No abstract available.
Ischium ; Osteomyelitis

PURPOSE: To evaluate, if possible, the radiographic features of tuberculous osteitis in the greater trochanter and ischium, and to determine the cause of the lesions. MATERIALS AND METHODS: We retrospectively reviewed the plain radiographic findings of 14 ptients with histologically proven tuberculous osteitis involvingthe greater trochanter and ischium. In each case, the following were analyzed : morphology of bone destruction, including cortical erosion; periosteal reaction ; presence or abscence of calcific shadows in adjacent softtissue. On the basis of an analysis of radiographic features and correlation of the anatomy with adjacent structures we attempted to determine causes. RESULTS: Of the 14 cases evaluated, 12 showed varrious degrees of extrinsic erosion on the outer cortical bone of the greater trochanter and ischium ; in two cases, bone destruction was so severe that the radiographic features of advanced perforated osteomyelitis were simulated. Inaddition to findings of bone destruction, in these twelve cases, the presence of sequestrum or calcific shadows was seen in adjacent soft tissue. CONCLUSION: Tuberculous osteitis in the greater trochanter and ischium showed the characteristic findings of chronic extrinsic erosion. On the basis of these findings we can suggest that the selesions result from an extrinsic pathophysiologic cause such as adjacent bursitis.
Bursitis ; Femur* ; Ischium* ; Osteitis* ; Osteomyelitis

No abstract available.
Ischium ; Surgical Flaps ; Sciatica ; Pain

PURPOSE: To evaluate the usefulness of electronic portal imaging device through objective compare of the images acquired using an EPID and a conventional port film. MATERIAL AND METHODS: From Apr. to Oct. 1997, a total of 150 sets of images from 20 patients who received radiation therapy in the pelvis area were evaluated in the Inha University Hospital and Severance Hospital. A dual image recording technique was devised to obtain both electronic portal images and port film images simultaneously with one treatment course. We did not perform double exposure. Five to ten images were acquired from each patient. All images were acquired from posteroanterior (PA) view except images from two patients. A dose rate of 100-300 MU/min and a 10- MV X-ray beam were used and 2-10 MUs were required to produce a verification image during treatment. Kodak diagnostic film with metal/film imaging cassette which was located on the top of the EPID detector was used for the port film. The source to detector distance was 140 cm. Eight anatomical landmarks (pelvic brim, sacrum, acetabulum, iliopectineal line, symphysis, ischium, obturator foramen, sacroiliac joint) were assessed. Four radiation oncologist joined to evaluate each image. The individual landmarks in the port film or in the EPID were rated - very clear (1), clear (2), visible (3), not clear (4), not visible (5). RESULTS: Using an video camera based EPID system, there was no difference of image quality between no enhanced EPID images and port film images. However, when we provided some change with window level for the portal image, the visibility of the sacrum and obturator foramen was improved in the portal images than in the port film images. All anatomical landmarks were more visible in the portal images than in the port film when we applied the CLAHE mode enhancement. The images acquired using an matrix ion chamber type EPID were also improved image quality after window level adjustment. CONCLUSION: The quality of image acquired using an electronic portal imaging device was comparable to that of the port film. When we used the enhance mode or window level adjustment, the image quality of the EPID was superior to that of the port film. EPID may replace the port film.
Acetabulum ; Animals ; Humans ; Ischium ; Mice ; Pelvis ; Sacrum

The area overlying the ischium is the most frequent site for the development and recurrence of pressure sores in the paraplegic patient. This report describes a newly-designed inferior gluteus maximus myocutaneous island flap that is useful for the repair of ischial pressure sores in paraplegic patients. Sacral sore develops a wide and flat ulcer crater. However, ischial sore seems to develop large and deep bursa with relatively small openings. We have used a newly-designed gluteus maximus myocutaneous island flap according to the specific characteristics of ischial sore. The flap is designed in the fashion of a small skin island with a large muscle flap. This flap with its abundant and constant blood supply had proved very reliable in the surgical management of ischial pressure sore. There is also the possible advantage of cushioning with the bulk of muscle for greater long-term durability. Incision could be extended for a complete bursetomy and partial ischiectomy. The reliability, versatility and low morbidity of the inferior gluteus maximus island flap has been demonstrated by its use in our consecutive series of 7 patients with 8 ischial pressure sores. We conclude that this newly-designed inferior gluteus maximus myocutaneous island flap can be applied in deep, infected ischial sore according to the specific characteristics of ischial sore, and it is a very useful method in comparison to other flaps.
Humans ; Ischium ; Pressure Ulcer ; Recurrence ; Skin ; Ulcer

Tuberculous infection of the ischium is a rare condition. It is recommended that antituberculosis chemotherapy is combined with surgical intervention. The patient in this case had an abscess on his right gluteal region and he had undergone an operation without antituberculosis chemotherapy. After eight years, an abscess recurred in the same area and he was treated with surgical resection. Antituberculosis chemotherapy was administered following histopathological confirmation of tuberculosis. At 1 year postoperatively, the patient had no pain and there was no evidence of recurrence.
Abscess ; Buttocks ; Humans ; Ischium ; Pelvis ; Recurrence ; Tuberculosis

PURPOSE: We hypothesized that the central dislocation of the femoral head does generally not occur in transverse acetabular fractures, although it does usually occur in both column fractures. MATERIALS AND METHODS: Fifty-two transverse and both column acetabular fracture cases were evaluated retrospectively. The distances between (a) the sciatic notch on the fracture side and the vertical axis of the pelvis (VA line) and (b) the contralateral intact sciatic notch and the VA line were measured. The a/b ratio corresponded to the superior iliac segment displacement or rotation. The ratio of the distance between the fracture side femoral head and the VA line (c) and the distance between the contralateral intact femoral head and the VA line (d) corresponded to the femoral head displacement. The width of ischium (e) on fractured side and (f) contralateral side were measured. The e/f ratio increment reflected ischiadic fragment mobility. RESULTS: The median value of femoral head displacement (c/d) of the transverse fracture group (n=25) was 1.02 (1.000-1.07). Ischiadic fragment rotation (e/f ratio) of the transverse fracture group was 1.000. The median value of femoral head displacement (c/d) of the both column fractures (n=27) was 0.78 (0.64-0.85). Ischiadic fragment rotation (e/f ratio) of the both-column group was 1.15 (1.06-1.23). The differences between groups according to measurements were statistically significant. CONCLUSION: In contrary to Letournel description, our findings showed no medialization of femoral head in transverse acetabular fractures in general. This might be an illusion resulting from external rotation of the superior iliac segment.
Acetabulum* ; Dislocations* ; Head* ; Hip Dislocation ; Illusions ; Ischium ; Pelvis ; Retrospective Studies

PURPOSE: We hypothesized that the central dislocation of the femoral head does generally not occur in transverse acetabular fractures, although it does usually occur in both column fractures. MATERIALS AND METHODS: Fifty-two transverse and both column acetabular fracture cases were evaluated retrospectively. The distances between (a) the sciatic notch on the fracture side and the vertical axis of the pelvis (VA line) and (b) the contralateral intact sciatic notch and the VA line were measured. The a/b ratio corresponded to the superior iliac segment displacement or rotation. The ratio of the distance between the fracture side femoral head and the VA line (c) and the distance between the contralateral intact femoral head and the VA line (d) corresponded to the femoral head displacement. The width of ischium (e) on fractured side and (f) contralateral side were measured. The e/f ratio increment reflected ischiadic fragment mobility. RESULTS: The median value of femoral head displacement (c/d) of the transverse fracture group (n=25) was 1.02 (1.000-1.07). Ischiadic fragment rotation (e/f ratio) of the transverse fracture group was 1.000. The median value of femoral head displacement (c/d) of the both column fractures (n=27) was 0.78 (0.64-0.85). Ischiadic fragment rotation (e/f ratio) of the both-column group was 1.15 (1.06-1.23). The differences between groups according to measurements were statistically significant. CONCLUSION: In contrary to Letournel description, our findings showed no medialization of femoral head in transverse acetabular fractures in general. This might be an illusion resulting from external rotation of the superior iliac segment.
Acetabulum* ; Dislocations* ; Head* ; Hip Dislocation ; Illusions ; Ischium ; Pelvis ; Retrospective Studies

Fatigue fracture of the pelvis is the form of fracture due to repetitive micro-stress accumulation, can be affected by a number of factors such as patient's nutritional status, biomechanics, social status and so on. Still there is no study about precise standard degree of external force that lead to stress fracture, but it may caused by compression force, traction force or complex force and others. Avulsion stress to ischial tuberosity or anterior superior iliac spine by attached muscle is known as the main factor for the avulsion fracture. This report will deal with 19 years old conscripted policeman who occurred ischial tuberosity avulsion fracture after training of 6-hour running for 5 days accompanying hip hyper-flexion motion. This reports aims to provide case study of stress fracture occurred after 5 days of exercise which is relatively short period who had no specific trauma history or pain.
Fractures, Stress* ; Hip ; Ischium ; Nutritional Status ; Pelvis ; Running ; Spine ; Traction

The incidence of avulsion fracture of ischial tuberosity is reported to present in 1.4%–4% of hamstring injuries. The injury mechanism is known to be caused by a sudden forceful hip flexion in the extended knee with eccentric load to the hamstrings. Although the majority of hamstring injuries are strains of the muscle, avulsion fracture of ischial tuberosity occurs rarely. In this report, a 13-year-old boy with avulsion fracture of ischial tuberosity is presented. Successful clinical outcome was achieved with careful conservative management. Previous literatures including operative indications are reviewed.
Adolescent ; Hip ; Humans ; Incidence ; Ischium ; Knee ; Male ; Soccer*