Pediatric-Specific Lesions in Unstable Pelvic Ring Fractures of Skeletally Immature Children: Impact on Diagnosis and Management Decisions.

Surgical fixation of pediatric pelvic ring injuries is gaining popularity to avoid the poor long-term outcomes of pelvic asymmetry. The surgical techniques and fixation choices depend on the individual injuries affecting the anterior and posterior pelvic ring areas. The immature bony pelvis of young children has anatomic differences including soft bones, elastic ligaments, and the presence of growth centers. Understanding the unique pediatric lesions with unstable pelvic fractures is essential for treatment decisions. Anterior lesions include pubic symphysis disruption through the pubic apophysis, single ramus fractures, pubic rami fractures through the triradiate cartilage, and/or the ischiopubic synchondrosis; ischiopubic ramus infolding injury; or the unstable superior and inferior quadrant lesions. Posterior pelvic lesions include iliac wing infolding and sacroiliac joint dislocation or transiliac (crescent) fracture/dislocations through the iliac apophysis growth plate. Pubic symphysis and sacroiliac disruptions are physeal injuries in children, and they have excellent healing potential. External fixation is an ideal choice for anterior ring fixation including bony and pubic symphysis injuries. Posterior lesions are mostly sacroiliac joint disruptions with iliac apophysis separation that can serve as a landmark for vertical displacement correction. Posterior lesions can be treated by percutaneous iliosacral screw fixation or open reduction techniques.

Motion preservation for open book injuries of the pubic symphysis -a biomechanical cadaver study.

INTRODUCTION: Open book injuries are challenging injuries that oftentimes require surgical treatment. Currently, treatment is performed with symphyseal plating requiring extensive surgery and entirely limiting physiological movement of the symphyseal joint, frequently resulting in implant failure. Therefore, we investigated the biomechanical properties of a minimally invasive tape suture construct (modified SpeedBridge™) as an alternative stabilization technique for the treatment of open book injuries in human cadaver pelvic rings. MATERIALS AND METHODS: The symphysis of 9 human cadaver pelvises was dissected and dilated to 3 cm creating an open book injury. Next, the two osteosynthesis methods (plating, modified SpeedBridge™) were applied. All specimens then underwent cyclic horizontal and vertical loading, simulating biomechanical forces while sitting, standing and walking. For statistical analysis, 3D dislocation (mm) was calculated. RESULTS: Total displacement (mm) of the pubic symphysis displayed the following means and standard deviations: native group 1.34 ± 0.62 mm, open book group 3.01 ± 1.26 mm, tape group 1.94 ± 0.59 mm and plate group 1.37 ± 0.41 mm. Comparison between native and open book (p = 0.029), open book and plate (p = 0.004), open book and tape (p = 0.031), as well as tape and plate group (p = 0.002) showed significant differences. No significant differences were found when comparing the native and tape (p = 0.059), as well as the native and plate (p = 0.999) group. CONCLUSION: While both osteosynthesis techniques sufficiently stabilized the injury, symphyseal plating displayed the highest rigidity. The modified SpeedBridge™ as a tape suture construct provided statistically sufficient biomechanical stability while maintaining symphyseal micro mobility, consequently allowing ligamental healing of the injured joint without iatrogenic arthrodesis.

[Treatment of osteitis pubis: arthrodesis with a new technique regarding two cases and review of the literature]. / Tratamiento de la osteítis del pubis: artrodesis con nueva técnica a propósito de dos casos y revisión de la literatura.

INTRODUCTION: pain in the pubic symphysis, even if studied in athletes, still sets out diagnostic and therapeutic challenges in other patient groups. Within this context, refractory osteorthritis of the pubic symphysis presents itself as an issue lacking clear therapeutic consensus. MATERIAL AND METHODS: two women over 65 years old and presenting osteoarthritis of the pubic symphysis were evaluated. Following unsuccessful conventional therapies, arthrodesis via subpubic plate, wire suture and autologous graft from the iliac crest was performed. RESULTS: after a one-year of following, both patients experienced clinical and radiographic improvement. Bone arthrodesis was achieved without significant complications, proving to be a viable surgical option. CONCLUSION: this study supports the medium and long-term efficacy of arthrodesis of the pubic symphysis in refractory cases of osteoarthrisis. Therefore, the technique can be considered a surgical option in the management of said condition.

INTRODUCCIÓN: el dolor en la sínfisis púbica, aunque estudiado en atletas, plantea desafíos diagnósticos y terapéuticos en otros grupos. En este contexto, la artrosis refractaria de la sínfisis púbica se presenta como un problema sin consenso terapéutico claro. MATERIAL Y MÉTODOS: se evaluaron dos mujeres mayores de 65 años con artrosis de la sínfisis púbica. Tras terapias convencionales infructuosas, se optó por la artrodesis mediante placa suprapúbica, sutura alámbrica e injerto óseo autólogo de la rama íleo-púbica. RESULTADOS: después de un año de seguimiento, ambas pacientes experimentaron mejoría clínica y radiográfica. La artrodesis se consolidó sin complicaciones evidentes, proporcionando una opción quirúrgica viable. CONCLUSIÓN: este estudio respalda la eficacia a medio y largo plazo de la artrodesis de la sínfisis púbica en casos refractarios de artrosis. La técnica utilizada puede considerarse como una opción quirúrgica eficaz en el manejo de esta condición.

RTSeg-net: A lightweight network for real-time segmentation of fetal head and pubic symphysis from intrapartum ultrasound images.

The segmentation of the fetal head (FH) and pubic symphysis (PS) from intrapartum ultrasound images plays a pivotal role in monitoring labor progression and informing crucial clinical decisions. Achieving real-time segmentation with high accuracy on systems with limited hardware capabilities presents significant challenges. To address these challenges, we propose the real-time segmentation network (RTSeg-Net), a groundbreaking lightweight deep learning model that incorporates innovative distribution shifting convolutional blocks, tokenized multilayer perceptron blocks, and efficient feature fusion blocks. Designed for optimal computational efficiency, RTSeg-Net minimizes resource demand while significantly enhancing segmentation performance. Our comprehensive evaluation on two distinct intrapartum ultrasound image datasets reveals that RTSeg-Net achieves segmentation accuracy on par with more complex state-of-the-art networks, utilizing merely 1.86 M parameters-just 6 % of their hyperparameters-and operating seven times faster, achieving a remarkable rate of 31.13 frames per second on a Jetson Nano, a device known for its limited computing capacity. These achievements underscore RTSeg-Net's potential to provide accurate, real-time segmentation on low-power devices, broadening the scope for its application across various stages of labor. By facilitating real-time, accurate ultrasound image analysis on portable, low-cost devices, RTSeg-Net promises to revolutionize intrapartum monitoring, making sophisticated diagnostic tools accessible to a wider range of healthcare settings.

PSFHS: Intrapartum ultrasound image dataset for AI-based segmentation of pubic symphysis and fetal head.

During the process of labor, the intrapartum transperineal ultrasound examination serves as a valuable tool, allowing direct observation of the relative positional relationship between the pubic symphysis and fetal head (PSFH). Accurate assessment of fetal head descent and the prediction of the most suitable mode of delivery heavily rely on this relationship. However, achieving an objective and quantitative interpretation of the ultrasound images necessitates precise PSFH segmentation (PSFHS), a task that is both time-consuming and demanding. Integrating the potential of artificial intelligence (AI) in the field of medical ultrasound image segmentation, the development and evaluation of AI-based models rely significantly on access to comprehensive and meticulously annotated datasets. Unfortunately, publicly accessible datasets tailored for PSFHS are notably scarce. Bridging this critical gap, we introduce a PSFHS dataset comprising 1358 images, meticulously annotated at the pixel level. The annotation process adhered to standardized protocols and involved collaboration among medical experts. Remarkably, this dataset stands as the most expansive and comprehensive resource for PSFHS to date.

Laparoscopic treatment of fourteen cases of pelvic ring disruption: a case series.

PURPOSE: Open surgical approaches for the treatment of anterior pelvic arc lesions are associated with several complications. We present the first retrospective descriptive case series on the use of laparoscopy as an alternative. METHODS: This descriptive, retrospective, single-centre study enrolled all patients who underwent laparoscopy for the treatment of pelvic ring disruption between May 2020 and March 2022. The primary outcome was the procedure failure rate based on conversion to open surgery. Secondary outcomes were the duration of the surgical procedure, x-ray exposure, length of hospitalisation, postoperative pain assessment, and functional scores at the last follow-up. RESULTS: The study included two females and 12 males. The mean age of the study participants was 44.2 (23-67) years. In total, nine (64.3%) patients had pubic symphysis disjunction, four (28.6%) had bilateral fractures of the obturator frames, and one (7%) had both. None of the patients required conversion to open surgery. The median operating times for symphysis pubis disruption, obturator frame fracture, and patients with both injuries were 90.0 (60-120), 135 (105-180), and 240 min, respectively. The median overall operating time was 102.5 (60-240) min. The median Iowa Pelvic Score and Majeed Functional Score at the last follow-up were 87 (70-99) and 84 (70-100), respectively. CONCLUSION: Laparoscopic internal fixation is a reliable treatment for pelvic ring disruption. The clinical and radiological outcomes of our patients suggest the usefulness of this technique as an alternative to open approaches.

Ozone Therapy for a Soccer Player With Osteitis Pubis: A Case Report.

CONTEXT: Osteitis pubis (OP), which occurs as a result of excessive use of the symphysis pubis and parasymphysis bones, is more common in long-distance runners and kicking athletes, especially football players. Due to the poor results of commonly used treatments for OP, there is a need for investigation of more effective treatments, such as ozone therapy. Ozone therapy is used to treat a variety of diseases, including musculoskeletal conditions. CASE PRESENTATION: A 30-year-old amateur soccer player diagnosed with OP received conservative treatment with traditional physiotherapy and analgesic medications. After 6 months and no resolution of symptoms, the patient presented to the sports medicine outpatient clinic seeking alternative therapy options. MANAGEMENT AND OUTCOMES: The patient received ozone injections in 3 sessions administered at 10-day intervals. At 1, 3, 6 and 12 months after the treatment, the patient's complaints and pain levels were re-evaluated and examined. The patient was able to return to competition at the same level after the first injection. No recurrence was revealed at a minimum of 12 months of follow-up. CONCLUSION: In this article, we present a case in which OP was successfully treated with ozone injection.

3D CT based age estimation from the pubic symphyseal surface in an Indian population using the Chen et al. method.

The pubic symphyseal surface is one of the reliable parameters used to estimate age, as it consistently shows degenerative observational variations throughout the lifespan, particularly from the 3rd decade onwards. These changes have been extensively studied to generate population-specific models for forensic age estimation. In the past, there have been many studies used to estimate age at death from the pubis symphysis using skeletal remains. However, due to dearth of contemporary skeletal repositories, and the resource intensive maceration process required for obtaining examination quality bones, studies on cadaver are difficult to conduct. Moreover, due to recent advancements in the science of medical imaging, newer radiological modalities like computed tomography (CT) can be used to visualize previously inaccessible areas such as the pubic symphysis in cadavers and the living alike, and subsequent age estimation is feasible. Recently, Chen et al. (2008, 2011) conducted a study on the cadaveric Chinese Han population in both males and females separately by using nine morphological changes and scoring them according to the changes that occurred. The present study aimed to estimate an individual's age using CT images of the pubic symphysis, by applying the scoring method for its morphological changes given by Chen et al. The present study was conducted on 263 randomly selected participants (Males = 154, Females = 109), who came for diagnostic purposes to the hospital. The CT images of these individuals were collected after obtaining ethical approval and proper consent from the study participants. Each of the morphological indicators was assessed, and appropriate scores were given according to criteria given by Chen et al. In the present study, both linear and multiple regression models to estimate age using the pubic symphyseal morphological changes were developed. From the results of the present study, it was concluded that the Chen et al. scoring method can be used to accurately estimate age from 3DCT images of the living, and the models derived in the present study could be applicable to individuals from the Indian subcontinent.

New Anatomical Concepts regarding Pubic-Related Groin Pain: A Dissection Study.

OBJECTIVE: Pubis-related groin pain remains a difficult topic in orthopedic and sports medicine. A better understanding of the anatomy of the adductors and the pubic ligaments is necessary. The aim of this study is to map all the musculotendinous attachments to the pubic ligaments and to investigate in detail all the possible inter-adductor fusions. METHODS: The pubic symphyses were dissected in eight male and fourteen female embalmed cadavers (mean age 85 years), focusing on the fusion between the adductors, pubic ligaments, and musculotendinous attachments at the pubic ligaments. The 95% confidence intervals for the prevalence of the different conjoint tendons and tendon attachment to ligament were calculated. RESULTS: The presence of three types of conjoint tendons was found: adductor brevis and gracilis (AB/G) 90.9 [72.2 - 97.5]%; adductor brevis and adductor longus (AB/AL) 50.0 [30.7 - 69.3]%; adductor longus and gracilis (AL/G) 50.0 [30.7 - 69.3]%. The AL, AB and G were in every cadaver attached to the anterior pubic ligament (APL). 64% of the AB and 100% of the G were attached to the inferior pubic ligament (IPL). CONCLUSION: The proximal anatomy of the adductors is more complex than initially described. This study identified three possible conjoint tendons between the proximal adductors. The AB/G conjoint tendon was significantly more present than the AB/AL or AL/G conjoint tendon. The IPL has attachments only from the AB and G. Rectus Abdominis (RA) and AL were not attached to IPL. Mapping the musculotendinous attachments on the pubic ligaments creates more clarity on the pathophysiology of lesions in this area.

Sacral insufficiency fractures are a frequent and painful consequence of pubic symphysis osteomyelitis.

BACKGROUND: Pubic symphysis osteomyelitis can result from urosymphyseal fistula formation. High rates of sacropelvic insufficiency fractures have been reported in this population. The aim of this study was to describe the presentation and risk factors for sacral insufficiency fractures (SIF) associated with surgical treatment of pubic symphysis osteomyelitis. METHODS: A retrospective review was performed for 54 patients who underwent surgery for pubic symphysis osteomyelitis associated with a urosymphyseal fistula at a single institution from 2009 to 2022. Average age was 71 years and 53 patients (98%) were male. All patients underwent debridement or partial resection of the pubic symphysis at the time of fistula treatment. Average width of the symphyseal defect was 65 mm (range 9-122) after treatment. RESULTS: Twenty patients (37%) developed SIF at a mean time of 4 months from osteomyelitis diagnosis. Rate of sacral fracture on Kaplan-Meier analysis was 31% at 6 months, 39% at 12 months, and 41% at 2 years. Eleven patients developed SIF prior to pubic debridement and 12 patients developed new or worsening of pre-existing SIF following surgery. Width of pubic resection was higher in patients who developed SIF (76 mm vs. 62 mm), but this did not meet statistical significance (p = 0.18). CONCLUSION: Sacral insufficiency fracture is a common sequela of pubic symphysis osteomyelitis. These fractures are often multifocal within the pelvis and can occur even prior to pubic resection. Pubectomy further predisposes these patients to fracture. Clinicians should maintain a high index of suspicion for these injuries in patients with symphyseal osteomyelitis.

Applicability of the Suchey-Brooks method for age estimation in an Indian population: A computed tomography-based exploration using Bayesian analysis and machine learning.

Age estimation occupies a prominent niche in the identification process. In cases where skeletal remains present for examination, age is often estimated from markers distributed throughout the skeletal framework. Within the pelvis, the pubic symphysis constitutes one of the more commonly utilized skeletal markers for age estimation, with the Suchey-Brooks method comprising one of the more commonly employed methods for pubic symphyseal age estimation. The present study was targeted towards assessing the applicability of the Suchey-Brooks method for pubic symphyseal age estimation, an aspect largely unreported for an Indian population. In order to do so, clinically undertaken pelvic computed tomography scans of individuals were evaluated using the Suchey-Brooks method, and the error associated with the method was established using Bayesian analysis and different machine learning regression models. Amongst different supervised machine learning models, support vector regression and random forest furnished lowest error computations in both sexes. Using both Bayesian analysis and machine learning, lower error computations were observed in females, suggesting that the method demonstrates greater applicability for this sex. Inaccuracy and root mean square error obtained with Bayesian analysis and machine learning illustrates that both statistical modalities furnish comparable error computations for pubic symphyseal age estimation using the Suchey-Brooks method. However, given the numerous advantages associated with machine learning, it is recommended to use the same within medicolegal settings. Error computations obtained with the Suchey-Brooks method, regardless of the statistical modality utilized, indicate that the method should be used in amalgamation with additional markers to garner accurate estimates of age.

Radiographic age estimation based on degenerative changes of vertebrae.

Age estimation is an important component of decedent identification. When assessing adult remains, anthropologists frequently use gross examination of skeletal elements, such as clavicles, ribs, and pubic symphyses. For fleshed bodies, this requires the removal of these elements and maceration prior to analysis. A new method was developed using radiographic imaging to estimate age from degenerative changes of the lower thoracic and upper lumbar vertebrae. This technique will complement anthropological age estimation methods in young and middle-aged adults and may serve as a stand-alone method for older individuals. Digital radiographs from 240 medical examiner cases were evaluated. The sample included 120 females and 120 males between the ages of 18 and 101 years. A 3-phased scoring system was used for the target vertebrae. Transition analysis was conducted on binned average scores and a Bayesian approach was used to assign age intervals. At the 90% credible interval, individuals in Bin 1 were under 36 years of age while those in Bin 3 were over 47 years of age. Individuals in Bin 2 showed too much age variation to be informative. No significant differences were found between males and females. These findings will be especially useful in the age estimation of older adults and may eliminate the need for skeletal sampling in medicolegal cases where advanced degenerative changes are radiographically observed in the lower thoracic and/or upper lumbar vertebrae. This method was developed for use on fleshed individuals but may also be applicable to skeletonized remains.

Technical note: Interest of focused fields in post-mortem computed tomography using photorealistic images for age at death estimation from the pubic symphysis.

INTRODUCTION: The morphological assessment of the pubic symphysis using the Suchey-Brooks method is considered a reliable age at death indicator. Age at death estimation methods can be adapted to the images obtained from post-mortem computed tomography (PMCT). The aim of this study is to evaluate the utility of pubic symphysis photorealistic images obtained through Global illumination rendering (GIR) for age at death estimation from whole-body PMCT and from focused PMCT on the pubic bone. MATERIALS AND METHODS: We performed virtual age at death estimation using the Suchey Brooks method from both the whole-body field of view (Large Field of View: LFOV) and the pubis-focused field of view (Small and Field of View: SFOV) of 100 PMCT. The 3D photorealistic images were evaluated by three forensic anthropologists and the results were statistically evaluated for accuracy of the two applied PMCT methods and the intra- and inter-observer errors. RESULTS: When comparing the two acquisitions of PMCT, the accuracy rate reaches 98.5% when using a pubic-focused window (SFOV) compared to 86% with a whole-body window (LFOV). Additionally, the intra- and inter-observer variability has demonstrated that the focused window provides better repeatability and reproducibility. CONCLUSION: Adding a pubic-focused field of view to standard PMCT and processing it with GIR appears to be an applicable technique that increases the accuracy rate for age at death estimation from the pubic symphysis.

Septic Arthritis of the Pubic Symphysis in a 16-Year-Old Male Adolescent: A Case Report.

CASE: A 16-year-old male adolescent presented with 4 weeks of right-sided hip pain and fever in the setting of recent groin trauma. He was diagnosed with septic arthritis of the pubic symphysis (SAPS) and was treated nonoperatively with antibiotics. Symptoms recurred, and he underwent surgical drainage of the pubic symphysis followed by a prolonged course of antibiotics. Follow-up at 12 months indicated complete symptom resolution. CONCLUSION: This is the ninth reported adolescent case of SAPS. Although the presentation and disease course closely resembled those reported in the literature, this is the only case that required surgical intervention after failed nonoperative management.

Unrecognised entrapment of a herniated bladder at the pubic symphysis following reduction and external fixation of an unstable pelvic fracture.

Bladder injury is frequently associated with complex pelvic fractures with men being the predominant population to sustain such injuries. Entrapment of the bladder through the site of pelvic fracture is a rare clinical entity. We report a case of an entrapped bladder post closed reduction and external fixation of an unstable anteroposterior compression type 3 (APC-3) fracture. This report highlights the diagnostic difficulty with identifying an entrapped bladder and the patient's functional outcome after 1 year of follow-up.

[Research progress of pubic symphysis diastasis].

Objective: To review the research progress of pubic symphysis diastasis and provide effective reference for orthopedic surgeons in the diagnosis and treatment of pubic symphysis diastasis. Methods: The anatomy, injury mechanism, treatment, and other aspects of pubic symphysis diastasis were summarized and analyzed by reviewing the relevant research literature at domestically and internationally in recent years. Results: The incidence of pubic symphysis diastasis is high in pelvic fractures, which is caused by the injury of the ligaments and fibrocartilage disc around the pubic symphysis by external force. The treatment plan should be individualized according to the pelvic stability and the needs of patients, aiming to restore the stability and integrity of the pelvis and improve the quality of life of patients after surgery. Conclusion: At present, the research on pubic symphysis diastasis still needs to be improved. In the future, high-quality, multi-center, and large-sample studies are of great significance for the selection of treatment methods and the evaluation of effectiveness for patients with pubic symphysis diastasis.

Comparison of two surgical interventions for advanced stages pubis and pubic symphysis tuberculosis in adults: A retrospective study of 33 cases.

PURPOSE: To compare the clinical efficacy of two surgical interventions in treating advanced stages TB of the pubis and pubic symphysis. METHODS: Between June 2010 and January 2020, 33 cases of the advanced pubis and pubic symphysis TB were treated with a one-stage debridement procedure (debridement only group, n = 15) or a one-stage debridement with bone grafting and plate fixation procedure (debridement + plating group, n = 18). The visual analog scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), operation time, intraoperative blood loss, complications, time of bone graft fusion, and improvement in the mental component summary (MCS) and physical component summary (PCS) of Short Form-36 (SF-36) were compared and analyzed. RESULTS: All patients were followed for 24.9 (SD 1.6) months. All patients were completely cured of the pubis and pubic symphysis TB with no recurrence. There were no significant differences (P >0.05) between the two groups in terms of age, follow-up period and intraoperative blood loss. The post-operative VAS scores, ESR and CRP levels, PCS and MCS scores of two groups significantly improved compared to pre-therapy. The mean operation time in debridement + plating group was 140.9 (43.2) min, which was significantly longer than in debridement only group [94.9(21.8) min, P < 0.01]. The final follow-up (FFU) indices of the VAS score in debridement only group were higher than those in debridement + plating group [1.9 (0.8) vs 1.3 (0.5), P=0.012]. A satisfactory average bony fusion time of 12.2 (3.3) months was achieved in debridement + plating group . CONCLUSIONS: A one-stage debridement, bone grafting, and reconstruction plate fixation procedure achieved reconstruction of the integrity and stability of the pelvic ring, pain relief, and rapid cure of bone TB. This procedure is a safe and effective treatment option for advanced pubis and pubic symphysis TB.

Postpartum pubic symphysis diastasis resulting in a prepubic abscess and osteomyelitis.

Postpartum pubic symphysis diastasis (PSD) refers to an abnormal widening of the pubic symphysis after delivery. It is a rare and underdiagnosed condition that causes severe pain and can be complicated by osteomyelitis and abscess formation. This article reports a case of a para 4 woman in her 30s with postpartum PSD after vaginal delivery who presented with a prepubic abscess. Multimodal treatment consisted of incision and drainage, physiotherapy and prolonged antibiotic treatment.

Age-at-death estimation based on micro-CT assessment of pubic symphysis: Potentially new methodological approach.

BACKGROUND: Although various methods for age-at-death estimation of skeletal remains are available, this is still an unsolved issue in forensic anthropology, especially concerning elderly individuals. Moreover, the lack of population-specific methods often made age-at-death estimation unreliable in other populations. AIM: Our study aimed to examine whether micro-computed tomography (micro-CT) analysis of pubic bone samples obtained from the contemporary Serbian population could be used in anthropological and forensic practice for age-at-death estimation. METHODOLOGY: This study encompassed 62 pubic samples obtained from 26 adult male and 36 adult female cadaveric donors (age range: 22-91 years). Initially, staging according to the Suchey-Brooks phases was performed by two experienced investigators, followed by micro-CT assessment of pubic bone trabecular and cortical compartments (spatial resolution of the scans was 10 µm). RESULTS: Our results revealed an age-associated decline in trabecular and cortical micro-architecture of elderly male and female individuals, with the most prominent changes present in trabecular bone volume fraction and total porosity of the anterior and posterior cortical surface of the pubic bone. Those parameters were used to generate age-at-death estimation equations. One sample t-test did not reveal a significant difference between estimated age-at-death and real (known) age-at-death in the overall sample (mean absolute error [MAE] of 4.76 years), female (MAE of 9.66 years) and male cadaveric donors (MAE of 6.10 years, p > 0.05). CONCLUSION: Our data indicated that micro-architectural features of trabecular and cortical compartments of pubic bone could potentially be applied as an additional reliable method for age-at-death estimation in the Serbian population.

Radiographic assessment of the pubic symphysis in elite male adolescent football players: Development and reliability of the Maturing Adolescent Pubic Symphysis (MAPS) classification.

INTRODUCTION: The pubic symphysis is susceptible to growth related injuries long after the adolescent growth spurt. Our study describes the radiographic maturation of the pubic symphysis on pelvic radiographs in adolescent football players and introduces the Maturing Adolescent Pubic Symphysis classification (MAPS classification). METHODS: Anteroposterior pelvic radiographs of 105 healthy adolescent male football players between 12 and 24 years old were used to develop the classification system. The radiological scoring of the symphyseal joint was developed over five rounds. The final MAPS classification items were scored in random order by two experienced readers, blinded to the age of the participant and to each other's scoring. The inter- and intra-rater reliability were examined using weighted kappa (κ). RESULTS: We developed a classification system with descriptive definitions and an accompanying pictorial atlas. The symphyseal joint was divided into three regions: the superior corners, and the upper and lower regions of the joint line. Inter-rater reliability was substantial to almost perfect: superior region: κ = 0.70 (95% CI 0.60---0.79), upper region of the joint line: κ = 0.89 (95% CI 0.86---0.92), lower region of the joint line: κ = 0.65 (95% CI 0.55---0.75). The intra-observer reliability showed similar results. CONCLUSION: The Maturing Adolescent Pubic Symphysis classification (MAPS classification) is a reliable descriptive classification of the radiographic maturation of the pubic symphysis joint in athletic males. The stages can provide a basis for understanding in clinical practice and will allow future research in this field.