Hip Structural Analysis Reveals Impaired Hip Geometry in Girls With Type 1 Diabetes.

CONTEXT: Among patients with type 1 diabetes (T1D), the risk of hip fracture is up to 6-fold greater than that of the general population. However, the cause of this skeletal fragility remains poorly understood. OBJECTIVE: To assess differences in hip geometry and imaging-based estimates of bone strength between youth with and without T1D using dual-energy x-ray absorptiometry (DXA)-based hip structural analysis. DESIGN: Cross-sectional comparison. PARTICIPANTS: Girls ages 10 to 16 years, including n = 62 with T1D and n = 61 controls. RESULTS: The groups had similar age, bone age, pubertal stage, height, lean mass, and physical activity. Bone mineral density at the femoral neck and total hip did not differ in univariate comparisons but was lower at the femoral neck in T1D after adjusting for bone age, height, and lean mass. Subjects with T1D had significantly lower cross-sectional area, cross-sectional moment of inertia, section modulus, and cortical thickness at the narrow neck, with deficits of 5.7% to 10.3%. Cross-sectional area was also lower at the intertrochanteric region in girls with T1D. Among those T1D subjects with HbA1c greater than the cohort median of 8.5%, deficits in hip geometry and strength estimates were more pronounced. CONCLUSIONS: DXA-based hip structural analysis revealed that girls with T1D have unfavorable geometry and lower estimates of bone strength at the hip, which may contribute to skeletal fragility and excess hip fracture risk in adulthood. Higher average glycemia may exacerbate effects of T1D on hip geometry.

Age-related change and gender differences in pelvic morphology of healthy children.

BACKGROUND: An increasing number of studies about the hip joint morphology with childhood-specific hip diseases have been reported. But there have been few reports on pelvic morphology of healthy children. The purpose of this study was to assess the pelvic morphology of healthy children in detail and clarify the age-related change and gender difference of it. METHODS: We retrospectively assessed the pelvic morphology of 97 healthy children (3-18 years old) using their pelvic computed tomography (CT) data. Superior iliac angle (SIA), inferior iliac angle (IIA), and ischiopubic angle (IPA) as the parameters of pelvic winging, and acetabular anteversion and anterior acetabular sector angle (AASA), posterior acetabular sector angle (PASA), superior acetabular sector angle (SASA) as the parameters of acetabular coverage, are measured. Pearson's correlation coefficient was used for examining the correlation between the each measurement and the age of cases. Multiple linear regression analysis was performed to investigate the possibility of association of age and sex with each measurement. RESULTS: In female, it was found that IIA, AASA, PASA, SASA were significantly correlated with the age of the cases. And in male, SIA, IIA, IPA, AASA, PASA were significantly correlated with the age. Multiple linear regression analysis revealed the significant difference of the distribution between males and females was observed in IIA, IPA, AVcen, PASA, and these measurements were lager for female. CONCLUSIONS: In this study, we revealed the age-related change and gender difference of the pelvic morphology of healthy children, and this could be useful information in evaluating the hip with what appears to be an abnormal acetabular anteversion and acetabular inclination in the patients with childhood specific hip disease. Additionally, it will also help us to make operation plans pertaining to the hip.

The "Risser+" grade: a new grading system to classify skeletal maturity in idiopathic scoliosis.

PURPOSE: This study aims to propose and validate a new unified "Risser+" grade that combines the North American (NA) and European (EU) variants of the classic Risser score. The "Risser+ " grade can effectively combine the North American and European Risser Classifications for skeletal maturity with adequate intra-rater/inter-rater reliability and agreement. METHODS: Agreement and reliability were evaluated for 6 raters (3-NA, 3-EU) who assessed 120 pelvic radiographs from the BrAIST trial, all female, average age 13.4 (range 10.1-16.5 years). Blinded raters reviewed x-rays at two time-points. Intra- and inter-rater agreement (RA) were established with Krippendorff's alpha (k-alpha), while intra- and inter-rater reliability (RR) were established with intraclass correlation coefficients (ICC). Acceptable agreement and reliability were set a priori at 0.80. RESULTS: Inter-RA for the second reading met study requirements (k-alpha = 0.86 [0.81-0.90]) compared to the first reading (0.72 [0.63-0.79]) while combined readings was close to target agreement (0.79 [0.74-0.84]). Removal of 20 readings demonstrating outlier tendencies increased agreement for the first, second, and combined reads (k-alpha = 0.85, 0.89, 0.87, respectively). Intra-RA was sufficient for 4 out of 6 raters (k-alpha > 0.80) and one rater from EU and NA presented subpar intra-RA (k-alpha = 0.64 and 0.74, respectively). Inter-RR met study requirements overall reads (ICC = 0.96 [0.95-0.97]) including the first (0.94 [0.92-0.95]) and second (0.97 [0.97-0.98]) reads, independently. CONCLUSIONS: The Risser+ system showed excellent reliability across multiple reads and raters and demonstrated 79% agreement overall reads and ratings. Agreement increased to over 85% when raters could distinguish Risser 0 + from Risser 5. These slides can be retrieved from electronic supplementary material.

Efficacy of three-dimensional cinematic rendering computed tomography images in visualizing features related to age estimation in pelvic bones.

Morphological changes on the surface of the pelvic bone can be used to estimate the age at death of a person. These features can be visualized using three dimensional computed tomography (3D CT) images. A newly introduced 3D CT technique, cinematic volume rendering, improves visualization of the surface of bones by integrating the effect of light on the images. The aim of this study is to evaluate the efficacy of this 3D CT technique in visualizing features related to age estimation in pelvic bones. Dry pelvic bones of 35 subjects were scanned and then 3D reconstruction of the images was performed using the cinematic rendering technique. The 3D CT images of the pubic symphyses and the auricular surfaces were interpreted by two radiologists and a forensic osteologist using age estimation features derived from the Suchey-Brooks and the Buckberry-Chamberlain methods The interpretation of the dry pelvic bones was done by an expert anatomist and used as a gold standard. The percentages of correct interpretations and level of agreement in grading using 3D CT and using dry bones were high for features in the pubic symphyses including surface patterns (100%, k=1), presence of lower extremities (100%, k=1), and patterns of pubic rims (91.4%, range 87.5-100%, k=0.88). In the auricular surface of the ilium, all specimens with an apical activity were correctly interpreted (100%, k=1), but detection was moderate to poor for transverse organization (71.4%, k=0.43), macroporosity (70%, k=0.38.), and microporosity (52.9%, k=0.25). Cinematic volume rendering has a high level of efficacy in identifying age-related features on pubic symphyses, but it inadequately displays features on the auricular surface.

Predicted final spinal height in patients with adolescent idiopathic scoliosis can be achieved by surgery regardless of maturity status.

AIMS: The aim of this study was to investigate the impact of maturity status at the time of surgery on final spinal height in patients with an adolescent idiopathic scoliosis (AIS) using the spine-pelvic index (SPI). The SPI is a self-control ratio that is independent of age and maturity status. PATIENTS AND METHODS: The study recruited 152 female patients with a Lenke 1 AIS. The additional inclusion criteria were a thoracic Cobb angle between 45° and 70°, Risser 0 to 1 or 3 to 4 at the time of surgery, and follow-up until 18 years of age or Risser stage 5. The patients were stratified into four groups: Risser 0 to 1 and selective fusion surgery (Group 1), Risser 0 to 1 and non-selective fusion (Group 2), Risser 3 to 4 and selective fusion surgery (Group 3), and Risser 3 to 4 and non-selective fusion (Group 4). The height of spine at follow-up (HOSf) and height of pelvis at follow-up (HOPf) were measured and the predicted HOS (pHOS) was calculated as 2.22 (SPI) × HOPf. One-way analysis of variance (ANOVA) was performed for statistical analysis. RESULTS: Of the 152 patients, there were 32 patients in Group 1, 27 patients in Group 2, 48 patients in Group 3, and 45 patients in Group 4. Significantly greater HOSf was observed in Group 3 compared with Group 1 (p = 0.03) and in Group 4 compared with Group 2 (p = 0.02), with similar HOPf (p = 0.75 and p = 0.83, respectively), suggesting that patients who undergo surgery at Risser grade of 0 to 1 have a shorter spinal height at follow-up than those who have surgery at Risser 4 to 5. HOSf was similar to pHOS in both Group 1 and Group 2 (p = 0.62 and p = 0.45, respectively), indicating that undergoing surgery at Risser 0 to 1 does not necessarily affect final spinal height. CONCLUSION: This study shows that fusion surgery at Risser 0 may result in growth restriction unlike fusion surgery at Risser 3 to 4. Despite such growth restriction, AIS patients could reach their predicted or 'normal' spinal height after surgery regardless of baseline maturity status due to the longer baseline spinal length in AIS patients and the remaining growth potential at the non-fusion levels. Cite this article: Bone Joint J 2018;100-B:1372-6.

Maturation of pelvic ossification centers on computed tomography in normal children.

BACKGROUND: The pelvis is composed of three paired primary ossification centers: the pubis, the ischium and the ilium. During maturation, multiple secondary ossification centers can be seen in the synchondroses between these bones and in the pelvic apophyses. The fragmented appearance of these centers can be confused with pathology. OBJECTIVE: To examine development of pelvic ossification centers by CT and determine normal appearance throughout childhood. MATERIALS AND METHODS: Three pediatric radiologists reviewed 325 pelvic CT scans in children and young adults 5-18 years old and graded 6 pelvic ossification centers to evaluate maturational changes in critical structures. RESULTS: Rate and progression of ossification and age at complete fusion vary with gender at the different ossification centers in the growing pelvis. CONCLUSION: Knowledge of the normal CT appearance of ossification centers throughout childhood is important to differentiate the normal appearance from pathology.

Loss in the making: absence of pelvic fins and presence of paedomorphic pelvic girdles in a Late Devonian antiarch placoderm (jawed stem-gnathostome).

Within jawed vertebrates, pelvic appendages have been modified or lost repeatedly, including in the most phylogenetically basal, extinct, antiarch placoderms. One Early Devonian basal antiarch, Parayunnanolepis, possessed pelvic girdles, suggesting the presence of pelvic appendages at the origin of jawed vertebrates; their absence in more derived antiarchs implies a secondary loss. Recently, paired female genital plates were identified in the Late Devonian antiarch, Bothriolepis canadensis, in the position of pelvic girdles in other placoderms. We studied these putative genital plates along an ontogenetic series of B. canadensis; ontogenetic changes in their morphology, histology and elemental composition suggest they represent endoskeletal pelvic girdles composed of perichondral and endochondral bone. We suggest that pelvic fins of derived antiarchs were lost, while pelvic girdles were retained, but reduced, relative to Parayunnanolepis This indicates developmental plasticity and evolutionary lability in pelvic appendages, shortly after these elements evolved at the origin of jawed vertebrates.

Pelvic incidence variation among individuals: functional influence versus genetic determinism.

Pelvic incidence has become one of the most important sagittal parameters in spinal surgery. Despite its great importance, pelvic incidence can vary from 33° to 85° in the normal population. The reasons for this great variability in pelvic incidence remain unexplored. The objective of this article is to present some possible interpretations for the great variability in pelvic incidence under both normal and pathological conditions and to further understand the determinants of pelvic incidence from the perspective of the functional requirements for bipedalism and genetic backgrounds via a literature review. We postulate that both pelvic incidence and pelvic morphology may be genetically predetermined, and a great variability in pelvic incidence may already exist even before birth. This great variability may also serve as a further reminder that the sagittal profile, bipedal locomotion mode, and genetic background of every individual are unique and specific, and clinicians should avoid making universally applying broad generalizations of pelvic incidence. Although PI is an important parameter and there are many theories behind its variability, we still do not have clear mechanistic answers.

Tracking of Areal Bone Mineral Density From Age Eight to Young Adulthood and Factors Associated With Deviation From Tracking: A 17-Year Prospective Cohort Study.

We have previously shown that bone mineral density (BMD) tracks strongly from age 8 to 16 years. This study aimed to describe whether this strong tracking continued to age 25 years and describe factors associated with deviation from tracking. Ninety-nine participants were followed from age 8 to 25 years and 197 participants from age 16 to 25 years. Outcomes measured were BMD at the spine, hip, and total body (by dual-energy X-ray absorptiometry [DXA]). Other factors measured were anthropometrics, inhaled corticosteroids (ICS) use, history of being breastfed, sports participation, fitness (by physical work capacity [PWC170 ]), lean mass (LM), and fat mass (FM) (by DXA). There was moderate to strong tracking of BMD from age 8 to 25 years (correlation coefficients: males, 0.59 to 0.65; females, 0.70 to 0.82) and strong tracking from age 16 to 25 years (males, 0.81 to 0.83; females, 0.84 to 0.88) after adjustment for change in body size. From age 8 to 25 years, 54% to 56% of participants kept their BMD tertile position. PWC170 at age 8 years, relative and absolute change in LM, and sports participation at age 25 years predicted males would improve their tertile position or remain in the highest tertile of spine or hip BMD. However, relative and absolute change in FM had the opposite association in males while absolute change in FM predicted positive deviation in females. From age 16 to 25 years, LM, PWC170 , sports participation at age 16 years, and change in LM, PWC170 , and sports participation at age 25 years predicted positive deviation in males. LM at age 16 years was positively associated and PWC170 negatively associated with positive deviation in females. BMD tracks from childhood to early adulthood in both males and females. There appears to be greater capacity to alter tracking before age 16 years. Increasing LM in both sexes and improving fitness and sports participation in males during growth might be effective strategies to improve BMD in early adulthood. © 2017 American Society for Bone and Mineral Research.

Age estimation in a sub-adult Western Australian population based on the analysis of the pelvic girdle and proximal femur.

The accurate and precise estimation of skeletal age by a forensic anthropologist is both a professional and judicial requirement. When unknown skeletal remains are referred to the anthropologist, the estimation of the requisite biological attributes (e.g., age and sex) should accordingly be based on the application of population-specific standards (statistical data). Deviations from the latter practice may result in reduced accuracy and compromised identification. Towards informing appropriate forensic practice, the aim of the present study is to develop statistically quantified age estimation models for a contemporary sub-adult Western Australian population based on the timing of fusion in the os coxa and proximal femur. The study sample comprises 562 known age and sex MDCT scans (292 male, 270 female) representing contemporary Western Australian individuals birth through 30 years of age. Scans are viewed in multi-planar reconstructed (MPR) and/or three-dimensionally reconstructed images using OsiriX®. Fusion status is scored according to a three-stage system across a total of nine sites in the proximal femur and os coxae. Observer accordance, bilateral asymmetry and sex-specific variation in fusion timing are statistically quantified. Polynomial regression is used to formulate age prediction models; transition analysis is used to calculate age ranges and determine the mean age for transition between an unfused, fusing and fused status. Observer accordance in stage assignation is acceptable (Ï°=0.79) and there is no significant bilateral variation in fusion timing. It was found that the mean age of commencement of fusion is significantly earlier (∼2 years) in females. The accuracy (SEE) of the polynomial models ranges from ±3.29 to ±3.80 years and the transition analysis shows that fusion of the iliac crest is delayed in comparison to other attributes of os coxa and proximal femur. Results of the present study confirm that the pelvic girdle and proximal femur can be used to accurately estimate chronological age in the study population.

Age related changes in pelvis size among adolescent and adult females with reference to parturition from Naraingarh, Haryana (India).

This research examines the ontogenic patterns of changes in growth during adolescence, pelvis variations and growth during twenties and thirties of age, structural remodeling of pelvis related to childbirth and relationship of pelvis area with physique based on the cross-sectional data on 391 females from the state of Haryana. Peak growth velocity for body height and breadths of skeletal traits occurred between 11 and 12 years, much before mean age of menarche at 13.5 years; while for body weight and body mass index (BMI) occurred between 14 and 15 years, after the mean age of menarche. Untill the age 11 years, 11.87% of growth in stature was remaining, 19.37% for bi-cristal breadth, 25.96% for bi-ischial breadth and 35.82% for pelvic area. The hypothesis of critical value of pelvic width of 240mm at iliocristale for menarche to occur has been only a statistical association. Higher prevalence of malnutrition during pubertal phase than pre- and post-pubertal phases was due to greater nutritional needs during puberty. Among adult females, BMI was very poorly correlated with stature but very strongly correlated with body breadths, body breadth-stature indices and body weight. The body mass and pelvis size continued to change during 20s and first half of 30s. The continued increase of BMI was due to increase in body fat and muscle mass in females 18 years and older. To tease apart age and parturition effects on pelvis variations, the analysis showed that pelvic bones remodeling took place after the first child was born and not after the subsequent births, and it was a sign of childbirth phenotypic plasticity rather than age. Pelvis area was strongly associated with stature, BMI and age. Mean pelvic area of tall females was greater than those of medium and short stature. Females with broad shoulders had significantly greater mean pelvis area than those with narrow shoulders and medium shoulders. Females having thin/lean physique had the smallest mean pelvis area compared to those having medium and obese types of physiques. The stepwise multiple regression analysis revealed that BMI was the major determinant factor (multiple r=0.37) of pelvis area; addition of stature component increased the value of multiple r to 0.50, while addition of age marginally increased multiple r to 0.53.

Developmental evidence for obstetric adaptation of the human female pelvis.

The bony pelvis of adult humans exhibits marked sexual dimorphism, which is traditionally interpreted in the framework of the "obstetrical dilemma" hypothesis: Giving birth to large-brained/large-bodied babies requires a wide pelvis, whereas efficient bipedal locomotion requires a narrow pelvis. This hypothesis has been challenged recently on biomechanical, metabolic, and biocultural grounds, so that it remains unclear which factors are responsible for sex-specific differences in adult pelvic morphology. Here we address this issue from a developmental perspective. We use methods of biomedical imaging and geometric morphometrics to analyze changes in pelvic morphology from late fetal stages to adulthood in a known-age/known-sex forensic/clinical sample. Results show that, until puberty, female and male pelves exhibit only moderate sexual dimorphism and follow largely similar developmental trajectories. With the onset of puberty, however, the female trajectory diverges substantially from the common course, resulting in rapid expansion of obstetrically relevant pelvic dimensions up to the age of 25-30 y. From 40 y onward females resume a mode of pelvic development similar to males, resulting in significant reduction of obstetric dimensions. This complex developmental trajectory is likely linked to the pubertal rise and premenopausal fall of estradiol levels and results in the obstetrically most adequate pelvic morphology during the time of maximum female fertility. The evidence that hormones mediate female pelvic development and morphology supports the view that solutions of the obstetrical dilemma depend not only on selection and adaptation but also on developmental plasticity as a response to ecological/nutritional factors during a female's lifetime.

Effect of growing rod on sagittal and spinopelvic parameters in early-onset scoliosis patients.

Growing rod is a commonly used surgery for early-onset scoliosis (EOS). However, the effect of growing-rod lengthening on the spinopelvic alignment is unclear. In this study, 21 EOS patients treated by growing rod were evaluated retrospectively and thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI) , sacral slope (SS), pelvic tilt (PT), and sagittal vertical axis (SVA) were measured. Preoperatively, the mean TK, LL, PI, PT, SS, and SVA were 27.4°, 35.2°, 43.8°, 7.5°, 33.8°, and 47.7 mm respectively. After the last lengthening, TK, LL, PI, PT, SS, and SVA were 28.3°, 28.06°, 41.4°, 7°, 5.2°, and 42.6 mm, respectively. The sagittal plane parameters in our EOS patients were not significantly altered during the lengthening period.

Can neonatal pelvic osteotomies permanently change pelvic shape in patients with exstrophy? Understanding late rediastasis.

BACKGROUND: Pelvic osteotomies are frequently used as part of the surgical management of bladder exstrophy. The outcomes are often measured on the basis of the residual symphyseal diastasis. The aims of this study were to evaluate and validate a more reliable radiographic measure of ischiopubic rotation, to utilize this measure in analyzing pelves from patients with exstrophy and controls, and to propose a model for rediastasis in a pelvis with exstrophy. METHODS: Pelvic radiographs of 164 normal children two months to eighteen years of age were used to determine the changes in interpubic and interischial distances and in the interischial/interpubic (IS/IP) ratio with age. Twenty-one pelvic CT (computed tomography) studies of normal children, two to sixteen years of age, were also used to study the change in the ischiopubic divergence angle. The same parameters were measured on radiographs or CT or magnetic resonance imaging studies of seventy-three patients with classic bladder exstrophy who were followed for two to nineteen years after exstrophy closure with or without pelvic osteotomies. RESULTS: In normal children, the interpubic distance and the ischiopubic divergence angle had a narrow range and were constant with age, whereas the interischial distance and the IS/IP ratio increased progressively and were strongly correlated with age. In the patients with exstrophy, the interpubic distance was positively correlated with the interischial distance, whereas the IS/IP ratio was lower than that in normal controls and was not correlated with age. CONCLUSIONS: The IS/IP ratio is a useful measure of ischiopubic rotation and can be used to characterize pelvic growth, including the phenomenon of rediastasis in patients with exstrophy. Pelvic rediastasis is a progressive increase in interpubic distance resulting from growth without loss of rotational correction, as shown by the constancy of the IS/IP ratio with age in these patients. A better rotational position at the time of osteotomy may lead to a better pelvic shape at maturity. CLINICAL RELEVANCE: Symphyseal rediastasis following neonatal pelvic osteotomies in patients with exstrophy is not due to loss of correction and progressive derotation of the hemipelves but is a consequence of the normal three-dimensional growth of the pelvis. The best correction of the pelvic deformity should always be the aim even in neonatal pelvic osteotomies because this will permanently change the pelvic shape.

How is sagittal balance acquired during bipedal gait acquisition? Comparison of neonatal and adult pelves in three dimensions. Evolutionary implications.

We compare adult and intact neonatal pelves, using a pelvic sagittal variable, the angle of sacral incidence, which presents significant correlations with vertebral curvature in adults and plays an important role in sagittal balance of the trunk on the lower limbs. Since the lumbar curvature develops in the child in association with gait acquisition, we expect a change in this angle during growth which could contribute to the acquisition of sagittal balance. To understand the mechanisms underlying the sagittal balance in the evolution of human bipedalism, we also measure the angle of incidence of hominid fossils. Fourty-seven landmarks were digitized on 50 adult and 19 intact neonatal pelves. We used a three-dimensional model of the pelvis (DE-VISU program) which calculates the angle of sacral incidence and related functional variables. Cross-sectional data from newborns and adults show that the angle of sacral incidence increases and becomes negatively correlated with the sacro-acetabular distance. During ontogeny the sacrum becomes curved, tends to sink down between the iliac blades as a wedge and moves backward in the sagittal plane relative to the acetabula, thus contributing to the backwards displacement of the center of gravity of the trunk. A chain of correlations links the degree of the sacral slope and of the angle of incidence, which is tightly linked with the lumbar lordosis. We sketch a model showing the coordinated changes occurring in the pelvis and vertebral column during the acquisition of bipedalism in infancy. In the australopithecine pelves, Sts 14 and AL 288-1, and in the Homo erectus Gona pelvis the angle of sacral incidence reaches the mean values of humans. Discussing the incomplete pelves of Ardipithecus ramidus, Australopithecus sediba and the Nariokotome Boy, we suggest how the functional linkage between pelvis and spine, observed in humans, could have emerged during hominid evolution.

Composition and functionality of bone affected by dietary glycated compounds.

Our aim was to investigate the effects of Maillard reaction products (MRPs) from bread crust (BC) on bone composition and its mechanical properties, determining whether any such effects are related to the molecular weight of different MRPs. For 88 days after weaning rats were fed a control diet or diets containing BC, or its soluble low molecular weight (LMW), soluble high molecular weight (HMW) or insoluble fractions. Animals' food consumption and body weights were monitored. After sacrifice, the femur, pelvic bone and tibia were removed for composition, physical and biomechanical properties analysis. It was found that body and femur weights, density, volume and organic matrix decreased, whereas pentosidine increased after consumption of experimental diets, especially in the HMW and insoluble groups (104.7 and 102.9 mmol mol(-1) collagen) vs. the control group (41.7 mmol mol(-1) collagen). Bone stiffness fell by 50% in the LMW, HMW and insoluble groups and failure load and energy to failure tended to decrease in the same animals after MRPs intake. Consumption of diets containing assayed MRPs during growth leads to lower bone size and introduces some changes in its mechanical behavior which appear to be related to an increase in the pentosidine level of bone.

Surprising evidence of pelvic growth (widening) after skeletal maturity.

Following an increase in length and width during childhood and adolescence, skeletal growth is generally assumed to stop. This study investigates the influence of aging on the dimensions of the pelvis and the L4 lumbar vertebra during adulthood. The dimensions of the pelvis, L4 vertebra, and femoral heads were calculated for 246 patients who had received pelvic and abdominal Computed Tomography scans from the UNC Health Care System. Linear regression analysis determined the significance of relationships between age and width of the pelvis. There was a strong correlation between increasing patient age and increasing width of the pelvis at the trochanters, (0.333 mm/year of age p<0.0001), at the iliac wings, (0.371 mm/year of age p < 0.0002), and between the femoral heads, indicating that the bony pelvis widens over 20 mm between the ages of 20 and 80. The pelvic inlet did not enlarge over time while the distance between the hips and the femoral head diameter did significantly increase. The height of L4 did not increase over time, but the L4 width did increase. These correlations were seen in both genders. Surprisingly, our results suggest that the pelvis and L4 vertebra increase in width after skeletal maturity and cessation of longitudinal growth.

Bilateral rib-to-pelvis technique for managing early-onset scoliosis.

BACKGROUND: Early-onset scoliosis describes progressive spinal deformity of varying etiologies in the growing child. The management of early-onset scoliosis is challenging, with many treatment options but no conclusive evidence for the best treatment method. QUESTIONS/PURPOSES: We describe a bilateral percutaneous rib-to-pelvis technique, present our early experience with this technique in patients with early-onset scoliosis, identify adverse events, and determine whether these are comparable to those for other current techniques. DESCRIPTION OF TECHNIQUE: The VEPTR(®) device is placed through three small incisions that allow for attachment of rib hooks bilaterally at the upper end and through pelvic hooks at the distal end, providing distraction forces to correct the deformity while allowing for growth. PATIENTS AND METHODS: We retrospectively reviewed all 37 patients with early-onset scoliosis treated with the bilateral rib-to-pelvis VEPTR(®) technique from 2003 and 2009. Patients were evaluated for demographics, diagnosis, curve correction, and adverse events and divided into two groups: ambulatory and nonambulatory. The 18 ambulatory patients underwent 139 procedures and the 19 nonambulatory patients underwent 100 procedures. Average followups were 84 and 64 months in the ambulatory and nonambulatory groups, respectively. RESULTS: The rate of adverse events per procedure was 13%. Thirty-nine percent of ambulatory patients developed a marked crouched gait over time. The rate of adverse events in the nonambulatory group was 15%. CONCLUSIONS: This technique appears a reasonable alternative to growing rods for the management of early-onset scoliosis in nonambulatory children due to the low rate of adverse events. Due to the increased incidence of crouched gait, we have abandoned this technique in ambulatory children unless there is no option to attach the distal fixation to the spine.

Síndrome de los isquiotibiales acortados / Shortened hamstring syndrome

La falta de flexibilidad en los músculos isquiotibiales condiciona una disminución de la movilidad pelviana que lleva invariablemente al cambio biomecánico en la distribución de presiones en la columna vertebral. La incidencia del síndrome de los isquiotibiales acortados es mayor en varones y puede tener relación con lesiones musculares, alteraciones articulares, actividad deportiva y estilo de vida. Muchos de los actuales estudios se centran en los beneficios de entrenamiento de la flexibilidad, actuando en los mecanismos involucrados en ellos mediante la aplicación de programas de estiramientos, con el objetivo de incrementar la longitud musculotendinosa(AU)

Lack of flexibility in the hamstring muscle conditions a decrease of pelvic mobility. Thisinvariably leads to biomechanical changes in the distribution of pressures in the spine.The incidence of the shortened hamstrings syndrome is greater in men and can beassociated to muscles injuries, joint alterations, sport activity and style of life.Many of the present investigations are focused on the benefits of training flexibility, actingon the mechanisms involved in such through the application of stretching programs,in order to increase the muscle tendinuos length(AU)