Pelvic radiograph (PXR) is essential for detecting proximal femur and pelvis injuries in trauma patients, which is also the key component for trauma survey. None of the currently available algorithms ...can accurately detect all kinds of trauma-related radiographic findings on PXRs. Here, we show a universal algorithm can detect most types of trauma-related radiographic findings on PXRs. We develop a multiscale deep learning algorithm called PelviXNet trained with 5204 PXRs with weakly supervised point annotation. PelviXNet yields an area under the receiver operating characteristic curve (AUROC) of 0.973 (95% CI, 0.960-0.983) and an area under the precision-recall curve (AUPRC) of 0.963 (95% CI, 0.948-0.974) in the clinical population test set of 1888 PXRs. The accuracy, sensitivity, and specificity at the cutoff value are 0.924 (95% CI, 0.912-0.936), 0.908 (95% CI, 0.885-0.908), and 0.932 (95% CI, 0.919-0.946), respectively. PelviXNet demonstrates comparable performance with radiologists and orthopedics in detecting pelvic and hip fractures.
•The purpose of this study is to provide an analysis of iliosacral screw insertion sites on the posterior ilium.•Improved outcomes of LC II injuries treated percutaneously marks the importance of a ...preoperative plan to determine amenability of percutaneous iliosacral screw fixation.•Mapping iliosacral screw start sites can be helpful for preoperative planning of percutaneous pelvic ring injury fixation.•This has demonstrated a relatively predictable region of screw start site on the posterior ilium, which is dependent on the sacral morphology and sacral level.•Iliosacral screws start sites on the posterior ilium have reliable regions that can be used to plan posterior fixation of pelvic ring injuries.
Lateral compression type II pelvic ring injuries can be treated with fixation through open or percutaneous approaches depending on the injury pattern and available osseous fixation pathways. The start site of iliosacral screws to stabilize these injuries should be on the unstable posterior iliac fragment; however, our understanding of start sites for iliosacral screws has not been developed. The purpose of this study is to provide an analysis of iliosacral screw start sites on the posterior ilium to help guide treatment of pelvic ring injuries.
One-hundred and seventeen consecutive patients at an academic level I trauma center with pelvic ring injuries who underwent surgical treatment with iliosacral screws were included in the final analysis. The start sites of iliosacral screws with confirmed intraosseous placement on a postoperative computed tomography were mapped on the posterior ilium and analyzed according to the sacral segment and type of iliosacral screw.
One-hundred and seventeen patients were included in the final analysis. Of the total of 272 iliosacral screw insertion sites analyzed, 145 (53%) were sacroiliac-style screws and 127 (47%) were transsacral screws. The insertion sites for sacroiliac-style screws and transsacral screws at different sacral segment levels can vary but have predictable regions on the posterior ilium relative to reliable osseous landmarks.
Iliosacral screws start sites on the posterior ilium have reliable regions that can be used to plan posterior fixation of pelvic ring injuries.
Purpose
Upper-tract urothelial carcinoma (UTUC) is a relatively uncommon disease with limited available evidence on specific topics. The purpose of this article was to review the previous literature ...to summarize the current knowledge about UTUC epidemiology, diagnosis, preoperative evaluation and prognostic assessment.
Methods
Using MEDLINE, a non-systematic review was performed including articles between January 2000 and February 2016. English language original articles, reviews and editorials were selected based on their clinical relevance.
Results
UTUC accounts for 5–10 % of all urothelial cancers, with an increasing incidence. UTUC and bladder cancer share some common risk factors, even if they are two different entities regarding practical, biological and clinical characteristics. Aristolochic acid plays an important role in UTUC pathogenesis in certain regions. It is further estimated that approximately 10 % of UTUC are part of the hereditary non-polyposis colorectal cancer spectrum disease. UTUC diagnosis remains mainly based on imaging and endoscopy, but development of new technologies is rapidly changing the diagnosis algorithm. To help the decision-making process regarding surgical treatment, extent of lymphadenectomy and selection of neoadjuvant systemic therapies, predictive tools based on preoperative patient and tumor characteristics have been developed.
Conclusions
Awareness regarding epidemiology, diagnosis, preoperative evaluation and prognostic assessment changes is essential to correctly diagnose and manage UTUC patients, thereby potentially improving their outcomes.
•Penetrating trauma covers gunshot wounds and stab and puncture wounds.•Firearm related injuries make up the bulk of the mortality in penetrating trauma.•Nonoperative management acceptable in select ...patients.•CT is accurate in predicting the need for laparotomy in penetrating abdominal trauma.•Specific CT findings can indicate need for laparotomy or endovascular therapy.
Penetrating abdominal trauma comprises a wide variety of injuries that will manifest themselves at imaging depending on the distinct mechanism of injury. The use of computed tomography (CT) for hemodynamically stable victims of penetrating torso trauma continues to increase in clinical practice allowing more patients to undergo initial selective non-surgical management. High diagnostic accuracy in this setting helps patients avoid unnecessary surgical intervention and ultimately reduce morbidity, mortality and associated medical costs. This review will present the evidence and the controversies surrounding the imaging of patients with penetrating abdominopelvic injuries. Available protocols, current MDCT technique controversies, organ-specific injuries, and key MDCT findings requiring intervention in patients with penetrating abdominal and pelvic trauma are presented. In the hemodynamically stable patient, the radiologist will play a key role in the triage of these patients to operative or nonoperative management.
Introduction
Aging spine is characterized by facet joints arthritis, degenerative disc disease, bone remodeling and atrophy of extensor muscles resulting in a progressive kyphosis of the lumbar ...spine.
Objective
The aim of this paper is to describe the different compensatory mechanisms for patients with severe degenerative lumbar spine.
Material and methods
According to the severity of the imbalance, three stages are observed: balanced, balanced with compensatory mechanisms and imbalanced. For the two last stages, the compensatory mechanisms permit to limit the consequences of loss of lumbar lordosis on global sagittal alignment and therefore contribute to keep the sagittal balance of the spine.
Results
The basic concept is to extend adjacent segments of the kyphotic spine allowing for compensation of the sagittal unbalance but potentially inducing adverse effects.
Conclusion
Finally, we propose a three-step algorithm to analyze the global balance status and take into consideration the presence of the compensatory mechanisms in the spinal, pelvic and lower limb areas.
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 knownage/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.
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