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Fractured Inferior Pubic Ramus with Ipsilateral Total Hip Replacement: A Case Report and Review of the Literature  [PDF]
Sarkhell Radha,Michael Shenouda,Alexandra Hazlerigg,Sujith Konan,Alison Hulme
Case Reports in Orthopedics , 2013, DOI: 10.1155/2013/674732
Abstract: Pubic rami fractures are common. They are associated with significant morbidity and mortality. These fractures are usually classified as stable injuries and traditionally receive limited orthopaedic input. Management typically involves hospital admission and early input from physiotherapists and occupational therapists. Early mobilisation is advocated as a central part of managing these patients, with emphasis on secondary prevention. We report a case diagnosed as minimally displaced inferior pubic ramus fracture in a patient with an ipsilateral total hip replacement (THR). The patient was mobilised early and despite analgesia continued to complain of groin pain. Repeat radiographs showed a fracture of the acetabulum with displacement of the acetabular component of the hip replacement. We advocate early orthopaedic input for all pubic rami fractures, particularly in patients with hip arthroplasty, and thorough investigation including a CT scan of the pelvis to exclude acetabular extension prior to mobilisation. 1. Introduction Pubic rami fractures are the most common pelvic fracture pattern, with an estimated incidence of 25.6/100000 per year in individuals over 60 years [1]. This figure is predicted to increase with an aging population [2]. Patients can have significant morbidity and mortality associated with a pubic ramus fracture, with one-year mortality estimated at 13% and 5-year survival at 45.6% [1]. Poor prognostic indicators include an older age and presence of dementia [1]. In practice, the discovery of a pubic ramus fracture would not normally generate significant concern [3]. The patient is usually discharged with adequate analgesia and started on an active early mobilisation program [3]. There is currently a debate regarding which speciality is most appropriate to care for patients with pubic rami fractures. A study performed at the Royal Infirmary of Edinburgh reported that 80% of their patients with pelvic fractures did not require orthopaedic input [1]. The authors advocated that all patients with an isolated pubic ramus fracture should be admitted to the geriatric unit with orthopaedic input limited only for those cases with additional fractures [1]. We report a case of inferior pubic ramus fracture in a patient with a total hip arthroplasty. In this case, early mobilisation had a detrimental effect on the patient’s outcome. 2. Case Presentation A 64-year-old lady with past medical history of learning difficulties and osteoarthritis presented to our emergency department following a mechanical trip and fall landing onto her left side.
Preliminary results of cannulated screw fixation for isolated pubic ramus fractures
Jasper Winkelhagen,Michel P. J. van den Bekerom,Hugo W. Bolhuis,Mike Hogervorst
Strategies in Trauma and Limb Reconstruction , 2012, DOI: 10.1007/s11751-012-0134-7
Abstract: Isolated pubic ramus fractures are common fractures in the elderly, and treatment is typically non-operative. Up to 35 % of patients have a prolonged hospital stay due to pain. A small number of these patients do not respond to standard (non-operative) treatment. We retrospectively reviewed six patients with isolated pubic ramus fractures and persistent pain who were treated with percutaneous retrograde pubic ramus screw fixation. The study group consisted of six women with an average age of 81 years (72–86 years). Patients with symptomatic posterior pelvic ring injuries were excluded. All patients showed improvement after surgery, with three patients pain free and three patients with reduced pain. The mean time spent in the hospital was 9 days (range 3–18 days). There were complications post-operatively: two patients had pneumonia, two with confusional states, and one patient had a urinary tract infection. Despite these events, which are associated with surgery in patients with comorbidites from advanced age, retrograde pubic ramus screw fixation is an effective treatment option for patients with persistent pain from isolated pubic fractures.
Osteomyelitis of the pubic ramus misdiagnosed as septic arthritis of the hip
Saeed M Al-Qahtani
West African Journal of Medicine , 2004,
Abstract: This is a case report of an 11-year-old male Saudi who presented with osteomyelitis of the left pubic ramus who was misdiagnosed and treated as a case of septic arthritis of the hip. Subsequent re-evaluation upon referral was carried out using CT scan and MRI which clarified the diagnosis. The lesion was explored, the pus drained and necrotic material excised. The patient was subsequently managed on antibiotics with complete resolution. The rarity of pelvic osteomyelitis in childhood is stressed and the causes for delay in diagnosis are stressed. Key Words: Osteomyelitis, Pubic ramus, Misdiagnosed. Résumé II s'agit d'un rapport d'un saoudien du sexe masculin, agé de 11 ans qui s'est présenté atteint de l'osteomyelite du pubis ramus du c té gauche chez qui on a fait une erreur du diagnostic donc a été traité pour un cas de l'arthrite septique de la hanche. Au cours d'une réévaluation ultérieure a la suite d'un envoi avec ;'utilisation du CT Scan et MRI qui ont éclairci le diagnostic. La lésion a été traitée, drain le pus et coupé le matériel nécrotique. Puis on a traité le patient avec l'administration des antiboitiques avec une résolution complète. On mis en relief la rareté d'ostéomyelite pendant l'enfance et les causes pour le retard pendant le diagnostic. West African Journal of Medicine Vol.23(3) 2004: 267-269
Two cases with isolated and complex cardiac defects together with inferior vena cava anomaly
Münevver Y?ld?r?mer,Münevver Y?ld?r?mer,Mecnun ?etin,Mecnun ?etin
Dicle Medical Journal , 2012,
Abstract: Systemic venous anomalies are rare congenital anomalies.Although they appear in different symptoms, they areusually asymptomatic and they can be detected incidentallyduring investigation of other congenital heart anomalies.The knowledge of this kind of anomalies before cardiacangiography and open heart surgery is important toprevent time loss and unexpected complications. Echocardiographytransabdominal view is used and angiographyis performed for confirmation. We report two casesin which absent suprarenal inferior vena cava with venaazygos continuity was present. One is isolated and one ispresent with cardiac atrioventricular septal defect
Sonographic Measurement of the Inferior Vena Cava as A Marker of Blood Loss
A. Sefidbakht,A. Assadsangabi,A. Nabavizadeh
Iranian Journal of Radiology , 2007,
Abstract: Background and Objective: Detecting and monitoring blood loss is always a challenging dilemma in emer-gency settings. Measuring diameter of inferior vena cava in trauma patients may be useful in this regard. This has been classically done with CT; however do-ing it with Ultrasound as a bedside easily available modality is a novel approach. Materials and Methods: Between January 2006 and March 2006, 88 injured patients referred to Namazee Hospital, were investigated. The patients were di-vided in to two groups: a shock group (n=11, 12.5%) and a control group (n=77, 87.5%) who were trauma patients with normal blood pressure. The maximum antero-posterior diameter of inferior vena cava was measured ultrasonographically both in inspiration and expiration by M-Mode in subxyphoid area. Sta-tistical analysis included tests for normality and cor-relation analysis. Results: The average diameter of inferior vena cava in the control group was 11.2 mm and 9.5mm in expira-tion and inspiration respectively. In contrast the above values were 5.6 and 4.3 mm in shock group. Correlation analysis revealed a negative correlation between the diameter of inferior vena cava and the presence of shock (r=0.61). Conclusion: The diameter of inferior vena cava was found to correlate with shock in trauma patients. This measurement can be added to FAST sonography of trauma patient with minimum additional time.
Theoretical electron energy loss spectroscopy of isolated graphene  [PDF]
Duncan J. Mowbray
Physics , 2014, DOI: 10.1002/pssb.201451174
Abstract: A thorough understanding of the electronic structure is a necessary first step for the design of nanoelectronics, chemical/bio-sensors, electrocatalysts, and nanoplasmonics using graphene. As such, theoretical spectroscopic techniques to describe collective excitations of graphene are of fundamental importance. Starting from density functional theory (DFT), linear response time dependent DFT in frequency-reciprocal space within the random phase approximation (TDDFT-RPA) is used to describe the loss function -Im{1/{\epsilon}(q,{\omega})} for isolated graphene. To ensure any spurious interactions between layers are removed, both a radial cutoff of the Coulomb kernel, and extra vacuum directly at the TDDFT-RPA level are employed. A combination of both methods is found to provide a correct description of the electron energy loss spectra of isolated graphene, at a significant reduction in computational cost compared to standard methods.
Sulcus nervi dorsalis penis/clitoridis: anatomical and clinical implications  [PDF]
Sedy J
Neuroanatomy , 2007,
Abstract: Sulcus nervi dorsalis penis/clitoridis is a distinct groove located on the inferior ramus of pubis and ventralsurface of the body of pubis. In male, it accomodates the dorsal nerve of penis whereas in female the dorsalnerve and artery of clitoris. Close relation of dorsal nerve of penis/clitoris and pubis, represented by the courseof sulcus nervi dorsalis penis/clitoridis has a major impact in surgical disciplines. Exact preparation of thedorsal nerve of penis is crucial in correct performance of conversion of genitalia in patients with transsexualismin reconstruction of posterior urethra, in hypospadia, during performance of penile blocade during circumcisionand in revascularization surgery of erectile dysfunction. The role of sulcus nervi dorsalis penis in the Alcock’s syndrome is discussed. Similarly, it is advisable to takecare of the dorsal nerve of clitoris inside sulcus nervi dorsalis clitoridis during reduction clitoridoplasty inpatients with adrenogenital syndrome and during the insertion of transobturator vaginal tape. Injury of dorsalnerve of penis/clitoris leads to hypestesia or anestesia of glans penis/clitoridis. The injury of dorsal artery ofclitoris leads to hematoma. It is possible to use sulcus nervi dorsalis penis/clitoridis for sexing of isolated pubis for antropological orforensic purposes. Lateral border of sulcus nervi dorsalis penis corresponds to vertical ridge and lateral borderof sulcus nervi dorsalis clitoridis to ventral arc – two parameters, which are parts of the Phenice’s method forsexing of isolated pubic bones.
A rare case of benign isolated schwannoma in the inferior orbit  [cached]
Garg Rajiv,Dhawan Anuradha,Gupta Noopur,D′souza P
Indian Journal of Ophthalmology , 2008,
Abstract: A rare case of unilateral orbital schwannoma arising from the infraorbital nerve is presented. An excision biopsy with complete removal of the mass in the inferior orbit was performed. A definitive diagnosis was made on histopathological examination. The clinical and histological features of schwannoma are discussed. A need for early removal of such tumors is recommended to prevent complications.
Inferior Right Hepatic Vein: A Useful Anatomic Variation for Isolated Resection of Segment VIII  [PDF]
Klaus Steinbrück,Reinaldo Fernandes,Giuliano Bento,Rafael Vasconcelos,Gustavo Stoduto,Thomas Auel,Lúcio F. Pacheco-Moreira
Case Reports in Surgery , 2013, DOI: 10.1155/2013/371264
Abstract: Anatomical resection of segment VIII (SVIII) is one of the most difficult hepatectomies to perform. Although it is the best choice of surgical treatment for tumors located at SVIII, its feasibility can be compromised when the right hepatic vein (RHV) must be resected en bloc with SVIII. Herein we describe a case of a cirrhotic patient that was submitted to segmentectomy VIII in bloc with the main trunk of the RHV, due to hepatocellular carcinoma. The resection could only be performed because a well developed inferior right hepatic vein (IRHV) was present. Anatomical variations of the liver vascularization should be used by liver surgeons to improve surgical results. 1. Background Right hepatectomy is the procedure of choice for most patients with normal liver function and hepatic tumors located in the right liver, especially those in close contact to the right hepatic vein (RHV). Parenchyma-sparing resection may be required, however, in patients with impaired liver function and this is common in patients with cirrhosis and hepatocellular carcinoma (HCC). For tumors confined to segment VIII (SVIII) of the liver, the procedure of segmentectomy VIII offers a chance of anatomically resecting the tumor while preserving most of the liver tissue. This procedure, however, can be really challenging when the tumor is to close to the RHV. Up to 21% of patients have a large inferior right hepatic vein (IRHV) that drains the inferior segments of the right hemiliver [1]. The presence of this variation facilitates the isolated resection of SVIII, even when the RHV must be ligated and divided. Herein we describe a case of isolated segmentectomy VIII due to HCC in a cirrhotic patient, in which the presence of an IRHV enabled the section of the RHV without harming the drainage of inferior segments. 2. Patient and Methods A 66-year-old woman was admitted to our hospital with an abdominal ultrasonography showing a 2?cm nodule in SVIII of the liver. She had been previously diagnosed with Hepatitis B, but received no further treatment. Laboratory tests revealed AST 34?U/L, ALT 28?U/L, total bilirubin 0.8?mg/dL, INR 1.1 and albumin 4.5?g/dL, which demonstrated a minor liver disfunction. As she had no ascites or encephalopathy, she was classified as Child-Pugh’s grade A. Alpha-fetoprotein level was 845?ng/mL. MRI confirmed a 2.5 tumor touching and compressing the main trunk of RHV (Figure 1) and was consistent with HCC. The exam revealed also an IRHV (Figure 2) draining segments V and VI directly into the inferior vena cava, which encourage us to perform an isolated resection
Effects of Curved Periacetabular Osteotomy on the Stress Fields of the Pubic Rami and Ischium: A Finite Element Model Analysis  [PDF]
Norio Imai, Yoichiro Dohmae, Ken Suda, Dai Miyasaka, Tomoyuki Ito, Naoto Endo
Open Journal of Orthopedics (OJO) , 2013, DOI: 10.4236/ojo.2013.34036
Abstract: Background: Postoperative pubic or ischial stress fracture may be a complication after curved periacetabular osteotomy (CPO). The discontinuity of the superior pubic rami is a risk factor for this complication. We investigated the stress field differences in standing and sitting positions after CPO. Methods: We used finite element analysis to assess the effects of inferior pubic rami and ischial fractures with or without discontinuity of superior pubic rami. We used the “union model”, obtained from a bony union at the osteotomy site of the superior pubic rami from 38-year-old woman who had undergone CPO for left hip dysplasia. We deleted the bony union region and created a discontinuity in the superior pubic rami equal to the non-union, creating the “discontinuity model”. We compared the stress field and stress value in the simulated standing and half weight-bearing positions on the operative side, one-legged standing position on the non-operative side, and the sitting position. Findings: In 4 cases, the inferior rami experienced the highest stress. Stress values in the discontinuity model were higher than those in the union model: 1.7 times in the case of one-legged standing on the operative side, 2.4 times in the case of half weight-bearing on the operative side, 3.8 times in the case of one-legged standing on the non-operative side, and 2.0 times in the sitting position, respectively. Interpretation: We recommend patients delay weight bearing on the operative side, avoid the sitting position as long as possible, and sit down slowly to prevent inferior pubic rami and ischial fractures after CPO.

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