Search Results (21)

The human pelvis is a complex structure, which participates in the biomechanical functioning of the musculoskeletal system. Although it is considered a symmetrical entity, the morphology of the pelvis is subject to different factors that alter its anatomy, function or biomechanics, such as age, bipedal locomotion, obstetric changes and sexual dimorphism. However, how these factors influence pelvic asymmetry is unknown. Some evidence suggests that this condition leads to different pathological states, such as chronic low back pain, scoliosis, post-traumatic pelvic dysfunctions and obstetric changes. Therefore, pelvic asymmetries present a significant challenge in clinical practice due to their multifactorial nature and their potential impact on quality of life. Multidisciplinary research and collaboration are essential to improve understanding and develop more effective and specific identification and treatment approaches in the presence of pelvic asymmetries. Full article

Background and Objectives: Anterior sacroiliac fracture dislocation (ASFD), also known as locked pelvis, is a rarely reported diagnosis. The types of ASFDs are often misdiagnosed as lateral compression fractures due to the presence of crescent fractures. In this study, we distinguished ASFD from lateral compression fractures (LC 2) and studied their characteristics. Materials and Methods: This is a retrospective study involving patients from a Level 1 trauma center. Fifty-nine patients under the age of 65 years with crescent fractures caused by a high-energy mechanism were investigated. Results: The incidence of ASFD was 25% (15 of 59) in patients with crescent fractures. Among the 15 patients, 6 had override of the ilium over the sacrum, inhibiting reduction in the sacroiliac joint. Pre-operative radiographic evaluations revealed that vertical displacement of the ASFD was larger than that of lateral compression fracture (LC 2) in the outlet view (mean 9.5 vs. 1.9 mm, p = 0.013), and the pelvic asymmetry ratio was larger in ASFD (mean 7.8 vs. 4.1, p = 0.006) in the pelvis AP view. All patients achieved union after surgery. Post-operative radiography showed no significant vertical displacement difference. There was no difference in vascular injury or hemodynamic instability requiring embolization or preperitoneal pelvic packing (PPP) between the two groups. Conclusions: Patients with ASFD have greater vertical displacement and asymmetry compared to patients with LC 2 fractures. These fractures must be distinguished for appropriate reduction and anterior plate fixation. Full article

Background: Racehorses commonly train and race in one direction, which may result in gait asymmetries. This study quantified gait symmetry in two cohorts of Thoroughbreds differing in their predominant exercising direction; we hypothesized that there would be significant differences in the direction of asymmetry between cohorts. Methods: 307 Thoroughbreds (156 from Singapore Turf Club (STC)—anticlockwise; 151 from Hong Kong Jockey Club (HKJC)—clockwise) were assessed during a straight-line, in-hand trot on firm ground with inertial sensors on their head and pelvis quantifying differences between the minima, maxima, upward movement amplitudes (MinDiff, MaxDiff, UpDiff), and hip hike (HHD). The presence of asymmetry (≥5 mm) was assessed for each variable. Chi-Squared tests identified differences in the number of horses with left/right-sided movement asymmetry between cohorts and mixed model analyses evaluated differences in the movement symmetry values. Results: HKJC had significantly more left forelimb asymmetrical horses (Head: MinDiff p < 0.0001, MaxDiff p < 0.03, UpDiff p < 0.01) than STC. Pelvis MinDiff (p = 0.010) and UpDiff (p = 0.021), and head MinDiff (p = 0.006) and UpDiff (p = 0.017) values were significantly different between cohorts; HKJC mean values indicated left fore- and hindlimb asymmetry, and STC mean values indicated right fore- and hindlimb asymmetry. Conclusion: the asymmetry differences between cohorts suggest that horses may adapt their gait to their racing direction, with kinematics reflecting reduced ‘outside’ fore- and hindlimb loading. Full article

In horses, quantitative assessment of gait parameters, as with the use of inertial measurement units (IMUs) systems, might help in the decision-making process. However, it requires financial investment, is time-consuming, and lacks accuracy if displaced. An innovative artificial intelligence marker-less motion tracking system (AI-MTS) may overcome these limitations in the field. Our aim was to compare the level of agreement and accuracy between both systems and visual clinical assessment. Twenty horses underwent locomotion analysis by visual assessment, IMUs, and AI-MTS systems, under the following conditions: straight hard (SH), straight soft (SS), left and right circle hard (LCH, RCH), and soft (LCS, RCS). A greater number of horses were considered sound by clinical examination, compared to those identified as symmetric by the two gait analysis systems. More limbs were considered asymmetric by the AI-MTS compared to IMUs, suggesting its greater sensitivity. The greatest agreement between the two systems was found for the difference between two minima in vertical head position in SH, while the lowest for the difference between two minima in vertical pelvis position in SS, reflecting the difficulties in assessing asymmetry of the hindlimbs. It is unknown what degree of asymmetry is clinically relevant, suggesting that more consistent use in training horses may help determine the thresholds for asymmetry. Some degree of asymmetry may be clinically relevant, suggesting its regular use in training horses. Full article

Background: The purpose of this study was to assess specific rehabilitation methods’ effectiveness in early idiopathic scoliosis (IS) development, focusing on lower limb functional inequality’s role in scoliosis progression. Materials and Methods: This study comprised 812 patients aged 6–16 years at risk of developing idiopathic scoliosis (IS). The mean (SD) age was 10.66 (3.16) years. Patients were categorized into high- and medium-risk groups based on the angle of trunk rotation (ATR) size. Specific scoliosis physiotherapy was used, and the average follow-up period was 28.1 ± 14.5 months. Changes in ATR, Cobb angle, and functional length of the lower limbs pre- and post-treatment were statistically analyzed across three age groups (6–9, 10–12, and 13–16 years) and three scoliosis locations. Results: Significant effectiveness of early rehabilitation was observed in the high-risk group of children aged 6–9 years. In the medium-risk group, significant reductions in ATR were observed in both the 6–9 and 10–12 age groups across all three scoliosis locations. Additionally, there was a significant decrease in the Cobb angle in the thoracolumbar region and a significant reduction in lower limb inequality across all age groups and scoliosis locations. Conclusions: The early implementation of specific physiotherapy may enhance the efficacy of idiopathic scoliosis treatment by attenuating factors contributing to its progression. Full article

The aim of this study was to compare seat pressure asymmetries before and after 30 min cycling at constant intensity in association with pelvic anthropometric parameters and skeletal muscle fatigue. Twelve male road cyclists aged 18–30 years (mean training experience 9.9 ± 2.5 years) participated. Pelvic anthropometric data and body composition were measured with dual-energy X-ray absorptiometry. Participants performed 30 min cycling at 50% peak power output at constant intensity on a cyclus-2 ergometer. Muscle fatigue during cycling was assessed by surface electromyogram spectral mean power frequency (MPF) for the back, gluteal, and thigh muscles. The pressure mapping system was used to assess sitting symmetry before and after the cycling exercise. At the end of cycling, MPF was decreased (p < 0.05) in the dominant side’s erector spinae muscle and the contralateral gluteal muscle. After the exercise, a significant (p < 0.05) asymmetry in seat pressure was observed under the ischial tuberosity based on the peak pressure right to left ratio, whereas peak pressure decreased under the left ischial tuberosity. After the exercise, the relationship (p < 0.05) between pelvis width and pressure under the ischial tuberosity occurred on the dominant side of the body. In conclusion, an asymmetry was revealed after the constant-load cycling exercise by peak pressure ratio right to left side. Further studies should address the role of seat pressure asymmetries before and after cycling exercises at different intensities and durations. Full article

Spinopelvic malignment is commonly seen with non-ambulatory cerebral palsy (CP). Axial plane deformation is not well described in the literature. The purpose of this study was to describe and quantify the axial plane deformity in CP using CT scans and compare it to normal controls. We retrospectively collected data using CT scans of the abdomen and pelvis of 40 patients with GMFCS IV/V CP and neuromuscular scoliosis (CPP) and normal controls (NP) matched by age and sex. Pre-operative Cobb angle was recorded for the CP patients. Pelvic anatomy was evaluated at the supra-acetabular region of bone using two angles—iliac wing angle and sacral ala angle, measured for each hemipelvis. The larger of each hemipelvis angle was considered externally rotated while the smaller angle was considered internally rotated, termed as follows—iliac wing external (IWE) and internal (IWI); sacral ala external (SAE), and internal (SAI). Differences were noted using an independent t-test while correlations with Cobb angle were performed using Pearson’s correlation. Iliac wing measurements showed the externally rotated hemipelvis showed a significantly greater magnitude compared with normal controls at 47.3 ± 18.1 degrees vs. 26.4 ± 3.7 degrees in NP (p < 0.001) while no internal rotation was observed (p > 0.05). Sacral ala measurements showed greater magnitude in both external and internal rotation. SAE was 119.5 ± 9.5 degrees in CPP vs. 111.2 ± 7.7 degrees in NP (p < 0.001) while SAI was 114.1 ± 8.5 degrees in CPP vs. 107.9 ± 7.5 degrees in NP (p = 0.001). In the CP cohort, the mean Cobb angle was 61.54 degrees (n = 37/40). Cobb angle correlated with the degree of external iliac wing rotation—IWE (r = 0.457, p = 0.004) and degree of absolute difference in the rotation of the iliac wing (r = 0.506, p = 0.001). The pelvis in a patient with CP scoliosis is asymmetrically oriented exhibiting a greater external rotation of one hemipelvis relative to normal controls. The severity of neuromuscular scoliosis is related to the pelvic axial rotation in CP patients. Axial plane deformity exists in the CP pelvis and this deformity warrants consideration when considering spinopelvic instrumentation strategies and outcomes of supra-pelvic and infra-pelvic pathologies. Full article

Stroke is a leading cause of disability, impairing the ability to generate propulsive forces and causing significant lateral gait asymmetry. We aim to improve stroke survivors’ gaits by promoting weight-bearing during affected limb stance. External forces can encourage this; e.g., vertical forces can augment the gravitational force requiring higher ground reaction forces, or lateral forces can shift the center of mass over the stance foot, altering the lateral placement of the center of pressure. With our novel design of a mobile Tethered Pelvic Assist Device (mTPAD) paired with the DeepSole system to predict the user’s gait cycle percentage, we demonstrate how to apply three-dimensional forces on the pelvis without lower limb constraints. This work is the first result in the literature that shows that with an applied lateral force during affected limb stance, the center of pressure trajectory’s lateral symmetry is significantly closer to a 0% symmetry (5.5%) than without external force applied (−9.8%,p<0.05). Furthermore, the affected limb’s maximum relative pressure (p) significantly increases from 233.7p to 234.1p (p<0.05) with an applied downward force, increasing affected limb loading. This work highlights how the mTPAD increases weight-bearing and propulsive forces during gait, which is a crucial goal for stroke survivors. Full article

(1) Background: A set of relevant police ergonomic parameters (PEP) have been used for the assessment and prevention of occupational risks involved in police physical interventions (PITs). Through this set of PEPs, a comparison has been made between two traditional PITs against two novel OTPs (operational tactical procedures). (2) Method: The data have been collected by means of a motion capture suit fitted with 19 inertial measurement units (IMUs). A specific and powerful software package specific for ergonomic analysis has been used to manage the large amount of data registered and to generate a series of three-dimensional plots. Traditional PITs and newer OTPs have been performed for their analysis. Specifically, the PEPs corresponding to the implementation of four PITs have been analyzed by collecting the measurements provided by a set of IMUs installed on a motion capture suit, and their occupational risk assessments have been compared against those corresponding to newer OTPs. (3) Results: For the four PITs, the PEPs have been analyzed with the measured values from the IMUs, throughout the duration of each technique. The two traditional intervention techniques have scored higher than the new OTPs in the REBA system, the asymmetry angle, L5-pelvis shear and joint contact forces, and the total muscle power measurements. (4) Conclusions: It has been confirmed that the new OTPs minimize the risk of injuries, since their PEPs reached lower values than those corresponding to the traditional PITs, which are still being taught at police academies. Full article

Despite a growing number of effective therapeutic options for patients with pancreatic adenocarcinoma, the prognosis remains dismal mostly due to the late-stage presentation and spread of the cancer to other organs. Because a genomic analysis of pancreas tissue revealed that it may take years, if not decades, for pancreatic cancer to develop, we performed radiomics and fat fraction analysis on contrast-enhanced CT (CECT) scans of patients with historical scans showing no evidence of cancer but who subsequently went on to develop pancreas cancer years later, in an attempt to identify specific imaging features of the normal pancreas that may portend the subsequent development of the cancer. In this IRB-exempt, retrospective, single institution study, CECT chest, abdomen, and pelvis (CAP) scans of 22 patients who had evaluable historical imaging data were analyzed. The images from the “healthy” pancreas were obtained between 3.8 and 13.9 years before the diagnosis of pancreas cancer was established. Afterwards, the images were used to divide and draw seven regions of interest (ROIs) around the pancreas (uncinate, head, neck-genu, body (proximal, middle, and distal) and tail). Radiomic analysis on these pancreatic ROIs consisted of first order quantitative texture analysis features such as kurtosis, skewness, and fat quantification. Of all the variables tested, fat fraction in the pancreas tail (p = 0.029) and asymmetry of the histogram frequency curve (skewness) of pancreas tissue (p = 0.038) were identified as the most important imaging signatures for subsequent cancer development. Changes in the texture of the pancreas as measured on the CECT of patients who developed pancreas cancer years later could be identified, confirming the utility of radiomics-based imaging as a potential predictor of oncologic outcomes. Such findings may be potentially useful in the future to screen patients for pancreatic cancer, thereby helping detect pancreas cancer at an early stage and improving survival. Full article

Background: Equinus deformity with or without concomitant drop foot is a common finding in children with unilateral spastic cerebral palsy and spastic hemiplegia of other causes. Hypothetically, these deformities may lead to pelvic retraction and hip internal rotation during gait. Orthoses are used to reduce pes equinus during gait and to restore hindfoot first contact. Objective: We aimed to investigate whether the use of orthotic equinus correction reduces rotational hip and pelvic asymmetries. Methods: In a retrospective study, 34 children with unilateral spastic cerebral palsy or spastic hemiplegia of other causes underwent standardized instrumented 3D gait analysis with and without orthotic equinus management. We analyzed the differences in the torsional profile during barefoot walking and while wearing orthoses, as well as investigated the influence of ankle dorsiflexion and femoral anteversion on pelvic and hip kinematics and hip kinetics. Results: Wearing orthoses corrected pes equinus and pelvic internal rotation at the end of the stance phase and in the swing phase compared to barefoot walking. Hip rotation and the rotational moment did not significantly change with orthoses. Orthotic management or femoral anteversion did not correlate to pelvic and hip asymmetry. Conclusion: The findings indicate that the correction of the equinus by using orthoses had a variable effect on the asymmetry of the hip and pelvis and internal rotation; both appear to have a multifactorial cause that is not primarily driven by the equinus component. Full article

Computer vision is a subcategory of artificial intelligence focused on extraction of information from images and video. It provides a compelling new means for objective orthopaedic gait assessment in horses using accessible hardware, such as a smartphone, for markerless motion analysis. This study aimed to explore the lameness assessment capacity of a smartphone single camera (SC) markerless computer vision application by comparing measurements of the vertical motion of the head and pelvis to an optical motion capture multi-camera (MC) system using skin attached reflective markers. Twenty-five horses were recorded with a smartphone (60 Hz) and a 13 camera MC-system (200 Hz) while trotting two times back and forth on a 30 m runway. The smartphone video was processed using artificial neural networks detecting the horse’s direction, action and motion of body segments. After filtering, the vertical displacement curves from the head and pelvis were synchronised between systems using cross-correlation. This rendered 655 and 404 matching stride segmented curves for the head and pelvis respectively. From the stride segmented vertical displacement signals, differences between the two minima (MinDiff) and the two maxima (MaxDiff) respectively per stride were compared between the systems. Trial mean difference between systems was 2.2 mm (range 0.0–8.7 mm) for head and 2.2 mm (range 0.0–6.5 mm) for pelvis. Within-trial standard deviations ranged between 3.1–28.1 mm for MC and between 3.6–26.2 mm for SC. The ease of use and good agreement with MC indicate that the SC application is a promising tool for detecting clinically relevant levels of asymmetry in horses, enabling frequent and convenient gait monitoring over time. Full article

Background: The aim of the work is to define the morphological peculiarities of the pelvic autonomic nervous system (ANS) and their importance in the clinical and surgical interventions in the lesser pelvis. Material and methods: Anatomical variations in the formation of the pelvic ANS were observed in 20 cadavers. The study included 17 men (85%), aged 18 to 84, and 3 women, aged 27 to 86. The average age was 53.8 years. The subjects most often died by violent death in car accidents, by asphyxia, or by sudden death. The study was approved by the Ethics Committee of the Health Care Surveillance Authority, Bratislava, Slovakia. We studied cadavers without congenital or detected anomalies, cancer, deformities of the body, or spinal or abdominal surgeries within 24 h of death. We observed a relationship between the dimensions and the number of ganglia, as well as the number and course of nerve branches and anastomoses. In the pelvic area, we observed the hypogastric plexus superior, hypogastric plexus inferior, and the truncus sympathicus. In all cadavers, we clarified the lumbosacral plexuses after evisceration. In the lumbosacral region, the roots were defined based on their participation in the formation of the plexuses. To show the intimate relationship between both systems, we also focused on the details of the structure (rami communicantes) related to the connections of the ANS with the spinal nervous system. Results: Anatomical variations in the formation of the pelvic ANS were observed in all cases. We included cases with more than two truncus sympathicus ganglia as the segmental type. The segmental form occurred in 14 (70%) cases, and was concentrated in 6 (30%) cases. Rami communicantes provided anastomoses to the spinal nerves. Small ganglia were observed on the rami communicantes. With the concentrated type, we observed the division of the sympathetic and parasympathetic systems. With the segmental and concentrated forms, symptoms of the “diffuse form” may occur, which we observed in all cases. We observed significant right-left asymmetry and differences in the formation of ganglia and anastomoses. Conclusions: This study allowed us to identify and describe the morphological peculiarities of the pelvic ANS and their possible influence on the clinical picture. Asymmetry and dependence of their occurrence on the type of ANS was observed. The variations were frequent. Their preoperative diagnosis is difficult to impossible. The absence or lack of intraoperative vigilance can lead to the damage of pelvic ANS during operations and blockades of the pelvic plexus. The acquired knowledge can be helpful in clarifying clinical signs and symptoms of these conditions. Full article

Defining whether a gait asymmetry should be considered as lameness is challenging. Gait analysis systems now provide relatively accurate objective data, but their interpretation remains complex. Thresholds for discriminating between horses that are visually assessed as being lame or sound, as well as thresholds for locating the lame limb with precise sensitivity and specificity are essential for accurate interpretation of asymmetry measures. The goal of this study was to establish the thresholds of asymmetry indices having the best sensitivity and specificity to represent the visual single-limb lameness assessment made by expert veterinarians as part of their routine practice. Horses included in this study were evaluated for locomotor disorders at a clinic and equipped with the EQUISYM^® system using inertial measurement unit (IMU) sensors. Visual evaluation by expert clinicians allocated horses into five groups: 49 sound, 62 left forelimb lame, 67 right forelimb lame, 23 left hindlimb lame, and 23 right hindlimb lame horses. 1/10 grade lame horses were excluded. Sensors placed on the head (_H), the withers (_W), and the pelvis (_P) provided vertical displacement. Relative difference of minimal (AI-min) and maximal (AI-max) altitudes, and of upward (AI-up) and downward (AI-down) amplitudes between right and left stance phases were calculated. Receiver operating characteristic (ROC) curves discriminating the sound horses from each lame limb group revealed the threshold of asymmetry indice associated with the best sensitivity and specificity. AI-up_W had the best ability to discriminate forelimb lame horses from sound horses with thresholds (left: −7%; right: +10%) whose sensitivity was greater than 84% and specificity greater than 88%. AI-up_P and AI-max_P discriminated hindlimb lame horses from sound horses with thresholds (left: −7%; right: +18% and left: −10%; right: +6%) whose sensitivity was greater than 78%, and specificity greater than 82%. Identified thresholds will enable the interpretation of quantitative data from lameness quantification systems. This study is mainly limited by the number of included horses and deserves further investigation with additional data, and similar studies on circles are warranted. Full article

Repeatability and reproducibility of any measuring system must be evaluated to assess possible limitations for its use. The objective of this study was to establish the repeatability and the inter-operator reproducibility of a sensors-based system (EQUISYM^®) for quantifying gait asymmetries in horses.. Seven wireless IMUs were placed on the head, the withers, the pelvis, and the 4 cannon bones on three horses, by four different operators, four times on each horse, which led to a total of 48 repetitions randomly assigned. Data were collected along three consecutive days and analysed to calculate total variance, standard deviation and the variance attributable to the operator on multiple asymmetry variables. Maximal percentage of variance due to the operator (calculated out of the total variance) was 5.3% and was related to the sensor placed on the head. The results suggest a good reproducibility of IMU-based gait analysis systems for different operators repositioning the system and repeating the same measurements at a succession of time intervals. Future studies will be useful to confirm that inter-operator reproducibility remains valid in larger groups and on horses with different degrees of locomotor asymmetry. Full article