The pelvic fractures in childhood can be considered a marker for injury severity, because the associated injuries usually are severe, needing operative treatment and leading to a high mortality rate (12%). Level of Evidence IV, Case Series.

  1. [Deep infiltrating endometriosis surgical management and pelvic nerves injury].

    Science.gov (United States)

    Fermaut, M; Nyangoh Timoh, K; Lebacle, C; Moszkowicz, D; Benoit, G; Bessede, T

    2016-05-01

    Deep pelvic endometriosis surgery may need substantial excisions, which in turn expose to risks of injury to the pelvic nerves. To limit functional complications, nerve-sparing surgical techniques have been developed but should be adapted to the specific multifocal character of endometriotic lesions. The objective was to identify the anatomical areas where the pelvic nerves are most at risk of injury during endometriotic excisions. The Medline and Embase databases have been searched for available literature using the keywords "hypogastric nerve or hypogastric plexus [Mesh] or autonomic pathway [Mesh], anatomy, endometriosis, surgery [Mesh]". All relevant French and English publications, selected based on their available abstracts, have been reviewed. Five female adult fresh cadavers have been dissected to localize the key anatomical areas where the pelvic nerves are most at risk of injury. Six anatomical areas of high risk for pelvic nerves have been identified, analysed and described. Pelvic nerves can be damaged during the dissection of retrorectal space and the anterolateral rectal excision. Furthermore, before an uterosacral ligament excision, a parametrial excision, a colpectomy or a dissection of the vesico-uterine ligament, the hypogastric nerves, splanchnic nerves, inferior hypogastric plexus and its efferent pathways must be mapped out to avoid injury. The distance between the deep uterin vein and the pelvic splanchnic nerves were measured on four cadavers and varied from 2.5cm to 4cm. Six key anatomical pitfalls must be known in order to limit the functional complications of the endometriotic surgical excision. Applying nerve-sparing surgical techniques for endometriosis would lead to less urinary functional complications and a better short-term postoperative satisfaction. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  2. Straight leg elevation to rule out pelvic injury.

    Science.gov (United States)

    Bolt, Caroline; O'Keeffe, Francis; Finnegan, Pete; Dickson, Kristofer; Smit, De Villiers; Fitzgerald, Mark C; Mitra, Biswadev

    2017-10-09

    Pelvic x-ray is frequently used as a screening tool during initial assessment of injured patients. However routine use in the awake and alert blunt trauma patient may be questioned due to low yield. We propose a clinical tool that may avoid unnecessary imaging by examining whether the ability to straight leg raise, without pain, can rule out pelvic injury. We conducted a prospective cohort study with the exposure variables of ability to straight leg raise and presence of pain on doing so, and presence of pelvic fracture on x-ray as the primary outcome variable. Of the 328 participants, 35 had pelvic fractures, and of these 32 were either unable to straight leg raise, or had pain on doing so, with a sensitivity of 91.43% (95% CI: 76.94-98.2%) and a negative predictive value of 98.57% (95% CI: 95.88-99.70%). The 3 participants with a pelvic fracture who could straight leg raise with no pain, all had a GCS of less than 15, and therefore, among the sub-group of patients with GCS15, a 100% sensitivity and 100% negative predictive value for straight leg raise with no pain to rule out pelvic fracture was demonstrated. Among awake, alert patients, painless straight leg raise can exclude pelvic fractures and be incorporated into initial examination during reception and resuscitation of injured patients. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  3. Management of severe pelvic injury following road traffic accident in ...

    African Journals Online (AJOL)

    A 34 year old woman involved in road traffic accident with severe anterior and posterior pelvic fractures with associated soft tissue injury was referred from Wa Regional Hospital 18 hours after the accident to Tania Specialist Hospital in Tamale. Emergency resuscitative measures such as catheterization and management of ...

  4. Iliosacral screw fixation of the unstable pelvic ring injuries.

    Science.gov (United States)

    Rysavý, M; Pavelka, T; Khayarin, M; Dzupa, V

    2010-06-01

    To report on the early results and possible complications of iliosacral screw fixation in the management of unstable pelvic ring injuries. One hundred and two unstable pelvic ring injuries were treated using iliosacral screw fixation for posterior pelvic ring disruptions. Closed manipulative reductions of the posterior lesion were attempted for all patients. Open reductions were used in the minority of patients with unsatisfactory closed reductions as assessed fluoroscopically at the time of surgery. Anterior fixations were by means of open reduction in 62 patients and by external fixation in 14 patients, and by screws in 7 patients. Twenty patients had no anterior fixation. Plain anteroposterior, inlet and outlet radiographs of the pelvis were obtained postoperatively at six weeks, three months, six months and one year. A pelvic computed tomography scan was performed postoperatively in those patients where residual displacement or screw misplacement was suspected. Complications were recorded. One patient died 31 days after the trauma due to pneumonia and one died 9 months after the surgery after a fall from a height in a second suicidal attempt. There were two posterior pelvic infections and one anterior pelvic infection. Screw misplacement occurred in seven cases. In six cases a misplaced screw produced transient L5 neuroapraxia. There was no fixation failure requiring revision surgery. There was one case of injury to the superior gluteal artery. Unstable pelvic ring disruptions are severe injuries, associated with a high rate of morbidity and mortality. Pelvic fractures can be treated by variety of methods. Treatment with traction and pelvic slings does not offer accurate reduction and confines the patient to prolong bed rest with all potential complications. Several authors documented lower morbidity and mortality rates and shorter hospital stay in patients treated by early operative stabilization of pelvic injuries. The timing of the surgery is still

  5. The value of 'binder-off' imaging to identify occult and unexpected pelvic ring injuries.

    Science.gov (United States)

    Fagg, James A C; Acharya, Mehool R; Chesser, Tim J S; Ward, Anthony J

    2017-11-21

    To determine the effectiveness of 'binder-off' plain pelvic radiographs in the assessment of pelvic ring injuries. All patients requiring operative intervention at our tertiary referral pelvic unit/major trauma centre for high-energy pelvic injuries between April 2012 and December 2014 were retrospectively identified. Pre-operative pelvic imaging with and without pelvic binder was reviewed with respect to fracture pattern and pelvic stability. The frequency with which the imaging without pelvic binder changed the opinion of the pelvic stability and need for operative intervention, when compared with the computed tomography (CT) scans and anteroposterior (AP) radiographs with the binder on, was assessed. Seventy-three percent (71 of 97) of patients had initial imaging with a pelvic binder in situ. Of these, 76% (54 of 71) went on to have 'binder-off' imaging. Seven percent (4 of 54) of patients had unexpected unstable pelvic ring injuries identified on 'binder-off' imaging that were not identified on CT imaging in binder. Trauma CT imaging of the pelvis with a pelvic binder in place is inadequate at excluding unstable pelvic ring injuries, and, based on the original findings in this paper, we recommend additional plain film 'binder-off' radiographs, when there is any clinical concern. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. [Complex pelvic traumas : data linkage of the German Pelvic Injury Register and the TraumaRegister DGU®].

    Science.gov (United States)

    Burkhardt, M; Nienaber, U; Krause, J; Pizanis, A; Moersdorf, P; Culemann, U; Aghayev, E; Paffrath, T; Pohlemann, T; Holstein, J H

    2015-11-01

    Complex pelvic traumas, i.e., pelvic fractures accompanied by pelvic soft tissue injuries, still have an unacceptably high mortality rate of about 18 %. We retrospectively evaluated an intersection set of data from the TraumaRegister DGU® and the German Pelvic Injury Register from 2004-2009. Patients with complex and noncomplex pelvic traumas were compared regarding their vital parameters, emergency management, stay in the ICU, and outcome. From a total of 344 patients with pelvic injuries, 21 % of patients had a complex and 79 % a noncomplex trauma. Complex traumas were significantly less likely to survive (16.7 % vs. 5.9 %). Whereas vital parameters and emergency treatment in the preclinical setting did not differ substantially, patients with complex traumas were more often in shock and showed acute traumatic coagulopathy on hospital arrival, which resulted in more fluid volumes and transfusions when compared to patients with noncomplex traumas. Furthermore, patients with complex traumas had more complications and longer ICU stays. Prevention of exsanguination and complications like multiple organ dysfunction syndrome still pose a major challenge in the management of complex pelvic traumas.

  7. Application of Circumferential Compression Device (Binder in Pelvic Injuries: Room for Improvement

    Directory of Open Access Journals (Sweden)

    Matthew Roth

    2016-11-01

    Full Text Available Introduction The use of a noninvasive pelvic circumferential compression device (PCCD to achieve pelvic stabilization by both decreasing pelvic volume and limiting inter-fragmentary motion has become commonplace, and is a well-established component of Advanced Trauma Life Support (ATLS protocol in the treatment of pelvic ring injuries. The purpose of this study was to evaluate the following: 1 how consistently a PCCD was placed on patients who arrived at our hospital with unstable pelvic ring injuries; 2 if they were placed in a timely manner; and 3 if hemodynamic instability influenced their use. Methods We performed an institutional review board-approved retrospective study on 112 consecutive unstable pelvic ring injuries, managed over a two-year period at our Level I trauma center. Our hospital electronic medical records were used to review EMT, physician, nurses’, operative notes and radiographic images, to obtain information on the injury and PCCD application. The injuries were classified by an orthopaedic trauma surgeon and a senior orthopaedic resident. Proper application of a pelvic binder using a sheet is demonstrated. Results Only 47% of unstable pelvic fractures received PCCD placement, despite being the standard of care according to ATLS. Lateral compression mechanism pelvic injuries received PCCDs in 33% of cases, while anterior posterior compression (APC and vertical shear (VS injuries had applications in 63% of cases. Most of these PCCD devices were applied after imaging (72%. Hemodynamic instability did not influence PCCD application. Conclusion PCCD placement was missed in many (37% of APC and VS mechanism injuries, where their application could have been critical to providing stability. Furthermore, to provide rapid stability, pelvic circumferential compression devices should be applied after secondary examination, rather than after receiving imaging results. Better education on timing and technique of PCCD placement at our

  8. Application of Circumferential Compression Device (Binder) in Pelvic Injuries: Room for Improvement

    Science.gov (United States)

    Vaidya, Rahul; Roth, Matthew; Zarling, Bradley; Zhang, Sarah; Walsh, Christopher; Macsuga, Jessica; Swartz, John

    2016-01-01

    Introduction The use of a noninvasive pelvic circumferential compression device (PCCD) to achieve pelvic stabilization by both decreasing pelvic volume and limiting inter-fragmentary motion has become commonplace, and is a well-established component of Advanced Trauma Life Support (ATLS) protocol in the treatment of pelvic ring injuries. The purpose of this study was to evaluate the following: 1) how consistently a PCCD was placed on patients who arrived at our hospital with unstable pelvic ring injuries; 2) if they were placed in a timely manner; and 3) if hemodynamic instability influenced their use. Methods We performed an institutional review board-approved retrospective study on 112 consecutive unstable pelvic ring injuries, managed over a two-year period at our Level I trauma center. Our hospital electronic medical records were used to review EMT, physician, nurses’, operative notes and radiographic images, to obtain information on the injury and PCCD application. The injuries were classified by an orthopaedic trauma surgeon and a senior orthopaedic resident. Proper application of a pelvic binder using a sheet is demonstrated. Results Only 47% of unstable pelvic fractures received PCCD placement, despite being the standard of care according to ATLS. Lateral compression mechanism pelvic injuries received PCCDs in 33% of cases, while anterior posterior compression (APC) and vertical shear (VS) injuries had applications in 63% of cases. Most of these PCCD devices were applied after imaging (72%). Hemodynamic instability did not influence PCCD application. Conclusion PCCD placement was missed in many (37%) of APC and VS mechanism injuries, where their application could have been critical to providing stability. Furthermore, to provide rapid stability, pelvic circumferential compression devices should be applied after secondary examination, rather than after receiving imaging results. Better education on timing and technique of PCCD placement at our institution

  9. Interventional treatment experience in multiple injury with major abdominal or pelvic injuries: 160 cases analysis

    Directory of Open Access Journals (Sweden)

    Tian-Xi Zhang

    2018-02-01

    Conclusion: The emergent intervention for embolization and haemorrhage control of multiple trauma patients with a major abdominal or pelvic injury and visceral organ haemorrhage has the advantages of less trauma, shorter operation time, shorter hospital stay, less blood transfusion in comparison to the traditional emergency surgeries.

  10. Comparison of external fixation versus the trauma pelvic orthotic device on unstable pelvic injuries: a cadaveric study of stability.

    Science.gov (United States)

    Prasarn, Mark L; Horodyski, MaryBeth; Conrad, Bryan; Rubery, Paul T; Dubose, Dewayne; Small, John; Rechtine, Glenn R

    2012-06-01

    Most institutions treating pelvic fractures use some method of acute mechanical stabilization. This typically involves use of pelvic binders or circumferential sheeting, and/or external fixation. The comparative value of these different modalities is controversial. We hypothesized that an external fixator would provide more stability to an unstable pelvic injury than a commercially available binder device (trauma pelvic orthotic device [T-POD]). Unstable pelvic injuries (Tile C) were surgically created in five fresh whole human cadavers. Electromagnetic sensors were placed on the same position of each hemipelvis. The amount of angular motion during testing was measured using a Fastrak, three-dimensional, electromagnetic motion analysis device. Maximum displacements were recorded during application of the stabilizing devices, bed transfer, logrolling, and head-of-bed elevation. External fixation frames were constructed by placing two 5.0-mm half pins into the iliac crest and then connected them with a 10-mm curved bar. The T-POD device was placed at the level of the greater trochanters as per manufacturer's recommendations. While logrolling the patient and performing bed transfers, the T-POD conferred more stability in all planes of motion, although this did not reach statistical significance. During elevation of the head of the bed, the T-POD allowed less motion in the sagittal and coronal planes but permitted equivalent motion in axial rotation. These differences were not statistically significant. There were no significant differences in stability conferred by an external fixator or a T-POD for unstable pelvic injuries. We advocate acute, temporary stabilization of pelvic injuries with a binder device and early conversion to internal fixation when the patient's medical condition allows. Copyright © 2012 by Lippincott Williams & Wilkins.

  11. Comparison of circumferential pelvic sheeting versus the T-POD on unstable pelvic injuries: A cadaveric study of stability.

    Science.gov (United States)

    Prasarn, Mark L; Conrad, Bryan; Small, John; Horodyski, MaryBeth; Rechtine, Glenn R

    2013-12-01

    Commercially available binder devices are commonly used in the acute treatment of pelvic fractures, while many advocate simply placing a circumferential sheet for initial stabilization of such injuries. We sought to determine whether or not the T-POD would provide more stability to an unstable pelvic injury as compared to circumferential pelvic sheeting. Unstable pelvic injuries (OTA type 61-C-1) were surgically created in five fresh, lightly embalmed whole human cadavers. Electromagnetic sensors were placed on each hemi-pelvis. The amount of angular motion during testing was measured using a Fastrak, three-dimensional, electromagnetic motion analysis device (Polhemus Inc., Colchester, VT). Either a T-POD or circumferential sheet was applied in random order for testing. The measurements recorded in this investigation included maximum displacements for sagittal, coronal, and axial rotation during application of the device, bed transfer, log-rolling, and head of bed elevation. There were no differences in motion of the injured hemi-pelvis during application of either the T-POD or circumferential sheet. During the bed transfer, log-rolling, and head of bed elevation, there were no significant differences in displacements observed when the pelvis was immobilized with either a sheet or pelvic binder (T-POD). A circumferential pelvic sheet is more readily available, costs less, is more versatile, and is equally as efficacious at immobilizing the unstable pelvis as compared to the T-POD. We advocate the use of circumferential sheeting for temporary stabilization of unstable pelvic injuries. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. Risk factors associated with bladder and urethral injuries in female children with pelvic fractures: An analysis of the National Trauma Data Bank.

    Science.gov (United States)

    Delaney, Kristen M; Reddy, Srinivas H; Dayama, Anand; Stone, Melvin E; Meltzer, James A

    2016-03-01

    Bladder and/or urethral injuries (BUIs) secondary to pelvic fractures are rare in children and are associated with a high morbidity. These injuries are much less likely to occur in females and are often missed in the emergency department. To help clinicians detect these injuries in female children, larger studies are needed to identify risk factors specific to this patient population. This study aimed to identify risk factors associated with BUI in female children with a pelvic fracture. We reviewed the National Trauma Data Bank for females younger than 16 years who sustained a pelvic fracture from 2010 to 2012. Patients with penetrating injuries were excluded. Variables including patient characteristics, mechanism of injury, and type of pelvic fracture were selected for bivariate analysis. Variables with an association of p fractures were identified. The median patient age was 12 years (interquartile range [IQR], 7-14 years). BUI was identified in 81 patients (3%). Patients with BUI had a significantly higher median Injury Severity Score (ISS) (25 [IQR, 17-34] vs. 13 [IQR, 6-22], p fractures (adjusted OR, 2.3; 95% CI, 1.3-3.9), and sacral spine injury (adjusted OR, 1.6; 95% CI, 1.0-2.6). In total, 62 patients (77%; 95% CI, 67-86%) with BUI had at least one of these findings. Female children who sustained a pelvic fracture and have a vaginal laceration, disruption of the pelvic circle, multiple pelvic fractures, or a sacral spine injury seem to be at highest risk for BUI. Prognostic/epidemiologic study, level III.

  13. Iliac Artery and Vein Injury Without Pelvic Fracture Due To Blunt Trauma: A Rare Case

    Directory of Open Access Journals (Sweden)

    Mustafa Cuneyt Cicek

    2014-08-01

    Full Text Available Iliac vascular injuries have high morbidity and mortality rates. Penetrant abdominal and pelvic vascular injuries are more common compared to blunt traumas. Pelvic vascular injuries associated with blunt trauma are quite likely to occur in accompaniment with pelvic fracture. A 23 year old male patient was admitted to the emergency room due to a motorcycle accident. Shock picture was prevalent in the patient. Shaft fracture was present in left femur and flow was not detected in arterial and venous colour Doppler ultrasonography. Patient underwent emergency surgery. Left main iliac artery and vein were normal, however, external iliac vein was lacerated in two spots, and blood vessel wall integrity was damaged in one part of left external iliac artery. Clinical presentation and traumatic retroperitoneal hematoma management of iliac artery and venous injuries due to blunt trauma without pelvic fracture are discussed in the presented case.

  14. Maxillofacial and dental injuries sustained in hurling.

    LENUS (Irish Health Repository)

    Murphy, C

    2010-06-01

    The incidence of facial injuries in hurling has decreased since the introduction of helmets with facial protection. The aim of this study was to identify the incidence of facial and dental injuries sustained in hurling training or matches and compliance with wearing helmets, with or without modified or unmodified faceguards. This prospective study included all patients who attended the Mid Western Regional Hospital Limerick, with injuries sustained while playing hurling during 2007 and 2008 seasons. The study population included 70 patients. Forty two (60%) injuries occurred during practice and 28(40%) during matches. Fifty two players (75%) sustained facial injuries whilst no helmet was worn. Eighteen injuries (25%) were sustained by players wearing helmets. Th study demonstrates that 60% of injuries occur during training when players do not wear helmets. We support the recent introduction by the GAA making it compulsory to wear helmets with faceguard protection from January 1st 2010.

  15. Health service use in adults 20-64 years with traumatic brain injury, spinal cord injury or pelvic fracture. A cohort study with 9-year follow-up

    DEFF Research Database (Denmark)

    Laursen, Bjarne; Helweg-Larsen, Karin

    2012-01-01

    To estimate the health service use over 9 years after the injury year for patients with traumatic brain injury (TBI), spinal cord injury (SCI) and pelvic fracture (PF), and compare with non-injured....

  16. A case report: periprosthetic acetabulum fracture with combined pelvic ring injury.

    Science.gov (United States)

    Cha, Emily; Ertl, Janos P; Mullis, Brian H

    2012-05-01

    Periprosthetic fractures of the acetabulum are largely underreported in the literature, none of which describes the management of such injuries associated with a pelvic ring injury. Our case report discusses our approach to managing a periprosthetic both-column acetabulum fracture associated with an open-book pelvic ring injury. Instead of a revision total hip arthroplasty, we chose to perform an open reduction internal fixation to maintain sufficient bone stock for future revision, if necessary. At 18 months postoperative follow-up, the patient was ambulating independently and had sufficient range of motion that was comparable to the contralateral hip.

  17. Magnetic resonance-based female pelvic anatomy as relevant for maternal childbirth injury simulations.

    Science.gov (United States)

    Hoyte, Lennox; Damaser, Margot S

    2007-04-01

    The objectives of the study are to review the female pelvic floor anatomy relevant to childbirth simulations, to discuss available methods for clinical evaluation of female pelvic floor function, and to review the variation in pelvic floor changes after vaginal childbirth. A high-resolution magnetic resonance (MR) data set from an asymptomatic nullipara was used to illustrate the MR anatomy of the female pelvic floor. Manual segmentation was performed and three-dimensional reconstructions of the pelvic floor structures were generated, which were used to illustrate the 3D anatomy of the pelvic floor. Variation in the post partum appearance of the levator ani muscles is illustrated using other 2D MR data sets, which depict unilateral and bilateral disruptions in the puborectalis portion of levator ani, as well as shape variations, which may be seen in the post partum levator. The clinical evaluation of the pelvic floor is then reviewed. The female pelvis is composed of a bony scaffold, from which the pelvic floor muscles (obturator internus, levator ani) are suspended. The rectum fits in a midline groove in the levator ani. The vagina is suspended across the midline, attaching bilaterally to the obturator and levator ani. The vagina supports the bladder and urethra. MR studies have demonstrated disruptions in levator ani attachments after vaginal childbirth. Such disruptions are rare in women who have not given birth vaginally. Changes to the neuromuscular apparatus of the pelvic floor can also be demonstrated after vaginal delivery. The combination of childbirth-related anatomic and neurological injury to the pelvic floor may be associated with pelvic floor dysfunction (PFD). These changes are difficult to study in vivo but may be studied through simulations. Appropriate consideration of clinical anatomy is important in these simulations.

  18. Imaging of abdominal and pelvic injuries from the Boston Marathon bombing.

    Science.gov (United States)

    Singh, Ajay K; Sodickson, Aaron; Abujudeh, Hani

    2016-02-01

    The aim of this study is to describe the imaging findings of abdominal and pelvic injuries in victims of the Boston Marathon bombing. A retrospective review of 87 patients following the Boston Marathon bombing was performed to evaluate for abdominal and pelvic injuries on plain radiography or CT scans of the abdomen and pelvis. Imaging exams were evaluated for shrapnel, soft tissue injury, visceral damage, vascular disruption, and fractures. The injuries were classified as primary, secondary, tertiary, and quaternary blast injuries. Eleven of the 87 patients had positive findings in the abdomen or pelvis (M:F = 7:4, average age 34.6 years). There were 22 ball bearings, two nails, one screw, and two irregular metal fragments in the 11 patients with secondary blast (shrapnel) injuries. There was no peritoneal penetration or visceral injury seen in any of the patients. One patient had multiple transverse process fractures, representing tertiary blast injury. All but one patient had superficial penetrating abdominal or pelvic injuries secondary to shrapnel. There were no cases of bowel or solid visceral organ injuries due to the lack of peritoneal violation from the relatively low-powered explosions. Absence of peritoneal penetration by shrapnel indicates no need for laparotomy following low-powered explosions.

  19. Evaluation of pelvic ring injuries using SPECT/CT

    Energy Technology Data Exchange (ETDEWEB)

    Scheyerer, Max J. [University Hospital Zurich, Division of Trauma Surgery, Department of Surgery, Zurich (Switzerland); University Medical Center, Centre for Orthopaedic and Trauma Surgery, Cologne (Germany); Huellner, Martin; Pietsch, Carsten [University Hospital Zurich, Division of Nuclear Medicine, Department of Medical Radiology, Zurich (Switzerland); Werner, Clement M.L. [University Hospital Zurich, Division of Trauma Surgery, Department of Surgery, Zurich (Switzerland); Veit-Haibach, Patrick [University Hospital Zurich, Division of Nuclear Medicine, Department of Medical Radiology, Zurich (Switzerland); University Hospital Zurich, Diagnostic and Interventional Radiology, Department of Medical Radiology, Zurich (Switzerland)

    2014-08-12

    The incidence of pelvic fractures is relatively low compared with other fracture locations. The low incidence is in great contrast to the high morbidity and mortality. Particularly in the elderly, with apparently isolated fractures of the pubic rami, these observations are believed to be due to additional occult lesions of the posterior pelvic ring. In these cases diagnosis cannot be established by conventional imaging alone and SPECT/CT is considered as a diagnostic adjunct. The aim of this study was to assess concomitant bony or soft tissue lesions within the pelvic ring in a population of patients with fractures of the anterior elements. In all patients with no obvious lesions of the posterior pelvic ring on X-rays and CT or with suspicious but inconclusive findings on CT an additional SPECT/CT was carried out in a non-acute setting within 3 days of the trauma. In all cases additional lesions within the pelvic ring were found. Most lesions were vertical sacral fractures, followed by transverse fractures, one non-dislocated fracture of the acetabulum on the side of the pubic rami fracture, and one post-traumatic dilatation of the sacroiliac joint with increased tracer uptake. According to our results after SPECT/CT all patients with pubic rami fracture suffered additional lesions, none detectable previously by X-ray or CT, within the pelvic ring. In this context SPECT/CT has proved to be very helpful in the clinical routine to visualize occult fractures and instability within the sacroiliac joint. (orig.)

  20. Patterns of pelvic and acetabular injury among Sudanese patients ...

    African Journals Online (AJOL)

    Background: Most of major pelvic fractures result from very high energy trauma and require urgent hospital treatment. However more minor, stable fractures may only require a period of rest and analgesia followed by gradual mobilization. Extended civil development and increased means of transportation in Sudan during ...

  1. Use of an antigravity treadmill for rehabilitation of a pelvic stress injury.

    Science.gov (United States)

    Tenforde, Adam S; Watanabe, Laine M; Moreno, Tamara J; Fredericson, Michael

    2012-08-01

    Pelvic stress injuries are a relatively uncommon form of injury that require high index of clinician suspicion and usually MRI for definitive diagnosis. We present a case report of a 21-year-old female elite runner who was diagnosed with pelvic stress injury and used an antigravity treadmill during rehabilitation. She was able to return to pain-free ground running at 8 weeks after running at 95% body weight on the antigravity treadmill. Ten weeks from time of diagnosis, she competed at her conference championships and advanced to the NCAA Championships in the 10,000-meters. She competed in both races without residual pain. To our knowledge, this is the first published case report on use of an antigravity treadmill in rehabilitation of bone-related injuries. Our findings suggest that use of an antigravity treadmill for rehabilitation of a pelvic stress injury may result in appropriate bone loading and healing during progression to ground running and faster return to competition. Future research may identify appropriate protocols for recovery from overuse lower extremity injuries and other uses for this technology, including neuromuscular recovery and injury prevention. Copyright © 2012 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  2. Pelvic Organ Distribution of Mesenchymal Stem Cells Injected Intravenously after Simulated Childbirth Injury in Female Rats

    Directory of Open Access Journals (Sweden)

    Michelle Cruz

    2012-01-01

    Full Text Available The local route of stem cell administration utilized presently in clinical trials for stress incontinence may not take full advantage of the capabilities of these cells. The goal of this study was to evaluate if intravenously injected mesenchymal stem cells (MSCs home to pelvic organs after simulated childbirth injury in a rat model. Female rats underwent either vaginal distension (VD or sham VD. All rats received 2 million GFP-labeled MSCs intravenously 1 hour after injury. Four or 10 days later pelvic organs and muscles were imaged for visualization of GFP-positive cells. Significantly more MSCs home to the urethra, vagina, rectum, and levator ani muscle 4 days after VD than after sham VD. MSCs were present 10 days after injection but GFP intensity had decreased. This study provides basic science evidence that intravenous administration of MSCs could provide an effective route for cell-based therapy to facilitate repair after injury and treat stress incontinence.

  3. Unstable pelvic ring injuries. Outcome and timing of surgical treatment by internal fixation.

    Science.gov (United States)

    Zamzam, Mohammed M

    2004-11-01

    To evaluate the radiological and functional results of surgical treatment of unstable pelvic injuries and to study the factors affecting the final outcome. Thirty-eight patients with unstable type C pelvic injuries from King Khalid University Hospital, Riyadh and North West Armed Forces Hospital, Tabuk, Kingdom of Saudi Arabia during the period January 1996 through to January 2001 were reviewed. There were 31 males and 7 females. The mean age was 37-years. Thirty-two patients had 76 associated skeletal fractures. A percutaneous iliosacral screw was carried out for all patients in the study. Anterior stabilization was needed for 23 patients. There were 2 complications of fixation, an iatrogenic S1 root injury and dismantled symphyseal plate. The average hospital stay was 29 days and the average time to start mobilization was 15 days. The radiological result was satisfactory in 32 patients (84%) while functional result was satisfactory in 27 patients (71%). Unstable pelvic ring injuries should be managed surgically and must be carried out as soon as the general condition of the patient allows, even up to 4-weeks.

  4. Mortality in patients with pelvic fractures

    DEFF Research Database (Denmark)

    Hauschild, Oliver; Strohm, Peter C; Culemann, Ulf

    2008-01-01

    BACKGROUND: Pelvic and acetabular fractures are rare injuries and account for approximately 3% to 8% of all fractures. Often the result of high energy blunt trauma, most of the patients sustaining pelvic injuries are at high risk of associated injuries strongly influencing outcome and survival...... rates. Because of anatomic differences it has been suggested that pediatric pelvic fractures are different injuries as compared with that of adults. However, this has been controversially discussed. Aim of this multicenter register study was to identify similarities and differences between pediatric...... and adult pelvic trauma and evaluate the influence of changes in medical treatment by comparison of two treatment periods. METHODS: In this multicenter register study, data of 4,291 patients treated from 1991 to 1993 (n = 1,723) or 1998 to 2000 (n = 2,568) for pelvic fractures in one of the 23 participating...

  5. Rugby Injuries Sustained during Tournament Play.

    Science.gov (United States)

    Kauffman, T

    1985-01-01

    Rugby football is a fast growing physical contact sport that is known for its ruggedness and injuries. Tournament play tests the stamina of the individual players and may have a cumulative wear and tear effect that results in different types of injuries. This study was conducted to determine what body parts are injured in a rugby tournament and how serious those injuries are. Climatic conditions, mainly heat and humidity, were considered to be major factors. Heat-related injuries were the single most important cause for termination of play. This type of injury is very serious and may be reduced or prevented by following simple guidelines for play based on the temperature-humidity index. Most other injuries were strains, sprains, contusions, and several lacerations to the knee, thorax, head, and neck; none was catastrophic. The reputation that rugby football is brutal does not seem justified by the injuries sustained in this tournament. J Orthop Sports Phys Ther 1985;7(1):16-19.

  6. Pelvic fractures resulting from snowboarding.

    Science.gov (United States)

    Ogawa, Hiroyasu; Sumi, Hiroshi; Sumi, Yasuhiko; Shimizu, Katsuji

    2010-03-01

    Information regarding pelvic fractures sustained during snowboarding is scant. To analyze the epidemiologic data, injury patterns, and types of pelvic fractures sustained during snowboarding. Case series; Level of evidence, 4. We analyzed the epidemiologic factors, injury patterns, and types of pelvic fractures in 145 patients with snowboarding-related pelvic fractures who were admitted to our institution from the 1998-1999 to the 2006-2007 ski season. The incidence of snowboarding-related pelvic fractures was 0.102 per 10 000 ski lift tickets, which amounted to 2% of all snowboarding-related fractures (fifth most common type of fracture among all snowboarding-related fractures). Of the pelvic fractures, 85.5% were stable (type A according to the Tile classification) and 14.5% were unstable (types B and C according to the Tile classification). Isolated sacral fractures had the second-highest incidence (24.1%) after pubic bone and/or ischium fractures (46.9%). A distinct female prevalence was seen (52.4%). Jumps and isolated falls were the main mechanisms of injury (80%), and the incidence of collision was significantly higher in the unstable group than in the stable group (P = .037). In all, 57.9% patients classified their skill level as "intermediate," and only 9.7% of patients had received professional snowboarding lessons. A total of 30 subjects (20.8%) had other injuries along with pelvic fractures; the patients with multiple injuries were significantly more frequent in the unstable group than in the stable group (P = .035). Pelvic fractures resulting from snowboarding accidents included a higher proportion with isolated sacral fractures in the stable group and a lower prevalence of associated injuries in the unstable group compared with those resulting from other causes.

  7. Minimally invasive treatment of unstable pelvic ring injuries with modified pedicle screw-rod fixator.

    Science.gov (United States)

    Wu, Xiao-Tian; Liu, Zuo-Qing; Fu, Wen-Qin; Zhao, Shan

    2018-01-01

    Objective To evaluate the clinical application of the minimally invasive modified pedicle screw-rod fixator for unstable pelvic ring injuries, including its feasibility, merits, and limitations. Methods Twenty-three patients (13 males, 10 females; average age, 36.3 years) with unstable pelvic ring injuries underwent anterior fixation using a modified pedicle screw-rod fixator with or without posterior fixation using a transiliac internal fixator. The clinical findings were assessed using Majeed scores. The quality of reduction was evaluated using the Matta criteria. Results Clinical results at 1 year postoperatively were excellent in 14 patients, good in 7, and fair in 2. The two patients with fair results had intermittent pain at the sacroiliac joint because of the posterior implant. One woman complained of persistent pain at the pubic tubercle during sexual intercourse. Iatrogenic neuropraxia of the unilateral lateral femoral cutaneous nerve occurred in three patients. Unilateral femoral nerve palsy occurred in one patient. The quality of fracture reduction was excellent in 12 patients, good in 8, and fair in 3. Heterotopic ossification occurred in eight patients; all were asymptomatic. Conclusions Minimally invasive modified pedicle screw-rod fixation is an effective alternative treatment for pelvic ring injuries.

  8. Antenatal pelvic floor biometry is related to levator ani muscle injury.

    Science.gov (United States)

    Chan, S S C; Cheung, R Y K; Yiu, K W; Lee, L L; Chung, T K H

    2016-10-01

    To evaluate the relationship between antenatal pelvic floor biometry and levator ani muscle (LAM) injury in Chinese women. Three-dimensional transperineal ultrasound was performed in nulliparous Chinese women with a singleton pregnancy at 9-12 weeks, 26-28 weeks and 36-38 weeks of gestation and again at 12 months after delivery. Hiatal anteroposterior (AP) diameter, transverse diameter and area were measured on the antenatal ultrasound volumes obtained at rest, on Valsalva maneuver and during pelvic floor muscle contraction (PFMC). LAM injury was evaluated using ultrasound volumes obtained during PFMC at 12 months after delivery. In total, 328 women completed the study. At 12 months after delivery, 38 (14.8% of those who delivered vaginally) women had LAM injury; 28 were unilateral (14 right- and 14 left-sided) and 10 were bilateral. In all three trimesters there was smaller hiatal AP diameter and hiatal area in women with LAM injury when compared with women without injury. On multivariable analysis of the three factors, hiatal AP diameter at rest, hiatal area at rest and operative vaginal delivery, only hiatal AP diameter at rest in all three trimesters was an independent factor of LAM injury. A larger hiatal AP diameter at rest in the first, second and third trimesters reduced the likelihood of LAM injury with odds ratios of 0.21, 0.15 and 0.21, respectively. A smaller antenatal hiatal AP diameter at rest is a risk factor for LAM injury. The hiatal AP diameter is relatively simple to measure and the error in measurement is relatively small. A prospective study to confirm this relationship and to explore whether this measurement, performed in the midsagittal plane, is repeatable should be performed. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

  9. Obstetric and gynecological outcome in a patient with traumatic pelvic fracture and perineal injuries.

    Science.gov (United States)

    Goswami, Deepti; Kochhar, Puneet Kaur; Suri, Tarun; Zutshi, Vijay; Batra, Swaraj

    2012-08-01

    A 19-year-old woman presented with pelvic trauma following a road accident. She was hemodynamically stable. Examination revealed perineal injuries and type C pelvic fracture, which was stabilized with an external fixator. The broken ends of the pubic bone were brought together by an orthopedic wire. The detached vaginal wall and torn anal sphincter were surgically repaired after making a diverting colostomy. The postoperative period was uneventful. Colostomy was reversed after 3 months. Postoperatively the patient developed a cystocele, dyspareunia and vaginal pain. She conceived spontaneously and was planned for an elective cesarean at 37 weeks gestation; however, she presented in labor at 36 weeks and had a normal vaginal delivery. Pelvic fractures may be associated with genitourinary and anal sphincter injuries, which require management by a multidisciplinary team. On recovery the patient may develop prolapse, dyspareunia and persistent local pain. Spontaneous conception and normal vaginal delivery are nevertheless possible. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.

  10. [Multicentric study of patients with pelvic injury: basic analysis of the study group].

    Science.gov (United States)

    Dzupa, V; Chmelová, J; Pavelka, T; Obruba, P; Wendsche, P; Simko, P

    2009-10-01

    The aim of the study was to make a basic analysis of the patients treated for pelvic fractures in the year 2007 at 14 institutions in the Czech Republic and Slovakia. The group investigated consisted of 474 patients treated in 2007. In a one-year prospective descriptive study, patients' data were recorded according to a unified protocol. They included age, gender, mechanism of injury, fracture type, associated injuries, method of treatment, post-operative complications, length of hospital stay, injury/surgery-to-standing time and number of deaths during primary hospitalization.The ?2 test of independence in a contingency table was used to compare categorical data. The level of significance for the test was set at 5%. The group comprised 192 women and 282 men with an average age of 45.9 years (range, 15 to 95). In men, the frequency of pelvic fractures was significantly higher (pskeletal traction (30 patients, 6%), C-clamp (19 patients, 4%) or external fixation (22 patients, 5%) was temporarily applied during the primary treatment. Surgery was carried out in 187 patients (39%). The average operative time was 114 minutes (range, 45 to 315) Post-operative complications were recorded in 58 patients (30% of the surgically treated). The most frequent local com- plication was wound infection (11 patients, 6%). The average hospital stay was 27 days (range, 2 to 266); 181 patients (38%) required care at an anaesthesia and acute care department for an average of 14 days (range, 1 to 127). The injury/surgery-to-standing time was 30 days on average (range, 2 to 118 days). Twenty-six patients; nine women and 17 men (5%), died during primary hospitalization. Their average age was 62.5 years (74.1 years in women and 56.4 years in men). The higher number of injured men in the middle-age categories suggests a more risky behaviour of these men in driving motor cars and motorbikes and at work (falls from height, objects falling on them).Women significantly outnumbered men in simple

  11. Retrospective evaluation of concurrent intra-abdominal injuries in dogs with traumatic pelvic fractures: 83 cases (2008-2013).

    Science.gov (United States)

    Hoffberg, Jamie E; Koenigshof, Amy M; Guiot, Laurent P

    2016-01-01

    To report the occurrence of intra-abdominal injury (IA) in dogs with pelvic fractures due to blunt trauma, to evaluate for association between characterization of pelvic fractures and the presence of IA, and to evaluate for association between IA and other specific clinical conditions. Retrospective case series (2008-2013). University teaching hospital. Eighty-three client-owned dogs with pelvic fractures due to blunt trauma. None. Pelvic injuries included pubic fractures (90.4%), ischial fractures (80.7%), sacroiliac luxations (57.8%), iliac fractures (43.4%), acetabular fractures (30.1%), and sacral fractures (13.3%). Thirty-one dogs (37%) had IA, which included hemoabdomen (27 dogs), uroabdomen (3), and septic abdomen (3); 2 dogs had 2 types of IA. Dogs with sacral fractures were significantly more likely to have IA than dogs without sacral fractures (P = 0.0162). Characterization of pelvic fractures included the direction of compression, presence of a weight-bearing bone fracture, and degree of pelvic narrowing, none of which had an association with IA (P > 0.05). Dogs were more likely to have IA if they had cardiac dysrhythmia (P = 0.0002) or hematuria (P = 0.0001), and were more likely to have a hemoabdomen if they had cardiac dysrhythmia (P = 0.0005). Dogs with hematochezia were more likely to have a septic abdomen (P = 0.0123). Dogs were more likely to receive a transfusion if they had AI (P = 0.033) or hemoabdomen specifically (P = 0.0033). Overall survival to discharge was 89%, which was significantly greater than survival in dogs with pelvic injury that also had septic abdomen (33%; P = 0.0299). IA is common in dogs with pelvic fractures, especially those with sacral fractures. Pelvic fracture characterization had no bearing on the presence of IA. © Veterinary Emergency and Critical Care Society 2016.

  12. Traumatic Testicular Dislocation Associated with Lateral Compression Pelvic Ring Injury and T-Shaped Acetabulum Fracture

    Directory of Open Access Journals (Sweden)

    Daniel Howard Wiznia

    2016-01-01

    Full Text Available We report a case of a unilateral testicular dislocation to the superficial inguinal region associated with a lateral compression type pelvic ring injury (OTA classification 61-C3.3a2, b2, c3 and left T-shaped acetabulum fracture (OTA classification 62-B2 in a 44-year-old male who was in a motorcycle accident. The testicular dislocation was noted during the emergency department primary survey, and its location and viability were verified with ultrasound. The testicle was isolated during surgical stabilization of the left acetabulum through a Pfannenstiel incision and modified-Stoppa approach and returned through the inguinal canal to the scrotum. In follow-up, the patient did not suffer urologic or sexual dysfunction. All motorcycle collision patients presenting with pelvic ring injuries or acetabulum fractures should be worked up for possible testicular dislocation with a scrotal exam. Advanced imaging and a urologic consult may be necessary to detect and treat these injuries.

  13. REHABILITATION OF PATIENTS WITH UNSTABLE PELVIC RING INJURY IN POLYTRAUMA IN THE EARLY POSTOPERATIVE PERIOD

    Directory of Open Access Journals (Sweden)

    V. A. Shchetkin

    2014-01-01

    Full Text Available BACKGROUND. The relevance of such an issue as the treatment of patients with unstable pelvic ring fracture is caused by the high frequency of this pathology in the general structure of polytrauma — up to 34% and a high rate of poor functional treatment outcomes — up to 20%. Purpose of the study: the improvement of rehabilitation treatment in patients with polytrauma operated on for complex fractures of the pelvis, using mechanotherapy and electro stimulation in the complex of therapy of an early postoperative period.MATERIAL AND METHODS. There were 81 patients with severe pelvic ring injuries treated in N.V. Sklifosovsky Research Institute for Emergency Medicine in 2010 – 2013. The main group consisted of 29 patients who were recommended a comprehensive methodology of rehabilitation, including therapeutic exercises (TE, mechanotherapy using the simulator “RECK MOTOmed letto2” and electro stimulation using the “Galatea” apparatus. The test group consisted of 52 patients who underwent rehabilitation treatment only by methods of therapeutic exercises. Overall effectiveness of the treatment was evaluated using the Majeed score.CONCLUSION. Early use of therapeutic exercises in combination with mechanical therapy and electrical stimulation in patients operated on for unstable pelvic ring injuries, helps reduce pain syndrome, shortens the period of bed rest from 17.5 to 7.6 days and the duration of hospital stay from 46.1 to 35.2 days. At the same time, the 14.1% increase of excellent and good functional outcomes based on Majeed score is registered. 

  14. Developing a cumulative anatomic scoring system for military perineal and pelvic blast injuries.

    Science.gov (United States)

    Mossadegh, Somayyeh; Midwinter, M; Parker, P

    2013-03-01

    Improvised explosive device (IED) yields in Afghanistan have increased resulting in more proximal injuries. The injury severity score (ISS) is an anatomic aggregate score of the three most severely injured anatomical areas but does not accurately predict severity in IED related pelvi-perineal trauma patients. A scoring system based on abbreviated injury score (AIS) was developed to reflect the severity of these injuries in order to better understand risk factors, develop a tool for future audit and improve performance. Using standard AIS descriptors, injury scales were constructed for the pelvis (1, minor to 6, maximal). The perineum was divided into anterior and posterior zones as relevant to injury patterns and blast direction with each soft tissue structure being allocated a score from its own severity scale. A cumulative score, from 1 to 36 for soft tissue, or a maximum of 42 if a pelvic fracture was involved, was created for all structures injured in the anterior and posterior zones. Using this new scoring system, 77% of patients survived with a pelvi-perineal trauma score (PPTS) below 5. There was a significant increase in mortality, number of pelvic fractures and amputations with increase in score when comparing the first group (score 1-5) to the second group (score 6-10). For scores between 6 and 16 survival was 42% and 22% for scores between 17 and 21. In our cohort of 62 survivors, 1 patient with an IED related pelvi-perineal injury had a 'theoretically un-survivable' maximal ISS of 75 and survived, whereas there were no survivors with a PPTS greater than 22 but this group had no-one with an ISS of 75 suggesting ISS is not an accurate reflection of the true severity of pelvi-perineal blast injury. This scoring system is the initial part of a more complex logistic regression model that will contribute towards a unique trauma scoring system to aid surgical teams in predicting fluid requirements and operative timelines. In austere environments, it may also

  15. Pelvic fracture-related injuries of the bladder neck and prostate: their nature, cause and management.

    Science.gov (United States)

    Mundy, Anthony R; Andrich, Daniela E

    2010-05-01

    To report our experience of bladder neck injuries, which are a well recognized but rare consequence of pelvic fracture-related trauma to the lower urinary tract, as we have been unable to find any reference in the English literature to their specific nature, cause and management in adults. In the last 10 years we have treated 15 men with bladder neck injuries after pelvic fracture. Two were treated at our centre by delayed primary repair. Thirteen were initially treated elsewhere and presented to us 3 months to 5 years after their injury with intractable incontinence and various other symptoms most notably recurrent urinary infection and gross haematuria. Twelve of the injuries were at or close to the anterior midline and associated with lateral compression fractures or 'open-book' injuries. Five of them were confined to the bladder neck and prostatic urethra; the other seven extended into the subprostatic urethra. Four of these were associated with a coincidental typical rupture of the posterior urethra. All had an associated cavity involving the anterior disruption of the pelvic ring. Two of the injuries, following particularly severe trauma, were a simultaneous complete transection of the bladder neck and of the bulbo-membranous urethra with a sequestered prostate between. We have seen this in children before but not in adults. Another injury, also after particularly severe trauma, was an avulsion of the anterior aspect of the prostate. We have not seen this described before. Fourteen patients underwent lower urinary tract reconstruction and one underwent a Mitrofanoff procedure. All of the 14 had a layered reconstruction of the prostate and bladder neck and in 13, this was supplemented with an omental wrap. In all patients with an anterior midline rupture, the primary injury appeared to be to the prostate and prostatic urethra with secondary involvement of the bladder neck and the subprostatic urethra. The Mitrofanoff procedure was successful. Of the 14

  16. Pelvic injuries in combination with vascular lesions of branches from the iliac artery: Outcome - Incidence - Treatment strategy

    DEFF Research Database (Denmark)

    Schmal, H.; Klemt, C.; Uhrmeister, P.

    2002-01-01

    The acute haemorrhagic shock is one of the leading causes for death following severe pelvic injuries. Typical bleeding sources are fractured spongiosa surfaces, lesions of the major venous plexus or ruptures of branches originating from the iliac artery. This study characterizes the population...... from active hemorrhage because of vascular lacerations of iliac artery branches. Average of ISS, PTS, part of multiple injured patients, prevalence of rotary and vertical unstable fractures as well as mortality of patients with accompanying arterial injury was found to be much higher when compared...... to all patients with pelvic fractures. The immediate diagnostical angiography (70.59%) possibly in combination with a therapeutic embolization (41.18%) is a well established part in the treatment of patients with mainly pelvic bleeding sources. In most cases a surgical intervention is required. Initial...

  17. Modified pedicle screw-rod fixation as a minimally invasive treatment for anterior pelvic ring injuries: an initial case series.

    Science.gov (United States)

    Wu, Xiaotian; Liu, Zuoqing; Fu, Wenqin; Zhao, Shan; Feng, Juntao

    2017-06-06

    Unstable pelvic ring injuries often involve high mortality and morbidity. This study was aimed to evaluate the modified minimally invasive pedicle screw-rod fixation for anterior pelvic ring injuries, in the respects of its feasibility, merits, and limitations. Twenty-three patients with unstable pelvic ring injuries underwent the modified anterior pedicle screw-rod fixation, with or without posterior fixation. The clinical outcomes were assessed using Majeed scores, and the quality of reduction was evaluated according to the criteria of Matta. Majeed scores showed that the clinical outcomes at postoperatively 1 year were excellent in 14 patients, good in 7, and fair in 2. One woman complained of persistent pain at the pubic tubercle during sexual intercourse. Iatrogenic neuropraxia of the unilateral lateral femoral cutaneous nerve occurred in 3 patients. Unilateral femoral nerve palsy occurred in 1 patient. The reduction was found to be excellent in 12 patients, good in 8, and fair in 3. Heterotopic ossification occurred in 8 patients, all being asymptomatic. The modified pedicle screw-rod fixation with the minimally invasive technique offered an effective alternative for unstable anterior pelvic ring injuries.

  18. Sonographic finding of postpartum levator ani muscle injury correlates with pelvic floor clinical examination.

    Science.gov (United States)

    Lipschuetz, M; Valsky, D V; Shick-Naveh, L; Daum, H; Messing, B; Yagel, I; Yagel, S; Cohen, S M

    2014-12-01

    Correlation of the sonographic finding of levator ani muscle (LAM) injuries with clinical examination in primiparous women following vaginal delivery has not been fully described. We aimed to examine the correlation of three-dimensional transperineal ultrasound (3D-TPS) finding of LAM defects with results of clinical examination of the pelvic floor, at intermediate follow-up. Subjects were primiparae 3-21 months following vaginal delivery, who had not become pregnant or delivered in the interim. On 3D-TPS, LAM trauma was diagnosed when discontinuity and distortion were visible in the most anteromedial part of the pubovisceral muscle in the coronal C-plane or rendered image. Clinical examination was performed by a physiotherapist who was blinded to the ultrasound results, and included palpation of the medial and lateral parts of the LAM mass, evaluation of tissue quality and whether there was any palpable gap. Muscle strength was evaluated using the modified Oxford scale. Eighty-seven women were included, 19 (21.8%) of whom were found to have a sonographic LAM injury. Oxford score palpation parameter of asymmetric muscle mass or texture was significantly correlated with the finding of a LAM defect: of 68 women with normal 3D-TPS, 22 (32.4%) were found to have asymmetry of muscle mass or tissue quality on clinical examination vs 12 (63.2%) of 19 women with sonographic evidence of LAM injury (P = 0.016). Muscle strength and endurance parameters did not significantly correlate with the 3D-TPS findings. Our findings suggest that persistent 3D-TPS LAM injury after primary vaginal delivery has clinical expression in changes in mass and texture of the LAM, as assessed by palpation. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

  19. Biceps femoris tendon injuries sustained while playing hockey

    OpenAIRE

    Watura, Christopher; Harries, William

    2011-01-01

    A 42-year-old female nurse presented in March 2008 with a left proximal hamstring tendon injury sustained while playing hockey. At surgery, the proximal biceps femoris tendon and semitendonosus were found to be ruptured and were repaired. The patient made a good recovery but sustained a further hockey injury in January 2010 involving a complete tear and rupture of the biceps femoris tendon distally. This was managed conservatively and the patient was able to return to playing hockey 10 months...

  20. Epidemiology of Hospital-Treated Injuries Sustained by Fitness Participants

    Science.gov (United States)

    Gray, Shannon E.; Finch, Caroline F.

    2015-01-01

    Purpose: The purpose of this study was to provide an epidemiological profile of injuries sustained by participants in fitness activities in Victoria, Australia, based on hospital admissions and emergency department (ED) presentations and to identify the most common types, causes, and sites of these injuries. Method: Hospital-treated fitness…

  1. Injuries Sustained by the Mixed Martial Arts Athlete.

    Science.gov (United States)

    Jensen, Andrew R; Maciel, Robert C; Petrigliano, Frank A; Rodriguez, John P; Brooks, Adam G

    2016-08-16

    Mixed martial arts (MMA) is rapidly growing in popularity in the United States and abroad. This combat sport joins athletes from a wide variety of martial art disciplines, each with characteristic and distinguishing injury profiles, together in competition. Because of increasing participation by professionals and amateurs alike, injuries sustained by MMA athletes have been on the rise. A review of relevant publications using the search term mixed martial arts and each of its component combat sports (eg, Muay Thai, Brazilian jiu-jitsu) from 1980 through 2015 was completed using PubMed and Google Scholar. Clinical review. Level 5. The majority of studies on MMA injuries evaluate those sustained during competition, which range in incidence from 22.9 to 28.6 per 100 fight-participations. Striking-predominant disciplines such as boxing, karate, and Muay Thai have high rates of head and facial injuries, whereas submission-predominant disciplines such as Brazilian jiu-jitsu, judo, and wrestling have high rates of joint injuries. Numerous studies have evaluated injuries in athletes who participate in MMA and its component disciplines during competition but much remains to be discovered about injuries sustained during training and in specific patient populations such as adolescents and women. © 2016 The Author(s).

  2. Open and contaminated pediatric pelvic ring injury case report: Fixation without metal

    Directory of Open Access Journals (Sweden)

    Brian R. Dilworth

    2017-01-01

    Discussion/conclusion: A less invasive method for the anterior pelvic ring was used to avoid additional dissection due to extensive soft tissue loss, and to decrease hardware burden, which lessens the chance of complications such as infection. Suture fixation of the pubic symphysis provided stable fixation to allow healing in the current case of open pelvic fracture.

  3. Simultaneous Periprosthetic Acetabular Fracture and Contralateral B-Type Compression Injury of the Pelvic Ring: A Case Report of a Rare Injury Combination

    Directory of Open Access Journals (Sweden)

    Sven Märdian

    2013-01-01

    Full Text Available The periprosthetic fracture of the acetabulum is a rare injury, and its management is only sporadically reported in the literature. A few case reports are available which mainly focus on periprosthetic acetabular fractures in the elderly population. In our case, a 32-year-old patient suffered from a periprosthetic acetabular fracture in combination with a pelvic ring injury following a high velocity accident. The fracture morphology allowed a salvage of the prosthesis with an open reduction and internal fixation with a good radiographic and functional outcome one year after trauma.

  4. Musculoskeletal injuries sustained in modern army combatives.

    Science.gov (United States)

    Possley, Daniel R; Johnson, Anthony E

    2012-01-01

    Participation in martial arts has grown over the past 15 years with an estimated 8 million participants. In 2004, the Chief of Staff of the Army directed that all Initial Military Training soldiers receive Modern Army Combatives (MAC) training. The mechanical differences between the various martial arts styles incorporated into mixed martial arts/MAC pose challenges to the medical professional. We report the incidence of musculoskeletal injuries by Level 1 and 2 trained active duty soldiers participating in MAC over a 3-year period. From June 1, 2005 to January 1, 2009, the Orthopaedic Surgery service treated and tracked all injuries in MAC. Data was analyzed using the Chi(2) method of analysis. (p injuries reported inability to perform their military occupation specialty duties. The knee was most frequently injured followed by shoulder. Surgical intervention was warranted 24% of the time. Participants in MAC reported injuries severe enough to impact occupational duties at 15.5%. Surgical intervention was warranted only 24% of the time. The knee and shoulder are the most frequently injured body parts. Labral repair was the most frequent surgical procedure.

  5. Emergent management of APC-2 pelvic ring injuries with an anteriorly placed C-clamp.

    Science.gov (United States)

    Richard, Marc J; Tornetta, Paul

    2009-01-01

    Can anteriorly placed pelvic C-clamps be used successfully in the emergent management of APC-2 pelvic fractures? Prospective cohort. Level 1 trauma center. A single-surgeon series of 24 patients with an anteroposterior compression type 2 pelvic fracture. Application of an anteriorly placed pelvic C-clamp within 2 hours of presentation. Response to hypotension, complications related to pin placement, application time, and symphyseal reduction measured on anteroposterior radiograph. Twenty-four patients with a mean age of 29 years (14-58 years) had an APC-2 pelvic fracture diagnosed by an anteroposterior radiograph of the pelvis on presentation. All patients were emergently managed with an anteriorly placed C-clamp applied in the emergency room (10), angiography suite (9), or operating room (5). Eleven patients presented with hypotension (systolic blood pressure elevation of their blood pressure of 23 mm Hg (10-44 mm Hg). The symphyseal separation was reduced from a mean of 4.5 cm (3-9 cm) to pelvic C-clamp can be placed anteriorly as a part of the early management of APC-2 pelvic fractures with a short application time in a variety of patient care areas.

  6. Injury and Treatment Characteristics of Sport-Specific Injuries Sustained in Interscholastic Athletics

    OpenAIRE

    Lam, Kenneth C.; Snyder Valier, Alison R.; Valovich McLeod, Tamara C

    2015-01-01

    Background: The inclusion of clinical practice factors, beyond epidemiologic data, may help guide medical coverage and care decisions. Hypothesis: Trends in injury and treatment characteristics of sport-specific injuries sustained by secondary school athletes will differ based on sport. Study Design: Retrospective analysis of electronic patient records. Level of evidence: Level 4. Methods: Participants consisted of 3302 boys and 2293 girls who were diagnosed with a sport-related injury or con...

  7. Printed Three-dimensional Anatomic Templates for Virtual Preoperative Planning Before Reconstruction of Old Pelvic Injuries: Initial Results

    Directory of Open Access Journals (Sweden)

    Xin-Bao Wu

    2015-01-01

    Full Text Available Background: Old pelvis fractures are among the most challenging fractures to treat because of their complex anatomy, difficult-to-access surgical sites, and the relatively low incidence of such cases. Proper evaluation and surgical planning are necessary to achieve the pelvic ring symmetry and stable fixation of the fracture. The goal of this study was to assess the use of three-dimensional (3D printing techniques for surgical management of old pelvic fractures. Methods: First, 16 dried human cadaveric pelvises were used to confirm the anatomical accuracy of the 3D models printed based on radiographic data. Next, nine clinical cases between January 2009 and April 2013 were used to evaluate the surgical reconstruction based on the 3D printed models. The pelvic injuries were all type C, and the average time from injury to reconstruction was 11 weeks (range: 8-17 weeks. The workflow consisted of: (1 Printing patient-specific bone models based on preoperative computed tomography (CT scans, (2 virtual fracture reduction using the printed 3D anatomic template, (3 virtual fracture fixation using Kirschner wires, and (4 preoperatively measuring the osteotomy and implant position relative to landmarks using the virtually defined deformation. These models aided communication between surgical team members during the procedure. This technique was validated by comparing the preoperative planning to the intraoperative procedure. Results: The accuracy of the 3D printed models was within specification. Production of a model from standard CT DICOM data took 7 hours (range: 6-9 hours. Preoperative planning using the 3D printed models was feasible in all cases. Good correlation was found between the preoperative planning and postoperative follow-up X-ray in all nine cases. The patients were followed for 3-29 months (median: 5 months. The fracture healing time was 9-17 weeks (mean: 10 weeks. No delayed incision healing, wound infection, or nonunions occurred. The

  8. Technical and clinical outcome of percutaneous CT fluoroscopy-guided screw placement in unstable injuries of the posterior pelvic ring

    Energy Technology Data Exchange (ETDEWEB)

    Strobl, Frederik F.; Haeussler, Sophia M.; Paprottka, Philipp M.; Hoffmann, Ralf-Thorsten; Reiser, Maximilian F.; Trumm, Christoph G. [Institute for Clinical Radiology, Munich (Germany); Pieske, Oliver [Ludwig-Maximilians-University Hospital Munich, Department of Trauma Surgery, Munich (Germany)

    2014-08-15

    To evaluate technical success, complications, and effective dose in patients undergoing CT fluoroscopy-guided iliosacral screw placement for the fixation of unstable posterior pelvic ring injuries. Our retrospective analysis includes all consecutive patients with vertical sacral fractures and/or injury of the iliosacral joint treated with CT fluoroscopy-guided screw placement in our department from 11/2005 to 03/2013. Interventions were carried out under general anesthesia and CT fluoroscopy (10-20 mAs; 120 kV; 16- or 128-row scanner, Siemens Healthcare, Erlangen, Germany). Technical outcome, major and minor complications, and effective patient dose were analyzed. We treated 99 consecutive patients (mean age 53.1 ± 21.7 years, 50 male, 49 female) with posterior pelvic ring instability with CT fluoroscopy-guided screw placement. Intervention was technically successful in all patients (n = 99). No major and one minor local complication occurred (1 %, secondary screw dislocation). General complications included three cases of death (3 %) due to pulmonary embolism (n = 1), hemorrhagic shock (n = 1), or cardiac event (n = 1) during a follow-up period of 30 days. General complications were not related to the intervention. Mean effective patient radiation dose per intervention was 12.28 mSv ± 7.25 mSv. Mean procedural time was 72.1 ± 37.4 min. CT fluoroscopy-guided screw placement for the treatment of posterior pelvic ring instabilities can be performed with high technical success and a low complication rate. This method provides excellent intrainterventional visualization of iliac and sacral bones, as well as the sacral neuroforamina for precise screw placement by applying an acceptable effective patient dose. (orig.)

  9. Reduction and temporary stabilization of Tile C pelvic ring injuries using a posteriorly based external fixation system.

    Science.gov (United States)

    Martin, Murphy P; Rojas, David; Mauffrey, Cyril

    2017-12-05

    Tile C pelvic ring injuries are challenging to manage even in the most experienced hands. The majority of such injuries can be managed using percutaneous reduction techniques, and the posterior ring can be stabilized using percutaneous transiliac-transsacral screw fixation. However, a subgroup of patients present with inadequate bony corridors, significant sacral zone 2 comminution or significant lateral/vertical displacement of the hemipelvis through a complete sacral fracture. Percutaneous strategies in such circumstances can be dangerous. Those patients may benefit from prone positioning and open reduction of the sacral fracture with fixation through tension band plating or lumbo-pelvic fixation. Soft tissue handling is critical, and direct reduction techniques around the sacrum can be difficult due to the complex anatomy and the fragile nature of the sacrum making clamp placement and tightening a challenge. In this paper, we propose a mini-invasive technique of indirect reduction and temporary stabilization, which is soft tissue friendly and permits maintenance of reduction during definitive fixation surgical.

  10. Nerve injuries sustained during warfare: part I--Epidemiology.

    Science.gov (United States)

    Birch, R; Misra, P; Stewart, M P M; Eardley, W G P; Ramasamy, A; Brown, K; Shenoy, R; Anand, P; Clasper, J; Dunn, R; Etherington, J

    2012-04-01

    We describe 261 peripheral nerve injuries sustained in war by 100 consecutive service men and women injured in Iraq and Afghanistan. Their mean age was 26.5 years (18.1 to 42.6), the median interval between injury and first review was 4.2 months (mean 8.4 months (0.36 to 48.49)) and median follow-up was 28.4 months (mean 20.5 months (1.3 to 64.2)). The nerve lesions were predominantly focal prolonged conduction block/neurapraxia in 116 (45%), axonotmesis in 92 (35%) and neurotmesis in 53 (20%) and were evenly distributed between the upper and the lower limbs. Explosions accounted for 164 (63%): 213 (82%) nerve injuries were associated with open wounds. Two or more main nerves were injured in 70 patients. The ulnar, common peroneal and tibial nerves were most commonly injured. In 69 patients there was a vascular injury, fracture, or both at the level of the nerve lesion. Major tissue loss was present in 50 patients: amputation of at least one limb was needed in 18. A total of 36 patients continued in severe neuropathic pain. This paper outlines the methods used in the assessment of these injuries and provides information about the depth and distribution of the nerve lesions, their associated injuries and neuropathic pain syndromes.

  11. Peripheral injury of pelvic visceral sensory nerves alters GFRa (GDNF family receptor alpha localization in sensory and autonomic pathways of the sacral spinal cord

    Directory of Open Access Journals (Sweden)

    Shelley Lynne Forrest

    2015-04-01

    Full Text Available GDNF (glial cell line-derived neurotrophic factor, neurturin and artemin use their co-receptors (GFRα1, GFRα2 and GFRα3, respectively and the tyrosine kinase Ret for downstream signalling. In rodent dorsal root ganglia (DRG most of the unmyelinated and some myelinated sensory afferents express at least one GFRα. The adult function of these receptors is not completely elucidated but their activity after peripheral nerve injury can facilitate peripheral and central axonal regeneration, recovery of sensation, and sensory hypersensitivity that contributes to pain. Our previous immunohistochemical studies of spinal cord and sciatic nerve injuries in adult rodents have identified characteristic changes in GFRα1, GFRα2 or GFRα3 in central spinal cord axons of sensory neurons located in dorsal root ganglia. Here we extend and contrast this analysis by studying injuries of the pelvic and hypogastric nerves that contain the majority of sensory axons projecting to the pelvic viscera (e.g., bladder and lower bowel. At 7 d, we detected some effects of pelvic but not hypogastric nerve transection on the ipsilateral spinal cord. In sacral (L6-S1 cord ipsilateral to nerve injury, GFRα1-immunoreactivity (IR was increased in medial dorsal horn and CGRP-IR was decreased in lateral dorsal horn. Pelvic nerve injury also upregulated GFRα1- and GFRα3-IR terminals and GFRα1-IR neuronal cell bodies in the sacral parasympathetic nucleus that provides the spinal parasympathetic preganglionic output to the pelvic nerve. This evidence suggests peripheral axotomy has different effects on somatic and visceral sensory input to the spinal cord, and identifies sensory-autonomic interactions as a possible site of post-injury regulation.

  12. The diagnosis of pelvic fractures by 'springing'.

    OpenAIRE

    Grant, P. T.

    1990-01-01

    Thirty-six patients were studied prospectively to assess the benefit of 'springing' the pelvis in traumatized patients, to confirm or refute a fracture of the pelvis. None of the patients was multiply injured and half of those with fractures were elderly, sustaining their injuries in simple falls. Springing the pelvis was a poor predictor of the presence or absence of a pelvic fracture, at best it yielded a specificity of 71% and sensitivity of 59%. Its routine use in clinical examination sho...

  13. Bilateral femoral neck fractures associated with complex pelvic ring injuries in a pediatric patient: a case report.

    Science.gov (United States)

    Scott, Brandon; Taylor, Brandon; Shung, Joseph R; Nimityongskul, Prasit

    2017-07-01

    Femoral neck and pelvic fractures are rarely encountered in the pediatric population secondary to the resilient nature of the immature skeleton. Both fracture types usually result from high-energy blunt trauma including motor vehicle collisions, motor vehicle-pedestrian accidents, and falls from height. Considerable studies have been published on the natural history, management, and complications of pediatric pelvis and femoral neck fractures. However, few case reports have documented both fracture types in the same patient. Management of concomitant injuries presents unique challenges both for operative stabilization and for clinical postoperative care. After appropriate consent was obtained, a thorough review was performed of the patient's hospital records and imaging history. The senior author of the report also provided insight into the management of the patient's initial injuries and subsequent complications. Our case involves a 4-year-old female who was overrun by an all-terrain vehicle. Her orthopedic injuries included a nondisplaced Delbet type 3 fracture of the right femoral neck, a completely displaced Delbet type 3 fracture of the left femoral neck, bilateral sacroiliac fracture-dislocations, severe comminution of her left pubic rami, and a free-floating right pubic rami segment spanning from the triradiate cartilage to the pubic symphysis with severe rotational deformity. Her postoperative recovery was complicated by refracture of her left femoral neck (Delbet type 1), left hip osteomyelitis, and left femoral head avascular necrosis. The salient features of her operative management, subsequent complications, and functional recovery are described in this report. Cases of bilateral femoral neck fractures and multiple pelvic fractures in pediatric patients are sparsely documented in the literature because of their infrequent occurrence. Pediatric pelvic fractures typically do well with conservative treatment secondary to the incredible remodeling ability

  14. Work-related injury sustained by foreign workers in Singapore.

    Science.gov (United States)

    Carangan, M; Tham, K Y; Seow, E

    2004-03-01

    Singapore has a resident population of 3.26 million and 0.53 million foreign workers. The objective of the study was to compare the injuries sustained by foreign and local workers presenting to an emergency department (ED). Adult victims of work-related injury who presented to an urban public hospital ED from 1 December 1998 to 31 May 1999 were interviewed. Chart reviews were done for those hospitalised. Data collected were those of demographic, nature of injury, ambulance care, ED and hospital care, outcome and final diagnoses. There were 1244 local workers and 1936 foreign workers, giving a ratio of 1 local:1.6 foreign workers. The mean age of foreign workers was 29.6 years [standard deviation (SD) 6.2], which was younger (P workers. Fridays and Saturdays were the common days for injuries among foreign workers as opposed to Wednesdays and Mondays for local workers. Falls from height > or = 2m occurred among 9.1% of foreign workers, more (P workers, resulting in 2 out of 3 foreign workers death. Though the pattern of injuries was similar between foreign and local workers, foreign workers needed longer (P = 0.03) sick leave and more (P = 0.01) foreign workers were hospitalised, giving a ratio of 2 foreign workers for every 1 local worker hospitalised. Foreign workers had no difficulty accessing ED and hospital care for work-related injuries. The pattern and severity of injuries were similar between foreign and local workers but more foreign workers were hospitalised.

  15. Pelvic ring disruptions in emergency radiology

    Energy Technology Data Exchange (ETDEWEB)

    Stambaugh, Lloyd E. E-mail: stam@u.washington.edu; Blackmore, C.C. E-mail: craige@u.washington.edu

    2003-10-01

    Pelvic ring disruptions are a result of high-energy trauma and are a significant cause of morbidity and mortality in major trauma patients. The initial pelvic radiograph, in combination with computed tomographic imaging in selected patients, provides a quick and accurate method of diagnosing pelvic fractures. Pelvic fracture classification schemes have evolved over the past few decades, and include description of the mechanism of injury and assessment of pelvic stability. Understanding these classifications is important in developing an approach to interpretation of pelvic imaging and prediction of associated injuries. Armed with these tools, the emergency radiologist can detect pelvic fractures early and guide subsequent imaging and therapy.

  16. Pediatric injury prevention programs: Identifying markers for success and sustainability.

    Science.gov (United States)

    Chaudhary, Sofia; Pomerantz, Wendy J; Miller, Beverly; Pan, Anqi; Agarwal, Maneesha

    2017-11-01

    Injury is the leading cause of death in children. Although many pediatric hospitals and trauma centers provide injury prevention (IP) programming, there is no national standard. This study aims to identify characteristics of a sustainable and successful IP program by querying programs affiliated with the Injury Free Coalition for Kids (IFCK). The IFCK sites were sent a 30-question survey via e-mail. Questions focused on demographics, scope of IP activities, self-efficacy, and outcome measures including finances, academic productivity, and legislative advocacy. Counts and frequencies were calculated and compared using χ tests. The survey was completed by 38 (90.4%) of 42 sites. The majority were associated with a freestanding children's hospital (57.9%) and Level I pediatric trauma center (86.8%). Most programs (79%) had at least one dedicated full-time equivalent (FTE) staff. Research was most common on child passenger safety and teen driving. Nearly 30% of programs offered educational curricula to health care providers; these sites were more likely to have FTE support (p = 0.036). Steady sources of funding were identified for 60.5% of programs, with 47.8% citing their hospital as the primary source; 73% of respondents were confident in their program's capacity to sustain activities; these were more likely to be larger programs (p = 0.001) with steady sources of funding (p < 0.001). Despite 73.7% of sites having academic affiliations, 60.5% had 5 or fewer publications over the previous 5 years. In the prior 2 years, 55.3% of programs impacted legislative or policy changes. Funding, size of program, and FTE had no statistical correlation with research productivity or number of legislative/policy contributions. This study characterizes the variation among pediatric IP programs within IFCK sites, while highlighting the association between financial and FTE support from programs' institutions with sustainable IP programming. These results can assist programs in

  17. Forensic epidemiologic and biomechanical analysis of a pelvic cavity blowout injury associated with ejection from a personal watercraft (jet-ski).

    Science.gov (United States)

    Freeman, Michael D; Everson, Todd M; Kohles, Sean S

    2013-01-01

    Jet-propelled personal watercraft (PWC) or jet-skis have become increasingly popular. The means of propulsion of PWC, which is a jet of water forced out of small nozzle at the rear of the craft, combined with a high risk of falling off of the seat and into close proximity with the water jet stream, raise the potential for a unique type of injury mechanism. The most serious injuries associated with PWC falls are those that occur when the perineum passes in close proximity to the jet nozzle and the high-pressure water stream enters the vaginal or rectal orifice. We describe the forensic investigation into a case of an anovaginal "blowout" injury in a passenger who was ejected from the rear seat position of a PWC and subsequently suffered life-threatening injuries to the pelvic organs. The investigation included a biomechanical analysis of the injury mechanism, a summary of prior published reports of internal pelvic injuries resulting from PWC falls as well as other water sports and activities, and a comparison of the severity of the injuries resulting from differing mechanisms using the New Injury Severity Score (NISS). The mean (± standard deviation [SD]) NISS values for reported PWC injuries [not including the NISS of 38 in this case study] were 11.2 (± 9.5), while the mean value for reported water-skiing falls was half that of the PWC group at 5.6 (± 5.2). It was concluded that the analyzed injuries were unique to a PWC ejection versus other previously described non-PWC-associated water sport injuries. It is recommended that PWC manufacturers help consumers understand the potential risks to passengers with highly visible warnings and reduce injury risk with revised seat design, and/or passenger seat "deadman" switches. © 2012 American Academy of Forensic Sciences.

  18. Pelvic laparoscopy

    Science.gov (United States)

    ... after surgery. Pelvic laparoscopy is used both for diagnosis and treatment. It may be recommended for: An abnormal pelvic mass or ovarian cyst found using pelvic ultrasound Cancer ( ovarian , endometrial , or cervical) to see if it has spread, or to ...

  19. Functional Outcome With Percutaneous Ilio-sacral Screw Fixation For Posterior Pelvic Ring Injuries In Patients Involved In Heavy Manual Laboring

    Directory of Open Access Journals (Sweden)

    Abhishek SM

    2015-11-01

    Full Text Available Introduction: Unstable posterior pelvic ring injuries are best treated with operative methods due to better post-op functional score. Our patient cohort was involved in heavy manual laboring frequently required ground level work in their activities of daily living. There are very few outcome studies dealing exclusively with such patients. Materials & Methods: Forty one patients who were treated with percutaneous sacroiliac screw fixation under fluoroscopic guidance and were followed-up for at least one year were analyzed retrospectively for functional outcome using the Majeed score. Results: Twenty one (51.22% and thirteen (31.70% patients were found to be in excellent and good categories respectively and majority of the patients (thirty/73.17% were able to return to their original occupation with or without minor adjustments. Conclusion: Percutaneous ilio-sacral screw fixation for posterior pelvic unstable injuries is an acceptable mode of treatment in patients involved in heavy manual laboring.

  20. The extent of ligament injury and its influence on pelvic stability following type II anteroposterior compression pelvic injuries--A computer study to gain insight into open book trauma.

    Science.gov (United States)

    Böhme, Jörg; Lingslebe, Uwe; Steinke, Hanno; Werner, Michael; Slowik, Volker; Josten, Christoph; Hammer, Niels

    2014-07-01

    Surgical stabilization of the pelvis following type II anteroposterior compression pelvic injuries (APCII) is based on the assumption that the anterior sacroiliac, sacrospinous, and sacrotuberous ligaments disrupt simultaneously. Recent data on the ligaments contradict this concept. We aimed at determining the mechanisms of ligament failure in APCII computationally. In an individual osteoligamentous computer model of the pelvis, ligament load, and strain were observed for the two-leg stance, APCII with 100-mm symphyseal widening and for two-leg stance with APCII-related ligament failure, and validated with body donors. The anterior sacroiliac and sacrotuberous ligaments had the greatest load with 80% and 17% of the total load, respectively. APCII causes partial failure of the anterior sacroiliac ligament and the pelvis to become horizontally instable. The other ligaments remained intact. The sacrospinous ligament was negligibly loaded but stabilized the pelvis vertically. The interosseous sacroiliac and sacrotuberous ligaments are likely responsible for reducing the symphysis and might serve as an indicator of vertical stability. The sacrospinous ligament appears to be of minor significance in APCII but plays an important role in vertical stabilization. Further research is necessary to determine the influence of alterations in ligament and bone material properties. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  1. The association between hip and groin injuries in the elite junior football years and injuries sustained during elite senior competition.

    Science.gov (United States)

    Gabbe, B J; Bailey, M; Cook, J L; Makdissi, M; Scase, E; Ames, N; Wood, T; McNeil, J J; Orchard, J W

    2010-09-01

    To establish the relationship between the history of hip and groin injuries in elite junior football players prior to elite club recruitment and the incidence of hip and groin injuries during their elite career. Retrospective cohort study. Analysis of existing data. 500 Australian Football League (AFL) players drafted from 1999 to 2006 with complete draft medical assessment data. Previous history of hip/groin injury, anthropometric and demographic information. The number of hip/groin injuries resulting in > or =1 missed AFL game. Data for 500 players were available for analysis. 86 (17%) players reported a hip/groin injury in their junior football years. 159 (32%) players sustained a hip/groin injury in the AFL. Players who reported a previous hip or groin injury at the draft medical assessment demonstrated a rate of hip/groin injury in the AFL >6 times higher (IRR 6.24, 95% CI 4.43 to 8.77) than players without a pre-AFL hip or groin injury history. This study demonstrated that a hip or groin injury sustained during junior football years is a significant predictor of missed game time at the elite level due to hip/groin injury. The elite junior football period should be targeted for research to investigate and identify modifiable risk factors for the development of hip/groin injuries.

  2. Association between the Number of Injuries Sustained and 12-Month Disability Outcomes: Evidence from the Injury-VIBES Study

    Science.gov (United States)

    Gabbe, Belinda J.; Simpson, Pam M.; Lyons, Ronan A.; Ameratunga, Shanthi; Harrison, James E.; Derrett, Sarah; Polinder, Suzanne; Davie, Gabrielle; Rivara, Frederick P.

    2014-01-01

    Objective To determine associations between the number of injuries sustained and three measures of disability 12-months post-injury for hospitalised patients. Methods Data from 27,840 adult (18+ years) participants, hospitalised for injury, were extracted for analysis from the Validating and Improving injury Burden Estimates (Injury-VIBES) Study. Modified Poisson and linear regression analyses were used to estimate relative risks and mean differences, respectively, for a range of outcomes (Glasgow Outcome Scale-Extended, GOS-E; EQ-5D and 12-item Short Form health survey physical and mental component summary scores, PCS-12 and MCS-12) according to the number of injuries sustained, adjusted for age, sex and contributing study. Findings More than half (54%) of patients had an injury to more than one ICD-10 body region and 62% had sustained more than one Global Burden of Disease injury type. The adjusted relative risk of a poor functional recovery (GOS-Einjuries in disability studies. Future studies should consider the impact of multiple injuries to avoid under-estimation of injury burden. PMID:25501651

  3. Predictors for success of internal urethrotomy in patients with urethral contracture following perineal repair of pelvic fracture urethral injuries.

    Science.gov (United States)

    Hong, Young-Kwon; Choi, Kyung-Hwa; Lee, Young-Tae; Lee, Seung-Ryeol

    2017-05-01

    Internal urethrotomy (IU) in patients with urethral contracture following perineal repair of pelvic fracture urethral injuries (PRPFUI) is troublesome. We evaluated the clinical factors affecting the surgical outcome of IU for urethral contracture after PRPFUI. We retrospectively reviewed the records of 35 patients who underwent IU for urethral contracture after PRPFUI between March 2004 and June 2013. Ages of patients ranged from 18 to 50, and their follow-up duration was more than 1year after IU. The urethral contracture was confirmed by retrograde urethrogram or cysto-urethroscopy. Success was defined as greater than 15mL/s of peak urinary flow rate at 1year after IU without any clinical evidence of urethral contracture. Success rates were investigated according to the number of IU. Age, body mass index, urethral defect length before PRPFUI, time interval between the original urethral injury and the PRPFUI or between a previous operation and the PRPFUI, time interval between the PRPFUI and the urethral contracture, number of PRPFUI performed, and the type of urethral lengthening procedure were compared between patients with and without success according to the number of IU. Among the 35 patients, the overall success rate of IU was 37% (13/35) during the mean follow-up period of 53 months (range: 17-148 months). There were 8 and 5 patients with success in first and second IU, respectively. However, there was no success after third IU. Urethral defect length before PRPFUI was significantly shorter in patients with success who underwent first and second IU (psuccess between patients with and without previous repeated failures of PRPFUI in first and second IU (p<0.05). Short urethral defect length and no previous surgical failures before PRPFUI are good prognostic factors for IU following PRPFUI. Only one or two IUs will be helpful in patients with urethral contracture following PRPFUI. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Health service use in adults 20–64 years with traumatic brain injury, spinal cord injury or pelvic fracture. A cohort study with 9-year follow-up

    OpenAIRE

    Laursen, Bjarne; Helweg-Larsen, Karin

    2012-01-01

    Objectives To estimate the health service use over 9 years after the injury year for patients with traumatic brain injury (TBI), spinal cord injury (SCI) and pelvic fracture (PF), and compare with non-injured. Design A register-based cohort design with a 9-year follow-up period. Setting The Danish population. Participants The study included 434, 100 and 278 hospital-treated incident patients with TBI, SCI and PF, respectively, among 20-year-olds to 64-year-olds identified using the National P...

  5. Contemporary Role of Embolization of Solid Organ and Pelvic Injuries in Polytrauma Patients

    Directory of Open Access Journals (Sweden)

    Nikolaos D. Ptohis

    2017-08-01

    Full Text Available Abdominopelvic trauma (APT remains a leading cause of morbidity and mortality in the 15- to 44-year-old age group in the Western World. It can be life-threatening as abdominopelvic organs, specifically those in the retroperitoneal space, can bleed profusely. APT is divided into blunt and penetrating types. While surgery is notably considered as a definitive solution for bleeding control, it is not always the optimum treatment for the stabilization of a polytrauma patient. Over the past decades, there has been a shift toward more sophisticated strategies, such as non-operative management of abdominopelvic vascular trauma for haemodynamically stable patients. Angiographic embolization for bleeding control following blunt and/or penetrating intra- and retroperitoneal injuries has proven to be safe and effective. Embolization can achieve hemostasis and salvage organs without the morbidity of surgery, and the development and refinement of embolization techniques has widened the indications for non-operative treatment in solid organ injury. Moreover, advances in computed tomography provided more efficient scanning times with improved image quality. While surgery is still usually recommended for patients with penetrating injuries, non-operative management can be effectively used as well as an alternative treatment. We review indications, technical considerations, efficacy, and complication rates of angiographic embolization in APT.

  6. Haemodynamically Unstable Pelvic Fractures

    Science.gov (United States)

    2009-01-01

    Since bleeding from associated injuries significantly influences patient survival, prompt identification and management of all life- threatening injuries...after trauma. Arch Surg 2001;136: 676–81. 88. Ollerton JE, Sugrue M, Balogh Z, et al. Prospective study to evaluate the influence of FAST on trauma...FN. Bilateral peroneal nerve palsy following emergent stabilization of a pelvic ring injury. J Orthop Trauma 2003;17:67–70. 109. Shapiro M,McDonald

  7. History of pelvic fracture management: a review

    OpenAIRE

    Stahel, Philip F; Hammerberg, E Mark

    2016-01-01

    High-energy pelvic fractures represent potentially life-threatening injuries due to the risk of acute exsanguinating retroperitoneal hemorrhage. The first report of a severe pelvic ring disruption dates back to Charles Hewitt Moore?s seminal publication from 1851. Significant advantages in the understanding of injury mechanisms and treatment concepts of pelvic ring injuries evolved in the 20th century, and provided the basis to current classification-guided treatment and life-saving ?damage c...

  8. Motorcyclist's thumb: carpometacarpal injuries of the thumb sustained in motorcycle crashes.

    Science.gov (United States)

    Alexander, C; Abzug, J M; Johnson, A J; Pensy, R A; Eglseder, W A; Paryavi, E

    2016-09-01

    The purpose of this study was to investigate motorcycle crash thumb injury patterns. We hypothesized that ulnar collateral ligament injuries at the thumb metacarpophalangeal joint would be most common and there would be a side predilection due to the clutch and brake positions. Motorcyclist admissions following injury between 2002 and 2013 were reviewed, and phalangeal and metacarpal injuries treated acutely identified. Demographics, injury, and treatment characteristics were recorded. Association between laterality and injury type was assessed. Of 128 patients, 59 underwent acute treatment for thumb injuries. Eleven patients sustained thumb ulnar collateral ligament injuries; 27 sustained thumb carpometacarpal injuries. Most carpometacarpal injuries were fracture-dislocations (19/27). Thumb carpometacarpal injuries had no overall side predilection; ulnar collateral ligament injuries occurred more on the right. Carpometacarpal fractures and dislocations are the most frequent motorcycle crash thumb injury, probably due to the mechanics of gripping handlebars and the high-energy force directed into the palm and against the metacarpal base. Level IV. © The Author(s) 2015.

  9. Robotic-assisted laparoscopic transection and repair of an obturator nerve during pelvic lymphadenectomy for endometrial cancer.

    Science.gov (United States)

    Nezhat, Farr R; Chang-Jackson, Shao-Chun R; Acholonu, Uchenna C; Vetere, Patrick F

    2012-02-01

    Obturator nerve injury may occur in gynecologic surgery, particularly in cases in which extensive pelvic sidewall retroperitoneal dissection is performed. The lack of tactile feedback from the robotic surgical system may contribute to obturator nerve injury. If surgical division occurs, microsurgical end-to-end anastomosis of the obturator nerve may be performed. A 76-year-old woman with stage IA endometrial adenocarcinoma sustained a left obturator nerve transection during pelvic lymphadenectomy that was recognized immediately. Robotic-assisted laparoscopic repair was performed successfully, with the patient experiencing no residual neuropathy 6 months postoperatively. Robotic-assisted laparoscopic repair is feasible for the treatment of obturator nerve injury.

  10. emergency management of injuries sustained during child sexual ...

    African Journals Online (AJOL)

    Enrique

    the management of child rape victims has focused on the forensic, psychosocial ... management of the sexually abused child in the South African context. .... after the injury. Abdominal injuries. Injury to intra-abdominal organs is rarely a result of a sexual assault, but if not detected can cause death from blood loss or later ...

  11. Sport Injuries Sustained by Athletes with Disability: A Systematic Review.

    Science.gov (United States)

    Weiler, Richard; Van Mechelen, Willem; Fuller, Colin; Verhagen, Evert

    2016-08-01

    Fifteen percent of the world's population live with disability, and many of these individuals choose to play sport. There are barriers to sport participation for athletes with disability and sports injury can greatly impact on daily life, which makes sports injury prevention additionally important. The purpose of this review is to systematically review the definitions, methodologies and injury rates in disability sport, which should assist future identification of risk factors and development of injury prevention strategies. A secondary aim is to highlight the most pressing issues for improvement of the quality of injury epidemiology research for disability sport. A search of NICE, AMED, British Nursing Index, CINAHL, EMBASE and Medline was conducted to identify all publications up to 16 June 2015. Of 489 potentially relevant articles and reference searching, a total of 15 studies were included. Wide study sample heterogeneity prevented data pooling and meta-analysis. Results demonstrated an evolving field of epidemiology, but with wide differences in sports injury definition and with studies focused on short competitions. Background data were generally sparse; there was minimal exposure analysis, and no analysis of injury severity, all of which made comparison of injury risk and injury severity difficult. There is an urgent need for consensus on sports injury definition and methodology in disability sports. The quality of studies is variable, with inconsistent sports injury definitions, methodologies and injury rates, which prevents comparison, conclusions and development of injury prevention strategies. The authors highlight the most pressing issues for improvement of the quality in injury epidemiology research for disability sport.

  12. Resuscitation Strategies for Burn Injuries Sustained in Austere Environments to Improve Renal Perfusion and Function

    Science.gov (United States)

    2017-10-01

    vascular endothelial growth factor gene transfer on wound healing after burn injury , Crit. Care Med. 31 (2003) 1017–1025. D.M. Burmeister et al. BBA...G.L. Su, D.G. Remick, S.C. Wang, S. Arbabi, Attenuating burn wound inflammatory signaling reduces systemic inflammation and acute lung injury , J...AWARD NUMBER: W81XWH-16-2-0041 TITLE: Resuscitation Strategies for Burn Injuries Sustained in Austere Environments to Improve Renal Perfusion

  13. Evaluation of long-term pelvic floor symptoms after an obstetric anal sphincter injury (OASI) at least one year after delivery: A retrospective cohort study of 159 cases.

    Science.gov (United States)

    Desseauve, D; Proust, S; Carlier-Guerin, C; Rutten, C; Pierre, F; Fritel, X

    2016-01-01

    The aim of this study was to assess long-term pelvic floor symptoms after an obstetric anal sphincter injury (OASI). This retrospective cohort study included 237 cases of OASI (0.86% of deliveries) identified at Poitiers University Hospital between 2000 and 2011. Symptoms were assessed using validated self-administered questionnaires, including Female Pelvic Floor Questionnaire, Pescatori anal incontinence score, EuroQoL five-dimension score, and pain visual analogue scale (VAS). One hundred and sixty women (67%) filled out the questionnaires, on average 46 months after delivery (8-152). Among them, 93 (54%) reported at least one symptom occurring "frequently" (the most common being dyspareunia), and 45 (28%) a symptom occurring "daily" (the most common being flatus incontinence). Anal incontinence was reported by 32 (20%) women, flatus incontinence "frequently" or "daily" by 28 (18%), and stool incontinence "frequently" or "daily" by 9 (6%). Urinary incontinence was reported "frequently" or "daily" by 27 women (17%) at stress, 17 (11%) at urge, and 11 (7%) at mixed circumstances. Prolapse symptoms were reported "frequently" or "daily" by 6 women (4%). Pain during intercourse was reported "frequently" or "daily" by 17 women (11%). Twenty-four women (18%) reported chronic pelvic pain (VAS score≥4/10). Ninety-five percent of women reported a normal quality of life for mobility, self-care, and usual activities; however, alterations in pain/discomfort (32%) and anxiety/depression (33%) domains were frequently reported. Pelvic floor symptoms 4 years after OASI were highly prevalent. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  14. Survey of tail injuries sustained by working gundogs and terriers in Scotland.

    Science.gov (United States)

    Lederer, R; Bennett, D; Parkin, T

    2014-05-03

    Working dog owners in Scotland were invited to take part in an internet survey regarding the 2010/2011 shooting season, which was designed to estimate the prevalence of tail injuries; assess the risk of tail injuries in docked and undocked working dogs; and identify risk factors for owner-reported tail injuries. Of 2860 working dogs, 13.5 per cent sustained at least one tail injury during the 2010/2011 shooting season. Undocked spaniels and hunt point retrievers (HPRs) were at greatest risk of tail injury with 56.6 per cent of undocked spaniels and 38.5 per cent of undocked HPRs sustaining at least one tail injury during the season. There was no statistically significant difference in the risk of tail injury in dogs with tails docked by one-third, half or shorter. To prevent one tail injury in one shooting season, between two and 18 spaniels or HPRs would need to be docked as puppies. The authors believe that this work provides the best available evidence on which to base a consultation for changes to the legislation on tail docking in working dogs in Scotland. Docking the tails of HPRs and spaniels by one-third would significantly decrease the risk of tail injury sustained while working in these breeds.

  15. MODELING OF BONE FRAGMENTS FIXATION WITH AN EXTERNAL FIXATION DEVICE FOR BILATERAL ROTATION UNSTABLE PELVIC INJURIES B TYPE ACCORDING TO AO/ASIF CLASSIFICATION

    Directory of Open Access Journals (Sweden)

    V. G. Vinogradov

    2014-01-01

    Full Text Available Objective: to determine the stability of bone fragments fixation with an external fixation device in the simulation of bilateral partly unstable pelvic injuries of B type according to AO/ASIF classification and to identify the role of different fixation elements in the stability of fixation. Material and methods: the study was performed on the finite element model of a system “an external fixation device - pelvis” developed for a software package MSCNastran. Formation of a fracture of pubic and ischial pelvic bones was accomplished by means of rupture in the finite element network and decrease of elasticity modulus in the ilio-sacral joint on both sides up to 35 mm at the site of a fracture. Loads were carried on top of the body of the first sacral vertebra with a force of 500H.The second area of application of the load was from the bottom-up on the acetabular roof with a force of 250H. In this study the effect of different elements of an external fixation device on the stiffness of bone fragments fixation was evaluated. Symmetrical elements were removed both separately and together. As a result, the stiffness of a system decreased and the displacement at the fracture site increased. Conclusion: in a model of partly stable pelvic injuries accompanied by general rotation instability in the horizontal and sagittal planes to 35 mm, an external fixation device provided high stability of bone fragments (to 3 mm due to introduction of bone rods in the iliac wings with the obligatory introduction of the rod in the vertical branches of pubic bones and strengthening the anterior lower bar between the subsystems. What is more, installing the anterior upper bar or introduction of bone rods in the bodies of iliac bone are not necessary.

  16. The National Incidence and Resource Utilization of Burn Injuries Sustained While Smoking on Home Oxygen Therapy.

    Science.gov (United States)

    Assimacopoulos, Evangelia M; Liao, Junlin; Heard, Jason P; Kluesner, Karen M; Wilson, Jeffrey; Wibbenmeyer, Lucy A

    2016-01-01

    Considerable risk of burn injury exists for those patients on home oxygen therapy (HOT) who continue to smoke. In this study, the authors sought to establish the national incidence of burns incurred while smoking on HOT and to determine the resource utilization and sequelae of these injuries. A retrospective review of the American Burn Association's National Burn Repository was conducted to identify patients burned while on HOT during the years 2002 to 2011. Duplicate entries, as well as records of follow-up visits and readmissions, were removed. Univariate analysis was used to compare the differences between patients sustaining burn injuries related to HOT and patients with other mechanisms of injury. Multivariate analysis provided odds ratios for mortality controlling for all significant variables. The frequency of burns sustained on HOT significantly increased during the 10-year period reviewed and were associated with increased comorbidities and certain complications. Compared with non-HOT injuries, HOT injuries had higher incidence of inhalation injury and mortality. Inhalation injury was the strongest predictor of mortality in HOT burn injuries. The likelihood of poor prognosis was even more pronounced in patients who required intubation. Smoking was responsible for 83% of the HOT burn injuries described here. Therefore, smoking cessation counseling and treatment should be mandatory in all patients prescribed HOT.

  17. The nature and characteristics of abdominal injuries sustained during children's sports.

    Science.gov (United States)

    Noaman, Farah; Lam, Lawrence T; Soundappan, S V; Browne, Gary J

    2010-01-01

    To increase the evidence base by characterizing various features of pediatric sports-related abdominal injuries. A review of the trauma database at The Children's Hospital at Westmead was undertaken for all abdominal injuries presenting to the emergency department between 2001 and 2006. The Children's Hospital at Westmead is a tertiary-level pediatric trauma center servicing Sydney's west. It sees approximately 50,000 patients a year. Only those injuries occurring during an organized sport were included for analysis. Thirty-three of the original 513 patients were eligible for inclusion. The data collected included basic demographics, mechanism of injury, sport injury, time to presentation, length of stay, diagnoses, treatment, and complications. Injury severity scores were assigned retrospectively. Males sustained more injuries than females. Collisions and falls were the most common modes of injury. Rugby was the most common sport for injury. Most patients presented within 12 hours, and most presented with musculoskeletal injuries. Injury severity was usually mild; treatment, conservative; length of stay, short; and complications, uncommon. When characteristics were compared by sex, males had mostly collision injuries in high-impact/contact sports, with females having more falls in other sports. When characteristics were compared by age, the only statistically significant difference was in the organ injured: older children had more single solid organ injuries, and younger children had more multiple and hollow viscus injuries. Sports-related abdominal injuries in children are mostly minor and not as common as other injury mechanisms. Despite this, they can be serious, with early diagnosis often delayed because of their subtle nature. Sports-related abdominal injuries in children require a high index of suspicion in the part of the clinician if they are to be recognized early and managed effectively.

  18. Do Children Who Sustain Traumatic Brain Injury in Early Childhood Need and Receive Academic Services 7 Years After Injury?

    Science.gov (United States)

    Kingery, Kathleen M; Narad, Megan E; Taylor, H Gerry; Yeates, Keith Owen; Stancin, Terry; Wade, Shari L

    To examine the prevalence of academic need, academic service utilization, and unmet need as well as factors associated with academic service utilization 6.8 years after traumatic brain injury (TBI) in early childhood. Fifty-eight (16 severe, 14 moderate, 28 complicated mild) children with TBI and 72 children with orthopedic injury (OI) completed the long-term follow-up 6.8 years after injury in early childhood (ages 3-7 years). Injury group differences in rates of need for academic services, academic service utilization, and unmet need as well as factors associated with service utilization and unmet need were examined. Students with moderate and severe TBI had significantly greater rates of need than those with OI. A greater proportion of the severe TBI sample was receiving academic services at long-term follow-up than the OI and complicated mild groups however, among those with an identified need, injury group did not affect academic service utilization. Below average IQ/achievement scores was the only area of need predictive of academic service utilization. Rates of unmet need were high and similar across injury groups (46.2%-63.6%). The need for academic services among patients who sustained a TBI during early childhood remains high 6.8 years post injury. Findings underscore the importance of continued monitoring of behaviors and academic performance in students with a history of early childhood TBI. This may be especially true among children with less severe injuries who are at risk for being underserved.

  19. Characteristics of traumatic brain injuries sustained among veterans seeking homeless services.

    Science.gov (United States)

    Barnes, Sean M; Russell, Leah M; Hostetter, Trisha A; Forster, Jeri E; Devore, Maria D; Brenner, Lisa A

    2015-02-01

    This hypothesis-generating research describes the characteristics of traumatic brain injuries (TBIs) sustained among 229 Veterans seeking homeless services. Nearly all participants (83%) had sustained at least one TBI prior to their first episode of homelessness. Among participants with a TBI, assaults, transportation-related accidents, and falls were the most common causes of these injuries. Thirty percent of individuals sustained injuries with severity levels that would be expected to be associated with ongoing TBI-related deficits. Forty-three percent of the Veterans sustained at least one brain injury following their first episode of homelessness. Median lifetime number of TBIs was three. The severity of TBIs was similar among Veterans who sustained injuries before or after their first incident of homelessness. Findings suggest that future research should directly examine the potential bi-directional relationship between TBI and homelessness, as well as the impact of TBI-related deficits on Veterans' ability to benefit from homeless services and/or maintain stable housing.

  20. Chronic Pelvic Pain

    Science.gov (United States)

    ... Management Education & Events Advocacy For Patients About ACOG Chronic Pelvic Pain Home For Patients Search FAQs Chronic Pelvic Pain ... Chronic Pelvic Pain FAQ099, August 2011 PDF Format Chronic Pelvic Pain Gynecologic Problems What is chronic pelvic pain? What ...

  1. The Influence of Pelvic Ramus Fracture on the Stability of Fixed Pelvic Complex Fracture

    OpenAIRE

    Jianyin Lei; Yue Zhang; Guiying Wu; Zhihua Wang; Xianhua Cai

    2015-01-01

    This study aims to evaluate the biomechanical mechanism of pelvic ring injury for the stability of pelvis using the finite element (FE) method. Complex pelvic fracture (i.e., anterior column with posterior hemitransverse lesion) combined with pelvic ramus fracture was used to evaluate the biomechanics stability of the pelvis. Three FE fracture models (i.e., Dynamic Anterior Plate-Screw System for Quadrilateral Area (DAPSQ) for complex pelvic fracture with intact pubic ramus, DAPSQ for complex...

  2. Injuries sustained after falls from bridges across the United States-Mexico border at El Paso.

    Science.gov (United States)

    McLean, Susan F; Tyroch, Alan H

    2012-05-01

    To compare demographics and motivations for falls from bridges at the United States-Mexico border and in El Paso County, Texas, and to analyze injuries and injury patterns to support intentionality and to provide treatment recommendations. A retrospective observational review was conducted of hospital admissions to a trauma center after falls from bridges from 1995 to 2009. Statistical methods used were chi-square testing, T-test for means comparison, univariate correlations, and regression analysis. Of the 97 evaluated patients, 81.4% fell from U.S.-Mexico border bridges, including one patient who fell from a railway bridge; 74.7% of those falling from border bridges had a non-U.S. address, contrasting with 22.2% of those who fell within the United States. Falls over the border were associated with more immigration-related motivations and fewer suicide attempts. Injuries included lower extremities in 76 (78.4%) and thoracolumbar spine in 27 (27.8%) patients; 16 patients with a thoracolumbar spine fracture (59.3%) also had a lower extremity injury. Mean hospital length of stay was 7.2 days. Mean injury severity score was 8.45 (range 1-43). Age, injury severity score, and pelvic fracture increased the hospital length of stay. Patients fell while emigrating-immigrating based on residence and motivating factors. A dyad of lower extremity and thoracolumbar spine injuries coincided in 59.3% of those with a thoracolumbar spine injury; thoracolumbar spine imaging of patients evaluated after falls from bridges is recommended. Proposed prevention strategies include posting signs on bridges and installing catch-net safety barriers.

  3. The prevalence of dental, facial and head injuries sustained by schoolboy rugby players. A pilot study.

    Science.gov (United States)

    Jagger, Robert G; Abbasbhai, Ali; Patel, Dilan; Jagger, Daryll C; Griffiths, Alex

    2010-07-01

    The aim of the study was to determine the prevalence of dental, orofacial and head injuries and of mouthguard use among schoolboy rugby players. All members of the first and second XV rugby squads at three secondary schools (two in England and one in Australia) were included in the study. All participants answered a questionnaire that sought information regarding dental, orofacial and head injuries. Statistical differences between groups were determined using chi-square tests for categorical variables and Kruskal-Wallis tests for discrete (count) variables. One hundred and seventy-eight completed questionnaires were returned (100% response rate). One hundred and twenty-five (70%) players reported having sustained at least one injury (range 1-4). Facial injuries were common. Dental injuries were the most prevalent injury: 46 (26%) were reported. Fractured teeth were reported by 20 (11%) players, and avulsed teeth by 7 (4%). There was evidence of a difference between schools in the prevalence of injured players (P=0.014), but among those reporting injuries, there was no difference between schools in the number of injuries (P=0.95). All players said that they used a mouthguard regularly. Dental, orofacial and head injuries were commonly reported. Dental injuries were the most prevalent type of injury. All players used mouthguards regularly.

  4. Unstable Pelvic Fractures Associated with Femoral Shaft Fractures: A Retrospective Analysis

    Directory of Open Access Journals (Sweden)

    Chun-Liang Wu

    2013-04-01

    Full Text Available Background: Both pelvic fractures and femoral shaft fractures are caused by high-energy injuries. When unstable pelvic fractures and femoral shaft fractures occur concomitantly, the optimal treatment method is controversial. The aim of this study was to establish a reasonable principle for treating such complicated injuries. Methods: Forty patients sustaining unstable pelvic fractures and concomitant femoral shaft fractures were treated in a 7-year period. The initial management of the fractures was started at the emergency service according to the Advanced Trauma Life Support protocol. Unstable pelvic fractures were wrapped by cloth sheets and femoral shaft fractures were immobilized with a splint. Angiography was performed on patients with unstable hemodynamic status. The definitive treatment for combined fractures was performed after stabilizing the hemodynamics. Closed nailing was used for femoral shaft fractures, and pelvic fractures were treated with various techniques. Results: The mortality rate was 12.5% (5/40 during admission. Thirty-three patients were followed up for an average of 32 months (range, 12-76 months. There were 33 cases of unstable pelvic fractures and 36 instances of femoral shaft fractures. The union rate for pelvic fractures was 100% (33/33, while femoral shaft fractures had a 94.4% (34/36 union rate. The average healing time was 3.3 months (range, 1.6-8.1 months and 4.1 months (range, 2.5-18.2 months for pelvic and femoral shaft fractures, respectively. After fracture, 34 hips (94% achieved a satisfactory result in the Harris hip score and 30 knees (83% achieved a satisfactory result in the Mize knee score. Conclusions: Stabilization of the hemodynamics in patients with combined fractures should be the first aim. Angiography to stop arterial bleeding in the pelvis is often life-saving. The definitive treatment for combined fractures, such as pelvic fractures and femoral shaft fractures, should wait until hemodynamics

  5. Identification of risk factors for neurological deficits in patients with pelvic fractures.

    Science.gov (United States)

    Schmal, Hagen; Hauschild, Oliver; Culemann, Ulf; Pohlemann, Tim; Stuby, Fabian; Krischak, Gert; Südkamp, Norbert P

    2010-08-11

    This multicenter register study was performed to define injury and fracture constellations that are at risk to develop pelvic associated neural lesions. Data of 3607 patients treated from 2004 to 2009 for pelvic fractures were evaluated for neurological deficits depending on Tile classification, pelvic injury configuration, and treatment.In 223 patients (6.5%), neurological lesions were diagnosed on the day of discharge from the hospital. The degree of instability of the pelvic fracture correlated with occurrence of nerve lesions. Rate of neurological dysfunction increased from 1.5% in type A fractures to 14.4% in type C fractures (P<.001). As the most endangered anatomical regions in pelvic fractures, the roots L5 (18.3%) and S1 (15.6%) and isolated peripheral nerves (19.2%) were identified. Patients sustaining complex pelvic trauma (7.85%) suffered from significantly more neurological dysfunctions (33.5%) compared to patients without peripelvic organ or soft tissue injuries (P<.001). Whereas stable type A3 sacral fractures were not associated with a different risk to develop neurological deficits (3.8%), unstable sacral fractures with the need for operative fixation showed an increased rate of accompanying nerve lesions (15.4%; P<.001). Twenty-one (11.5%) operative sacral stabilizations were supplemented with nerve root decompression (mainly S1). Neurological complications in the course of treatment were seen in 69 cases (1.9%).A high degree of instability, complex pelvic trauma, and unstable sacral fractures predispose for additional neurological deficits in patients with pelvic fractures. Copyright 2010, SLACK Incorporated.

  6. Positioning injury, rhabdomyolysis, and serum creatine kinase-concentration course in patients undergoing robot-assisted radical prostatectomy and extended pelvic lymph node dissection.

    Science.gov (United States)

    Mattei, Agostino; Di Pierro, Giovanni Battista; Rafeld, Verena; Konrad, Christoph; Beutler, Jonas; Danuser, Hansjörg

    2013-01-01

    During robot-assisted radical prostatectomy (RARP), patients remain in a steep Trendelenburg position. This can cause positioning injuries as well as rhabdomyolysis. The primary diagnostic indicator of rhabdomyolysis is elevated serum creatine kinase (CK). We investigate whether RARP with extended pelvic lymph node dissection (ePLND) in a prolonged extreme Trendelenburg position can cause positioning injuries and rhabdomyolysis. We performed a prospective study of the first 60 patients undergoing RARP and ePLND for organ-confined prostate cancer at our institute. Positioning injuries were graded according to three degrees of clinical severity. Serum-CK, serum-pH, and base excess (BE) were measured before, during, and for 5 days after surgery. Rhabdomyolysis was defined by serum-CK levels >5000 IU/L. Median operative time was 317 minutes (range 200-475 min); median time in the Trendelenburg position was 282 minutes (range 170-470 min). Serum-CK was significantly elevated 6 hours postoperatively, peaking at 18 hours postoperatively. Serum-CK levels did not correlate with pH, BE, and perioperative creatinine values. Serum-CK course shows weak correlation with body mass index (BMI), operative time, Trendelenburg position time, and medium correlation with positioning injuries of any degree. Twenty-one of the 60 (35%) patients showed positioning-related injuries: 16 (27%) patients degree I, 2 (3%) patients degree II, and 3 (5%) patients degree III. Rhabdomyolysis developed in 10 patients. Postoperative renal failure did not develop in any patient receiving postoperative hypervolemic diuretic therapy nor any patient with injuries degrees I, II, or III. conclusion: Clinically relevant positioning injuries and rhabdomyolysis can occur in patients who are subjected to prolonged extreme Trendelenburg position during RARP and ePLND, especially at the beginning of the learning curve. Serum-CK increases significantly after surgery, peaking 18 hours postoperatively. Serum

  7. A computer-based analysis of injuries sustained by victims of a major air disaster.

    Science.gov (United States)

    Koelmeyer, T D; Beer, B; Mullins, P R

    1982-03-01

    A computer-based analysis of the injury patterns sustained by victims in the DC-10 aircraft that crashed into Mt. Erebus, Antarctica, On November 28, 1979, is presented. The distribution of these injury patterns supports the hypothesis that at impact the plane was in a nose-high attitude with respect to the slope and the impact point was the underside of the rear section of the fuselage.

  8. A pelvic implant orthosis in rodents, for spinal cord injury rehabilitation, and for brain machine interface research: construction, surgical implantation and validation.

    Science.gov (United States)

    Udoekwere, Ubong Ime; Oza, Chintan S; Giszter, Simon F

    2014-01-30

    Rodents are important model systems used to explore spinal cord injury (SCI) and rehabilitation, and brain machine interfaces (BMI). We present a new method to provide mechanical interaction for BMI and rehabilitation in rat models of SCI. We present the design and implantation procedures for a pelvic orthosis that allows direct force application to the skeleton in brain machine interface and robot rehabilitation applications in rodents. We detail the materials, construction, machining, surgery and validation of the device. We describe the statistical validation of the implant procedures by comparing stepping parameters of 8 rats prior to and after implantation and surgical recovery. An ANOVA showed no effects of the implantation on stepping. Paired tests in the individual rats also showed no effect in 7/8 rats and minor effects in the last rat, within the group's variance. Our method allows interaction with rats at the pelvis without any perturbation of normal stepping in the intact rat. The method bypasses slings, and cuffs, avoiding cuff or slings squeezing the abdomen, or other altered sensory feedback. Our implant osseointegrates, and thus allows an efficient high bandwidth mechanical coupling to a robot. The implants support quadrupedal training and are readily integrated into either treadmill or overground contexts. Our novel device and procedures support a range of novel experimental designs and motor tests for rehabilitative and augmentation devices in intact and SCI model rats, with the advantage of allowing direct force application at the pelvic bones. Copyright © 2013 Elsevier B.V. All rights reserved.

  9. Epidemiology of rugby injuries sustained by Free State University ...

    African Journals Online (AJOL)

    From 18 July 2003 to 1 August 2003 (the first three weeks after the June/July holidays), 25 injuries occurred. Conclusion Our findings were similar to those of other studies in certain respects but differed in others. Further research should investigate the effect of coaching techniques, fitness levels, protective gear and first aid ...

  10. emergency management of injuries sustained during child sexual ...

    African Journals Online (AJOL)

    Enrique

    vaginal rape being well documented — even in young infants under one year of age.3 These severe and brutal assaults can result in serious and sometimes life- threatening injury to the young child.4 A systematic approach to the care of these individuals is essential in order to achieve a satisfactory outcome. Traditionally.

  11. Searching for sustainability within public health policy: insights from an injury prevention perspective.

    Science.gov (United States)

    Errington, Gail; Evans, Catrin; Watson, Michael C

    2017-04-01

    Sustaining public health programmes in the long-term is key to ensuring full manifestation of their intended benefits. Although an increasing interest in sustainability is apparent within the global literature, empirical studies from within the European setting are few. The factors that influence sustainability are generally conceptualized at three levels: programme level, the immediate context and the wider environment. To-date attention has focused primarily on the former two. Using a community-based child injury prevention programme in England as an exemplar, this paper explores the concept of sustainability within the wider policy environment, and considers the impact of this on local programmes. A content review of global and UK national public health policies (1981-2014) relevant to child safety was undertaken. Interviews were held with senior representatives of global and UK agencies involved in developing child safety policy. Forty-nine policies were reviewed. The term 'sustain', or its derivatives, featured in 36 (73%) of these. Its' use however, related primarily to conservation of resources rather than continued programme operation. Potential mechanisms for supporting programme sustainability featured within some documents; however, the approach to sustainability was inconsistent between policies and over time. Policy stakeholders identified programme sustainability as relevant to their core business, but its' conceptualization varied according to individual interpretation. Programme sustainability is poorly addressed within global and UK-based public health policy. Strengthening a national and international policy focus on sustainability and incorporating sustainability into public health planning frameworks may create a more supportive environment for local programmes.

  12. Cervical Spinal Injury from Repeated Exposures to Sustained Acceleration.

    Science.gov (United States)

    1999-02-01

    load (51). Also, with arm movements the upper trapezius and the levator scapulae become involved and resist neck movement, thus directly and...proper diet and weight control; 2. Regular strength and aerobic training with stretching and functional respiration training; 3. Massage, sauna and...physical warm-up including stretching neck muscles immediately before taking off while the pilot is in the cockpit. 39 CHAPTER 10 CERVICAL INJURY AND

  13. A review of 10 years of scapula injuries sustained by UK military personnel on operations.

    Science.gov (United States)

    Roberts, Darren C; Power, D M; Stapley, S A

    2017-09-11

    Scapula fractures are relatively uncommon injuries, mostly occurring due to the effects of high-energy trauma. Rates of scapula fractures are unknown in the military setting. The aim of this study is to analyse the incidence, aetiology, associated injuries, treatment and complications of these fractures occurring in deployed military personnel. All UK military personnel returning with upper limb injuries from Afghanistan and Iraq were retrospectively reviewed using the Royal Centre for Defence Medicine database and case notes (2004-2014). Forty-four scapula fractures out of 572 upper limb fractures (7.7%) were sustained over 10 years. Blast and gunshot wounds (GSW) were leading causative factors in 85%. Over half were open fractures (54%), with open blast fractures often having significant bone and soft tissue loss requiring extensive reconstruction. Multiple injuries were noted including lung, head, vascular and nerve injuries. Injury Severity Scores (ISS) were significantly higher than the average upper limb injury without a scapula fracture (pmilitary personnel with GSW have a favourable chance of nerve recovery, 75% of brachial plexus injuries that are associated with blast have poorer outcomes. Fixation occurred with either glenoid fractures or floating shoulders (10%); these were as a result of high velocity GSW or mounted blast ejections. There were no cases of deep soft tissue infection or osteomyelitis and all scapula fractures united. Scapula fractures have a 20 times higher incidence in military personnel compared with the civilian population, occurring predominantly as a result of blast and GSW, and a higher than average ISS. These fractures are often associated with multiple injuries, including brachial plexus injuries, where those sustained from blast have less favourable outcome. High rates of union following fixation and low rates of infection are expected despite significant contamination and soft tissue loss. © Article author(s) (or their

  14. An epidemiologic comparison of high school sports injuries sustained in practice and competition.

    Science.gov (United States)

    Rechel, Julie A; Yard, Ellen E; Comstock, R Dawn

    2008-01-01

    More than 7 million US high school students play sports. To compare practice and competition injury rates and patterns in 5 boys' sports (football, soccer, basketball, wrestling, and baseball) and 4 girls' sports (soccer, volleyball, basketball, and softball) during the 2005-2006 school year. Prospective injury surveillance study. Injury data were collected from 100 nationally representative United States high schools via High School RIO (Reporting Information Online). Athletes from participating high schools injured while participating in a school-sanctioned practice or competition in one of the above sports. Practice and competition injury rates, body site, diagnosis, and severity. High school athletes participating in these 9 sports at participating schools sustained 4350 injuries during the 2005-2006 school year, which corresponds to an estimated 1 442 533 injuries nationally. The rate of injury per 1000 athlete-exposures was higher in competition (4.63) than in practice (1.69) (rate ratio [RR] = 2.73, 95% confidence interval [CI] = 2.58, 2.90). Of all sports, football had the highest competition (12.09) and practice (2.54) injury rates per 1000 athlete-exposures. Compared with injuries sustained during practice, higher proportions of competition injuries were head/face/neck injuries (proportion ratio [PR] = 1.61, 95% CI = 1.34, 1.94), particularly in boys' soccer (PR = 7.74, 95% CI = 2.53, 23.65) and girls' basketball (PR = 6.03, 95% CI = 2.39, 15.22). Competition injuries were more likely to be concussions (PR = 2.02, 95% CI = 1.56, 2.62), especially in boys' soccer (PR = 6.94, 95% CI = 2.01, 23.95) and girls' basketball (PR = 5.83, 95% CI = 2.06, 16.49). Higher proportions of competition injuries caused the athlete to miss more than 3 weeks of play (PR = 1.28, 95% CI = 1.08, 1.52), particularly in baseball (PR = 3.47, 95% CI = 1.48, 8.11) and volleyball (PR = 2.88, 95% CI = 1.01, 8.24). Rates and patterns of high school sport injuries differed between

  15. 42 CFR 102.50 - Medical records necessary to establish that a covered injury was sustained.

    Science.gov (United States)

    2010-10-01

    ... HEALTH AND HUMAN SERVICES VACCINES SMALLPOX COMPENSATION PROGRAM Required Documentation To Be Deemed... to establish that a smallpox vaccine recipient or vaccinia contact sustained a covered injury, a... records, including the admission history and physical examination, the discharge summary, all physician...

  16. Woodworking injuries: an epidemiologic survey of injuries sustained using woodworking machinery and hand tools.

    Science.gov (United States)

    Justis, E J; Moore, S V; LaVelle, D G

    1987-09-01

    Woodworking equipment produces approximately 720,000 injuries per year often causing severe psychologic and functional impairment. Responses from 1000 injured woodworkers to a demographic survey revealed that 60.5% of injuries occurred to amateur woodworkers; 42% of injuries were caused by the table saw and 37% of respondents reported amputation of one or more digits. The most significant causal factor reported was failure to use properly installed guards, but personal factors, such as fatigue and postprandial somnolence were also implicated. Twenty-seven percent of respondents required hospitalization for an average of 3.7 days, and 22.8% were treated by hand surgeons. Hand surgeons need to become more aware of the dangers of specific types of woodworking equipment and the injuries produced by these tools to better treat and perhaps, prevent woodworking injuries.

  17. The minimal energetic requirement of sustained awareness after brain injury

    DEFF Research Database (Denmark)

    Stender, Johan; Mortensen, Kristian Nygaard; Thibaut, Aurore

    2016-01-01

    Differentiation of the minimally conscious state (MCS) and the unresponsive wakefulness syndrome (UWS) is a persistent clinical challenge [1]. Based on positron emission tomography (PET) studies with [18F]-fluorodeoxyglucose (FDG) during sleep and anesthesia, the global cerebral metabolic rate...... changes in brain metabolism [4]. We here used FDG-PET to measure resting state brain glucose metabolism in 131 DOC patients to identify objective quantitative metabolic indicators and predictors of awareness. Quantitation of images was performed by normalizing to extracerebral tissue. We show that 42......, associated with the reemergence of consciousness after brain injury. Our data further revealed that regional variations relative to the global resting metabolic level reflect preservation of specific cognitive or sensory modules, such as vision and language comprehension. These findings provide a simple...

  18. Traumatic pelvic fractures in children and adolescents.

    Science.gov (United States)

    DeFrancesco, Christopher J; Sankar, Wudbhav N

    2017-02-01

    Although traumatic pelvic fractures in children are relatively rare, these injuries are identified in about 5% of children admitted to level 1 trauma centers after blunt trauma.1-4 Such injuries differ from adult pelvic fractures in important ways and require distinct strategies for management. While the associated mortality rate for children with pelvic fractures is much lower than that for adults, the patient may require urgent surgical intervention for associated life-threatening injuries such as head trauma and abdominal injury. Unstable pelvic ring fractures should be acutely managed using an initial approach similar to that used in adult orthopedic traumatology. Although very few pediatric pelvic fractures will ultimately need surgical treatment, patients with these injuries must be followed over time to confirm proper healing, ensure normal pelvic growth, and address any potential complications. The trauma team suspecting a pelvic fracture in a child must understand the implication of such a finding, identify fracture patterns that increase suspicion of associated injuries, and involve pediatric or adult orthopedic specialists as appropriate during the management of the patient. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Post Pelvic Radiotherapy Bony Changes

    Energy Technology Data Exchange (ETDEWEB)

    Huh, Seung Jae [Samsung Medical Center, Seoul (Korea, Republic of)

    2009-03-15

    There has been recent interest in radiation-induced bone injury in clinical conditions, especially for pelvic insufficiency fracture (PIF). A PIF is caused by the effect of normal or physiological stress on bone with demineralization and decreased elastic resistance. Pelvic radiotherapy (RT) can also contribute to the development of a PIF. A PIF has been regarded as a rare complication with the use of megavoltage equipment. However, recent studies have reported the incidence of PIFs as 8.2{approx}20% after pelvic RT in gynecological patients, an incidence that was higher than previously believed. The importance of understanding a PIF lies in the potential for misdiagnosis as a bony metastasis. If patients complain of pelvic pain after whole-pelvis radiation therapy, the presence of a PIF must be considered in the differential diagnosis. The use of multibeam arrangements and conformal RT to reduce the volume and dose of irradiated pelvic bone can be helpful to minimize the risk of fracture. In addition to a PIF, osteonecrosis and avascular necrosis of the femoral head can develop after radiation therapy. Osteoradionecrosis of the pelvic bone is a clinical diagnostic challenge that must be differentiated from an osseous metastasis. A post-radiation bone sarcoma can result as a long-term sequela of pelvic irradiation for uterine cervical cancer.

  20. Pelvic Actinomycosis

    Directory of Open Access Journals (Sweden)

    Alejandra García-García

    2017-01-01

    Full Text Available Introduction. Actinomycosis is a chronic bacterial infection caused by Actinomyces, Gram-positive anaerobic bacteria. Its symptomatology imitates some malignant pelvic tumours, tuberculosis, or nocardiosis, causing abscesses and fistulas. Actinomycoses are opportunistic infections and require normal mucous barriers to be altered. No epidemiological studies have been conducted to determine prevalence or incidence of such infections. Objective. To analyse the clinical cases of pelvic actinomycosis reported worldwide, to update the information about the disease. Methods. A systematic review of worldwide pelvic actinomycosis cases between 1980 and 2014 was performed, utilising the PubMed, Scopus, and Google Scholar databases. The following information was analysed: year, country, type of study, number of cases, use of intrauterine device (IUD, final and initial diagnosis, and method of diagnosis. Results. 63 articles met the search criteria, of which 55 reported clinical cases and 8 reported cross-sectional studies. Conclusions. Pelvic actinomycosis is confusing to diagnose and should be considered in the differential diagnosis of pelvic chronic inflammatory lesions. It is commonly diagnosed through a histological report, obtained after a surgery subsequent to an erroneous initial diagnosis. A bacterial culture in anaerobic medium could be useful for the diagnosis but requires a controlled technique and should be performed using specialised equipment.

  1. Injuries sustained during contact with law enforcement: An analysis from US trauma centers.

    Science.gov (United States)

    Schellenberg, Morgan; Inaba, Kenji; Cho, Jayun; Tatum, James M; Barmparas, Galinos; Strumwasser, Aaron; Grabo, Daniel; Bir, Cynthia; Eastman, Alexander; Demetriades, Demetrios

    2017-12-01

    Injuries sustained by civilians from interaction with police are a polarizing contemporary sociopolitical issue. Few comprehensive studies have been published using national hospital-based data. The aim of this study was to examine the epidemiology of these injuries to better understand this mechanism of injury. Patients entered into the National Trauma Data Bank (NTDB) (January 2007 to December 2012) with E-codes E970.0 to E976.0 (International Classification of Diseases, Ninth Revision, Clinical Modification), identifying injuries associated with law enforcement in the course of legal action, were enrolled. Patients' demographics, injury characteristics, procedures, and outcomes were collected and analyzed. Patients injured by other civilians (E960.0-E968.0) were used for comparison. Of 4,146,428 patients in the NTDB, 7,203 (0.17%) were injured during interaction with police. The numbers of patients in consecutive study years were 858, 1,103, 1,148, 1,274, 1,316, and 1,504. The incidence of these injuries was stable over time (0.17-0.18%) (p = 0.129). Patients had a median age of 31 years (range, 0-108), and 94.3% were male. Median injury severity score was 9 (interquartile range [IQR], 4-17). The most common mechanism of injury was gunshot wound (44%).Patients were white, 43%; black, 30%; Hispanic, 17%; Asian, 1%; and Other, 9%. As a proportion of the total race-specific NTDB trauma population, there was an average of 1.13 white patients, 2.71 Hispanic patients, and 3.83 black patients per 1,000. Mechanism, injury severity score, and outcomes did not vary by race. Compared to patients injured by civilians, patients injured by police are more likely to be white (43% vs 25%, p wounds (44% vs 32%, p trauma centers across the United States, the rate of injuries sustained during interactions with police has been stable over time. Gunshot wounds are the most common mechanism of injury. Proportionally, black patients are the most frequently injured race. When compared

  2. Late intellectual and academic outcomes following traumatic brain injury sustained during early childhood.

    Science.gov (United States)

    Ewing-Cobbs, Linda; Prasad, Mary R; Kramer, Larry; Cox, Charles S; Baumgartner, James; Fletcher, Stephen; Mendez, Donna; Barnes, Marcia; Zhang, Xiaoling; Swank, Paul

    2006-10-01

    Although long-term neurological outcomes after traumatic brain injury (TBI) sustained early in life are generally unfavorable, the effect of TBI on the development of academic competencies is unknown. The present study characterizes intelligence quotient (IQ) and academic outcomes an average of 5.7 years after injury in children who sustained moderate to severe TBI prior to 6 years of age. Twenty-three children who suffered inflicted or noninflicted TBI between the ages of 4 and 71 months were enrolled in a prospective, longitudinal cohort study. Their mean age at injury was 21 months; their mean age at assessment was 89 months. The authors used general linear modeling approaches to compare IQ and standardized academic achievement test scores from the TBI group and a community comparison group (21 children). Children who sustained early TBI scored significantly lower than children in the comparison group on intelligence tests and in the reading, mathematical, and language domains of achievement tests. Forty-eight percent of the TBI group had IQs below the 10th percentile. During the approximately 5-year follow-up period, longitudinal IQ testing revealed continuing deficits and no recovery of function. Both IQ and academic achievement test scores were significantly related to the number of intracranial lesions and the lowest postresuscitation Glasgow Coma Scale score but not to age at the time of injury. Nearly 50% of the TBI group failed a school grade and/or required placement in self-contained special education classrooms; the odds of unfavorable academic performance were 18 times higher for the TBI group than the comparison group. Traumatic brain injury sustained early in life has significant and persistent consequences for the development of intellectual and academic functions and deleterious effects on academic performance.

  3. A review of the number and severity of injuries sustained following a single motocross event.

    Science.gov (United States)

    Dick, Charles G; White, Simon; Bopf, Daniel

    2014-03-01

    Competitive and recreational motocross is an increasingly popular sport in Australia and worldwide. Children as young as 4-year-old can participate in this activity. It is recognised that this is a high risk sport despite the use of protective equipment and developments in course design. Injuries sustained range from minor contusions and fractures to severe life threatening spine and head injuries in adults and the paediatric population. In addition organised events can generate a surge of trauma that can burden small local hospitals, resulting in an unpredicted increase in the workload with subsequent delays to treatment. We present the trauma workload generated in a district hospital following a single motocross event. All patients attending a district hospital emergency department with injuries sustained during a single motocross event were identified through hospital and ambulance records. The nature of their injuries and the treatment required, the length of hospital stay and operative theatre time generated by their injuries were obtained from hospital and theatre records. 14 patients attended the emergency department over a 24-hour period, requiring 5 ambulances from the scene. 7 patients required hospital admission with 7 operations performed, consuming 12.2 h of operating theatre time and 21 days of hospital beds. 2 patients sustained head injuries requiring observation, one of which was transferred to a spinal unit for management of their spinal injuries. Motocross is a popular sport and at times has unacceptable risks of injury in organised competitions, especially with regards to paediatric injuries. Better course design, restrictions on participant age and limitations in vehicle speeds may help reduce the number of severe injuries. These events can also generate a sudden trauma burden to local hospital facilities with knock on effects on waiting times for theatre and potentially compromising not only treatment of the injured participants but also

  4. Recruitment of intracavernously injected adipose-derived stem cells to the major pelvic ganglion improves erectile function in a rat model of cavernous nerve injury.

    Science.gov (United States)

    Fandel, Thomas M; Albersen, Maarten; Lin, Guiting; Qiu, Xuefeng; Ning, Hongxiu; Banie, Lia; Lue, Tom F; Lin, Ching-Shwun

    2012-01-01

    Intracavernous (IC) injection of stem cells has been shown to ameliorate cavernous-nerve (CN) injury-induced erectile dysfunction (ED). However, the mechanisms of action of adipose-derived stem cells (ADSC) remain unclear. To investigate the mechanism of action and fate of IC injected ADSC in a rat model of CN crush injury. Sprague-Dawley rats (n=110) were randomly divided into five groups. Thirty-five rats underwent sham surgery and IC injection of ADSC (n=25) or vehicle (n=10). Another 75 rats underwent bilateral CN crush injury and were treated with vehicle or ADSC injected either IC or in the dorsal penile perineural space. At 1, 3, 7 (n=5), and 28 d (n=10) postsurgery, penile tissues and major pelvic ganglia (MPG) were harvested for histology. ADSC were labeled with 5-ethynyl-2-deoxyuridine (EdU) before treatment. Rats in the 28-d groups were examined for erectile function prior to tissue harvest. IC pressure recording on CN electrostimulation, immunohistochemistry of the penis and the MPG, and number of EdU-positive (EdU+) cells in the injection site and the MPG. IC, but not perineural, injection of ADSC resulted in significantly improved erectile function. Significantly more EdU+ ADSC appeared in the MPG of animals with CN injury and IC injection of ADSC compared with those injected perineurally and those in the sham group. One day after crush injury, stromal cell-derived factor-1 (SDF-1) was upregulated in the MPG, providing an incentive for ADSC recruitment toward the MPG. Neuroregeneration was observed in the group that underwent IC injection of ADSC, and IC ADSC treatment had beneficial effects on the smooth muscle/collagen ratio in the corpus cavernosum. CN injury upregulates SDF-1 expression in the MPG and thereby attracts intracavernously injected ADSC. At the MPG, ADSC exert neuroregenerative effects on the cell bodies of injured nerves, resulting in enhanced erectile response. Copyright © 2011 European Association of Urology. Published by Elsevier

  5. Recruitment of Intracavernously Injected Adipose-Derived Stem Cells to the Major Pelvic Ganglion Improves Erectile Function in a Rat Model of Cavernous Nerve Injury

    Science.gov (United States)

    Fandel, Thomas M.; Albersen, Maarten; Lin, Guiting; Qiu, Xuefeng; Ning, Hongxiu; Banie, Lia; Lue, Tom F.; Lin, Ching-Shwun

    2011-01-01

    Background Intracavernous (IC) injection of stem cells has been shown to ameliorate cavernous-nerve (CN) injury-induced erectile dysfunction (ED). However, the mechanisms of action of adipose-derived stem cells (ADSC) remain unclear. Objectives To investigate the mechanism of action and fate of IC injected ADSC in a rat model of CN crush injury. Design, setting, and participants Sprague-Dawley rats (n = 110) were randomly divided into five groups. Thirty-five rats underwent sham surgery and IC injection of ADSC (n = 25) or vehicle (n = 10). Another 75 rats underwent bilateral CN crush injury and were treated with vehicle or ADSC injected either IC or in the dorsal penile perineural space. At 1, 3, 7 (n = 5), and 28 d (n = 10) postsurgery, penile tissues and major pelvic ganglia (MPG) were harvested for histology. ADSC were labeled with 5-ethynyl-2-deoxyuridine (EdU) before treatment. Rats in the 28-d groups were examined for erectile function prior to tissue harvest. Measurements IC pressure recording on CN electrostimulation, immunohistochemistry of the penis and the MPG, and number of EdU-positive (EdU+) cells in the injection site and the MPG. Results and limitations IC, but not perineural, injection of ADSC resulted in significantly improved erectile function. Significantly more EdU+ ADSC appeared in the MPG of animals with CN injury and IC injection of ADSC compared with those injected perineurally and those in the sham group. One day after crush injury, stromal cell-derived factor-1 (SDF-1) was upregulated in the MPG, providing an incentive for ADSC recruitment toward the MPG. Neuroregeneration was observed in the group that underwent IC injection of ADSC, and IC ADSC treatment had beneficial effects on the smooth muscle/collagen ratio in the corpus cavernosum. Conclusions CN injury upregulates SDF-1 expression in the MPG and thereby attracts intracavernously injected ADSC. At the MPG, ADSC exert neuroregenerative effects on the cell bodies of injured nerves

  6. Urethral Injuries

    Science.gov (United States)

    ... include pelvic fractures and straddle injuries to the perineum. The perineum is the area between the anus and the ... tissues of the penis, scrotum, abdominal wall, or perineum. Complications that can result from urethral injuries include ...

  7. Evaluation of intrapleural contrast-enhanced abdominal pelvic CT-scan in detecting diaphragm injury in stable patients with thoraco-abdominal stab wound: a preliminary study.

    Science.gov (United States)

    Abbasy, Hamid Reza; Panahi, Farzad; Sefidbakht, Sepideh; Akrami, Majid; Paydar, Shahram; Mirhashemi, Sedighe; Bolandparvaz, Shahram; Asaadi, Kambiz; Salahi, Roohollah

    2012-09-01

    Many of the patients with thoraco-abdominal stab wound remain asymptomatic; in this regard, previous studies reported that 7-48% of asymptomatic patients had diaphragm injury (DI). Thoracoscopy or multidetector computed tomography (MDCT) scan is the best method to detect DI. We aimed to evaluate the role of CT scan with intrapleural contrast to rule out DI in stable thoraco-abdominal stab wounds. In a prospective study, we evaluated all haemodynamically stable patients with thoraco-abdominal stab wound, from October 2009 to 2010. Exclusion criteria included patients who needed emergency thoracotomy or laparotomy, those who were haemodynamically unstable and those with blunt trauma or gunshot injury. In the CT-scan department, 500 cc of diluted meglumine diatrozate was transfused into the pleural space via a chest tube and the CT scan was performed from the dome of the diaphragm to the pelvic cavity. In the second step, all patients were taken for thoracoscopy within 24h after admission. The CT-scan slide was considered positive if one of the following signs was found: (1) the diaphragm was obviously injured as seen in CT-scan slides and (2) contrast agent was seen in the peritoneal cavity. Sensitivity and specificity were calculated for CT scan and thoracoscopy. Four out of 40 patients had DI according to thoracoscopy. CT scan with intrapleural contrast predicted diaphragmatic injury correctly in all four patients. Considering thoracoscopy as the gold-standard method, the CT scan had two false-positive cases. The sensitivity of the intrapleural-contrast CT scan was 100% and its specificity was 94.4%. Our study showed that CT scan with intrapleural contrast can be an acceptable approach to rule out DI and limit the use of thoracoscopy for final diagnosis and repair of DI in cases with suspicious or positive CT-scan results, especially in trauma centres with high load of trauma patients and little accessible equipment. Copyright © 2011 Elsevier Ltd. All rights

  8. Effect of Early Pelvic Binder Use in the Emergency Management of Suspected Pelvic Trauma: A Retrospective Cohort Study.

    Science.gov (United States)

    Hsu, Sheng-Der; Chen, Cheng-Jueng; Chou, Yu-Ching; Wang, Sheng-Hao; Chan, De-Chuan

    2017-10-12

    We aimed to evaluate the effect of early pelvic binder use in the emergency management of suspected pelvic trauma, compared with the conventional stepwise approach. We enrolled trauma patients with initial stabilization using a pelvic binder when suspecting pelvic injury. The inclusion criteria were traumatic injury requiring a trauma team and at least one of the following: a loss of consciousness or a Glasgow coma score (GCS) of binder had shorter hospital and intensive care unit (ICU) stays. The study group achieved statistically significantly improved survival and lower mean blood transfusion volume and mortality rate, although they were more severe in the trauma score. We recommend prompt pelvic binder use for suspected pelvic injury before definitive imaging is available, as a cervical spine collar is used to protect the cervical spine from further injury prior to definitive identification and characterization of an injury.

  9. A prospective study of injuries sustained during competitive Muay Thai kickboxing.

    Science.gov (United States)

    Gartland, Sam; Malik, Mohammad Hammad; Lovell, Martyn

    2005-01-01

    To investigate prospectively the type and rate of injuries sustained during amateur Muay Thai competition. Prospective cohort study collection of data following clinical examination. Amateur Muay Thai competitions in the United Kingdom organized by the International Amateur Muay Thai Federation. Amateur Muay Thai boxers. Both sexes. Lightweight to super heavyweight. There were 92 participants, 12 females and 82 males. The average age was 17.3 years, and the average previous number of bouts was 3.9. A total of 588.5 minutes of competition time was assessed during a total of 10 events. Injury rates were 1.3 injuries per 100 minutes of competition in the lightweight category, 2.25 per 100 minutes of competition in the middleweight category, 30 per 100 minutes of competition in the heavyweight category, and 2.54 per 100 minutes of competition in the super heavyweight category. Compared with other reported martial arts, the injury rates are higher in Muay Thai. The head was shown to be the most common site of injury in amateur fighters, but there was an almost complete absence of lower limb injuries, which again is at variance with reported figures for other martial arts.

  10. Should money follow the patient: Financial implication for being the National Centre for the Treatment and Management of Pelvic and Acetabular Fractures in Ireland.

    LENUS (Irish Health Repository)

    Kelly, M E

    2013-03-13

    BACKGROUND: Pelvic and acetabular fractures are complex injuries requiring specialist treatment. Our institution is the National Centre for Treatment and Management of these injuries. AIM: To audit all referrals to our institution over a 6-month period and calculate the cost incurred by being the national referral centre. METHODS: Retrospective review of database, and subsequent allocation of Casemix points to assess total cost of treatment for each patient referred to our institution. RESULTS: 103 patients referred with pelvic or acetabular fracture for operative management. The furthest referral distance was 181miles. Over-all, the length of stay was 15.4 days. The average inclusive cost for a referral to our unit for operative management was €16,302. CONCLUSION: Pelvic and acetabular fractures are complex injuries that require specialist referral unit management. However for these units to remain sustainable money needs to "follow the patient".

  11. Pelvic lipomatosis

    Energy Technology Data Exchange (ETDEWEB)

    Rizatto, G.; Basadonna, P.; Del Zotto, A.; Lombardo, V.L.; Petz, G.

    1982-11-01

    The authors report the ultrasonographic findings in a case of pelvic lipomatosis presenting with pathognomonic radiographic features. Ultrasound alone may exclude other lesions but cannot make a specific diagnosis because the sonographic appearance of fat is often conflicting. Ultrasonography should be of value as a follow-up examination in patients with definite risk of progressive ureteral obstruction.

  12. Pelvic fractures: classification and nursing management.

    Science.gov (United States)

    Walker, Jennie

    Fractures to the pelvis can occur as a result of low-energy or high-energy trauma. Pelvic fractures may be associated with significant internal bleeding and injury to the organs within the pelvis. Patients with pelvic fractures often have complex healthcare needs; fractures resulting from high-energy trauma may be associated with multiple injuries, whereas fractures resulting from low-energy trauma, such as falls, may be associated with multiple patient comorbidities. Nurses have a fundamental role in the assessment and observation of the patient following pelvic fracture and are crucial in identifying any changes or deterioration in the patient's condition that require prompt intervention. This article focuses on the relevant anatomy of the pelvis, epidemiology and classification of pelvic fractures, and outlines the management and complications of pelvic fractures.

  13. Sustained delivery of nicotinamide limits cortical injury and improves functional recovery following traumatic brain injury.

    Science.gov (United States)

    Goffus, Andrea M; Anderson, Gail D; Hoane, Michael

    2010-01-01

    Previously, we have demonstrated that nicotinamide (NAM), a neuroprotective soluble B-group vitamin, improves recovery of function following traumatic brain injury (TBI). However, no prior studies have examined whether NAM is beneficial following continuous infusions over 7 days post-TBI. The purpose of this study was to investigate the preclinical efficacy of NAM treatment as it might be delivered clinically; over several days by slow infusion. Rats were prepared with either unilateral controlled cortical impact (CCI) injuries or sham procedures and divided into three groups: CCI-NAM, CCI-vehicle, and sham. Thirty minutes following CCI, Alzet osmotic mini-pumps were implanted subcutaneously. NAM was delivered at a rate of 50 mg/kg/day for 7 days immediately post-CCI. On day 7 following injury, the pumps were removed and blood draws were collected for serum NAM and nicotinamide adenine dinucleotide (NAD+) analyses. Starting on day 2 post-CCI, animals were tested on a battery of sensorimotor tests (bilateral tactile adhesive removal, locomotor placing, and limb-use asymmetry). Continuous infusion of NAM resulted in a significant serum elevation in NAM, but not NAD+. Statistical analyses of the tactile removal and locomotor placing data revealed that continuous administration of NAM significantly reduced the initial magnitude of the injury deficit and improved overall recovery compared to the vehicle-treated animals. NAM treatment also significantly decreased limb-use asymmetries compared to vehicle-treated animals. The overall extent of the cortical damage was also reduced by NAM treatment. No detrimental effects were seen following continuous infusion. The present results suggest that NAM delivered via a clinically relevant therapeutic regimen may truncate behavioral damage following TBI. Thus our results offer strong support for translation into the clinical population.

  14. Sustained delivery of nicotinamide limits cortical injury and improves functional recovery following traumatic brain injury

    OpenAIRE

    Goffus, Andrea M.; Anderson, Gail D; Hoane, Michael R.

    2010-01-01

    Previously, we have demonstrated that nicotinamide (NAM), a neuroprotective soluble B-group vitamin, improves recovery of function following traumatic brain injury (TBI). However, no prior studies have examined whether NAM is beneficial following continuous infusions over 7 days post-TBI. The purpose of this study was to investigate the preclinical efficacy of NAM treatment as it might be delivered clinically; over several days by slow infusion. Rats were prepared with either unilateral contr...

  15. Sustained Delivery of Nicotinamide Limits Cortical Injury and Improves Functional Recovery Following Traumatic Brain Injury

    OpenAIRE

    Goffus, Andrea M.; Anderson, Gail D; Hoane, Michael R.

    2010-01-01

    Previously, we have demonstrated that nicotinamide (NAM), a neuroprotective soluble B-group vitamin, improves recovery of function following traumatic brain injury (TBI). However, no prior studies have examined whether NAM is beneficial following continuous infusions over 7 days post-TBI. The purpose of this study was to investigate the preclinical efficacy of NAM treatment as it might be delivered clinically; over several days by slow infusion. Rats were prepared with either unilateral contr...

  16. Sustained Delivery of Nicotinamide Limits Cortical Injury and Improves Functional Recovery Following Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    Andrea M. Goffus

    2010-01-01

    Full Text Available Previously, we have demonstrated that nicotinamide (NAM, a neuroprotective soluble B-group vitamin, improves recovery of function following traumatic brain injury (TBI. However, no prior studies have examined whether NAM is beneficial following continuous infusions over 7 days post-TBI. The purpose of this study was to investigate the preclinical efficacy of NAM treatment as it might be delivered clinically; over several days by slow infusion. Rats were prepared with either unilateral controlled cortical impact (CCI injuries or sham procedures and divided into three groups: CCI-NAM, CCI-vehicle and sham. Thirty minutes following CCI, Alzet osmotic mini-pumps were implanted subcutaneously. NAM was delivered at a rate of 50 mg/kg/day for 7 days immediately post-CCI. On day 7 following injury, the pumps were removed and blood draws were collected for serum NAM and nicotinamide adenine dinucleotide (NAD+ analyses. Starting on day 2 post-CCI, animals were tested on a battery of sensorimotor tests (bilateral tactile adhesive removal, locomotor placing and limb-use asymmetry. Continuous infusion of NAM resulted in a significant serum elevation in NAM, but not NAD+. Statistical analyses of the tactile removal and locomotor placing data revealed that continuous administration of NAM significantly reduced the initial magnitude of the injury deficit and improved overall recovery compared to the vehicle-treated animals. NAM treatment also significantly decreased limb-use asymmetries compared to vehicle-treated animals. The overall extent of the cortical damage was also reduced by NAM treatment. No detrimental effects were seen following continuous infusion. The present results suggest that NAM delivered via a clinically relevant therapeutic regimen may truncate behavioral damage following TBI. Thus our results offer strong support for translation into the clinical population.

  17. Safety and effectiveness of pharmacotherapy for depression in adults who have sustained a traumatic brain injury: a systematic review protocol.

    Science.gov (United States)

    Clay, Fiona J; Perry, Luke A; Hicks, Amelia J; Batty, Rachel; Tufanaru, Catalin; Jayaram, Mahesh; Ponsford, Jennie; Hopwood, Malcolm

    2017-09-01

    The objective of this systematic review is to synthesize the current evidence on the effectiveness and harms of pharmacotherapy in the management of depression in adults who have sustained a traumatic brain injury.

  18. Zones of Hemorrhage: Defining Vascular Injury in Military Patients with Complex Pelvic Fractures a Consensus Panel Review

    Science.gov (United States)

    2013-03-01

    Dover, DE where a complete forensic examination is performed. The AFME database was queried for service members who were either killed in action or...documentation to include autopsy reports and electronic imaging (CT scans and radiographs). These data were abstracted to create the STReC pelvis database.13...The STReC pelvis database was then reviewed for associated vascular injury or amputation. In addition to autopsy reports and imaging studies

  19. A systematic process to prioritize prevention activities sustaining progress toward the reduction of military injuries.

    Science.gov (United States)

    Canham-Chervak, Michelle; Hooper, Tomoko I; Brennan, Fred H; Craig, Stephen C; Girasek, Deborah C; Schaefer, Richard A; Barbour, Galen; Yew, Kenneth S; Jones, Bruce H

    2010-01-01

    To sustain progress toward injury reduction and other health promotion goals, public health organizations need a systematic approach based on data and an evaluation of existing scientific evidence on prevention. This paper describes a process and criteria developed to systematically and objectively define prevention program and policy priorities. Military medical surveillance data were obtained and summarized, and a working group of epidemiology and injury experts was formed. After reviewing the available data, the working group used predefined criteria to score leading military unintentional injury causes on five main criteria that assessed factors contributing to program and policy success: (1) importance of the problem, (2) effectiveness of existing prevention strategies, (3) feasibility of establishing programs and policies, (4) timeliness of implementation and results, and (5) potential for evaluation. Injury problems were ranked by total median score. Causes with the highest total median scores were physical training (34 points), military parachuting (32 points), privately-owned vehicle crashes (31 points), sports (29 points), falls (27 points), and military vehicle crashes (27 points). Using a data-driven, criteria-based process, three injury causes (physical training, military parachuting, and privately owned-vehicle crashes) with the greatest potential for successful program and policy implementation were identified. Such information is useful for public health practitioners and policymakers who must prioritize among health problems that are competing for limited resources. The process and criteria could be adapted to systematically assess and prioritize health issues affecting other communities. Published by Elsevier Inc.

  20. Sustained release of estrogens from PEGylated nanoparticles for treatment of secondary spinal cord injury

    Science.gov (United States)

    Barry, John

    Spinal Cord Injury (SCI) is a debilitating condition which causes neurological damage and can result in paralysis. SCI results in immediate mechanical damage to the spinal cord, but secondary injuries due to inflammation, oxidative damage, and activated biochemical pathways leading to apoptosis exacerbate the injury. The only currently available treatment, methylprednisolone, is controversial because there is no convincing data to support its therapeutic efficacy for SCI treatment. In the absence of an effective SCI treatment option, 17beta-estradiol has gained significant attention for its anti-oxidant, anti-inflammatory, and anti-apoptotic abilities, all events associated with secondary. Sadly, 17beta-estradiol is associated with systemic adverse effects preclude the use of free estrogen even for local administration due to short drug half-life in the body. Biodegradable nanoparticles can be used to increase half-life after local administration and to bestow sustained release. Sustained release using PEGylated biodegradable polymeric nanoparticles constructed from poly(lactic-co-glycolic acid) (PLGA) will endow a consistent, low, but effective dose to be delivered locally. This will limit systemic effects due to local administration and low dose, sustained release. PLGA was chosen because it has been used extensively for sustained release, and has a record of safety in humans. Here, we show the in vitro efficacy of PEGylated nanoparticles loaded with 17beta-estradiol for treatment of secondary SCI. We achieved a high loading efficiency and controlled release from the particles over a several day therapeutic window. The particles also show neuroprotection in two in vitro cell culture models. Both the dose and pretreatment time with nanoparticles was evaluated in an effort to translate the treatment into an animal model for further study.

  1. Lumbo-Pelvic-Hip Complex Pain in a Competitive Basketball Player

    Science.gov (United States)

    Reiman, Michael P.; Cox, Kara D.; Jones, Kay S.; Byrd, J. W.

    2011-01-01

    Establishing the cause of lumbo-pelvic-hip complex pain is a challenge for many clinicians. This case report describes the mechanism of injury, diagnostic process, surgical management, and rehabilitation of a female high school basketball athlete who sustained an injury when falling on her right side. Diagnostics included clinical examination, radiography of the spine and hip joint, magnetic resonance imaging arthrogram, 3-dimensional computed tomography scan, and computed tomography of the hip joint. A systematic multidisciplinary clinical approach resulted in the patient’s return to previous functional levels. PMID:23015993

  2. Performance of primary repair on colon injuries sustained from low-versus high-energy projectiles

    Science.gov (United States)

    Lazovic, Ranko; Radojevic, Nemanja; Curovic, Ivana

    2017-01-01

    Among various reasons, colon injuries may be caused by low- or high-energy firearm bullets, with the latter producing a temporary cavitation phenomenon. The available treatment options include primary repair and two-stage management, but recent studies have shown that primary repair can be widely used with a high success rate. This paper investigates the differences in performance of primary repair on these two types of colon injuries. Two groups of patients who sustained colon injuries due to single gunshot wounds, were retrospectively categorized based on the type of bullet. Primary colon repair was performed in all patients selected based on the inclusion and exclusion criteria (Stone and Fabian's criteria). An almost absolute homogeneity was attained among the groups in terms of age, latent time before surgery, and four trauma indexes. Only one patient from the low-energy firearm projectile group (4%) developed a postsurgical complication versus nine patients (25.8%) from the high-energy group, showing statistically significant difference (p = 0.03). These nine patients experienced the following postsurgical complications: pneumonia, abscess, fistula, suture leakage, and one multiorgan failure with sepsis. Previous studies concluded that one-stage primary repair is the best treatment option for colon injuries. However, terminal ballistics testing determined the projectile's path through the body and revealed that low-energy projectiles caused considerably lesser damage than their high-energy counterparts. Primary colon repair must be performed definitely for low-energy short firearm injuries but very carefully for high-energy injuries. Given these findings, we suggest that the treatment option should be determined based not only on the bullet type alone but also on other clinical findings. PMID:26874437

  3. Military personnel sustaining Lisfranc injuries have high rates of disability separation.

    Science.gov (United States)

    Balazs, George C; Hanley, M G; Pavey, G J; Rue, J-Ph

    2017-06-01

    Lisfranc injuries are relatively uncommon midfoot injuries disproportionately affecting young, active males. Previous studies in civilian populations have reported relatively good results with operative treatment. However, treatment results have not been specifically examined in military personnel, who may have higher physical demands than the general population. The purpose of this study was to examine rates of return to military duty following surgical treatment of isolated Lisfranc injuries. Surgical records and radiographic images from all active duty US military personnel treated for an isolated Lisfranc injury between January 2005 and July 2014 were examined. Demographic information, injury data, surgical details and subsequent return to duty information were recorded. The primary outcome was ability to return to unrestricted military duty following treatment. The secondary outcome was secondary conversion to a midfoot arthrodesis following initial open reduction internal fixation. Twenty-one patients meeting inclusion criteria were identified. Median patient age was 23 years, and mean follow-up was 43 months. Within this cohort, 14 patients were able to return to military service, while seven required a disability separation from the armed forces. Of the 18 patients who underwent initial fixation, eight were subsequently revised to midfoot arthrodesis for persistent pain. Military personnel sustaining Lisfranc injuries have high rates of persistent pain and disability, even after optimal initial surgical treatment. Military surgeons should counsel patients on the career-threatening nature of this condition and high rates of secondary procedures. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  4. [The application of ultrasonography to estimate blood vessel injury of upper limbs sustaining electric burns].

    Science.gov (United States)

    Chai, Jia-ke; Li, Li-gen; Chen, Yue-xiu; Hu, Xiao-juan; Yang, Yong-ming

    2003-12-01

    To explore a new method in estimating extent and degree of arterial injury in upper limbs sustaining high tension electric burns. Eighteen patients (twenty-four upper limbs) with high tension electricity injury were admitted from December 1998 to September 2002, The damaged limbs consisted of four parts: wrist wound part, 5 cm, 10 cm, 15 cm parts around wrist wound, where the radial and ulnar arteries were detected using B ultrasound and color WP Doppler examination. The changes of endangium, vessel diameter, thickness of the vessel wall and volume of blood flow were recorded respectively. The parameters of normal radial and ulnar arteries were also determined as normal control. B ultrasound and color WP Doppler examination showed that the endangium in radial and ulnar arteries become coarse, edema or exfoliation. The vessel wall was thicker than that of the normal control and the thickness was heterogeneity. The vessel wall could be necrosis in severe patient and the vessel cavity was stricture or beaded. Thrombosis or occlusion could occur at the site of severe injury area in vessel. The decrease in volume of blood flow was observed. The condition of the radial and ulnar arteries become well apart from 10 - 15 cm of wrist wound. The ultrasonography can be used to detect the changes in endangium, diameter, thickness of the vessel wall, blood flow volume in injury blood vessel caused by electric burn injury. It is helpful in judging the degree and extent of injury vessel and could be a safe, non-invasive diagnostic method and is worth popularizing.

  5. PELVIC ORGAN PROLAPES

    OpenAIRE

    Ketut Yoga Mira Pratiwi; I Gede Mega Putra

    2013-01-01

    Pelvic organ prolapse (POP) is defined as a decrease in abnormal or herniation of the pelvic organs out of place attached to its normal position or in the pelvic cavity. As for the anatomy of the pelvic organs consists of bones, muscles, and nerves. The presence of damage to the pelvic connective tissue and visceral attachment pelvic organs the cause occurs. The symptoms that appear in patients POP not specific to distinguish prolapse of some compartments but can reflect the degree of prolaps...

  6. Individuals sustaining snowboarding and skiing accidents have different maxillofacial injury profiles.

    Science.gov (United States)

    John, Mike T

    2010-12-01

    Facial trauma: how dangerous are skiing and snowboarding?. Tuli T, Haechl O, Berger N, Laimer K, Jank S, Kloss F, Brandstätter A, Gassner R. J Oral Maxillofac Surg 2010;68(2):293-9. REVIEWER NAME: Mike T. John, DDS, MPH, PhD. To compare the prevalence of maxillofacial injury types in individuals who sustained snowboarding and skiing accidents. Information not available. Retrospective case series. Level 2: Limited-quality, patient-oriented evidence. Not applicable. Copyright © 2010 Elsevier Inc. All rights reserved.

  7. Are routine pelvic radiographs in major pediatric blunt trauma necessary?

    Energy Technology Data Exchange (ETDEWEB)

    Lagisetty, Jyothi [Memorial Hermann Medical Center, Emergency Medicine Department, Houston, TX (United States); Slovis, Thomas [Wayne State University School of Medicine, Department of Radiology, Pediatric Imaging, Children' s Hospital of Michigan, Detroit, MI (United States); Thomas, Ronald [Children' s Hospital of Michigan, Wayne State University of Medicine, Department of Pediatrics, Detroit, MI (United States); Knazik, Stephen; Stankovic, Curt [Wayne State University of Medicine, Division of Emergency Medicine, Children' s Hospital of Michigan, Detroit, MI (United States)

    2012-07-15

    Screening pelvic radiographs to rule out pelvic fractures are routinely used for the initial evaluation of pediatric blunt trauma. Recently, the utility of routine pelvic radiographs in certain subsets of patients with blunt trauma has been questioned. There is a growing amount of evidence that shows the clinical exam is reliable enough to obviate the need for routine screening pelvic radiographs in children. To identify variables that help predict the presence or absence of pelvic fractures in pediatric blunt trauma. We conducted a retrospective study from January 2005 to January 2010 using the trauma registry at a level 1 pediatric trauma center. We analyzed all level 1 and level 2 trauma victims, evaluating history, exam and mechanism of injury for association with the presence or absence of a pelvic fracture. Of 553 level 1 and 2 trauma patients who presented during the study period, 504 were included in the study. Most of these children, 486/504 (96.4%), showed no evidence of a pelvic fracture while 18/504 (3.6%) had a pelvic fracture. No factors were found to be predictive of a pelvic fracture. However, we developed a pelvic fracture screening tool that accurately rules out the presence of a pelvic fracture P = 0.008, NPV 99, sensitivity 96, 8.98 (1.52-52.8). This screening tool combines eight high-risk clinical findings (pelvic tenderness, laceration, ecchymosis, abrasion, GCS <14, positive urinalysis, abdominal pain/tenderness, femur fracture) and five high-risk mechanisms of injury (unrestrained motor vehicle collision [MVC], MVC with ejection, MVC rollover, auto vs. pedestrian, auto vs. bicycle). Pelvic fractures in pediatric major blunt trauma can reliably be ruled out by using our pelvic trauma screening tool. Although no findings accurately identified the presence of a pelvic fracture, the screening tool accurately identified the absence of a fracture, suggesting that pelvic radiographs are not warranted in this subset of patients. (orig.)

  8. High-energy pediatric pelvic and acetabular fractures.

    Science.gov (United States)

    Amorosa, Louis F; Kloen, Peter; Helfet, David L

    2014-10-01

    Pediatric pelvic and acetabular fractures are rare injuries. They are almost always the result of a high-energy injury mechanism. A full trauma protocol should be instituted, having a high index of suspicion for associated life-threatening injuries. In the past, it was recommended that almost all of these injuries be treated nonoperatively. However, pelvic and acetabular fractures do not all remodel well. Prospective studies are needed to establish optimal treatment guidelines. Until then, in the presence of instability or significant displacement, operative fixation by a pelvic and acetabular fracture specialist should be considered to allow the best possible outcome. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. [Pregnancy, delivery and pelvic floor disorders].

    Science.gov (United States)

    Aukee, Pauliina; Tihtonen, Kati

    2010-01-01

    Pregnancy and vaginal delivery affect pelvic floor by increased intra-abdominal pressure, direct muscle trauma, nerve injury and connective tissue damage. Even if pelvic floor dysfunction is more common after vaginal delivery compared to cesarean section, the differences are less clear after long-term follow up. This implies that other factors such as age, estrogen levels, genetic factors and overweight have also a role in the pathophysiology of pelvic floor dysfunctions. It is possible to prevent some of the birth injuries by careful obstetric management. Pelvic floor muscle training during pregnancy or after delivery may reduce the incidence of fecal and urinary incontinence after delivery, but data about long-term effects is scarce.

  10. Survival trends and predictors of mortality in severe pelvic trauma

    DEFF Research Database (Denmark)

    Pohlemann, Tim; Stengel, Dirk; Tosounidis, Georgios

    2011-01-01

    STUDY OBJECTIVE: To determine longitudinal trends in mortality, and the contribution of specific injury characteristics and treatment modalities to the risk of a fatal outcome after severe and complex pelvic trauma. METHODS: We studied 5048 patients with pelvic ring fractures enrolled in the German...... Pelvic Trauma Registry Initiative between 1991 and 1993, 1998 and 2000, and 2004 and 2006. Complete datasets were available for 5014 cases, including 508 complex injuries, defined as unstable fractures with severe peri-pelvic soft tissue and organ laceration. Multivariable mixed-effects logistic...... with this type of injury was 18% (95% CI 9-32%) in 2006. CONCLUSION: In contrast to an overall decline in trauma mortality, complex pelvic ring injuries remain associated with a significant risk of death. Awareness of this potentially life-threatening condition should be increased amongst trauma care...

  11. Comparison of the incidence, nature and cause of injuries sustained on grass and new generation artificial turf by male and female football players. Part 2: training injuries.

    Science.gov (United States)

    Fuller, Colin W; Dick, Randall W; Corlette, Jill; Schmalz, Rosemary

    2007-08-01

    To compare the incidence, nature, severity and cause of training injuries sustained on new generation artificial turf and grass by male and female footballers. The National Collegiate Athletic Association Injury Surveillance System was used for a two-season (August to December) prospective study involving American college and university football teams (2005 season: men 52 teams, women 64 teams; 2006 season: men 54 teams, women 72 teams). Injury definitions and recording procedures were compliant with the international consensus statement for epidemiological studies of injuries in football. Athletic trainers recorded details of the playing surface and the location, diagnosis, severity and cause of all training injuries. The number of days lost from training and match play was used to define the severity of an injury. Training exposures (player hours) were recorded on a team basis. The overall incidence of training injuries for men was 3.34 injuries/1000 player hours on artificial turf and 3.01 on grass (incidence ratio 1.11; p = 0.21) and for women it was 2.60 injuries/1000 player hours on artificial turf and 2.79 on grass (incidence ratio 0.93; p = 0.46). For men, the mean severity of injuries that were not season ending injuries was 9.4 days (median 5) on artificial turf and 7.8 days (median 4) on grass and, for women, 10.5 days (median 4) on artificial turf and 10.0 days (median 5) on grass. Joint (non-bone)/ligament/cartilage and muscle/tendon injuries to the lower limbs were the most common general categories of injury on artificial turf and grass for both male and female players. Most training injuries were acute (men: artificial turf 2.92, grass 2.63, p = 0.24; women: artificial turf 1.94, grass 2.23, p = 0.21) and resulted from player-to-player contact (men: artificial turf 1.08, grass 0.85, p = 0.10; women: artificial turf 0.47, grass 0.56; p = 0.45). There were no major differences between the incidence, severity, nature or cause of training injuries

  12. [Recommendations for Releasing the Pelvic Binder After a Non-Invasive Pelvic Stabilisation Procedure Under Emergency Room Conditions].

    Science.gov (United States)

    Schweigkofler, U; Wohlrath, B; Paffrath, T; Flohé, S; Wincheringer, D; Hoffmann, R; Trentzsch, H

    2016-10-01

    Severe brain, thoracic and intrapelvic injuries, as well as heavy bleeding, are the main causes of death in patients with major trauma. Unstable pelvic ring fractures can cause this bleeding and the so-called "C problem". This is usually due to haemorrhagic shock caused by the loss of large volumes of blood from the presacral venous plexus, iliac vessels and the fracture surfaces. Many clinical studies have shown that, in the preclinical setting, unstable pelvic ring injuries are often underestimated. The application of a non-invasive external pelvic ring stabilisation (pelvic binder) is therefore recommended if a pelvic fracture is possible. Several circumferential pelvic binders have been developed and their prehospital use is increasing. Clinical and biomechanical studies have demonstrated that there is a favourable haemodynamic effect in unstable fractures, due to rapid closure of the pelvic ring. It is unclear whether the pelvic binder can be safely removed in a presumably haemodynamically stable patient. A correctly placed pelvic binder leads to anatomical closure of the pelvic ring. Therefore unstable pelvic ring fractures may be clinically and radiologically overlooked. This is a particular problem in unconscious patients. Furthermore, the real severity of the injury may then be underestimated in the diagnostic evaluation. Unconsidered opening of the pelvic binder can thus provoke renewed deterioration of the circulatory situation, especially if the injury was adequately treated by the binder and the C problem was controlled. The aim of this article is to describe procedures for handling pelvic binders, particularly as to how to deal with an already applied pelvic binder and how to "clear the pelvic region" while reducing the risk of haemodynamic instability. A detailed analysis of the literature and a Delphi-like discussion among several experts were performed. The following points were raised: 1) Assessment of the clinical situation, including trauma

  13. Multimodal nociceptive mechanisms underlying chronic pelvic pain.

    Science.gov (United States)

    Hellman, Kevin M; Patanwala, Insiyyah Y; Pozolo, Kristen E; Tu, Frank F

    2015-12-01

    We sought to evaluate candidate mechanisms underlying the pelvic floor dysfunction in women with chronic pelvic pain (CPP) and/or painful bladder syndrome (PBS)/interstitial cystitis. Notably, prior studies have not consistently controlled for potential confounding by psychological or anatomical factors. As part of a larger study on pelvic floor pain dysfunction and bladder pain sensitivity, we compared a measure of mechanical pain sensitivity, pressure pain thresholds (PPTs), between women with pelvic pain and pain-free controls. We also assessed a novel pain measure using degree and duration of postexam pain aftersensation, and conducted structural and functional assessments of the pelvic floor to account for any potential confounding. Phenotypic specificity of pelvic floor measures was assessed with receiver operator characteristic curves adjusted for prevalence. A total of 23 women with CPP, 23 women with PBS, and 42 pain-free controls completed the study. Women with CPP or PBS exhibited enhanced pain sensitivity with lower PPTs (1.18 [interquartile range, 0.87-1.41] kg/cm(2)) than pain-free participants (1.48 [1.11-1.76] kg/cm(2); P pain aftersensation (3.5 [0-9] vs 0 [0-1] minutes; P pelvic floor anatomy, muscle tone, or strength. The combination of PPTs and aftersensation duration correlated with severity of pelvic floor tenderness (R(2), 41-51; P pain-free controls from women with CPP or PBS (area under the curve, 0.87). Both experimental assessment of pelvic floor pain thresholds and measurement of sustained pain are independently associated with pelvic pain phenotypes. These findings suggest systematic clinical assessment of the time course of provoked pain symptoms, which occurs over seconds for mechanical pain thresholds vs minutes for aftersensation pain, would be helpful in identifying the fundamental mechanisms of pelvic floor pain. Longitudinal studies of therapies differentially targeting these discrete mechanisms are needed to confirm their

  14. Comparison of the incidence, nature and cause of injuries sustained on grass and new generation artificial turf by male and female football players. Part 1: match injuries.

    Science.gov (United States)

    Fuller, Colin W; Dick, Randall W; Corlette, Jill; Schmalz, Rosemary

    2007-08-01

    To compare the incidence, nature, severity and cause of match injuries sustained on grass and new generation artificial turf by male and female footballers. The National Collegiate Athletic Association Injury Surveillance System was used for a two-season (August to December) prospective study of American college and university football teams (2005 season: men 52 teams, women 64 teams; 2006 season: men 54 teams, women 72 teams). Injury definitions and recording procedures were compliant with the international consensus statement for epidemiological studies of injuries in football. Athletic trainers recorded details of the playing surface and the location, diagnosis, severity and cause of all match injuries. The number of days lost from training and match play was used to define the severity of an injury. Match exposures (player hours) were recorded on a team basis. The overall incidence of match injuries for men was 25.43 injuries/1000 player hours on artificial turf and 23.92 on grass (incidence ratio 1.06; p = 0.46) and for women was 19.15 injuries/1000 player hours on artificial turf and 21.79 on grass (incidence ratio = 0.88; p = 0.16). For men, the mean severity of non-season ending injuries was 7.1 days (median 5) on artificial turf and 8.4 days (median 5) on grass and, for women, 11.2 days (median 5) on artificial turf and 8.9 days (median 5) on grass. Joint (non-bone)/ligament/cartilage and contusion injuries to the lower limbs were the most common general categories of match injury on artificial turf and grass for both male and female players. Most injuries were acute (men: artificial turf 24.60, grass 22.91; p = 0.40; women: artificial turf 18.29, grass 20.64; p = 0.21) and resulted from player-to-player contact (men: artificial turf 14.73, grass 13.34; p = 0.37; women: artificial turf 10.72; grass 11.68; p = 0.50). There were no major differences in the incidence, severity, nature or cause of match injuries sustained on new generation artificial turf and

  15. Urinary Neutrophil Gelatinase–Associated Lipocalin (NGAL Distinguishes Sustained From Transient Acute Kidney Injury After General Surgery

    Directory of Open Access Journals (Sweden)

    Valerie Au

    2016-05-01

    Discussion: Urinary NGAL levels measured 2 to 3 hours after surgery were able to distinguish the kinetics of creatinine (sustained AKI vs. transient AKI over the subsequent week. Transient AKI is an easily reversible state that is likely not associated with substantial tubular injury and therefore NGAL release. Using AKIN criteria, both transient and sustained AKI are classified as AKI even though our data demonstrate that they are possibly different entities.

  16. The Influence of Pelvic Ramus Fracture on the Stability of Fixed Pelvic Complex Fracture

    Directory of Open Access Journals (Sweden)

    Jianyin Lei

    2015-01-01

    Full Text Available This study aims to evaluate the biomechanical mechanism of pelvic ring injury for the stability of pelvis using the finite element (FE method. Complex pelvic fracture (i.e., anterior column with posterior hemitransverse lesion combined with pelvic ramus fracture was used to evaluate the biomechanics stability of the pelvis. Three FE fracture models (i.e., Dynamic Anterior Plate-Screw System for Quadrilateral Area (DAPSQ for complex pelvic fracture with intact pubic ramus, DAPSQ for complex pelvic fracture with pubic ramus fracture, and DAPSQ for complex pelvic fracture with fixed pubic ramus fracture were established to explore the biomechanics stability of the pelvis. The pubic ramus fracture leads to an unsymmetrical situation and an unstable situation of the pelvis. The fixed pubic ramus fracture did well in reducing the stress levels of the pelvic bone and fixation system, as well as displacement difference in the pubic symphysis, and it could change the unstable situation back to a certain extent. The pelvic ring integrity was the prerequisite of the pelvic stability and should be in a stable condition when the complex fracture is treated.

  17. Outcome analysis of pelvic ring fractures

    Directory of Open Access Journals (Sweden)

    Sen Ramesh

    2010-01-01

    Full Text Available Background: The behavior of pelvic ring fractures in the long run has been very sparsely studied. The purpose of this study is to assess the long-term outcome of pelvic ring fractures. Materials and Methods: A total of 24 patients with pelvic ring fractures, not involving the acetabulum, were followed up for an average duration of 33 months (range 24-49 months. The clinicoradiological assessment was done using the pelvic scoring system adapted from Cole et al. Parameters assessed included sacroiliac (SI joint involvement and, among SI joint injuries, the presence of a fracture disruption and the degree of displacement. Results: Pain and limp were present in 13 patients (54.2% each and residual working disability in 9 patients (37.5%. The overall Cole′s pelvic score was 31.3 ± 7.02 of a total score of 40. The average pelvic score in patients with SI disruption was 29.2 ± 6.75; much lower than patients without SI disruption with an average score of 34.9 ± 6.25 reaching statistical significance. The pelvic score among patients with a displacement ≤10 mm was 33.0 ± 3.92 and with a displacement> 10 mm 25.88 ± 7.14. The difference was statistically significant. Conclusions: Pelvic ring injuries can lead to long term problems significantly. The involvement of the SI joint affects the long-term outcome adversely, more so if the residual displacement is> 10 mm. The pelvic scoring system is comprehensive and depicts subtle differences in the outcome, which the individual parameters of the assessment fail to show.

  18. Sticks and stones may break my bones: work-related orthopaedic injuries sustained during obstetrics and gynaecology training.

    Science.gov (United States)

    Yoong, W; Sanchez-Crespo, J; Rob, J; Parikh, M; Melendez, J; Pillai, R; Opriou, D

    2008-07-01

    Backache is a common cause of morbidity among doctors and 50% of the obstetricians and gynaecologists suffering from this attribute it to work practice and posture. Occupational injuries remain poorly studied among obstetricians and gynaecologists and we have therefore tried to assess the extent and demographics of work-related injuries sustained during training by sending an eight-item questionnaire to 418 Registrar grade trainees in the London area. A low 23.2% response rate (97/418) was obtained, despite second questionnaires being sent to initial non-responders. Out of the 97 responders, 28 (28.7%) had suffered injuries at work at least once throughout their career. There was female preponderance in those reporting injuries, with a female to male ratio of 3:1. Of the 28 positive responders, 11 were UK graduates, 7 EU and the remaining 10 from Colombia, West Indies, India and Sudan. The mean age was 32.5 +/- 4.2 years, with 21 of the 28 (75%) being senior trainees (post-MRCOG). The injuries reported were: forearm (4); wrist (7); thumb (3); hands (1) shoulder and neck (9), ankle (1) and lower back (6). Of these, 18 sought medical help and received treatment for these injuries, which included long-term physiotherapy, although no-one required surgery. Eight were forced to take time off work, with a cumulative total of 80 days; one had to prolong her training by 3 months. Seven trainees sustained their injuries (e.g. ligamentous strain of wrist and scaphoid fracture) while performing caesarean sections, while forceps deliveries were the cause of six occupational injuries (e.g. ligamentous strain of sacroiliac joint). Work-related injuries can have adverse effects on training and workforce. Awareness of correct surgical techniques and adoption of ergonomic posture when performing procedures may help to minimise the risk of a work-related injury.

  19. Characteristics of upper extremity injuries sustained by falling during snowboarding: a study of 1918 cases.

    Science.gov (United States)

    Yamauchi, Koun; Wakahara, Kazuhiko; Fukuta, Masashi; Matsumoto, Kazu; Sumi, Hiroshi; Shimizu, Katsuji; Miyamoto, Kei

    2010-07-01

    Little epidemiological research on characteristics of upper extremity injuries resulting from snowboarding has been conducted, particularly in relation to snowboarding stance, falling direction, and the side of the body where the injury occurs. Snowboarding stance and the direction of the fall may influence the frequency of the side or the location of the upper extremity injury. Descriptive epidemiology study. This study analyzed the information obtained from 1918 patients with fractures or dislocations of the upper extremity (excluding the fingers and scapula) sustained during snowboarding/sliding between 2000 and 2008. Diagnosis, injured part and side, stance (regular or goofy), and falling directions were prospectively analyzed. Associations among these parameters were also analyzed. As characterized by skill level, patients were beginners (57.9%), intermediates (38.0%), and experts (4.0%). Eighty-eight percent had not received instruction from licensed instructors. Diagnoses included wrist fractures (53.7%), upper arm fractures (16.8%), shoulder dislocations (11.5%), and elbow dislocations (9.8%). In sum, 1742 (90.8%) patients were in regular stance when they fell, whereas 176 (9.2%) were in goofy stance. There was a significant difference in the prevalence of the injured side between the 2 stances. When the injured sides were classified according to the sliding direction, wrist fractures (61.7%) occurred on the side opposite the sliding direction, whereas shoulder dislocations (65.6%), upper arm fractures (82.9%), and elbow dislocations (79.8%) occurred on the same side as the sliding direction. When the injured sides were classified according to the falling direction, wrist fractures (68.1%) and elbow dislocations (63.5%) occurred because of backward falls, and shoulder dislocations (68.9%) and upper arm fractures (60.7%) occurred because of forward falls. Two snowboarding stances as well as 2 falling directions had a significant influence on the frequency of

  20. The functional outcome of surgically treated unstable pelvic ring fractures by open reduction, internal fixation

    Directory of Open Access Journals (Sweden)

    Kaykhosro Mardanpour

    2011-07-01

    Full Text Available Background:Unstable Pelvic fracture,a result of high energy antero-posterior compression injury, has been managed based on internal fixation and open reduction. The mode of fixation in Unstable Pelvic fracture has, however, been a subject of controversy and some authors have proposed a need to address the issue of partial breach of the pelvic ring elements in these injuries. This study was performed to evaluate the functional and radiological results of treatment of pelvic ring fractures by open reduction, internal fixation. Methods: Thirty eight patients with unstable pelvic fractures, treated from 2002 to2008 were retrospectively reviewed. The mean age of patients’ was 37 years old (range 20 to 67. Twenty six patients were men and 12 women. The most common cause was a road traffic accident (N=37, 97%. There were 11 type-C and 27 type-B fractures according to Tile’s classification. Thirty six patients sustained additional injuries. The most prevalent additional injuries were lower extremity fractures. Open reduction, internal fixation as a definite management was applied for all patients. Quality of reduction was graded according to the grades proposed by Matta and Majeed’s score was used to assess the clinical outcome. The mean period of follow-up was 25 months (ranged from 6 to 109 months. About 81.6% of patients had either good or excellent radiological reduction. Results: The functional outcome was excellent in 66%, good in 15%, fair in 11% and poor in 7% of the patients. There were 4 postoperative infections. No sexual function problem was reported. Nerve deficits recovered completely in 2 and partially in 3 of 11 patients with preoperative neurologic deficiency. There was no significant relation between functional outcome and the site of fracture Conclusion: Unstable pelvic ring fracture injuries should be managed surgically by rigid stabilization that must be carried out as soon as the general ndition of the patient permits, and

  1. Injury and treatment characteristics of sport-specific injuries sustained in interscholastic athletics: a report from the athletic training practice-based research network.

    Science.gov (United States)

    Lam, Kenneth C; Snyder Valier, Alison R; Valovich McLeod, Tamara C

    2015-01-01

    The inclusion of clinical practice factors, beyond epidemiologic data, may help guide medical coverage and care decisions. Trends in injury and treatment characteristics of sport-specific injuries sustained by secondary school athletes will differ based on sport. Retrospective analysis of electronic patient records. Level 4. Participants consisted of 3302 boys and 2293 girls who were diagnosed with a sport-related injury or condition during the study years. Injury (sport, body part, diagnosis via ICD-9 codes) and treatment (type, amount, and duration of care) characteristics were grouped by sport and reported using summary statistics. Most injuries and treatments occurred in football, girls' soccer, basketball, volleyball, and track and field. Sprain or strain of the ankle, knee, and thigh/hip/groin and concussion were the most commonly documented injuries across sports. The injury pattern for boys' wrestling differed from other sports and included sprain or strain of the elbow and neck and general medical skin conditions. The most frequently reported service was athletic training evaluation/reevaluation treatment, followed by hot/cold pack, therapeutic exercise, manual therapy techniques, electrical stimulation, and strapping of lower extremity joints. Most sports required 4 to 5 services per injury. With the exception of boys' soccer and girls' softball, duration of care ranged from 10 to 14 days. Girls' soccer and girls' and boys' track and field reported the longest durations of care. Injury and treatment characteristics are generally comparable across sports, suggesting that secondary school athletic trainers may diagnose and treat similar injuries regardless of sport. Subtle sport trends, including skin conditions associated with boys' wrestling and longer duration of care for girls' soccer, are important to note when discussing appropriate medical coverage and care.

  2. Management of pelvic fractures in dog | Sharma | Nigerian ...

    African Journals Online (AJOL)

    Pelvic fractures are common sequelae of major traumatic injury of dogs and cat which, comprise of at least 25% of all fractures in veterinary practice (Piermattei et al., 2006). Fracture of ilium, the most common fracture seen in the pelvis account for 46% of all pelvic fracture (Henry, 1985; De Camp, 2005). Whereas ...

  3. Postoperative pelvic pain: An imaging approach.

    Science.gov (United States)

    Farah, H; Laurent, N; Phalippou, J; Bazot, M; Giraudet, G; Serb, T; Poncelet, E

    2015-10-01

    Postoperative pelvic pain after gynecological surgery is a readily detected but unspecific sign of complication. Imaging as a complement to physical examination helps establish the etiological diagnosis. In the context of emergency surgery, vascular, urinary and digestive injuries constitute the most frequent intraoperative complications. During the follow-up of patients who had undergone pelvic surgery, imaging should be performed to detect recurrent disease, postoperative fibrosis, adhesions and more specific complications related to prosthetic material. Current guidelines recommend using pelvic ultrasonography as the first line imaging modality whereas the use of pelvic computed tomography and/or magnetic resonance imaging should be restricted to specific situations, depending on local availability of equipment and suspected disease. Copyright © 2015 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  4. Emergency management of hemodynamically unstable pelvic fractures

    Directory of Open Access Journals (Sweden)

    ZHAO Xiao-gang

    2012-02-01

    Full Text Available 【Abstract】Pelvic fractures are serious injuries. Death within 24 hours is most often a result of acute blood loss. The emergency management of these patients is challenging and controversial. The key issues in its management are identifying the site(s of hemorrhage and then controlling the bleeding. Management of hemodynamically unstable patients with pelvic fracture requires a multidisci- plinary team. The issues addressed in this management algorithm are diagnostic evaluation, damage control resuscitation, indications for noninvasive pelvic stabilization, preperitoneal pelvic packing and the critical decisions concerning surgical options and angiography. This review article focuses on the recent body of know- ledge on those determinations. Key words: Pelvis; Hemodynamic; Emergencies; Practice management

  5. Characteristics of the injuries of Syrian refugees sustained during the civil war.

    Science.gov (United States)

    Kocamer Şimşek, Betül; Dokur, Mehmet; Uysal, Erdal; Çalıker, Necdet; Gökçe, Oruç Numan; Deniz, İbrahim Kürşat; Uğur, Murat; Geyik, Murat; Kaya, Mehmet; Dağlı, Güner

    2017-05-01

    the most widely seen among civilians brought to Turkey because of gunshot injuries sustained during the Civil War in Syria. The number of emergency operations performed in the study sample was high, and critical care follow-up durations were long. In addition, the NISS and ASA scores of mortal cases were fairly high.

  6. Pelvic Inflammatory Disease (PID)

    Science.gov (United States)

    Pelvic Inflammatory Disease (PID) - CDC Fact Sheet Untreated sexually transmitted diseases (STDs) can cause pelvic inflammatory disease (PID), a serious condition, in women. 1 in 8 women with a history of ...

  7. Chest injuries associated with earthquakes: an analysis of injuries sustained during the 2008 Wen-Chuan earthquake in China.

    Science.gov (United States)

    Hu, Jia; Guo, Ying-Qiang; Zhang, Er-Yong; Tan, Jin; Shi, Ying-Kang

    2010-08-01

    The goal of this study was to analyze the patterns, therapeutic modalities, and short-term outcomes of patients with chest injuries in the aftermath of the Wen-Chuan earthquake, which occurred on May 12, 2008 and registered 8.0 on the Richter scale. Of the 1522 patients who were referred to the West China Hospital of Sichuan University from May 12 to May 27, 169 patients (11.1%) had suffered major chest injuries. The type of injury, the presence of infection, Abbreviated Injury Score (AIS 2005), New Injury Severity Score (NISS), treatment, and short-term outcome were all documented for each case. Isolated chest injuries were diagnosed in 129 patients (76.3%), while multiple injuries with a major chest trauma were diagnosed in 40 patients (23.7%). The mean AIS and the median NISS of the hospitalized patients with chest injuries were 2.5 and 13, respectively. The mortality rate was 3.0% (5 patients). Most of the chest injuries were classified as minor to moderate trauma; however, coexistent multiple injuries and subsequent infection should be carefully considered in medical response strategies. Coordinated efforts among emergency medical support groups and prior training in earthquake preparedness and rescue in earthquake-prone areas are therefore necessary for efficient evacuation and treatment of catastrophic casualties.

  8. Injury prediction in a side impact crash using human body model simulation.

    Science.gov (United States)

    Golman, Adam J; Danelson, Kerry A; Miller, Logan E; Stitzel, Joel D

    2014-03-01

    Improved understanding of the occupant loading conditions in real world crashes is critical for injury prevention and new vehicle design. The purpose of this study was to develop a robust methodology to reconstruct injuries sustained in real world crashes using vehicle and human body finite element models. A real world near-side impact crash was selected from the Crash Injury Research and Engineering Network (CIREN) database. An average sedan was struck at approximately the B-pillar with a 290 degree principal direction of force by a lightweight pickup truck, resulting in a maximum crush of 45 cm and a crash reconstruction derived Delta-V of 28 kph. The belted 73-year-old midsized female driver sustained severe thoracic injuries, serious brain injuries, moderate abdominal injuries, and no pelvic injury. Vehicle finite element models were selected to reconstruct the crash. The bullet vehicle parameters were heuristically optimized to match the crush profile of the simulated struck vehicle and the case vehicle. The Total Human Model for Safety (THUMS) midsized male finite element model of the human body was used to represent the case occupant and reconstruct her injuries using the head injury criterion (HIC), half deflection, thoracic trauma index (TTI), and pelvic force to predict injury risk. A variation study was conducted to evaluate the robustness of the injury predictions by varying the bullet vehicle parameters. The THUMS thoracic injury metrics resulted in a calculated risk exceeding 90% for AIS3+ injuries and 70% risk of AIS4+ injuries, consistent with her thoracic injury outcome. The THUMS model predicted seven rib fractures compared to the case occupant's 11 rib fractures, which are both AIS3 injuries. The pelvic injury risk for AIS2+ and AIS3+ injuries were 37% and 2.6%, respectively, consistent with the absence of pelvic injury. The THUMS injury prediction metrics were most sensitive to bullet vehicle location. The maximum 95% confidence interval width

  9. Traumatic injury of the bladder and urethra

    Science.gov (United States)

    Injury - bladder and urethra; Bruised bladder; Urethral injury; Bladder injury; Pelvic fracture; Urethral disruption ... Types of bladder injuries include: Blunt trauma (such as a blow to the body) Penetrating wounds (such as bullet or stab wounds) The ...

  10. early experience of operative treatment of pelvic and acetabular ...

    African Journals Online (AJOL)

    Background: There is a large number of patients who sustain pelvic and acetabular fractures in Kenya. A number of these patients have undergone internal fixation at our institution but there is no local data to show the results of such treatment. Objective: To review early post-operative results of pelvic and acetabular fracture ...

  11. Geriatric trauma: demographics, injuries, and mortality.

    Science.gov (United States)

    Keller, Julie M; Sciadini, Marcus F; Sinclair, Elizabeth; O'Toole, Robert V

    2012-09-01

    To identify injuries that elderly sustain during high-energy trauma and determine which are associated with mortality. Retrospective review of prospectively collected database. Academic trauma center. Patients selected from database of all trauma admissions from January 2004 through June 2009. Study population consisted of patients directly admitted from scene of injury who sustained high-energy trauma with at least one orthopaedic injury and were 65 years or older (n = 597). Review of demographics, trauma markers, injuries, and disposition statuses. Statistical analysis using χ test, Student t test, and logistic regression analysis. The most common fractures were of the rib, distal radius, pelvic ring, facial bones, proximal humerus, clavicle, ankle, and sacrum. The injuries associated with the highest mortality rates were fractures of the cervical spine with neurological deficit (47%), at the C2 level (44%), and of the proximal femur (25%), pelvic ring (25%), clavicle (24%), and distal humerus (24%). The fractures significantly associated with mortality were fractures of the clavicle (P = 0.001), foot joints (P = 0.001), proximal humerus or shaft and head of the humerus (P = 0.002), sacroiliac joint (P = 0.004), and distal ulna (P = 0.002). Elderly patients present with significantly worse injuries, remain in the hospital longer, require greater use of resources after discharge, and die at 3 times the rate of the younger population. Although the high mortality rates associated with cervical spine, hip, and pelvic ring fractures were not unexpected, the injuries that were statistically associated with mortality were unexpected. Injuries such as clavicle fracture were statistically associated with mortality. As our population ages and becomes more active, the demographic may gain in clinical importance. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

  12. [Correlation of subjective and objective assessment of vaginal prolapse surgery - secondary analysis of randomized controlled study in patients with pelvic floor injury treated with vaginal mesh or with sacrospinous ligament fixation].

    Science.gov (United States)

    Švabík, K; El Haddad, R; Mašata, J; Hubka, P; Martan, A

    2015-10-01

    We had provided secondary analysis of our randomized controlled study comparing vaginal mesh with sacrospinous fixation for vaginal prolapse. We correlated data from subjective and objective assessment. Secondly we had provided correlations results of subjective and objective assessment between patient with anatomical failure and those without. The aim of this analysis was to provide correlation between objective and subjective outcome measures. Subanalysis of randomized controlled study. Obstetric Gynecology Department, First Faculty of Medicine of Charles University and General University Hospital in Prague. This is secondary analysis of single center randomized controlled study comparing two standard procedures for vaginal prolapse after hysterectomy in patients with levator avulsion injury. We had analyzed pre- and postoperative subjective POPDI score (Pelvic Organ Prolapse Distress Inventory) and correlated this score with most prolapsed portion of vaginal wall. We had compared all vaginal compartments using POPQ (Pelvic Organ Prolapse Quantification): anterior wall with point Ba, apical with point C, and posterior with point Bp. Subsequently we compared subjective POPDI score in group of patients with anatomical failure and those without. We had included in randomized study 70 women. Mean preoperative POPDI score was 65.25 (3.57-200). We didnt found any correlation between subjective score and objective assessment in preoperative data: POPDI vs. Ba (p = 0.75) POPDI vs. C (p = 0.57) a POPDI vs. Bp (p = 0.22) and no correlation in postoperative assessment. Postoperative POPDI score decreased to 26.1, but there was no difference in POPDI score in woman with anatomical failure and no failure - 17.4 vs. 23.3 (p = 0.64)CONCLUSION: Secondary analysis of randomized controlled study had shown that objective and subjective assessment have poor correlation. We didnt found any correlation between degree of prolapse and intensity of complains. The large inter

  13. Multimodal nociceptive mechanisms underlying chronic pelvic pain

    Science.gov (United States)

    HELLMAN, Kevin M.; PATANWALA, Insiyyah Y.; POZOLO, Kristen E.; TU, Frank F.

    2015-01-01

    Objective To evaluate candidate mechanisms underlying the pelvic floor dysfunction in women with chronic pelvic pain and/or painful bladder syndrome/interstitial cystitis. Notably, prior studies have not consistently controlled for potential confounding by psychological or anatomical factors. Study Design As part of a larger study on pelvic floor pain dysfunction and bladder pain sensitivity, we compared a measure of mechanical pain sensitivity, pressure pain thresholds, between women with pelvic pain and pain-free controls. We also assessed a novel pain measure using degree and duration of post-exam pain aftersensation, and conducted structural and functional assessments of the pelvic floor to account for any potential confounding. Phenotypic specificity of pelvic floor measures was assessed with receiver-operator characteristic curves adjusted for prevalence. Results A total of 23 women with chronic pelvic pain, 23 painful bladder syndrome, and 42 pain-free controls completed the study. Women with chronic pelvic pain or painful bladder syndrome exhibited enhanced pain sensitivity with lower pressure pain thresholds (1.18 [interquartile range: 0.87–1.41] kg/cm2) than pain-free participants (1.48 [1.11–1.76] kg/cm2; ppelvic pain there were no consistently observed group differences in pelvic floor anatomy, muscle tone or strength. The combination of pressure pain thresholds and aftersensation duration correlated with severity of pelvic floor tenderness (R2 =41–51, p’spelvic pain or painful bladder syndrome (area under the curve=0.87). Conclusion Both experimental assessment of pelvic floor pain thresholds and measurement of sustained pain are independently associated with pelvic pain phenotypes. These findings suggest systematic clinical assessment of the time course of provoked pain symptoms, which occurs over seconds for mechanical pain thresholds vs. minutes for aftersensation pain, would be helpful in identifying the fundamental mechanisms of pelvic

  14. Concussion Increases Odds of Sustaining a Lower Extremity Musculoskeletal Injury After Return to Play Among Collegiate Athletes.

    Science.gov (United States)

    Brooks, M Alison; Peterson, Kaitlin; Biese, Kevin; Sanfilippo, Jennifer; Heiderscheit, Bryan C; Bell, David R

    2016-03-01

    Previous studies have identified abnormalities in brain and motor functioning after concussion that persist well beyond observed clinical recovery. Recent work suggests subtle deficits in neurocognition may impair neuromuscular control and thus potentially increase risk of lower extremity musculoskeletal injury after concussion. To determine the odds of sustaining an acute lower extremity musculoskeletal injury during the 90-day period after return to play from concussion in a cohort of National Collegiate Athletic Association (NCAA) Division I collegiate athletes. Cohort study; Level of evidence, 3. Included in this study were 87 cases of concussion among 75 athletes (58 men; 17 women) participating in NCAA Division I football, soccer, hockey, softball, basketball, wrestling, or volleyball at a single institution from 2011 to 2014. The 90-day period after return to play for each case of concussion was reviewed for acute noncontact lower extremity musculoskeletal injury. Each 90-day period after return to play was matched to the same 90-day period in up to 3 controls. Control athletes without a history of concussion in the previous year were matched to concussed athletes by sport team/sex, games played, and position. A total of 182 control (136 men; 46 women) 90-day periods were reviewed for acute injury. Conditional logistic regression was used to assess the association between concussion and subsequent risk of acute lower extremity musculoskeletal injury. The incidence of acute lower extremity musculoskeletal injury was higher among recently concussed athletes (15/87; 17%) compared with matched controls (17/182; 9%). The odds of sustaining an acute lower extremity musculoskeletal injury during the 90-day period after return to play were 2.48 times higher in concussed athletes than controls during the same 90-day period (odds ratio, 2.48; 95% CI, 1.04-5.91; P = .04). Concussed athletes have increased odds of sustaining an acute lower extremity musculoskeletal

  15. Characterization of spinal injuries sustained by American service members killed in Iraq and Afghanistan: a study of 2,089 instances of spine trauma.

    Science.gov (United States)

    Schoenfeld, Andrew J; Newcomb, Ronald L; Pallis, Mark P; Cleveland, Andrew W; Serrano, Jose A; Bader, Julia O; Waterman, Brian R; Belmont, Philip J

    2013-04-01

    This study sought to characterize spine injuries among soldiers killed in Iraq or Afghanistan whose autopsy results were stored by the Armed Forces Medical Examiner System. The Armed Forces Medical Examiner System data set was queried to identify American military personnel who sustained a spine injury in conjunction with wounds that resulted in death during deployment in Iraq or Afghanistan from 2003 to 2011. Demographic and injury-specific characteristics were abstracted for each individual identified. The raw incidence of spinal injuries was calculated and correlations were drawn between the presence of spinal trauma and military specialty, mechanism and manner of injury, and wounds in other body regions. Significant associations were also sought for specific injury patterns, including spinal cord injury, atlantooccipital injury, low lumbar vertebral fractures, and lumbosacral dissociation. Statistical calculations were performed using χ statistic, z test, t test with Satterthwaite correction, and multivariate logistic regression. Among 5,424 deceased service members, 2,089 (38.5%) were found to have sustained at least one spinal injury. Sixty-seven percent of all fatalities with spinal injury were caused by explosion, while 15% occurred by gunshot. Spinal fracture was the most common type of injury (n = 2,328), while spinal dislocations occurred in 378, and vertebral column transection occurred in 223. Fifty-two percent sustained at least one cervical spine injury, and spinal cord injury occurred in 40%. Spinal cord injuries were more likely to occur as a result of gunshot (p injuries (p spinal injury risk and the periods 2003 to 2007 and 2008 to 2011, although atlantooccipital injuries and spinal cord injury were significantly reduced beginning in 2008 (p spinal trauma in modern warfare seems to be higher than previously reported. Epidemiologic study, level III.

  16. High-energy pediatric pelvic and acetabular fractures

    NARCIS (Netherlands)

    Amorosa, Louis F.; Kloen, Peter; Helfet, David L.

    2014-01-01

    Pediatric pelvic and acetabular fractures are rare injuries. They are almost always the result of a high-energy injury mechanism. A full trauma protocol should be instituted, having a high index of suspicion for associated life-threatening injuries. In the past, it was recommended that almost all of

  17. EEG indices correlate with sustained attention performance in patients affected by diffuse axonal injury.

    Science.gov (United States)

    Coelli, Stefania; Barbieri, Riccardo; Reni, Gianluigi; Zucca, Claudio; Bianchi, Anna Maria

    2017-11-09

    The aim of this study is to assess the ability of EEG-based indices in providing relevant information about cognitive engagement level during the execution of a clinical sustained attention (SA) test in healthy volunteers and DAI (diffused axonal injury)-affected patients. We computed three continuous power-based engagement indices (P β /P α , 1/P α , and P β / (P α + P θ )) from EEG recordings in a control group (n = 7) and seven DAI-affected patients executing a 10-min Conners' "not-X" continuous performance test (CPT). A correlation analysis was performed in order to investigate the existence of relations between the EEG metrics and behavioral parameters in both the populations. P β /P α and 1/P α indices were found to be correlated with reaction times in both groups while P β / (P α + P θ ) and P β /P α also correlated with the errors rate for DAI patients. In line with previous studies, time course fluctuations revealed a first strong decrease of attention after 2 min from the beginning of the test and a final fading at the end. Our results provide evidence that EEG-derived indices extraction and evaluation during SA tasks are helpful in the assessment of attention level in healthy subjects and DAI patients, offering motivations for including EEG monitoring in cognitive rehabilitation practice. Graphical abstract Three EEG-derived indices were computed from four electrodes montages in a population of seven healthy volunteers and a group of seven DAI-affected patients. Results show a significant correlation between the time course of the indices and behavioral parameters, thus demonstrating their usefulness in monitoring mental engagement level during a sustained attention task.

  18. An assessment of pelvic binder placement at a UK major trauma centre.

    Science.gov (United States)

    Naseem, H; Nesbitt, P D; Sprott, D C; Clayson, A

    2017-09-15

    Introduction Pelvic binders are used to reduce the haemorrhage associated with pelvic ring injuries. Application at the level of the greater trochanters is required. We assessed the frequency of their use in patients with pelvic ring injuries and their positioning in patients presenting to a single major trauma centre. Methods A retrospective review of our trauma database was performed to randomly select 1000 patients for study from April 2012 to December 2016. Patients with a pelvic binder or a pelvic ring injury defined by the Young and Burgess classification were included. Computed tomography was used to identify and measure pelvic binder placement. Results 140 patients were identified: 110/140 had a binder placed. Of the total, 54 (49.1%) patients had satisfactory placement and 56 (50.9%) had unsatisfactory placement; 30/67 (44.8%) patients with a pelvic ring injury had no binder applied, of whom 6 (20%) had an unstable injury; 9/67 patients died. Discussion This is the first study assessing pelvic binder placement in patients at a UK major trauma centre. Unsatisfactory positioning of the pelvic binder is a common problem and it was not used in a large proportion of patients with pelvic ring injuries. This demonstrates that there is a need for continuing education for teams dealing with major trauma.

  19. Pediatric pelvic fracture urethral distraction defect causing complete urethrovaginal avulsion.

    Science.gov (United States)

    Singh, Ritesh Kumar; Kaushal, Devashish; Khattar, Nikhil; Nayyar, Rishi; Manasa, T; Sood, Rajeev

    2018-01-01

    Pelvic fracture with urethral injury in girls is an uncommon entity that is usually associated with concomitant vaginal lacerations. Management options vary from immediate exploration and urethral anastomosis to delayed urethroplasty. We report our experience of managing a 10-year old girl presenting 6 months after a pelvic fracture with urethrovaginal injury and a completely obliterated urethral meatus managed successfully with a single-stage bladder tube repair.

  20. Pudendal nerve in pelvic bone fractures.

    Science.gov (United States)

    Báča, Václav; Báčová, Tereza; Grill, Robert; Otčenášek, Michal; Kachlík, David; Bartoška, Radek; Džupa, Valér

    2013-07-01

    Pelvic ring injuries rank among the most serious skeletal injuries. According to published data, pelvic fractures constitute 3-8% of all fractures. There has been a threefold increase in the number of these fractures over the last 10 years. A significant factor determining the choice of the therapeutic procedure, timing and sequence of individual steps, and also the prognosis of the patient with a fractured pelvis, are associated injuries defined as injuries to the organs and anatomical structures found in the pelvic region. Published data describes the incidence of injury to neurogenic structures as ranging between 9 and 21%, to the urogenital tract between 5 and 11%, to the gastrointestinal tract in 3-17% and to the gynecologic organs up to 1%. The pathway of the pudendal nerve may be affected in types B and C fractures where the root fibers emerge from the foramina sacralia and plexus sacralis is formed, on the one hand, and in types A, B and C fractures during the nerve's course alongside the inferior pubic ramus. In order to determine the frequency of potential injury to the pudendal nerve, a set of 225 pelvic fractures treated between 2007 and 2009 was assessed; 38 fixed hemipelves were also used to study the length of the course of the pudendal nerve alongside the inferior pubic ramus, on the one hand, and the distances from the symphysis pubica at the crossing of the branches of the n. pudendus-n. dorsalis penis and the branches for the muscles of the diaphragma urogenitale on the other hand. The work elucidated the selected distances and discuss their possible clinical relevance for evaluation of the seriousness of pelvic fractures from the perspective of late sequelae in the region innervated by the pudendal nerve. Copyright © 2012 Elsevier Ltd. All rights reserved.

  1. Pelvic Fractures in Children Results from the German Pelvic Trauma Registry: A Cohort Study.

    Science.gov (United States)

    Zwingmann, Jörn; Aghayev, Emin; Südkamp, Norbert P; Neumann, Mirjam; Bode, Gerrit; Stuby, Fabian; Schmal, Hagen

    2015-12-01

    As pelvic fractures in children and adolescents are very rare, the surgical management is not well delineated nor are the postoperative complications. The aim of this study using the prospective data from German Pelvic Trauma Registry study was to evaluate the various treatment approaches compared to adults and delineated the differences in postoperative complications after pelvic injuries.Using the prospective pelvic trauma registry established by the German Society of Traumatology and the German Section of the Arbeitsgemeinschaft für Osteosynthesefragen (AO), International in 1991, patients with pelvic fractures over a 12-year time frame submitted by any 1 of the 23 member level I trauma centers were reviewed.We identified a total of 13,525 patients including pelvic fractures in 13,317 adults and 208 children aged ≤14 years and compared these 2 groups. The 2 groups' Injury Severitiy Score (ISS) did not differ statistically. Lethality in the pediatric group was 6.3%, not statistically different from the adults' 4.6%. In all, 18.3% of the pediatric pelvic fractures were treated surgically as compared to 22.7% in the adult group. No child suffered any thrombosis/embolism, acute respiratory distress syndrome (ARDS), multiorgan failure (MOF), or neurologic deficit, nor was any septic MOF detected. The differences between adults and children were statistically significant in that the children suffered less frequently from thrombosis/embolism (P = 0.041) and ARDS and MOF (P = 0.006).This prospective multicenter study addressing patients with pelvic fractures reveals that the risk for a thrombosis/embolism, ARDS, and MOF is significant lower in pediatric patients than in adults. No statistical differences could be found in the ratios of operative therapy of the pelvic fractures in children compared to adults.

  2. Pelvic fractures in professional cyclists: a report of 3 cases.

    Science.gov (United States)

    Cerynik, Douglas L; Roshon, Michael; Abzug, Joshua M; Harding, Susan P; Tom, James A

    2009-05-01

    Professional riders demonstrate increased risk factors for such injuries including both extensive time on the bike in addition to a possible underlying osteopenia secondary to the nonimpact nature of the sport. Nonoperative management of stable, nondisplaced pelvic fractures in professional cyclists offers excellent results. Case series. Three cases of professional cyclists with pelvic fractures were reviewed. All 3 cyclists were able to return to professional competition and remain symptom free. Accurate early diagnosis of pelvic fractures, with the aid of computed tomography, is crucial. Early nonweightbearing with a progression to weightbearing as tolerated and early return to stationary training are appropriate. Accurate diagnosis and careful nonoperative management of stable, nondisplaced pelvic fractures in professional cyclists offers excellent results. Accurate diagnosis of pelvic fractures in high-demand athletes with few complaints and no obvious findings on plain film radiographs. Control of weightbearing and competitive status to prevent injury progression. Gauged return to competition at professional level.

  3. PELVIC ORGAN PROLAPES

    Directory of Open Access Journals (Sweden)

    Ketut Yoga Mira Pratiwi

    2013-04-01

    Full Text Available Pelvic organ prolapse (POP is defined as a decrease in abnormal or herniation of the pelvic organs out of place attached to its normal position or in the pelvic cavity. As for the anatomy of the pelvic organs consists of bones, muscles, and nerves. The presence of damage to the pelvic connective tissue and visceral attachment pelvic organs the cause occurs. The symptoms that appear in patients POP not specific to distinguish prolapse of some compartments but can reflect the degree of prolapse as a whole. Physical examination focused on pelvic examination, beginning with inspection on the vulva and vagina to identify the presence of erosion, ulceration, or other lesions. As for the existing therapy options include observation, non-operative management, and operative management.

  4. Initial and sustained brain responses to threat anticipation in blood-injection-injury phobia

    Directory of Open Access Journals (Sweden)

    Leonie Brinkmann

    2017-01-01

    Full Text Available Blood-injection-injury (BII phobia differs from other subtypes of specific phobia in that it is associated with elevated disgust-sensitivity as well as specific autonomic and brain responses during processing of phobia-relevant stimuli. To what extent these features play a role already during threat anticipation is unclear. In the current fMRI experiment, 16 female BII phobics and 16 female healthy controls anticipated the presentation of phobia-specific and neutral pictures. On the behavioral level, anxiety dominated the anticipatory period in BII phobics relative to controls, while both anxiety and disgust were elevated during picture presentation. By applying two different models for the analysis of brain responses to anticipation of phobia-specific versus neutral stimuli, we found initial and sustained increases of activation in anterior cingulate cortex (ACC, insula, lateral and medial prefrontal cortex (PFC, thalamus and visual areas, as well as initial activation in the amygdala for BII phobics as compared to healthy controls. These results suggest that BII phobia is characterized by activation of a typical neural defense network during threat anticipation, with anxiety as the predominant emotion.

  5. Initial and sustained brain responses to threat anticipation in blood-injection-injury phobia.

    Science.gov (United States)

    Brinkmann, Leonie; Poller, Hendrik; Herrmann, Martin J; Miltner, Wolfgang; Straube, Thomas

    2017-01-01

    Blood-injection-injury (BII) phobia differs from other subtypes of specific phobia in that it is associated with elevated disgust-sensitivity as well as specific autonomic and brain responses during processing of phobia-relevant stimuli. To what extent these features play a role already during threat anticipation is unclear. In the current fMRI experiment, 16 female BII phobics and 16 female healthy controls anticipated the presentation of phobia-specific and neutral pictures. On the behavioral level, anxiety dominated the anticipatory period in BII phobics relative to controls, while both anxiety and disgust were elevated during picture presentation. By applying two different models for the analysis of brain responses to anticipation of phobia-specific versus neutral stimuli, we found initial and sustained increases of activation in anterior cingulate cortex (ACC), insula, lateral and medial prefrontal cortex (PFC), thalamus and visual areas, as well as initial activation in the amygdala for BII phobics as compared to healthy controls. These results suggest that BII phobia is characterized by activation of a typical neural defense network during threat anticipation, with anxiety as the predominant emotion.

  6. A computational study of injury severity and pattern sustained by overweight drivers in frontal motor vehicle crashes.

    Science.gov (United States)

    Kim, Jong-Eun; Kim, Il Hwan; Shum, Phillip C; Shih, Alan M; Pintar, Frank; Shen, Wei; Ma, Xiaoguang; Laud, Purushottam W; Heymsfield, Steven B; Allison, David B; Zhu, Shankuan

    2014-01-01

    The objective of this study was to examine the role of body mass and subcutaneous fat in injury severity and pattern sustained by overweight drivers. Finite element models were created to represent the geometry and properties of subcutaneous adipose tissue in the torso with data obtained from reconstructed magnetic resonance imaging data-sets. The torso adipose tissue models were then integrated into the standard multibody dummy models together with increased inertial parameters and sizes of the limbs to represent overweight occupants. Frontal crash simulations were carried out considering a variety of occupant restraint systems and regional body injuries were measured. The results revealed that differences in body mass and fat distribution have an impact on injury severity and pattern. Even though the torso adipose tissue of overweight subjects contributed to reduce abdominal injury, the momentum effect of a greater body mass of overweight subjects was more dominant over the cushion effect of the adipose tissue, increasing risk of other regional body injuries except abdomen. Through statistical analysis of the results, strong correlations (p risks (p < 0.001) of head, thorax and lower extremity injury than observed in non-overweight males. The findings have important implications for improving the vehicle and occupant safety systems designed for the increasing global obese population.

  7. Intra-pelvic pressure changes after pelvic fracture: A cadaveric study quantifying the effect of a pelvic binder and limb bandaging over a bolster.

    Science.gov (United States)

    Morris, Rhys; Loftus, Andrew; Friedmann, Yasmin; Parker, Paul; Pallister, Ian

    2017-04-01

    Unstable pelvic fractures can be life-threatening due to catastrophic haemorrhage. Non-invasive methods of reducing and stabilising these injuries include pelvic binder application and also lower limb bandaging over a knee-flexion bolster. Both of these methods help close the pelvic ring and should tamponade bleeding. This study aimed to quantify the intra-pelvic pressure changes that occurred with 3 different manoeuvres: lower limb bandaging over a bolster; a Trauma Pelvic Orthotic Device (T-POD) pelvic binder, and a combination of both. Following a pilot study with 2 soft embalmed cadavers, a formal study with 6 unembalmed cadavers was performed. For each specimen an unstable pelvic injury was created (OA/OTA 61-C1) by dividing the pelvic ring anteriorly and posteriorly. A 3-4cm manometric water-filled balloon was placed in the retropubic space and connected to a 50ml syringe and water manometer via a 3-way tap. A baseline pressure of 8cmH2O (equating to the average central venous pressure) was used for each cadaver. Steady intra-pelvic pressures (more reliably reflecting the pressures achieved following an intervention) were used in the subsequent statistical analysis, using R statistical language and Rstudio. Paired t-test or Wilcoxon's rank sum test were used (depending on the normality of the dataset) to determine the impact of each intervention on the intra-pelvic pressure. The mean steady intra-pelvic pressures were significantly greater than the baseline pressure for each intervention. The binder and limb bandaging over a bolster alone increased the mean steady pelvic pressures significantly to 24 (SE=5) (pbinder application significantly increased intra-pelvic pressure above the baseline pressure. This was further increased through combining these interventions, which could be useful clinically to augment haemorrhage control in these fractures. Lower-limb bandaging over a bolster, and pelvic binder application, both significantly increased intra-pelvic

  8. [Effects on erectile function of transplanted major pelvic ganglion into the corpus cavernosum of adult rats with bilateral cavernous nerve injury].

    Science.gov (United States)

    Cui, Dian-sheng; Hu, Li-quan; Li, Shi-wen; Zheng, Xin-min

    2004-05-22

    To investigate the effects on erectile function of transplanted major pelvic ganglion into the corpus cavernosum of adult male rats undergoing transection of bilateral cavernous nerves. Twenty-six male Sprague-Dawley rats (3 - 4 month-old and 300 - 400 g/each) were divided into 2 groups: experimental group (transection of bilateral cavernous nerves and transplantation of left ganglion into left crus of penis, n = 16) and control group (transection of bilateral cavernous nerves only, n = 10). Erectile function was measured by injecting APO, and intracavernous pressure was measured 1 and 3 months afterwards by electric-stimulating the right major pelvic ganglion or the left crus. Half animals in each group were sacrificed 1 and 3 months afterwards for detecting nNOS-containing nerve fibers of corpus cavernosum. Electron microscopy of the implanted area was performed to assess neuronal survival. Both of the two groups have no erectile response to APO injection. Electrostimulation on the right major pelvic ganglion and left crus failed to produce erection in experimental group. The mean pressure changes in the two groups, measured by stimulating the left crus, were (9.41 +/- 3.20) and (4.16 +/- 2.58) cmH(2)O 1 month afterwards, and (13.67 +/- 4.18) and (5.09 +/- 2.74) cmH(2)O 3 months afterwards, respectively (P < 0.05). An increased number of nNOS-containing nerve fibers in left crus was detected in experimental group 1 and 3 months later, compared with control one (218.7 +/- 24.5, 18.0 +/- 3.7; 183.2 +/- 19.7, 19.0 +/- 3.8; P < 0.05). Ultrastructure examination by transmission electron microscope confirmed the survival of the implanted ganglion. Major pelvic ganglion can survive in the corpus cavernosum, and it has significant effects on the number of nNOS-containing nerve fibers and the alteration of intracavernous pressure.

  9. [The risk factors for pelvic floor trauma following vaginal delivery].

    Science.gov (United States)

    Michalec, I; Tomanová, M; Navrátilová, M; Šimetka, O; Procházka, M

    2015-01-01

    The evaluation of the risk and protective factors for pelvic floor trauma in relation to vaginal delivery. Review. Department of Obstetrics and Gynecology, University Hospital of Ostrava. The aim was to provide a comprehensive survey of studies focused on risk factors for pelvic floor trauma following vaginal delivery; and to constitute the relationship between the risk and protective factors and levator ani injury. To state the prognosis of the pelvic floor injury before a child delivery is difficult and almost impossible, but it has been assumed that an operative vaginal delivery (obstetrical forceps) represents a significant risk factor for avulsion. The change in obstetric practice can prevent the injury and thus to reduce an adverse effect. Pregnancy and the methods of childbirth are important factors with an impact on pelvic floor injury, potentially contributing to the development of pelvic organ prolapse, and stress and anal incontinence. The recognition of the factors, the proper training of medical staff in the management of labour, and subsequently the proper treatment of perineal tears should prevent pelvic floor injury.

  10. Effectiveness of Embolization or Sclerotherapy of Pelvic Veins for Reducing Chronic Pelvic Pain: A Systematic Review.

    Science.gov (United States)

    Daniels, Jane P; Champaneria, Rita; Shah, Laila; Gupta, Janesh K; Birch, Judy; Moss, Jonathan G

    2016-10-01

    Chronic pelvic pain (CPP) in the presence of dilated and refluxing pelvic veins is often described as pelvic congestion syndrome (PCS), although the causal relationship between pelvic vein incompetence and CPP has not been established. Percutaneous embolization is the principal treatment for PCS, with high success rates cited. This study was undertaken to systematically and critically review the effectiveness of embolization of incompetent pelvic veins. A comprehensive search strategy encompassing various terms for pelvic congestion, pelvic pain, and embolization was deployed in 17 bibliographic databases, with no restriction on study design. Methodologic quality was assessed. The quality and heterogeneity generally precluded meta-analysis. Results were tabulated and described narratively. Twenty-one prospective case series and one poor-quality randomized trial of embolization (involving a total of 1,308 women) were identified. Early substantial relief from pain was observed in approximately 75% of women undergoing embolization, and generally increased over time and was sustained. Significant pain reductions following treatment were observed in all studies that measured pain on a visual analog scale. Repeat intervention rates were generally low. There were few data on the impact on menstruation, ovarian reserve, or fertility, but no concerns were noted. Transient pain was common following foam embolization, and there was a < 2% risk of coil migration. Embolization appears to provide symptomatic relief of CPP in the majority of women and is safe, although the quality of the evidence is low. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

  11. Myofascial pelvic pain.

    Science.gov (United States)

    Spitznagle, Theresa Monaco; Robinson, Caitlin McCurdy

    2014-09-01

    Individuals with pelvic pain commonly present with complaints of pain located anywhere below the umbilicus radiating to the top of their thighs or genital region. The somatovisceral convergence that occurs within the pelvic region exemplifies why examination of not only the organs but also the muscles, connective tissues (fascia), and neurologic input to the region should be performed for women with pelvic pain. The susceptibility of the pelvic floor musculature to the development of myofascial pain has been attributed to unique functional demands of this muscle. Conservative interventions should be considered to address the impairments found on physical examination. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Intractable epilepsy and craniocerebral trauma: analysis of 163 patients with blunt and penetrating head injuries sustained in war.

    Science.gov (United States)

    Kazemi, Hadi; Hashemi-Fesharaki, Sohrab; Razaghi, Soodeh; Najafi, Masomeh; Kolivand, Peir Hossein; Kovac, Stjepana; Gorji, Ali

    2012-12-01

    Post-traumatic epileptic seizure is a common complication of brain trauma including military injuries. We present clinical characteristics and correlates of post-traumatic epilepsy in 163 head-injured veterans suffering from intractable epilepsy due to blunt or penetrating head injuries sustained during the Iraq-Iran war. The medical records of 163 war veterans who were admitted by the Epilepsy Department of the Shefa Neuroscience Center between 2005 and 2009 were retrospectively reviewed. The mean follow-up period after developing epilepsy was 17.2 years. The time interval between the trauma and the first seizure was shorter and the seizure frequency was higher in epileptic patients suffering from penetrating head trauma. There was no difference in seizure type between epileptic patients traumatised by blunt or penetrating injury. Patients with seizure frequency of more than 30 per month mostly had simple partial seizure. Frontal and parietal semiologies were observed more frequently in patients with penetrating trauma, whereas patients with blunt trauma showed a higher temporal semiology. The most common brain lesion observed by CT scan was encephalomalacia followed by porencephaly and focal atrophy. There was no association between intracerebral retained fragments and different characteristic features of epilepsy. Patients with military brain injury carry a high risk of intractable post-traumatic epilepsy decades after their injury, and thus require a long-term medical follow-up. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. Survival trends and predictors of mortality in severe pelvic trauma: estimates from the German Pelvic Trauma Registry Initiative.

    Science.gov (United States)

    Pohlemann, Tim; Stengel, Dirk; Tosounidis, Georgios; Reilmann, Heinrich; Stuby, Fabian; Stöckle, Uli; Seekamp, Andreas; Schmal, Hagen; Thannheimer, Andreas; Holmenschlager, Francis; Gänsslen, Axel; Rommens, Pol Maria; Fuchs, Thomas; Baumgärtel, Friedel; Marintschev, Ivan; Krischak, Gert; Wunder, Stephan; Tscherne, Harald; Culemann, Ulf

    2011-10-01

    To determine longitudinal trends in mortality, and the contribution of specific injury characteristics and treatment modalities to the risk of a fatal outcome after severe and complex pelvic trauma. We studied 5048 patients with pelvic ring fractures enrolled in the German Pelvic Trauma Registry Initiative between 1991 and 1993, 1998 and 2000, and 2004 and 2006. Complete datasets were available for 5014 cases, including 508 complex injuries, defined as unstable fractures with severe peri-pelvic soft tissue and organ laceration. Multivariable mixed-effects logistic regression analysis was employed to evaluate the impact of demographic, injury- and treatment-associated variables on all-cause in-hospital mortality. All-cause in-hospital mortality declined from 8% (39/466) in 1991 to 5% (33/638) in 2006. Controlling for age, Injury Severity Score, pelvic vessel injury, the need for emergency laparotomy, and application of a pelvic clamp, the odds ratio (OR) per annum was 0.94 (95% confidence interval [CI] 0.91-0.96). However, the risk of death did not decrease significantly in patients with complex injuries (OR 0.98, 95% CI 0.93-1.03). Raw mortality associated with this type of injury was 18% (95% CI 9-32%) in 2006. In contrast to an overall decline in trauma mortality, complex pelvic ring injuries remain associated with a significant risk of death. Awareness of this potentially life-threatening condition should be increased amongst trauma care professionals, and early management protocols need to be implemented to improve the survival prognosis. Copyright © 2011 Elsevier Ltd. All rights reserved.

  14. Pelvic reconstruction improves pelvic floor strength in pelvic organ prolapse patients

    Directory of Open Access Journals (Sweden)

    Zhong Guan

    2015-10-01

    Conclusion: The modified pelvic reconstruction procedure could improve pelvic floor muscle strength in POP patients, which remains lower when compared with the normal population. Pelvic floor muscle strength should be included in the assessment of surgical outcomes in POP.

  15. Evaluation of skiing and snowboarding injuries sustained in terrain parks versus traditional slopes.

    Science.gov (United States)

    Brooks, M Alison; Evans, Michael D; Rivara, Frederick P

    2010-04-01

    This study compares skiing and snowboarding injuries in terrain parks versus slopes at two ski areas, 2000-05. A total of 3953 (26.7%) injuries occurred in terrain parks, predominantly among young male snowboarders. Terrain park injuries were more likely to be severe, involving head (RR 1.31, 95% CI 1.16 to 1.48) or back (RR 1.96, 95% CI 1.67 to 2.29).

  16. Prediction of work resumption and sustainability up to 1 year after mild traumatic brain injury.

    Science.gov (United States)

    de Koning, Myrthe E; Scheenen, Myrthe E; van der Horn, Harm J; Timmerman, Marieke E; Hageman, Gerard; Roks, Gerwin; Spikman, Jacoba M; van der Naalt, Joukje

    2017-10-31

    To study return to work (RTW) after mild traumatic brain injury (mTBI) at several intervals after injury and to predict RTW on the basis of occupational factors in addition to demographic, personality, and injury-related factors at 6 and 12 months after injury. This was a prospective cohort study (UPFRONT study, n = 1,151) of patients with mTBI admitted to the emergency department. Patients received questionnaires at 2 weeks and 3, 6, and 12 months after injury. RTW was divided into 3 levels: complete (cRTW), partial (pRTW), and no RTW. Rates of cRTW increased from 34% at 2 weeks to 77% at 12 months after injury, pRTW varied from 8% to 16% throughout the year. Logistic regression (complete vs incomplete RTW) demonstrated that apart from previously identified predictors such as demographics (e.g., age and education) and injury characteristics (e.g., cause and severity of injury) and indicators of psychological distress, occupational factors were of influence on work resumption after 6 months (area under the curve [AUC] = 0.82), At 12 months, however, the model was based solely on the presence of extracranial injuries and indicators of maladaptation after injury (AUC = 0.81). RTW after mTBI is a gradual process, with varying levels of RTW throughout the first year after injury. Different predictors were relevant for short- vs long-term work resumption, with occupational factors influencing short-term RTW. However, for both short- and long-term RTW, posttraumatic complaints and signs of psychological distress early after injury were relevant predictors, allowing early identification of patients at risk for problematic work resumption. © 2017 American Academy of Neurology.

  17. Robust human body model injury prediction in simulated side impact crashes.

    Science.gov (United States)

    Golman, Adam J; Danelson, Kerry A; Stitzel, Joel D

    2016-01-01

    This study developed a parametric methodology to robustly predict occupant injuries sustained in real-world crashes using a finite element (FE) human body model (HBM). One hundred and twenty near-side impact motor vehicle crashes were simulated over a range of parameters using a Toyota RAV4 (bullet vehicle), Ford Taurus (struck vehicle) FE models and a validated human body model (HBM) Total HUman Model for Safety (THUMS). Three bullet vehicle crash parameters (speed, location and angle) and two occupant parameters (seat position and age) were varied using a Latin hypercube design of Experiments. Four injury metrics (head injury criterion, half deflection, thoracic trauma index and pelvic force) were used to calculate injury risk. Rib fracture prediction and lung strain metrics were also analysed. As hypothesized, bullet speed had the greatest effect on each injury measure. Injury risk was reduced when bullet location was further from the B-pillar or when the bullet angle was more oblique. Age had strong correlation to rib fractures frequency and lung strain severity. The injuries from a real-world crash were predicted using two different methods by (1) subsampling the injury predictors from the 12 best crush profile matching simulations and (2) using regression models. Both injury prediction methods successfully predicted the case occupant's low risk for pelvic injury, high risk for thoracic injury, rib fractures and high lung strains with tight confidence intervals. This parametric methodology was successfully used to explore crash parameter interactions and to robustly predict real-world injuries.

  18. Shock-absorbing insoles reduce the incidence of lower limb overuse injuries sustained during Royal Marine training.

    Science.gov (United States)

    House, Carol; Reece, Allyson; Roiz de Sa, Dan

    2013-06-01

    This study was undertaken to determine whether the incidence of lower limb overuse injuries (LLOIs) sustained during Royal Marine training could be reduced by issuing the recruits with shock-absorbing insoles (SAIs) to wear in their military boots. This was a retrospective longitudinal trial conducted in two phases. Injury data from 1,416 recruits issued with standard Saran insoles and 1,338 recruits issued with SAI were compared. The recruits in the two groups were of similar height, body mass, and aerobic fitness and followed the same training course. The incidence of LLOI sustained by the recruits was lower (p tibial periostitis, tenosynovitis of foot, achilles tendonopathy, other tendonopathy and anterior knee pain were lower (p Tibial stress fracture incidence was lower (p < 0.05) in the SAI Group but metatarsal and femoral stress fracture incidences were the same for the two insole groups. Thus, issuing SAIs to military recruits undertaking a sustained, arduous physical training program with a high incidence of LLOI would provide a beneficial reduction in the incidence of LLOI. Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.

  19. Comparison of the incidence, nature and cause of injuries sustained on dirt field and artificial turf field by amateur football players

    Directory of Open Access Journals (Sweden)

    Kordi Ramin

    2011-02-01

    Full Text Available Abstract Background Data on the incidence, nature, severity and cause of match football injuries sustained on dirt field are scarce. The objectives of this study was to compare the incidence, nature, severity and cause of match injuries sustained on dirt field and artificial turf field by amateur male football players. Methods A prospective two-cohort design was employed. Participants were 252 male football players (mean age 27 years, range 18-43 in 14 teams who participated in a local championship carried on a dirt field and 216 male football players (mean age 28 years, range 17-40 in 12 teams who participated in a local championship carried on a artificial turf field in the same zone of the city. Injury definitions and recording procedures were compliant with the international consensus statement for epidemiological studies of injuries in football. Results The overall incidence of match injuries for men was 36.9 injuries/1000 player hours on dirt field and 19.5 on artificial turf (incidence rate ratio 1.88; 95% CI 1.19-3.05. Most common injured part on dirt field was ankle (26.7% and on artificial turf was knee (24.3%. The most common injury type in the dirt field was skin injuries (abrasion and laceration and in the artificial turf was sprain and ligament injury followed by haematoma/contusion/bruise. Most injuries were acute (artificial turf 89%, dirt field 91% and resulted from player-to-player contact (artificial turf 59.2%, dirt field 51.4%. Most injuries were slight and minimal in dirt field cohort but in artificial turf cohort the most injuries were mild. Conclusions There were differences in the incidence and type of football match injuries sustained on dirt field and artificial turf.

  20. Pelvic floor imaging

    NARCIS (Netherlands)

    Stoker, J.; Halligan, S.; Bartram, C. I.

    2001-01-01

    A greater awareness of the therapies now available for pelvic floor dysfunction has increased demand for specialized imaging of this region. Some of the techniques required are available at relatively few centers, and the purpose of this review is to introduce the emerging subspecialty of pelvic

  1. Recruitment of Intracavernously Injected Adipose-Derived Stem Cells to the Major Pelvic Ganglion Improves Erectile Function in a Rat Model of Cavernous Nerve Injury

    OpenAIRE

    Thomas M Fandel; Albersen, Maarten; Lin, Guiting; Qiu, Xuefeng; Ning, Hongxiu; Banie, Lia; Lue, Tom F.; Lin, Ching-Shwun

    2011-01-01

    Intracavernous (IC) injection of stem cells has been shown to ameliorate cavernous-nerve (CN) injury-induced erectile dysfunction (ED). However, the mechanisms of action of adipose-derived stem cells (ADSC) remain unclear.

  2. Ureteric injuries following laparoscopic hysterectomy: A report of ...

    African Journals Online (AJOL)

    and pelvic relaxation, and forms 29.2% of all hysterectomies in the ... pelvic surgery, presence of endometriosis, pelvic inflammatory disease .... Pelvic Floor Dysfuct. 2002; 13: 18-21. 12. Oh Br, Kwon D.D., Park K.S., et al. Late presentation of ureteral injury after laparoscopic surgery. Obstet. Gynecol. 2000; 95:337-339. 13.

  3. Effect of pelvic floor muscle exercises on pulmonary function

    Science.gov (United States)

    Han, DongWook; Ha, Misook

    2015-01-01

    [Purpose] This study aimed to determine the correlation between pelvic floor muscle strength and pulmonary function. In particular, we examined whether pelvic floor muscle exercises can improve pulmonary function. [Subjects] Thirty female college students aged 19–21 with no history of nervous or musculoskeletal system injury were randomly divided into experimental and control groups. [Methods] For the pulmonary function test, spirometry items included forced vital capacity and maximal voluntary ventilation. Pelvic floor muscle exercises consisted of Kegel exercises performed three times daily for 4 weeks. [Results] Kegel exercises performed in the experimental group significantly improved forced vital capacity, forced expiratory volume in 1 second, PER, FEF 25–75%, IC, and maximum voluntary ventilation compared to no improvement in the control group. [Conclusion] Kegel exercises significantly improved pulmonary function. When abdominal pressure increased, pelvic floor muscles performed contraction at the same time. Therefore, we recommend that the use of pelvic floor muscle exercises be considered for improving pulmonary function. PMID:26644681

  4. Effect of pelvic floor muscle exercises on pulmonary function.

    Science.gov (United States)

    Han, DongWook; Ha, Misook

    2015-10-01

    [Purpose] This study aimed to determine the correlation between pelvic floor muscle strength and pulmonary function. In particular, we examined whether pelvic floor muscle exercises can improve pulmonary function. [Subjects] Thirty female college students aged 19-21 with no history of nervous or musculoskeletal system injury were randomly divided into experimental and control groups. [Methods] For the pulmonary function test, spirometry items included forced vital capacity and maximal voluntary ventilation. Pelvic floor muscle exercises consisted of Kegel exercises performed three times daily for 4 weeks. [Results] Kegel exercises performed in the experimental group significantly improved forced vital capacity, forced expiratory volume in 1 second, PER, FEF 25-75%, IC, and maximum voluntary ventilation compared to no improvement in the control group. [Conclusion] Kegel exercises significantly improved pulmonary function. When abdominal pressure increased, pelvic floor muscles performed contraction at the same time. Therefore, we recommend that the use of pelvic floor muscle exercises be considered for improving pulmonary function.

  5. Sustained Inflation at Birth Did Not Alter Lung Injury from Mechanical Ventilation in Surfactant-Treated Fetal Lambs

    Science.gov (United States)

    Hillman, Noah H.; Kemp, Matthew W.; Miura, Yuichiro; Kallapur, Suhas G.; Jobe, Alan H.

    2014-01-01

    Background Sustained inflations (SI) are used with the initiation of ventilation at birth to rapidly recruit functional residual capacity and may decrease lung injury and the need for mechanical ventilation in preterm infants. However, a 20 second SI in surfactant-deficient preterm lambs caused an acute phase injury response without decreasing lung injury from subsequent mechanical ventilation. Hypothesis A 20 second SI at birth will decrease lung injury from mechanical ventilation in surfactant-treated preterm fetal lambs. Methods The head and chest of fetal sheep at 126±1 day GA were exteriorized, with tracheostomy and removal of fetal lung fluid prior to treatment with surfactant (300 mg in 15 ml saline). Fetal lambs were randomized to one of four 15 minute interventions: 1) PEEP 8 cmH2O; 2) 20 sec SI at 40 cmH2O, then PEEP 8 cmH2O; 3) mechanical ventilation with 7 ml/kg tidal volume; or 4) 20 sec SI then mechanical ventilation at 7 ml/kg. Fetal lambs remained on placental support for the intervention and for 30 min after the intervention. Results SI recruited a mean volume of 6.8±0.8 mL/kg. SI did not alter respiratory physiology during mechanical ventilation. Heat shock protein (HSP) 70, HSP60, and total protein in lung fluid similarly increased in both ventilation groups. Modest pro-inflammatory cytokine and acute phase responses, with or without SI, were similar with ventilation. SI alone did not increase markers of injury. Conclusion In surfactant treated fetal lambs, a 20 sec SI did not alter ventilation physiology or markers of lung injury from mechanical ventilation. PMID:25419969

  6. Effects of low-dose IV ketamine on peripheral and central pain from major limb injuries sustained in combat.

    Science.gov (United States)

    Polomano, Rosemary C; Buckenmaier, Chester C; Kwon, Kyung H; Hanlon, Alexandra L; Rupprecht, Christine; Goldberg, Cynthia; Gallagher, Rollin M

    2013-07-01

    Examine response patterns to low-dose intravenous (IV) ketamine continuous infusions on multiple pain outcomes, and demonstrate effectiveness, safety, and tolerability of ketamine administration on general wards. Retrospective case series of consecutive patients given low-dose IV ketamine continuous infusions. Walter Reed Army Medical Center, Washington, DC. Nineteen eligible inpatients with neuropathic pain from major limb injuries sustained in combat with inadequate pain control from multimodal analgesia. A 3-day IV infusion of ketamine at doses ≤ 120 μg/kg/h. Daily present (PPI), average (API), and worst (WPI) pain intensity (0-10), global pain relief (GPR) (1 "no relief" to 5 "complete relief"), daily assessments of adverse events, and daily opioid requirements measured during therapy. A significant reduction in PPI (P injury pain were safe and effective, and demonstrated response patterns over time and by baseline pain score stratification and presence or absence of PLP. Wiley Periodicals, Inc.

  7. Direct and indirect costs of surgically treated pelvic fractures.

    Science.gov (United States)

    Aprato, Alessandro; Joeris, Alexander; Tosto, Ferdinando; Kalampoki, Vasiliki; Stucchi, Alessandro; Massè, Alessandro

    2016-03-01

    Pelvic fractures requiring surgical fixation are rare injuries but present a great societal impact in terms of disability, as well as economic resources. In the literature, there is no description of these costs. Main aim of this study is to describe the direct and indirect costs of these fractures. Secondary aims were to test if the type of fracture (pelvic ring injury or acetabular fracture) influences these costs (hospitalization, consultation, medication, physiotherapy sessions, job absenteeism). We performed a retrospective study on patients with surgically treated acetabular fractures or pelvic ring injuries. Medical records were reviewed in terms of demographic data, follow-up, diagnosis (according to Letournel and Tile classifications for acetabular and pelvic fractures, respectively) and type of surgical treatment. Patients were interviewed about hospitalization length, consultations after discharge, medications, physiotherapy sessions and absenteeism. The study comprised 203 patients, with a mean age of 49.1 ± 15.6 years, who had undergone surgery for an acetabular fracture or pelvic ring injury. The median treatment costs were 29.425 Euros per patient. Sixty percent of the total costs were attributed to health-related work absence. Median costs (in Euros) were 2.767 for hospitalization from trauma to definitive surgery, 4.530 for surgery, 3.018 for hospitalization in the surgical unit, 1.693 for hospitalization in the rehabilitation unit, 1.920 for physiotherapy after discharge and 402 for consultations after discharge. Total costs for treating pelvic ring injuries were higher than for acetabular fractures, mainly due to the significant higher costs of pelvic injuries regarding hospitalization from trauma to definitive surgery (p fractures are associated with both high direct costs and substantial productivity loss.

  8. Epidemiology of injuries sustained by players during the 16th Under-17 South American Soccer Championship.

    Science.gov (United States)

    Pangrazio, O; Forriol, F

    2016-01-01

    We performed an epidemiological study of the traumatic injuries during the XVI South American U-17 Football Championship, 2015. Observational surveys submitted by the 10 teams medical services of 220 players. Thirty-five games were held and 116 goals (3.31 per game) were recorded. 103 lesions, ie, 2.94 per game or 32.7 injuries per 1,000 min were recorded. Fifty-six were from direct contact and 66 requiring treatment. 36% of the injuries were punished by fault and 26% of the injuries also saw card. Injuries were most common in the ankle (15 cases), Achilles tendon (14 cases) and thigh (14 cases), followed by trauma to the knee and foot (7 cases each), face and the lumbar region (6 cases each), being rare in the upper extremity. Injuries during Soccer World Cup are difficult to predict and prevent, but serious injuries are rare. Is necessary to establish protocols that get adequate health care at all levels to solve problems produce, both in training and during the competition, and be prepared to solve the serious problems that may arise. Copyright © 2015 SECOT. Published by Elsevier Espana. All rights reserved.

  9. Epidemiology of Injuries Sustained as a Result of Intentional Player Contact in High School Football, Ice Hockey, and Lacrosse: 2005-2006 Through 2015-2016.

    Science.gov (United States)

    Bartley, Justin H; Murray, Monica F; Kraeutler, Matthew J; Pierpoint, Lauren A; Welton, K Linnea; McCarty, Eric C; Comstock, R Dawn

    2017-12-01

    Lacrosse and ice hockey are quickly growing in popularity, while football remains the most popular sport among high school student-athletes. Injuries remain a concern, given the physical nature of these contact sports. To describe the rates and patterns of injuries sustained as a result of intentional player contact in United States high school boys' football, ice hockey, and lacrosse. Descriptive epidemiology study. We conducted a secondary analysis of High School RIO (Reporting Information Online) data, including exposure and injury data collected from a large sample of high schools in the United States from 2005-2006 through 2015-2016. Data were analyzed to calculate rates, assess patterns, and evaluate potential risk factors for player-to-player contact injuries. A total of 34,532 injuries in boys' football, ice hockey, and lacrosse occurred during 9,078,902 athlete-exposures (AEs), for a rate of 3.80 injuries per 1000 AEs in the 3 contact sports of interest. The risk of injuries was found to be greater in competition compared with practice for all 3 sports, with the largest difference in ice hockey (rate ratio, 8.28) and the smallest difference in lacrosse (rate ratio, 3.72). In all 3 contact sports, the most commonly injured body site in competition and practice caused by both tackling/checking and being tackled/checked was the head/face. However, a significantly greater proportion of concussions sustained in football were the result of tackling compared with being tackled (28.2% vs 24.1%, respectively). In addition, a significantly greater proportion of concussions were sustained in competition compared with practice for all 3 sports. This study is the first to collectively compare injury rates and injury patterns sustained from intentional player-to-player contact in boys' high school football, ice hockey, and lacrosse. Notably, there was a relatively high risk of injuries and concussions during football practices.

  10. Effect of pelvic floor muscle exercises on pulmonary function

    OpenAIRE

    Han, Dongwook; Ha, Misook

    2015-01-01

    [Purpose] This study aimed to determine the correlation between pelvic floor muscle strength and pulmonary function. In particular, we examined whether pelvic floor muscle exercises can improve pulmonary function. [Subjects] Thirty female college students aged 19?21 with no history of nervous or musculoskeletal system injury were randomly divided into experimental and control groups. [Methods] For the pulmonary function test, spirometry items included forced vital capacity and maximal volunta...

  11. The role of door orientation on occupant injury in a nearside impact: a CIREN, MADYMO modeling and experimental study.

    Science.gov (United States)

    Tencer, Allan F; Kaufman, Robert; Huber, Philippe; Mock, Charles

    2005-12-01

    This study addressed the effects of vehicle height mismatch in side impact crashes. A light truck or SUV tends to strike the door of a passenger car higher causing the upper border to lead into the occupant space. Conversely, an impact centered lower on the door, from a passenger car, causes the lower border to lead. We proposed the hypothesis that the type of injury sustained by the occupant could be related to door orientation during its intrusion into the passenger compartment. Data on door orientation and nearside occupant injuries were collected from 125 side impact crashes reported in the CIREN database. Experimental testing was performed using a pendulum carrying a frame and a vehicle door, impacting against a USDOT SID. The frame allowed the door orientation to be changed. A model was developed in MADYMO (v 6.2) using the more biofidelic dummies, BIOSID, and SIDIIs as well as USDOT SID. In side impact crashes with the lower border of the door leading, 81% of occupants sustained pelvic injury, 42% suffered rib fractures, and the rate of organ injury was 0.84. With the upper border leading, 46% of occupants sustained pelvic injury, 71% sustained rib fracture, and the rate of organ injuries per case increased to 1.13. The differences in the groups with respect to pelvic injury were significant at p = 0.01, rib fracture, p = 0.10, and organ injury, p = 0.001. Experimental testing showed that when the door angle changed from lower to upper border leading, peak T4 acceleration increased by 273% and pelvic acceleration decreased by 44%. The model demonstrated that when the door angle changed from lower to upper border leading, the USDOT SID showed a 29% increase in T4 acceleration and a 57% decrease in pelvic acceleration. The BIOSID dummy demonstrated a 36% increase in T1 acceleration, a 44% increase in abdominal rib 1 deflection, a 91% increase in thoracic rib 1 deflection, and a 33% decrease in pelvic acceleration. These data add more insight to the problem of

  12. The impact of sustained hot weather on risk of acute work-related injury in Melbourne, Australia

    Science.gov (United States)

    McInnes, Judith Anne; MacFarlane, Ewan M.; Sim, Malcolm R.; Smith, Peter

    2018-02-01

    It has been reported that weather-related high ambient temperature is associated with an increased risk of work-related injury. Understanding this relationship is important because work-related injuries are a major public health problem, and because projected climate changes will potentially expose workers to hot days, including consecutive hot days, more often. The aim of this study was to quantify the impact of exposure to sustained periods of hot weather on work-related injury risk for workers in Melbourne, Australia. A time-stratified case crossover study design was utilised to examine the association between two and three consecutive days and two and three consecutive nights of hot weather and the risk of work-related injury, using definitions of hot weather ranging from the 60th to the 95th percentile of daily maximum and minimum temperatures for the Melbourne metropolitan area, 2002-2012. Workers' compensation claim data was used to identify cases of acute work-related injury. Overall, two and three consecutive days of hot weather were associated with an increased risk of injury, with this effect becoming apparent at a daily maximum temperature of 27.6 °C (70th percentile). Three consecutive days of high but not extreme temperatures were associated with the strongest effect, with a 15% increased risk of injury (odds ratio 1.15, 95% confidence interval 1.01-1.30) observed when daily maximum temperature was ≥33.3 °C (90th percentile) for three consecutive days, compared to when it was not. At a threshold of 35.5 °C (95th percentile), there was no significant association between temperature and injury for either two or three consecutive days of heat. These findings suggest that warnings to minimise harm to workers from hot weather should be given, and prevention protocol initiated, when consecutive warm days of temperatures lower than extreme heat temperatures are forecast, and well before the upper ranges of ambient daytime temperatures are reached.

  13. The impact of sustained hot weather on risk of acute work-related injury in Melbourne, Australia

    Science.gov (United States)

    McInnes, Judith Anne; MacFarlane, Ewan M.; Sim, Malcolm R.; Smith, Peter

    2017-09-01

    It has been reported that weather-related high ambient temperature is associated with an increased risk of work-related injury. Understanding this relationship is important because work-related injuries are a major public health problem, and because projected climate changes will potentially expose workers to hot days, including consecutive hot days, more often. The aim of this study was to quantify the impact of exposure to sustained periods of hot weather on work-related injury risk for workers in Melbourne, Australia. A time-stratified case crossover study design was utilised to examine the association between two and three consecutive days and two and three consecutive nights of hot weather and the risk of work-related injury, using definitions of hot weather ranging from the 60th to the 95th percentile of daily maximum and minimum temperatures for the Melbourne metropolitan area, 2002-2012. Workers' compensation claim data was used to identify cases of acute work-related injury. Overall, two and three consecutive days of hot weather were associated with an increased risk of injury, with this effect becoming apparent at a daily maximum temperature of 27.6 °C (70th percentile). Three consecutive days of high but not extreme temperatures were associated with the strongest effect, with a 15% increased risk of injury (odds ratio 1.15, 95% confidence interval 1.01-1.30) observed when daily maximum temperature was ≥33.3 °C (90th percentile) for three consecutive days, compared to when it was not. At a threshold of 35.5 °C (95th percentile), there was no significant association between temperature and injury for either two or three consecutive days of heat. These findings suggest that warnings to minimise harm to workers from hot weather should be given, and prevention protocol initiated, when consecutive warm days of temperatures lower than extreme heat temperatures are forecast, and well before the upper ranges of ambient daytime temperatures are reached.

  14. Myofascial pelvic pain.

    Science.gov (United States)

    Kotarinos, Rhonda

    2012-10-01

    Myofascial pelvic pain is fraught with many unknowns. Is it the organs of the pelvis, is it the muscles of the pelvis, or is the origin of the pelvic pain from an extrapelvic muscle? Is there a single source or multiple? In this state of confusion what is the best way to manage the many symptoms that can be associated with myofascial pelvic pain. This article reviews current studies that attempt to answer some of these questions. More questions seem to develop as each study presents its findings.

  15. Ultrasonography of pelvic masses

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Chu Wan; Lee, Kyung Hi; Yeon, Kyung Mo; Choo, Dong Woon; Rha, Keun Yung; Kim, Syng Wook [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1980-06-15

    56 cases of ultrasonography in patient with proven pelvic mass were reviewed. Ultrasonography is a very useful noninvasive diagnostic modality in the patient with clinically suspected pelvic masses giving accurate assessment of the size, location, internal structure and origin as well as its existence. A specific diagnosis was possible in selected patients with ovarian cystadenoma, dermoids, uterine myoma, and H-mode. Nonspecific pattern was common in pelvic abscess and ectopic pregnancy. Diagnostic errors were primarily due to small lesions (2 cm or less in diameter) or misinterpretation of the lesion.

  16. The nature and extent of war injuries sustained by combat specialty personnel killed and wounded in Afghanistan and Iraq, 2003-2011.

    Science.gov (United States)

    Schoenfeld, Andrew J; Dunn, John C; Bader, Julia O; Belmont, Philip J

    2013-08-01

    Previous studies regarding combat wounding have a limited translational capacity due to inclusion of soldiers from all military branches and occupational specialties as well as a lack of information regarding soldiers who died in theater. A search was performed of the Department of Defense Trauma Registry and Armed Forces Medical Examiner data set for the years 2003 to 2011 to identify all injured personnel with the military specialty 19D (cavalry scout). A manual search was conducted for each record identified, and age, rank, location and manner of injury, mechanism of injury, Injury Severity Score (ISS), and extent of wounding were abstracted. The incidence of injuries by body region and rates for specific types of wounds were determined. Statistically significant associations between rank, location of injury, manner of injury, body region involved, and injury mechanism were assessed using χ2 analysis. Associations between ISS, rank, manner of injury, and survival were evaluated by t test with Satterthwaite correction. A total of 701 casualties were identified with 3,189 distinct injuries. Mean (SD) age of injured personnel was 25.9 (6.0) years. Thirty-five percent of the cohort was composed of soldiers who died in theater. Explosions were the most common mechanism of injury (70%), while 18% of wounds occurred owing to gunshot. Extremity wounds and injuries to the head and neck represented 34% of casualty burden. Thoracic trauma occurred in 16%, and abdominal injuries occurred in 17%. Wounds with a frequency exceeding 5% included skin, extremity, facial, brain, and gastrointestinal injuries. Vascular injury occurred in 4%. Gunshot wounds were a greater cause of injury in Afghanistan (p = 0.001) and resulted in a higher percentage of thoracic injuries (p trauma sustained by combat-specific personnel seems to be different from that experienced by all soldiers deployed to a war zone.

  17. Dental injuries sustained by high school athletes in the United States, from 2008/2009 through 2013/2014 academic years.

    Science.gov (United States)

    Collins, Christy L; McKenzie, Lara B; Ferketich, Amy K; Andridge, Rebecca; Xiang, Huiyun; Comstock, R Dawn

    2016-04-01

    Risk of dental injuries is present in a variety of sports. Mouthguards are effective yet underutilized. This study aimed to estimate the rate of dental injuries among high school athletes and investigate the utilization of mouthguards across multiple high school sports. Athlete exposure and dental injury data were collected during the 2008/2009 through 2013/2014 academic years from a large sample of high schools in the United States as part of the National High School Sports-Related Injury Surveillance Study. There were 222 dental injuries sustained during 24,787,258 athlete exposures for a rate of 0.90 per 100,000 athlete exposures. The rate of dental injuries in competition (1.8) was three times higher than the rate in practice (0.6) (RR: 3.1, 95% CI: 2.3-4.0). Rates of dental injuries varied by sport with the highest rates in girls' field hockey (3.9) and boys' basketball (2.6). Dental injuries most commonly occurred as a result of contact with another player (61.3%) and contact with a playing apparatus (31.5%). For the majority of dental injuries, the athlete was not wearing a mouthguard (72.5%). Among injuries where athletes were wearing mouthguards, the majority were self-fitted (95.9%). Although dental injuries were relatively uncommon, the majority occurred while the athlete was not wearing a mouthguard. As previous studies have shown that mouthguards are effective in preventing injuries, all high school athletes participating in a sport that places them at risk of sustaining a dental injury should wear a mouthguard consistently in both competition and practice. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Peripheral Total Tau in Military Personnel Who Sustain Traumatic Brain Injuries During Deployment.

    Science.gov (United States)

    Olivera, Anlys; Lejbman, Natasha; Jeromin, Andreas; French, Louis M; Kim, Hyung-Suk; Cashion, Ann; Mysliwiec, Vincent; Diaz-Arrastia, Ramon; Gill, Jessica

    2015-10-01

    Approximately one-third of military personnel who deploy for combat operations sustain 1 or more traumatic brain injuries (TBIs), which increases the risk for chronic symptoms of postconcussive disorder, posttraumatic stress disorder, and depression and for the development of chronic traumatic encephalopathy. Elevated concentrations of tau are observed in blood shortly following a TBI, but, to our knowledge, the role of tau elevations in blood in the onset and maintenance of chronic symptoms after TBI has not been investigated. To assess peripheral tau levels in military personnel exposed to TBI and to examine the relationship between chronic neurological symptoms and tau elevations. Observational assessment from September 2012 to August 2014 of US military personnel at the Madigan Army Medical Center who had been deployed within the previous 18 months. Plasma total tau concentrations were measured using a novel ultrasensitive single-molecule enzyme-linked immunosorbent assay. Classification of participants with and without self-reported TBI was made using the Warrior Administered Retrospective Casualty Assessment Tool. Self-reported symptoms of postconcussive disorder, posttraumatic stress disorder, and depression were determined by the Neurobehavioral Symptom Inventory, the Posttraumatic Stress Disorder Checklist Military Version, and the Quick Inventory of Depressive Symptomatology, respectively. Group differences in tau concentrations were determined through analysis of variance models, and area under the receiver operating characteristic curve determined the sensitivity and specificity of tau concentrations in predicting TBI and chronic symptoms. Seventy participants with self-reported TBI on the Warrior Administered Retrospective Casualty Assessment Tool and 28 control participants with no TBI exposure were included. Concentration of total tau in peripheral blood. Concentrations of plasma tau were significantly elevated in the 70 participants with self

  19. Physical activity and the pelvic floor.

    Science.gov (United States)

    Nygaard, Ingrid E; Shaw, Janet M

    2016-02-01

    women. However, future research is needed to fill the many gaps in our knowledge. Prospective studies are needed in all populations, including potentially vulnerable women, such as those with high genetic risk, levator ani muscle injury, or asymptomatic pelvic organ prolapse, and on women during potentially vulnerable life periods, such as the early postpartum or postoperative periods. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Occupant and Crash Characteristics in Thoracic and Lumbar Spine Injuries Resulting From Motor Vehicle Collisions

    Science.gov (United States)

    Rao, Raj D.; Berry, Chirag; Yoganandan, Narayan; Agarwal, Arnav

    2016-01-01

    Injury Scale grade 2 or more) associated with T and L spine injuries involved the chest (seen in 65.6% of 631 occupants). In contrast to occupants with major T and L spine injuries, those with minor T and L spine injuries showed a strikingly greater association with pelvic and abdominal injuries. Occupants with minor T and L spine injuries had a higher mean ISS (27.1) than those with major T and L spine injuries (25.6). Among occupants wearing a three-point seat belt, 35.3% sustained T and L spine injuries, while only 11.6% of the unbelted occupants sustained T and L spine injuries. Three-point belted individuals were more likely to sustain burst fractures, while two-point belted occupants sustained flexion-distraction injuries most often, and unbelted occupants had a predilection for fracture-dislocations of the T and L spine. Three-point seat belts were protective against neurologic injury, higher ISS and fatality. Conclusions T and L spine fracture patterns are influenced by age of occupant and type and use of seat belts. Despite a reduction in overall injury severity and mortality, seat belt use is associated with an increased incidence of T and L spine fractures. Minor T and L spine fractures were associated with an increased likelihood of pelvic and abdominal injuries and higher ISS scores, demonstrating their importance in predicting overall injury severity. Extension injuries occurred in older, obese individuals, and were associated with a high fatality rate. Future advancements in automobile safety engineering should address the need to reduce T and L spine injuries in belted occupants. PMID:24486471

  1. Pelvic (between the hips) radiation - discharge

    Science.gov (United States)

    ... radiation treatment area on your body is large. Alternative Names Radiation of the pelvis - discharge; Cancer treatment - pelvic radiation; Prostate cancer - pelvic radiation; Ovarian cancer - pelvic radiation; Cervical ...

  2. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... organs and is often used to determine the cause of unexplained pain. CT scanning is fast, painless, ... procedure is typically used to help diagnose the cause of abdominal or pelvic pain and diseases of ...

  3. Pelvic Inflammatory Disease

    Science.gov (United States)

    Pelvic inflammatory disease (PID) is an infection and inflammation of the uterus, ovaries, and other female reproductive organs. It causes scarring ... United States. Gonorrhea and chlamydia, two sexually transmitted diseases, are the most common causes of PID. Other ...

  4. Pelvic Support Problems

    Science.gov (United States)

    ... myself? • Are there exercises for POP? • How are Kegel exercises done? • What is a pessary? • Can surgery ... exercises for POP? Pelvic floor exercises, also called Kegel exercises, are used to strengthen the muscles that ...

  5. Chronic pelvic pain

    National Research Council Canada - National Science Library

    Slawomir Wozniak

    2016-01-01

    [b][/b][b]Introduction. [/b]Chronic pelvic pain (CPP) affects about 10–40% of women presenting to a physician, and is characterised by pain within the minor pelvis persisting for over 6 months. [b...

  6. Chronic pelvic floor dysfunction.

    Science.gov (United States)

    Hartmann, Dee; Sarton, Julie

    2014-10-01

    The successful treatment of women with vestibulodynia and its associated chronic pelvic floor dysfunctions requires interventions that address a broad field of possible pain contributors. Pelvic floor muscle hypertonicity was implicated in the mid-1990s as a trigger of major chronic vulvar pain. Painful bladder syndrome, irritable bowel syndrome, fibromyalgia, and temporomandibular jaw disorder are known common comorbidities that can cause a host of associated muscular, visceral, bony, and fascial dysfunctions. It appears that normalizing all of those disorders plays a pivotal role in reducing complaints of chronic vulvar pain and sexual dysfunction. Though the studies have yet to prove a specific protocol, physical therapists trained in pelvic dysfunction are reporting success with restoring tissue normalcy and reducing vulvar and sexual pain. A review of pelvic anatomy and common findings are presented along with suggested physical therapy management. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Pelvic Inflammatory Disease

    Science.gov (United States)

    ... Home Page Bacterial Vaginosis (BV) Chlamydia Genital Herpes Gonorrhea Hepatitis HIV/AIDS & STDs Human Papillomavirus (HPV) Pelvic ... PID when certain bacteria, such as chlamydia or gonorrhea, move upward from a woman's vagina or cervix ...

  8. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... often used to determine the cause of unexplained pain. CT scanning is fast, painless, noninvasive and accurate. ... help diagnose the cause of abdominal or pelvic pain and diseases of the internal organs, small bowel ...

  9. Penetrating cardiac injury: sustaining health by building team resilience in growing civilian violence.

    Science.gov (United States)

    Pol, Manjunath Maruti; Prasad, K Shiv Krishna; Deo, Vishant; Uniyal, Madhur

    2016-09-02

    Penetrating cardiac injury (PCI) is gradually increasing in developing countries owing to large-scale manufacturing of illegal country-made weapons. These injuries are associated with significant morbidity and mortality. Logistically it is difficult to have all organ-based specialists arrive together and attend every critically injured patient round-the-clock in developing countries. It is therefore important for doctors (physicians, surgeons and anaesthetists) to be trained for adequate management of critically injured patients following trauma. We report the approach towards 2 cases of haemodynamically unstable PCI managed by a team of trauma doctors. Time lag (duration between injury and arrival at hospital) and quick horizontal resuscitation are important considerations in the treatment. By not referring these patients to different hospitals the team actually reduced the time lag, and a quick life-saving surgery by trauma surgeons (trained in torso surgery) offered these almost dying patients a chance of survival. 2016 BMJ Publishing Group Ltd.

  10. Anorectal and Pelvic Pain.

    Science.gov (United States)

    Bharucha, Adil E; Lee, Tae Hee

    2016-10-01

    Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this comprehensive review will focus on the 3 most common nonstructural, or functional, disorders associated with pelvic pain: functional anorectal pain (ie, levator ani syndrome, unspecified anorectal pain, and proctalgia fugax), interstitial cystitis/bladder pain syndrome, and chronic prostatitis/chronic pelvic pain syndrome. The first 2 conditions occur in both sexes, while the latter occurs only in men. They are defined by symptoms, supplemented with levator tenderness (levator ani syndrome) and bladder mucosal inflammation (interstitial cystitis). Although distinct, these conditions share several similarities, including associations with dysfunctional voiding or defecation, comorbid conditions (eg, fibromyalgia, depression), impaired quality of life, and increased health care utilization. Several factors, including pelvic floor muscle tension, peripheral inflammation, peripheral and central sensitization, and psychosocial factors, have been implicated in the pathogenesis. The management is tailored to symptoms, is partly supported by clinical trials, and includes multidisciplinary approaches such as lifestyle modifications and pharmacological, behavioral, and physical therapy. Opioids should be avoided, and surgical treatment has a limited role, primarily in refractory interstitial cystitis. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  11. Pelvic and acetabular trauma care in Ireland: the past, present and future

    LENUS (Irish Health Repository)

    Queally, JM

    2017-08-01

    Pelvic injuries involve injury to the osseo-ligamentous ring structure of the pelvis or the acetabulum of either hip joint. They are typically caused by high-energy trauma and may be associated with significant morbidity or mortality at the time of injury due to excessive haemorrhage and associated abdominal, chest or head injuries with mortality rates of 8.6% to 19.1% reported for closed injuries and rates of up to 50% reported for open injuries1. Despite the severity of these injuries and the potential for poor long term outcomes, these injuries were managed with non-surgical treatment until the middle of the 20th century. Treatment typically involved prolonged bed rest, traction or compression devices, pelvic slings and spica casts with poor outcomes due to persistent pelvic deformity in pelvic injures and early osteoarthritis in acetabular fractures2,3. In the 1930’s, with the advent of radiography, significant progress was made in terms of understanding injury patterns, subsequent displacement and the significance of pelvic instability and deformity post injury. Along with the improved definitive management of pelvic injuries, similar progress was made with the immediate management of life-threatening haemodynamic instability and resuscitation with a significant improvement in mortality rate achieved over the past 50 years3,4. In contemporary trauma care, to ensure optimal outcomes, pelvic trauma is now considered a subspecialty practised in tertiary centres by fellowship trained specialists. Herein we describe the evolution of pelvic trauma care in Ireland over the past 30 years in an overall context of improved international paradigms of care and discuss potential future developments

  12. Pelvic Organ Prolapse: New Concepts in Pelvic Floor Anatomy.

    Science.gov (United States)

    Maldonado, Pedro A; Wai, Clifford Y

    2016-03-01

    As the field of reconstructive pelvic surgery continues to evolve, with descriptions of new procedures to repair pelvic organ prolapse, it remains imperative to maintain a functional understanding of pelvic floor anatomy and support. The goal of this review was to provide a focused, conceptual approach to differentiating anatomic defects contributing to prolapse in the various compartments of the vagina. Rather than provide exhaustive descriptions of pelvic floor anatomy, basic pelvic floor anatomy is reviewed, new and historical concepts of pelvic floor support are discussed, and relevance to the surgical management of specific anatomic defects is addressed. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Anatomy of pelvic floor dysfunction.

    Science.gov (United States)

    Corton, Marlene M

    2009-09-01

    Normal physiologic function of the pelvic organs depends on the anatomic integrity and proper interaction among the pelvic structures, the pelvic floor support components, and the nervous system. Pelvic floor dysfunction includes urinary and anal incontinence; pelvic organ prolapse; and sexual, voiding, and defecatory dysfunction. Understanding the anatomy and proper interaction among the support components is essential to diagnose and treat pelvic floor dysfunction. The primary aim of this article is to provide an updated review of pelvic support anatomy with clinical correlations. In addition, surgical spaces of interest to the gynecologic surgeon and the course of the pelvic ureter are described. Several concepts reviewed in this article are derived and modified from a previous review of pelvic support anatomy.

  14. Prevention Practice Differences Among Persons With Spinal Cord Injuries Who Rarely Versus Frequently Sustain Pressure Ulcers

    Science.gov (United States)

    Jones, Michael L.; Marini, Irmo; Slate, John R.

    2005-01-01

    Pressure ulcers are common among people with spinal cord injury (SCI) and not only are costly to treat but also affect the quality of life of those affected by them. Despite a plethora of literature on prevention, there are few wellness studies focusing on the practices of people who do not develop pressure ulcers. This preliminary study sought to…

  15. Injuries sustained by passengers travelling in the cargo area of light ...

    African Journals Online (AJOL)

    Introduction. Despite its inherently dangerous nature, the practice of transporting passengers in the cargo area of light delivery vehicles (LDVs) is widespread in South Africa. Objective. To review the patterns and outcome of injuries associated with events involving LDVs transporting passengers. Methods. All patients ...

  16. What’s new in the functional anatomy of pelvic organ prolapse?

    Science.gov (United States)

    DeLancey, John O. L.

    2017-01-01

    Purpose of Review Provide an evidence-based review of pelvic floor functional anatomy related to pelvic organ prolapse. Recent Findings Pelvic organ support depends on interactions between the levator ani muscle and pelvic connective tissues. Muscle failure exposes the vaginal wall a pressure differential producing abnormal tension on the attachments of the pelvic organs to the pelvic side-wall. Birth-induced injury to the pubococcygeal portion of the levator ani muscle is seen in 55% of women with prolapse and 16% of women with normal support. Failure of the connective tissue attachments between the uterus and vagina to the pelvic wall (cardinal, uterosacral, paravaginal) are strongly related with prolapse (effect sizes ~2.5) and are also highly correlated with one another (r ~0.85). Small differences exist with prolapse in factors involving the vaginal wall length and width (effect sizes ~1). The primary difference in ligament properties between women with and without prolapse is found in ligament length. Only minor differences in ligament stiffness are seen. Summary Pelvic organ prolapse occurs due to injury to the levator ani muscles and failure of the connections between the pelvic organs to the pelvic sidewall. Abnormalities of the vaginal wall fascial tissues may play a minor role. PMID:27517338

  17. Pelvic fractures-A guide to classification and management

    Energy Technology Data Exchange (ETDEWEB)

    Slater, S.J. [Department of Radiology, Leeds Teaching Hospitals, Leeds (United Kingdom); Radiology Academy, Leeds General Infirmary, Jubilee Wing, Great George St., Leeds LS1 3EX (United Kingdom)], E-mail: s.j.slater@doctors.org.uk; Barron, D.A. [Department of Radiology, Leeds Teaching Hospitals, Leeds (United Kingdom); Musculoskeletal Radiology Dept, Leeds General Infirmary, Jubilee Wing, Great George St, Leeds LS1 3EX (United Kingdom)], E-mail: Dominic.barron@leedsth.nhs.uk

    2010-04-15

    Pelvic fractures are common in polytrauma and continue to pose a difficult management dilemma for even the most experienced clinicians. Due to the high energy mechanisms involved, there are often multiple other injuries and many specialists may be involved. Deriving an effective management strategy relies on early diagnosis and prioritisation of the most immediately life-threatening injuries. Contrary to ATLS advice, CT can be used to facilitate this even in the haemodynamically unstable patient. This article defines the role of CT in pelvic fractures and provides an overview of fracture classification.

  18. PHYSICAL ACTIVITY AND THE PELVIC FLOOR

    Science.gov (United States)

    Nygaard, Ingrid E.; Shaw, Janet M.

    2015-01-01

    , future research is needed to fill the many gaps in our knowledge. Prospective studies are needed in all populations, including potentially vulnerable women, such as those with high genetic risk, levator ani muscle injury, or asymptomatic pelvic organ prolapse, and on women during potentially vulnerable life periods, such as the early postpartum or postoperative periods. PMID:26348380

  19. Prognostic indicators of social outcomes in persons who sustained an injury in a road traffic crash.

    Science.gov (United States)

    Gopinath, Bamini; Jagnoor, Jagnoor; Harris, Ian A; Nicholas, Michael; Casey, Petrina; Blyth, Fiona; Maher, Christropher G; Cameron, Ian D

    2015-05-01

    There is a lack of longitudinal studies with adequate sample size and follow-up period which have objectively assessed social outcomes among those with mild or moderate musculoskeletal injury or that are not limited to hospital inpatients. We aimed to address this gap by prospectively assessing the potential predictors of return to pre-injury work and daily activities. Persons with mild/moderate musculoskeletal injuries from a vehicle-related crash were surveyed within the first 3 months after the crash (baseline; n=364), and at 12 (n=284) and 24 months (n=252). Participants self-reported return to work, and whether it was return to full or modified duties at work. Analyses were restricted to 170 participants who reported being in pre-injury paid work and had provided information at either 12 months only or at both 12 and 24 months. Return to usual activities was assessed using the European Quality of Life-5 Dimensions (EQ-5D) scale 'Usual Activities' dimension. Twenty-four months after injury 82% (n=121) had returned to work. After multivariable adjustment, not being admitted to hospital was associated with 44% higher likelihood of returning to work at 24 months. Not having any pre-injury chronic illness was associated with returning to work after 24 months, multivariable-adjusted risk ratio (RR), 1.21 (95% confidence intervals, CI: 1.02-1.45). Each 1-SD increase in Medical Outcomes Survey Short Form-12 Mental Component Summary (SF-12 MCS) score at baseline was associated with returning to work at 24 months RR 1.13 (95% CI: 1.02-1.25). Younger age, higher SF-12 physical component summary (PCS), and EQ-5D visual analogue scale (VAS) scores were mutually independent predictors of returning to usual activities 24 months later. A range of bio-psychosocial factors, particularly quality of life measures, independently predicted social outcomes including return to work and return to usual daily activities. These determinants could be measured early in the recovery

  20. Identification of risk factors for neurological deficits in patients with pelvic fractures

    DEFF Research Database (Denmark)

    Schmal, Hagen; Hauschild, Oliver; Culemann, Ulf

    2010-01-01

    This multicenter register study was performed to define injury and fracture constellations that are at risk to develop pelvic associated neural lesions. Data of 3607 patients treated from 2004 to 2009 for pelvic fractures were evaluated for neurological deficits depending on Tile classification, ...

  1. Management of open pelvic fracture in a resource poor setting: a ...

    African Journals Online (AJOL)

    Fractures of the pelvis account for less than 5% of skeletal injuries. Open pelvic fractures are rare, comprising approximately 4% of pelvic fractures. They are caused by significant external trauma with the force usually affecting multiple anatomical sites on the patients body. It has high morbidity and mortality rates of up to 44 ...

  2. [Establishement for regional pelvic trauma database in Hunan Province].

    Science.gov (United States)

    Cheng, Liang; Zhu, Yong; Long, Haitao; Yang, Junxiao; Sun, Buhua; Li, Kanghua

    2017-04-28

    To establish a database for pelvic trauma in Hunan Province, and to start the work of multicenter pelvic trauma registry.
 Methods: To establish the database, literatures relevant to pelvic trauma were screened, the experiences from the established trauma database in China and abroad were learned, and the actual situations for pelvic trauma rescue in Hunan Province were considered. The database for pelvic trauma was established based on the PostgreSQL and the advanced programming language Java 1.6.
 Results: The complex procedure for pelvic trauma rescue was described structurally. The contents for the database included general patient information, injurious condition, prehospital rescue, conditions in admission, treatment in hospital, status on discharge, diagnosis, classification, complication, trauma scoring and therapeutic effect. The database can be accessed through the internet by browser/servicer. The functions for the database include patient information management, data export, history query, progress report, video-image management and personal information management.
 Conclusion: The database with whole life cycle pelvic trauma is successfully established for the first time in China. It is scientific, functional, practical, and user-friendly.

  3. Descriptive Epidemiology of Injuries Sustained in National Collegiate Athletic Association Men's and Women's Volleyball, 2013-2014 to 2014-2015.

    Science.gov (United States)

    Baugh, Christine M; Weintraub, Gil S; Gregory, Andrew J; Djoko, Aristarque; Dompier, Thomas P; Kerr, Zachary Y

    2017-10-01

    There were 18,844 volleyball players in the National Collegiate Athletic Association (NCAA) in the 2014-2015 academic year. Little research has examined sex-based differences among these athletes. To examine injury epidemiology in NCAA men's and women's volleyball athletes. Descriptive epidemiology study. Level 3. Injury surveillance data from the 2013-2014 through 2014-2015 academic years were obtained from the NCAA Injury Surveillance Program for 6 men's and 33 women's collegiate volleyball teams. Injury rates per 1000 athlete-exposures (AEs) and injury rate ratios (IRRs) with 95% CIs were calculated. Time-loss (TL) injuries resulted in participation restriction for at least 24 hours, and non-time-loss (NTL) injuries resulted in participation restriction of less than 24 hours. Overall, 83 and 510 injuries were reported in men and women, respectively, leading to injury rates of 4.69 and 7.07 per 1000 AEs. The injury rate was greater in women than men (IRR, 1.51; 95% CI, 1.19-1.90). TL injury rates were 1.75 and 2.62 per 1000 AEs for men and women, respectively. The ankle was the most commonly injured body part among TL injuries (men, 25.8%; women, 24.3%); the knee was the most commonly injured body part among NTL injuries (men, 25.5%; women, 16.3%). Among TL injuries, common diagnoses included sprains (men, 25.8%; women, 31.2%) and concussions (men, 19.4%; women, 14.8%). Most TL concussions were due to ball contact (men, 83.3%; women, 53.6%). Compared with men, women had a greater NTL overuse injury rate (IRR, 3.47; 95% CI, 1.61-7.46). Compared with women, men had a greater TL injury rate associated with ball contact (IRR, 2.24; 95% CI, 1.07-4.68). There are differences in injury patterns and rates between male and female intercollegiate volleyball players. Although a limited-contact sport, a notable number of concussions were sustained, mostly from ball contact. Understanding injury patterns may aid clinicians in injury diagnosis, management, and prevention.

  4. Assessing the opinions of subjects with or without sustained hand injury about toe-to-thumb transfer

    Directory of Open Access Journals (Sweden)

    Ismail Kucuker

    2015-12-01

    Full Text Available Introduction: Traumatic finger amputations may lead to significant functional and aesthetic impairment yet when compared with the number of finger amputations, toe-to-hand transplantation numbers are very low. Material Method: In this study we aimed to assess the thoughts of healthy subjects, with or without previously sustained hand injury, about toe-to-hand transplantation and re-assess their thoughts following a brief informative description of the surgery. Results: We found that after visual briefing, willingness to undergo toe-to-hand transplantation dramatically increased. Conclusion: Visual briefings including video presentations have a great impact on eliminating negative prejudgement. [Hand Microsurg 2015; 4(3.000: 58-62

  5. [Overactive pelvic floor syndrome].

    Science.gov (United States)

    Rognlid, Maria; Lindsetmo, Rolv-Ole

    2010-10-21

    The etiology of the overactive pelvic floor syndrome is not fully understood and no gold standards are available for diagnosis or treatment. The article presents an overview of literature, and discusses diagnostics and treatment. Literature was identified through a non-systematic search in PubMed, and discussed in light of the authors' clinical experience with the patient group. The main symptoms of overactive pelvic floor syndrome are pain and defecation difficulties; the latter often leads to chronic constipation. Other symptoms depend on which parts of the pelvic floor that are most affected. Pain is often chronic and ranges from mild to severe; it is aggravated by micturition, sexual intercourse, orgasm, defecation and sitting on hard surfaces, and reduces the ability to work and quality of life in general. Injection of Botulinum toxin in the pelvic floor muscles seems to alleviate pain in many patients. Physiotherapy of the pelvic floor and treatment offered by pain clinics can also be useful. A close cooperation between gastroenterologists, surgeons, urologists, gynecologists, neurologists, physiotherapists and possibly pain clinics is important to improve the situation for these patients.

  6. Pelvic floor muscle function in women with pelvic floor dysfunction

    DEFF Research Database (Denmark)

    Tibaek, Sigrid; Dehlendorff, Christian

    2014-01-01

    The objectives of this study were to investigate the level of pelvic floor muscle (PFM) function in women with pelvic floor dysfunction (PFD) referred by gynaecologists and urologists for in-hospital pelvic floor muscle training (PFMT), and to identity associated factors for a low level of PFM...

  7. Pelvic floor muscle training exercises

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/003975.htm Pelvic floor muscle training exercises To use the sharing features on this page, please enable JavaScript. Pelvic floor muscle training exercises are a series of exercises ...

  8. Identifying injuries and motor vehicle collision characteristics that together are suggestive of diaphragmatic rupture.

    Science.gov (United States)

    Reiff, Donald A; McGwin, Gerald; Metzger, Jesse; Windham, Samuel T; Doss, Marilyn; Rue, Loring W

    2002-12-01

    Diaphragmatic rupture (DR) remains a diagnostic challenge because of the lack of an accurate test demonstrating the injury. Our purpose was to identify motor vehicle collision (MVC) characteristics and patient injuries that collectively could identify the presence of a DR. The National Automotive Sampling System was used to identify occupants involved in MVCs from 1995 to 1999 who sustained abdominal (Abbreviated Injury Scale score >or= 2) and/or thoracic injuries (Abbreviated Injury Scale score >or= 2). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to quantify the association between patient injuries, vehicle collision characteristics, and DR. Sensitivity and specificity were also calculated to determine the ability of organ injury and MVC characteristics to correctly classify patients with and without DR. Overall, occupants sustaining a DR had a significantly higher delta-V (DeltaV) (49.8 kilometers per hour [kph] vs. 33.8 kph, psplenic injury (OR, 8.4; 95% CI, 3.9-17.8), pelvic fractures (OR, 4.7; 95% CI, 2.7-8.0), and hepatic injuries (OR, 4.2; 95% CI, 1.7-10.6). Combining frontal or near-side lateral occupant compartment intrusion >or= 30 cm or DeltaV >or= 40 kph with specific organ injuries generated a sensitivity for indicating the likelihood of diaphragm injury ranging from 68% to 89%. Patients with any of the following characteristics had a sensitivity for detecting DR of 91%: splenic injury, pelvic fracture, DeltaV >or= 40 kph, or occupant compartment intrusion from any direction >or= 30 cm. Specific MVC characteristics combined with patient injuries have been identified that are highly suggestive of DR. For this subpopulation, additional invasive procedures including exploratory laparotomy, laparoscopy, or thoracoscopy may be warranted to exclude DR.

  9. The incidence and nature of injuries sustained on grass and 3rd generation artificial turf: a pilot study in elite Saudi National Team footballers.

    Science.gov (United States)

    Almutawa, M; Scott, M; George, K P; Drust, B

    2014-02-01

    To compare the incidence, severity and nature of injuries sustained by Saudi National Team footballers during match-play and training on natural grass and 3rd generation (3G) artificial turf. Injury data was collected on all Saudi National Team players competing at the Gulf Cup (Yemen December 2010: 3G) and the Asian Cup (Qatar January 2011; grass). A total of 49 players were studied (mean ± SD; Age 27 ± 4 yr; body mass 71.4 ± 6.7 kg; height 176.8 ± 6.3 cm; professional playing experience 9 ± 3 yr) of which 31 competed at the Gulf Cup, 32 at the Asian Cup (14 at both). A prospective cohort design was used to investigate the incidence, nature and severity of injuries sustained with data collected using a standardised injury questionnaire. All data were collected by the team physiotherapist with the definition of injury set at any injury that required player and clinician contact. Injury and exposure data were collected and reported for games, training and all football activity. A total of 82 injuries [incidence - 56.1 per 1000 h total game and training exposure] were recorded at the Asian Cup (grass) and 72 injuries [incidence - 37.9 per 1000 h total game and training exposure] were recorded at the Gulf Cup (3G). Incidence data for training, game and all football exposure injury rates were higher when playing on grass. The vast majority of injuries on both surfaces were very minor that, whilst requiring medical attention, did not result in loss of match/training exposure. Injuries that resulted in 1-3 days absence from training or game play had similar incidence rates (Grass: 7.4 vs. 3G: 7.4 injuries per 1000 h exposure). More severe injuries were less frequent but with a higher incidence when playing on grass. Lower limb injuries were the most common in both tournaments with a higher incidence on grass (Grass: 14.2 vs. 3G: 7.9 injuries per 1000 h exposure). Muscle injuries were the most frequent of all injuries with similar incidence rates on

  10. Triple Pelvic Osteotomy and Double Pelvic Osteotomy.

    Science.gov (United States)

    Guevara, Francisco; Franklin, Samuel P

    2017-07-01

    Triple and double pelvic osteotomy (TPO, DPO) are performed with the goal of increasing acetabular ventro-version, increasing femoral head coverage, and decreasing femoral head subluxation. Since the first descriptions of TPO, there have been modifications in technique, most notably omission of the ischial osteotomy for DPO, and improvements in the implants, including availability of locking TPO/DPO bone plates. Associated complication rates seem to have declined accordingly. The most salient questions regarding these procedures remain what selection criteria should be used to identify candidates and whether halting or preventing osteoarthritis is necessary to consider these surgeries clinically beneficial. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Mental fatigue after very severe closed head injury: Sustained performance, mental effort, and distress at two levels of workload in a driving simulator

    NARCIS (Netherlands)

    Riese, H.; Hoedemaeker, M.; Brouwer, W.H.; Mulder, L.J.M.; Cremer, R.; Veldman, J.B.P.

    1999-01-01

    In patients with very severe closed head injury (CHI), returning to work is often problematic. The present study focuses on a persistent complaint of these patients, viz. mental fatigue. To study this, the effect of sustained workload is assessed in a continuous dynamic divided attention task. Three

  12. Mental fatigue after very severe closed head injury : Sustained performance, mental effort, and distress at two levels of workload in a driving simulator

    NARCIS (Netherlands)

    Riese, H; Hoedemaeker, M; Brouwer, WH; Mulder, LJM; Veldman, JBP

    In patients with very severe closed head injury (CHI), returning to work is often problematic. The present study focuses on a persistent complaint of these patients, viz. mental fatigue. To study this, the effect of sustained workload is assessed in a continuous dynamic divided attention task. Three

  13. Bladder management of patients with spinal cord injuries sustained in the 2008 Wenchuan earthquake

    Directory of Open Access Journals (Sweden)

    De-Yi Luo

    2012-11-01

    Full Text Available This study’s aim is provide an overview of the patients who suffered spinal cord injury (SCI after the magnitude 8.0 Wenchuan earthquake, including each patient’s demographic and epidemiological characteristics, bladder management status, and quality of life (QOL. We also assessed the relationships between bladder management methods, symptomatic urinary tract infection (SUTI, and QOL. Two years after the 2008 Wenchuan earthquake, a cross-sectional face-to-face survey was conducted on 180 patients with SCI. A self-administered questionnaire and the WHOQOL-BREF assessment were used to assess injury-related information, bladder management methods, and SUTI. Statistical analysis was performed using the Chi-square test and analysis of variance. A p value <0.05 was considered statistically significant. This study found that a male-to-female ratio of approximately 1.2:1, including 98 (54.4% male patients and 82 (45.6% female patients. Thoracic-level injuries were seen in 82 patients (45.56%, 60 (33.33% patients had lumbar-level injuries, 18 (8.33% patients had thoracolumbar-level injuries, and a small number of patients had cervical- or sacral-level injuries. Sixty-two patients (34.44% demonstrated normal voiding, 65 (36.11% required manually assisted voiding, 29 (16.11% required catheterization, and 24 (13.33% used aurine-collecting apparatus. The prevalence of SUTI was 43.89%. Patients who emptied their bladder via manually assisted voiding, catheterization, or with the use of a urine-collecting apparatus demonstrated higher rates of SUTI compared with patients who voided normally (p < 0.05; the patients who required catheterization had higher rates of SUTI compared with patients who required manually assisted voiding (p < 0.05. When manually assisted voiding and catheterization were compared with the use a urine-collecting apparatus, no statistically significant differences were observed in terms of the risk of developing SUTI. The patients

  14. Anorectal and pelvic floor anatomy

    NARCIS (Netherlands)

    Stoker, Jaap

    2009-01-01

    The anorectum and pelvic floor are crucial in maintaining continence, facilitating evacuation, providing pelvic organ support while in females the pelvic floor is part of the birth canal. The anal sphincter is a multilayered cylindrical structure, including the smooth muscle internal sphincter and

  15. Angioembolization for pelvic hemorrhage control

    DEFF Research Database (Denmark)

    Hauschild, Oliver; Aghayev, Emin; von Heyden, Johanna

    2012-01-01

    BACKGROUND: Hemorrhage from pelvic vessels is a potentially lethal complication of pelvic fractures. There is ongoing controversy on the ideal treatment strategy for patients with pelvic hemorrhage. The aim of the study was to analyze the role of angiography and subsequent embolization in patient...

  16. Current Concepts of Pelvic Congestion and Chronic Pelvic Pain

    Science.gov (United States)

    2001-01-01

    Chronic pelvic pain in women is a common and disabling illness caused by numerous organic pathologies usually accompanied by varying psychological dysfunctions. Many patients may receive misdiagnosis, misdirected therapies, or do not seek help at all. Pelvic congestion may be responsible for pain in patients without more common diseases, such as endometriosis and pelvic adhesions, among others. Our view of this condition is evolving. In the United States, this medical condition remains controversial. More recent research from the United Kingdom has caused a fresh look at the diagnosis and treatment of chronic pelvic pain produced by pelvic congestion. Potentially, many patients may benefit from a reconsideration of this approach. PMID:11394421

  17. Social cognition and its relationship to functional outcomes in patients with sustained acquired brain injury

    Directory of Open Access Journals (Sweden)

    Ubukata S

    2014-11-01

    Full Text Available Shiho Ubukata,1,2 Rumi Tanemura,2 Miho Yoshizumi,1 Genichi Sugihara,1 Toshiya Murai,1 Keita Ueda1 1Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, 2Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan Abstract: Deficits in social cognition are common after traumatic brain injury (TBI. However, little is known about how such deficits affect functional outcomes. The purpose of this study was to investigate the relationship between social cognition and functional outcomes in patients with TBI. We studied this relationship in 20 patients with TBI over the course of 1 year post-injury. Patients completed neurocognitive assessments and social cognition tasks. The social cognition tasks included an emotion-perception task and three theory of mind tasks: the Faux Pas test, Reading the Mind in the Eyes (Eyes test, and the Moving-Shapes paradigm. The Craig Handicap Assessment and Reporting Technique was used to assess functional outcomes. Compared with our database of normal subjects, patients showed impairments in all social cognition tasks. Multiple regression analysis revealed that theory of mind ability as measured by the Eyes test was the best predictor of the cognitive aspects of functional outcomes. The findings of this pilot study suggest that the degree to which a patient can predict what others are thinking is an important measure that can estimate functional outcomes over 1 year following TBI. Keywords: Eyes test, social emotion perception, social function, social participation, theory of mind

  18. NK1.1+ cells promote sustained tissue injury and inflammation after trauma with hemorrhagic shock.

    Science.gov (United States)

    Chen, Shuhua; Hoffman, Rosemary A; Scott, Melanie; Manson, Joanna; Loughran, Patricia; Ramadan, Mostafa; Demetris, Anthony J; Billiar, Timothy R

    2017-07-01

    Various cell populations expressing NK1.1 contribute to innate host defense and systemic inflammatory responses, but their role in hemorrhagic shock and trauma remains uncertain. NK1.1+ cells were depleted by i.p. administration of anti-NK1.1 (or isotype control) on two consecutive days, followed by hemorrhagic shock with resuscitation and peripheral tissue trauma (HS/T). The plasma levels of IL-6, MCP-1, alanine transaminase (ALT), and aspartate aminotransferase (AST) were measured at 6 and 24 h. Histology in liver and gut were examined at 6 and 24 h. The number of NK cells, NKT cells, neutrophils, and macrophages in liver, as well as intracellular staining for TNF-α, IFN-γ, and MCP-1 in liver cell populations were determined by flow cytometry. Control mice subjected to HS/T exhibited end organ damage manifested by marked increases in circulating ALT, AST, and MCP-1 levels, as well as histologic evidence of hepatic necrosis and gut injury. Although NK1.1+ cell-depleted mice exhibited a similar degree of organ damage as nondepleted animals at 6 h, NK1.1+ cell depletion resulted in marked suppression of both liver and gut injury by 24 h after HS/T. These findings indicate that NK1.1+ cells contribute to the persistence of inflammation leading to end organ damage in the liver and gut. © Society for Leukocyte Biology.

  19. Recognizing and treating pelvic pain and pelvic floor dysfunction.

    Science.gov (United States)

    Prather, Heidi; Spitznagle, Theresa Monaco; Dugan, Sheila A

    2007-08-01

    The reported prevalence rates of pain within the pelvis range from 3.8% to 24% in women aged 15 to 73 years. Despite the significant number of women affected, pelvic floor pain and dysfunction are commonly overlooked in women seeking medical care. Physiatrists are uniquely qualified to manage these patients because of their knowledge of the musculoskeletal and nervous systems and their awareness of the relationships among pain, physiology, and function. When evaluating women who have pelvic pain, practitioners must ask questions about history of urinary or fecal incontinence, dyspareunia, or pelvic pain with certain activities or associated with menses, surgery, or trauma. If left unidentified, pelvic floor dysfunction can deter individuals from normal bowel and bladder function, intimacy, and even engagement in work and social functions. This article introduces pelvic floor anatomy, neurophysiology, and function and provides an overview of pelvic pain and pelvic floor dysfunctions and their recognition and treatment.

  20. Epidemiology of Injuries Sustained as a Result of Intentional Player Contact in High School Football, Ice Hockey, and Lacrosse: 2005-2006 Through 2015-2016

    Science.gov (United States)

    Bartley, Justin H.; Murray, Monica F.; Kraeutler, Matthew J.; Pierpoint, Lauren A.; Welton, K. Linnea; McCarty, Eric C.; Comstock, R. Dawn

    2017-01-01

    Background: Lacrosse and ice hockey are quickly growing in popularity, while football remains the most popular sport among high school student-athletes. Injuries remain a concern, given the physical nature of these contact sports. Purpose: To describe the rates and patterns of injuries sustained as a result of intentional player contact in United States high school boys’ football, ice hockey, and lacrosse. Study Design: Descriptive epidemiology study. Methods: We conducted a secondary analysis of High School RIO (Reporting Information Online) data, including exposure and injury data collected from a large sample of high schools in the United States from 2005-2006 through 2015-2016. Data were analyzed to calculate rates, assess patterns, and evaluate potential risk factors for player-to-player contact injuries. Results: A total of 34,532 injuries in boys’ football, ice hockey, and lacrosse occurred during 9,078,902 athlete-exposures (AEs), for a rate of 3.80 injuries per 1000 AEs in the 3 contact sports of interest. The risk of injuries was found to be greater in competition compared with practice for all 3 sports, with the largest difference in ice hockey (rate ratio, 8.28) and the smallest difference in lacrosse (rate ratio, 3.72). In all 3 contact sports, the most commonly injured body site in competition and practice caused by both tackling/checking and being tackled/checked was the head/face. However, a significantly greater proportion of concussions sustained in football were the result of tackling compared with being tackled (28.2% vs 24.1%, respectively). In addition, a significantly greater proportion of concussions were sustained in competition compared with practice for all 3 sports. Conclusion: This study is the first to collectively compare injury rates and injury patterns sustained from intentional player-to-player contact in boys’ high school football, ice hockey, and lacrosse. Notably, there was a relatively high risk of injuries and

  1. Health-related quality of life 24 months after sustaining a minor musculoskeletal injury in a road traffic crash: A prospective cohort study.

    Science.gov (United States)

    Gopinath, Bamini; Jagnoor, Jagnoor; Harris, Ian A; Nicholas, Michael; Casey, Petrina; Blyth, Fiona; Maher, Christopher G; Cameron, Ian D

    2017-04-03

    A better understanding of the long-term factors that independently predict poorer quality of life following mild to moderate musculoskeletal injuries is needed. We aimed to establish the predictors of quality of life (including sociodemographic, health, psychosocial, and pre-injury factors) 24 months after a noncatastrophic road traffic injury. In a prospective cohort study of 252 participants with mild/moderate injury sustained in a road traffic crash, quality of life was measured 24 months following the baseline survey. A telephone-administered questionnaire obtained information on various potential explanatory variables. Health-related quality of life was measured using the European Quality of Life-5 Dimensions (EQ-5D) and Medical Outcomes Survey Short Form-12 (SF-12). Multivariable linear regression analyses determined the associations between explanatory variables and quality of life measures. Mean SF-12 physical component summary (PCS) and mental component summary (MCS) scores increased by 7.3 and 2.5 units, respectively, from baseline to 24-month follow-up. Each 10-year increase in baseline age was independently associated with 3.1-unit (P life measures (EQ-5D summary and/or VAS scores and/ or SF-12 MCS) included marital status, smoking, hospital admission, pre-injury health (anxiety/depression and chronic illness), and whiplash injury. Sociodemographic indicators, pre-injury health, and biopsychosocial correlates were independently associated with health-related quality of life 24 months following a noncatastrophic road traffic crash injury.

  2. Abdominal and Pelvic CT

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    Full Text Available ... to help diagnose the cause of abdominal or pelvic pain and diseases of the internal organs, small bowel and colon, such as: infections such as appendicitis , pyelonephritis or infected fluid collections, also known as abscesses. inflammatory bowel disease such as ulcerative colitis or Crohn's ...

  3. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... traditional x-rays, particularly of soft tissues and blood vessels. top of page What are some common uses of the procedure? This procedure is typically used to help diagnose the cause of abdominal or pelvic pain and diseases of the internal organs, small bowel and colon, ...

  4. [Pelvic floor muscle training and pelvic floor disorders in women].

    Science.gov (United States)

    Thubert, T; Bakker, E; Fritel, X

    2015-05-01

    Our goal is to provide an update on the results of pelvic floor rehabilitation in the treatment of urinary incontinence and genital prolapse symptoms. Pelvic floor muscle training allows a reduction of urinary incontinence symptoms. Pelvic floor muscle contractions supervised by a healthcare professional allow cure in half cases of stress urinary incontinence. Viewing this contraction through biofeedback improves outcomes, but this effect could also be due by a more intensive and prolonged program with the physiotherapist. The place of electrostimulation remains unclear. The results obtained with vaginal cones are similar to pelvic floor muscle training with or without biofeedback or electrostimulation. It is not known whether pelvic floor muscle training has an effect after one year. In case of stress urinary incontinence, supervised pelvic floor muscle training avoids surgery in half of the cases at 1-year follow-up. Pelvic floor muscle training is the first-line treatment of post-partum urinary incontinence. Its preventive effect is uncertain. Pelvic floor muscle training may reduce the symptoms associated with genital prolapse. In conclusion, pelvic floor rehabilitation supervised by a physiotherapist is an effective short-term treatment to reduce the symptoms of urinary incontinence or pelvic organ prolapse. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  5. CT incidence of Morel-Lavallee lesions in patients with pelvic fractures: a 4-year experience at a level 1 trauma center.

    Science.gov (United States)

    Beckmann, Nicholas M; Cai, Chunyan

    2016-12-01

    The aim of this study is to determine the incidence and location of Morel-Lavallee lesions (MLLs) on pelvic CTs performed in evaluation of pelvic fractures and determine if correlation exists between MLLs and mechanism of injury or pelvic ring injury pattern. A retrospective review was performed of pelvic CTs on 1493 consecutive patients presenting with pelvic fractures at our level 1 trauma center. MLLs occurred in 182 of 1493 patients presenting with pelvic fractures. Statistical significance in MLL incidence was found across mechanism of injuries with MLLs being seen most frequently in MCC/ATV accidents and crush injuries. A little over half of MLLs occurred over the lateral thigh with almost all other MLLs occurring over the posterior (flank or lumbar) region. MLLs were much more common in vertical shear and spinopelvic dissociation pelvic ring fracture patterns compared to lateral compression and AP compression patterns. In lateral compression injuries, MLLs most commonly occurred over the thigh. In all other pelvic ring injury patterns, MLLs were predominately posterior. MLL's are not as rare as previously believed. The lateral thigh and lumbar/flank regions should be closely inspected on pelvic trauma patients to identify MLLs, particularly in patients with a spinopelvic dissociation injury pattern.

  6. Motorcycle fuel tanks and pelvic fractures: A motorcycle fuel tank syndrome.

    Science.gov (United States)

    Meredith, Lauren; Baldock, Matthew; Fitzharris, Michael; Duflou, Johan; Dal Nevo, Ross; Griffiths, Michael; Brown, Julie

    2016-08-17

    Pelvic injuries are a serious and commonly occurring injury to motorcycle riders involved in crashes, yet there has been limited research investigating the mechanisms involved in these injuries. This study aimed to investigate the mechanisms involved in pelvic injuries to crashed motorcyclists. This study involved in-depth crash investigation and 2 convenience-based data sets were used. These data sets investigated motorcycle crashes in the Sydney, Newcastle, and Adelaide regions. Participants included motorcycle riders who had crashed either on a public road or private property within the study areas. The mechanism of injury and the type of injuries were investigated. The most frequent cause of pelvic injuries in crashed motorcyclists was due to contact with the motorcycle fuel tank during the crash (85%). For riders who had come into contact with the fuel tank, the injury types were able to be grouped into 3 categories based on the complexity of the injury. The complexity of the injury appeared to increase with impact speed but this was a nonsignificant trend. The pelvic injuries that did not occur from contact with the fuel tank in this sample differed in asymmetry of loading and did not commonly involve injury to the bladder. They were commonly one-sided injuries but this differed based on the point of loading; however, a larger sample of these injuries needs to be investigated. Overall improvements in road safety have not been replicated in the amelioration of pelvic injuries in motorcyclists and improvements in the design of crashworthy motorcycle fuel tanks appear to be required.

  7. Role of pelvic floor in lower urinary tract function.

    Science.gov (United States)

    Chermansky, Christopher J; Moalli, Pamela A

    2016-10-01

    The pelvic floor plays an integral part in lower urinary tract storage and evacuation. Normal urine storage necessitates that continence be maintained with normal urethral closure and urethral support. The endopelvic fascia of the anterior vaginal wall, its connections to the arcus tendineous fascia pelvis (ATFP), and the medial portion of the levator ani muscles must remain intact to provide normal urethral support. Thus, normal pelvic floor function is required for urine storage. Normal urine evacuation involves a series of coordinated events, the first of which involves complete relaxation of the external urethral sphincter and levator ani muscles. Acquired dysfunction of these muscles will initially result in sensory urgency and detrusor overactivity; however, with time the acquired voiding dysfunction can result in intermittent urine flow and incomplete bladder emptying, progressing to urinary retention in severe cases. This review will start with a discussion of normal pelvic floor anatomy and function. Next various injuries to the pelvic floor will be reviewed. The dysfunctional pelvic floor will be covered subsequently, with a focus on levator ani spasticity and stress urinary incontinence (SUI). Finally, future research directions of the interaction between the pelvic floor and lower urinary tract function will be discussed. Copyright © 2015 Elsevier B.V. All rights reserved.

  8. Skeletal injuries associated with sexual abuse

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    Johnson, Karl; Chapman, Stephen [Department of Radiology, Birmingham Children' s Hospital, Steelhouse Lane, B4 6NH, Birmingham (United Kingdom); Hall, Christine M. [Department of Radiology, Great Ormond Street Hospital for Children, London (United Kingdom)

    2004-08-01

    Background: Sexual abuse is often associated with physical abuse, the most common injuries being bruising and other soft-tissue injuries, but fractures occur in 5% of sexually abused children. The fractures described to date have formed part of the spectrum of injuries in these children and have not been specifically related to the abusive act. Objective: To describe concurrent sexual abuse and fractures. Materials and methods: Three children with pelvic or femoral shaft injuries in association with sexual abuse. Results: A 3-year-old girl with extensive soft-tissue injuries to the arms, legs and perineum also sustained fractures of both pubic rami and the sacral side of the right sacro-iliac joint. A 5-month-old girl with an introital tear was shown to have an undisplaced left femoral shaft fracture. A 5-year-old girl presented with an acute abdomen and pneumoperitoneum due to a ruptured rectum following sexual abuse. She had old healed fractures of both pubic rami with disruption of the symphysis pubis. Conclusions: Although the finding of a perineal injury in a young child may be significant enough for the diagnosis of abuse, additional skeletal injuries revealed by radiography will assist in confirmation of that diagnosis and may be more common than hitherto suspected. (orig.)

  9. Racial differences in pelvic anatomy by magnetic resonance imaging.

    Science.gov (United States)

    Handa, Victoria L; Lockhart, Mark E; Fielding, Julia R; Bradley, Catherine S; Brubaker, Linda; Cundiff, Geoffrey W; Ye, Wen; Richter, Holly E

    2008-04-01

    To use static and dynamic magnetic resonance imaging (MRI) to compare dimensions of the bony pelvis and soft tissue structures in a sample of African-American and white women. This study used data from 234 participants in the Childbirth and Pelvic Symptoms Imaging Study, a cohort study of 104 primiparous women with an obstetric anal sphincter tear, 94 who delivered vaginally without a recognized anal sphincter tear and 36 who underwent by cesarean delivery without labor. Race was self-reported. At 6-12 months postpartum, rapid acquisition T2-weighted pelvic MRIs were obtained. Bony and soft tissue dimensions were measured and compared between white and African-American participants using analysis of variance, while controlling for delivery type and age. The pelvic inlet was wider among 178 white women than 56 African-American women (10.7+/-0.7 cm compared with 10.0.+0.7 cm, Ppelvic floor mobility than white women. This difference was not observed among women who had sustained an obstetric sphincter tear. White women have a wider pelvic inlet, wider outlet, and shallower anteroposterior outlet than African-American women. In addition, after vaginal delivery, white women demonstrate less pelvic floor mobility. These differences may contribute to observed racial differences in obstetric outcomes and to the development of pelvic floor disorders.

  10. Pediatric "off-road vehicle" trauma: determinants of injury severity and type.

    Science.gov (United States)

    Sandler, Gideon; Soundappan, Soundappan Sv; Manglick, Maria P; Fahy, Fiona E; Ross, Frank; Lam, Lawrence; Cass, Danny

    2012-12-01

    This study aimed to describe the determinants of the severity and type of injuries sustained by children hurt in off-road vehicle (ORV) accidents. This was a retrospective clinical study for which data were obtained from the trauma database at the Children's Hospital at Westmead covering the 10-year period between January 1, 1998, and December 31, 2007. Data points collected included age, sex, Injury Severity Score (ISS), body region injured, type of vehicle, accident setting, mechanism of injury, estimated speed, position of the rider, use of a helmet and/or protective clothing, and hospital length of stay. The study end points were determinants of injury severity and type. Statistical analysis of the collected data was done with the standard statistical software package, SPSS. A total of 288 children (242 male [84%] and 46 female [16%] patients) presented for ORV-related trauma. Helmets significantly diminished the chance of sustaining a head injury occasioning a skull fracture. Jumping was associated with increased ISS and a higher chance of sustaining an abdominal and/or thoracic injury. Older children were more likely to sustain pelvic and spinal injures, be injured while traveling at high speed, and be injured while going over a jump. Mean ISS was significantly lower if trauma was sustained while riding a mini motorcyle in any setting and any ORV at home. Further research (prospective, federal, and multi-institutional) is needed with a view to optimizing training schedules, rules, regulations, and licensing requirements for pediatric ORV riders.

  11. Massive perineal wound slough after treatment of complex pelvic and acetabular fractures using a traction table.

    Science.gov (United States)

    Hammit, Matthew D; Cole, Peter A; Kregor, Philip J

    2002-09-01

    An operating table with the capacity for skeletal traction against a pudendal post is a helpful and commonly used piece of equipment for certain pelvic and acetabular fracture patterns. Perineal soft tissue trauma and urogenital injuries are associated with some pelvic and acetabular fractures. The perineal region is vulnerable to compromise after such injuries. There is little documentation available in the literature that addresses intraoperative complications of the perineum after the use of a traction table for pelvic fractures. We present here a case in which prolonged traction against a pudendal post during operative fixation of complex pelvic and acetabular fractures resulted in massive perineal wound slough. This case should heighten surgeons' awareness of the vulnerability of the perineum to injury with the use of a traction table and should prompt measures to prevent complications.

  12. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... injuries and bleeding quickly enough to help save lives. Tell your doctor if there’s a possibility you ... injuries and bleeding quickly enough to help save lives. CT has been shown to be a cost- ...

  13. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... scanning is fast, painless, noninvasive and accurate. In emergency cases, it can reveal internal injuries and bleeding ... vessels. CT examinations are fast and simple; in emergency cases, they can reveal internal injuries and bleeding ...

  14. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... accurate. In emergency cases, it can reveal internal injuries and bleeding quickly enough to help save lives. ... kidney and bladder stones. abdominal aortic aneurysms (AAA), injuries to abdominal organs such as the spleen, liver, ...

  15. Management of pelvic chondrosarcoma

    Directory of Open Access Journals (Sweden)

    Florin Groșeanu

    2016-11-01

    Full Text Available The partial or complete excision of the hemipelvis with sparing of the lower limb is an option of the treatment of pelvic chondrosarcoma and a therapeutic alternative of the interilio-abdominal disarticulation. The operation has in principle the same indications as the interilio-abdominal disarticulation and offers a good solution for avoiding a mutilating operation. The 149 cases include: 120 biopsies, 29 excisional biopsies, 6 interilioabdominal disarticulations and 14 resections – reconstruction’s, one of with prosthetic reconstruction. The prognostic score was established by assessing: the surgical stage, the site of the tumor, the surgical margins of the tumor, the functional mobility and the postoperative activity. The wide excision of the tumor, a stable reconstruction and an efficient recovery are essential for a successful treatment of pelvic chondrosarcoma. The limb sparing resection-reconstruction represents a highly surgical demanding procedure, followed up by complications in 60% of the cases, so that should be performed only by high skilled surgeons. Hemipelvectomy still remains a well-established life-saving surgery method for patients suffering from vast oncological extensions, where a pelvic resection is not an option.

  16. Pelvic reconstruction improves pelvic floor strength in pelvic organ prolapse patients.

    Science.gov (United States)

    Guan, Zhong; Li, Huai-Fang; Yang, Xiang; Guo, Li-Li

    2015-10-01

    To evaluate pelvic floor muscle strength after the modified pelvic reconstruction procedure for pelvic organ prolapse (POP). Patients were assigned to two groups consisting of 37 patients diagnosed with POP and undergoing modified pelvic reconstruction (reconstruction group), and 30 patients admitted to our hospital during the same period for other surgical indications (control group). Vaginal palpation of pelvic floor muscle strength was performed according to the modified Oxford grading system before operating on the two groups and again in the 3(rd) month following surgery for the reconstruction group. A comparative study was performed to evaluate the differences between the two groups and the improvement of pelvic floor muscle strength in the reconstruction group. The pelvic floor muscle strength was significantly improved postoperatively when compared with preoperative results in the reconstruction group (t = -17.478, p pelvic reconstruction procedure could improve pelvic floor muscle strength in POP patients, which remains lower when compared with the normal population. Pelvic floor muscle strength should be included in the assessment of surgical outcomes in POP. Copyright © 2015. Published by Elsevier B.V.

  17. Anorectal and pelvic floor anatomy.

    Science.gov (United States)

    Stoker, Jaap

    2009-01-01

    The anorectum and pelvic floor are crucial in maintaining continence, facilitating evacuation, providing pelvic organ support while in females the pelvic floor is part of the birth canal. The anal sphincter is a multilayered cylindrical structure, including the smooth muscle internal sphincter and the outer striated muscle layer. The latter comprises the external sphincter as lower outer half and puborectalis as upper outer half of the sphincter. The external sphincter is continuous with the rectum at the anorectal junction. The pelvic floor constitutes four principal layers: endopelvic fascia, the muscular pelvic diaphragm (commonly referred to as levator plate), the perineal membrane (urogenital diaphragm) and the superficial transverse perineii. Anorectum and pelvic floor have multiple interconnections by fascia and ligaments as well as multiple indirect connections to the bony pelvis. Other structures as perineal body and a fibro-elastic network add to this support.

  18. Source of bleeding in trauma patients with pelvic fracture and haemodynamic instability.

    Science.gov (United States)

    Montmany, Sandra; Rebasa, Pere; Luna, Alexis; Hidalgo, José M; Cánovas, Gabriel; Navarro, Salvador

    2015-01-01

    The main cause of mortality in trauma patients with pelvic fractures is hypovolemic shock. We analyzed the association between the source of bleeding, mechanism of action and type of fracture. Prospective descriptive study involving trauma patients older than 16 years old, admitted to the intensive care unit or dead before admission, with pelvic fractures and hemodynamic instability. Hemodynamic instability was defined as SBP 100 beats/min. Pelvic fracture was defined by the Tile classification. A total of 157 of 1088 trauma patients had pelvic fracture. We included 63 patients, all hemodynamically unstable. A total of 85% of pelvic fractures after falls from great heights bled from the fracture itself, compared to only 44% of victims of impact (hit). A total of 65% of patients with stable pelvic fracture bled from associated lesions; 70% of patients with unstable fracture bled from the fracture itself. There is an interaction between the mechanism of action and type of fracture. The probability of pelvic bleeding is higher in the precipitated patient (> 80%) regardless of the type of fracture. Bleeding from associated injuries is greater in impact victims, doubling when the fracture is stable (91%). Mechanism of action is a key to determine the source of bleeding in patients with pelvic fracture. After falls patients bleed from the fracture itself, while patients with an impact (hit) can bleed both from the fracture and associated injuries, depending on the type of fracture. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Primary versus delayed repair for bile duct injuries sustained during cholecystectomy: results of a survey of the Association Francaise de Chirurgie.

    Science.gov (United States)

    Iannelli, Antonio; Paineau, Jacques; Hamy, Antoine; Schneck, Anne-Sophie; Schaaf, Caroline; Gugenheim, Jean

    2013-08-01

    Bile duct injuries (BDIs) sustained during a cholecystectomy still remain a major surgical problem, and it is still not clear whether the injury should be repaired immediately or a delayed repair is preferred. A retrospective national French survey was conducted to compare the results of immediate (at time of cholecystectomy), early (within 45 days after a cholecystectomy) and late (beyond 45 days after a cholecystectomy) surgical repair for BDI sustained during a cholecystectomy. Forty-seven surgical centres provided 640 cases of bile duct injury sustained during a cholecystectomy of which 543 were analysed for the purpose of the present study. The timing of repair was immediate in 194 cases (35.7%), early in 216 cases (39.8%) and late in 133 cases (24.5%). The type of repair was a suture repair in 157 cases (81%), and a bilio-digestive reconstruction in 37 cases (19%) for immediate repair; a suture repair in 119 cases (55.1%) and a bilio-digestive anastomosis in 96 cases (44.9%) for the early repair; and a bilio-digestive reconstruction in 129 cases (97%) and a suture repair in 4 cases (3%) for late repair. A second procedure was required in 110 cases (56.7%) for immediate repair, 80 cases (40.7%) for early repair (P < 0.05) and in 9 cases (6.8%) for late repair (P < 0.001). The timing of surgical repair for a bile duct injury sustained during a cholecystectomy influences significantly the rate of a second procedure and a late repair should be preferred option. © 2012 International Hepato-Pancreato-Biliary Association.

  20. Neurobiological Mechanisms of Pelvic Pain

    Science.gov (United States)

    Leone Roberti Maggiore, Umberto; Candiani, Massimo

    2014-01-01

    Pelvic pain is a common condition which significantly deteriorates health-related quality of life. The most commonly identified causes of pain in the pelvic region are gynaecologic, urologic, gastrointestinal, neurological, and musculoskeletal. However, in up to 33% of patients the source of this symptom is not identified, frustrating both patients and health-care professionals. Pelvic pain may involve both the somatic and visceral systems, making the differential diagnosing challenging. This paper aimed to review the mechanisms involved in pelvic pain perception by analyzing the neural plasticity and molecules which are involved in these complex circuits. PMID:25110704

  1. Musculoskeletal etiologies of pelvic pain.

    Science.gov (United States)

    Prather, Heidi; Camacho-Soto, Alejandra

    2014-09-01

    Several musculoskeletal diagnoses are frequently concomitant with pelvic floor pathology and pain. The definition of pelvic pain itself often depends on the medical specialist evaluating the patient. Because there is variability among disorders associated with pelvic pain, patients may seek treatment for extended periods as various treatment options are attempted. Further, health care providers should recognize that there may not be a single source of dysfunction. This article discusses the musculoskeletal disorders of the pelvic girdle (structures within the bony pelvis) and their association with lumbar spine and hip disorders. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. A qualitative investigation into nurses' perceptions of factors influencing staff injuries sustained during physical interventions employed in response to service user violence within one secure learning disability service.

    Science.gov (United States)

    Lovell, Andrew; Smith, Debra; Johnson, Paula

    2015-07-01

    The aim of the study was to examine learning disability nurses' perceptions of incidents involving physical intervention, particularly factors contributing to injuries sustained by this group. This article reports on a qualitative study undertaken within one secure NHS Trust to respond to concerns about staff injuries sustained during physical interventions to prevent incidents of service user violence from escalating out of control. The context of the study relates to increasing debate about the most effective approaches to incidents of violence and agression. A qualitative research design was utilized for the study. Semi-structured interviews were undertaken with 20 participants, two from each of the 10 incidents involving staff injury sustained during physical intervention. Four themes were produced by the analysis, the first, knowledge and understanding, contextualized the other three, which related to the physical intervention techniques employed, the interpretation of the incident and the impact on staff. Service user violence consistently poses nurses with the challenge of balancing the need to respond in order to maintain the safety of everyone whilst simultaneous supporting and caring for people with complex needs. This study highlights the need for further exploration of the contributory factors to the escalation of potentially violent situations. Services may have good systems in place for responding to and managing service user violence but appear less effective in understanding the reasons for and developing strategies to prevent violence occurring. © 2015 John Wiley & Sons Ltd.

  3. Road Traffic Related Injury Research and Informatics. New Opportunities for Biomedical and Health Informatics as a Contribution to the United Nations' Sustainable Development Goals?

    Science.gov (United States)

    Al-Shorbaji, N; Haux, R; Krishnamurthy, R; Marschollek, M; Mattfeld, D C; Bartolomeos, K; Reynolds, T A

    2015-01-01

    The United Nations has recently adopted 17 sustainable development goals for 2030, including ensuring healthy lives and promoting well-being for all at all ages, and making cities and human settlements inclusive, safe, resilient and sustainable. Road injuries remain among the ten leading causes of death in the world, and are projected to increase with rapidly increasing motorisation globally. Lack of comprehensive data on road injuries has been identified as one of the barriers for effective implementation of proven road safety interventions. Building, linking and analysing electronic patient records in conjunction with establishing injury event and care registries can substantially contribute to healthy lives and safe transportation. Appropriate use of new technological approaches and health informatics best practices could provide significant added value to WHO's global road safety work and assist Member States in identifying prevention targets, monitoring progress and improving quality of care to reduce injury-related deaths. This paper encourages the initiation of new multidisciplinary research at a global level.

  4. Protective effect of SP600125 against liver cell injury in rats under repeated and sustained high +Gz exposure

    Directory of Open Access Journals (Sweden)

    Wen-bing LI

    2015-01-01

    Full Text Available Objective To explore the effect of JNK inhibitor SP600125 on expression of JNK/c-jun in liver cells of rats under repeated and sustained high +Gz exposure and its mechanism of the effect. Methods Eighteen inbred adult male Wistar rats were randomly divided into control group, +10Gz group and SP600125 group (n=6. The rats in +10Gz group and SP600125 group were fixed to the rotating arm of a centrifuge with head towards the axis. The increase rate of acceleration was 1G/s with a peak-time of 3 minutes, and the +Gz exposure was repeated 5 times with an interval of 30 minutes. SP600125 was given to rats of SP600125 group 30 minutes before the first centrifugation by intraperitoneal injection. All of the animals were sacrificed 30 minutes after centrifugation. Blood samples were collected from inferior vena cava to determine the plasma level of aspartate aminotransferase (AST and alanine aminotransferase (ALT. The expression of c-jun mRNA was determined by quantitative real-time RT-PCR (qRTPCR. The expressions of p-JNK, JNK, p-c-jun and c-jun protein were determined by Western blotting. The morphological change in the liver tissue was observed after HE staining. Results The plasma level of ALT and AST, expression level of c-jun mRNA and p-JNK, p-c-jun, c-jun protein in the liver tissue of SP600125 group were significantly higher than those of control group (P0.05. HE staining revealed disorganized hepatic cords, irregular liver cells, vacuolar changes, and marked edema of hepatocytes, and collapsed hepatic sinusoids in +10Gz group, but these changes were alleviated obviously in SP600125 group. Conclusion SP600125 could alleviate the liver cell injury in rats under repeated and sustained high +Gz exposure. DOI: 10.11855/j.issn.2577-7402.2014.11.02

  5. Pelvic floor physical therapy in urogynecologic disorders.

    Science.gov (United States)

    Kotarinos, Rhonda K

    2003-08-01

    Physical therapists are uniquely qualified to treat pelvic floor dysfunction with conservative management techniques. Techniques associated with incontinence and support functions of the pelvic floor include bladder training and pelvic floor rehabilitation: pelvic floor exercises, biofeedback therapy, and pelvic floor electrical stimulation. Pain associated with mechanical pelvic floor dysfunction can be treated by physical therapists utilizing various manual techniques and modalities. Research documents that conservative management is effective in treating many conditions associated with pelvic floor dysfunction. Research should be conducted to determine if addressing diastasis recti and contracture of the pelvic floor musculature should be a component of the standard physical therapy protocol.

  6. Paediatric acetabular fractures. Data from the German Pelvic Trauma Registry Initiative.

    Science.gov (United States)

    von Heyden, Johanna; Hauschild, Oliver; Strohm, Peter C; Stuby, Fabian; Südkamp, Norbert P; Schmal, Hagen

    2012-10-01

    The aim of this study was to present an analysis of acetabular fractures during childhood as compared to those in adults. Within a multicenter register study, data of 3 time periods (1991-93, 1998-2000, 2004-2008) were pooled and analyzed for incidence, epidemiology, classification, outcome and treatment of acetabular fractures in children (< 15 years). One hundred fifty three children (2.1%) among 7360 patients with pelvic fractures were included in the study. Only 15 children sustained an acetabular fracture (9.8%). Simple fracture types according to Letournels' classification were more frequent in paediatric patients (p < 0.01), receiving less often operative treatment. Multiple injuries were present in 36% of children, the average Injury Severity Score (ISS) of all children was 17 points. Clinical results were good with an average Merle d'Aubigné score of 16.4 points and a Karnofsky performance of 90%. Fractures of the acetabulum in childhood remain a rare injury with distinct fracture characteristics, usually caused by high impact accidents.

  7. Bioelectrical activity of the pelvic floor muscles after 6-week biofeedback training in nulliparous continent women.

    Science.gov (United States)

    Chmielewska, Daria; Stania, Magdalena; Smykla, Agnieszka; Kwaśna, Krystyna; Błaszczak, Edward; Sobota, Grzegorz; Skrzypulec-Plinta, Violetta

    2016-01-01

    The aim of the study was to evaluate the effects of a 6-week sEMG-biofeedback-assisted pelvic floor muscle training program on pelvic floor muscle activity in young continent women. Pelvic floor muscle activity was recorded using a vaginal probe during five experimental trials. Biofeedback training was continued for 6 weeks, 3 times a week. Muscle strenghtening and endurance exercises were performed alternately. SEMG (surface electromyography) measurements were recorded on four different occasions: before training started, after the third week of training, after the sixth week of training, and one month after training ended. A 6-week sEMG-biofeedback-assisted pelvic floor muscle training program significantly decreased the resting activity of the pelvic floor muscles in supine lying and standing. The ability to relax the pelvic floor muscles after a sustained 60-second contraction improved significantly after the 6-week training in both positions. SEMG-biofeedback training program did not seem to affect the activity of the pelvic floor muscles or muscle fatigue during voluntary pelvic floor muscle contractions. SEMG-biofeedback-assisted pelvic floor muscle training might be recommended for physiotherapists to improve the effectiveness of their relaxation techniques.

  8. Pharmacokinetics of fluconazole in critically ill patients with acute kidney injury receiving sustained low-efficiency diafiltration.

    Science.gov (United States)

    Sinnollareddy, Mahipal G; Roberts, Michael S; Lipman, Jeffrey; Robertson, Thomas A; Peake, Sandra L; Roberts, Jason A

    2015-02-01

    Fluconazole is a widely used antifungal agent in critically ill patients. It is predominantly (60-80%) excreted unchanged in urine. Sustained low-efficiency diafiltration (SLED-f) is increasingly being utilised in critically ill patients because of its practical advantages over continuous renal replacement therapy. To date, the effect of SLED-f on fluconazole pharmacokinetics and dosing has not been studied. The objective of this study was to describe the pharmacokinetics of fluconazole in critically ill patients with acute kidney injury receiving SLED-f and to compare this with other forms of renal replacement therapy. Serial blood samples were collected at pre- and post-filter ports within the SLED-f circuit during SLED-f and from an arterial catheter before and after SLED-f from three patients during one session. Fluconazole concentrations were measured using a validated chromatography method. Median clearance (CL) and 24-h area under the concentration-time curve (AUC0-24) were 2.1L/h and 152 mg·h/L, respectively, whilst receiving SLED-f. Moreover, 72% of fluconazole was cleared by a single SLED-f session (6h) compared with previous reports of 33-38% clearance by a 4-h intermittent haemodialysis session. CL and AUC0-24 were comparable with previous observations in a pre-dilution mode of continuous venovenous haemodiafiltration. The observed rebound concentration of fluconazole post SLED-f was 200mg daily are likely to be required to achieve the PK/PD target for common pathogens because of significant fluconazole clearance by SLED-f. Crown Copyright © 2014. Published by Elsevier B.V. All rights reserved.

  9. [Quality of life in women after anterior pelvic exenteration].

    Science.gov (United States)

    Loran, O B; Veliev, E I; Seregin, A V; Khachatryan, A L; Guspanov, R I; Seregin, I V

    2016-04-01

    60 women, who underwent anterior pelvic exenteration with different types of urine derivation since 2004 till 2014 years in urology department, RMAPO, S.P. Botkin city hospital, were included in retrospective investigation. Middle age of patients was 53,2+/-3 (32-68). 38 women with bladder cancer and 22 women with urinary injuries after radiation therapy underwent anterior pelvic exenteration. Aim of this work is to perform quality of life comparison of patients after anterior pelvic exenteration with different types of urine derivation. Patients were divided in 3 groups: 1-st group 39 (65%) women, who underwent Brickers operation, 2-nd group 19 (31,66% ) women, who had Studers operation and 3-rd group - 2 (3,34%), patients who underwent continent urine derivation with formation of catheterizing urinary reservoir. Questionnaire (SF-36) was used to evaluate quality of life. Observation period was from 2 to 10 years. Postsurgical lethality was 3%, 5-years survival rate was 60,9+/-15,8% and 5-years recurrence-free survival rate was 55,4+/-12,6%. We established that quality of life in women who underwent orthotopic urine derivation was higher than in patients who underwent incontinent ileoconduit formation. Better quality of life was demonstrated by women, who had catheterizing urinary reservoir, but it is difficult to compare this group with the others, because of small number of patients with heterotopic catheterizing reservoir. Regarding the results of our investigation we made next conclusions: In spite of difficult technique, high risk of postoperative complications and lethality, anterior pelvic exenteration provide 5-years survival rate for 70% of patients In locally advanced tumors of pelvic organs anterior pelvic exenteration is salvational operation and keep satisfactory quality of life Orthotopic intestinal urine derivation is better to provide satisfactory quality of life for patients with invasive bladder cancer. For women with urinary injuries after

  10. Laparoscopy for pelvic floor disorders.

    Science.gov (United States)

    Van Geluwe, B; Wolthuis, A; D'Hoore, A

    2014-02-01

    Surgical treatment of pelvic floor disorders has significantly evolved during the last decade, with increasing understanding of anatomy, pathophysiology and the minimally-invasive 'revolution' of laparoscopic surgery. Laparoscopic pelvic floor repair requires a thorough knowledge of pelvic floor anatomy and its supportive components before repair of defective anatomy is possible. Several surgical procedures have been introduced and applied to treat rectal prolapse syndromes. Transabdominal procedures include a variety of rectopexies with the use of sutures or prosthesis and with or without resection of redundant sigmoid colon. Unfortunately there is lack of one generally accepted standard treatment technique. This article will focus on recent advances in the management of pelvic floor disorders affecting defecation, with a brief overview of contemporary concepts in pelvic floor anatomy and different laparoscopic treatment options. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  11. Radiologic imaging and percutaneous treatment of pelvic lymphocele

    Energy Technology Data Exchange (ETDEWEB)

    Karcaaltincaba, Musturay [Department of Radiology, Division of Abdominal and Interventional Radiology, Hacettepe University School of Medicine, Sihhiye, Ankara 06100 (Turkey); Akhan, Okan [Department of Radiology, Division of Abdominal and Interventional Radiology, Hacettepe University School of Medicine, Sihhiye, Ankara 06100 (Turkey)]. E-mail: oakhan@hacettepe.edu.tr

    2005-09-01

    Pelvic lymphocele, also known as lymphocyst, is a cystic structure caused by lymphatic injury usually secondary to pelvic lymphadenectomy and renal transplantation. Lymphoceles can cause morbidity and rarely mortality by compression of adjacent structures and infectious complications. This review discusses etiology and treatment options for pelvic lymphoceles including surgical and percutaneous methods with emphasis on percutaneous techniques particularly in conjunction with sclerotherapy. Percutaneous catheter drainage with sclerotherapy procedure with various sclerosing agents is described in detail. Ethanol, povidone-iodine, tetracycline, doxycycline, bleomycin, talc and fibrin glue can be used as sclerosing agents. Combination of sclerosing agents to percutaneous catheter drainage significantly improves success rate in the treatment of pelvic lymphoceles. Infected lymphoceles are usually treated solely with percutaneous catheter drainage. Percutaneous treatment can be tailored according to volume of lymphoceles. We generally prefer single session sclerotherapy and 1 day catheter drainage in lymphoceles less than 150 mL, and larger ones are treated by multi-session sclerotherapy until daily drainage decreases below 10 mL. Percutaneous treatment preferably with sclerotherapy should be considered as the first-line treatment modality for pelvic lymphoceles due to its effectiveness, widespread applicability on an outpatient basis, ease of procedure and low complication rate.

  12. Pelvic Muscle Rehabilitation: A Standardized Protocol for Pelvic Floor Dysfunction

    Directory of Open Access Journals (Sweden)

    Rodrigo Pedraza

    2014-01-01

    Full Text Available Introduction. Pelvic floor dysfunction syndromes present with voiding, sexual, and anorectal disturbances, which may be associated with one another, resulting in complex presentation. Thus, an integrated diagnosis and management approach may be required. Pelvic muscle rehabilitation (PMR is a noninvasive modality involving cognitive reeducation, modification, and retraining of the pelvic floor and associated musculature. We describe our standardized PMR protocol for the management of pelvic floor dysfunction syndromes. Pelvic Muscle Rehabilitation Program. The diagnostic assessment includes electromyography and manometry analyzed in 4 phases: (1 initial baseline phase; (2 rapid contraction phase; (3 tonic contraction and endurance phase; and (4 late baseline phase. This evaluation is performed at the onset of every session. PMR management consists of 6 possible therapeutic modalities, employed depending on the diagnostic evaluation: (1 down-training; (2 accessory muscle isolation; (3 discrimination training; (4 muscle strengthening; (5 endurance training; and (6 electrical stimulation. Eight to ten sessions are performed at one-week intervals with integration of home exercises and lifestyle modifications. Conclusions. The PMR protocol offers a standardized approach to diagnose and manage pelvic floor dysfunction syndromes with potential advantages over traditional biofeedback, involving additional interventions and a continuous pelvic floor assessment with management modifications over the clinical course.

  13. Numerical simulation of the damage evolution in the pelvic floor muscles during childbirth.

    Science.gov (United States)

    Oliveira, Dulce A; Parente, Marco P L; Calvo, Begoña; Mascarenhas, Teresa; Natal Jorge, Renato M

    2016-02-29

    Several studies have shown that pelvic floor injuries during a vaginal delivery can be considered a significant factor in the development of pelvic floor dysfunction. Such disorders include a group of conditions affecting women like urinary incontinence, pelvic organ prolapse and fecal incontinence. Numerical simulations are valuable tools that are contributing to the clarification of the mechanisms behind pelvic floor disorders. The aim of this work is to propose a mechanical model implemented in the finite element method context to estimate the damage in the pelvic floor muscles by mechanical effects during a vaginal delivery of a fetus in vertex presentation and occipitoanterior position. The constitutive model adopted has already been successfully used in the simulation of childbirth and the structural damage model added has previously been applied to characterize the damage process in biological soft tissues undergoing finite deformations. The constitutive parameters were fit to experimental data available in the literature and the final proposed material model is suitable to estimate the mechanical damage in the pelvic floor muscle during a vaginal delivery. The computational model predicts that even an apparently uneventful vaginal delivery inflicts injuries to the pelvic floor muscles, particularly during the extension of the fetus head, having been obtained more than 10% of damaged fibers. As a clinical evidence, the present work allows to conclude that the puborectalis component of the levator ani muscle is the most prone to damage. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Unusual Bones Articulating With the Pelvic Girdle

    African Journals Online (AJOL)

    the pectoral girdle but none for the pelvis (3,4). Acces- sory pelvic bones may offer ... Pelvic radiographs demonstrated accessory pelvic bones, with all the appearances of clavicles, articulating with the pelvic girdle. Unlike in the normal clavicle, these bones were on the posterior ... the clavicular fracture (4). These accessory ...

  15. Post-traumatic urethrocutaneous fistula with pelvic fracture in a boy: A case report and literature review

    Directory of Open Access Journals (Sweden)

    Charu Tiwari

    2016-09-01

    Full Text Available Traumatic genitourinary injuries especially urethral injuries are rare in children. Most of these injuries occur in conjunction with a pelvic fracture after blunt trauma. These injuries call for an immediate diagnosis and appropriate management. Good results have been reported after delayed repair. However, urethral stricture, incontinence and erectile dysfunction are the known complications. We report a traumatic urethral injury causing urethrocutaneous fistula in a seven year boy

  16. Pregnancy-induced adaptations in intramuscular extracellular matrix of rat pelvic floor muscles.

    Science.gov (United States)

    Alperin, Marianna; Kaddis, Timothy; Pichika, Rajeswari; Esparza, Mary C; Lieber, Richard L

    2016-08-01

    Birth trauma to pelvic floor muscles is a major risk factor for pelvic floor disorders. Intramuscular extracellular matrix determines muscle stiffness, supports contractile component, and shields myofibers from mechanical strain. Our goal was to determine whether pregnancy alters extracellular matrix mechanical and biochemical properties in a rat model, which may provide insights into the pathogenesis of pelvic floor muscle birth injury. To examine whether pregnancy effects were unique to pelvic floor muscles, we also studied a hind limb muscle. Passive mechanical properties of coccygeus, iliocaudalis, pubocaudalis, and tibialis anterior were compared among 3-month old Sprague-Dawley virgin, late-pregnant, and postpartum rats. Muscle tangent stiffness was calculated as the slope of the stress-sarcomere length curve between 2.5 and 4.0 μm, obtained from a stress-relaxation protocol at a bundle level. Elastin and collagen isoform concentrations were quantified by the use of enzyme-linked immunosorbent assay. Enzymatic and glycosylated collagen crosslinks were determined by high-performance liquid chromatography. Data were compared by the use of repeated-measures, 2-way analysis of variance with Tukey post-hoc testing. Correlations between mechanical and biochemical parameters were assessed by linear regressions. Significance was set to P pelvic floor muscle stiffness did not differ from virgins (P > .3). A substantial increase in collagen V in coccygeus and pubocaudalis was observed in late-pregnant, compared with virgin, animals, (P pelvic floor muscles (P pelvic floor muscles, the tibialis anterior was unaltered by pregnancy. In contrast to other pelvic tissues, pelvic floor muscle stiffness increased in pregnancy, returning to prepregnancy state postpartum. This adaptation may shield myofibers from excessive mechanical strain during parturition. Biochemical alterations in pelvic floor muscle extracellular matrix due to pregnancy include increase in collagen V

  17. Significance of clinical examination, CT and MRI scan in the diagnosis of posterior pelvic ring fractures.

    Science.gov (United States)

    Nüchtern, J V; Hartel, M J; Henes, F O; Groth, M; Jauch, S Y; Haegele, J; Briem, D; Hoffmann, M; Lehmann, W; Rueger, J M; Großterlinden, L G

    2015-02-01

    Patients with a fracture in the anterior pelvic ring often simultaneously demonstrate pain in the posterior pelvic ring. The aim of the present prospective study was to assess the sensitivity of CT, MRI and clinical examination in the detection of fractures in the posterior pelvic ring in patients with fractures of the anterior pelvic ring diagnosed in conventional radiographs. Sixty patients with radiographic signs of an anterior pelvic ring injury were included in this prospective analysis. Following a focused clinical examination of the posterior pelvis, all patients underwent both a CT and then a MRI scan of their pelvis. Two board certified radiologists evaluated the CT and MRI scans independently. To estimate the presence of osteoporosis the Hounsfield units of the vertebral body of L5 were measured in each case. Fifty-three women and seven men, with a mean age of 74.7+/-15.6 years were included into the study. A fracture of the posterior pelvic ring was found in fourty-eight patients (80%) patients using MRI. Fractures of the posterior pelvic ring would have been missed in eight cases (17%), if only CT had been used. Eighty-five percent of the patients with a posterior fracture had an osteoporosis. The majority of the cases suffered from a low energy trauma. Thirty-eight patients (83%) with positive clinical signs at the posterior pelvic ring actually had a fracture of the posterior pelvic ring in the MRI. The clinical examination proved to be equally effective to CT in detecting posterior pelvic ring fractures. The significance of both, clinical examination and CT was confirmed in the detection of fractures in the posterior pelvic ring. MRI examination of the pelvis however, was found to be superior in detecting undislocated fractures in a cohort of patients with a high incidence of osteoporosis. Using MRI may be beneficial in select cases, especially when reduced bone density is suspected. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Acute kidney injury secondary to iatrogenic bilateral ureteric ligation ...

    African Journals Online (AJOL)

    Background: Bilateral ureteric injury, although rare is a complication that could follow obstetric, gynaecologic and other pelvic surgeries. Majority of cases are diagnosed postoperatively, hence a high index of suspicion is required in patients who develop acute kidney injury (AKI) following abdomino-pelvic surgeries.

  19. An epidemiological study on pattern of thoraco-abdominal injuries sustained in fatal road traffic accidents of Bangalore: Autopsy-based study

    Directory of Open Access Journals (Sweden)

    N Bayapa Reddy

    2014-01-01

    Full Text Available Background: The statistical profile reflects a global estimate of 5.1 million deaths in 2000, which was due to injuries that accounted for 10% of deaths due to all causes. Out of this, a quarter of injury-related deaths occurred in the South-East Asian region. Road Traffic Accident (RTA is one among the top 5 causes of morbidity and mortality in South-East Asian countries. Most common cause of blunt abdominal trauma in India is road traffic accident followed by pedestrian accidents, abdominal blows, and fall from heights. Aims: To analyze the epidemiology and pattern of fatal thoraco-abdominal injuries in road traffic accidents. Materials and Methods: An autopsy-based cross-sectional study conducted. A purposive sampling technique was applied to select the study sample of 100 post-mortems of road traffic accident between November 2008 and May 2010 subjected to medico-legal autopsy at the department of Forensic Medicine, KIMS Hospital Bangalore. Results: The majority of the victims were aged 21 to 40 years, 50 (50.0%, most of the victims were male 92 (92.0%; and male/female ratio was 11.5:1. Commonest offending agents in heavy motor vehicles were 54 (54.0%. Bony cage sustained injuries were observed in 71; out of this, fractures of ribs were observed in 45 (63.3% victims, clavicle in 14 (19.7%, sternum was 6 (8.4%, and vertebrae 6 (8.4% of fatal road traffic accidents. Internal thoracic injuries were observed in 26 cases. Among internal thoracic injuries, lungs were the most commonly involved organ 24 (92.3% followed by the heart 2 (7.6%. Lung sustained more lacerations 19 (79.1% than contusions 5 (20.8%. Internal abdominal injuries were observed in 49 cases. In road traffic accidents, the most commonly injured abdominal organs were solid organs such as liver 16 (32.6% followed by spleen 9 (18.3%. Conclusions: Majority of the times in road traffic accidents, young and productive males were injured or lost their life. This study may help the

  20. More than 50% of players sustained a time-loss injury (>1 day of lost training or playing time) during the 2012 Super Rugby Union Tournament: a prospective cohort study of 17,340 player-hours.

    Science.gov (United States)

    Schwellnus, Martin P; Thomson, Alan; Derman, Wayne; Jordaan, Esme; Readhead, Clint; Collins, Rob; Morris, Ian; Strauss, Org; Van der Linde, Ewoudt; Williams, Arthur

    2014-09-01

    Professional Rugby Union is a contact sport with a high risk of injury. To document the incidence and nature of time-loss injuries during the 2012 Super Rugby tournament. Prospective cohort study. 2012 Super Rugby tournament (Australia, New Zealand, South Africa). 152 players from 5 South African teams. Team physicians collected daily injury data through a secure, web-based electronic platform. Data included size of the squad, type of day, main player position, training or match injury, hours of play (training and matches), time of the match injury, mechanism of injury, main anatomical location of the injury, specific anatomical structure of the injury, the type of injury, the severity of the injury (days lost). The proportion (%) of players sustaining a time-loss injury during the tournament was 55%, and 25% of all players sustained >1 injury. The overall incidence rate (IR/1000 player-hours) of injuries was 9.2. The IR for matches (83.3) was significantly higher than for training (2.1) and the IR was similar for forwards and backs. Muscle/tendon (50%) and joint/ligament (32.7%) injuries accounted for >80% of injuries. Most injuries occurred in the lower (48.1%) and upper limb (25.6%). 42% of all injuries were moderate (27.5%) or severe (14.8%), and tackling (26.3%) and being tackled (23.1%) were the most common mechanisms of injury. The IR of injuries was unrelated to playing at home compared with away (locations ≥6 h time difference). 55% of all players were injured during the 4-month Super Rugby tournament (1.67 injuries/match). Most injuries occurred in the lower (knee, thigh) or upper limb (shoulder, clavicle). 42% of injuries were severe enough for players to not play for >1 week. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. Pelvic floor muscle function and pelvic organ prolapse

    OpenAIRE

    Brækken, Ingeborg Hoff

    2010-01-01

    Avhandling (doktorgrad) – Norges idrettshøgskole, 2010. The overall high prevalence of pelvic organ prolapse (POP) and related problems indicates a need for identification of risk factors, prevention and treatment strategies. The aetiology of POP is considered to be multifactorial. Only a minority of the many proposed risk factors for POP can easily be prevented. Treatment of POP is surgery, use of a pessary or pelvic floor muscle training (PFMT). Today there is a lack of evide...

  2. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... pain or injury from trauma with very high accuracy, enabling faster treatment and often eliminating the need ... by infection and inflammation, the speed, ease and accuracy of a CT examination can reduce the risk ...

  3. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... pancreatitis or liver cirrhosis. cancers of the liver, kidneys, pancreas, ovaries and bladder as well as lymphoma. kidney and bladder stones. abdominal aortic aneurysms (AAA), injuries ...

  4. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... painless, noninvasive and accurate. In emergency cases, it can reveal internal injuries and bleeding quickly enough to ... cross-sectional images generated during a CT scan can be reformatted in multiple planes, and can even ...

  5. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... fast, painless, noninvasive and accurate. In emergency cases, it can reveal internal injuries and bleeding quickly enough ... parts absorb the x-rays in varying degrees. It is this crucial difference in absorption that allows ...

  6. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... experienced radiologist can diagnose many causes of abdominal pain or injury from trauma with very high accuracy, enabling faster treatment and often eliminating the need for additional, more ...

  7. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... the technologist verifies that the images are of high enough quality for accurate interpretation. The CT examination ... abdominal pain or injury from trauma with very high accuracy, enabling faster treatment and often eliminating the ...

  8. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... diseases of the small bowel, colon and other internal organs and is often used to determine the ... and accurate. In emergency cases, it can reveal internal injuries and bleeding quickly enough to help save ...

  9. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... contrast materials and a metallic taste in your mouth that lasts for at most a minute or ... can diagnose many causes of abdominal pain or injury from trauma with very high accuracy, enabling faster ...

  10. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... a special electronic image recording plate. Bones appear white on the x-ray; soft tissue, such as ... can diagnose many causes of abdominal pain or injury from trauma with very high accuracy, enabling faster ...

  11. Atypical Pelvic Crescent Fracture Caused by Vertical Shear Force

    OpenAIRE

    Park, Sang-Eun; Lee, Se-Won; Kim, Weon-Yoo; Park, Yong

    2014-01-01

    The crescent fracture consists of a posterior iliac wing fracture with extension into the sacroiliac joint and a dislocation of the sacroiliac joint. This fracture represents a subset of lateral compression injury. The strong posterior ligaments of sacroiliac joint remain intact and a fracture fragment (crescent shape) involving the posterior superior iliac spines remains firmly attached to the sacrum. We report a patient with atypical pelvic crescent fracture that is mainly influenced by ver...

  12. Surgery for Pelvic Organ Prolapse

    Science.gov (United States)

    ... organs. Targeting specific symptoms may be another option. Kegel exercises may be recommended in addition to symptom- ... Inability to control bodily functions such as urination. Kegel Exercises: Pelvic muscle exercises that assist in bladder ...

  13. Pelvic Inflammatory Disease (PID) Statistics

    Science.gov (United States)

    ... Follow STD STD on Twitter STD on Facebook Sexually Transmitted Diseases (STDs) Pelvic Inflammatory Disease (PID) Statistics Recommend on Facebook Tweet Share Compartir 1 in 8 women with a history of PID experience difficulties getting ...

  14. Gluteal Compartment Syndrome Secondary to Pelvic Trauma

    Directory of Open Access Journals (Sweden)

    Fernando Diaz Dilernia

    2016-01-01

    Full Text Available Gluteal compartment syndrome (GCS is extremely rare when compared to compartment syndrome in other anatomical regions, such as the forearm or the lower leg. It usually occurs in drug users following prolonged immobilization due to loss of consciousness. Another possible cause is trauma, which is rare and has only few reports in the literature. Physical examination may show tense and swollen buttocks and severe pain caused by passive range of motion. We present the case of a 70-year-old man who developed GCS after prolonged anterior-posterior pelvis compression. The physical examination revealed swelling, scrotal hematoma, and left ankle extension weakness. An unstable pelvic ring injury was diagnosed and the patient was taken to surgery. Measurement of the intracompartmental pressure was measured in the operating room, thereby confirming the diagnosis. Emergent fasciotomy was performed to decompress the three affected compartments. Trauma surgeons must be aware of the possibility of gluteal compartment syndrome in patients who have an acute pelvic trauma with buttock swelling and excessive pain of the gluteal region. Any delay in diagnosis or treatment can be devastating, causing permanent disability, irreversible loss of gluteal muscles, sciatic nerve palsy, kidney failure, or even death.

  15. Penile Rehabilitation after Pelvic Cancer Surgery

    Directory of Open Access Journals (Sweden)

    Fouad Aoun

    2015-01-01

    Full Text Available Erectile dysfunction is the most common complication after pelvic radical surgery. Rehabilitation programs are increasingly being used in clinical practice but there is no high level of evidence supporting its efficacy. The principle of early penile rehabilitation stems from animal studies showing early histological and molecular changes associated with penile corporal hypoxia after cavernous nerve injury. The concept of early penile rehabilitation was developed in late nineties with a subsequent number of clinical studies supporting early pharmacologic penile rehabilitation. These studies included all available phosphodiesterase type 5 inhibitors, intracavernosal injection and intraurethral use of prostaglandin E1 and to lesser extent vacuum erectile devices. However, these studies are of small number, difficult to interpret, and often with no control group. Furthermore, no studies have proven an in vivo derangement of endothelial or smooth muscle cell metabolism secondary to a prolonged flaccid state. The purpose of the present report is a synthetic overview of the literature in order to analyze the concept and the rationale of rehabilitation program of erectile dysfunction following radical pelvic surgery and the evidence of such programs in clinical practice. Emphasis will be placed on penile rehabilitation programs after radical cystoprostatectomy, radical prostatectomy, and rectal cancer treatment. Future perspectives are also analyzed.

  16. Pelvic fracture in multiple trauma: are we still up-to-date with massive fluid resuscitation?

    Science.gov (United States)

    Burkhardt, Markus; Kristen, Alexander; Culemann, Ulf; Koehler, Daniel; Histing, Tina; Holstein, Joerg H; Pizanis, Antonius; Pohlemann, Tim

    2014-10-01

    Until today the mortality of complex pelvic trauma remains unacceptably high. On the one hand this could be attributed to a biological limit of the survivable trauma load, on the other hand side an ongoing inadequate treatment might be conceivable too. For the management of multiple trauma patients with life-threatening pelvic fractures, there is ongoing international debate on the adequate therapeutic strategy, e.g. arterial embolization or pelvic packing, as well as aggressive or restrained volume therapy. Whereas traditional pelvis-specific trauma algorithms still recommend massive fluid resuscitation, there is upcoming evidence that a restrained volume therapy in the preclinical setting may improve trauma outcomes. Less intravenous fluid administration may also reduce haemodilution and concomitant trauma-associated coagulopathy. After linking the data of the TraumaRegister DGU(®) and the German Pelvic Injury Register, for the first time, the initial fluid management for complex pelvic traumas as well as for different Tile/OTA types of pelvic ring fractures could be addressed. Unfortunately, the results could not answer the question of the adequate fluid resuscitation but confirmed the actuality of massive fluid resuscitation in the prehospital and emergency room setting. Low-volume resuscitation seems not yet accepted in practice in managing multiple trauma patients with pelvic fractures at least in Germany. Nevertheless, prevention of exsanguination and of complications like multiple organ dysfunction syndrome still poses a major challenge in the management of complex pelvic ring injuries. Even nowadays, fluid management for trauma, not only for pelvic fractures, remains a controversial area and further research is mandatory. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. Epidemiology of Genitourinary Injuries among Male U.S. Service Members Deployed to Iraq and Afghanistan: Early Findings from the Trauma Outcomes and Urogenital Health (TOUGH) Project.

    Science.gov (United States)

    Janak, Judson C; Orman, Jean A; Soderdahl, Douglas W; Hudak, Steven J

    2017-02-01

    In this study we report the number, nature and severity of genitourinary injuries among male U.S. service members deployed to Operations Iraqi Freedom and Enduring Freedom. This retrospective cross-sectional study of the Department of Defense Trauma Registry used ICD-9-CM codes to identify service members with genitourinary injuries, and used Abbreviated Injury Scale codes to determine injury severity, genitourinary organs injured and comorbid injuries. From October 2001 to August 2013, 1,367 male U.S. service members sustained 1 or more genitourinary injuries. The majority of injuries involved the external genitalia (1,000, 73.2%), including the scrotum (760, 55.6%), testes (451, 33.0%), penis (423, 31%) and/or urethra (125, 9.1%). Overall more than a third of service members with genitourinary injury sustained at least 1 severe genitourinary injury (502, 36.7%). Loss of 1 or both testes was documented in 146 men, including 129 (9.4%) unilateral orchiectomies and 17 (1.2%) bilateral orchiectomies. Common comorbid injuries included traumatic brain injury (549, 40.2%), pelvic fracture (341, 25.0%), colorectal injury (297, 21.7%) and lower extremity amputations (387, 28.7%). An unprecedented number of U.S. service members sustained genitourinary injury while deployed to Operation Iraqi Freedom/Operation Enduring Freedom. Further study is needed to describe the long-term impact of genitourinary injury and determine the potential need for novel treatments to improve sexual, urinary and/or reproductive function among service members with severe genital injury. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  18. Modelling the pelvic floor for investigating difficulties during childbirth

    Science.gov (United States)

    Li, Xinshan; Kruger, Jennifer A.; Chung, Jae-Hoon; Nash, Martyn P.; Nielsen, Poul M. F.

    2008-03-01

    Research has suggested that athletes involved in high-intensity sports for sustained periods have a higher probability of experiencing prolonged second stage of labour compared to non-athletes. The mechanism responsible for this complication is unknown but may depend on the relative size or tone of the pelvic floor muscles. Prolonged training can result in enlargement and stiffening of these muscles, providing increased resistance as the fetal head descends through the birth canal during a vaginal birth. On the other hand, recent studies have suggested an association between increased muscle bulk in athletes and higher distensibility. This project aims to use mathematical modelling to study the relationship between the size and tone of the pelvic floor muscles and the level of difficulty during childbirth. We obtained sets of magnetic resonance (MR) images of the pelvic floor region for a female athlete and a female non-athlete. Thirteen components of the pelvic floor were segmented and used to generate finite element (FE) models. The fetal head data was obtained by laser scanning a skull replica and a FE model was fitted to these data. We used contact mechanics to simulate the motion of the fetal head moving through the pelvic floor, constructed from the non-athlete data. A maximum stretch ratio of 3.2 was induced in the muscle at the left lateral attachment point to the pubis. We plan to further improve our modelling framework to include active muscle contraction and fetal head rotations in order to address the hypotheses that there is a correlation between the level of difficulty and the size or tone of the pelvic floor muscles.

  19. [Vascular complications after pelvic rami fracture].

    Science.gov (United States)

    Fernández-Lombardía, J; Paz-Aparicio, A; Hernández-Vaquero, D

    2014-01-01

    The case is presented of a 78 year-old patient who suffered a right ileo- and ischiopubic rami fracture after a casual fall. A few hours later, she presented with sudden abdominal pain and hypotension. Imaging test showed extraperitoneal hemorrhage with active bleeding and hemodynamic compromise. The progressive worsening, with anemia and hemodynamic instability, required her being sent to the reference hospital for selective embolization of the bleeding point. After embolization, the patient́s situation stabilized, and she was then able to sit down one week later. The fracture consolidated 3 months later. Although low-energy pelvic fractures by lateral compression do not usually present with complications, sometimes they require a strict control due to the potential risk of vascular injuries. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  20. One-year mortality after isolated pelvic fractures with posterior ring involvement in elderly patients.

    Science.gov (United States)

    Bible, Jesse E; Kadakia, Rishin J; Wegner, Adam; Richards, Justin E; Mir, Hassan R

    2013-06-01

    Previous 1-year mortality studies of pelvic fractures in elderly patients have focused on pubic rami fractures, in elderly patients with multiple injuries, or both. Baseline information on the 1-year mortality of isolated pelvic fractures in elderly patients is unavailable. The purpose of this study was to evaluate the 1-year mortality of elderly patients (aged 60 years or older) after isolated pelvic fractures with posterior ring involvement (Orthopaedic Trauma Association type 61-B and C). All patients aged 60 years or older treated for pelvic injuries at a single Level I trauma center over a 12-year period were retrospectively reviewed (N=1223). Exclusion criteria were associated injuries to other body systems (Abbreviated Injury Scale greater than 2), ballistic injuries, long bone fractures, concurrent acetabular fractures, and type 61-A fractures or isolated pubic rami fractures without posterior involvement. Mortality data were obtained from the Social Security Death Index. Seventy patients met the inclusion criteria. Patients treated nonoperatively were significantly older compared with those treated operatively. However, the Charlson Comorbidity Index did not significantly differ between treatment groups. A significantly higher percentage of type-B fractures (83.0%) were treated nonoperatively compared with type-C fractures, which were treated operatively 88.2% of the time. Mortality rates at 3 and 6 months and 1 year postoperatively were 7.1%, 11.4%, and 12.9%, respectively. These results suggest that the 1-year mortality rates of isolated pelvic fractures in elderly patients are lower than those reported previously for hip fractures and pelvic fractures with concurrent injuries. Although age was identified as a significant variable differing between patients treated operatively vs nonoperatively, comorbidities were not. Copyright 2013, SLACK Incorporated.

  1. Does splenic embolization and grade of splenic injury impact nonoperative management in patients sustaining blunt splenic trauma?

    Science.gov (United States)

    Jeremitsky, Elan; Kao, Amy; Carlton, Chad; Rodriguez, Aurelio; Ong, Adrian

    2011-02-01

    Nonoperative management (NOM) for blunt splenic trauma (BST) is an established practice. The impact of splenic embolization (SE) in the algorithm for NOM has not been well studied. This study evaluates the role of SE and spleen injury grade on failure of NOM. Retrospective cohort of trauma registry over a 7-year period (2000-2006) for patients who suffered BST was studied. Data including demographics, splenic injury grade, and SE were recorded. Characteristics were compared between the successful and failed NOM groups. Kaplan-Meier, life table, and Cox-proportional hazard regression analyses were performed. Of the 499 patients who suffered BST, 407 (81.6%) patients had successful NOM and 92 (18.4%) patients failed NOM (including splenectomies performed within 1 hour of admission). Failed NOM group had a higher splenic injury grade compared with the successful NOM group (P NOM occurred by 24 hours. Grade 3 and 4 injuries that failed NOM occurred by 150 hours. SE was protective against splenectomy (Hazard Ratio (HR) 0.18, 95% confidence interval: 0.06-0.55, P = 0.004), whereas splenic injury grades III or higher was associated with increased risk of splenectomy (grade III: HR 5.26, P = 0.003; grade IV: HR 6.84, P = 0.002; grade V: HR 9.81, P = 0.002) compared with those with splenic injury grade I. Splenic embolization is a protective measure to reduce the failure of NOM. Spleen injury grade III and higher was significantly associated with NOM failure and would require a 5-day inpatient observation.

  2. Pelvic Floor Dysfunction in Aging Women

    Directory of Open Access Journals (Sweden)

    Gin-Den Chen

    2007-12-01

    Full Text Available The occurrence of pelvic floor dysfunction may increase steadily during the aging process in women. Pelvic floor dysfunction may be associated with dysfunctions of micturition, defecation, prolapse, and sex. The natural history and mechanism of pelvic floor dysfunction in aged women are not well understood or explored. In this article, we review the effect of age on the prevalence of pelvic floor dysfunction and on the structural and functional changes of the lower urinary tract, anorectum and pelvic floor. Altogether, the aging process has a negative impact on either the function or structure of the lower urinary tract, anorectum and pelvic floor in women.

  3. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... injuries to abdominal organs such as the spleen, liver, kidneys or other internal organs in cases of trauma. CT scanning of the abdomen/pelvis is also performed to: guide biopsies and other procedures such as abscess drainages and ...

  4. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... bowel disease such as ulcerative colitis or Crohn's disease , pancreatitis or liver cirrhosis. cancers of the liver, kidneys, pancreas, ovaries ... injuries to abdominal organs such as the spleen, liver, kidneys or other internal ... of heart disease, asthma, diabetes, kidney disease or thyroid problems. Any ...

  5. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... top of page What are the benefits vs. risks? Benefits Viewing a CT scan, an experienced radiologist can diagnose many causes of abdominal pain or injury from trauma with very high accuracy, enabling faster treatment and often eliminating the ...

  6. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... as ulcerative colitis or Crohn's disease , pancreatitis or liver cirrhosis. cancers of the liver, kidneys, pancreas, ovaries and bladder as well as ... injuries to abdominal organs such as the spleen, liver, kidneys or other internal organs in cases of ...

  7. Radiographic diagnosis of sagittal plane rotational displacement in pelvic fractures: a cadaveric model and clinical case study.

    Science.gov (United States)

    Shui, Xiaolong; Ying, Xiaozhou; Kong, Jianzhong; Feng, Yongzeng; Hu, Wei; Guo, Xiaoshan; Wang, Gang

    2015-08-01

    Our objective was to measure the sagittal plane rotational (flexion and extension) displacement of hemipelvis radiologically and analyze the ratio of flexion and extension displacement of unstable pelvic fractures. We used 8 cadaveric models to study the radiographic evidence of pelvic fractures in the sagittal plane. We performed pelvic osteotomy on 8 cadavers to simulate anterior and posterior pelvic ring injury. Radiological data were measured in the flexion and extension group under different angles (5°, 10°, 15°, 20°, and 25°). We retrospectively reviewed 164 patients who were diagnosed with a unilateral fracture of the pelvis. Pelvic ring displacement was identified and recorded radiographically in cadaveric models. The flexion and extension displacement of pelvic fractures was measured in terms of the vertical distance of fracture from the top of iliac crest to the pubic tubercle (CD) or from the top of iliac crest to the lowest point of ischial tuberosity (AB). Fifty-seven pelves showed flexion displacement and 15 showed extension displacement. Closed reduction including internal fixation and external fixation was successfully used in 141 cases (86.0 %). The success rates of closed reduction in flexion and extension displacement groups were 77 and 73 %, respectively, which were lower than in unstable pelvic ring fractures. The sagittal plane rotation (flexion and extension) displacement of pelvic fractures could be measured by special points and lines on the radiographs. Minimally invasive reduction should be based on clearly identified differences between the sagittal plane rotation and the vertical displacement of pelvic fractures.

  8. The utility of presacral drainage in penetrating rectal injuries in adult and pediatric patients.

    Science.gov (United States)

    Savoie, Kate B; Beazley, Thomas M; Cleveland, Brent; Khaneki, Sina; Markel, Troy A; Hammer, Peter M; Savage, Stephanie; Williams, Regan F

    2017-11-01

    With changing weaponry associated with injuries in civilian trauma, there is no clinical census on the utility of presacral drainage (PSD) in penetrating rectal injuries (PRIs), particularly in pediatric patients. Patients with PRI from July 2004-June 2014 treated at two free-standing children's hospitals and two adult level 1 trauma centers were compared by age (pediatric patients ≤16 years) and PSD. A stratified analysis was performed based on age. The primary outcome was pelvic/presacral abscess. We identified 81 patients with PRI; 19 pediatric, 62 adult. Forty patients had PSD; only three pediatric patients had a drain. Adult patients were more likely to have sustained gunshot wounds (84%), whereas pediatric patients were more likely to sustain impalement injuries (59%). Pediatric patients were more likely to have distal extraperitoneal injuries (56% versus 27% in adults, P = 0.03). PSD was more common in adult patients (59% versus 14%, P = 0.0004), African-Americans (71% versus 11% Caucasian, P adult and pediatric patients. There were three cases of pelvic/presacral abscess, all in the adult patients (P = 0.31); one patient with PSD and two without PSD (P = 0.58). In stratified analysis, there were no differences in any infectious complication between those with and without PSD. Pelvic/presacral abscess is a rare complication of PRI, especially in pediatric patients. PSD is not associated with decreased rates of infectious complications and may not be necessary in the treatment of PRI. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Combat Injury Coding: A Review and Reconfiguration

    Science.gov (United States)

    2013-01-01

    the clavicle, scapula, and pelvic girdle were grouped with the torso where they are anatomically located rather than in the upper and lower extremities...follows: 1. Head and neck: injuries to the head, face, and neck 2. Torso: injuries to the chest and abdomen, including the pel- vic girdle and...parasymphysis, or mandible avulsion) Open wound with loss of e10% muscle mass of trunk, buttocks, or pelvic girdle Amputation or crush hands, bilateral Open

  10. Pelvic floor muscle examination in female chronic pelvic pain.

    Science.gov (United States)

    Fitzgerald, Colleen M; Neville, Cynthia E; Mallinson, Trudy; Badillo, Suzanne A; Hynes, Christina K; Tu, Frank F

    2011-01-01

    To determine if women with self-reported chronic pelvic pain (CPP) were more likely to have positive findings on two vaginal pelvic floor muscle (PFM) tests compared to women without CPP when the examiner was blinded to pain status. This was a prospective, cross-sectional study. Blinded examiners performed two vaginal pelvic floor tests (tenderness and strength) on 48 participants: 19 with self-reported CPP and 29 who were pain-free. Relative frequency of positive findings between groups and the total number of positive physical examination findings were calculated. Women with self-reported CPP were more likely to have PFM tenderness (63.2% with physician [M.D.] examiners [board certified in physical medicine and rehabilitation] and 73.7% with physical therapist [P.T.] examiners) as compared to pain-free participants (Fisher's exact test [FET]), 48 p examination across disciplines may be helpful in distinguishing subgroups and treating women with CPP.

  11. Effectiveness of non invasive external pelvic compression: a systematic review of the literature.

    Science.gov (United States)

    Bakhshayesh, Peyman; Boutefnouchet, Tarek; Tötterman, Anna

    2016-05-18

    Pelvic fractures might carry a significant risk of bleeding. A wide variety of pelvic binders together with pelvic sheets are available and offer an adjunct to the initial management of poly-trauma patients with pelvic injuries. These devices are collectively referred to as pelvic circumferential compression devices (PCCDs). The aim of this study was to review the literature for evidence pertinent to the efficacy and safety of PCCDs. Using the PRISMA guidelines a systematic search on PubMed, Web of Science, CINAHL, Embase and Scopus was carried out. Articles included were in English language and published between 1999 and 2015. Studies included were appraised with narrative data synthesis. Seven articles addressed mechanical properties of non-invasive external mechanical devices, six articles focused on physiological aspects, and three studies evaluated the pressure characteristics of these devices. We found 4 case reports regarding adverse effects. None of the studies identified addressed the cost effectiveness or pain relief issues related to the use of PCCDs. Based on available literature, PCCDs are widely used in the initial management of patients with suspected pelvic bleeding. There is evidence to suggest that external compression reduces disrupted pelvic rings. There are some complications reported following application of PCCDs. Hemorrhagic source and physiological effectiveness of PCCDs needs to be addressed in future studies. In the meantime judicious application of PCCDs will continue to be recommended.

  12. Functional anatomy of pelvic floor

    Directory of Open Access Journals (Sweden)

    Salvatore Rocca Rossetti

    2016-03-01

    Full Text Available Generally, descriptions of the pelvic floor are discordant, since its complex structures and the complexity of pathological disorders of such structures; commonly the descriptions are sectorial, concerning muscles, fascial developments, ligaments and so on. On the contrary to understand completely nature and function of the pelvic floor it is necessary to study it in the most unitary view and in the most global aspect, considering embriology, philogenesy, anthropologic development and its multiple activities others than urological, gynaecological and intestinal ones. Recent acquirements succeeded in clarifying many aspects of pelvic floor activity, whose musculature has been investigated through electromyography, sonography, magnetic resonance, histology, histochemistry, molecular research. Utilizing recent research concerning not only urinary and gynecologic aspects but also those regarding statics and dynamics of pelvis and its floor, it is now possible to study this important body part as a unit; that means to consider it in the whole body economy to which maintaining upright position, walking and behavior or physical conduct do not share less than urinary, genital, and intestinal functions. It is today possible to consider the pelvic floor as a musclefascial unit with synergic and antagonistic activity of muscular bundles, among them more or less interlaced, with multiple functions and not only the function of pelvic cup closure.

  13. Functional anatomy of pelvic floor.

    Science.gov (United States)

    Rocca Rossetti, Salvatore

    2016-03-31

    Generally, descriptions of the pelvic floor are discordant, since its complex structures and the complexity of pathological disorders of such structures; commonly the descriptions are sectorial, concerning muscles, fascial developments, ligaments and so on. On the contrary to understand completely nature and function of the pelvic floor it is necessary to study it in the most unitary view and in the most global aspect, considering embriology, philogenesy, anthropologic development and its multiple activities others than urological, gynaecological and intestinal ones. Recent acquirements succeeded in clarifying many aspects of pelvic floor activity, whose musculature has been investigated through electromyography, sonography, magnetic resonance, histology, histochemistry, molecular research. Utilizing recent research concerning not only urinary and gynecologic aspects but also those regarding statics and dynamics of pelvis and its floor, it is now possible to study this important body part as a unit; that means to consider it in the whole body economy to which maintaining upright position, walking and behavior or physical conduct do not share less than urinary, genital, and intestinal functions. It is today possible to consider the pelvic floor as a musclefascial unit with synergic and antagonistic activity of muscular bundles, among them more or less interlaced, with multiple functions and not only the function of pelvic cup closure.

  14. [Anatomical study of pelvic colon].

    Science.gov (United States)

    James, Y E; Tchangai, B; Kassegne, I; Keke, K; James, K D

    2016-12-01

    Identifying the different kinds of anatomical sigmoid colon in our environment and determine what exposes the most to the occurrence of pelvic colon volvulus. This is a transverse prospective study from 1 January 2007 to 31 December 2012 on a series of 63 patients (33 men and 30 women) who underwent laparotomy for non-colonic pathologies. For all patients, the following parameters were recorded: C1: total length of the pelvic colon; C2: the length of the root of the meso-sigmoid; C3: the height of the meso-sigmoid; C4: maximum width of the meso-sigmoid. C1 through the entire series was 61,3cm. C2 average was 5.5cm. C3 height and maximum width C4 were on average 14,6cm and 7.6cm, respectively. Comparison of parameters in men and women showed no significant difference. This study allows us to know the different types of pelvic colons among the population of our operated patients. The measurements performed on the pelvic colon of patients presenting volvulus will help to attribute objectively the true authorship of this surgical emergency to an anatomical type of pelvic colon. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  15. Detection of bleeding in patients with major pelvic fractures: value of contrast-enhanced CT.

    Science.gov (United States)

    Cerva, D S; Mirvis, S E; Shanmuganathan, K; Kelly, I M; Pais, S O

    1996-01-01

    We performed a retrospective review of trauma patients who had undergone both pelvic angiography and preangiographic i.v. contrast-enhanced CT to determine whether CT can accurately demonstrate the presence or absence of pelvic bleeding in patients with multisystem trauma and major pelvic fractures. We reviewed the medical records and imaging studies of all patients, identified through a trauma radiology database, who had undergone pelvic angiography and preangiographic contrast-enhanced CT during a 48-month period. Results of CT scans were recorded by consensus interpretation of three radiologists without knowledge of angiographic findings. Sites of contrast material extravasation seen on CT scans were noted and compared with sites of bleeding or vascular injury identified by selective pelvic angiography. Thirty patients with blunt trauma and pelvic fractures underwent both pelvic angiography and preangiographic CT studies. Findings on pelvic angiograms were positive at 26 sites in 19 patients and included contrast agent extravasation at 23 sites and vessel abnormalities without extravasation at three sites. Preangiographic pelvic CT scans showed contrast agent extravasation at 20 sites in 16 patients. Three patients had no contrast agent extravasation demonstrated by CT but had bleeding demonstrated by angiography. CT detected bleeding in 16 of 19 patients who had extravasation or vascular injury demonstrated by angiography, for a sensitivity of 84%. Results of pelvic angiography were negative in 11 patients, and none had evidence of bleeding on preangiographic CT scans. Two sites of contrast agent extravasation identified in two patients by CT did not show bleeding at angiography, for a specificity of 85% for the detection of bleeding. The overall accuracy of CT for determining the presence or absence of bleeding was 90%. Knowledge of sites of ongoing hemorrhage is crucial for optimizing the sequence of diagnostic and therapeutic studies in patients with blunt

  16. Development and testing of a pelvic goniometer designed to measure pelvic tilt and hip flexion.

    Science.gov (United States)

    Sprigle, Stephen; Flinn, Nannette; Wootten, Mary; McCorry, Stephanie

    2003-06-01

    To determine the reliability and validity of a pelvic goniometer designed to measure the pelvic tilt and hip flexion during seated posture. Assessment of the seated posture requires measurement of the pelvis and hip. Determining accurate pelvic tilt and hip flexion angles during sitting is often difficult using standard techniques. A pelvic goniometer has been designed to measure pelvic tilt and hip flexion angle of persons in a seated posture. VALIDATION of the pelvic goniometer was done radiographically. Ten male volunteers sat in three postures--erect, forward or anterior tilt, and posterior tilt. Pelvic tilt and hip angle were recorded using radiographs and the pelvic goniometer. Reliability of pelvic and conventional goniometers was done using seated nondisabled subjects with physical therapists performing measurements. the average differences and correlation between the pelvic goniometer and radiographic measures were as follows--pelvic tilt: -4.9 degrees, 0.93; hip angle 1.2 degrees, 0.81. Reliability: average range of hip angle across three measures was about 3 degrees for both goniometers. The data indicate that the pelvic goniometer has utility in measuring pelvic tilt and hip angle, especially within the seated posture. Because it measures both pelvic tilt and hip angle, the pelvic goniometer has an advantage over conventional goniometers that only measure the latter. A valid and reliable tool that measures pelvic tilt and hip angle of persons in a seated posture is needed for clinical research and practice. Its applications include wheelchair seating evaluations and ergonomic assessments of seated workers.

  17. Too little sleep and an unhealthy diet could increase the risk of sustaining a new injury in adolescent elite athletes.

    Science.gov (United States)

    von Rosen, P; Frohm, A; Kottorp, A; Fridén, C; Heijne, A

    2017-11-01

    Little is known about health variables and if these variables could increase the risk of injuries among adolescent elite athletes. The primary aim was to present overall data on self-perceived stress, nutrition intake, self-esteem, and sleep, as well as gender and age differences, on two occasions among adolescent elite athletes. A secondary aim was to study these health variables as potential risk factors on injury incidence. A questionnaire was e-mailed to 340 adolescent elite athletes on two occasions during a single school year: autumn semester and spring semester. The results show that during autumn semester, the recommended intake of fruits, vegetables, and fish was not met for 20%, 39%, and 43% of the adolescent elite athletes, respectively. The recommended amount of sleep during weekdays was not obtained by 19%. Multiple logistic regression showed that athletes sleeping more than 8 h of sleep during weekdays reduced the odds of injury with 61% (OR, 0.39; 95% CI, 0.16-0.99) and athletes reaching the recommended nutrition intake reduced the odds with 64% (OR, 0.36; 95% CI, 0.14-0.91). Our findings suggest that nutrition intake and sleep volume are of importance in understanding injury incidence. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Magnetic Resonance Imaging (MRI): Dynamic Pelvic Floor

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Magnetic Resonance Imaging (MRI) – Dynamic Pelvic Floor Dynamic pelvic floor magnetic resonance imaging (MRI) is a noninvasive test that uses a ...

  19. How Are Pelvic Floor Disorders Diagnosed?

    Science.gov (United States)

    ... Share Facebook Twitter Pinterest Email Print How are pelvic floor disorders diagnosed? A physical exam may be all ... fee ). This test is used to evaluate the pelvic floor and rectum while the patient is having a ...

  20. How Are Pelvic Floor Disorders Commonly Treated?

    Science.gov (United States)

    ... Share Facebook Twitter Pinterest Email Print How are pelvic floor disorders commonly treated? Many women do not need ... Treatment Nonsurgical treatments commonly used for PFDs include: Pelvic floor muscle training (PFMT). Also called Kegel (pronounced KEY- ...

  1. Clinical examination is superior to plain films to diagnose pelvic fractures compared to CT.

    Science.gov (United States)

    Duane, Therèse M; Dechert, Tracey; Wolfe, Luke G; Brown, Holly; Aboutanos, Michel B; Malhotra, Ajai K; Ivatury, Rao R

    2008-06-01

    We prospectively compared clinical examination (CE) with plain films (PXR) and both tools with CT in patients sustaining blunt trauma. There were 1388 patients who had both PXR and CT of whom 168 (12.1%) were diagnosed with a fracture by CT. CE findings most predictive of fracture included age (OR, 1.025; CI, 1.011-1.039), hip pain (OR, 4.971; CI, 2.508-9.854), internal rotation of the leg (OR, 4.880; CI, 1.980-12.027), or tenderness to palpation over the sacrum (OR, 2.297; CI, 1.144-4.612), over the right or left hip (OR, 3.626; CI, 1.823-7.214), or diffusely throughout the pelvis (OR, 16.445; CI, 4.277-63.237). These factors were still predictive of pelvic fractures even in patients with a Glasgow Coma Scale score less than 13. There were 136 fractures identified by PXR all of which were identified by CE (sensitivity 100% [136 of 136], negative predictive value 100% [619 of 619]). There were six patients with negative clinical examinations and positive CTs (sensitivity 96.4% [162 of 168], negative predictive value 99.03% [613 of 619]), none of which were hemodynamically significant. The sensitivity for PXR compared with CT was 79.17 per cent (133 of 168) and the NPV was 97.2 per cent (1217 of 1252). CE is a reliable way to diagnose pelvic fractures and PXR is a poor screening tool for these injuries compared with CT. Because the majority of patients undergo CT after blunt trauma, routine screening radiographs should be eliminated.

  2. Pregnancy-induced adaptations in the intrinsic structure of rat pelvic floor muscles.

    Science.gov (United States)

    Alperin, Marianna; Lawley, Danielle M; Esparza, Mary C; Lieber, Richard L

    2015-08-01

    Maternal birth trauma to the pelvic floor muscles (PFMs) is a major risk factor for pelvic floor disorders. Modeling and imaging studies suggest that demands placed on PFMs during childbirth exceed their physiologic limits; however many parous women do not sustain PFM injury. Here we determine whether pregnancy induces adaptations in PFM architecture, the strongest predictor of muscle function, and/or intramuscular extracellular matrix (ECM), responsible for load bearing. To establish if parallel changes occur in muscles outside of the PFM, we also examined a hind limb muscle. Coccygeus, iliocaudalis, pubocaudalis, and tibialis anterior of 3-month-old Sprague-Dawley virgin, mid-pregnant, and late-pregnant; 6-month-old virgin; and 4- and 12-week postpartum rats (N = 10/group) were fixed in situ and harvested. Major architectural parameters determining muscle's excursion and force-generating capacity were quantified, namely, normalized fiber length (Lfn), physiologic cross-sectional area, and sarcomere length. Hydroxyproline content was used as a surrogate for intramuscular ECM quantity. Analyses were performed by 2-way analysis of variance with Tukey post hoc testing at a significance level of .05. Pregnancy induced a significant increase in Lfn in all PFMs by the end of gestation relative to virgin controls. Fibers were elongated by 37% in coccygeus (P pregnancy. By 12 weeks' postpartum, Lfn of all PFMs returned to the prepregnancy values. Relative to virgin controls, ECM increased by 140% in coccygeus, 52% in iliocaudalis, and 75% in pubocaudalis in late-pregnant group, but remained unchanged across time in the tibialis anterior. Postpartum, ECM collagen content returned to prepregnancy levels in iliocaudalis and pubocaudalis, but continued to be significantly elevated in coccygeus (P pregnancy induces unique adaptations in the structure of the PFMs, which adjust their architectural design by adding sarcomeres in series to increase fiber length as well as mounting

  3. Ultrasonographic findings of pelvic masses

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Youn Jin; Hong, In Soo; Yoo, Hyung Sik; Park, Chang Yun [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1982-09-15

    Ultrasonography affords an accurate assessment of the presence, size, location and internal consistency of a pelvic mass. We present our experience of 105 cases of pelvic masses in female patients by ultrasonography, and the results are as described: 1. Ultrasonography is nonspecific, however, the possibility of mucinous cystadenoma of ovary, teratoma (demoid cyst), uterine leiomyoma and trophoblastic disease can be suggested due to their characteristic internal consistency. 2. Thin smooth internal septation seen within mucinous cystadenoma, eccentric solid mural component of dermoid cyst, enlarged uterine wall with lobulated outer margin of leiomyoma, and yesicular appearance of trophoblastic disease were the specific sonographic features. 3. Loculated ascites and hydronephrosis were identified with malignant ovarian neoplasm and pelvic metastasis. 4. Accurate ultrasonographic diagnosis was made in 88 cases (83.7%) and it may be improved with clinical history of the mass in question.

  4. Early development of the human pelvic diaphragm

    NARCIS (Netherlands)

    Koch, Wijnandus Franciscus Robertus Maria

    2006-01-01

    The last decade an increasing interest in the pelvic floor can be observed in medical sciences. The lack of data on the development of the human pelvic floor is striking. The early development of the human pelvic diaphragm was studied. Materials and methodsUse was made of 38 human embryos and

  5. Biomechanics of the pelvic floor musculature

    NARCIS (Netherlands)

    Janda, S.

    2006-01-01

    The present thesis was motivated by two main goals. The first research goal of the thesis was to understand the complex biomechanical behaviour of the pelvic floor muscles. The second goal was to study the mechanism of the pelvic organ prolapse (genital prolapse). The pelvic floor in humans is a

  6. MANAGEMENT OF PELVIC FRACTURES IN DOG

    African Journals Online (AJOL)

    EDITOR-IN-CHIEF

    Fracture of ilium, the most common fracture seen in the pelvis account for 46% of all pelvic fracture (Henry, 1985; De Camp, 2005). Whereas, acetabular fracture comprises 12 % of pelvic fractures in dogs (De Camp, 2005). In smaller dogs, most of the pelvic fractures recover without surgery. But immediate surgery is.

  7. Office Evaluation of Pelvic Pain.

    Science.gov (United States)

    Bennis, Stacey; Hwang, Sarah

    2017-08-01

    The history and physical examination are important keys to diagnosis and treatment of patients with chronic pelvic pain. The comprehensive history should include questioning regarding patient's pain complaint and a thorough history and review of any body system that may be involved, including neuromusculoskeletal, obstetric, gynecologic, gastrointestinal, urologic, dermatologic, infectious, oncologic, and psychiatric. The physical examination should also follow a focused systems-based approach and includes examination of gastrointestinal, dermatologic, neurologic, and musculoskeletal (including lumbosacral spine, sacroiliac joints, pelvis, and hips) systems, and the pelvic floor (internal and external examination, including neuromuscular anatomy). Copyright © 2017 Elsevier Inc. All rights reserved.

  8. DIFFERENTIAL DIAGNOSIS OF DEEP GLUTEAL PAIN IN A FEMALE RUNNER WITH PELVIC INVOLVEMENT: A CASE REPORT

    Science.gov (United States)

    Podschun, Laura; Kolber, Morey J.; Garcia, Ashley; Rothschild, Carey E.

    2013-01-01

    Background: Gluteal injuries, proximal hamstring injuries, and pelvic floor disorders have been reported in the literature among runners. Some suggest that hip, pelvis, and/or groin injuries occur in 3.3% to 11.5% of long distance runners. The purpose of this case report is to describe the differential diagnosis and treatment approach for a patient presenting with combined hip and pelvic pain. Case description: A 45-year-old female distance runner was referred to physical therapy for proximal hamstring pain that had been present for several months. This pain limited her ability to tolerate sitting and caused her to cease running. Examination of the patient's lumbar spine, pelvis, and lower extremity led to the initial differential diagnosis of hamstring syndrome and ischiogluteal bursitis. The patient's primary symptoms improved during the initial four visits, which focused on education, pain management, trunk stabilization and gluteus maximus strengthening, however pelvic pain persisted. Further examination led to a secondary diagnosis of pelvic floor hypertonic disorder. Interventions to address the pelvic floor led to resolution of symptoms and return to running. Outcomes: Pain level on the Visual Analog Scale decreased from 7/10 to 1/10 over the course of treatment. The patient was able to return to full sport activity and improved sitting tolerance to greater then two hours without significant discomfort. Discussion: This case suggests the interdependence of lumbopelvic and lower extremity kinematics in complaints of hamstring, posterior thigh and pelvic floor disorders. This case highlights the importance of a thorough examination as well as the need to consider a regional interdependence of the pelvic floor and lower quarter when treating individuals with proximal hamstring pain. Level of Evidence: Level 4 PMID:24175132

  9. Indigo carmine extravasation to upper limb after pelvic reconstructive surgery.

    Science.gov (United States)

    Lindo, Fiona M; Chung, Christopher P; Yandell, Paul M

    2013-02-01

    The use of dyes during cystoscopy to visualize the ureters adequately is prevalent in gynecologic surgery. Observing ureteral patency after procedures such as a hysterectomy or pelvic reconstruction is important for identifying injury to the upper urinary tract. Indigo carmine is commonly used. Knowing the possible adverse effects and being aware of unusual presentations with the use of indigo carmine are important in managing and counseling patients. We present a case in which a patient developed indigo carmine extravasation to her upper limb after pelvic reconstructive surgery. The blue discoloration disappeared after 1 day. Indigo carmine extravasation to other parts of the body can occur without long-term complications. It takes 24-48 hours for the dye to clear subcutaneously.

  10. Socio-demographic characteristics of women sustaining injuries during pregnancy: a study from the Danish National Birth Cohort

    OpenAIRE

    Virk, Jasveer; Hsu, Paul; Olsen, Jørn

    2012-01-01

    Objectives To describe adverse birth outcomes associated with hospital-treated injuries that took place among women in the Danish National Birth Cohort. Design Longitudinal cohort study. Setting Denmark. Participants 90 452 women and their offspring selected from the Danish National Birth Cohort. Primary and secondary outcome measures To determine if injured women were more likely to deliver an infant preterm, with low birth weight, stillborn or have a spontaneous abortion, the authors estima...

  11. Deceleration during 'real life' motor vehicle collisions – a sensitive predictor for the risk of sustaining a cervical spine injury?

    Directory of Open Access Journals (Sweden)

    Hartwig Erich

    2009-03-01

    Full Text Available Abstract Background The predictive value of trauma impact for the severity of whiplash injuries has mainly been investigated in sled- and crash-test studies. However, very little data exist for real-life accidents. Therefore, the predictive value of the trauma impact as assessed by the change in velocity of the car due to the collision (ΔV for the resulting cervical spine injuries were investigated in 57 cases after real-life car accidents. Methods ΔV was determined for every car and clinical findings related to the cervical spine were assessed and classified according to the Quebec Task Force (QTF. Results In our study, 32 (56% subjects did not complain about symptoms and were therefore classified as QTF grade 0; 25 (44% patients complained of neck pain: 8 (14% were classified as QTF grade I, 6 (10% as QTF grade II, and 11 (19% as QTF grade IV. Only a slight correlation (r = 0.55 was found between the reported pain and ΔV. No relevant correlation was found between ΔV and the neck disability index (r = 0.46 and between ΔV and the QTF grade (r = 0.45 for any of the collision types. There was no ΔV threshold associated with acceptable sensitivity and specificity for the prognosis of a cervical spine injury. Conclusion The results of this study indicate that ΔV is not a conclusive predictor for cervical spine injury in real-life motor vehicle accidents. This is of importance for surgeons involved in medicolegal expertise jobs as well as patients who suffer from whiplash-associated disorders (WADs after motor vehicle accidents. Trial registration The study complied with applicable German law and with the principles of the Helsinki Declaration and was approved by the institutional ethics commission.

  12. Genitourinary Injuries Sustained by Female U.S. Service Members During Operation Iraqi Freedom and Operation Enduring Freedom

    Science.gov (United States)

    2017-10-07

    Defense Trauma Registry (DODTR) was reviewed to identify all US SMs diagnosed with GU injury from 2001 to 2013. The DODTR includes data for wounded ...and Operation Enduring Freedom (OEF) a large number of female SMs have been wounded while serving in combat support roles. This included an...SMs treated at any US combat support hospital, the in-theater equivalent of a civilian trauma center. Female SMs with ICD-9-CM diagnosis codes and/or

  13. Ice Hockey Injuries.

    Science.gov (United States)

    Sim, Franklin H.; Simonet, William T.

    1988-01-01

    The article describes the mechanisms, management, and prevention of each type of injury to which hockey players are prone. It surveys the injuries sustained by ice hockey players and discusses treatment of specific injuries, including those injuries to the head, eye, shoulder, hand, thigh, scalp, and face. (JL)

  14. Ten Years of Equine-related Injuries: Severity and Implications for Emergency Physicians.

    Science.gov (United States)

    Davidson, Scott B; Blostein, Paul A; Schrotenboer, Andrew; Sloffer, Chris A; VandenBerg, Sheri L

    2015-11-01

    The size, speed, and unpredictable nature of horses present a significant risk for injury in all equine-related activities. We sought to examine the mechanism, severity, frequency, body regions affected, surgical requirements, rehabilitation needs, safety equipment utilization, and outcomes of equine-related injured patients. Records of inpatients who sustained an equine-related injury from 2002-2011 with International Classification of Diseases, Ninth Revision codes E828 and E906 were retrospectively reviewed for pertinent data. Ninety patients, 70% female, age (mean ± SD) 37.3 ± 19.4 years, length of stay 3.7 ± 4.5 days, Injury Severity Score 12.9 ± 8.4. Predominant mechanism of injury was fall from horse (46.7%). The chest (23%) was most frequently injured, followed by brain/head (21.5%). Thirty patients (33%) required 57 surgical procedures. Twenty percent of patients required occupational therapy and 33.3% required physical therapy while hospitalized. Only 3% required rehabilitation, with 90% discharged directly home. Safety equipment was not used in 91.9% of patients. One patient sustained a cord injury. Six patients expired, all from extensive head injuries. The majority of equine-related injuries occur while pursuing recreational activities and are due to falls. Our patients experienced more severe injuries to the trunk and head and required more surgical intervention for pelvic, facial, and brain injuries than previously reported. Failure to use safety equipment contributes to the risk of severe injury. Education and injury prevention is essential. The need for complex surgical intervention by multiple specialties supports transfer to Level I trauma centers. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Prevalence and patterns of foot injuries following motorcycle trauma.

    Science.gov (United States)

    Jeffers, R F; Tan, H Boon; Nicolopoulos, C; Kamath, R; Giannoudis, P V

    2004-02-01

    To determine the prevalence and patterns of foot injuries following motorcycle trauma. Prospective. Yorkshire Region Trauma Units (Level 1 trauma centers with trauma research). Individuals injured in motorcycle road traffic accidents between January 1993 and December 1999. Patient demographics, protective devices (helmet) use, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), clinical details, therapeutic interventions, resuscitation requirements, duration of hospital stay, mortality, and type of foot injuries sustained. The parent population of 1239 contained 53 (4.3%) foot-injured motorcyclists (49 men) with a mean age of 31.7 years (range 18-79 years). Fifty-two were drivers and one was a rear-seat passenger. Mean ISS was 6.9 (range 4-33), significantly lower than the parent population mean of 34.98 (range 9-75) (P = 0.001). Mean GCS was 14.7 (range 13-15). The motorcyclists' injuries included 26 metatarsal fractures (49.1%), 14 talar fractures (26.4%), 7 os calcis fractures (13.2%), and 6 toe fractures (11.3%). Associated foot injuries included three partial foot amputations, four Lisfranc dislocations, three cases of foot compartment syndrome (two crush injuries with no fracture, one open fourth metatarsal fracture with associated Lisfranc dislocation). Forty-six motorcyclists had more than one foot injury. Associated injuries included 22 ankle fractures (41.5%), 15 tibial fractures (28.3%), 6 femoral fractures (11.3%), 5 pelvic ring fractures (9.4%), 23 upper limb injuries (43.4%), and 3 cases of chest trauma (5.7%). No one sustained abdominal trauma or head injury compared with the parent population. All patients required operative stabilization of foot fractures, including their associated injuries. Mean hospital stay was 10.9 days (range 1-35 days). In the parent population, there were 71 deaths (6.0%), whereas there was only 1 death (1.9%) in the foot-injured group (with fractures including open book pelvic, T6-8, unilateral open femur, tibial, ankle

  16. The 3D Pelvic Inclination Correction System (PICS): A universally applicable coordinate system for isovolumetric imaging measurements, tested in women with pelvic organ prolapse (POP).

    Science.gov (United States)

    Reiner, Caecilia S; Williamson, Tom; Winklehner, Thomas; Lisse, Sean; Fink, Daniel; DeLancey, John O L; Betschart, Cornelia

    2017-07-01

    In pelvic organ prolapse (POP), the organs are pushed downward along the lines of gravity, so measurements along this longitudinal body axis are desirable. We propose a universally applicable 3D coordinate system that corrects for changes in pelvic inclination and that allows the localization of any point in the pelvis at rest or under dynamic conditions on magnetic resonance images (MRI) of pelvic floor disorders in a scanner- and software independent manner. The proposed 3D coordinate system called 3D Pelvic Inclination Correction System (PICS) is constructed utilizing four bony landmark points, with the origin set at the inferior pubic point, and three additional points at the sacrum (sacrococcygeal joint) and both ischial spines, which are clearly visible on MRI images. The feasibility and applicability of the moving frame was evaluated using MRI datasets from five women with pelvic organ prolapse, three undergoing static MRI and two undergoing dynamic MRI of the pelvic floor in a supine position. The construction of the coordinate system was performed utilizing the selected landmarks, with an initial implementation completed in MATLAB. In all cases the selected landmarks were clearly visible, with the construction of the 3D PICS and measurement of pelvic organ positions performed without difficulty. The resulting distance from the organ position to the horizontal PICS plane was compared to a traditional measure based on standard measurements in 2D slices. The two approaches demonstrated good agreement in each of the cases. The developed approach makes quantitative assessment of pelvic organ position in a physiologically relevant 3D coordinate system possible independent of pelvic movement relative to the scanner. It allows the accurate study of the physiologic range of organ location along the body axis ("up or down") as well as defects of the pelvic sidewall or birth-related pelvic floor injuries outside the midsagittal plane, not possible before in a 2D

  17. Anatomy and Physiology of the Pelvic Floor.

    Science.gov (United States)

    Eickmeyer, Sarah M

    2017-08-01

    Understanding the anatomic relationship of the pelvic floor muscles with the pelvic girdle, spine, and hips aids the rehabilitation provider in diagnosis, management, and appropriate referrals. The bony anatomy of the pelvic girdle consists of 3 bones and 3 joints. The pelvic floor muscles are comprised mainly of the levator ani muscles with somatic innervation from the lumbosacral plexus. The bony and muscular pelvis is highly interconnected to the hip and gluteal musculature, which together provide support to the internal organs and core muscles. Pelvic floor physiology is centered on bladder and bowel control, sexual functioning, and pregnancy. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Pelvic floor muscle rehabilitation using biofeedback.

    Science.gov (United States)

    Newman, Diane K

    2014-01-01

    Pelvic floor muscle exercises have been recommended for urinary incontinence since first described by obstetrician gynecologist Dr. Arnold Kegel more than six decades ago. These exercises are performed to strengthen pelvic floor muscles, provide urethral support to prevent urine leakage, and suppress urgency. In clinical urology practice, expert clinicians also teach patients how to relax the muscle to improve bladder emptying and relieve pelvic pain caused by muscle spasm. When treating lower urinary tract symptoms, an exercise training program combined with biofeedback therapy has been recommended as first-line treatment. This article provides clinical application of pelvic floor muscle rehabilitation using biofeedback as a technique to enhance pelvic floor muscle training.

  19. Silent pelvic splenosis: Case report.

    Science.gov (United States)

    Lai, Tingmin; Meng, Chunfeng

    2015-01-01

    Splenosis is a benign, usually asymptomatic, condition involving autotransplantation of splenic tissue that occurs frequently after splenic rupture caused by trauma or surgery [1]. Up to 67% of the patients presenting splenic rupture may develop splenosis [2]. The interval of time between the initial trauma and the diagnosis varies from 3 to 45 years with an average interval of 21 years [3]. Since the finding of this entity is usually accidental, the real incidence is not well known. Although splenosis following traumatic splenectomy after traffic accidents is well-documented in the literature, there do not seem to be many reported cases where splenosis produced gynecological complications [4]. There were fewer than 100 cases of splenosis reported since the first report of Buchbinder and Lipkoff in 1939 [5] in the English language medical literature of which only a minority appeared in the gynecological literature. A case of pelvic and omentum majus splenosis in a patient is presented. Pelvic splenosis remains a rare finding in clinical practice. In most reported cases in the literature, the diagnosis was not considered before surgery. This approach may obviate the need for invasive evaluation for a primary or secondary neoplasm, and thus unnecessary surgery, and therefore preserve probable functional splenic tissue. Our case was diagnosed using non-surgical modalities. Our case emphasizes the rare diagnosing of pelvic splenosis in the evaluating pelvic mass with the tissue evidence instead of surgery. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  20. Bone Health and Pelvic Radiotherapy.

    Science.gov (United States)

    Higham, C E; Faithfull, S

    2015-11-01

    Survivors who have received pelvic radiotherapy make up many of the long-term cancer population, with therapies for gynaecological, bowel, bladder and prostate malignancies. Individuals who receive radiotherapy to the pelvis as part of their cancer treatment are at risk of insufficiency fractures. Symptoms of insufficiency fractures include pelvic and back pain and immobility, which can affect substantially quality of life. This constellation of symptoms can occur within 2 months of radiotherapy up to 63 months post-treatment, with a median incidence of 6-20 months. As a condition it is under reported and evidence is poor as to the contributing risk factors, causation and best management to improve the patient's bone health and mobility. As radiotherapy advances, chronic symptoms, such as insufficiency fractures, as a consequence of treatment need to be better understood and reviewed. This overview explores the current evidence for the effect of radiotherapy on bone health and insufficiency fractures and identifies what we know and where gaps in our knowledge lie. The overview concludes with the need to take seriously complaints of pelvic pain from patients after pelvic radiotherapy and to investigate and manage these symptoms more effectively. There is a clear need for definitive research in this field to provide the evidence-based guidance much needed in practice. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  1. Biomechanical comparison of supraacetabular external fixation and anterior pelvic bridge plating.

    Science.gov (United States)

    Çavuşoğlu, Ali Turgay; Erbay, Fatma Kübra; Özsoy, Mehmet Hakan; Demir, Teyfik

    2017-10-01

    Unstable pelvic ring injuries are complex and risky injuries due to high morbidity and mortality. Although anterior pelvic external fixator is a suitable method for rapid stabilization of an injured pelvic ring, due to some disadvantages such as high complication rate, nerve damage, and difficulties of patient's mobility and comfort, there has recently been increased searching for alternative methods for stabilization of the pelvic ring. Pubic symphysis zone freely moves in pelvic models. This study aims to evaluate the biomechanical stability of anterior pelvic bridge plating and compare it with supraacetabular external fixators in an untreated unstable pelvic fracture model. Samples were loaded statically with 2-mm/min loading rate in single leg standing position. Maximum load was 2.3 kN. When loading the samples, photographs were taken continuously. Stiffness values were calculated from the load displacement curves. Some reference parameters were described and were measured from unloaded and 2.3-kN-loaded photographs of the test. The mean stiffness values were 491.14 ± 52.22, 478.55 ± 41.44, and 470.25 ± 44.51 N/mm for anterior pelvic bridge plating group, supraacetabular external fixator group, and Control group, respectively. According to the measured parameters from photographs, the mean displacement at the pubic symphysis was 4.7 ± 0.32, 15.8 ± 2.01, and 18.2 ± 0.47 mm for anterior pelvic bridge plating, supraacetabular external fixator, and Control group, respectively. The highest displacement in the pubic symphysis was found in Control group, and minimum displacement was observed in anterior pelvic bridge plating group. When the perpendicular distance between the right and left lower end of ischium was examined, it was observed that displacement was minimum in anterior pelvic bridge plating group compared to other two groups, regarding to the high stability of pubic symphysis. In conclusion, this study revealed

  2. Prospectively Identified Deficits in Sagittal Plane Hip-Ankle Coordination in Female Athletes who Sustain a Second Anterior Cruciate Ligament Injury after Anterior Cruciate Ligament Reconstruction and Return to Sport

    Science.gov (United States)

    Paterno, Mark V.; Kiefer, Adam W.; Bonnette, Scott; Riley, Michael A.; Schmitt, Laura C.; Ford, Kevin R.; Myer, Gregory D.; Shockley, Kevin; Hewett, Timothy E.

    2015-01-01

    Background Athletes who return to sport after anterior cruciate ligament reconstruction are at increased risk of future ACL injury. Altered coordination of lower extremity motion may increase this risk. The purpose of this study was to prospectively determine if altered lower extremity coordination patterns exist in athletes who go on to sustain a 2nd anterior cruciate ligament injury. Methods Sixty-one female athletes who were medically cleared to return to sport after anterior cruciate ligament reconstruction were included. Hip-ankle coordination was assessed prior to return to sport with a dynamic postural coordination task. Within 12 months, 14 patients sustained a 2nd ACL injury. Fourteen matched subjects were selected for comparative analysis. Cross-recurrence quantification analysis characterized hip-ankle coordination patterns. A group × target speed (slow vs. fast) × leg (involved vs. uninvolved) analysis of variance was used to identify coordination differences. Findings A main effect of group (p = 0.02) indicated that the single injury group exhibited more stable hip-ankle coordination [166.2 (18.9)] compared to the 2nd injury group [108.4 (10.1)]. A leg × group interaction was also observed (p = .04). The affected leg of the single injury group exhibited more stable coordination [M = 187.1 (23.3)] compared to the affected leg of the 2nd injury group [M = 110.13 (9.8)], p = 0.03. Interpretation Hip-ankle coordination was altered in female athletes who sustained a 2nd anterior cruciate ligament injury after return to sport. Failure to coordinate lower extremity movement in the absence of normal knee proprioception may place the knee at high-risk. PMID:26416200

  3. Caring touch as a bodily anchor for patients after sustaining a motor vehicle accident with minor or no physical injuries - a mixed methods study.

    Science.gov (United States)

    Airosa, Fanny; Arman, Maria; Sundberg, Tobias; Öhlén, Gunnar; Falkenberg, Torkel

    2016-03-22

    Patients who sustain a motor vehicle accident may experience long-term distress, even if they are uninjured or only slightly injured. There is a risk of neglecting patients with minor or no physical injuries, which might impact future health problems. The aim of this study was to explore patients' subjective experiences and perspectives on pain and other factors of importance after an early nursing intervention consisting of "caring touch" (tactile massage and healing touch) for patients subjected to a motor vehicle accident with minor or no physical injuries. A mixed method approach was used. The qualitative outcomes were themes derived from individual interviews. The quantitative outcomes were measured by visual analogue scale for pain (VAS, 0-100), sense of coherence (SOC), post-traumatic stress (IES-R) and health status (EQ-5D index and EQ-5D self-rated health). Forty-one patients of in total 124 eligible patients accepted the invitation to participate in the study. Twenty-seven patients completed follow-up after 6 months whereby they had received up to eight treatments with either tactile massage or healing touch. Patients reported that caring touch may assist in trauma recovery by functioning as a physical "anchor" on the patient's way of suffering, facilitating the transition of patients from feeling as though their body is "turned off" to becoming "awake". By caring touch the patients enjoyed a compassionate care and experience moments of pain alleviation. The VAS pain ratings significantly decreased both immediately after the caring touch treatment sessions and over the follow-up period. The median scores for VAS (p injuries, a caring touch intervention is associated with patients' report of decreased pain and improved wellbeing up to 6 months after the accident. ClinicalTrials.gov Id: NCT02610205 . Date 25 November 2015.

  4. A QEEG index of level of functional dependence for people sustaining acquired brain injury: the Seville Independence Index (SINDI).

    Science.gov (United States)

    Leon-Carrion, Jose; Martin-Rodriguez, Juan Francisco; Damas-Lopez, Jesus; Martin, Juan Manuel Barroso Y; Dominguez-Morales, Maria Del Rosario

    2008-01-01

    To find an easy-to-use, valid and reliable tool for evaluating the level of functional dependence of an individual with brain damage who seeks a diagnosis of his/her functional dependence in daily activities. Eighty-one patients with acquired brain injury (ABI) in post-acute phase, 40 traumatic brain injury (TBI) and 41 cerebral vascular accident (CVA), were assessed using quantitative electroencephalography (QEEG) and grouped according to the FIM + FAM scale. Discriminant analysis was performed on QEEG variables to obtain a discriminant function with the best discriminative capacity between functionality groups. Discriminant analysis showed classification accuracy of 100% in the training set sample and 75% in an external cross-validation sample; 100% sensitivity and 100% specificity were reached. Coherence measures were the most numerous variables in the function. These results point out that the discriminant function may be a useful tool in objective evaluations of patients seeking a diagnosis of their level of dependence and that it could be included in current functionality assessment protocols.

  5. Injuries to children riding BMX bikes.

    OpenAIRE

    Illingworth, C M

    1984-01-01

    One hundred children presented over 40 days with BMX bike injuries, 40 of which had been sustained while trying to perform stunts. Injuries in this series were compared with previously reported injuries from accidents on ordinary bicycles. BMX bike injuries differed little from ordinary bike injuries except in the greater proportion of injuries due to stunts and the smaller incidence of head injuries.

  6. Biomechanical pregnant pelvic system model and numerical simulation of childbirth: impact of delivery on the uterosacral ligaments, preliminary results.

    Science.gov (United States)

    Lepage, J; Jayyosi, C; Lecomte-Grosbras, P; Brieu, M; Duriez, C; Cosson, M; Rubod, C

    2015-04-01

    We created a pregnant woman pelvic model to perform a simulation of delivery to understand the pathophysiology of urogenital prolapse by studying the constraints on the pelvic components (muscles, ligaments, pelvic organs) during childbirth. These simulations will also provide valuable tools to understand and teach obstetrical mechanics. We built a numerical model of the pelvic system from a term pregnant woman, using the finite element method on a mesh built from magnetic resonance images of a nulliparous pregnant woman. Mechanical properties of pelvic tissues already determined by the team were adapted to account for pregnancy. The system allows delivery to be simulated. When a fetal head at the 50th percentile for the term goes through the pelvic system, uterosacral ligaments undergo a deformation of around 30 %. Uterosacral ligaments are the major pelvic sustaining structures, their lesion may be a potential cause of urogenital prolapse. We built a model of childbirth as a function of pregnancy term by varying volumes of fetal head and uterus. The impact on uterosacral ligaments is higher when the fetal head is larger. Our modelling is rather complete considering that it involves many organs including ligaments. It allows us to analyse the effect of childbirth on uterosacral ligaments and to understand how they impact on pelvic statics. First results are promising, but optimisation and future simulations will be needed. We also plan to simulate various delivery scenarios (cephalic, breech presentation, instrumental extraction), which will be useful to study perineal lesions and also to teach obstetrical mechanics.

  7. Assessment of pelvic fractures resulting from the 2010 Haiti earthquake: opportunities for improved care.

    Science.gov (United States)

    Dailey, Steven K; Casstevens, E Christopher; Archdeacon, Michael T; Mamczak, Christiaan N; Burgess, Andrew R

    2014-03-01

    On January 12, 2010, a catastrophic 7.0 magnitude earthquake shook the Haitian capital of Port-au-Prince. Because of their sudden and destructive nature, earthquakes can result in unfamiliar mass casualty situations accompanied by devastating orthopedic injuries. Evaluation of the pelvic fractures resulting from this earthquake revealed several factors that we hope will facilitate optimal preparation and planning for future disaster situations. A cohort of patients with earthquake-related pelvic ring fractures who were treated aboard the USNS Comfort was retrospectively analyzed. Anteroposterior radiographs of the pelvis were evaluated and categorized according to the Young-Burgess classification system. Sixty-eight patients were included in the cohort. The mean (SD) age was 29.6 (14.4) years. Nineteen patients (29.7%) were male, and 49 (70.3%) were female. Pelvic fractures were categorized as anteroposterior compression in 7 patients, lateral compression (LC) in 47 patients, vertical shear (VS) in 8 patients, and combination of pelvic ring/acetabulum in 6 patients. Among the 23 patients treated operatively, the mean (SD) delay from injury to surgery was 19.2 (7.4) days. Patients showed predominance toward LC injuries (69.1%), consistent with crush under rubble. Thirty-one percent of the fractures were considered unstable (anteroposterior compression Type III, LC Type III, VS, and combination of pelvic ring/acetabulum). The VS injuries observed (11.8%) may be the result of a previously unidentified injury mechanism, an upright individual being struck by falling rubble, violently applying a downward force to the body over an extended lower extremity. A substantial delay in the treatment observed in this series may lead to an underestimation of both quantity and severity of pelvic fractures as critically ill patients may have perished before evaluation and treatment. In addition, the application of pelvic sheeting techniques may be a lifesaving intervention for

  8. Validation of the Pelvic Floor Distress Inventory-20 and the Pelvic Floor Impact Questionnaire-7 in Danish women with pelvic organ prolapse

    DEFF Research Database (Denmark)

    Due, Ulla; Brostrøm, Søren; Lose, Gunnar

    2013-01-01

    To translate the Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) and to evaluate their psychometric properties in Danish women with symptomatic pelvic organ prolapse.......To translate the Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) and to evaluate their psychometric properties in Danish women with symptomatic pelvic organ prolapse....

  9. Integrated total pelvic floor ultrasound in pelvic floor defaecatory dysfunction.

    Science.gov (United States)

    Hainsworth, A J; Solanki, D; Hamad, A; Morris, S J; Schizas, A M P; Williams, A B

    2017-01-01

    Imaging for pelvic floor defaecatory dysfunction includes defaecation proctography. Integrated total pelvic floor ultrasound (transvaginal, transperineal, endoanal) may be an alternative. This study assesses ultrasound accuracy for the detection of rectocele, intussusception, enterocele and dyssynergy compared with defaecation proctography, and determines if ultrasound can predict symptoms and findings on proctography. Treatment is examined. Images of 323 women who underwent integrated total pelvic floor ultrasound and defaecation proctography between 2011 and 2014 were blindly reviewed. The size and grade of rectocele, enterocele, intussusception and dyssynergy were noted on both, using proctography as the gold standard. Barium trapping in a rectocele or a functionally significant enterocele was noted on proctography. Demographics and Obstructive Defaecation Symptom scores were collated. The positive predictive value of ultrasound was 73% for rectocele, 79% for intussusception and 91% for enterocele. The negative predictive value for dyssynergy was 99%. Agreement was moderate for rectocele and intussusception, good for enterocele and fair for dyssynergy. The majority of rectoceles that required surgery (59/61) and caused barium trapping (85/89) were detected on ultrasound. A rectocele seen on both transvaginal and transperineal scanning was more likely to require surgery than if seen with only one mode (P = 0.0001). If there was intussusception on ultrasound the patient was more likely to have surgery (P = 0.03). An enterocele visualized on ultrasound was likely to be functionally significant on proctography (P = 0.02). There was, however, no association between findings on imaging and symptoms. Integrated total pelvic floor ultrasound provides a useful screening tool for women with defaecatory dysfunction such that defaecatory imaging can avoided in some. Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.

  10. [Internal Fixation of Sacro-iliac Joint in Unstable Fractures of the Pelvic Ring.].

    Science.gov (United States)

    Soukup, B

    1999-01-01

    Unstable fractures of the pelvic ring are always serious injuries posing problems from many aspects. Among the most serious are definitely unstable fractures of the pelvic ring with both vertical and rotational instability, i. e. type C fractures according to AO classification scheme. The recent therapeutic concept recommends in case of these fractures an active reconstruction on the dorsal SI complex which evidently improves the final perspective of patients with such a severe injury. The author presents his own clinical experience and literary data relating to the treatment of 11 patients who underwent reconstruction in the region of dorsal sacro-iliac complex due to type C unstable fracture. Clinical results achieved on the basis of the evaluation of a group of 11 patients are favourable and promising despite a significant complexity of the problems of unstable pelvic fractures. In 9 patients the anatomical result on radiograph was excellent, 9 patients regained full mobility after the proper physiotherapy, 10 patients resumed their work and 6 patients resumed even professional sports activity. In the conclusion the author states that in suitable, mainly young and fully stabilized patients the reconstruction surgery on the dorsal pelvic SI segment is fully justified which is documented both by the literary data and his own experience. Key words: unstable pelvic fractures.

  11. Management and outcome of pelvic fractures in elderly patients: a retrospective study of 40 cases.

    Science.gov (United States)

    Dong, Jinlei; Hao, Wei; Wang, Bomin; Wang, Lubo; Li, Lianxin; Mu, Weidong; Yang, Yongliang; Xin, Maoyuan; Wang, Fu; Zhou, Dongsheng

    2014-01-01

    Pelvic fractures are uncommon in elderly patients and so are infrequently addressed in the literature. The purpose of this study was to investigate the management and outcome of pelvic fractures in elderly patients. We retrospectively reviewed the records of pelvic fractures in elderly patients (age ≥55 years) who were treated in our department from September 1997 to May 2010. A total of 40 elderly patients with pelvic fractures were identified. Their mean age was 65.8 years (range 55-87 years). About 68% (n = 27) were men. The average Injury Severity Score (ISS) was 17.8 (range 6-45). Twelve (30%) patients required blood transfusion (mean 10 units) during the first 24 hours. The fractures were most frequently due to falling from a standing position (48%). Almost half (48%) were grade I breaks. Associated injuries were present in 70% (n = 28) of patients, and 65% (n = 26) had medical co-morbidities. Altogether, 29 patients (73%) underwent non-surgical management of their pelvic fracture. The average hospital stay was 25 days. There were five in-hospital deaths and one death 10 months after discharge. High ISSs (>25) were associated with increased in-hospital mortality (P = 0.018). At the final assessment (mean follow-up 15 months), 52% of the surviving patients had experienced decreased self-sufficiency. Pelvic fractures in elderly patients result in high morbidity and mortality rates. A high ISS (>25) can be used to identify a patient at high risk. We recommend aggressive resuscitation and intensive care for that patient. For patients with an unstable pelvic or displaced acetabular fracture (≥2 mm) who can endure surgery, open reduction and internal fixation can provide adequate fixation for early weight-bearing and restoration of the bone stock.

  12. Efficacy of biofeedback-assisted pelvic floor muscle training in ...

    African Journals Online (AJOL)

    Background: Stress urinary incontinence (SUI), fecal incontinence (FI) and/or pelvic floor dyssynergia, with pelvic organ prolapse (POP) are described as pelvic floor dysfunction (PFD). Pelvic floor muscle training (PFMT) is the first-line therapy in the treatment of PFD either alone or combined with biofeedback assisted pelvic ...

  13. [Sacral fracture with spino-pelvic dissociation: a literature review].

    Science.gov (United States)

    Cearra, I; Alonso, R; Martínez-Ogalla, D; Hoyos, J; Lauzirika, A; Mongil, R; Alvarez-Irusteta, E

    2013-01-01

    The term, sacral fracture with traumatic spino-pelvic dissociation, is applied to those fractures of the sacrum in which there are both transverse and sagittal fracture lines in the sacrum, leading to a mechanical dissociation of the spine and the proximal fragment of the sacrum from the remaining sacrum and the pelvis. It is a quite rare pathological condition, and probably underdiagnosed. As it usually results from a high energy multiple trauma, an early diagnosis and treatment are mandatory for a better functional prognosis. We present a literature review of this relatively unknown injury. © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  14. Pelvic floor: anatomy and function.

    Science.gov (United States)

    Bharucha, A E

    2006-07-01

    The pelvic floor is a dome-shaped striated muscular sheet that encloses the bladder, uterus, and rectum, and, together with the anal sphincters, has an important role in regulating storage and evacuation of urine and stool. This article reviews the anatomy, nerve supply, pharmacology, and functions of the anal sphincters and the pelvic floor. The internal and external anal sphincters are primarily responsible for maintaining faecal continence at rest and when continence is threatened, respectively. Defecation is a somato-visceral reflex regulated by dual nerve supply (i.e. somatic and autonomic) to the anorectum. The net effects of sympathetic and cholinergic stimulation are to increase and reduce anal resting pressure, respectively. Faecal incontinence and functional defecatory disorders may result from structural changes and/or functional disturbances in the mechanisms of faecal continence and defecation.

  15. Pelvic lymphoma: An unusual presentation

    Directory of Open Access Journals (Sweden)

    Fakhrolmolouk Yassaee

    2011-01-01

    Full Text Available Pelvic lymphoma is not a common condition and aggressive recurrence of chronic lymphocytic leukemia (CLL as a cause is rarely reported. We report a case of lymphoma of left adnexa in a postmenopausal woman, with a three week history of abdominal and left flank pain. Past medical history was consistent with diagnosis of CLL. She had received chemotherapy. Due to abdominal and flank pain and abdominopelvic mass, exploratory laparotomy was done with the impression of ovarian malignancy. A large uterus with adnexal mass and a large tumoral bladder was seen. Biopsy was done from adnexal mass which was compatible with lymphoma. The abdomen was closed and the patient was referred for chemotherapy. Lymphoma usually does not involve the pelvic organs. After laparotomy, her condition deteriorated and she expired.

  16. Does application position of the T-POD affect stability of pelvic fractures?

    Science.gov (United States)

    Prasarn, Mark L; Small, John; Conrad, Bryan; Horodyski, Nicole; Horodyski, Marybeth; Rechtine, Glenn R

    2013-05-01

    Most trauma centers place pelvic binders on unstable pelvic fractures for acute management and control of hemorrhage. It has been proposed that the binders be placed at the level of the greater trochanters of the femur. Our hypothesis was that application of the T-POD at this site would provide better immobilization of an unstable pelvic injury than a more cephalad location. Unstable pelvic injuries (OTA type 61-C1) were surgically created in 9 fresh whole human cadavers. Electromagnetic sensors were affixed to the intact and injured sides of the pelvis. A Fastrak, three-dimensional electromagnetic motion analysis device was used to determine the angular motion occurring at the fractured sites. Maximum displacements for sagittal, coronal, and axial rotation were recorded during application of the binder, while performing bed transfers, while logrolling, and elevating the head of the bed. The T-POD device was placed either over the greater trochanters or at the level of the anterior superior iliac spine as per manufacturer's recommendations. There were no significant differences in the amount of motion produced during application of the T-POD at either location. There was less motion observed in all planes of motion during all maneuvers when the T-POD was placed at the level of the greater trochanters versus anterior superior iliac spine. During bed transfers, this was statistically significant in all planes. This was statistically significant while logrolling in the axial plane and the coronal plane during head of bed elevation. We advocate the placement of pelvic binder devices at the level of the greater trochanters for improved control of the fracture in an unstable pelvic injury. This may result in improved control of hemorrhage, better access to the abdomen, and greater patient comfort.

  17. A case of pelvic lipomatosis

    OpenAIRE

    岡, 裕也; 畑山, 忠; 滝, 洋二; 飛田, 収一; 上山, 秀麿; 小松, 洋輔

    1991-01-01

    This is a report of the fifth case of pelvic lipomatosis in Japan. A 52-year-old man presented himself in our hospital with a complaint of left lower abdominal pain on August 28, 1988. At that time, physical examination was unremarkable with the exception of mild obesity. The excretory urogram and retrograde pyelogram revealed left hydroureteronephrosis with tapering of the left lower ureter. Urethrocystogram showed an elongated posterior urethra with anterior displacement and elevation of th...

  18. Pelvic morphology in ischiofemoral impingement

    Energy Technology Data Exchange (ETDEWEB)

    Bredella, Miriam A.; Azevedo, Debora C.; Oliveira, Adriana L.; Simeone, Frank J.; Chang, Connie Y.; Torriani, Martin [Massachusetts General Hospital, Department of Radiology, Musculoskeletal Imaging and Intervention, Boston, MA (United States); Stubbs, Allston J. [Wake Forest University School of Medicine, Department of Orthopedic Surgery, Division of Sports Medicine, Winston-Salem, NC (United States)

    2014-11-06

    To assess MRI measures to quantify pelvic morphology that may predispose to ischiofemoral impingement (IFI). We hypothesized that patients with IFI have a wider interischial distance and an increased femoral neck angle compared with normal controls. The study was IRB-approved and complied with HIPAA guidelines. IFI was diagnosed based on clinical findings (hip or buttock pain) and ipsilateral edema of the quadratus femoris muscle on MRI. Control subjects did not report isolated hip/buttock pain and underwent MRI for surveillance of neoplasms or to exclude pelvic fractures. Two MSK radiologists measured the ischiofemoral (IF) and quadratus femoris (QF) distance, the ischial angle as a measure of inter-ischial distance, and the femoral neck angle. The quadratus femoris muscle was evaluated for edema. Groups were compared using ANOVA. Multivariate standard least-squares regression modeling was used to control for age and gender. The study group comprised 84 patients with IFI (53 ± 16 years, 73 female, 11 male) and 51 controls (52 ± 16 years, 33 female, 18 male). Thirteen out of 84 patients (15 %) had bilateral IFI. Patients with IFI had decreased IF and QF distance (p < 0.0001), increased ischial angle (p = 0.004), and increased femoral neck angle (p = 0.02) compared with controls, independent of age and gender. Patients with IFI have increased ischial and femoral neck angles compared with controls. These anatomical variations in pelvic morphology may predispose to IFI. MRI is a useful method of not only assessing the osseous and soft-tissue abnormalities associated with IFI, but also of quantifying anatomical variations in pelvic morphology that can predispose to IFI. (orig.)

  19. Primary pelvic floor reconstruction after pelvic evisceration with “Collost” membranes

    OpenAIRE

    Z. Z. Mamedli; H. E. Dmumabaev; D. H. Hudoerov; Yu. E. Suraeva; A. V. Nalbandyan

    2016-01-01

    This article displays the results of successful combined treatment of patient with recurrence of rectal carcinoma with use of preoperative chemotherapy followed by infralevator pelvic exenteration and primary reconstruction of pelvic floor using xenotransplant “Kollost”.

  20. Primary pelvic floor reconstruction after pelvic evisceration with “Collost” membranes

    Directory of Open Access Journals (Sweden)

    Z. Z. Mamedli

    2016-01-01

    Full Text Available This article displays the results of successful combined treatment of patient with recurrence of rectal carcinoma with use of preoperative chemotherapy followed by infralevator pelvic exenteration and primary reconstruction of pelvic floor using xenotransplant “Kollost”.

  1. Smoking and pregnancy-related pelvic pain

    DEFF Research Database (Denmark)

    Biering, Karin; Nøhr, Ellen Aagaard; Olsen, Jørn

    2010-01-01

    OBJECTIVE: To investigate possible associations between smoking and pregnancy-related pelvic pain. DESIGN: Nested case-control study. SETTING: Denmark 2000-2001. POPULATION: The Danish National Birth Cohort. METHODS: The women were interviewed twice in pregnancy and twice after childbirth....... The first pregnancy interview provided information on smoking and possible confounding factors,whereas the first interview after birth addressed case identification.Cases (n = 2302) were defined on the basis of self-reported pelvic pain, and controls were selected among women who did not report pelvic pain...... (n = 2692). Logistic regression analysis was used to estimate associations between smoking and pelvic pain.MAIN OUTCOME MEASURE: Pregnancy-related pelvic pain. RESULTS: Compared with non-smokers, women who smoked during pregnancy had an adjusted odds ratio of 1.2 (1.0-1.4) for overall pelvic pain...

  2. Sustained delivery of activated Rho GTPases and BDNF promotes axon growth in CSPG-rich regions following spinal cord injury.

    Directory of Open Access Journals (Sweden)

    Anjana Jain

    2011-01-01

    Full Text Available Spinal cord injury (SCI often results in permanent functional loss. This physical trauma leads to secondary events, such as the deposition of inhibitory chondroitin sulfate proteoglycan (CSPG within astroglial scar tissue at the lesion.We examined whether local delivery of constitutively active (CA Rho GTPases, Cdc42 and Rac1 to the lesion site alleviated CSPG-mediated inhibition of regenerating axons. A dorsal over-hemisection lesion was created in the rat spinal cord and the resulting cavity was conformally filled with an in situ gelling hydrogel combined with lipid microtubes that slowly released constitutively active (CA Cdc42, Rac1, or Brain-derived neurotrophic factor (BDNF. Treatment with BDNF, CA-Cdc42, or CA-Rac1 reduced the number of GFAP-positive astrocytes, as well as CSPG deposition, at the interface of the implanted hydrogel and host tissue. Neurofilament 160kDa positively stained axons traversed the glial scar extensively, entering the hydrogel-filled cavity in the treatments with BDNF and CA-Rho GTPases. The treated animals had a higher percentage of axons from the corticospinal tract that traversed the CSPG-rich regions located proximal to the lesion site.Local delivery of CA-Cdc42, CA-Rac1, and BDNF may have a significant therapeutic role in overcoming CSPG-mediated regenerative failure after SCI.

  3. A within-subject analysis of the effects of remote cueing on pelvic alignment in dancers.

    Science.gov (United States)

    Holt, Kimberly M; Welsh, Thomas M; Speights, Jaclyn

    2011-03-01

    Many professionals who treat and train dancers believe that good alignment at the pelvis can facilitate movement efficiency and reduce injury risk in a variety of dance genres. This study evaluated the effects of a remote cueing technique on pelvic alignment for dancers in a university-based professional training program. Two female dancers participated in 20-minute individualized observation and training sessions twice a week for eight weeks. Pelvic alignment improved to criterion levels for both dancers, suggesting that individualized approaches may have special utility in training dancers.

  4. Gynecological pelvic pain as emergency pathology.

    Science.gov (United States)

    Rivera Domínguez, A; Mora Jurado, A; García de la Oliva, A; de Araujo Martins-Romeo, D; Cueto Álvarez, L

    Acute pelvic pain is a common condition in emergency. The sources of acute pelvic pain are multifactorial, so it is important to be familiar with this type of pathologies. The purpose of this article is review the main causes of gynecological acute pelvic pain and their radiologic appearances to be able to make an accurate diagnosis and provide objective criteria for patient management. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. The pelvic floor in health and disease.

    OpenAIRE

    Shelton, A A; Welton, M L

    1997-01-01

    Normal pelvic floor function involves a set of learned and reflex responses that are essential for the normal control and evacuation of stool. A variety of functional disturbances of the pelvic floor, including incontinence and constipation, are not life threatening, but can cause significant distress to affected patients. Understanding the normal anatomy and physiology of the pelvic floor is essential to understanding and treating these disorders of defecation. This article describes the nor...

  6. Prevention of ureteral injuries in gynecologic surgery.

    Science.gov (United States)

    Chan, John K; Morrow, Joelle; Manetta, Alberto

    2003-05-01

    Pelvic surgery is the most common cause of iatrogenic ureteral injury. The majority of patients with ureteral injuries have no identifiable predisposing risk factors. A simple maneuver that has been taught successfully at our institution that facilitates the identification of the ureter is described. When injury is discovered during surgery, correction of the injury can be repaired with minimal risk of long-term sequelae. Postoperatively, patients with ureteral injury typically present with costovertebral angle tenderness, ileus, fever, and flank pain with a minimal rise in serum creatinine. To prevent ureteral injuries, the surgeon must have a thorough knowledge of the location of the ureter during various pelvic procedures and the specific regions where it is most susceptible to injury.

  7. Recognizing Myofascial Pelvic Pain in the Female Patient with Chronic Pelvic Pain

    Science.gov (United States)

    Pastore, Elizabeth Anne; Katzman, Wendy B.

    2012-01-01

    Myofascial pelvic pain (MFPP) is a major component of chronic pelvic pain (CPP) and often is not properly identified by healthcare providers. The hallmark diagnostic indicator of MFPP is myofascial trigger points in the pelvic floor musculature that refer pain to adjacent sites. Effective treatments are available to reduce MFPP, including myofascial trigger point release, PMID:22862153

  8. Contribution of pelvic floor muscles to stiffness of the pelvic ring

    NARCIS (Netherlands)

    Pool-Goudzwaard, A.L.; Hoek van Dijke, G; van Gurp, M; Mulder, P; Snijders, C.J.; Stoeckart, R.

    2004-01-01

    STUDY DESIGN: A biomechanical study in embalmed specimens, on the relation between applied tension in the pelvic floor muscles, stiffness of the pelvic ring and generation of movement in the sacroiliac joints. OBJECTIVE: To gain insight into the effect of tension in the pelvic floor muscles on

  9. Pelvic floor muscle function in a general population of women with and without pelvic organ prolapse.

    NARCIS (Netherlands)

    Slieker-ten Hove, M.C.; Pool-Goudzwaard, A.; Eijkemans, M.C.J.; Steegers-Theunissen, R.P.M.; Burger, C.; Vierhout, M.E.

    2010-01-01

    INTRODUCTION AND HYPOTHESIS: This study aims to examine the relationship between pelvic floor muscle function (PFMF) and pelvic organ prolapse (POP) in a general female population. METHODS: Cross-sectional study on women aged 45-85 years. Validated questionnaires were used to assess pelvic floor

  10. [Functional anatomy of the pelvic floor].

    Science.gov (United States)

    Yiou, René; Delmas, Vincent

    2013-01-01

    The pelvic floor is the support of the pelvic viscera. The levator ani muscle (LA) with its two bundles (pubo- and iliococcygeus) is the major component of this pelvic floor. LA is formed essentially by type I fibers (slow twitch, with high oxidative capability and presence of slow myosin) as in postural muscles. The aerobic metabolism makes LA fragile to excentric contraction and to mitochondrial dysfunction. The innervation of the pelvic floor comes from the 2nd, 3rd, 4th anterior sacral roots; denervation affects pelvic dynamism. Perineum includes the musculofascial structures under the LA: ventrally the striated sphincter of urethra and the ischiocavernosus and bulbospongiosus, caudally the fatty tissue filling the ischioanal fossa. Pelvic fascia covers the muscles ; it presents reinforcements : the uterosacral and cardinal ligaments, the arcus tendineus fascia pelvis (ATFP) and the arcus tendineus levator ani (ATLA). The pelvis statics is supported by the combined action of all this anatomical structures anteriorly forming the perineal "hammock," medially the uterosacral and cardinal ligaments, posteriorly the rectovaginal fascia and the perineal body. The angles formed by the pelvic viscera with their evacuation ducts participate to the pelvic statics. During the pelvic dynamics the modification of these angles expresses the action of the musculofascial structures.

  11. Testing of the Anorectal and Pelvic Floor Area

    Science.gov (United States)

    ... Disorders of the Large Intestine Disorders of the Pelvic Floor Motility Testing Personal Stories Contact About GI Motility ... Disorders of the Large Intestine Disorders of the Pelvic Floor Motility Testing Personal Stories Contact Anorectal and Pelvic ...

  12. Assessment of pelvic floor dysfunctions using dynamic magnetic resonance imaging

    Directory of Open Access Journals (Sweden)

    Hoda Salah Darwish

    2014-03-01

    Conclusion: Dynamic MRI is an ideal, non invasive technique which does not require patient preparation for evaluation of pelvic floor. It acts as one stop shop for diagnosing single or multiple pelvic compartment involvement in patients with pelvic floor dysfunction.

  13. National Childhood Vaccine-Injury Compensation Act. Hearing before the Committee on Labor and Human Resources, United States Senate, Ninety-Eighth Congress on S.2117 to Amend the Public Health Service Act to Provide for the Compensation of Children and Others Who Have Sustained Vaccine-Related Injury, and for Other Purposes.

    Science.gov (United States)

    Congress of the U.S., Washington, DC. Senate Committee on Labor and Human Resources.

    Statements are presented which were made at this hearing to amend the Public Health Service Act to provide for the compensation of children and others who have sustained vaccine-related injury. While the hearing focused on the costs and the regulatory burden that might be imposed by the legislation, the following areas were also addressed: (1) the…

  14. Volleyball injuries.

    Science.gov (United States)

    Eerkes, Kevin

    2012-01-01

    There has been a significant increase in the numbers of people playing indoor and beach volleyball since the early 1980s and, consequently, an increase in injuries. Most injuries are related to repetitive jumping and hitting the ball overhead. The ankle is the most commonly injured joint, but the knee, shoulder, low back, and fingers also are vulnerable. The shoulder in particular is subject to extreme torque when hitting and jump serving the ball. Some injuries have a predilection for those playing on sand versus those playing in an indoor court. The clinician caring for volleyball players should be aware of the types of injuries these players sustain and how to help them return to play promptly and appropriately. This article reviews the specific injuries that are most common as a result of participating in the sport of volleyball.

  15. Pelvic floor function is independently associated with pelvic organ prolapse.

    Science.gov (United States)

    Braekken, I H; Majida, M; Ellström Engh, M; Holme, I M; Bø, K

    2009-12-01

    To investigate the risk factors for pelvic organ prolapse (POP), including physical activity, clinically measured joint mobility and pelvic floor muscle (PFM) function. One-to-one age- and parity-matched case-control study. Akershus university hospital and one outpatient physiotherapy clinic in Norway. Forty-nine women with POP (POP quantification, stage>or=II) and 49 controls (stages 0 and I) were recruited from community gynaecologists and advertisements in newspapers. Validated questionnaires, interview and clinical examination, including Beighton's scoring system (joint hypermobility) and vaginal pressure transducer measurements (PFM function), were used. Univariate and multivariate conditional logistic regression analyses for one-to-one matched case-control studies were used, and odds ratios with 95% CIs are reported. Pelvic floor muscle function (strength, endurance and resting pressure), socioeconomic status, body mass index, heavy occupational work, physical activity, family history, obstetric factors and markers of connective tissue weakness (striae, varicose veins, bruising, diastasis recti abdominis, joint hypermobility). No significant differences were found between groups with regard to postmenopausal status, current smoking, current low-intensity exercise, type of birth (caesarean, forceps, vacuum), birth weight, presence of striae, diastasis recti abdominis and joint hypermobility. Body mass index (OR 5.0; 95% CI 1.1-23.0), socioeconomic status (OR 10.5; 95% CI 2.2-50.1), heavy occupational work (OR 9.6; 95% CI 1.3-70.3), anal sphincter lacerations (OR 4.5; 95% CI 1.0-20.0), PFM strength (OR 7.5; 95% CI 1.5-36.4) and endurance (OR 11.5; 95% CI 2.0-66.9) were independently related to POP. Body mass index, socioeconomic status, heavy occupational work, anal sphincter lacerations and PFM function were independently associated with POP, whereas joint mobility and physical activity were not.

  16. Conditioning lesions before or after spinal cord injury recruit broad genetic mechanisms that sustain axonal regeneration: superiority to camp-mediated effects.

    Science.gov (United States)

    Blesch, Armin; Lu, Paul; Tsukada, Shingo; Alto, Laura Taylor; Roet, Kasper; Coppola, Giovanni; Geschwind, Dan; Tuszynski, Mark H

    2012-05-01

    Previous studies indicate that peripheral nerve conditioning lesions significantly enhance central axonal regeneration via modulation of cAMP-mediated mechanisms. To gain insight into the nature and temporal dependence of neural mechanisms underlying conditioning lesion effects on central axonal regeneration, we compared the efficacy of peripheral sciatic nerve crush lesions to cAMP elevations (in lumbar dorsal root ganglia) on central sensory axonal regeneration when administered either before or after cervical spinal cord lesions. We found significantly greater effects of conditioning lesions compared to cAMP elevations on central axonal regeneration when combined with cellular grafts at the lesion site and viral neurotrophin delivery; further, these effects persisted whether conditioning lesions were applied prior to or shortly after spinal cord injury. Indeed, conditioning lesions recruited extensively greater sets of genetic mechanisms of possible relevance to axonal regeneration compared to cAMP administration, and sustained these changes for significantly greater time periods through the post-lesion period. We conclude that cAMP-mediated mechanisms account for only a portion of the potency of conditioning lesions on central axonal regeneration, and that recruitment of broader genetic mechanisms can extend the effect and duration of cellular events that support axonal growth. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. Pushed to the Margins and Pushing Back: A Case Study of One Adult’s Reflections on Social Interactions After a Traumatic Brain Injury Sustained as an Adolescent

    Science.gov (United States)

    Roscigno, Cecelia I.; Van Liew, Kevin

    2009-01-01

    Traumatic brain injury (TBI) is a worldwide chronic health problem. Current empirical approaches to defining factors that contribute to a meaningful life after TBI have been limited to the biomedical perspective. Such a limited paradigm fails to address how people with TBI find meaning and act on and are acted on by the world in which they live. Between 2005 and 2007 an in-depth qualitative case study was conducted. The primary data source was a man’s retrospective journal writings about his life after sustaining a severe TBI. The qualitative perspective of symbolic interactionism framed this case study analysis. Meaning is strongly influenced by the ways in which the social world interacts with the injured person. Despite an accumulation of negative social experiences, a traumatically brain-injured person can also assign positive meanings to the quality of his or her life. This has been ignored or explained away as a defense mechanism in previous investigations. More studies that include unbiased methods able to capture subjective experiences and what they mean to individuals with TBI are needed. This information will lead to more relevant interventions and better outcome instruments for use with this population. PMID:18727337

  18. bladder injury during infected total hip arthroplasty prosthesis ...

    African Journals Online (AJOL)

    motor vehicle crash or fall, or from an external blow to the lower abdomen (1-3). The most frequently accompanying injury is a pelvic fracture, occuring in >95% of bladder ruptures caused by blunt trauma. Other concomitant injuries were defined as gunshot wounds which account for <10% of bladder injuries. (1,4).

  19. Efficacy of treatment in peri-pelvic Morel-Lavallee lesion: a systematic review of the literature.

    Science.gov (United States)

    Shen, Chao; Peng, Jian-Ping; Chen, Xiao-Dong

    2013-05-01

    Morel-Lavallee lesion (MLL) of the peri-pelvic region is less common and various treatments have been introduced to manage the lesion. No standard treatment is recommended. We performed a systematic review of literature to (1) identify the classification of peri-pelvic MLL; (2) review the treatments of the lesion and their complications; (3) define the optimal treatment of peri-pelvic MLL. A systematic search was performed via PubMed, ISI Web of Knowledge, and Embase for English abstract articles from 1966 to 2012. We identified 21 articles detailing 153 patients with peri-pelvic MLL, most of which were level IV studies. The treatments and clinical results were reviewed. For peri-pelvic MLL patients, surgical intervention was better than conservative therapy. Sclerhodesis method is attended with good outcome in the symptomatic MLL patients without fractures. Patients with peri-pelvic fractures could be managed with local suction drainage or open debridement with dead space closure technique during fracture fixation. The delayed-diagnosis cases might be treated with mass resection when fibrosis capsule was obtained in magnetic resonance imaging. Peri-pelvic MLL can be treated with various surgical methods depending on the formation of fibrosis capsule and associated injuries. Dead space closure technique is emphasized in the treatment of MLL. Higher quality of literature is required to prove this result in future research.

  20. Nutritional support for patients sustaining traumatic brain injury: a systematic review and meta-analysis of prospective studies.

    Directory of Open Access Journals (Sweden)

    Xiang Wang

    Full Text Available BACKGROUND: In traumatic brain injury (TBI, the appropriate timing and route of feeding, and the efficacy of immune-enhancing formulae have not been well established. We performed this meta-analysis aiming to compare the effects of different nutritional support modalities on clinical outcomes of TBI patients. METHODS: We systematically searched Pubmed, Embase, and the Cochrane Library until October, 2012. All randomized controlled trials (RCTs and non-randomized prospective studies (NPSs that compared the effects of different routes, timings, or formulae of feeding on outcomes in TBI patients were selected. The primary outcomes included mortality and poor outcome. The secondary outcomes included the length of hospital stay, the length of ventilation days, and the rate of infectious or feeding-related complications. FINDINGS: 13 RCTs and 3 NPSs were included. The pooled data demonstrated that, compared with delayed feeding, early feeding was associated with a significant reduction in the rate of mortality (relative risk [RR] = 0.35; 95% CI, 0.24-0.50, poor outcome (RR = 0.70; 95% CI, 0.54-0.91, and infectious complications (RR = 0.77; 95% CI, 0.59-0.99. Compared with enteral nutrition, parenteral nutrition showed a slight trend of reduction in the rate of mortality (RR = 0.61; 95% CI, 0.34-1.09, poor outcome (RR = 0.73; 95% CI, 0.51-1.04, and infectious complications (RR = 0.89; 95% CI, 0.66-1.22, whereas without statistical significances. The immune-enhancing formula was associated with a significant reduction in infection rate compared with the standard formula (RR = 0.54; 95% CI, 0.35-0.82. Small-bowel feeding was found to be with a decreasing rate of pneumonia compared with nasogastric feeding (RR = 0.41; 95% CI, 0.22-0.76. CONCLUSION: After TBI, early initiation of nutrition is recommended. It appears that parenteral nutrition is superior to enteral nutrition in improving outcomes. Our results lend support to

  1. Pelvic floor morphometry and function in women with and without puborectalis avulsion in the early postpartum period.

    Science.gov (United States)

    Cyr, Marie-Pierre; Kruger, Jennifer; Wong, Vivien; Dumoulin, Chantale; Girard, Isabelle; Morin, Mélanie

    2017-03-01

    Pelvic floor muscles are subject to considerable stretching during vaginal birth. In 13-36% of women, stretching results in avulsion injury whereby the puborectalis muscle disconnects from its insertion points on the pubis bone. Until now, few studies have investigated the effect of this lesion on pelvic floor muscles in the early postpartum period. The primary aim of this study was to compare pelvic floor muscle morphometry and function in primiparous women with and without puborectalis avulsion in the early postpartum period. Our secondary objective was to compare the 2 groups for pelvic floor disorders and impact on quality of life. In all, 52 primiparous women diagnosed with (n = 22) or without (n = 30) puborectalis avulsion injury were assessed at 3 months postpartum. Pelvic floor muscle morphometry was evaluated with 3-/4-dimensional transperineal ultrasound at rest, maximal contraction, and Valsalva maneuver. Different parameters were measured in the midsagittal and axial planes: bladder neck position, levator plate angle, anorectal angle, and levator hiatus dimensions. The dynamometric speculum was used to assess pelvic floor muscle function including: passive properties (passive forces and stiffness) during dynamic stretches, maximal strength, speed of contraction, and endurance. Pelvic floor disorder-related symptoms (eg, urinary incontinence, vaginal and bowel symptoms) and impact on quality of life were evaluated with the International Consultation on Incontinence Questionnaire and the Pelvic Floor Impact Questionnaire-Short Form. Pelvic Organ Prolapse Quantification was also assessed. In comparison to women without avulsion, women with avulsion presented an enlarged hiatus area at rest, maximal contraction, and Valsalva maneuver (P ≤ .013) and all other ultrasound parameters were found to be significantly altered during maximal contraction (P ≤ .014). They showed lower passive forces at maximal and 20-mm vaginal apertures as well as lower

  2. Halo-pelvic traction for severe kyphotic deformity secondary to spinal tuberculosis.

    Science.gov (United States)

    Muheremu, Aikeremujiang; Ma, Yuan; Ma, Yong; Ma, Junyi; Cheng, Junjie; Xie, Jiang

    2017-07-01

    To evaluate the efficacy and safety of Halo-pelvic ring traction in the treatment of severe kyphotic deformity secondary to spinal tuberculosis.Eighty patients with severe kyphotic deformity due to spinal tuberculosis were included in the study. Forty of those patients (experimental group) received Halo- pelvic ring traction before surgery and the rest (control group) received surgical treatment directly. Two groups were compared by means of the duration of surgery, intraoperative blood loss, correction of Cobb angle, change in patient height, and American Spinal Injury Association (ASIA) impairment scale.Halo-pelvic traction group achieved significantly (P spinal kyphotic deformity due to spinal tuberculosis to increase efficacy and safety of surgical treatment.

  3. MRI-based registration of pelvic alignment affected by altered pelvic floor muscle characteristics.

    Science.gov (United States)

    Bendová, Petra; Růzicka, Pavel; Peterová, Vera; Fricová, Martina; Springrová, Ingrid

    2007-11-01

    Pelvic floor muscles have potential to influence relative pelvic alignment. Side asymmetry in pelvic floor muscle tension is claimed to induce pelvic malalignment. However, its nature and amplitude are not clear. There is a need for non-invasive and reliable assessment method. An intervention experiment of unilateral pelvic floor muscle activation on healthy females was performed using image data for intra-subject comparison of normal and altered configuration of bony pelvis. Sequent magnetic resonance imaging of 14 females in supine position was performed with 1.5 T static body coil in coronal orientation. The intervention, surface functional electrostimulation, was applied to activate pelvic floor muscles on the right side. Spatial coordinates of 23 pelvic landmarks were localized in each subject and registered by specially designed magnetic resonance image data processing tool (MPT2006), where individual error calculation; data registration, analysis and 3D visualization were interfaced. The effect of intervention was large (Cohen's d=1.34). We found significant differences in quantity (Pmuscle activation on the right side, pelvic structures shifted most frequently to the right side in ventro-caudal direction. The right femoral head, the right innominate and the coccyx showed the largest displacements. The consequences arising from the capacity of pelvic floor muscles to displace pelvic bony structures are important to consider not only in management of malalignment syndrome but also in treatment of incontinence. The study has demonstrated benefits associated with processing of magnetic resonance image data within pelvic region with high localization and registration reliability.

  4. Krukenberg Tumour Simulating Uterine Fibroids and Pelvic ...

    African Journals Online (AJOL)

    To report a case of cancer of the colonwhich presented as secondaries to the ovaries. Case report. The case presented is that of a 39 year old female who presented with lower abdominal pain and a multinodular pelvic mass which led to an initial diagnosis of multiple uterine fibroids and pelvic inflammatory disease.

  5. Laparoscopic Pelvic Floor Repair Using Polypropylene Mesh

    Directory of Open Access Journals (Sweden)

    Shih-Shien Weng

    2008-09-01

    Conclusion: Laparoscopic pelvic floor repair using a single piece of polypropylene mesh combined with uterosacral ligament suspension appears to be a feasible procedure for the treatment of advanced vaginal vault prolapse and enterocele. Fewer mesh erosions and postoperative pain syndromes were seen in patients who had no previous pelvic floor reconstructive surgery.

  6. Unified wavelet and Gaussian filtering for segmentation of CT images; application in segmentation of bone in pelvic CT images.

    Science.gov (United States)

    Vasilache, Simina; Ward, Kevin; Cockrell, Charles; Ha, Jonathan; Najarian, Kayvan

    2009-11-03

    The analysis of pelvic CT scans is a crucial step for detecting and assessing the severity of Traumatic Pelvic Injuries. Automating the processing of pelvic CT scans could impact decision accuracy, decrease the time for decision making, and reduce health care cost. This paper discusses a method to automate the segmentation of bone from pelvic CT images. Accurate segmentation of bone is very important for developing an automated assisted-decision support system for Traumatic Pelvic Injury diagnosis and treatment. The automated method for pelvic CT bone segmentation is a hierarchical approach that combines filtering and histogram equalization, for image enhancement, wavelet analysis and automated seeded region growing. Initial results of segmentation are used to identify the region where bone is present and to target histogram equalization towards the specific area. Speckle Reducing Anisotropic Didffusion (SRAD) filter is applied to accentuate the desired features in the region. Automated seeded region growing is performed to refine the initial bone segmentation results. The proposed method automatically processes pelvic CT images and produces accurate segmentation. Bone connectivity is achieved and the contours and sizes of bones are true to the actual contour and size displayed in the original image. Results are promising and show great potential for fracture detection and assessing hemorrhage presence and severity. Preliminary experimental results of the automated method show accurate bone segmentation. The novelty of the method lies in the unique hierarchical combination of image enhancement and segmentation methods that aims at maximizing the advantages of the combined algorithms. The proposed method has the following advantages: it produces accurate bone segmentation with maintaining bone contour and size true to the original image and is suitable for automated bone segmentation from pelvic CT images.

  7. Combat Trousers as Effective Improvised Pelvic Binders A Comparative Cadaveric Study.

    Science.gov (United States)

    Loftus, Andrew; Morris, Rhys; Friedmann, Yasmin; Pallister, Ian; Parker, Paul

    2017-01-01

    Improvised explosive devices and landmines can cause pelvic fractures, which, in turn, can produce catastrophic hemorrhage. This cadaveric study compared the intrapelvic pressure changes that occurred with the application of an improvised pelvic binder adapted from the combat trousers worn by British military personnel with the commercially available trauma pelvic orthotic device (TPOD). Six unembalmed cadavers (three male, three female) were used to simulate an unstable pelvic fracture with complete disruption of the posterior arch (AO/OTA 61-C1) by dividing the pelvic ring anteriorly and posteriorly. A 3-4cm manometric balloon filled with water was placed in the retropubic space and connected to a 50mL syringe and water manometer via a three-way tap. A baseline pressure of 8cm H2O (average central venous pressure) was set. The combat trouser binder (CTB) and TPOD were applied to each cadaver in a random sequence and the steady intrapelvic pressure changes were recorded. Statistical analysis was performed using the Wilcoxon rank-sum test and a paired t test depending on the normality of the data to determine impact on the intrapelvic pressure of each intervention compared with baseline. The median steady intrapelvic pressure achieved after application of the CTB was 16cm H2O and after application of the TPOD binder was 18cm H2O, both of which were significantly greater than the baseline pressure (ρ .05). Pelvic injuries are increasingly common in modern theaters of war. The CTB is a novel, rapidly deployable, yet effective, method of pelvic binding adapted from the clothes the casualty is already wearing. This technique may be used in austere environments to tamponade and control intrapelvic hemorrhage. 2017.

  8. Evaluation of the relationship between pelvic fracture and abdominal compartment syndrome in traumatic patients

    Directory of Open Access Journals (Sweden)

    Sheikhi Rahim Ali

    2013-01-01

    Full Text Available Introduction: An increase in abdominal pressure can lead to so-called intra-abdominal compartment syndrome (ACS. Multiple factors such as an increase in retroperitoneal volume due to pancreatitis, bleeding and edema as a result of pelvic fracture can lead to compartment syndrome. Prevention is better than cure in compartment syndrome. By measuring the intra-abdominal pressure (IAP through the bladder, a quick and accurate assessment of abdominal pressure is achieved. Therefore, this study aimed to evaluate the relationship between pelvic fracture and ACS in traumatic patients. Materials and Methods: This research was a descriptive-analytical study conducted on 100 patients referring to the Shiraz Nemazee Hospital in 2010. IAP was monitored every 4 h in patients suspected to be at high risk for ACS, e.g., those undergoing severe abdominal trauma and pelvic fracture. The IAP was measured via the urinary bladder using the procedure described by Kron et al. Data collected were analyzed using SPSS software. Results: The findings showed that ACS occurred in 28 of 100 patients. With regard to the associated injuries with abdominal trauma, 19% of all patients and 46/42% of the patients with ACS had pelvic fracture. Chi-square test revealed a significant relationship between pelvic fracture and incidence rate of ACS ( P < 0.001. Conclusions: According to the collected data, pelvic fracture due to a trauma can be one of the important causes of an increase in IAP and ACS. In this lethal condition, prevention is better than cure. Therefore, serial measurement of IAP through the bladder in high-risk patients (those with pelvic fracture by trauma is recommended to the nurses to diagnose this condition and to decrease the incidence of mortality.

  9. Injury profile and injury risk factors in junior tennis players

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    Hjelm, Nina

    2010-01-01

    The aim of the present investigation was to prospectively study injuries sustained by a cohort of junior players at all levels in a typical tennis club with respect to gender, anatomic location of injuries, type of injuries, and their degree of severity as well as cause of injuries, injury occasion and time of the year when injured. A further aim was to evaluate potential intrinsic as well as extrinsic injury risk factors in the same junior tennis players. All 12-18 year...

  10. Imaging pelvic floor disorders. 2. rev. ed.

    Energy Technology Data Exchange (ETDEWEB)

    Stoker, Jaap [Amsterdam Univ. (Netherlands). Dept. of Radiology; Taylor, Stuart A. [University College Hospital, London (United Kingdom). Dept. of Specialist X-Ray; DeLancey, John O.L. (eds.) [Michigan Univ., Ann Arbor, MI (United States). L4000 Women' s Hospital

    2008-07-01

    This volume builds on the success of the first edition of imaging pelvic floor disorders and is aimed at those practitioners with an interest in the imaging, diagnosis and treatment of pelvic floor dysfunction. Concise textual information from acknowledged experts is complemented by high-quality diagrams and images to provide a thorough update of this rapidly evolving field. Introductory chapters fully elucidate the anatomical basis underlying disorders of the pelvic floor. State of the art imaging techniques and their application in pelvic floor dysfunction are then discussed in detail. Additions since the first edition include consideration of the effect of aging and new chapters on perineal ultrasound, functional MRI and MRI of the levator muscles. The closing sections of the book describe the modern clinical management of pelvic floor dysfunction, including prolapse, urinary and faecal incontinence and constipation, with specific emphasis on the integration of diagnostic and treatment algorithms. (orig.)

  11. PROBLEMS AND PITFALLS IN PELVIC RECONSTRUCTIVE SURGERY

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    Paul A. Riss

    2003-12-01

    Full Text Available Background. Pelvic reconstructive surgery requires a solid understanding of the anatomy of the small pelvis and the pelvic floor, in particular to avoid complications during and after pelvic reconstructive surgery.Methods. Possible complications of the pelvic floor reconstructive surgery are analised. There are 2 typical surgical problems encountered in pelvic reconstructive surgery: lesion of adjacent structures (rectum, bladder, ureter, small bowel and hemorrhage.Results. Postoperatively there is always a risk of pain, stenosis and dyspareunia, erosion of allograft, voiding problems, incontinence and prolapse.Conclusions. These complications can be reduced by insisting on an exact preoperative diagnosis and by choosing the correct procedure, by having a good knowledge of anatomy and by using meticulous surgical technique.

  12. Occupational lifting and pelvic pain during pregnancy

    DEFF Research Database (Denmark)

    Larsen, Pernille Stemann; Strandberg-Larsen, Katrine; Juhl, Mette

    2013-01-01

    OBJECTIVES: Pelvic pain during pregnancy is a common ailment, and the disease is a major cause of sickness absence during pregnancy. It is plausible that occupational lifting may be a risk factor of pelvic pain during pregnancy, but no previous studies have examined this specific exposure. The aim...... of this study was to examine the association between occupational lifting and pelvic pain during pregnancy. METHODS: The study comprised 50 143 pregnant women, enrolled in the Danish National Birth Cohort in the period from 1996-2002. During pregnancy, the women provided information on occupational lifting...... (weight load and daily frequency), and six months post partum on pelvic pain. Adjusted odds ratios for pelvic pain during pregnancy according to occupational lifting were calculated by logistic regression. RESULTS: Any self-reported occupational lifting (>1 time/day and loads weighing >10 kg...

  13. The management of episiotomy technique and its effect on pelvic floor muscles during a malposition childbirth.

    Science.gov (United States)

    Oliveira, Dulce A; Parente, Marco P L; Calvo, Begoña; Mascarenhas, Teresa; Jorge, Renato M Natal

    2017-08-01

    Vaginal childbirth is the leading cause of pelvic floor muscles injury, which contributes to pelvic floor dysfunction, being enhanced by fetal malposition. Therefore, the aim of the present study is to verify the influence of mediolateral episiotomies in the mechanics of the pelvic floor with the fetus in occiput posterior position when compared to the occiput anterior position. Numerical simulations of vaginal deliveries, with and without episiotomy, are performed based on the Finite Element Method. The biomechanical model includes the pelvic floor muscles, a surface to delimit the anterior region of the birth canal and a fetus. Fetal malposition induces greater extension of the muscle compared to the normal position, leading to increases of stretch. The faster enlargement may be responsible for a prolonged second stage of labor. Regarding the force required to achieve delivery, the difference between the analyzed cases are 35 N, which might justify the increased need of surgical interventions. Furthermore, episiotomy is essential in reducing the damage to values near the ones obtained with normal position, making the fetal position irrelevant. These biomechanical models have become extremely useful tools to provide some understanding of pelvic floor function during delivery helping in the development of preventative strategies.

  14. Can application of a pelvic belt change injured hamstring muscle activity?

    Science.gov (United States)

    Arumugam, Ashokan; Milosavljevic, Stephan; Woodley, Stephanie; Sole, Gisela

    2012-02-01

    Hamstring injuries are commonly reported in various sports involving sprinting, high-velocity running and kicking. Aberrant biomechanics and neuromotor control of the lumbopelvic and thigh segments have been reported to play a significant role in hamstring injury incidence and recurrence. Recent evidence suggests that external pelvic compression (EPC) applied with a pelvic belt can augment the stability of the pelvic joints, and alter neuromotor control of the lumbopelvic and thigh muscles in individuals with and without (somatic) lumbopelvic and groin dysfunction. However, the effects of EPC on neuromotor control of injured hamstring muscles remain unknown. We have explored the putative neuromotor link between the lumbopelvic segment and hamstring muscles, and generated hypotheses based on plausible mechanisms through which EPC could affect injured hamstring muscle strength and recruitment. Recent guidelines argue that rehabilitation of hamstring injuries should follow a multi-modal approach and include strategies to improve stability and neuromotor control of the lumbopelvic segment. Further investigations exploring these hypotheses would confirm whether EPC could be recommended as an assessment, intervention and rehabilitation tool for hamstring injury. Copyright © 2011 Elsevier Ltd. All rights reserved.

  15. Effect of antenatal pelvic floor muscle training on labor and birth.

    Science.gov (United States)

    Bø, Kari; Fleten, Caroline; Nystad, Wenche

    2009-06-01

    To estimate whether women doing pelvic floor muscle training before and during pregnancy have increased risk of perineal lacerations, episiotomy, vacuum/forceps delivery, or acute cesarean delivery. Participants were 18,865 primiparous women in the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health. Data were collected by self-completed questionnaires at gestational weeks 17 and 30 and analyzed by logistic regression analysis. Data about obstetric outcomes were obtained from the Medical Birth Registry of Norway. Pelvic floor muscle training was categorized as less than once per week, one to two times per week, and at least three times per week both before and during pregnancy. The results are presented as adjusted odds ratios (OR) with 95% confidence intervals (CIs). Of women who performed pelvic floor muscle training less than once per week, 7.2% sustained a third-degree or fourth-degree laceration compared with 6.3% of women who performed pelvic floor muscle training at least three times per week. A similar pattern was present for rates of episiotomy (29.1% compared with 24.9%), vacuum/forceps delivery (15.9% compared with 15.0%), and acute cesarean delivery (9.5% compared with 7.5%). Adjusting for factors that might be associated with pelvic floor muscle training and the outcomes under study did not distort the effect of pelvic floor muscle training. Exercising at least three times per week was not associated with third-degree and fourth-degree perineal lacerations, episiotomy, vacuum/forceps delivery, or acute cesarean delivery (adjusted OR 0.86 [95% CI 0.60-1.24], 0.82 [0.67-1.01], 0.95 [0.74-1.22], and 0.75 [0.53-1.05], respectively). Pelvic floor muscle training before and during pregnancy does not affect labor and birth outcomes or complication rates. II.

  16. Snowboarding injuries in children

    Science.gov (United States)

    Drkulec, John A.; Letts, Mervyn

    2001-01-01

    Objective To study injury patterns of snowboarding trauma in children. Design A retrospective case series. Setting A major pediatric trauma centre. Patients A cohort of 113 children (97 boys, 16 girls), mean age 13.9 years, who sustained 118 injuries secondary to snowboarding. Interventions All fractures were treated by immobilization in a cast; 19 children required a closed reduction. Outcome measures Sex and age of patients, mechanism of injury, injury sustained, treatments and complications. Results Falls on the outstretched hand from a loss of balance accounted for 66 (57%) of the injuries, uncontrolled falls for 42 (36%) and collisions for 5 (4%). Seventy-nine percent of the injuries were to the upper extremity, whereas 7% were to the lower extremity. Conclusions The predominance of snowboarding injuries of the upper extremity seen in children differs significantly from those in adults in whom lower extremity injuries are more common. PMID:11764877

  17. Surgical Stabilization of Pelvic and Acetabular Fractures: A Review on the Determinants of Clinical Outcomes

    Directory of Open Access Journals (Sweden)

    SS Sathappan

    2010-03-01

    Full Text Available AIM: Pelvic and acetabular fractures are associated with high-energy trauma. The aim of this study was to identify factors that are associated with specific clinical outcomes following treatment for these fractures. METHODS: A consecutive series of 30 patients who had surgical intervention for either pelvic or acetabular fractures formed the sample for this study. Clinical variables reviewed were: age, associated injuries, number of surgical procedures, time to surgery and post-operative complications. Clinical outcomes were assessed using Matta’s grading of post- operative fracture reduction alignment, and functional outcomes were graded using D'Aubigne & Postel’s Hip scoring system. RESULTS: Study subjects included twelve pelvic fractures and eighteen acetabular fractures. Patients older than 50 years of age had poorer hip scores despite surgery. Earlier fracture fixation (within five days was associated with better hip scores. Patients with acetabular fractures generally had better functional outcomes than patients with pelvic fractures (mean hip score 15.0 vs. 13.5. Closer anatomical reduction of acetabular fractures was associated with better functional outcome. CONCLUSION: Improved clinical outcomes are associated with younger age, fewer concomitant injuries, shorter time interval to surgery and more closely approximated anatomical fracture reduction.

  18. Transarterial Embolization of Arterial Bleeding in Patients with Pelvic Bone Fractures

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    Song, Ji Soo; Kwak, Hyo Sung; Han, Young Min [Chonbuk National University Hospital, Jeonju (Korea, Republic of)

    2009-11-15

    This study was designed to evaluate the usefulness of transcatheter arterial embolization (TAE) in hemodynamically unstable patients with a pelvic bone fracture. From November 2004 to July 2007, we retrospectively reviewed 211 patients with pelvic bone fractures. Of these patients, 24 patients with CT findings of active bleeding or hemodynamic instability underwent pelvic angiography. There were 13 female and 11 male patients, with an age range from 21 to 92 years (mean age, 58.3 years). To evaluate arterial injuries, angiography was performed, followed by TAE using coils, gelfoams and N-butyl-2-cyanoacrylate. The evaluation of risk factors between patients who were still alive and patients who had expired was performed statistically by use of the Student's t test and chisquared analysis. A total of 28 TAE procedures were performed in 24 patients and 50 injured arteries were occluded. Six patients (25%) died due to hypovolemic shock within 47 hours. Five of the patients were hemodynamically unstable (BP below 76/56 mmHg) prior to the angiographic procedure and one patient had a pseudoaneurysm located at the superior mesenteric artery. Dopamine usage and blood pressure before the procedure for patients showed a statistically significant difference between patients were still alive and patients who had expired (p = 0.01, p = 0.001). TAE is a safe and effective treatment for an arterial injury of a pelvic bone fracture. The outcome of patients with a hemodynamically unstable state before TAE is poor.

  19. Pattern of injury after rock-climbing falls is not determined by harness type.

    Science.gov (United States)

    Hohlrieder, Matthias; Lutz, Martin; Schubert, Heinrich; Eschertzhuber, Stephan; Mair, Peter

    2007-01-01

    Experimental data indicate that when using a sit harness alone, any major fall during rock climbing may cause life-threatening thoraco-lumbar hyperextension trauma or "head down position" during suspension. To clarify the actual influence of the type of harness on the pattern and severity of injury, accidents involving a major fall in a climbing harness were analyzed retrospectively. Individuals with a height of fall equal to or exceeding 5 m were identified through a search of accident and emergency records for the period from 2000 to 2004. Data concerning the circumstances of the fall and the patterns of injury were obtained from personal interviews, flight and accident reports, as well as hospital medical records. Of a total of 113 climbers identified, 73 (64.6%) used a sit harness alone, whereas 40 (35.4%) used a body harness. Fractures and dislocations of the extremities, the shoulder, and the pelvic region were the most common injuries, while the most severe injuries occurred in the head and neck region. Although most falls were associated with mild or moderate injuries, 13 (11.5%) climbers sustained severe or critical multisystem trauma. Falls on more difficult routes were associated with less severe injury. The type of harness used did not influence the pattern or severity of injury. In particular, no evidence was found for the existence of a thoraco-lumbar hyperextension trauma. The type of harness does not influence the pattern or severity of injury, and the forces transferred via the harness do not cause a specific harness-induced pathology. We did not find any evidence that hyperextension trauma of the thoraco-lumbar region is an important mechanism of injury in climbers using a sit harness alone. Rock contact during the fall, and not the force transferred through the harness, is the major cause of significant injury in climbing accidents.

  20. Total pelvic floor ultrasound for pelvic floor defaecatory dysfunction: a pictorial review

    Science.gov (United States)

    Solanki, Deepa; Schizas, Alexis M P; Williams, Andrew B

    2015-01-01

    Total pelvic floor ultrasound is used for the dynamic assessment of pelvic floor dysfunction and allows multicompartmental anatomical and functional assessment. Pelvic floor dysfunction includes defaecatory, urinary and sexual dysfunction, pelvic organ prolapse and pain. It is common, increasingly recognized and associated with increasing age and multiparity. Other options for assessment include defaecation proctography and defaecation MRI. Total pelvic floor ultrasound is a cheap, safe, imaging tool, which may be performed as a first-line investigation in outpatients. It allows dynamic assessment of the entire pelvic floor, essential for treatment planning for females who often have multiple diagnoses where treatment should address all aspects of dysfunction to yield optimal results. Transvaginal scanning using a rotating single crystal probe provides sagittal views of bladder neck support anteriorly. Posterior transvaginal ultrasound may reveal rectocoele, enterocoele or intussusception whilst bearing down. The vaginal probe is also used to acquire a 360° cross-sectional image to allow anatomical visualization of the pelvic floor and provides information regarding levator plate integrity and pelvic organ alignment. Dynamic transperineal ultrasound using a conventional curved array probe provides a global view of the anterior, middle and posterior compartments and may show cystocoele, enterocoele, sigmoidocoele or rectocoele. This pictorial review provides an atlas of normal and pathological images required for global pelvic floor assessment in females presenting with defaecatory dysfunction. Total pelvic floor ultrasound may be used with complementary endoanal ultrasound to assess the sphincter complex, but this is beyond the scope of this review. PMID:26388109

  1. The hemodynamic tolerability and feasibility of sustained low efficiency dialysis in the management of critically ill patients with acute kidney injury

    Directory of Open Access Journals (Sweden)

    Nisenbaum Rosane

    2010-11-01

    Full Text Available Abstract Background Minimization of hemodynamic instability during renal replacement therapy (RRT in patients with acute kidney injury (AKI is often challenging. We examined the relative hemodynamic tolerability of sustained low efficiency dialysis (SLED and continuous renal replacement therapy (CRRT in critically ill patients with AKI. We also compared the feasibility of SLED administration with that of CRRT and intermittent hemodialysis (IHD. Methods This cohort study encompassed four critical care units within a single university-affiliated medical centre. 77 consecutive critically ill patients with AKI who were treated with CRRT (n = 30, SLED (n = 13 or IHD (n = 34 and completed at least two RRT sessions were included in the study. Overall, 223 RRT sessions were analyzed. Hemodynamic instability during a given session was defined as the composite of a > 20% reduction in mean arterial pressure or any escalation in pressor requirements. Treatment feasibility was evaluated based on the fraction of the prescribed therapy time that was delivered. An interrupted session was designated if Results Hemodynamic instability occurred during 22 (56.4% SLED and 43 (50.0% CRRT sessions (p = 0.51. In a multivariable analysis that accounted for clustering of multiple sessions within the same patient, the odds ratio for hemodynamic instability with SLED was 1.20 (95% CI 0.58-2.47, as compared to CRRT. Session interruption occurred in 16 (16.3, 30 (34.9 and 11 (28.2 of IHD, CRRT and SLED therapies, respectively. Conclusions In critically ill patients with AKI, the administration of SLED is feasible and provides comparable hemodynamic control to CRRT.

  2. Soda pop vending machine injuries.

    Science.gov (United States)

    Cosio, M Q

    1988-11-11

    Fifteen male patients, 15 to 24 years of age, sustained injuries after rocking soda machines. The machines fell onto the victims, resulting in a variety of injuries. Three were killed. The remaining 12 required hospitalization for their injuries. Unless changes are made to safeguard these machines, people will continue to suffer severe and possibly fatal injuries from what are largely preventable accidents.

  3. Clinical anatomy of the pelvic floor.

    Science.gov (United States)

    Fritsch, H; Lienemann, A; Brenner, E; Ludwikowski, B

    2004-01-01

    The study presented here comparing cross-sectional anatomy of the fetal and the adult pelvic connective tissue with the results of modern imaging techniques and actual surgical techniques shows that the classical concepts concerning the subdivision of the pelvic connective tissue and muscles need to be revised. According to clinical requirements, the subdivision of the pelvic cavity into anterior, posterior, and middle compartments is feasible. Predominating connecting tissue structures within the different compartments are: Paravisceral fat pad within the anterior compartment (Fig. 17, I), rectal adventitia or perirectal tissue within the posterior compartment (Fig. 17, II), and uterosacral ligaments within the middle compartment. The nerve-vessel guiding plate can be found in all of these compartments; it starts within the posterior compartment and it ends within the anterior one. It constitutes the morphological border between the anterior and posterior compartments in the male. This border is supplied by the uterosacral ligaments in the female. Whereas in gross anatomy no further border is discernable between anterior and posterior or middle compartment, the rectal fascia (hardly visible in embalmed cadavers) demarcates the rectal adventitia and is one of the most important pelvic structures for the surgeon. In principle, the outlined subdivision of the pelvic connective tissue is identical in the male and in the female; facts that become clear from early human life and that are already established during this period (Fig. 18). The uterus is interposed between the bladder and rectum and subdivides the pelvic peritoneum into two pouches thus establishing the only real difference between male and female pelvic cavity. The preferential direction of the pelvic connective tissue fibers is not changed by the interposition of the uterovaginal complex. The pelvic floor muscles are composed of the portions of the levator ani muscle, the muscles of the cavernous organs

  4. [Patients with hemodynamic unstable pelvic fractures in extremis: pelvic packing or angiography?].

    Science.gov (United States)

    Liñán-Padilla, A; Giráldez-Sánchez, M Á; Serrano-Toledano, D; Lázaro-Gonzálvez, A; Cano-Luís, P

    2013-01-01

    The multidisciplinary management of patients with pelvic trauma has improved prognosis, but mortality is still very high. The appropriate treatment strategy remains controversial, especially regarding the control of bleeding in patients whose clinical situation is extreme by using angiography or pelvic packing. We propose using a tool of evidence-based medicine (CAT) the benefit of the completion of pelvic packing in relation to a specific clinical question from a specific situation. What is best for the management of bleeding, extraperitoneal pelvic packing or angiography, in patients with hemodynamically unstable pelvic fracture in extremis? From this study we can conclude that angiography may improve control of bleeding in patients with arterial bleeding and hemodynamically stable but the packing has priority in patients with pelvic fractures and hemodynamic instability. © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  5. Operative laparoscopy for pelvic and extrapelvic pathology.

    Science.gov (United States)

    Comparetto, G; Petronio, M; Pagano, G; Ubaldi, F

    1992-01-01

    The treatment of pelvic adhesions has been the first and more successful indication for operative laparoscopy. Frequently this intervention is the first step of others laparoscopic procedures. The different modalities of these interventions, i.e. by electrocautery or by scissor, or by laser are discussed. Among indications of operative laparoscopy for pelvic pathology the treatment of endometrial implants has been considered. In this paper less frequent indications for operative laparoscopy as pelvic abscess, or complementary operation as appendicectomy and colecistectomy are also discussed.

  6. Epidemiology of 3825 injuries sustained in six seasons of National Collegiate Athletic Association men's and women's soccer (2009/2010-2014/2015).

    Science.gov (United States)

    Roos, Karen G; Wasserman, Erin B; Dalton, Sara L; Gray, Aaron; Djoko, Aristarque; Dompier, Thomas P; Kerr, Zachary Y

    2017-07-01

    To describe the epidemiology of National Collegiate Athletic Association (NCAA) men's and women's soccer injuries during the 2009/2010-2014/2015 academic years. This descriptive epidemiology study used NCAA Injury Surveillance Program (NCAA-ISP) data during the 2009/2010-2014/2015 academic years, from 44 men's and 64 women's soccer programmes (104 and 167 team seasons of data, respectively). Non-time-loss injuries were defined as resulting in soccer and 2271 women's soccer injuries with injury rates of 8.07/1000 athlete exposures (AE) and 8.44/1000AE, respectively. Injury rates for men and women did not differ in competitions (17.53 vs 17.04/1000AE; RR=1.03; 95% CI 0.94 to 1.13) or practices (5.47 vs 5.69/1000AE; RR=0.96; 95% CI 0.88 to 1.05). In total, 47.2% (n=733) of men's soccer injuries and 47.5% (n=1079) of women's were non-time loss. Most injuries occurred to the lower extremity and were diagnosed as sprains. Women had higher concussion rates (0.59 vs 0.34/1000AE; RR=1.76; 95% CI 1.32 to 2.35) than men. Non-time-loss injuries accounted for nearly half of the injuries in men's and women's soccer. Sex differences were found in competition injuries, specifically for concussion. Further study into the incidence, treatment and outcome of non-time-loss injuries may identify a more accurate burden of these injuries. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  7. Subsequent Injuries Are More Common Than Injury Recurrences: An Analysis of 1 Season of Prospectively Collected Injuries in Professional Australian Football.

    Science.gov (United States)

    Finch, Caroline F; Cook, Jill; Kunstler, Breanne E; Akram, Muhammad; Orchard, John

    2017-07-01

    It is known that some people can, and do, sustain >1 injury over a playing season. However, there is currently little high-quality epidemiological evidence about the risk of, and relationships between, multiple and subsequent injuries. To describe the subsequent injuries sustained by Australian Football League (AFL) players over 1 season, including their most common injury diagnoses. Cohort study; Level of evidence, 3. Within-player linked injury data on all date-ordered match-loss injuries sustained by AFL players during 1 full season were obtained. The total number of injuries per player was determined, and in those with >1 injury, the Subsequent Injury Classification (SIC) model was used to code all subsequent injuries based on their Orchard Sports Injury Classification System (OSICS) codes and the dates of injury. There were 860 newly recorded injuries in 543 players; 247 players (45.5%) sustained ≥1 subsequent injuries after an earlier injury, with 317 subsequent injuries (36.9% of all injuries) recorded overall. A subsequent injury generally occurred to a different body region and was therefore superficially unrelated to an index injury. However, 32.2% of all subsequent injuries were related to a previous injury in the same season. Hamstring injuries were the most common subsequent injury. The mean time between injuries decreased with an increasing number of subsequent injuries. When relationships between injuries are taken into account, there is a high level of subsequent (and multiple) injuries leading to missed games in an elite athlete group.

  8. [Surgical treatment of unstable pelvic fractures combined with acetabular fractures].

    Science.gov (United States)

    Wang, Tao; Wang, Jun; Li, Zong-yuan; Liu, Gang

    2015-05-01

    To discuss the treatment strategy of acetabular fractures and unstable pelvic fracture of the hip and to evaluate its outcome. Retrospective analysis of clinical data in 32 patients with unstable pelvic fracture and acetabular fractures from January 2007 to June 2013 were collected. There were 18 males and 14 females aged from 18 to 62 years old (means 38 years old). According to Tile classification of pelvic fracture, 11 cases were type B1, 8 were type B2.1, 7 were type B2.2, 3 were type C1.1, 2 were type C1.2, 1 was type C3. According to Judet-Letournel classification, anterior column fracture was in 1 case, transverse fracture in 8, transverse plus posterior wall fracture in 6, T-type fracture in 1, anterior column plus half transverse fractures in 5, double column fracture in 11. Other combined injuries were treated early, the surgical operation were performed after stable condition. The hip joint function and the fracture reduction were assessed during follow-up. The operative time was from 1.8 to 6.5 hours (averaged 3 hours). Two fat patients' incision occurred in fat liquefaction and healed after dressing, no incision infection happened. Only 1 case was lost to follow-up, 31 patients were followed up with a mean time of 23 months (6 to 42 months). The healing time of pelvic fracture was from 8 to 18 weeks (averaged in 10.6 weeks). The hip function was evaluated according to the Matta and Tornetta standard postoperatively, the result was excellent in 15 cases, good in 14 cases, fair and poor in 1 case respectively. The Majeed score of the hip function was 83.65? 7.67, the result was excellent in 15 cases, good in 12 cases and fair in 4 cases. The healing time of acetabular fractures was from 8 to 16 weeks (averaged in 10.2 weeks). The fracture reduction was assessed by Matta standard, the result was excellent in 15 cases, good in 12 cases and fair in 4 cases. The heterotopic ossification was evaluated by Brooker standard, 4 cases were grade I, 1 case was

  9. Prospective observational research on the clinical profile and outcome analysis among a cohort of patients sustaining traumatic cervical spine and cord injury in a peripheral tertiary spine care centre in Nepal [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Sunil Munakomi

    2017-11-01

    Full Text Available Background: In developing nations like Nepal, spinal cord injury has multispectral consequences for both the patient and their family members. It has the tendency to cripple and handicap the patients, and burn out their caretakers, both physically and mentally. Furthermore, the centralization of health care with only a handful of dedicated rehabilitation centers throughout Nepal further places patients into disarray. This study was carried out as a pilot study to determine the modes of injury, age groups affected, clinical profiles and patterns of injury sustained, as well as the efficacy of managing a subset of patients, who have sustained cervical spine and cord injuries. Methods: This was a prospective cohort study comprising of 163 patients enrolled over a period of three years that were managed in the spine unit of College of Medical Sciences, Bharatpur, Nepal. Results: Road traffic accidents were implicated in 51% of these patients. 65% of them were in the age group of 30-39 years. Traumatic subluxation occurred in 73 patients with maximum involvement of the C4/5 region (28.76%. Good outcome was seen in patients with ASIA ‘C’ and ‘D’ with 55% of patients showed improvement from ‘C’ to ‘D’ and 95% of patients showed improvement from ‘D’ to ‘E’ at 1 year follow up. The overall mortality in the patients undergoing operative interventions was only 1.98%. Conclusions: The prevalence of cervical spine injuries in the outreach area is still significant. The outcome of managing these patients, even in the context of a resource limited setup in a spine unit outside the capital city of a developing nation, can be as equally as effective and efficient compared to the outcome from a well-equipped and dedicated spine unit elsewhere.

  10. 3D reconstruction of pelvic floor for numerical simulation purpose

    OpenAIRE

    Fatima Alexandre; Rania F El Sayed; Teresa Mascarenhas; Natal M N Jorge; Parente, MP; Fernandes,AA; Tavares, Joao Manuel R.S.

    2008-01-01

    Female pelvic floor disorders (stress urinary incontinence, fecal incontinence, pelvic organ prolapse) affect approximately 60% of woman over 60 years old [1]. The real geometry and architecture of female pelvic floor and connective tissues are complex and difficult to visualize from two-dimensional (21)) images. To facilitate the understanding of pelvic floor geometry, in this work 31) models were building. A 3D helpful model of pelvic floor could aid the understanding of the anatomy and phy...

  11. Pelvic radiography in ATLS algorithms: A diminishing role?

    OpenAIRE

    Buggy Donald J; Stoupis Christoforos; Martinolli Luca; Benneker Lorin M.; Behrendt Isabelle; Hilty Matthias P; Zimmermann Heinz; Exadaktylos Aristomenis K

    2008-01-01

    Abstract Background Pelvic x-ray is a routine part of the primary survey of polytraumatized patients according to Advanced Trauma Life Support (ATLS) guidelines. However, pelvic CT is the gold standard imaging technique in the diagnosis of pelvic fractures. This study was conducted to confirm the safety of a modified ATLS algorithm omitting pelvic x-ray in hemodynamically stable polytraumatized patients with clinically stable pelvis in favour of later pelvic examination by CT scan. Methods We...

  12. Recognizing myofascial pelvic pain in the female patient with chronic pelvic pain.

    Science.gov (United States)

    Pastore, Elizabeth A; Katzman, Wendy B

    2012-01-01

    Myofascial pelvic pain (MFPP) is a major component of chronic pelvic pain (CPP) and often is not properly identified by health care providers. The hallmark diagnostic indicator of MFPP is myofascial trigger points in the pelvic floor musculature that refer pain to adjacent sites. Effective treatments are available to reduce MFPP, including myofascial trigger point release, biofeedback, and electrical stimulation. An interdisciplinary team is essential for identifying and successfully treating MFPP. © 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  13. Percutaneous iliosacral fixation in external rotational pelvic fractures. A biomechanical analysis.

    Science.gov (United States)

    Giráldez-Sánchez, Miguel A; Lázaro-Gonzálvez, Ángel; Martínez-Reina, Javier; Serrano-Toledano, David; Navarro-Robles, Alfredo; Cano-Luis, Pedro; Fragkakis, Evangelos M; Giannoudis, Peter V

    2015-02-01

    Although the gold standard in open book pelvic fractures remains the pubic symphysis (PS) plate fixation, the clinical outcomes are not satisfactory, despite the excellent anatomical reduction assessed radiologically. Some authors suggest that residual instability of the posterior pelvic elements may be responsible for the chronic pain and the early osteoarthritic changes in the sacroiliac joint (SIJ). To evaluate whether the isolated posterior fixation with one or two iliosacral screws (ISSs) is sufficient to provide adequate stability for the treatment of Burgess Young APC-II (YB APC-II) type of pelvic ring injuries. Biomechanical experimental study using 7 fresh human pelvises, where an YB APC-II pelvic injury was previously implemented. The isolated posterior fixation of the pelvic ring with 1 or 2 ISSs directed in the S1 vertebra body was analysed in each specimen following an axial load of 300N. The different displacement of the SIJ and of the PS were analysed in all three spatial axes, using the validated optical measurement system 3D PONTOS 5M. A multivariate version of Friedman test (non-parametric ANOVA for repeated measures) was performed. The isolated fixation of the SIJ with 1 ISS did not show any differences with respect to the intact pelvis (p=0.851). Regarding the PS, both type of fixations (with 1 or 2 ISSs) confirmed an acceptable correction and adequate control of the PS even though with some differences compared to the intact pelvis (p=0.01). The presence of the second ISS found not to offer any significant additional benefit. The three-dimensional analysis of the behaviour of the pelvic elements, in these two different types of fixation, did not show any statistical significant differences (p=0.645). The posterior fixation with ISS can represent an alternative option for treatment of pelvic injuries associated with rotational instability. Further prospective clinical studies are necessary to determine, the influence of the residual pubic

  14. Pelvic exenteration for locally advanced primary and recurrent pelvic neoplasm: a series of 54 resectable cases

    Directory of Open Access Journals (Sweden)

    Sergio Renato Pais Costa

    2008-09-01

    Full Text Available Objective: To report on a series of 54 patients with pelvic neoplasms submitted to curative pelvic exenteration at a tertiary hospital and describe the results (morbidity, mortality, and long-term survival. Methods: The complete data of 54 patients submitted to pelvic exenteration between 1999 and 2007 were evaluated. Sixteen men and 38 women with a mean age of 65 years and median age of 66 years (36 to 77 were studied. Surgical procedures included total pelvic exenteration (n = 26, anterior pelvic exenteration(n = 5, and posterior pelvic exenteration (n = 23. Rresults: The mean operative time was 402 minutes (280 to 585. The average volume of intraoperative bleeding was 2,013 ml (300 to 5,800. Postoperative mortality was 5% (n = 3. The overall morbidity rate was 46%(n = 25. Histological evaluation demonstrated that 47 resections were R0 (87% while seven were R1 (13%. The overall survival rate in five years was 23.5% (n = 12. Cconclusions: Despite its aggressive nature and high morbidity, pelvic exenteration is still justified in locally advanced pelvic neoplasms or even in isolated pelvic recurrence, since it affords a greater long-term control of the neoplasm.

  15. Impaired contraction and decreased detrusor innervation in a female rat model of pelvic neuropraxia.

    Science.gov (United States)

    Hannan, Johanna L; Powers, Shelby A; Wang, Vinson M; Castiglione, Fabio; Hedlund, Petter; Bivalacqua, Trinity J

    2017-07-01

    Bilateral pelvic nerve injury (BPNI) is a model of post-radical hysterectomy neuropraxia, a common sequela. This study assessed the time course of changes to detrusor autonomic innervation, smooth muscle (SM) content and cholinergic-mediated contraction post-BPNI. Female Sprague-Dawley rats underwent BPNI or sham surgery and were evaluated 3, 7, 14, and 30 days post-BPNI (n = 8/group). Electrical field-stimulated (EFS) and carbachol-induced contractions were measured. Gene expression was assessed by qPCR for muscarinic receptor types 2 (M2) and 3 (M3), collagen type 1α1 and 3α1, and SM actin. Western blots measured M2 and M3 protein expression. Bladder sections were stained with Masson's trichrome for SM content and immunofluorescence staining for nerve terminals expressing vesicular acetylcholine transporter (VAChT), tyrosine hydroxylase (TH), and neuronal nitric oxide synthase (nNOS). Bilateral pelvic nerve injury caused larger bladders with less SM content and increased collagen type 1α1 and 3α1 gene expression. At early time points, cholinergic-mediated contraction increased, whereas EFS-mediated contraction decreased and returned to baseline by 30 days. Protein and gene expression of M3 was decreased 3 and 7 days post-BPNI, whereas M2 was unchanged. TH nerve terminals surrounding the detrusor decreased in all BPNI groups, whereas VAChT and nNOS terminals decreased 14 and 30 days post-BPNI. Bilateral pelvic nerve injury increased bladder size, impaired contractility, and decreased SM and autonomic innervation. Therapeutic strategies preventing nerve injury-mediated decline in neuronal input and SM content may prevent the development of a neurogenic bladder and improve quality of life after invasive pelvic surgery.

  16. HMGB1/TLR4 signaling induces an inflammatory response following high-pressure renal pelvic perfusion in a porcine model.

    Science.gov (United States)

    Shao, Yi; Sha, Minglei; Chen, Lei; Li, Deng; Lu, Jun; Xia, Shujie

    2016-11-01

    Percutaneous nephrolithotomy (PCNL) causes a rapid increase in renal pelvic pressure in the kidney, which induces an inflammatory response. High-mobility group box-1 (HMGB1) is known to trigger the recruitment of inflammatory cells and the release of proinflammatory cytokines following ischemia reperfusion injury in the kidney, but the contribution of HMGB1 to the inflammatory response following high-pressure renal pelvic perfusion has not been investigated. In this study, high-pressure renal pelvic perfusion was induced in anesthetized pigs to examine the effect of HMGB1 on the inflammatory response. HMGB1 levels in the kidney increased following high-pressure renal pelvic perfusion, together with elevated levels of inflammatory cytokines in the plasma and kidney and an accumulation of neutrophils and macrophages. Inhibition of HMGB1 alleviated this inflammatory response while perfusion with recombinant HMGB1 had an augmentative effect, confirming the involvement of HMGB1 in the inflammatory response to high-pressure renal pelvic perfusion. HMGB1 regulated the inflammatory response by activating Toll-like receptor 4 (TLR4) signaling. In conclusion, this study has demonstrated that HMGB1/TLR4 signaling contributes to the inflammatory response following high-pressure renal pelvic perfusion in a porcine model and has implications for the management of inflammation after PCNL. Copyright © 2016 the American Physiological Society.

  17. Prevalence of urinary incontinence and pelvic floor muscle dysfunction in primiparae two years after cesarean section: cross-sectional study

    Directory of Open Access Journals (Sweden)

    Angélica Mércia Pascon Barbosa

    Full Text Available CONTEXT AND OBJECTIVE There is uncertainty in the literature regarding the theory that obstetric events and pelvic floor injuries give rise to lower risk of subsequent urinary incontinence among women delivering via cesarean section than among women delivering vaginally. The objective of this study was to assess the two-year postpartum prevalence of urinary incontinence and pelvic floor muscle dysfunction and the factors responsible for them. DESIGN AND SETTING Cross-sectional study, conducted in a public university. METHODS 220 women who had undergone elective cesarean section or vaginal childbirth two years earlier were selected. Their urinary incontinence symptoms were investigated, and their pelvic floor muscle dysfunction was assessed using digital palpation and a perineometer. RESULTS The two-year urinary incontinence prevalences following vaginal childbirth and cesarean section were 17% and 18.9%, respectively. The only risk factor for pelvic floor muscle dysfunction was weight gain during pregnancy. Body mass index less than 25 kg/m 2 and normal pelvic floor muscle function protected against urinary incontinence. Gestational urinary incontinence increased the risk of two-year postpartum urinary incontinence. CONCLUSION Gestational urinary incontinence was a crucial precursor of postpartum urinary incontinence. Weight gain during pregnancy increased the subsequent risk of pelvic floor muscle dysfunction, and elective cesarean section did not prevent urinary incontinence.

  18. Blast injury to the perineum.

    Science.gov (United States)

    Davendra, M Sharma; Webster, C E; Kirkman-Brown, J; Mossadegh, S; Whitbread, T

    2013-03-01

    Recent military operations have resulted in a small but significant number of military personnel suffering severe perineal injuries. In association with lower limb amputation and pelvic fracture, this complex is described as the 'signature injury' of the current conflict in Afghanistan. There are significant consequences of surviving severe perineal injury but the experience of managing these casualties is limited. This article gives an overview of the processes developed to meet these challenges and introduces a series of articles which examine the subject in finer detail.

  19. Pelvic Inflammatory Disease (PID) Fact Sheet

    Science.gov (United States)

    ... Vietnamese) Recommend on Facebook Tweet Share Compartir Untreated sexually transmitted diseases (STDs) can cause pelvic inflammatory disease (PID), a serious condition, in women. 1 in 8 women with a history of ...

  20. PERCUTANEOUS ENDOSCOPIC ELECTRORESECTION OF RENAL PELVIC TUMORS

    Directory of Open Access Journals (Sweden)

    B. K. Komyakov

    2014-07-01

    Full Text Available The paper gives the results of percutaneous electroresection of the renal pelvic wall with a tumor in 4 patients. The operation has been made for absolute indications: 3 patients had a single kidney and the fourth patient had a single functioning left kidney (the right pelvic dystopic kidney failed to function. In all the patients, the primary symptom of the disease was macrohematuria, the examination for which revealed a renal pelvic tumor measuring 1.2 to 2.5 cm in size. There were no complications after percutaneous electroresection of the renal pelvic wall with a tumor. Intrarenal BCG therapy was performed in the postoperative period. Percutaneous electroresection is indicated for tumors of the renal pelvis and the upper third of the ureter of the single kidney.

  1. Rare Etiology of Obstructive Uropathy: Pelvic Lipomatosis

    National Research Council Canada - National Science Library

    Miglani, Uday; Sinha, Tapan; Gupta, Sanjay K; Doddamani, Daresh; Sethi, Gurwinder S; Talwar, Raghav; Agrawal, Shalabh; Chandra, Mahesh; Rana, Yajvender P.S; Harkar, Sandeep

    2010-01-01

    We present a case of a 32-year-old hypertensive and obese male who had bilateral obstructive uropathy, and who was diagnosed as having pelvic lipomatosis on the basis of clinicoradiological findings...

  2. Conservative treatment of excessive anterior pelvic tilt

    DEFF Research Database (Denmark)

    Brekke, Anders Falk

    , DK-5000 Odense C, Denmark ABSTRACT (1795 anslag) Background: Excessive anterior pelvic tilt has been linked to pain and dysfunction of the hip and pelvic region. Conservative treatment (e.g. manual therapy and physical training) is suggested in correcting the tilt and eventually related symptoms...... demonstrated a significant reduction in anterior pelvic tilt. The two studies intervening on symptomatic subjects demonstrated a significant reduction in pain and disability, respectively. Conclusions: Very low quality of evidence suggests that further studies are needed to clarify whether conservative......Conservative treatment of excessive anterior pelvic tilt: A systematic review Anders Falk Brekke1,2,3, Søren Overgaard1,2, Asbjørn Hróbjartsson4, Anders Holsgaard-Larsen1,2 1Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital 2Department...

  3. Base excess determined within one hour of admission predicts mortality in patients with severe pelvic fractures and severe hemorrhagic shock.

    Science.gov (United States)

    Abt, Rahel; Lustenberger, Thomas; Stover, John F; Benninger, Emanuel; Lenzlinger, Philipp M; Stocker, Reto; Keel, Marius

    2009-10-01

    Unstable pelvic ring fractures with exsanguinating hemorrhages are rare but potentially lifethreatening injuries. The aim of this retrospective study was to evaluate whether early changes in acid- base parameters predict mortality of patients with severe pelvic trauma and hemorrhagic shock. Data for 50 patients with pelvic ring disruption and severe hemorrhage were analyzed retrospectively. In all patients, the pelvic ring was temporarily stabilized by C-clamp. Patients with ongoing bleeding underwent laparotomy with extra and/or intraperitoneal pelvic packing, as required. Base excess, lactate, and pH were measured upon admission and at 1, 2, 3, 4, 6, 8, and 12 h postadmission. Patients were categorized as early survivors (surviving the first 12 h after admission) and nonsurvivors. Statistical analysis was performed by Mann-Whitney test; significance was assumed at p < 0.05. Receiver operating characteristic curves were generated for early mortality from each acid-base variable. Sixteen patients (32%) were nonsurvivors due to hemorrhagic shock (n = 13) or severe traumatic brain injury (n = 3). Thirty-four patients were early survivors. Base excess, lactate, and pH significantly discriminated between early survivors and nonsurvivors. Base excess determined 1 h after admission discriminated most strongly, with an area under the receiver operating characteristic curve of 0.915 (95% confidence interval, 0.836-0.993; p < 0.001). Base excess, lactate, and pH discriminate early survivors from nonsurvivors suffering from severe pelvic trauma and hemorrhagic shock. Base excess measured 1 h after admission best predicted early mortality following pelvic trauma with concomitant hemorrhage.

  4. Can motor control training lower the risk of injury for professional football players?

    Science.gov (United States)

    Hides, Julie A; Stanton, Warren R

    2014-04-01

    Among injuries reported by the Australian Football League (AFL), lower limb injuries have shown the highest incidence and prevalence rates. Deficits in the muscles of the lumbopelvic region, such as a smaller size of multifidus (MF) muscle, have been related to the occurrence of lower limb injuries in the preseason in AFL players. Motor control training programs have been effective in restoring the size and control of the MF muscle, but the relationship between motor control training and occurrence of injuries has not been extensively examined. This pre- and postintervention trial was delivered during the playing season as a panel design with three groups. The motor control program involved voluntary contractions of the MF, transversus abdominis, and pelvic floor muscles while receiving feedback from ultrasound imaging and progressed into a functional rehabilitation program. Assessments of muscle size and function were performed using magnetic resonance imaging and included the measurement of cross-sectional areas of MF, psoas, and quadratus lumborum muscles and the change in trunk cross-sectional area due to voluntarily contracting the transversus abdominis muscle. Injury data were obtained from club records. Informed consent was obtained from all study participants. A smaller size of the MF muscle (odds ratio [OR] = 2.38) or quadratus lumborum muscle (OR = 2.17) was predictive of lower limb injury in the playing season. At the time point when one group of players had not received the intervention (n = 14), comparisons were made with the combined groups who had received the intervention (n = 32). The risk of sustaining a severe injury was lower for those players who received the motor control intervention (OR = 0.09). Although there are many factors associated with injuries in AFL, motor control training may provide a useful addition to strategies aimed at reducing lower limb injuries.

  5. Origin and nature of pelvic ureter innervation.

    Science.gov (United States)

    Zaitouna, Mazen; Alsaid, Bayan; Lebacle, Cédric; Timoh, Krystel Nyangoh; Benoît, Gérard; Bessede, Thomas

    2017-02-01

    Innervation of the pelvic ureter traditionally comes from the pelvic plexus. This innervation is independent: adrenergic and cholinergic. The purpose of this study was to describe more precisely the origin and nature of its innervation (adrenergic, cholinergic, nitrergic, and somatic). Six specimens of normal human fetal pelvis (four male and two female) from 20 to 30 weeks gestation were studied. The sections of these fetuses, carried out every 5 µm without interval, were treated with Hematoxylin Eosin (HE), with Masson's trichrome (TriM), immunolabeling of smooth muscle cells with smooth anti-actin, of nerves with anti-S100 protein, anti-tyrosine hydroxylase, anti-VAChT, anti-nNOS, and with anti- peripheral myelin protein 22 (PMP 22). The slides were scanned and two-dimensional images reconstructed in 3D, and analyzed. The terminal pelvic ureter travels above and inside the inferior hypogastric plexus (IHP). The nerve fibers that innervate the ureterovesical junction come mainly from the superior hypogastric plexus (SHP) which gives off the hypogastric nerves and pelvic branches of the sacral plexus that form the IHP. Most nerve fibers meet below the ureter, behind the bladder to form an ascending bundle, which innervates the pelvic ureter. Immunohistochemical analysis shows that the nerves of the pelvic ureter consist of adrenergic, cholinergic, and nitrergic fibers. The innervation of the distal ureter depends mainly on the SHP. This innervation is adrenergic, cholinergic, and nitrergic. It innervates the pelvic ureter in an ascending manner. This anatomical information can change rectal resection and ureteral reimplantation techniques and drug treatments for pelvic ureter stones. Neurourol. Urodynam. 36:271-279, 2017. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  6. Prevention and management of pelvic organ prolapse

    OpenAIRE

    Giarenis, Ilias; Robinson, Dudley

    2014-01-01

    Pelvic organ prolapse is a highly prevalent condition in the female population, which impairs the health-related quality of life of affected individuals. Despite the lack of robust evidence, selective modification of obstetric events or other risk factors could play a central role in the prevention of prolapse. While the value of pelvic floor muscle training as a preventive treatment remains uncertain, it has an essential role in the conservative management of prolapse. Surgical trends are cu...

  7. Pelvic muscle rehabilitation in males following prostatectomy.

    Science.gov (United States)

    Moul, J W

    1998-12-01

    Post-prostatectomy incontinence (PPI) is a common problem in the era of increased detection of prostate cancer and use of radical prostatectomy. Whether temporary or permanent, mild or more severe, PPI can be effectively treated and improved by pelvic muscle rehabilitation. It is important for urologic nurses to understand the various pelvic muscle rehabilitation methods--for example, Kegel exercises, biofeedback, and electrical stimulation--to better educate and care for PPI patients and their families.

  8. Healthy adults can more easily elevate the pelvic floor in standing than in crook-lying: an experimental study.

    Science.gov (United States)

    Kelly, Malina; Tan, B-K; Thompson, Judith; Carroll, Sara; Follington, Melissa; Arndt, Alicia; Seet, Melissa

    2007-01-01

    Are there any differences in the displacement and endurance of an elevating voluntary pelvic floor muscle contraction in standing and in crook-lying? Are there any differences in these variables between males and females in either test position? An experimental study. Forty-five nulliparous female and 20 male participants aged 23 years (SD 3) with no symptoms of urinary incontinence or low back pain. Voluntary pelvic floor muscle contraction was measured in both standing and crook-lying. Transabdominal ultrasound was used to measure the displacement (mm) and endurance (s) of pelvic floor elevation. Displacement was greater in standing than in crook-lying (mean difference 2.6 mm, 95% CI 1.5 to 3.7). There was no difference between males and females (mean difference 1.3 mm, 95% CI 0.5 to 3.2). Similarly, endurance of pelvic floor elevation was longer in standing than in crook-lying (mean difference 17.3 s, 95% CI 12.2 to 22.4). Again there was no difference between males and females (mean difference 0.5 s, 95% CI 9.3 to 8.3). Standing was found to be a more effective position for achieving and sustaining an elevation of the pelvic floor compared to crook-lying, regardless of sex, and this should be taken into account when assessing and training pelvic floor muscle contraction.

  9. Thromboelastography in Orthopaedic Trauma Acute Pelvic Fracture Resuscitation: A Descriptive Pilot Study.

    Science.gov (United States)

    Mamczak, Christiaan N; Maloney, Megan; Fritz, Braxton; Boyer, Bryan; Thomas, Scott; Evans, Ed; Ploplis, Victoria A; Castellino, Francis J; McCollester, Jonathon; Walsh, Mark

    2016-06-01

    To describe the adjunctive use of thromboelastography (TEG) in directing initial blood component therapy resuscitation of patients with polytrauma with acute pelvic/acetabular fractures. Retrospective cohort review. Level-2 trauma center. Forty adult trauma activations with acute pelvic and/or acetabular fractures were treated with standard fracture care and TEG with adjuvant platelet mapping (TEG/PM) analysis to guide their initial 24-hour resuscitation. TEG with PM provided goal-directed hemostatic resuscitation using component blood products and an established hospital transfusion protocol. Transfusions were triggered by abnormal TEG/PM results and/or the presence of active hemorrhage, persistent hemorrhagic shock, and abnormal base deficit levels. The correction of trauma-induced coagulopathy was determined by the return of a normal TEG/PM tracing. The numbers of component blood products transfused in the first 24 hours using TEG/PM were calculated. Subgroup analysis of transfusion requirements and differences between pelvic ring and acetabular fracture patterns were determined. More than 90% of patients received a transfusion of at least 1 blood product with 84% of transfusions occurring within 6 hours of admission. TEG/PM-guided resuscitation yielded greater volumes of platelets and packed red blood cells (PRBCs) versus fresh frozen plasma (FFP) (P = 0.018) with an average transfusion ratio of 2.5:1:2.8 (PRBC:FFP:platelet). There was a trend toward greater transfusion requirements in combined injuries versus pelvic ring or acetabular fractures (P = 0.08). TEG with PM is a valuable adjunct to guide the acute phase of resuscitation in patients with polytrauma with pelvic injuries because it allows a real-time assessment of the coagulation status. The routine use of TEG/PM may result in transfusion ratios of blood products different from those of the current empiric 1:1:1 guidelines. Therapeutic Level IV. See Instructions for Authors for a complete description

  10. Failures and complications in pelvic floor surgery.

    Science.gov (United States)

    Ashok, Kiran; Petri, Eckhard

    2012-08-01

    To review current literature on the failures of different surgical approaches in pelvic floor surgery, in particular the use of alloplastic materials, and to analyze complications related to them. A Medline search was performed to retrieve English language literature (from the year 1995 to 2011) on the success rates, failures, and complications profiles of pelvic floor surgery. Search terms used are "pelvic organ prolapse," "stress urinary incontinence," "complications," "vaginal mesh," "mid-urethral slings," and "colposuspension." The review includes surgical techniques for the correction of pelvic organ prolapse and stress urinary incontinence. Failure rates and complications in different studies are compiled and analyzed. Use of synthetic materials in pelvic organ prolapse surgery has reduced surgical failures but it is associated with an increased risk of complications compared to traditional surgical repairs. Synthetic mid-urethral slings for stress urinary incontinence seem to have good success rates over long term, but they have unique complication profile including de novo development of overactive bladder, voiding dysfunction, sling exposures, dyspareunia, and long-term pain. However, some of these complications seem to be related to wrong surgical indications and improper surgical techniques, although some complications may be directly related to the use of synthetic material itself. Use of synthetic materials in pelvic floor surgery has definitely reduced surgical failures, but at the same time, it is associated with an increased risk of complications (some of which are unique to synthetic materials) compared to traditional surgical repairs.

  11. An Exploratory Study of Special Educational Needs Co-Ordinators' Knowledge and Experience of Working with Children Who Have Sustained a Brain Injury

    Science.gov (United States)

    Howe, Julia; Ball, Heather

    2017-01-01

    This research aimed to measure Special Educational Needs Co-ordinators' knowledge of the educational implications of acquired brain injury in children and young people and whether experience of working with pupils with a brain injury or additional training impacts upon this knowledge. Data was collected within one local authority in England using…

  12. Constant elevation in renal pelvic pressure induces an increase in urinary N-acetyl-beta-D-glucosaminidase in a nonobstructive porcine model.

    Science.gov (United States)

    Fung, L C; Atala, A

    1998-01-01

    To clarify the physiological significance of renal pelvic pressure elevations encountered in the evaluation of hydronephrotic kidney we examined the effects of different levels of renal pelvic pressure on the induction of renal injury. A nonobstructive porcine model was created in which the urine drained against a constant predetermined pressure gradient. Renal pelvic pressure of 10, 20 and 40 cm. was created in 2, 2 and 4 animals, respectively. During 18 to 23 hours serial urinary N-acetyl-beta-D-glucosaminidase levels were determined as an indicator of renal tubular injury. Tissue specimens were examined histologically and renal arterial blood flow was monitored. Urinary N-acetyl-beta-D-glucosaminidase levels in the kidneys subjected to 10 cm. water remained essentially unchanged. However, at 20 and 40 cm. water statistically significant increases were observed. Similarly, renal arterial blood flow was unchanged at 10 cm. water but it became significantly lower than in controls at 20 and 40 cm. water. Histological evaluation revealed mild to moderate tubular dilatation in the kidneys subjected to 20 and 40 cm. water. Excessively high collecting system pressure induced renal cellular injury, as reflected by an increase in urinary N-acetyl-beta-D-glucosaminidase levels. While renal pelvic pressure up to 10 cm. water appeared to be innocuous, renal cellular injury was evident within as little as 1 hour at renal pelvic pressures 20 cm. water or greater. The degree of N-acetyl-beta-D-glucosaminidase in the urine also correlated with a decrease in renal arterial blood flow.

  13. Injury Pattern in Icelandic Elite Male Handball Players.

    Science.gov (United States)

    Rafnsson, Elis Thor; Valdimarsson, Örnólfur; Sveinsson, Thorarinn; Árnason, Árni

    2017-10-10

    To examine the incidence, type, location, and severity of injuries in Icelandic elite male handball players and compare across factors like physical characteristics and playing position. Prospective cohort study. The latter part of the preseason and the competitive season of Icelandic male handball. Eleven handball teams (185 players) from the 2 highest divisions in Iceland participated in the study. Six teams (109 players) completed the study. Injuries were recorded by the players under supervision from their team physiotherapists or coaches. Coaches recorded training exposure, and match exposure was obtained from the Icelandic and European Handball Federations. The players directly recorded potential risk factors, such as age, height, weight, previous injuries, and player position. Injury incidence and injury location and number of injury days. Recorded time-loss injuries were 86, of which 53 (62%) were acute and 33 (38%) were due to overuse. The incidence of acute injuries was 15.0 injuries/1000 hours during games and 1.1 injuries/1000 hours during training sessions. No significant difference was found in injury incidence between teams, but number of injury days did differ between teams (P = 0.0006). Acute injuries were most common in knees (26%), ankles (19%), and feet/toes (17%), but overuse injuries occurred in low back/pelvic region (39%), shoulders (21%), and knees (21%). Previous knee injuries were the only potential risk factor found for knee injury. The results indicate a higher rate of overuse injuries in low back/pelvic region and shoulders than in comparable studies.

  14. Automatic transmission vehicle injuries.

    Science.gov (United States)

    Fidler, M

    1973-04-07

    Four drivers sustained severe injuries when run down by their own automatic cars while adjusting the carburettor or throttle linkages. The transmission had been left in the "Drive" position and the engine was idling. This accident is easily avoidable.

  15. Pelvic floor tenderness in the etiology of superficial dyspareunia.

    Science.gov (United States)

    Yong, Paul J; Mui, Justin; Allaire, Catherine; Williams, Christina

    2014-11-01

    To calculate the prevalence of pelvic floor tenderness in the population of women with pelvic pain and to determine its implications for symptoms of pelvic pain. We conducted a retrospective review of patients with pelvic pain at a tertiary referral centre. Pelvic floor tenderness was defined as levator ani tenderness on at least one side during single digit pelvic examination. The prevalence of pelvic floor tenderness in this cohort of women with pelvic pain was compared with the prevalence in a cohort of women without pain attending a gynaecology clinic. In the women with pelvic pain, multiple regression was performed to determine which variables were independently associated with pelvic floor tenderness. The prevalence of pelvic floor tenderness was 40% (75/189) in the cohort with pelvic pain, significantly greater than the prevalence of 13% (4/32) in the cohort without pain (OR 4.61; 95% CI 1.55 to 13.7, P = 0.005). On multiple logistic regression, superficial dyspareunia (OR 4.45; 95% CI 1.86 to 10.7, P = 0.001), abdominal wall pain (OR 4.04; 95% CI 1.44 to 11.3, P = 0.005), and bladder base tenderness (OR 4.65; 95% CI 1.87 to 11.6, P = 0.001) were independently associated with pelvic floor tenderness. Pelvic floor tenderness was similarly present in women with or without underlying endometriosis. Pelvic floor tenderness is common in women with pelvic pain, with or without endometriosis, and is a contributor to superficial dyspareunia. Pelvic floor tenderness was also associated with abdominal wall pain and bladder base tenderness, suggesting that nervous system sensitization is involved in the etiology of pelvic floor tenderness.

  16. Pelvic floor muscle function in a general population of women with and without pelvic organ prolapse

    NARCIS (Netherlands)

    M.C.P. Slieker-ten Hove (Marijke); A.L. Pool-Goudzwaard (Annelies); M.J.C. Eijkemans (René); R.P.M. Steegers-Theunissen (Régine); C.W. Burger (Curt); M.E. Vierhout (Mark)

    2010-01-01

    textabstractIntroduction and hypothesis: This study aims to examine the relationship between pelvic floor muscle function (PFMF) and pelvic organ prolapse (POP) in a general female population. Methods: Cross-sectional study on women aged 45-85 years. Validated questionnaires were used to assess

  17. Triple pelvic ring fixation in patients with severe pregnancy-related low back and pelvic pain.

    NARCIS (Netherlands)

    Zwienen, C.M. van; Bosch, E.W. van den; Snijders, C.J.; Vugt, A.B. van

    2004-01-01

    STUDY DESIGN: Single-group prospective follow-up study. OBJECTIVES: To assess the functional outcome of internal fixation of the pelvic ring in patients with severe pregnancy-related low back and pelvic pain (PLBP) in whom all other treatments failed. BACKGROUND DATA: More than half of all pregnant

  18. Prevalence of myofascial chronic pelvic pain and the effectiveness of pelvic floor physical therapy.

    Science.gov (United States)

    Bedaiwy, Mohamed A; Patterson, Betsy; Mahajan, Sangeeta

    2013-01-01

    To determine the prevalence of myofascial pain and the outcome of transvaginal pelvic floor physical therapy for the treatment of chronic pelvic pain caused by myofascial pelvic pain in a tertiary care facility. A retrospective chart review was performed on all women who presented to our facility between January 2005 and December 2007. Those diagnosed with myofascial pelvic pain and referred for transvaginal pelvic floor physical therapy over this 3-year period were evaluated. Participants with an initial pain score of > or = 4, myofascial pelvic pain on examination, and who attended 2 or more physician visits were included in the analysis. Patient physical examination findings, symptoms, and verbal pain ratings were reviewed. In all, 146 (13.2%) of 1,106 initially screened patients were diagnosed with myofascial pain. Seventy-five (51%) of the 146 patients who were referred for physical therapy were included, and 75% had an initial pain score of > or = 7. Pain scores significantly improved proportional to the number of physical therapy visits completed, with 63% of patients reporting significant pain improvement. Transvaginal physical therapy is an effective treatment for chronic pelvic pain resulting from myofascial pelvic pain.

  19. Relations between pregnancy-related low back pain, pelvic floor activity and pelvic floor dysfunction.

    NARCIS (Netherlands)

    Pool-Goudzwaard, A.; Slieker ten Hove, M.C.; Vierhout, M.E.; Mulder, P.H.M. de; Pool, J.; Snijders, C.J.; Stoeckart, R.

    2005-01-01

    To assess the occurrence of pelvic floor dysfunction (PFD) in pregnancy- related low back and pelvic pain (PLBP) patients, a cross-sectional study was performed, comprising 77 subjects. Each subject underwent physical assessment, and filled in the Urogenital Distress Inventory completed with

  20. Relations between pregnancy-related low back pain, pelvic floor activity and pelvic floor dysfunction

    NARCIS (Netherlands)

    Pool-Goudzwaard, A.L.; Slieker ten Hove, M.C.; Vierhout, M.E.; de Mulder, PH; Pool, J.J.M.; Snijders, C.J.; Stoeckart, R.

    2005-01-01

    To assess the occurrence of pelvic floor dysfunction (PFD) in pregnancy- related low back and pelvic pain (PLBP) patients, a cross-sectional study was performed, comprising 77 subjects. Each subject underwent physical assessment, and filled in the Urogenital Distress Inventory completed with

  1. Lifestyle advice with or without pelvic floor muscle training for pelvic organ prolapse

    DEFF Research Database (Denmark)

    Due, Ulla; Brostrøm, Søren; Lose, Gunnar

    2016-01-01

    INTRODUCTION AND HYPOTHESIS: We evaluated the effect of adding pelvic floor muscle training (PFMT) to a structured lifestyle advice program. METHODS: This was a single-blinded randomized trial of women with symptomatic pelvic organ prolapse (POP) stage ≥ II. Participants were randomized...

  2. Pelvic floor muscle dysfunctions are prevalent in female chronic pelvic pain

    DEFF Research Database (Denmark)

    Loving, S; Thomsen, Thordis; Jaszczak, Poul P.

    2014-01-01

    BACKGROUND: No current standardized set of pelvic floor muscle (PFM) outcome measures have been specifically tested for their applicability in a general female chronic pelvic pain (CPP) population. We aimed to compare PFM function between a randomly selected population-based sample of women...

  3. Effects of pregnancy and childbirth on the pelvic floor

    Directory of Open Access Journals (Sweden)

    Michel Naser

    2012-04-01

    Full Text Available The pelvic floor dysfunctions include urinary incontinence, pelvic organ prolapsed and anal incontinence. One in ten women will be subjected to surgery for pelvic floor dysfunction during their lifetime. In addition, between 30% and 50% will have a recurrence of these interventions. Motherhood is a factor that contributes significantly to the submission of pelvic dysfunctions. There is still no proven evidence that vaginal delivery is an absolutely crucial factor for the presence of pelvic floor dysfunction. There is extensive research on pregnancy and child birth and their effects on the pelvic floor and if some of the obstetric action scan be modified in order to protect it from potential damage.

  4. Clinical presentation of geriatric polytrauma patients with severe pelvic fractures: comparison with younger adult patients.

    Science.gov (United States)

    Kanezaki, Shozo; Miyazaki, Masashi; Notani, Naoki; Tsumura, Hiroshi

    2016-12-01

    Elderly polytrauma patients with pelvic fractures are at higher risk than young adults for severe medical outcomes and/or death in the early post-trauma phase. The aim of our study was to identify predictive factors of medical severity among geriatric polytrauma patients. We conducted a retrospective cross-sectional study of polytrauma patients treated at our center, who had a pelvic fracture and at least two other injuries with an abbreviated injury score ≥3. Our study group included 15 geriatric (mean age, 65 years) and 13 young (mean age, 39 years) adults. Factors related to medical status on admission were compared between the groups to identify those predictive of a severe medical outcome, defined by massive transfusion (>10 units of red blood cells) within the first 24 h of admission and/or death. Groups were comparable in terms of injury severity score (mean, 29), systolic blood pressure, heart rate, shock index, hemoglobin level, the prothrombin time-to-international normalized ratio (PT-INR) and base deficit. Over two-third of geriatric patients required a massive transfusion, with two patients dying, compared with the death of one young patient. Among geriatric patients, predictors of a severe medical outcome were extravasation of contrast medium on computed tomography, a hemoglobin level 1.1 and a base deficit >2 mmol/l. Even with our aggressive treatment algorism of pelvic fractures, particularly for the elderly, most of the geriatric polytrauma patients with severe pelvic fractures were at a high risk of massive transfusion. Extravasation on enhanced computed tomography and abnormal levels of select blood serum markers could assist in the early identification of geriatric polytrauma patients at risk for a severe medical outcome.

  5. Repetitive posterior iliac crest autograft harvest resulting in an unstable pelvic fracture and infected non-union: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Ziran Navid M

    2007-12-01

    Full Text Available Abstract Fractures of the pelvic ring have been well studied, and the biomechanical relationship between the anterior and posterior elements is an important concept to understand these complex injuries. The vast majority of these injuries are due to trauma. However, in rare circumstances, autogenous bone graft harvesting may lead to an unstable pelvic ring. In this case report, we describe a rare complication in a 70-year old female patient who developed an unstable pelvis and an infected non-union secondary to repeated posterior iliac graft harvest. The orthopaedic surgeon should be aware of this detrimental complication associated with extensive or repeated posterior iliac crest graft harvest.

  6. [Clinical application of percutaneous iliosacral screws combined with pubic ramus screws in Tile B pelvic fracture].

    Science.gov (United States)

    Xu, Qi-Fei; Lin, Kui-Ran; Zhao, Dai-Jie; Zhang, Song-Qin; Feng, Sheng-Kai; Li, Chen

    2017-03-25

    To investigate the application and effect of minimally invasive percutaneous anterior pelvic pubic ramus screw fixation in Tile B fractures. A retrospective review was conducted on 56 patients with posterior pelvic ring injury combined with fractures of anterior pubic and ischiadic ramus treated between May 2010 and August 2015, including 31 males and 25 females with an average age of 36.8 years old ranging from 35 to 65 years old. Based on the Tile classification, there were 13 cases of Tile B1 type, 28 cases of Tile B2 type and 15 cases of Tile B3 type. Among them, 26 patients were treated with sacroiliac screws combined with external fixation (external fixator group) and the other 30 patients underwent sacroiliac screw fixation combined with anterior screw fixation (pubic ramus screw group). Postoperative complications, postoperative ambulation time, fracture healing, blood loss, Majeed pelvic function score and visual analogue scale(VAS) were compared between two groups. Fifty-four patients were followed up from 3 to 24 months with a mean of 12 months. There were no significant difference in the peri-operative bleeding and operation time between two groups( P >0.05). The postoperative activity time and fracture healing time of pubic ramus screw group were shorter than those of the external fixator group, the differences were statistically significant( P safty treatment method to the Tile B pelvic fracture. It has advantages of early ambulation, relief of the pain and few complications.

  7. The influence of lumbar extensor muscle fatigue on lumbar-pelvic coordination during weightlifting.

    Science.gov (United States)

    Hu, Boyi; Ning, Xiaopeng

    2015-01-01

    Lumbar muscle fatigue is a potential risk factor for the development of low back pain. In this study, we investigated the influence of lumbar extensor muscle fatigue on lumbar-pelvic coordination patterns during weightlifting. Each of the 15 male subjects performed five repetitions of weightlifting tasks both before and after a lumbar extensor muscle fatiguing protocol. Lumbar muscle electromyography was collected to assess fatigue. Trunk kinematics was recorded to calculate lumbar-pelvic continuous relative phase (CRP) and CRP variability. Results showed that fatigue significantly reduced the average lumbar-pelvic CRP value (from 0.33 to 0.29 rad) during weightlifting. The average CRP variability reduced from 0.17 to 0.15 rad, yet this change ws statistically not significant. Further analyses also discovered elevated spinal loading during weightlifting after the development of lumbar extensor muscle fatigue. Our results suggest that frequently experienced lumbar extensor muscle fatigue should be avoided in an occupational environment. Lumbar extensor muscle fatigue generates more in-phase lumbar-pelvic coordination patterns and elevated spinal loading during lifting. Such increase in spinal loading may indicate higher risk of back injury. Our results suggest that frequently experienced lumbar muscle fatigue should be avoided to reduce the risk of LBP.

  8. Carotid artery dissection and motor vehicle trauma: patient demographics, associated injuries and impact of treatment on cost and length of stay.

    Science.gov (United States)

    Kray, Jared E; Dombrovskiy, Viktor Y; Vogel, Todd R

    2016-07-08

    Blunt carotid arterial injury (BCI) is a rare injury associated with motor vehicle collision (MVC). There are few population based analyses evaluating carotid injury associated with blunt trauma and their associated injuries as well as outcomes. The Nationwide Inpatient Sample (NIS) 2003-2010 data was queried to identify patients after MVC who had documented BCI during their hospitalizations utilizing ICD-9-CM codes. Demographics, associated injuries, interventions performed, length of stay, and cost were evaluated. 1,686,867 patients were estimated having sustained MVC; 1,168 BCI were estimated. No patients with BCI had open repair, 4.24 % had a carotid artery stent (CAS), and 95.76 % of patients had no operative intervention. Age groups associated with BCI were: 18-24 (27.8 %), 47-60 (22.3 %), 35-46 (20.6 %), 25-34 (19.1 %), >61 (10.2 %). Associated injuries included long bone fractures (28.5 %), stroke and intracranial hemorrhage (28.5 %), cranial injuries (25.6 %), thoracic injuries (23.6 %), cervical fractures (21.8 %), facial fractures (19.9 %), skull fractures (18.8 %), pelvic fractures (18.5 %), hepatic (13.3 %) and splenic (9.2 %) injuries. Complications included respiratory (44.2 %), bleeding (16.1 %), urinary tract infections (8.9 %), and sepsis (4.9 %). Overall mortality was 14.1 % without differences with regard to intervention (18.5 % vs. 13.9 %; P = 0.36). Stroke and intracranial hemorrhage was associated with a 2.7 times greater risk of mortality. Mean length of stay for patients with BCI undergoing stenting compared to no intervention were similar (13.1 days vs. 15.9 days) but had a greater mean cost ($83,030 vs. $63,200, p = 0.3). BCI is a rare injury associated with MVC, most frequently reported in younger patients. Frequently associated injuries were long bone fractures, stroke and intracranial hemorrhage, thoracic injuries, and pelvic fractures which are likely associated with the force/mechanism of injury. The

  9. Dynamic pelvic floor imaging: MRI techniques and imaging parameters.

    Science.gov (United States)

    Reiner, Caecilia S; Weishaupt, Dominik

    2013-10-01

    Magnetic resonance imaging (MRI) is an excellent tool to understand the complex anatomy of the pelvic floor and to assess pelvic floor disorders. MRI enables static and dynamic imaging of the pelvic floor. Using static T2-weighted sequences the morphology of the pelvic floor can be visualized in great detail. A rapid half-Fourier T2-weighted, balanced steady state free precession, or gradient-recalled echo sequence are used to obtain sagittal images while the patient is at rest, during pelvic squeeze, during pelvic strain and to document the evacuation process. On these images the radiologist identifies the pubococcygeal line (PCL) (which represents the level of the pelvic floor). In normal findings, the base of the anterior and the middle compartment are above the PCL at rest, and the pelvic floor elevates during contraction. During straining the pelvic floor muscles should relax and the pelvic floor descends normally less than 3 cm below the PCL. Pelvic floor MRI based on the static and dynamic MRI sequences allows for the detection and characterization of a vast array of morphologic and functional pelvic floor disorders. In this review, we focus on technical aspects of static and dynamic pelvic floor MRI.

  10. Pelvic floor health: a concept analysis.

    Science.gov (United States)

    Pierce, Heather; Perry, Lin; Gallagher, Robyn; Chiarelli, Pauline

    2015-05-01

    To report an analysis of the concept 'pelvic floor health'. 'Pelvic floor health' is a term used by multiple healthcare disciplines, yet as a concept is not well defined. Rodger's evolutionary view was used to guide this analysis. Academic literature databases and public domain websites viewed via the Internet search engine Google. Literature in English, published 1946-July 2014 was reviewed. Websites were accessed in May 2014, then analysed of presentation for relevance and content until data saturation. Thematic analysis identified attributes, antecedents and consequences of the concept. Based on the defining attributes identified in the analysis, a contemporary definition is offered. 'Pelvic floor health' is the physical and functional integrity of the pelvic floor unit through the life stages of an individual (male or female), permitting an optimal quality of life through its multifunctional role, where the individual possesses or has access to knowledge, which empowers the ability to prevent or manage dysfunction. This analysis provides a definition of 'pelvic floor health' that is based on a current shared meaning and distinguishes the term from medical and lay terms in a complex, multifaceted and often under-reported area of healthcare knowledge. This definition provides a basis for theory development in future research, by focusing on health rather than disorders or dysfunction. Further development of the meaning is required in an individual's social context, to ensure a contemporaneous understanding in a dynamic system of healthcare provision. © 2015 John Wiley & Sons Ltd.

  11. Pelvic floor function and anatomy after childbirth.

    Science.gov (United States)

    Baytur, Yesim Bulbul; Serter, Selim; Tarhan, Serdar; Uyar, Yildiz; Inceboz, Umit; Pabuscu, Yuksel

    2007-07-01

    To investigate pelvic floor muscle function and anatomy after childbirth in continent women differing in obstetric history. Young, continent women, age range 20-40 years, were recruited into 3 groups: 1. elective, prelabor cesarean delivery (n =12); 2. vaginal delivery (n = 15); and 3. age-matched nulliparas as controls (n = 13). Pelvic floor muscle strength was measured by a perineometer and also assessed by vaginal palpation. Magnetic resonance imaging of the pelvic floor at rest and on maximal strain was performed. Statistical analysis was carried out using SPSS 10.0 (Chicago, Illinois) for Windows (Microsoft, Redmond, Washington); p Pelvic floor muscle strength was not different between the vaginal delivery and cesarean groups. The descent of the bladder and cervix on straining was greater in the subjects who delivered vaginally than in the cesarean delivery and nulliparous groups. There was a positive and significant correlation between the duration of labor and the area of the levator sling and also between birth weight and the descent of the cervix on straining. The results of this study show that delivery method does not affect pelvic muscle strength.

  12. The surgical treatment of pelvic bone metastases.

    Science.gov (United States)

    Müller, Daniel A; Capanna, Rodolfo

    2015-01-01

    Pelvic bone metastases are a growing concern in the field of orthopedic surgery. Patients with pelvic metastasis are individually different with different needs of treatment in order to attain the best possible quality of life despite the advanced stage of disease. A holistic collaboration among the oncologist, radiation therapist, and orthopedic surgeon is mandatory. Special attention has to be directed to osteolytic lesions in the periacetabular region as they can provoke pathological fractures and subsequent functional impairment. Different reconstruction techniques for the pelvis are available; the choice depends on the patient's prognosis, size of the bone defect, and response of the tumor to adjuvant treatment. If all the conservative treatments are exhausted and the patient is not eligible for surgery, one of the various percutaneous ablation procedures can be considered. We propose a pelvic analogue to the treatment algorithm in long bone metastasis and a scoring system in pelvic metastasis. This algorithm aims to simplify the teamwork and to avoid under- or overtreatment of pelvic bone metastases.

  13. The Surgical Treatment of Pelvic Bone Metastases

    Directory of Open Access Journals (Sweden)

    Daniel A. Müller

    2015-01-01

    Full Text Available Pelvic bone metastases are a growing concern in the field of orthopedic surgery. Patients with pelvic metastasis are individually different with different needs of treatment in order to attain the best possible quality of life despite the advanced stage of disease. A holistic collaboration among the oncologist, radiation therapist, and orthopedic surgeon is mandatory. Special attention has to be directed to osteolytic lesions in the periacetabular region as they can provoke pathological fractures and subsequent functional impairment. Different reconstruction techniques for the pelvis are available; the choice depends on the patient’s prognosis, size of the bone defect, and response of the tumor to adjuvant treatment. If all the conservative treatments are exhausted and the patient is not eligible for surgery, one of the various percutaneous ablation procedures can be considered. We propose a pelvic analogue to the treatment algorithm in long bone metastasis and a scoring system in pelvic metastasis. This algorithm aims to simplify the teamwork and to avoid under- or overtreatment of pelvic bone metastases.

  14. Management of severe pelvic injury following road traffic accident in ...

    African Journals Online (AJOL)

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  15. Numerical Investigation on the Biomechanical Performance of Laparoscopic-Assisted Plate Used for Fixing Pelvic Anterior Ring Fracture

    Directory of Open Access Journals (Sweden)

    Yiqian He

    2017-01-01

    Full Text Available Because of the minimal soft tissue injury, the laparoscopic-assisted internal fixation is a promising technique in fixing the pelvic anterior ring fracture. The aim of this study was to investigate the biomechanical performance of the laparoscopic-assisted plate by the finite element method. Four kinds of implants were investigated, that is, the laparoscopic-assisted plate (LAP, the percutaneous anterior pelvic bridge (PAPB, the transramus intraosseous screw (TIS, and the open reduction (OR. The stability of the implants was investigated under three loading cases, showing that when the LAP was used, the stress at the fracture site was smaller than that at other parts, while for other implants, the high stress was always around the fracture site. In conclusion, the LAP demonstrated a good biomechanical performance in fixing the pelvic anterior ring fracture and is a promising technique in clinical applications.

  16. Patients Without Intraoperative Neuromonitoring (IONM) Alerts During VEPTR Implantation Did Not Sustain Neurological Injury During Subsequent Routine Expansions: A Retrospective Multicenter Cohort Study.

    Science.gov (United States)

    LaGreca, Jaren; Flynn, Tara; Cahill, Patrick J; Samdani, Amer; Vitale, Michael G; El-Hawary, Ron; Smith, John T; Phillips, Jonathan H; Flynn, John M; Glotzbecker, Michael; Garg, Sumeet

    2017-03-21

    The purpose of this study was to determine the rate of intraoperative neurological monitoring (IONM) alerts and neurological injury during vertical expandable prosthetic titanium rib (VEPTR) treatment and evaluate the utility of IONM during VEPTR expansion procedures in patients who have not previously had neurological injury or IONM alerts. After institutional review board approval, VEPTR procedures and IONM records were reviewed at 17 institutions for patients treated with VEPTR from 2005 to 2011. All consecutive cases in patients with minimum 2-year follow-up were included. Patients with prior history of growing rods or other invasive spine-based surgical treatment were excluded. Surgeries were categorized into implant, revision, expansion, and removal procedures. Cases with IONM alerts or neurological injury had additional detailed review. Descriptive statistics were used for data analysis. In total, 2355 consecutive VEPTR procedures (352 patients) consisting of 299 implant, 377 revision, 1587 expansion, and 92 removal procedures were included. In total, 620 VEPTR procedures had IONM, and 539 of those had IONM records available for review. IONM alerts occurred in 9/539 procedures (1.7%): 3/192 implants (1.6%), 3/58 revisions (5.2%), and 3/258 expansions (1.2%). New neurological injury occurred in 3/2355 procedures (0.1%), 3/352 patients (0.9%). All 3 injuries were in implant procedures, only 1 had an IONM alert. All 3 had upper extremity motor deficits (1 had sensory deficit also). All had full recovery at 17, 30, and 124 days postinjury. One patient without prior neurological injury or IONM alert had an IONM alert during expansion that resolved after an increase in blood pressure. The remaining IONM alerts during expansions were all in children with prior IONM alerts during implant, revision, or exchange procedures. The highest rate of neurological injury in VEPTR surgery was found for implant procedures. There were no instances of neurological injury during

  17. Ice hockey injuries.

    Science.gov (United States)

    Benson, Brian W; Meeuwisse, Willem H

    2005-01-01

    This article reviews the distribution and determinants of injuries reported in the pediatric ice hockey literature, and suggests potential injury prevention strategies and directions for further research. Thirteen electronic databases, the ISI Web of Science, and 'grey literature' databases were searched using a combination of Medical Subject Headings and text words to identify potentially relevant articles. The bibliographies of selected studies were searched to identify additional articles. Studies were selected for review based on predetermined inclusion and exclusion criteria. A comparison between studies on this topic area was difficult due to the variability in research designs, definition of injury, study populations, and measurements used to assess injury. The majority of injuries were sustained during games compared with practices. The two most commonly reported injuries were sprains/strains and contusions. Players competing at the Minor hockey, High School, and Junior levels of competition sustained most of their injuries to the upper extremity, head, and lower extremity, respectively. The primary mechanism of injury was body checking, followed by stick and puck contact. The frequency of catastrophic eye injuries has been significantly reduced with the world-wide mandation of full facial protection for all Minor hockey players. Specific hockey-related injury risk factors are poorly delineated and rarely studied among pediatric ice hockey players leaving large gaps in the knowledge of appropriate prevention strategies. Risk management strategies should be focused at avoiding unnecessary foreseeable risk, and controlling the risks inherent to the sport. Suggestions for injury prevention and future research are discussed.

  18. Laparoscopy and ultrasound examination in women with acute pelvic pain

    DEFF Research Database (Denmark)

    Mikkelsen, A L; Felding, C

    1990-01-01

    The results of preoperative pelvic examination and eventual ultrasound examination were correlated with the laparoscopic findings in 316 women with acute pelvic pain. The predictive values of normal and abnormal findings at pelvic examination were 46.9 and 82.1%, respectively. 42.1% of the women...... had ultrasound examination performed. This investigation showed to be helpful especially in patients with normal findings at pelvic examination. If ultrasonic findings were abnormal the results at laparoscopy were also abnormal in 90%. On the contrary, normal findings at ultrasound examination did...... not exclude abnormal pelvic findings. The predictive value of normal results at ultrasound examination was 50.0%. This discrepancy between ultrasonic and pelvic findings can be explained by the size of the pelvic masses. Ultrasound examination is a valuable tool in the evaluation of patients with acute pelvic...

  19. Effects of pelvic floor muscle training during pregnancy

    National Research Council Canada - National Science Library

    de Oliveira, Claudia; Lopes, Marco Antonio Borges; Carla Longo e Pereira, Luciana; Zugaib, Marcelo

    2007-01-01

    ... perineometer (with and without biofeedback). The functional evaluation of the pelvic floor muscles showed a significant increase in pelvic floor muscle strength during pregnancy in both groups (P < .001...

  20. Effects of pelvic floor muscle training during pregnancy.

    Science.gov (United States)

    de Oliveira, Claudia; Lopes, Marco Antonio Borges; Carla Longo e Pereira, Luciana; Zugaib, Marcelo

    2007-08-01

    The objective of the present study was to evaluate the effect of pelvic floor muscle training in 46 nulliparous pregnant women. The women were divided into 2 groups: an exercise group and a control group. Functional evaluation of the pelvic floor muscle was performed by digital vaginal palpation using the strength scale described by Ortiz and by a perineometer (with and without biofeedback). The functional evaluation of the pelvic floor muscles showed a significant increase in pelvic floor muscle strength during pregnancy in both groups (P pelvic floor muscles. Pelvic floor muscle training resulted in a significant increase in pelvic floor muscle pressure and strength during pregnancy. A significant positive correlation between functional evaluation of the pelvic floor muscle and perineometry was observed during pregnancy.

  1. Effects of pelvic floor muscle training during pregnancy

    National Research Council Canada - National Science Library

    Oliveira, Claudia de; Lopes, Marco Antonio Borges; Pereira, Luciana Carla Longo e; Zugaib, Marcelo

    2007-01-01

    ... perineometer (with and without biofeedback). RESULTS: The functional evaluation of the pelvic floor muscles showed a significant increase in pelvic floor muscle strength during pregnancy in both groups (P < .001...

  2. Transvaginal Ultrasound-Guided Aspiration of Pelvic Abscesses

    Directory of Open Access Journals (Sweden)

    P. J. Corsi

    1999-01-01

    Full Text Available Objective: To assess the utility of a less invasive approach to the care of women with a pelvic abscess, we retrospectively reviewed the outcome of women with pelvic abscesses managed by transvaginal ultrasound-guided aspiration.

  3. Injury Pattern and Mortality of Noncompressible Torso Hemorrhage in UK Combat Casualties

    Science.gov (United States)

    2013-08-01

    injury to the liver, kidney, or spleen) or pelvic fracture with ring disruption. Patients with ongoing hemorrhage were identified using either a...of a named axial vessel or vessels within the pulmonary parenchyma of the chest, the solid organs of the abdomen, or those of the boney pelvis .8 This...Grade 4 or greater solid-organ injury (liver, kidney, or spleen), or pelvic fracture associated with ring disruption and hemorrhage. Named torso vessel

  4. Evaluation of embolization for periuterine varices involving chronic pelvic pain secondary to pelvic congestion syndrome.

    Science.gov (United States)

    Siqueira, Flavio Meirelles; Monsignore, Lucas Moretti; Rosa-E-Silva, Julio Cesar; Poli-Neto, Omero Benedicto; Castro-Afonso, Luis Henrique de; Nakiri, Guilherme Seizem; Muglia, Valdair Francisco; Abud, Daniel Giansante

    2016-12-01

    To evaluate the clinical response and success rate after periuterine varices embolization in patients with chronic pelvic pain secondary to pelvic congestion syndrome and to report the safety of endovascular treatment and its rate of complications. Retrospective cohort of patients undergoing endovascular treatment of pelvic congestion syndrome in our department from January 2012 to November 2015. Data were analyzed based on patient background, imaging findings, embolized veins, rate of complications, and clinical response as indicated by the visual analog pain scale. We performed periuterine varices embolization in 22 patients during the study, four of which required a second embolization. Seventeen patients reported a reduction in pelvic pain after the first embolization and three patients reported a reduction in pelvic pain after the second embolization. Minor complications were observed in our patients, such as postural hypotension, postoperative pain, and venous perforation during the procedure, without clinical repercussion. Periuterine varices embolization in patients with chronic pelvic pain secondary to pelvic congestion syndrome appears to be an effective and safe technique.

  5. Lawnmower injuries in children.

    LENUS (Irish Health Repository)

    Nugent, Nora

    2012-02-03

    OBJECTIVE: Power lawnmowers can pose significant danger of injury to both the operator and the bystander, from direct contact with the rotary blades or missile injury. Our objective was to review our experience with paediatric lawnmower-associated trauma, and the safety recommendations available to operators of power lawnmowers. METHODS: The patient cohort comprised paediatric (<16 years of age) patients treated for lawnmower-associated trauma, by the plastic surgery service, between 1996 and 2003. These patients were identified retrospectively. Age at the time of injury, location and extent of bony and soft tissue injuries sustained, treatment instituted and clinical outcome were recorded. Brochures and instruction manuals of six lawnmower manufacturers were reviewed, and safety recommendations noted. RESULTS: Fifteen patients were identified. The majority of injuries occurred from direct contact with the rotary blades (93%); the remaining child sustained a burn injury. Fourteen children (93%) required operative intervention. Seven patients (46%) sustained injuries resulting in amputation, two of whom had major limb amputations. All children, except the burns patient, underwent wound debridement and received antibiotic therapy. Reconstructive methods ranged from primary closure to free tissue transfer. Many patients required multiple procedures. In all instruction manuals, instructions to keep children and pets indoors or out of the yard when mowing were found. CONCLUSIONS: Lawnmower injuries can be devastating, particularly in children. Many victims have lasting deformities as a result of their injuries. Awareness of and stringent adherence to safety precautions during use of power lawnmowers can prevent many of these accidents.

  6. Brain Injury Association of America

    Science.gov (United States)

    ... Only) 1-800-444-6443 Welcome to the Brain Injury Association of America (BIAA) Brain injury is not an event or an outcome. ... misunderstood, under-funded neurological disease. People who sustain brain injuries must have timely access to expert trauma ...

  7. Pelvic radiotherapy and sexual dysfunction in women

    DEFF Research Database (Denmark)

    Jensen, Pernille Tine; Froeding, Ligita Paskeviciute

    2015-01-01

    BACKGROUND: During the past decade there has been considerable progress in developing new radiation methods for cancer treatment. Pelvic radiotherapy constitutes the primary or (neo) adjuvant treatment of many pelvic cancers e.g., locally advanced cervical and rectal cancer. There is an increasing...... of life (QOL) issues; sexual functioning has proved to be one of the most important aspects of concern in long-term survivors. METHODS: An updated literature search in PubMed was performed on pelvic radiotherapy and female sexual functioning/dysfunction. Studies on gynaecological, urological...... and gastrointestinal cancers were included. The focus was on the period from 2010 to 2014, on studies using PROs, on potential randomized controlled trials (RCTs) where female sexual dysfunction (FSD) at least constituted a secondary outcome, and on studies reporting from modern radiotherapy modalities. RESULTS...

  8. Prevention and management of pelvic organ prolapse

    Science.gov (United States)

    Giarenis, Ilias

    2014-01-01

    Pelvic organ prolapse is a highly prevalent condition in the female population, which impairs the health-related quality of life of affected individuals. Despite the lack of robust evidence, selective modification of obstetric events or other risk factors could play a central role in the prevention of prolapse. While the value of pelvic floor muscle training as a preventive treatment remains uncertain, it has an essential role in the conservative management of prolapse. Surgical trends are currently changing due to the controversial issues surrounding the use of mesh and the increasing demand for uterine preservation. The evolution of laparoscopic and robotic surgery has increased the use of these techniques in pelvic floor surgery. PMID:25343034

  9. Imaging of the posterior pelvic floor

    Energy Technology Data Exchange (ETDEWEB)

    Stoker, Jaap [Department of Radiology, Academic Medical Center, University of Amsterdam (Netherlands); Bartram, Clive I.; Halligan, Steve [Intestinal Imaging Centre, St. Mark' s Hospital, London (United Kingdom)

    2002-04-01

    Disorders of the posterior pelvic floor are relatively common. The role of imaging in this field is increasing, especially in constipation, prolapse and anal incontinence, and currently imaging is an integral part of the investigation of these pelvic floor disorders. Evacuation proctography provides both structural and functional information for rectal voiding and prolapse. Dynamic MRI may be a valuable alternative as the pelvic floor muscles are visualised, and it is currently under evaluation. Endoluminal imaging is important in the management of anal incontinence. Both endosonography and endoanal MRI can be used for detection of anal sphincter defects. Endoanal MRI has the advantage of simultaneously evaluating external sphincter atrophy, which is an important predictive factor for the outcome of sphincter repair. Many aspects of constipation and prolapse remain incompletely understood and treatment is partly empirical; however, imaging has a central role in management to place patients into treatment-defined groups. (orig.)

  10. Complete Pelvic Floor Repair in Treating Fecal Incontinence

    OpenAIRE

    Lee, Patrick Y. H.; Steele, Scott R

    2005-01-01

    Fecal incontinence is associated with 20 to 40% of the patients with pelvic floor prolapse. Successful management of fecal incontinence requires not only an understanding of anorectal function but also a thorough understanding of pelvic floor anatomy and how pelvic floor prolapse affects fecal continence. Imaging techniques have been instrumental in visualizing pelvic floor prolapse and have helped correlate surgical findings. Stabilization of the perineal body appears to be a key component t...

  11. [Pelvic actinomycosis: Diagnostic and therapeutic aspects].

    Science.gov (United States)

    Mbarki, C; Ben Abdelaziz, A; Sahnoun, R; El Kadhi, Y; Douik, F; Hsayaoui, N; Mezghenni, S; Oueslati, H

    2016-03-01

    Actinomycosis is a rare little known granulomatous suppurative disease, more common in women, aided by the use of contraceptive purposes intrauterine device (IUD). Pelvic location is the rarest with an extension to adjacent organs making preoperative diagnosis difficult and misleading clinical presentation. Early diagnosis of this affection determines the therapeutic strategy and avoids mutilating interventions especially in young women. We reviewed the record of women who consulted the department of obstetrics and gynecology at Ben Arous hospital (Tunisia) between January 2003 and December 2013 for a pelvic pain syndrome and in whom diagnosis of actinomycosis was suspected by clinical and imaging and confirmed by pathology. Eight cases of gynecologic abdominopelvic actinomycosis were diagnosed during the study period. Seven patients were carriers of an intrauterine device, with an average duration of 5 years wearing. Functional signs were essentially pelvic pain and fever. Physical examination of patients mainly showed two clinical presentations: a pelvic tumor syndrome or abdominopelvic and an array of pelvic abscess or pelvic inflammatory disease. Radiological investigations were allowed to suspect the diagnosis of actinomycosis only in one patient, in whom percutaneous biopsy confirmed the histological diagnosis without resorting to a surgical procedure. Operative procedures performed were varied as appropriate. The diagnosis of actinomycosis was made by pathology without any cases of bacterial isolation. All patients received antibiotic treatment with penicillin. The subsequent evolution was favorable. The diagnosis of actinomycosis should be considered in any invasive abdominal mass of neoplastic appearance and in case of table of genital infection especially in patients bearing IUD for 5 years or more. Copyright © 2016. Published by Elsevier SAS.

  12. Functional imaging of the pelvic floor

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    Lienemann, Andreas E-mail: andreaslienemann@web.de; Fischer, Tanja

    2003-08-01

    Introduction/Objective: Pelvic floor dysfunction and associated pelvic organ prolapse represent a major problem in our present-day society, mostly afflicting parous women. Magnetic resonance imaging (MRI) is assuming an increasingly important role in the more accurate delineation of the extent of the problem. This article briefly reviews one of the main radiological methods for the dynamic evaluation of the pelvic floor: functional cine MRI. Methods and Material: Out of the literature the smallest common denominator for functional cine MRI can be defined as follows: high field system; patient either in supine or sitting position; fast gradient echo sequence; midsagittal slice orientation; either a stack of slices or repeated measurements at the same slice position with the patient at rest or straining; image analysis using the pubococcygeal reference line. Results: All except two publications stress the usefulness of functional cine MRI in the evaluation of patients with organ descent and prolapse. This well accepted method allows for the visualization of all relevant structures in the anterior, middle and posterior compartment. It is especially useful in the detection of enteroceles, and provides a reliable postoperative follow-up tool. Isolated urinary or stool incontinence are not an indication for functional cine MRI, as is the case in patients with equivocal clinical findings. To date it does not allow for real 3D imaging of the pelvic floor or sufficient determination of fascial defects. Discussion: Functional cine MRI of the pelvic floor is a promising new imaging method for the detection of organ descent and prolapse in patients with equivocal clinical findings. The combination of function and morphology allows for an innovative view of the pelvic floor, and thus adds to our understanding of the various interactions of the structures.

  13. Laparoendoscopic single site in pelvic surgery

    Directory of Open Access Journals (Sweden)

    Rafael Sanchez-Salas

    2012-01-01

    Full Text Available Laparoendoscopic single site (LESS has recently gained momentum as feasible techniques for minimal access surgery. Our aim is to describe the current status of laparoendoscopic single site (LESS in pelvic surgery. A comprehensive revision of the literature in LESS pelvic surgery was performed. References for this manuscript were obtained by performing a review of the available literature in PubMed from 01-01-01 to 30-11-11. References outside the search period were obtained selected manuscript΄s bibliography. Search terms included: pelvic anatomy, less in gynecology, single port colectomy, urological less, single port, single site, NOTES, LESS and single incision. 314 manuscripts were initially identified. Out of these, 46 manuscripts were selected based in their pelvic anatomy or surgical content; including experimental experience, clinical series and literature reviews. LESS drastically limit the surgeon′s ability to perform in the operative field and the latter becomes hardened by the lack of space in anatomical location like the pelvis. Potential advantages of LESS are gained with the understanding that the surgical procedure is more technically challenging. Pelvic surgical procedures related to colorectal surgery, gynecology and urology have been performed with LESS technique and information available is mostly represented by case reports and short case series. Comparative series remain few. LESS pelvic surgery remain in its very beginning and due to the very specific anatomical conditions further development of LESS surgery in the mentioned area can be clearly be facilitated by using robotic technology. Standardization ad reproducibility of techniques are mandatory to further develop LESS in the surgical arena..

  14. Laparoendoscopic single site in pelvic surgery

    Science.gov (United States)

    Sanchez-Salas, Rafael; Clavijo, Rafael; Barret, Eric; Sotelo, Rene

    2012-01-01

    Laparoendoscopic single site (LESS) has recently gained momentum as feasible techniques for minimal access surgery. Our aim is to describe the current status of laparoendoscopic single site (LESS) in pelvic surgery. A comprehensive revision of the literature in LESS pelvic surgery was performed. References for this manuscript were obtained by performing a review of the available literature in PubMed from 01-01-01 to 30-11-11. References outside the search period were obtained selected manuscript΄s bibliography. Search terms included: pelvic anatomy, less in gynecology, single port colectomy, urological less, single port, single site, NOTES, LESS and single incision. 314 manuscripts were initially identified. Out of these, 46 manuscripts were selected based in their pelvic anatomy or surgical content; including experimental experience, clinical series and literature reviews. LESS drastically limit the surgeon's ability to perform in the operative field and the latter becomes hardened by the lack of space in anatomical location like the pelvis. Potential advantages of LESS are gained with the understanding that the surgical procedure is more technically challenging. Pelvic surgical procedures related to colorectal surgery, gynecology and urology have been performed with LESS technique and information available is mostly represented by case reports and short case series. Comparative series remain few. LESS pelvic surgery remain in its very beginning and due to the very specific anatomical conditions further development of LESS surgery in the mentioned area can be clearly be facilitated by using robotic technology. Standardization ad reproducibility of techniques are mandatory to further develop LESS in the surgical arena.. PMID:22557719

  15. Influence of a pelvic floor training programme to prevent perineal trauma: A quasi-randomised controlled trial.

    Science.gov (United States)

    Leon-Larios, Fatima; Corrales-Gutierrez, Isabel; Casado-Mejía, Rosa; Suarez-Serrano, Carmen

    2017-07-01

    perineal injury is common after birth and may be caused by tears or episiotomy or both. Perineal massage has been shown to prevent episiotomies in primiparous women. On the other hand, pelvic floor exercises might have an influence by shortening the first and second stages of labour in the primigravida. the aim of this study was to investigate the effects of a pelvic floor training following a birth programme on perineal trauma. a single-blind quasi-randomized controlled trial with two groups: standard care and intervention. a tertiary, metropolitan hospital in Seville, Spain. women (n=466) who were 32 weeks pregnant, having a singleton pregnancy and anticipating a normal birth were randomised. Women in the experimental groups were asked to perform a pelvic floor training programme that included: daily perineal massage and pelvic floor exercises from 32 weeks of pregnancy until birth. They were allocated to an intervention group by clusters (antenatal education groups) randomized 1:1. The control group had standard care that did not involve a perineal/pelvic floor intervention. These women were collected in a labour ward at admission 1:3 by midwives. outcomes were analysed by intention-to-treat. Women assigned to the perineal/pelvic floor intervention showed a 31.63% reduction in episiotomy (50.56% versus 82.19%, ppelvic floor exercises and perineal massage may prevent episiotomies and tears in primiparous women. This programme can be recommended to primiparous women in order to prevent perineal trauma. the pelvic floor programme was associated with significantly lower rates of episiotomies and severe perineal trauma; and higher intact perineum when compared with women who received standard care only. the programme is an effective intervention that we recommend to all women at 32nd week of pregnancy to prevent perineal trauma. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Factors influencing postpartum women's willingness to participate in a preventive pelvic floor muscle training program: a web-based survey.

    Science.gov (United States)

    Moossdorff-Steinhauser, Heidi F A; Albers-Heitner, Pytha; Weemhoff, Mirjam; Spaanderman, Marc E A; Nieman, Fred H M; Berghmans, Bary

    2015-12-01

    Pregnancy and delivery are the most prominent risk factors for the onset of pelvic floor injuries and - later-on - urinary incontinence. Supervised pelvic floor muscle training during and after pregnancy is proven effective for the prevention of urinary incontinence on the short term. However, only a minority of women do participate in preventive pelvic floor muscle training programs. Our aim was to analyze willingness to participate (WTP) in an intensive preventive pelvic floor muscle training (PFMT) program and influencing factors, from the perspective of postpartum women, for participation. We included 169 three-month postpartum women in a web-based survey in the Netherlands. Demographic and clinical characteristics, knowledge and experience with PFMT and preconditions for actual WTP were assessed. Main outcome measures were frequencies and percentages for categorical data. Cross tabulations were used to explore the relationship between WTP and various independent categorical variables. A linear regression analysis was done to analyze which variables are associated with WTP. A response rate of 64% (n=169) was achieved. 31% of the women was WTP, 41% was hesitating, 12% already participated in PFMT and 15% was not interested (at all). No statistically significant association was found between WTP and risk or prognostic pelvic floor dysfunction factors. Women already having symptoms of pelvic floor dysfunction such as incontinence and pelvic organ prolapse symptoms were more WTP (p=0.010, p=0.001, respectively) as were women perceiving better general health (ppelvic floor management. Further research should focus on strategies to tackle major barriers and to introduce facilitators for postpartum women to participate in PFMT programs. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  17. Low-dose baclofen therapy raised plasma insulin-like growth factor-1 concentrations, but not into the normal range in a predictable and sustained manner in men with chronic spinal cord injury.

    Science.gov (United States)

    Bauman, William A; La Fountaine, Michael F; Cirnigliaro, Christopher M; Kirshblum, Steven C; Spungen, Ann M

    2013-09-01

    To evaluate, whether once-daily oral baclofen administration increases and/or sustains plasma insulin-like growth factor-1 (IGF-1) concentration in 11 men with chronic spinal cord injury (SCI) and IGF-1 deficiency (i.e. Plasma IGF-1 and self-reported side effects were measured at baseline and every other week for the duration of the study. The subjects were 43 ± 12 years old, had duration of injury of 20 ± 12 years; eight subjects had a complete motor injury, and eight had paraplegia. Nine of 11 subjects completed the 20 mg/day treatment and 5 subjects completed the 40 mg/day treatment. Plasma IGF-1 levels improved with each baclofen dose; however, only one subject increased from baseline and remained above the targeted physiological range of 250 ng/ml throughout treatment. A significant increase in IGF-1concentration was observed between baseline and week 2 (154 ± 63 vs. 21