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Deep gluteal syndrome (DGS) is a medical diagnosis in which the pathoanatomy of the subgluteal space contributes to pain. The growing recognition that gluteal neuropathies can be associated with the presence of a bone-neural conflict with irritation or compression may allow us to shed some light on this pathology. This study aims to determine whether the location of the sciatic nerve (SN) in relation to the ischial spine (IS) contributes to the development of DGS. The SN – IS relationship was analyzed based on magnetic resonance imaging (MRI) in 15 surgical patients (SPs), who underwent piriformis release, and in 30 control patients who underwent MRI of the pelvis for reasons unrelated to sciatica. The SN exit from the greater sciatic foramen was classified as either zone A (medial to the IS); zone B (on the IS); or zone C (lateral to the IS). The SN was significantly closer to the IS in SPs than in MRI controls (P = 0.014). When analyzing patients of similar age, SNs in SPs were significantly closer (P = 0.0061) to the IS, and located in zone B significantly more (P = 0.0216) as compared to MRI controls. Patients who underwent surgery for piriformis release showed a significant decrease in pain postoperatively (P < 0.0001). The results from this study suggest that the relationship between the IS and SN may play a role in the development of DGS. This may also help establish which patients would benefit more from surgical intervention. [ABSTRACT FROM AUTHOR]

Aims: Posterior column plating through the single anterior approach reduces the morbidity in acetabular fractures that require stabilization of both the columns. The aim of this study is to assess the effectiveness of posterior column plating through the anterior intrapelvic approach (AIP) in the management of acetabular fractures. Methods: We retrospectively reviewed the data from R G Kar Medical College, Kolkata, India, from June 2018 to April 2023. Overall, there were 34 acetabulum fractures involving both columns managed by medial buttress plating of posterior column. The posterior column of the acetabular fracture was fixed through the AIP approach with buttress plate on medial surface of posterior column. Mean follow-up was 25 months (13 to 58). Accuracy of reduction and effectiveness of this technique were measured by assessing the Merle d’Aubigné score and Matta’s radiological grading at one year and at latest follow-up. Results: Immediate postoperative radiological Matta’s reduction accuracy showed anatomical reduction (0 to 1 mm) in 23 cases (67.6%), satisfactory (2 to 3 mm) in nine (26.4%), and unsatisfactory (> 3 mm) in two (6%). Merle d’Aubigné score at the end of one year was calculated to be excellent in 18 cases (52.9%), good in 11 (32.3%), fair in three (8.8%), and poor in two (5.9%). Matta’s radiological grading at the end of one year was calculated to be excellent in 16 cases (47%), good in nine (26.4%), six in fair (17.6%), and three in poor (8.8%). Merle d’Aubigné score at latest follow-up deteriorated by one point in some cases, but the grading remained the same; Matta’s radiological grading at latest follow-up also remained unchanged. Conclusion: Stabilization of posterior column through AIP by medial surface plate along the sciatic notch gives good stability to posterior column, and at the same time can avoid morbidity of the additional lateral window. Cite this article: Bone Jt Open 2024;5(2):147–153.

Deep gluteal syndrome is a clinical condition in which discomfort may arise due to the pathoanatomy of the subgluteal space. We conducted an anatomical exploration to categorize the relationship of the piriformis muscle, sciatic nerve (SN), and pudendal nerve (PN) to the ischial spine (IS) and sacrospinous ligament. We analyzed 22 cadavers. The piriformis muscle, SN, and PN were exposed through either a transgluteal approach or a gluteal flap. The relationship of the neural structures to the IS, sacrospinous ligament, and ischial bone as they exit the greater sciatic foramen was observed, and the exit zones were classified as zone A, medial to the IS (entirely on sacrospinous ligament); zone B, on the IS; and zone C, lateral to the IS (entirely on ischial bone). The SN was observed either in zone B or zone C in all specimens. The PN was found to be in either zone A or zone B in 97.6% of specimens. The most common combinations were SN in zone B and PN in zone A (type I), and SN in zone C and PN in zone B (type II). The results from this study show clear anatomical differences in the SN-PN relationship, which may play a role in pain seen in deep gluteal syndrome. Moreover, classification of the SN-IS and PN-IS relationships described in this article will help describe different pathologies affecting the deep gluteal area. [ABSTRACT FROM AUTHOR]

The acquisition of habitual bipedal locomotion, which resulted in numerous modifications of the skeleton was a crucial step in hominid evolution. However, our understanding of the inherited skeletal modifications versus those acquired while learning to walk remains limited. We here present data derived from X‐rays and CT scans of quadrupedal adult humans and compare the morphology of the vertebral column, pelvis and femur to that of a bipedal brother. We show how a skeleton forged by natural selection for bipedal locomotion is modified when used to walk quadrupedally. The quadrupedal brother is characterised by the absence of femoral obliquity, a very high anteversion angle of the femoral neck, a very high collo‐diaphyseal angle and a very reduced lordosis. The differences in the pelvis are more subtle and complex, yet of functional importance. The modification of the ischial spines to an ischial ridge and the perfectly rounded shape of the sacral curvature are two unique features that can be directly attributed to a quadrupedal posture and locomotion. We propose a functional interpretation of these two exceptional modifications. Unexpectedly, the quadrupedal brother and sister show a greater angle of pelvic incidence compared to their bipedal brother, a trait previously shown to increase with learning to walk in bipedal subjects. Moreover, the evolution from an occasional towards a permanent bipedality has given rise to a functional association between the angle of pelvic incidence and the lumbar curvature, with high angles of incidence and greater lumbar curvature promoting stability during bipedal locomotion. The quadrupedal brother and sister with a high angle of incidence and a very reduced lordosis thus show a complete decoupling of this complex functional integration. [ABSTRACT FROM AUTHOR]

Anterior–posterior (A/P) radiography of the pelvis is essential to the diagnosis and treatment of developmental dysplasia of the hip (DDH). Multiple well-defined parameters of adult hip morphology with good reliability are readily available. The purpose of this study was to determine normative values and observed reliability for 10 common adult hip parameters in the developing pelvis of male and female patients aged 6 months–16 years. One hundred and fifty-eight standardized A/P pelvic radiographs were randomly selected from an existing trauma patient database and stratified into five age groups. Mean values or presence of categorical values and the observed reliability of 10 adult hip parameters (acetabular index/angle, pelvic width index, lateral center edge angle, Tönnis angle, acetabular to femoral head distance, femoral head diameter, coxa profunda/protrusio, ischial spine sign, crossover sign and posterior wall sign) were determined. Minimal differences in all parameters were observed between male and female patients. The observed inter-rater reliability of continuous parameters was 0.77–0.99. The observed intra-rater reliability was 0.7–0.99 with a combined intra-rater reliability of 0.88–0.99. The observed inter-rater reliability of categorical variables was 0.64–1.0. The intra-rater reliability of categorical variables was 0.83–1.0. Normative values for 10 common adult hip parameters were determined for male and female patients in the developing pelvis. Reliable knowledge of these values and their relationship to the age of the patient and/or stage of pelvic development associated may provide additional information to aid the treatment of DDH. [ABSTRACT FROM AUTHOR]