Evaluation of the Association between Pelvic Diameters and Pelvic Types on Computed Tomography Images in Healthy Turkish Females / Evaluación de la Asociación entre Diámetros Pélvicos y Tipos de Pelvis en Imágenes de Tomografías Computarizadas en Mujeres Turcas Sanas

SUMMARY: Pelvis contributes to both human locomotion and obstetrics, and normal vaginal delivery is associated with a spacious inlet, a large interspinosus diameter. This paper aimed to measure crucial diameters of pelvic ring, and to determine both the prevalence of pelvic types, and labor types including normal vaginal delivery or caesarean section in Turkish healthy females. Additionally, it was aimed to evaluate presence of relationship between pelvic types and pelvic diameters. Labor shape of subjects was obtained from hospital records. This retrospective study was carried out on 165 healthy subjects aged between 18 and 45 years. Anteroposterior diameter of the pelvic inlet (APDI), anteroposterior diameter of the pelvic outlet, sacrum length (SL), sacrum depth, conjugata vera, obstetrical conjugate, the diagonal conjugate, diameter transversa, diameter bispinous, intertuberous diameter were measured. From these measurements, brim index was calculated and decided to gynecoid, anthropoid and platypelloid type. Also, the andoid type was calculated to the ratio of posterior sagittal diameter of the inlet to conjugata obstetrica. 50.91 % of participants has gynecoid type pelvis, followed by 24.85 % anthropoid type, 14.55 % platypelloid, and 9.70 % android type pelvis. There was a significant difference in APDI, SL, SD, Conjugata vera, Conjugata obstetrica, Conjugata diagonalis, Conjugata transversa, diameter bispinous, diameter intertubercularis and Brim index measurements according to pelvic types. the first degree of narrowing (conjugata vera from 11 to 9) was found in 18 pelvises and 12 pelvises with the pathological degree of narrowing bellonged to the platypelloid type followed by android type pelvis with 6 pelvices. The android type pelvis is not appropriate for natural labor and a good assessment of birth canal can reduce the labor risks. Also, only 7 females who delivered with cesarean have gynecoid type pelvic type. The APDI and SL were significantly lower in subjects having pathological narrowing according to conjugata obstetrica values.

La pelvis contribuye tanto a la locomoción humana como a la obstetricia. El parto vaginal normal se asocia con una entrada espaciosa y un diámetro interespinoso grande. Este artículo tuvo como objetivo medir diámetros cruciales del anillo pélvico y determinar tanto la prevalencia de los tipos pélvicos como los tipos de parto, incluido el parto vaginal normal o la cesárea en mujeres turcas sanas. Además, se buscó evaluar la presencia de relación entre los tipos de pelvis y los diámetros de la pelvis. La forma laboral de los sujetos se obtuvo de los registros hospitalarios. Este estudio retrospectivo se llevó a cabo en 165 mujeres sanas con edades comprendidas entre 18 y 45 años. Se midieron el diámetro anteroposterior de la entrada pélvica (APDPI), el diámetro anteroposterior de la salida pélvica, la longitud del sacro (SL), la profundidad del sacro, la conjugada vera, el conjugado obstétrico, el conjugado diagonal, el diámetro transverso, el diámetro biespinoso y el diámetro intertuberoso. A partir de estas mediciones se calculó el índice del ala y se decidió tipo ginecoide, antropoide y platipoide. Además, el tipo androide se calculó en función de la relación entre el diámetro sagital posterior de la entrada y la conjugada obstétrica. El 50,91 % de los participantes tenía pelvis de tipo ginecoide, seguida del 24,85 % de pelvis de tipo antropoide, el 14,55 % de tipo platipeloide y el 9,70 % de tipo androide. Hubo una diferencia significativa en las mediciones de APDPI, SL, SD, Conjugada vera, Conjugada obstétrica, Conjugada diagonal, Conjugata transversa, diámetro biespinoso, diámetro intertubercular e índice de ala según los tipos de pelvis. El primer grado de estrechamiento (conjugada vera del 11 al 9) se encontró en 18 pelvis y 12 pelvis, siendo el grado patológico de estrechamiento del tipo platipeloide seguido de pelvis tipo androide con 6 pelvis. La pelvis tipo androide no es apropiada para el parto natural y una buena evaluación del canal del parto puede reducir los riesgos. Además, solo 7 mujeres que dieron a luz por cesárea tenían un tipo pélvico de tipo ginecoides. El APDPI y SL fueron significativamente más bajos en mujeres que tenían estrechamiento patológico según los valores obstétricos conjugados.

Bloqueos Nerviosos. Bases Anatómicas del Dolor Somático Abdomino-Pélvico / Nerve Blocks. Anatomy of the Somatic Innervation of the Abdomino-Pelvic Cavity

El dolor abdominal es una de las sintomatologías que afectan con frecuencia la cavidad abdomino-pélvica. Dicha cavidad posee una inervación somática en la que intervienen del séptimo a doceavo nervios intercostales, ramos colaterales y terminales del plexo lumbar y el nervio pudendo; siendo objetivo de este trabajo la descripción anatómica del dolor abdominopélvico a través del plexo lumbar, nervios intercostales y nervio pudendo, sus diferentes patrones y variaciones de conformación, y las implicancias de éstas últimas en las distintas maniobras clínico-quirúrgicas. Se realizó un estudio descriptivo, observacional y morfométrico de la inervación somática de la cavidad abdomino-pélvica, en 50 preparaciones cadavéricas, fijadas en solución de formaldehído, de la Tercera Cátedra de Anatomía, Facultad de Medicina, Universidad de Buenos Aires, entre Agosto/2017-Diciembre/2019. La descripción clásica del plexo lumbar se encontró en 35 casos; la presencia del nervio femoral accesorio en ningún caso; así como también la ausencia del nervio iliohipogástrico en ningún caso; el nervio obturador accesorio se halló en 2 casos; el nervio genitofemoral dividiéndose dentro de la masa muscular del psoas mayor en 6 casos; el nervio cutáneo femoral lateral emergiendo únicamente de la segunda raíz lumbar en 6 casos y por último se encontró la presencia de un ramo del nervio obturador uniéndose al tronco lumbosacro en un caso. Los nervios intercostales y el nervio pudendo presentaron una disposición clásica en todos los casos analizados. Es esencial un adecuado conocimiento y descripción del plexo lumbar, nervios intercostales y nervio pudendo para un adecuado abordaje de la cavidad abdomino-pélvica en los bloqueos nerviosos.

SUMMARY: Abdominal pain is one of the symptoms that affect the abdominal-pelvic cavity. The abdominal-pelvic cavity has a somatic innervation involving the seventh to twelfth intercostal nerves, collateral and terminal branches of the lumbar plexus and the pudendal nerve. The objective of this work is the description of the lumbar plexus, intercostal nerves and pudendal nerve, its different patterns and structure variations, as well as its implications during pain management in patients. A descriptive, observational, and morphometric study of patterns and structure variations of the lumbar plexus, intercostal nerves and pudendal nerve was conducted in 50 formalin-fixed cadaveric dissections of the Third Chair of Anatomy at the School of Medicine in the Universidad de Buenos Aires from August 2017 to December/2019. The standard description of the lumbar plexus was found in 35 cases; accessory femoral nerve was not present in any of the cases; absence of the iliohipogastric nerve was also not found in any case, while the accessory obturating nerve was found in 2 cases; genitofemoral nerve dividing within the muscle mass of psoas in 6 cases; lateral femoral cutaneous nerve emerging only from the second lumbar root in 6 cases and finally, presence of a branch of the obturating nerve was found joining the lumbosacral trunk in one case. The pudendal and intercostal nerve patterns presented a typical pathway in all cases. Adequate knowledge and description of the lumbar plexus, intercostal nerves and pudendal nerve is essential for an adequate approach of the abdominal-pelvic cavity in nerve blocks.

Atitudes e crenças de médicos ginecologistas- -obstetras e de pacientes do Hospital Universitário de Brasília sobre o rastreamento cervical e o exame pélvico / Attitudes and beliefs of obstetrician-gynecologists and patients at the University Hospital of Brasília about cervical screening and pelvic examination

Objetivo: Avaliar as atitudes e crenças de pacientes e médicos ginecologistas-obstetras sobre o rastreamento cervical e o exame pélvico no Hospital Universitário de Brasília (HUB). Métodos: Foram realizadas entrevistas com pacientes que aguardavam por uma consulta previamente agendada no ambulatório de ginecologia e com médicos ginecologistas-obstetras que atuavam no HUB. Cada grupo respondeu a um questionário que enfocava a realização do rastreamento cervical e do exame pélvico (EP). Resultados: No total, 387 pacientes responderam ao questionário. Dessas, apenas 4,13% sabiam que, de acordo com as diretrizes brasileiras, o rastreamento cervical deveria ser iniciado aos 25 anos de idade, 5,17% sabiam que ele deveria ser encerrado aos 64 anos e 97,93% esperavam um intervalo menor do que o trienal recomendado. Após serem informadas sobre as diretrizes, 66,93% acreditavam que o início aos 25 anos é tardio, 61,5%, que o encerramento aos 64 anos é precoce, 88,37%, que o intervalo trienal é muito longo e 94,06% ficaram com receio de que problemas de saúde pudessem aparecer nesse intervalo. Dos 44 médicos que responderam ao questionário, embora a maioria concordasse com as diretrizes, somente 31,82%, 38,64% e 34,1% as seguia com relação à frequência, à idade de início e à idade de encerramento, respectivamente. Quanto ao EP, aproximadamente metade dos participantes de cada grupo considerava que o exame deveria ser realizado nas consultas regulares com o ginecologista. Conclusão: Foi observada uma discrepância entre as expectativas das pacientes e as diretrizes para o rastreamento de câncer cervical. A maior parte das pacientes não as conhecia e, quando informadas, não concordava com elas. Quanto aos médicos ginecologistas- obstetras, a maioria não as seguia, apesar de conhecê-las. Quanto ao EP, grande parte dos médicos e pacientes considerava-o importante e acreditava que ele deveria ser realizado de forma rotineira nas consultas ginecológicas.

Objective: Evaluate the attitudes and beliefs of patients and obstetrician-gynecologists about cervical screening and pelvic examination in the University Hospital of Brasília (HUB). Methods: Face-to-face interviews with patients waiting for a previously scheduled consultation at the gynecology outpatient clinics and attending obstetrician-gynecologists at the HUB. Each group answered a questionnaire addressing cervical screening and pelvic examination (PE). Results: 387 patients answered the questionnaire. Of these, only 4.13% were aware that, according to Brazilian guidelines, cervical screening should begin at age 25, 5.17% that it should stop at age 64 and 97.93% expected a shorter interval than the recommended triennial. After being informed of the guidelines, 66.93% believed that starting at age 25 is late, 61.5% that stopping at 64 is early, 88.37% that the triennial interval is too long, and 94.06% would be afraid that health problems could appear during the interval. Of the 44 participating physicians, although most agreed with the guidelines, only 31.82%, 38.64% and 34.1% followed them regarding frequency, starting and stopping age, respectively. As for EP, approximately half of the participants in each group believed that it should be performed in regular consultations with the gynecologist. Conclusion: There was a discrepancy between patients' expectations and cervical screening guidelines. Most patients didn't know and, when informed, didn't agree with them. As for Ob-Gyn physicians, most did not follow these guidelines, despite knowing them. As for pelvic exam, most physicians and patients considered it important and believed it should be routinely performed during gynecological consultations.

Função sexual pós-histerectomia: quais os impactos e aspectos técnicos envolvidos? / Sexual function after hysterectomy: what are the impacts and technical aspects involved?

Objetivo: Identificar o impacto da histerectomia para patologias benignas sobre a sexualidade feminina. Métodos: Revisão de literatura com busca na plataforma PubMed, sendo selecionados 23 artigos em português e inglês publicados entre 2016 e 2021. Resultados: Foi descrita, majoritariamente, melhora na função sexual após histerectomia, semelhante às abordagens totais ou supracervicais e independentemente da via de acesso cirúrgico, apesar de impacto ligeiramente menor com a via laparoscópica. Na laparoscopia, houve melhor desfecho sexual no fechamento da cúpula vaginal, quando comparado ao fechamento via vaginal. Ademais, a ooforectomia concomitante apresentou resultados conflitantes e inconclusivos. Conclusão: A histerectomia afeta positivamente a saúde sexual feminina e aspectos técnicos podem interferir na função sexual, porém os dados são limitados. Devido à importância do tema, necessitam-se de mais estudos com metodologias padronizadas para possibilitar análises mais detalhadas.

Objective: To identify the impact of hysterectomy for benign pathologies on female sexuality. Methods: Literature review with search on PubMed platform, being selected 23 articles in Portuguese and English published between 2016 and 2021. Results: Improvement in sexual function after hysterectomy was mostly described, being similar in total or supracervical approaches and independent of the surgical access route, although it had slightly lower impact when laparoscopic. In the laparoscopic approach, there was better sexual outcome in the vaginal dome closure when compared to vaginal closure. In addition, concomitant oophorectomy showed conflicting and inconclusive results. Conclusion: Hysterectomy positively affects female sexual health and technical aspects may interfere with sexual function, but data are limited. Due to the importance of the theme, more studies with standardized methodologies are needed to enable more detailed analyses.

Axial Axis Metastasis / Metástase do eixo axial

Abstract Axial axis metastasis remains a challenge for surgical as well as other treatment modalities, like chemotherapy, immunotherapy, and radiotherapy. It is unequivocal that surgery provides pain improvements and preservation of neurological status, but this condition remains when associated with radiotherapy and other treatment modalities. In this review, we emphasize the current forms of surgical treatment in the different regions of the spine and pelvis. The evident possibility of percutaneous treatments is related to early or late cases, and in cases in which there are greater risks and instability to conventional surgeries associated with radiotherapy and have been shown to be the appropriate option for local control of metastatic disease.

Resumo As metástases no eixo axial permanecem um desafio para o tratamento cirúrgico bem como para outras modalidades, como quimioterapia, imunoterapia e radioterapia. É inequívoco que a cirurgia proporciona melhorias na dor e na preservação do status neurológico; porém, há permanência desta condição quando associada à radioterapia e a outras modalidades de tratamento. Nesta revisão damos ênfase às formas de tratamento cirúrgico atuais nas diferentes regiões da coluna vertebral e pelve. A evidente possibilidade de tratamentos percutâneos está relacionada a casos iniciais ou tardios, bem como a casos em que há maiores riscos e instabilidade às cirurgias convencionais associadas à radioterapia, e tem se mostrado a opção adequada para o controle local da doença metastática.

Eficácia, segurança e tolerabilidade da Enoxaparina para prevenção de tromboembolismo venoso nas cirurgias eletivas de abdome, pelve e varizes: revisão rápida de evidências / Seffectiveness,safety and tolerability of Enoxaparin for the prevention of venous thromboembolism in elective surgery of the abdomen, pelvis and varices: quick evidence review

Tecnologia: Enoxaparina comparada à profilaxia mecânica e/ou outros medicamentos disponíveis ou não no SUS. Indicação: Profilaxia de Tromboembolismo Venoso (TEV) em pacientes submetidos a cirurgia de abdome, pelve e varizes. Pergunta: Há superioridade em eficácia e segurança da enoxaparina (heparina de baixo peso molecular - HBPM) comparada à profilaxia mecânica e a outros medicamentos disponíveis ou não no SUS para prevenção de TEV em pacientes acima de 18 anos, não gestantes, em pós-operatório de cirurgias eletivas de abdome, pelve e varizes? Métodos: Revisão rápida de evidências (overview) de revisões sistemáticas, com levantamento bibliográfico realizado na base de dados PUBMED, utilizando estratégia estruturada de busca. A qualidade metodológica das revisões sistemáticas foi avaliada com AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews). Resultados: Foram selecionadas quatro e incluídas duas revisões sistemáticas com metanálise. Conclusão: HBPM no pós-operatório de cirurgia abdominal e pelve reduziu a incidência de TEV geral e TEV sintomático, sem aumentar risco de sangramento e mortalidade. Nas cirurgias de veias varicosas, foi observado uma redução de todos os eventos trombóticos e risco de TVP, sem aumentar risco de sangramento

Technology: Enoxaparin compared to mechanical prophylaxis and/or other drugs available or not in the SUS. Indication: Prophylaxis of Venous Thromboembolism (VTE) in patients undergoing surgery of the abdomen, pelvis and varicose veins. Question: There is superiority in efficacy and safety of enoxaparin, compared to mechanical prophylaxis and other drugs available or not in the SUS, for the prevention of VTE for patients over 18 years old, non-pregnant in the postoperative period of elective surgeries of the abdomen, pelvis and varicose veins? Methods: Rapid review of evidence (overview) from systematic reviews, with a bibliographic search in the PUBMED database, using a structured strategy. The methodological quality of systematic reviews was assessed with AMSTAR-2 (Methodological Quality Assessment of Systematic Reviews). Results: Four were selected and two systematic reviews with meta-analysis were included. Conclusion: LMWH in the postoperative period of abdominal and pelvic surgery reduced the incidence of general VTE and symptomatic VTE, without increasing the risk of bleeding and mortality. In varicose vein surgeries, a reduction in all thrombotic events and risk of DVT was observed, without increasing the risk of bleeding

Is There Any Difference Between a Spherical Marker and a Simple Coin for Hip Replacement Digital Planning? / Existe alguma diferença entre um marcador esférico e uma moeda simples para planejamento digital de substituição de quadril?

Abstract Objective To evaluate the accuracy and differences between 2 types of metallic markers, sphere, and coin, for radiographic calibration in the preoperative planning of hip arthroplasty. Methods Four spherical metallic markers and four coins, both 25 mm in diameter, were placed on the greater trochanter, pubic symphysis, between the thighs, and on the table of the exam, for radiographic examination of the hip in 33 patients with hip prosthesis. The prosthesis head was used for calibration and two examiners measured the markers' image diameters, and the results were analyzed statistically. Results In the greater trochanter, the sphere and the coin were not visualized in 19 radiographs (57.6%). Between the thighs, the coin marker was not visualized in 13 radiographs (39.4%). In the greater trochanter, the 25-mm accuracy of the coin and the sphere was, respectively, between 57.1 and 63.3% and between 64.3 and 92.9%. The coin between the thighs reached 25-mm accuracy in between 50 and 60% of cases. Over the exam table, the coin and sphere markers reached, respectively, the mean diameters of 22.91 mm and 23 mm, the lowest coefficient of variation, the lowest confidence interval, and the easiest positioning. There was statistical difference between the evaluations of the markers (coin vs. sphere) in all positions (p< 0.032), except for the exam table position (p= 0.083). Conclusions The coin between the thighs is the best marker for radiographic calibration in the preoperative planning of hip arthroplasty, and we suggest the use of another coin on the exam table for comparison, considering the 8% reduction in relation to its real size.

Resumo Objetivo Avaliar a precisão e as diferenças entre 2 tipos de marcadores metálicos, esfera e moeda, para calibração radiográfica no planejamento pré-operatório da artroplastia de quadril. Métodos Quatro marcadores metálicos esféricos e quatro moedas, ambas de 25 mm de diâmetro, foram colocadas em trocânter maior, sínfise púbica, entre as coxas e a mesa do exame, para exame radiográfico do quadril em 33 pacientes com prótese de quadril. A cabeça da prótese foi utilizada para calibração e dois examinadores mediram os diâmetros da imagem dos marcadores, e os resultados foram analisados estatisticamente. Resultados No trocânter maior, a esfera e a moeda não foram visualizadas em 19 radiografias (57,6%). Entre as coxas, o marcador de moeda não foi visualizado em 13 radiografias (39,4%). No trocânter maior, a precisão de 25 mm da moeda e da esfera foi, respectivamente, entre 57,1 e 63,3% e entre 64,3 e 92,9%. A moeda entre as coxas atingiu 25 mm de precisão entre 50 e 60%. Sobre a mesa de exame, os marcadores de moeda e esfera atingiram, respectivamente, diâmetros médios de 22,91 mm e 23 mm, o menor coeficiente de variação, o menor intervalo de confiança e o posicionamento mais fácil. Houve diferença estatística entre as avaliações dos marcadores (moeda vs. esfera) em todas as posições (p< 0,032), com exceção da posição na mesa de exame (p= 0,083). Conclusões A moeda entre as coxas é o melhor marcador para calibração radiográfica no planejamento pré-operatório da artroplastia de quadril, e sugerimos o uso de outra moeda na mesa de exame para comparação, considerando os 8% de redução em relação ao seu tamanho real.

Pelvimetric characteristics in agoutis (Dasyprocta prymnolopha) bred under human care / Características pelvimétricas em cutias (Dasyprocta prymnolopha) criadas sob cuidados humanos

The aim of the study was to establish the pattern of the agouti pelvis by obtaining external and radiographic internal pelvimetric values. Forty-three agouti (Dasyprocta prymnolopha), females and males bred in under human care were used. The parameters measured were the external biiliac diameter; the external biischiatic diameter; right and left external ilioischiatic diameters and radiographic internal measurements (true conjugated, the diagonal conjugated; the vertical, the sacral, sagittal, coxal tuberosity, upper biiliac, lower biiliac, and biischiatic diameter. The inlet pelvic area and the outlet pelvic area were calculated, as well the height/width ratios of the entrance area of the pelvis and the pelvic outlet area were calculated. The mean values for each body measurement of females and males were: weight 1.91kg and 2.04kg, external biiliac diameter 6.32cm and 6.30cm, external biischiatic diameter 4.34cm and 4.28cm, right external ilioischiatic diameter 9.01cm and 9.33cm, left external ilioischiatic diameter 9.13cm and 9.30cm, true conjugated 3.90cm and 3.68cm, diagonal conjugated 7.13cm and 6.91cm, vertical diameter 2.59cm and 2.45cm, sacral diameter 2.63cm and 2.44cm, sagittal diameter 3.30cm and 3.09cm, coxal tuberosity diameter 2.52cm and 2.43cm, upper biiliac diameter 6.28cm and 6.24cm, lower biiliac diameter 2.98cm and 2.58cm, biischiatic diameter 2.60cm and 2.70cm, height/width ratio - vertical/ lower biiliac diameter 0.88cm and 0.95cm, sagital/coxal tuberosity diameter 1.32cm and 1.28cm, inlet pelvic area 82.38cm and 77.83cm and outlet pelvic area 24.76cm and 20.07cm. Agouti are dolichopelvic animals, demonstrating the existence of a discrete sexual dimorphism in adults and low intensity correlations between the external and internal measures studied.

O objetivo deste estudo foi estabelecer o padrão da pelve de cutia, masculina e feminina, por meio da obtenção dos valores médios da pelvimetria externa e interna radiográfica. Foram utilizadas 43 cutias (Dasyprocta prymnolopha), fêmeas e machos criadas sob cuidados humanos. Os parâmetros medidos foram o diâmetro biilíaco externo; o diâmetro biisquiático externo; diâmetros ilioisquiáticos externos direito e esquerdo e medidas internas radiográficas (diâmetros conjugado verdadeiro, diagonal conjugado, vertical, sacral, sagital, tuberosidade coxal, biilíaco superior, biilíaco inferior e diâmetro biisquiático). A área pélvica de entrada e a área pélvica de saída foram calculadas , assim como foram calculadas as razões altura/largura da área de entrada da pelve e da área de saída da pelve. Os valores médios para as medidas das fêmeas e dos machos foram, respectivamente: peso 1,91kg e 2,04kg, diâmetro biilíaco externo 6,32cm e 6,30 cm, diâmetro ilioisquiático externo 4,34cm e 4,28cm, diâmetro ilioisquiático externo direito 9,01cm e 9,33cm, diâmetro ilioisquiático externo esquerdo 9,13cm e 9,30cm, diâmetro conjugado verdadeiro 3,90cm e 3,68cm, diâmetro conjugado diagonal 7,13cm e 6,91cm, diâmetro vertical 2,59cm e 2,45cm, diâmetro sacral 2,63cm e 2,44cm, diâmetro sagital 3,30cm e 3,09cm, tuberosidade coxal diâmetro 2,52cm e 2,43cm, diâmetro biilíaco superior 6,28cm e 6,24cm, diâmetro biilíaco inferior 2,98cm e 2,58cm, diâmetro biisquiático 2,60cm e 2,70cm, relação altura/largura - vertical/diâmetro biilíaco inferior 0,88cm e 0,95cm, diâmetro sagital/coxal tuberosidade 1,32cm e 1,28cm, área pélvica de entrada 82,38cm e 77,83 cm e área pélvica de saída 24,76cm e 20,07cm. As cutias são animais dolicopélvicos, demonstrando a existência de um discreto dimorfismo sexual em adultos e correlações de baixa intensidade entre as medidas externas e internas estudadas.

Pelvic lymph node dissection in high-risk prostate cancer

ABSTRACT Introduction: The therapeutic role of pelvic lymph node dissection (PLND) in prostate cancer (PCa) is unknown due to absence of randomized trials. Objective: to present a critical review on the therapeutic benefits of PLND in high risk localized PCa patients. Materials and Methods: A search of the literature on PLND was performed using PubMed, Cochrane, and Medline database. Articles obtained regarding diagnostic imaging and sentinel lymph node dissection, PLND extension, impact of PLND on survival, PLND in node positive "only" disease and PLND surgical risks were critically reviewed. Results: High-risk PCa commonly develops metastases. In these patients, the possibility of presenting lymph node disease is high. Thus, extended PLND during radical prostatectomy may be recommended in selected patients with localized high-risk PCa for both accurate staging and therapeutic intent. Although recent advances in detecting patients with lymph node involvement (LNI) with novel imaging and sentinel node dissection, extended PLND continues to be the most accurate method to stage lymph node disease, which may be related to the number of nodes removed. However, extended PLND increases surgical time, with potential impact on perioperative complications, hospital length of stay, rehospitalization and healthcare costs. Controversy persists on its therapeutic benefit, particularly in patients with high node burden. Conclusion: The impact of PLND on biochemical recurrence and PCa survival is unclear yet. Selection of patients may benefit from extended PLND but the challenge remains to identify them accurately. Only prospective randomized study would answer the precise role of PLND in high-risk pelvis confined PCa patients.

Tumor mesenquimático fosfatúrico de pelvis: abordaje multidisciplinario / Phosphaturic mesenchymal tumor of the pelvis: A multidisciplinary approach

El tumor mesenquimático fosfatúrico es una entidad clinicopatológica sumamente infrecuente. Además de provocar dolor óseo insidioso y polimialgias, se acompaña de alteraciones del metabolismo fosfocálcico de difícil manejo clínico. El abordaje multidisciplinario resulta la clave del éxito en esta enfermedad. Presentamos una paciente de 52 años de edad con antecedente de tumor mesenquimático fosfatúrico en la hemipelvis derecha con extensión a la cadera homolateral de 10 años de evolución. Clínicamente presentaba osteomalacia oncogénica (hipofosfatemia e hiperfosfaturia) que no se corregía, pese a un agente de última generación, el burosumab, un inhibidor del factor de crecimiento fibroblástico 23, que aumenta la reabsorción tubular renal de fosfatos. En un comité multidisciplinario, se decidió la resección con márgenes oncológicos y se logró una mejoría clínica franca. Comunicamos este caso, debido a que es un cuadro infrecuente. Nivel de Evidencia: IV

Phosphaturic mesenchymal tumor (PMT) is an infrequent clinicopathological entity. It presents insidious bone pain and polymyalgia, accompanied by alterations in calcium and phosphorus metabolism that are difficult to resolve clinically. A multidisciplinary approach is a key to success in this pathology. We present the case of a 52-year-old female patient with a 10-year history of PMT in the right hemipelvis with ipsilateral hip extension. From the clinical point of view, she presented oncogenic osteomalacia (hypophosphatemia and hyperphosphaturia) that did not correct despite being administered the latest generation medication, burosumab, an FGF-23 inhibitor that increases renal tubular phosphate reabsorption. Resection with oncological margins was decided by a multidisciplinary committee resolving her clinical condition. Due to the rarity of this pathology, we decided to report the case. Level of Evidence: IV

Cadera flotante: análisis comparativo de resultados y lesiones asociadas / Floating hip: comparative analysis of outcomes and associated injuries

Objetivo: Describir los tiempos de internación, cirugía y rehabilitación de una serie de pacientes con cadera flotante. El objetivo secundario fue comparar los resultados obtenidos en función de la reinserción laboral con los de pacientes que sufrieron fracturas de pelvis o acetábulo sin fractura femoral asociada. Materiales y Métodos: Estudio descriptivo, retrospectivo y multicéntrico de pacientes con trauma de pelvis y acetábulo de alta energía, divididos en dos grupos de estudio según la presencia de fractura de fémur asociada homolateral (cadera flotante) para su comparación, durante el período comprendido entre enero de 2014 y marzo de 2019. Resultados: Se incluyó a 102 pacientes con trauma de pelvis o acetábulo agrupados en 2 poblaciones según la presencia de cadera flotante (cadera flotante 23; pelvis/acetábulo 79). Las medianas de días de internación [cadera flotante 15,5 (rango 4-193); pelvis/acetábulo 7 (rango 3-31); p = 0,0001] y de la cantidad de cirugías por paciente [cadera flotante 5 (rango 3-8); pelvis/acetábulo 2 (rango 1-4); p = 0,0001] fueron mayores en los pacientes con cadera flotante. Además, la incapacidad laboral temporaria fue más alta (p = 0,00012), sin diferencias significativas en la tasa de recalificación laboral (p = 0,11). Conclusión: La asociación de la lesión cadera flotante aumentó significativamente el tiempo de internación, los procedimientos quirúrgicos necesarios y el tiempo de recuperación según la incapacidad laboral temporaria en pacientes con trauma de pelvis o acetábulo. Nivel de Evidencia: III

Objective: We aim to describe the lengths of hospitalization, surgery, and rehabilitation of a series of patients with floating hip. As a secondary objective, to compare the outcomes obtained in terms of return to work in patients who had suffered fractures of the pelvis or acetabulum without an associated femoral fracture. Materials and Methods: Descriptive, retrospective, and multicenter study of patients with high-energy trauma to the pelvis and acetabulum divided into two study populations according to the presence of associated ipsilateral femur fracture (floating hip) for comparison, during the period January 2014 - March 2019. Results: 102 patients with pelvis and/or acetabulum trauma were included, grouped into 2 populations according to the presence of a float-ing hip (Floating hip: 23 patients; Pelvis/acetabulum: 79 patients). The median days of hospitalization [floating hip: median = 15.5 (range = 4-193); pelvis/acetabulum: 7 (3-31); p = 0.0001] and the number of surgeries per patient [FH: median = 5 (range = 3-8); pelvis/acetabulum: 2 (1-4); p = 0.0001] were higher in patients with floating hip. Additionally, temporary work disability was higher (p = 0.00012), with no significant differences in the rate of job retraining (p = 0.11). Conclusion: Floating hip significantly increased the length of hospitalization, necessary surgical procedures, and recovery times according to temporary work disability in patients with trauma to the pelvis and/or acetabulum. Level of Evidence: III

Tratamiento de las fracturas de pelvis APCII. Variables que afectan el resultado final / Treatment of APCII pelvic fractures. Variables that affect the outcomes

Introducción: Las fracturas de pelvis se asocian frecuentemente a un trauma de alta energía. La tasa de mortalidad varía del 5% al 46%. El objetivo de este estudio fue explorar si las variables analizadas se asociaron con el resultado final del tratamiento de las fracturas de pelvis APCII (AO/OTA: 61B2.3). materiales y métodos:Se evaluó a 23 de 79 pacientes luego de aplicarles los criterios de selección. Las fracturas fueron clasificadas, según Young y Burgess, en una radiografía panorámica de pelvis, de entrada y de salida, y tomografía computarizada. Se evaluó el resultado clínico según la escala funcional de Majeed. Las variables evaluadas fueron: tratamiento en la urgencia, lesiones asociadas, días de espera hasta la cirugía, fijación utilizada, reducción posquirúrgica inmediata, infección del sitio quirúrgico. Resultados: No se halló una diferencia estadísticamente significativa entre el tipo de tratamiento realizado en la urgencia, las lesiones asociadas, los días de espera hasta la cirugía y el tipo de fijación, con el resultado final a largo plazo. Los pacientes que tuvieron una reducción posoperatoria inmediata <1 cm y los que no sufrieron una infección del sitio quirúrgico obtuvieron mejores resultados funcionales, de manera estadísticamente significativa. Conclusión: Las variables calidad de la reducción posquirúrgica inmediata e infección del sitio quirúrgico en pacientes con fractura de pelvis APCII se asocian directamente con los resultados funcional y clínico a largo plazo. Nivel de Evidencia: IV

Introduction: Pelvic fractures are frequently associated with high-energy trauma. Mortality varies from 5%-46%. In these patients, the factors related to poor outcomes are still controversial. Purpose: To explore if the variables analyzed were related with the long term outcomes of the treatment of an anterior-posterior compression type II pelvic fracture (APCII; AO/OTA: 61B2.3). Materials and methods: 79 cases were analyzed and 23 patients remained for evaluation according to inclusion and exclusion criteria. Pelvic radiographs (anteroposterior, inlet and outlet) and CT-scans were evaluated. The Young & Burgess classification was used to define the fracture pattern and the Majeed Score for clinical outcomes. Variables analyzed: emergency treatment, associated injuries, delay for definitive fixation, method of fixation, quality of immediate postoperative reduction and surgical site infection. Results: We did not find any statistical relation between the type of emergency treatment, associated injuries, delay for definitive fixation, method of fixation, and the long-term clinical outcome. Patients who had an immediate postoperative reduction of less than 1 cm and those who did not have a surgical site infection obtained better functional outcomes (statistically significant). Conclusion: The quality variables of immediate postoperative reduction and surgical site infection in patients with APCII pelvic fracture had a direct relation with long-term functional and clinical outcomes. Level of Evidence: IV

Morphological study of the pelvis and vertebral column in university dance major students / Estudio morfológico de la pelvis y la columna vertebral en estudiantes universitarios de danza

SUMMARY: The purpose of this study was to investigate the pelvis and spine of university dance major students. The spine and pelvic morphology were measured in 32 students (eight ballet, eight Korean dance, and eight modern dance) and eight general studies students. using dual energy X-ray absorptiometry and Formetric III 4D. First, as a result of measuring the front and rear tilt, a back tilt of the torso was found in all groups. Second, measurement of the left and right tilt of the spine showed a tilt to the right, and the angle and distance of the tilt were 1.25 ? 1.16 ? and 10.5 ? 9.3 mm, respectively in the ballet major group. Third, the kyphosis angle was the highest in the Korean dance students, exceeding the normal range (ballet: 46 ?, Korean dance: 54 ?, modern dance: 47 ?, general department: 49?). Although, there was no significant difference among the groups, but the spine and pelvic morphology were measured in different forms (shapes) according to the majors. Therefore, according to the major, the movements used to affect the shape of the spine and the pelvis are considered to change. This suggests that follow-up studies are needed. If the displacement is severe due to the movement, pain may occur and it is necessary to study how to identify the pain area when the pain occurs.

RESUMEN: El propósito de este estudio fue investigar la pelvis y la columna vertebral de estudiantes universitarios de danza. Se realizaron mediciones morfológicas de la columna y la pelvis en 32 estudiantes (ocho de ballet, ocho de danza coreana y ocho de danza moderna) y ocho estudiantes de estudios generales. utilizando absorciometría de rayos X de energía dual y formétrico ? 4D. Primero, como resultado de medir la inclinación delantera y trasera, se encontró una inclinación del torso hacia atrás en todos los grupos. En segundo lugar, la medición de la inclinación izquierda y derecha de la columna mostró una inclinación hacia la derecha, y el ángulo y la distancia de la inclinación fueron 1,25 ? 1,16 ? y 10,5 ? 9,3 mm, respectivamente, en el grupo principal de ballet. En tercer lugar, el ángulo de cifosis fue el más alto en los estudiantes de danza coreana, excediendo el rango normal (ballet: 46 ?, danza coreana: 54 ?, danza moderna: 47 ?, departamento general: 49 ?). Aunque no hubo diferencia significativa entre los grupos, la morfología de la columna y la pelvis se midió en diferentes formas (formas) según las carreras. Por lo tanto, según la especialidad, se considera que cambian los movimientos utilizados afectando la forma de la columna y la pelvis. Esto sugiere que se requieren estudios de seguimiento. Si el desplazamiento es severo debido al movimiento, este puede generar dolor y es necesario estudiar cómo identificar el área de dolor cuando ocurre.

Lesiones traumáticas de pelvis / Traumatic Pelvic Injuries

Introducción: El tratamiento del traumatismo pélvico es uno de los más complejos en la atención al trauma. La tasa de mortalidad es alta. Objetivo: Examinar los criterios actuales acerca de las lesiones traumáticas de pelvis y las posibles estrategias existentes para su tratamiento. Métodos: Se realizó una búsqueda de artículos publicados en la base de datos PubMed entre los años 2011-2020. Se excluyeron trabajos porque estaban duplicados o los datos de origen eran insuficientes. Resultados: Se analizaron los mecanismos de las lesiones, su fisiopatología, principios y pilares de la atención médica y recomendaciones para el uso de herramientas de diagnóstico en el trauma, entre otras. Las complicaciones se presentan en pacientes con trauma pélvico abierto que pueden tener secuelas crónicas como incontinencia fecal y urinaria, impotencia, dispareunia, discapacidad residual en las funciones físicas, absceso perineal y pélvico, dolor crónico y complicaciones vasculares como embolia o trombosis. La mayoría de las muertes (44,7 por ciento) ocurren el día del trauma. Un enfoque multidisciplinario en la atención a las lesiones traumáticas de pelvis, contribuye a una mejora en el rendimiento y en los resultados de los pacientes. Conclusiones: Las lesiones traumáticas del anillo pélvico son consecuencia de accidentes de alta energía y constituyen una de las lesiones de mayor gravedad a las que está expuesto el ser humano. La posibilidad de inestabilidad mecánica asociada a alteraciones hemodinámicas obliga a la adopción de protocolos de actuación inmediata, para evitar la elevada mortalidad que se asocia a estas lesiones(AU)

Introduction: The treatment of pelvic trauma is one of the most complex in trauma care. Mortality rate is high. Objective: To examine the current criteria about traumatic pelvic injuries and the possible existing strategies for their treatment. Methods: A search was carried out for articles published in PubMed database from 2011 to 2020. Works that were duplicated or had insufficient source data were excluded. Results: We analyzed injury mechanisms, pathophysiology, classifications, principles and pillars of medical care, and recommendations for the use of diagnostic tools in pelvic trauma, among others. Complications with functional limitations occur in patients with open pelvic trauma who may have chronic sequelae such as fecal and urinary incontinence, impotence, dyspareunia, residual disability in physical functions, perineal and pelvic abscess, chronic pain, and vascular complications such as embolism or thrombosis. Most deaths (44.7 percent) occur on the day of the trauma. A multidisciplinary approach to treating traumatic pelvic injuries contributes to improved performance and patient outcomes. Conclusions: Traumatic injuries to the pelvic ring are the consequence of high-energy accidents and constitute one of the most serious injuries to which humans are exposed. The possibility of mechanical instability associated with hemodynamic alterations requires the adoption of protocols for immediate action, to avoid the high mortality associated with these injuries(AU)

Resonancia magnética en el estudio de dos pacientes con dolor pélvico crónico asociado a endometriosis de infiltración profunda / Magnetic resonance imaging in the study of two patients with chronic pelvic pain associated to infiltrating endometriosis deep

INTRODUCCIÓN: La endometriosis de infiltración profunda (EIP) es una enfermedad crónica de difícil diagnóstico, que frecuentemente es confundida con otras patologías pelvianas. OBJETIVO: Presentar dos casos de endometriosis de infiltración profunda, donde la resonancia magnética (RM) de pelvis, fue importante para el diagnóstico y planificación del tratamiento quirúrgico. CASO CLÍNICO: Se describe el caso de dos pacientes. La primera de 24 años afectada por un nódulo de EIP retrocervical con extensión intestinal sintomática y la segunda, una paciente de 37 años con una recidiva sintomática de EIP en la cúpula vaginal después de una histerectomía total. RESULTADOS: La RM de pelvis describe en ambos casos la extensión de las lesiones endometriósicas y presenta una excelente correlación con los hallazgos intra operatorios en la laparoscopía quirúrgica. CONCLUSIONES: La RM de pelvis es un excelente recurso en el estudio diagnóstico de las pacientes con dolor pélvico crónico, tanto en el caso de EIP retrocervical con extensión intestinal y también en la recidiva de EIP en la cúpula vaginal después de una histerectomía total

INTRODUCTION: Deep infiltration endometriosis (DIE) is a chronic disease of difficult diagnosis, which is frequently confused with other pelvic pathologies. OBJETIVE: To present two cases of deep infiltrating endometriosis, where the pelvic magnetic resonance imaging (MRI) was important in the diagnosis and surgical treatment planning. CLINICAL CASES: Two cases, one 24 years-old patient suffering from retrocervical DIE nodule with symptomatic bowel involvement, and a 37 years-old patient, with a symptomatic DIE at the vaginal cuff after total hysterectomy. RESULTS: Pelvic MRI describes in both cases the extension of the endometriotic lesions and presents an excellent correlation with the intra operatory findings during surgical laparoscopy. CONCLUSIONS: Pelvic MRI is an excellent diagnostic tool for patients with pelvic pain, in case of retrocervical DIE with bowel involvement, and also in recurrence of DIE at the vaginal cuff after total hysterectomy

Dynamic Knee Alignment and Pelvic Balance: Comparison Regarding Gender in Young Soccer Athletes / Alinhamento dinâmico do joelho e equilíbrio pélvico: Comparação entre os sexos em atletas de futebol de base

Abstract Objective To evaluate knee alignment in the frontal plane and pelvic balance during the step-down test in female and male soccer players. Methods Cross-sectional study carried out with male and female soccer players from under-15 and under-17 teams of a professional club in Southern Brazil. The step-down test was performed, filmed with a video camera, and evaluated according to the angular measurements obtained during movement using the Kinovea software (open source), version 0.8.24. Results The sample consisted of 38 individuals, 19 males and 19 females. Female athletes had a greater varus angle (9.42º ± 1.65º) compared to male athletes (3.91º ± 2.0º; p = 0.04). There was no difference regarding the unilateral pelvic drop between the groups. In addition, the association between the hip-related pelvic drop and the projection angle on the frontal plane of the knee was weak in both genders. Conclusion Even though the pelvic drop was observed in both genders, young female athletes had greater varus knee angles on the step-down test, which require greater attention to minimize the risk of injury.

Resumo Objetivo Avaliar o alinhamento do joelho no plano frontal e o equilíbrio pélvico durante a descida de um degrau comparando atletas de futebol feminino e masculino. Métodos Estudo transversal, realizado com atletas de futebol das categorias sub-15 e sub-17, de ambos os sexos, de um clube profissional do Sul do Brasil. Foi realizado o teste de descida de um degrau, o qual foi filmado por uma câmera de vídeo, e, em sua avaliação, traçaram-se as medidas angulares durante o movimento por meio do software Kinovea (código aberto), versão 0.8.24. Resultados A amostra foi composta por 38 indivíduos, 19 do sexo masculino e 19 do sexo feminino. As atletas do sexo feminino apresentaram maior ângulo em varo (9,42º ± 1,65º) quando comparadas com os atletas masculinos (3,91º ± 2,0º; p = 0,04). Não houve diferença em relação à queda unilateral da pelve (drop pélvico) entre os grupos, e a associação entre o drop pélvico do quadril e o ângulo de projeção no plano frontal do joelho foi fraca em ambos os sexos. Conclusão Apesar de ambos os sexos terem apresentado queda pélvica, as atletas de base do sexo feminino apresentaram maior angulação do joelho em varo no teste de descida do degrau, e necessitam maior atenção para minimizar o risco de lesão.

Safety of Transrectal or Transvaginal Drainage of Pelvic Abscesses / Segurança da drenagem transretal ou transvaginal de abscessos pélvicos

Abstract Objective The literature on the safety and long-term sequelae of transrectal and transvaginal drainage of pelvic abscesses is limited. We evaluated the outcomes and safety of pelvic abscess drainage by interventional radiology at our institution. Methods After obtaining institutional review board approval, we retrospectively evaluated the outcomes of transrectal and transvaginal pelvic abscesses drainage using computed tomography, endorectal ultrasound, and or fluoroscopy. Results The study included 26 patients, with an age range of 24 to 88 years old, out of whom 53.8% were men. A total of 46.1% of the participants were African Americans and 26.9% were Caucasians. The average body mass index was 28.4 (range: 15.6 to 41.9). The most common etiology was penetrating abdominal injury (27%), followed by appendectomy (23%), diverticular disease (11.5%), anastomotic leak (11.5%), and disorders of gynecological causes (11.5%). The mean abscess diameter was 6.3 cm (range: 3.3 to 10.0 cm). Transrectal drainage was performed in all except one patient who had a transvaginal drainage. Transrectal ultrasound was used for drainage in 92.3% cases, and fluoroscopy was used as an additional imaging modality in 75% of the cases. An 8- or 10-Fr pigtail catheter was used in>80% of the patients. Drains were removed between 2 and 7 days in 92.3% of the cases. The average follow-up was 30.4 months (range: 1 to 107 months), and no long-term complications were reported. Only one patient required subsequent operative intervention for an anastomotic leak. Conclusions Pelvic abscess drainage by transrectal route using radiological guidance is a safe and effective procedure.

Resumo Objetivo A literatura sobre a segurança e as sequelas no longo prazo da drenagem transretal e transvaginal do abscesso pélvico é limitada. Avaliamos os resultados e a segurança da drenagem do abscesso pélvico por radiologia intervencionista em nossa instituição. Métodos Após obter a aprovação do conselho de revisão institucional, avaliamos retrospectivamente os resultados da drenagem de abscessos pélvicos transretais e transvaginais por meio de tomografia computadorizada, ultrassom endorretal, e/ou fluoroscopia. Resultados Participaram do estudo 26 pacientes, com faixa etária de 24 a 88 anos, dos quais 53,8% eram homens. Um total de 46,1% eram afro-descendentes, e 26,9% eram brancos. O índice de massa corporal médio foi de 28,4 (gama: 15,6 a 41,9). A etiologia mais comum foi lesão abdominal penetrante (27%), seguida de apendicectomia (23%), doença diverticular (11,5%), fístula anastomótica (11,5%) e distúrbios de causas ginecológicas (11,5%). O diâmetro médio do abscesso foi de 6,3 cm(gama: 3,3 a 10,0 cm). A drenagem transretal foi realizada em todos os pacientes, com exceção de uma, que foi submetida a uma drenagem transvaginal. A ultrassonografia transretal foi utilizada para drenagem em 92,3% dos casos, e a fluoroscopia como modalidade adicional de imagem, em 75% dos casos. Um catéter duplo J de 8 ou 10 Fr foi usado em>80% dos pacientes. Os drenos foram retirados entre 2 e 7 dias em 92,3% dos casos. O acompanhamentomédio foi de 30,4meses (gama: 1 a 107 meses), e nenhuma complicação de longo prazo foi relatada. Apenas um paciente necessitou de intervenção cirúrgica subsequente para um vazamento anastomótico. Conclusão A drenagem do abscesso pélvico por via transretal com orientação radiológica é um procedimento seguro e eficaz.

Comportamiento de las lesiones traumáticas del anillo pélvico / Behavior of the traumatic lesions of the pelvic ring

RESUMEN Introducción: las lesiones traumáticas del anillo pélvico constituyen un desafío para los cirujanos ortopedistas por su alta morbimortalidad y las consecuencias que de ellas derivan. Objetivo: describir el comportamiento de variables demográficas y clínicas en los pacientes atendidos por lesiones traumáticas del anillo pélvico en el Hospital Universitario "Comandante Faustino Pérez Hernández" de Matanzas Materiales y Métodos: se realizó un estudio longitudinal prospectivo descriptivo de los pacientes ingresados en el servicio de ortopedia y traumatología por presentar lesiones traumáticas del anillo pélvico en dicho centro en el período comprendido de enero del 2009 a enero del 2019. Se seleccionaron variables demográficas y clínicas Resultados: el estudio incluyó a 48 pacientes. Predominó el sexo masculino 29 pacientes para un 60,4%, la edad de mayor frecuencia estuvo entre 31 a 50 años. Predominaron las fracturas tipo B con 24 pacientes para 50% y el tratamiento quirúrgico con 27 pacientes para 56,2%, dentro de las complicaciones inmediatas predominó el shock hipovolémico en 14 pacientes para 29.1%, en las tardías la sepsis superficial con 6 pacientes, 12.5%. Conclusiones: las lesiones traumáticas del anillo pélvico siempre deben ser tratadas como lesiones graves, por lo que deben ser valoradas de forma multidisciplinaria y apegados a protocolos de actuación, y con especialistas de alta experiencia profesional (AU).

SUMMARY Introduction: pelvic ring traumatic lesions are a challenge for orthopedic surgeons due to their high morbi-mortality and the consequences derived from them. Objective: to describe the behavior of clinical and demographic variables in patients cared due to pelvic ring traumatic lesions in the University Hospital "Comandante Faustino Perez Hernandez" of Matanzas. Method: a descriptive, prospective, longitudinal research was carried out in patients admitted to the Orthopedics and Traumatology Service of the before-named hospital for presenting pelvic ring traumatic lesions in the period from January 2009 until January 2019. Clinical and demographic variables were chosen. Results: the study included 48 patients. Male sex predominated, 29 patients, 60.4 %; the most frequent age ranged between 31 and 50 years. Type B fractures predominated with 24 patients and 50 %; surgical treatment also predominated with 27 patients and 56.2 %; among the immediate complications, hypovolemic shock predominated in 14 patients for 29.1 %; among the late ones, surface sepsis predominated with 6 patients, 12.5 %. Conclusions: pelvic ring traumatic lesions should be always treated like serious lesions; therefore they should be evaluated in a multidiscipline way, adhered to the intervention protocols, and by highly experienced professionals (AU).