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Purpose: To determine the effect of hip external rotation or extension/adduction on minimizing the ischiofemoral distance (IFD) and assess the correlation between cadaveric and fluoroscopic IFD measurements in different hip positions., Methods: This cadaveric study involved 33 hip joints from 17 embalmed cadavers. IFD, the distance between the lesser trochanter and lateral ischium, was measured in different hip positions: neutral, external rotation at 30°, and external rotation at 60° with the hip in both neutral extension and adduction as well as 10° hip extension and 10° hip adduction. Differences in IFD related to positions and correlation between cadaveric and fluoroscopic measurements were analyzed., Results: IFD measurements showed that the greatest reduction occurred at 60° of external hip rotation, with a significant difference observed only between neutral and 60° external rotation in cadaveric groups (7.60 ± 4.68 vs 5.05 ± 3.48, 95% CI, 0.14-4.96; P = .036). No substantial difference was observed between the extension and adduction positions. Positive correlations were observed between cadaveric and fluoroscopic measurements, especially in the neutral position (r = 0.492, P = .004), external rotation at 30° (r = 0.52, P = .002), external rotation at 60° (r = 0.419, P = .015), and the extension/adduction positions combined with neutral rotation (r = 0.396, P = .023)., Conclusions: The IFD significantly decreased with increasing degrees of hip external rotation, particularly at 60°. No significant reduction was observed in the extension/adduction positions. In addition, positive correlations were observed between cadaveric and fluoroscopic measurements for specific hip positions: neutral rotation, external rotation at 30° and 60°, and extension/adduction at 10° with neutral rotation., Clinical Relevance: Surgeons can use this knowledge to improve hip impingement assessment through radiography, focusing on positions in which IFD reduction is most notable. Understanding the relationship between hip positions and IFD can enhance the diagnosis of ischiofemoral impingement syndrome and benefit patient care and outcomes., Competing Interests: Disclosures The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: A.S.R. has stocks, stock options, or other ownership interest in Enhatch and Conformis; received consulting fees from Heron Therapeutics; received education support from Gotham Surgical Solutions; and serves on the speakers’ bureau for Pfizer. All other authors (T.I., K.J., N.T., P.W., D.L., S.V.M., T.T., and S.K.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Within the pelvis the iliac crest and ischial tuberosity display delayed ossification and fusion, thus, presenting as reliable maturity indicators. Amongst the different iliac crest and ischial tuberosity age estimation methods, the modified Kreitner-Kellinghaus stages constitute one of the more promising methods. The present study was directed towards establishing the applicability of the modified Kreitner-Kellinghaus method using five supervised machine learning approaches. Clinical CT scans of consenting individuals were collected and scored using the modified Kreitner-Kellinghaus method for the iliac crest and ischial tuberosity, independently. Age was subsequently estimated using different machine learning models. Cumulative scores computed from both markers were additionally employed for age estimation using machine learning. For iliac crest age estimation, Random Forest and Gradient Boosting Regression furnished lowest mean absolute error (2.42 years) and root mean square error (3.06 years). For ischial tuberosity age estimation, Gradient Boosting Regression garnered the lowest computations of mean absolute error (2.60 years) and root mean square error (3.09 years). For cumulative score based age estimation, Support Vector Regression and Gradient Boosting Regression yielded lowest mean absolute error (2.48 years) and root mean square error (3.07 years). Obtained error computations indicate that the iliac crest is a more accurate age marker in comparison to the ischial tuberosity. Additionally, cumulative score-based approaches garnered similar/ marginally more precise results in comparison to the iliac crest with all five models. This marginal improvement is not sufficient to justify employing the relatively more complicated cumulative score-based approach for age estimation. Hence, whenever available, the iliac crest should be preferred over the ischial tuberosity/ cumulative score-based approaches for age estimation.

Background: In this study, we investigated the area that can be addressed with an approach in which the skin incision is made directly above the dorsal column with Thiel cadaveric specimens., Methods: Six Thiel cadaveric specimens were prepared. A skin incision was made directly above the dorsal column. The accessible proximal end from the proximal part of the greater sciatic notch to the gluteal ridge and the accessible distal end of the ischium were marked with a flat chisel. A molded 8-hole reconstruction plate was placed from the base of the ischium toward the gluteal ridge and fixed with 3 screws proximally and 2 screws distally. The length of the skin incision and the distance from each reference point on the bone to the reachable markings were assessed after the muscles were removed., Results: Mean skin incision length was 9.3 ± 0.7 (range, 8.0-10.0) cm. In 3 of 6 cases, proximal screws were inserted through different spaces between muscle fibers. In all cases, we were able to reach at least the greater sciatic notch, the gluteal ridge at the level of superior border of the acetabulum, and the base of the ischial tuberosity. In all cases, an 8-hole plate could be placed from the gluteal ridge to the base of the ischium. There were no superior gluteal artery or sciatic nerve injuries in any of the cases., Conclusion: We anatomically investigated the area that can be addressed with an approach in which the skin incision was made directly above the dorsal column. In all cases, we were able to access the areas needed to reduce the fracture and place the plates necessary to stabilize the fracture through a 9.3 ± 0.7 cm skin incision. This approach can be a useful minimally invasive posterior approach for acetabular fractures., Competing Interests: Declaration of competing interest DePuy Synthes lent us the surgical instruments needed to perform the dissection., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

We present a detailed anatomy of the pectoral girdles, pelvic girdles, and hindlimbs of adult and juvenile specimens of Pseudopus apodus (Pallas, 1775). We compared the individual bones of the appendicular skeleton of P. apodus with those of Anguis fragilis and species of Ophisaurus living in North America, North Africa, and Southeast Asia. We found no anatomical features in P. apodus in common with the species of Ophisaurus living in only North America, North Africa, and Southeast Asia. Additionally, we present the prehatching ontogeny of the pelvic girdle of P. apodus and A. fragilis and the prehatching ontogeny of the hindlimb of P. apodus. In the ontogeny of the pelvic girdle of P. apodus, it is possible to distinguish the ossification centers of ilium, ischium, and pubis. In contrast, in the ontogeny of A. fragilis, no ossification centers of ilium, ischium, and pubis are present, and no hindlimb element was detected. In Stage 1 of ontogeny in Pseudopus, the femur and tibia are present; in Stage 2, the nodule representing the fibula appears; and in Stage 3, in addition to the femur, tibia, and fibula, four tarsal elements are present. This anatomical condition corresponds to the anatomical composition of the hindlimb of the adult O. koellikeri. In Stage 4, the involution of all tarsal elements and fibula begins, and in the last two prehatching stages, only femur and tibia remain; this condition is present not only in the adults of Pseudopus, but also in those of several other species of Ophisaurus., (© 2021 American Association for Anatomy.)

Objective: To compare comfort and functional performance of the Northwestern University Flexible Subischial Vacuum (NU-FlexSIV) Socket with the ischial containment (IC) socket in persons with unilateral transfemoral amputation., Design: Randomized crossover trial with two 7-week periods., Setting: Private prosthetic clinics and university research laboratory., Participants: A total of 30 enrolled (N=30); 25 participants completed the study with full (n=18) or partial data (n=7)., Interventions: Two custom-fabricated sockets (IC and NU-FlexSIV), worn full-time for 7 weeks, with testing at 1, 4, and 7 weeks after socket delivery., Main Outcome Measures: The primary outcome was change in Socket Comfort Score (SCS) at 7 weeks. Secondary outcomes at 7 weeks included the Orthotic and Prosthetic Users' Survey (OPUS) to assess lower extremity functional status, health-related quality of life, and satisfaction with device, as well as the 5-Times Rapid Sit-to-Stand Test, Four Square Step Test, and T-Test of Agility to assess functional performance., Results: At 7 weeks, the mean SCS for IC (7.0±1.7) and NU-FlexSIV (8.4±1.1) Sockets were significantly different (P<.001; 95% confidence interval, 0.8-2.3). Results from a linear mixed-effects model, accounting for data from all time points, indicated that the SCS was 1.7 (SE=0.45) points higher for the NU-FlexSIV Socket (P<.001). For the secondary outcomes, only OPUS satisfaction with device was significantly better in the NU-FlexSIV Socket after accounting for all data points., Conclusions: The results suggest that after 7 weeks' accommodation, the NU-FlexSIV Socket was more comfortable and led to greater satisfaction with device than the IC socket in persons with unilateral transfemoral amputation and K3/K4 mobility. Other patient-reported outcomes and function were no different between sockets., (Copyright © 2021 The American Congress of Rehabilitation Medicine. All rights reserved.)

Purpose: The gluteal region is a key element of beauty balance and sexual appearance. However, there is no clear anatomical description of the infragluteal fold, nor any classification exists allowing standardizing treatment of this area in case of jeopardisation. The purpose of this study was to perform an anatomical description of the infragluteal fold (IGF) matching radiological and anatomical findings in describing specifically raise of the fibrous component at the bone level., Methods: Six volunteers (three males and three females) underwent an MRI scan (Siemens Aera® 1.5 T) of the pelvic region. T1 Vibe Morpho T2, Sag Space 3D, and Millimetric slices were performed in order to obtain a more detailed selection of the gluteal landmark. Trabecular connective tissue of the region was analyzed using Horos® ROI (region of interest) segmentation function. Four fresh cadavers (two males, two females, accounting for 8 hemipelvis) were dissected in order to compare the radiological findings., Results: The infragluteal fold is a connectival fibrous band extending from the ramus of the ischium (but not involving the ischial tuberosity, for a length of 21 mm ± 2 and 21 mm ± 3), the apex of the sacrum (for a length of 13 ± 2 and 11 mm ± 2), and the coccyx (for a length of 19 mm ± 2 and 20 mm ± 2, all measures referring to volunteers and cadavers, respectively) reaching superficially the dermis of the medial one-third of the cutaneous fold. No significant difference was found between volunteer and cadaver group in MRI measurement of bony origins, or between MRI and cadaveric dissection measurements., Conclusion: Knowledge of this structure will define novel surgical techniques in infragluteal fold restoration., (© 2021. Springer-Verlag France SAS, part of Springer Nature.)

The developmental patterns of the pelvic epiphyses are one of the anatomical markers used in the assessment of skeletal age and the legally relevant age threshold. In this study, four regression models and five classification models were developed for forensic age estimation and the determination of the 18-year threshold, respectively. A total of 2137 conventional pelvic radiographs (1215 males and 922 females) aged 10.00-25.99 years were analyzed, and the ossification and fusion of the iliac crest and ischial tuberosity epiphyses were scored separately. The epiphyses on both sides were used as inputs for all models. The accuracy of the regression models was compared using the mean absolute error (MAE) and root mean square error. The percentages of correct classifications were evaluated for the determination of the 18-year threshold. Support vector regression (SVR) and gradient boosting regression (GBR) showed higher accuracy for age estimation in both sexes. The lowest MAE was 1.38 years in males when using SVR and 1.16 years in females when using GBR. In the demarcation of minors and adults, the percentage of correct classification was over 92%, and the area under the receiver operating characteristic curves was over 0.91 in all models, except the Bernoulli naive Bayes classifier. This study demonstrated that the present models may be helpful for age estimation and the determination of the 18-year threshold. However, owing to the high effective dose of ionizing radiation used during conventional radiography of the pelvis, it is expected that these models will be tested with pelvic MRI for age estimation., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Assessment of pelvic configuration is an important factor in the prediction of a successful vaginal birth. However, manual evaluation of the pelvis is practically a vanishing art, and imaging techniques are not available as a real-time bed-side tool. Unlike the obstetrical conjugate diameter (OC) and inter spinous diameter (ISD), the pubic arch angle (PAA) can be easily measured by transperineal ultrasound. Objectives: Three-dimensional computed tomography bone reconstructions were used to measure the three main birth canal diameters, evaluate the correlation between them, and establish the normal reference range for the inlet, mid-, and pelvic outlet. Study design: Measurements of the PAA, obstetric conjugate (OC), and ISD were performed offline using three-dimensional post processing reconstruction in bone algorithm application of the pelvis on examinations performed for suspected renal colic in nonpregnant reproductive age woman. The mean of two measurements was used for statistical analysis which included reproducibility of measurements, regression curve estimation between PAA, OC, and ISD, and calculation of the respective reference range centiles for each PAA degree. Results: Two hundred ninety-eight women comprised the study group. The mean ± SD of the PAA, ISD, and OC were 104.9° (±7.4), 103.8 mm (±7.3), and 129.9 mm (±8.3), respectively. The intra- and interobserver agreement defined by the intraclass correlation coefficient (ICC) was excellent for all parameters (range 0.905-0.993). A significant positive correlation was found between PAA and ISD and between PAA and OCD (Pearson's correlation = 0.373 ( p  < .001), and 0.163 ( p  = .022), respectively). The best regression formula was found with quadratic regression for inter spinous diameter (ISD): 34.122778 + (0.962182*PAA - 0.002830*PAA 2 ), and linear regression for obstetric conjugate (OC): 110.638397 + 0.183156*PAA. Modeled mean, SD, and reference centiles of the ISD and OCD were calculated using the above regression models as function of the PAA. Conclusions: We report significant correlation between the three pelvic landmarks with greatest impact on the prediction of a successful vaginal delivery: the PAA which is easily measured sonographically and the ISD and OC which are not measurable by ultrasound. This correlation may serve as a basis for future studies to assess its utility and prognostic value for a safe vaginal delivery.

Flaring of the ischiopubic synchondrosis at the time of fusion is a common clinical observation in pediatrics and represents a normal physiological process in skeletal maturation. When presenting unilaterally, this flaring can mimic a range of serious pathological conditions such as osteomyelitis, osteal tumors, and traumatic injury. An improved understanding of ischiopubic synchondrosis fusion is therefore critical to avoid potential misdiagnosis. Retrospective multi-slice computed tomography pelvic scans of Australian individuals aged neonate to 24 years (n = 184) were assessed using a novel five stage morphological classification system of the maturation and fusion of the ischiopubic synchondrosis. Maturation scoring was conducted using both multiplanar formatting views and volume-rendered reconstructions in OsiriX™. Maturational stage was strongly related to age (P < 0.001) with fusion of the ischiopubic synchondrosis observed between the ages of 4 and 9 years in females and 7 and 13 years for males. The highest probability of fusion in our Queensland Australian population based on multinomial regression predictive modeling was between 7 and 10 years of age. We documented three variants of fusion: pubic and ischial outgrowths, appearance of a secondary ossification center, and a fusiform-shaped enlargement. This study provides the first predictive modeling of the timing of fusion of the ischiopubic synchondrosis using a reliable morphological classification system. The significant variation in timing and progression of fusion of the ischiopubic synchondrosis reported in this study, will aid in minimizing misdiagnosis and unnecessary treatment in children presenting with asymmetrical or delayed ischiopubic synchondrosis anomalies. Clin. Anat. 32:851-859, 2019. © 2019 Wiley Periodicals, Inc., (© 2019 Wiley Periodicals, Inc.)

The objectives were 1) to design and produce two novel unpadded bicycle saddles with a wide/medium width and partial nose cutout; 2) to investigate the responses on pressure distribution and perceived discomfort in female cyclists. For comparison, a standard saddle was also tested. Nineteen female cyclists pedaled on an ergometer cycle for 20 min with each saddle in a counterbalanced order. A pressure mat measured saddle interface pressure. Discomfort ratings were collected using a visual analogue scale. Total mean saddle pressure remained similar across saddles. The wide saddle increased anterior and decreased posterior mean saddle pressure as compared with the standard (p < .002) and the medium saddle (p < .001). Significantly increased ischial tuberosity discomfort was found for the novel saddles (p < .001), while crotch discomfort was not significantly different between saddles. The medium width saddle appeared to be the best compromise since increased crotch discomfort was avoided and saddle pressures were redistributed. Such design may be suggested as an alternative to traditional saddles for women reporting discomfort in the perineal region., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Sex determination of unknown individuals is one of the primary goals of Physical and Forensic Anthropology. The adult skeleton can be sexed using both morphological and metric traits on a large number of bones. The human pelvis is often used as an important element of adult sex determination. However, studies carried out about the pelvic bone in subadult individuals present several limitations due the absence of sexually dimorphic characteristics. In this study, we analyse the sexual dimorphism of the immature pubis and ischium bones, attending to their shape (Procrustes residuals) and size (centroid size), using an identified sample of subadult individuals composed of 58 individuals for the pubis and 83 for the ischium, aged between birth and 1year of life, from the Granada osteological collection of identified infants (Granada, Spain). Geometric morphometric methods and discriminant analysis were applied to this study. The results of intra- and inter-observer error showed good and excellent agreement in the location of coordinates of landmarks and semilandmarks, respectively. Principal component analysis performed on shape and size variables showed superposition of the two sexes, suggesting a low degree of sexual dimorphism. Canonical variable analysis did not show significant changes between the male and female shapes. As a consequence, discriminant analysis with leave-one-out cross validation provided low classification accuracy. The results suggested a low degree of sexual dimorphism supported by significant sexual dimorphism in the subadult sample and poor cross-validated classification accuracy. The inclusion of centroid size as a discriminant variable does not imply a significant improvement in the results of the analysis. The similarities found between the sexes prevent consideration of pubic and ischial morphology as a sex estimator in early stages of development. The authors suggest extending this study by analysing the different trajectories of shape and size in later ontogeny between males and females., (Copyright © 2018 Elsevier B.V. All rights reserved.)

The location of perianal abscesses and the course of the fistula follow certain patterns, especially in the relationship between external and internal openings. However, it is still not clear how the contents of the ischioanal fossa, especially the fibrous network of fat tissue, affect the route for such diseases. Ten male adult cadavers were selected for the study. Seven horizontal transverse section planes from 1 cm above the pubic symphysis to the inferior border of the lesser trochanter of the femur were recorded after P45 sheet plastination. We observed characteristics of fiber distribution in the ischioanal fossa and its relationship with surrounding structures in every plane. There was a dense strip-type fiber connecting with junction fascia between the obturator internus and gluteus maximus muscles. Close to the levator ani, obturator internus, and gluteus maximus, the fibers were very dense and continuous with the fascia on the surfaces of these three muscles. The function of the fibrous network was considered to be not only the support of fat tissue in the fossa but also cushioning during physiological actions such as defecation. We hope that these morphological results could help to elucidate the passage of fistulae and the locations susceptible to perianal abscesses. Clin. Anat. 30:1029-1033, 2017. © 2017 Wiley Periodicals, Inc., (© 2017 Wiley Periodicals, Inc.)

Human ischia contrast with those of great apes in being craniocaudally short and dorsally projecting. This configuration is thought to facilitate greater hip extension in humans during bipedal locomotion. This link has been used to infer kinematics in early hominins, but the consequences of variation in ischial configuration for gait remain uncertain. Kinematic data for a limited sample of extant nonhuman primates demonstrate that there is variation in hip extension in these taxa during bipedal behaviors-specifically, Hylobates and Ateles are capable of greater extension than Pan and Macaca. In this study, we tested the hypothesis that ischial length and orientation are functionally linked with hip extension during bipedalism among these taxa. As expected, humans have the shortest ischia, followed by gibbons, spider monkeys, chimpanzees, and macaques. Our predictions for ischial orientation are not supported, however: macaques, gibbons, and spider monkeys do not vary in this trait, and they have ischia that are less dorsally angled than that of the chimpanzee. The results for ischium length provide limited support for the idea that the early hominin Ardipithecus ramidus, with its long, caudally oriented ischium was not capable of humanlike extended-hip bipedalism, and that the ischial shortening observed in post-Ardipithecus hominins reflects a shift toward a more humanlike gait. In contrast, while our results do not necessarily refute a link between ischial orientation and hip extension in hominins, they do not provide comparative support, making changes in ischial orientation in this part of the fossil record more difficult to interpret. Anat Rec, 300:845-858, 2017. © 2017 Wiley Periodicals, Inc., (© 2017 Wiley Periodicals, Inc.)

Introduction and Hypothesis: To describe the relationships between pelvic bony landmarks to points along the third sacral nerve and to uterosacral ligament suspension sutures., Methods: Three transvaginal uterosacral ligament suspension sutures were placed bilaterally in unembalmed female human cadavers. The third sacral nerve was marked at the foramen (S3a) and at two additional points at 1-cm intervals along its course caudally (S3b, S3c). Three bony pelvic landmarks were identified and marked, including the ischial spine, pubic symphysis, and coccyx. Distances from each landmark to each suture and nerve point were measured. The distance from each landmark to each S3 nerve point was extended radially, encompassing an arbitrary zone in which sutures may be placed and thus where nerve injury may occur. Zones of potential nerve injury included: zone A (closest to the sacral nerve root), zone B, and zone C (closest to the landmark). Descriptive statistics were used and comparisons were made using Student's t test and ANOVA., Results: Ten cadaver specimens were dissected. For the ischial spine, the distances to points S3a, S3b, and S3c were 6.3, 5.4, and 4.6 cm respectively. Approximately two thirds of the sutures were noted beyond zone C, indicating a potentially increased risk of nerve injury with suture placement in zones farthest from the ischial spine given their proximity to the sacral nerve., Conclusions: Using the ischial spine as a landmark, increased sacral nerve injury could result from suture placement beyond the mean distance of 4.6 cm from the ischial spine. The use of bony landmarks in avoiding sacral nerve injury may be as important as suture depth and angle of suture placement.

Objective: To analyze the anatomical relationship between the pubic symphysis and the ischial spines to determine reliable landmarks for the assessment of fetal head descent by intrapartum translabial ultrasound (ITU)., Methods: All computed tomography (CT) scans performed for breech presentation and for twin delivery between 2006 and 2014 in a tertiary university hospital were obtained for measurement and analysis by two operators. The symphysis-left ischial spine angle (SIA) and the symphysis-left ischial spine distance (SID) were measured on three-dimensional reconstructions from the CT volume dataset. We calculated intra- and interobserver agreements for SIA and SID with 95% prediction intervals, created Bland-Altman plots with 95% limits of agreement and estimated the intraclass correlation coefficient (ICC). A sagittal plane projection from the SIA enabled calculation of a sagittal angle, corresponding to the angle of progression (AoP) on ITU., Results: SIA and SID were obtained from CT images from 458 women. Reproducibility was good for both SIA (intraobserver ICC, 0.94 (95% CI, 0.88-0.97) and interobserver ICC, 0.81 (95% CI, 0.66-0.92)) and SID (intraobserver ICC, 0.92 (95% CI, 0.82-0.97) and interobserver ICC, 0.83 (95% CI, 0.73-0.92)). The median SIA was 106° (interquartile range (IQR), 105-109°) and median SID was 26.1 (IQR, 23.4-29.5) mm. SIA and SID were not correlated with pelvic diameter or height. The 50 th percentile of AoP was 110°., Conclusion: Knowledge of the anatomical relationship between the pubic symphysis and ischial spines makes it possible to establish a sonographic method for assesssing fetal head descent by taking into account the level of the ischial spines. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd., (Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.)

Characterizing australopith pelvic morphology has been difficult in part because of limited fossilized pelvic material. Here, we reassess the morphology of an under-studied adult right ilium and pubis (Sts 65) from Member 4 of Sterkfontein, South Africa, and provide a hypothetical digital reconstruction of its overall pelvic morphology. The small size of the pelvis, presence of a preauricular sulcus, and shape of the sciatic notch allow us to agree with past interpretations that Sts 65 likely belonged to a female. The morphology of the iliac pillar, while not as substantial as in Homo, is more robust than in A.L. 288-1 and Sts 14. We created a reconstruction of the pelvis by digitally articulating the Sts 65 right ilium and a mirrored copy of the left ilium with the Sts 14 sacrum in Autodesk Maya. Points along the arcuate line were used to orient the ilia to the sacrum. This reconstruction of the Sts 65 pelvis looks much like a "classic" australopith pelvis, with laterally flared ilia and an inferiorly deflected pubis. An analysis of the obstetric dimensions from our reconstruction shows similarity to other australopiths, a likely transverse or oblique entrance of the neonatal cranium into the pelvic inlet, and a cephalopelvic ratio similar to that found in humans today., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

The partial skeleton of a leptoceratopsid dinosaur, Ischioceratops zhuchengensis gen. et sp. nov., was excavated from the bone-beds of the Upper Cretaceous Wangshi Group of Zhucheng, Shandong Province, China. This fossil represents the second leptoceratopsid dinosaur specimen recovered from the Kugou locality, a highly productive site in Zhucheng. The ischium of the new taxon is morphologically unique among known Dinosauria, flaring gradually to form an obturator process in its middle portion and resembling the shaft of a recurve bow. An elliptical fenestra perforates the obturator process, and the distal end of the shaft forms an axehead-shaped expansion. The discovery of Ischioceratops increases the known taxonomic diversity and morphological disparity of the Leptoceratopsidae.

Purpose: The current study was undertaken to better define the gross anatomical and dimensional characteristics of the proximal hamstring origin., Methods: Twelve paired whole-lower extremities from six embalmed cadavers were dissected. The gross anatomy of the proximal hamstrings was studied. With the tendons attached to the ischial tuberosity, the width and thickness of each tendon was measured 1 cm distally to their origin, and the distance from the most proximal border of the common origin of the semitendinosus (ST) and long head of the biceps (LB) to their distal junction was assessed. After removal of the hamstring group, the shape, orientation, and dimension of the tendon footprints were determined., Results: One cadaver demonstrated unique anatomy, which was considered as an anatomic variant and was therefore excluded from the study group. The ST and LB had a common origin on the posterolateral aspect of the ischial tuberosity (ST/LB), whereas the semimembranosus (SM) had a separated origin at the anterolateral aspect. The mean distance from the most proximal border of the ST/LB origin to the distal junction was 10.0 ± 1.3 cm. The shape of both footprints was longitudinal-oval, with the longitudinal axes of the SM and ST/LB footprints parallel aligned. Mean tendon width was 3.4 ± 0.5 cm for the common ST/LB complex and 4.2 ± 0.9 cm for the SM (p = 0.009). The corresponding values for tendon thickness were 1.0 ± 0.3 cm (ST/LB) and 0.8 ± 0.2 cm (SM), respectively (n.s.). Mean footprint length was 3.9 ± 0.4 cm for ST/LB and 4.5 ± 0.5 cm for SM (p = 0.002). The corresponding values for footprint height were 1.4 ± 0.5 cm (ST/LB) and 1.2 ± 0.3 cm (SM), respectively (n.s.)., Conclusion: The ST and LB had a common origin, whereas the SM originated separately. The site of origin of both tendons was the lateral aspect of the ischial tuberosity, with the SM footprint lying directly anterior to the footprint of the ST/LB complex. The footprint of the SM was significantly wider than the footprint of the ST/LB. The reported gross anatomic findings and dimensions may aid surgeons in anchor placement at the anatomical attachment site, thereby facilitating anatomic hamstring repair. In addition, the provided data may improve diagnosis and conservative treatment of proximal hamstring tendinopathy, since detailed knowledge about the normal anatomy is crucial for recognizing tendon abnormalities and for several conservative treatment modalities such as shockwave application or ultrasound-guided injections.

Objective: To evaluate morphological structure of uterosacral ligament (USL) and cardinal ligament (CL) in patients with severe pelvic organ prolapse (POP) by MRI technology, and to analysis and discuss its clinical significance., Methods: From November 2013 to February 2014 in Peking University People's Hospital, 26 elderly patients with III-IV degree of POP were selected as the POP group and 18 healthy elderly volunteers were selected as the control group during the same period. Pelvic MRI examination were performed in the two groups. The morphological characteristics of left and right side of the uterosacral-cardinal ligament on MRI and the attachment site of the starting and ending points between two group were described and compared., Results: In POP group, 25 cases of left USL starting point were located in the sacrospinous ligament/coccygeal muscle complex [58% (15/26)] or coccygeal muscle [38% (10/26)], ending point were located in the cervix and vagina [58% (15/26)] or cervix [38% (10/26)]; 24 cases of right USL starting point were located in the sacrospinous ligament/coccygeal muscle complex [31% (8/26)] or coccygeal muscle [62% (16/26)], 26 cases of right USL ending point were located in the cervix and vagina [62% (16/26)] or cervix [38% (10/26)]; the left and right CL in the POP group and the control group were both from the sacroiliac joint at the top of the greater sciatic foramen from the ipsilateral pelvic side wall; 1 case (4%, 1/26) of left CL in the POP group completely connected to the bladder, 10 cases (38%, 10/26) partly connected to the bladder; 14 cases (54%, 14/26) of right CL partly connected to the bladder, the rest ending points of left and right CL were located in cervix and (or) vagina. In the control group, 17 cases of left USL starting point were located in the sacrospinous ligament/coccygeal muscle complex (10/18) or coccygeal muscle (7/18), ending point were located in the cervix and vagina (12/18) or cervix (6/18); 18 cases of right USL starting point were located in the sacrospinous ligament/coccygeal muscle complex (10/18) or coccygeal muscle (8/18), ending point were located in the cervix and vagina (13/18) or cervix (5/18); 8 cases (8/18) of left CL partly connected to the bladder; 15 cases (15/18) of right CL partly connected to the bladder, the rest ending points of left and right CL were located in cervix and (or) vagina. There was no significant difference between the two groups on the starting and ending points (P > 0.05)., Conclusions: The observation of MRI could be consistent with the clinical anatomy on the starting and ending points, direction of travel in the uterosacral-cardinal ligament. The starting and ending points of the left and right side USL and the ending points of the left and right side CL are not completely symmetrical, the variation degree is large, some CL could be completely or partly inserted to the bladder.

Purpose: Proximal hamstring tears represent a challenge. Surgical repair of such tears has been reported utilizing both open and endoscopic techniques. It was hypothesized that the proximal attachments of the hamstring muscle group could be reproducibly and consistently measured from pertinent bony anatomical reference landmarks., Methods: Fourteen fresh-frozen, human cadaveric specimens were dissected, and measurements were taken regarding the proximal attachments of the hamstring muscle group in reference to bony landmarks. A highly precise coordinate measuring device was used for three-dimensional measurements of tendon footprints and bony landmarks, and relevant distances between structures were calculated., Results: The semitendinosus and long head of the biceps femoris shared a proximal origin (conjoined tendon), having an oval footprint with an average area of 567.0 mm(2) [95 % CI 481.0-652.9]. The semimembranosus (SM) footprint was crescent-shaped and located anterolateral to the conjoined tendon, with an average area of 412.4 mm(2) [95 % CI 371.0-453.8]. The SM footprint had an accessory tendinous extension that extended anteromedially forming a distinct footprint. A consistent bony landmark was found at the medial ischial margin, 14.6 mm [95 % CI 12.7-16.5] from the centre of the conjoined tendon footprint, which coincided with the distal insertion of the sacrotuberous ligament., Conclusion: The conjoined tendon was the largest attachment of the proximal hamstring group. Two other distinct attachment footprints were identified as the SM footprint and the accessory tendinous extension. The sacrotuberous ligament insertion served as a bony landmark. The anatomical data established in this study may aid in better restoring the anatomy during repair of proximal hamstring tears.

Purpose: To define the topographic anatomy of the footprint of the hamstrings origin on the ischium., Methods: Dissection of the hamstrings origin in 6 cadaveric pelvises was performed. The hamstrings origin was isolated with sharp dissection, and it was noted whether the semimembranosus had a separate attachment or whether there was one confluent tendon attached at the footprint. The common hamstrings tendon was then sharply dissected from the ischium, and the footprint was outlined with surgical marker followed by radiopaque paint. Paint was prepared by mixing 0.25 g Daler-Rowney acrylic artists ink scarlet no. 567 (Daler-Rowney, Bracknell, England) per gram of EZ-HD 98% v/w barium sulfate (E-Z-EM Inc, Lake Success, NY). The paint was then applied to the area of the footprint, and the specimen underwent a 0.5-mm-slice computed tomographic (CT) scan of the pelvis with 3-dimensional (3D) reconstructions. Vitrea (Vital Images, Minnetonka, MN) software was used to determine the surface area of the ligament footprint as well as the distance from the ischial tuberosity to the center of the footprint. The thickness of the bone underlying the footprint was measured. Data are presented as means ± standard error., Results: Five of 6 specimens had a common hamstrings tendon, whereas one had a separate attachment for the semimembranosus. The semimembranosus joined the common hamstrings tendon 2.33 ± 0.61 cm distal to the footprint. The average surface area of the hamstrings footprint measured 10.19 ± 0.75 cm(2). The distance from the tip of the ischial tuberosity to the center of the hamstrings footprint measured 3.73 ± 0.22 cm. The average thickness of the bone deep to the footprint was 3.77 ± 0.9 cm., Conclusions: This study provides a topographic description of the origin of the hamstrings footprint and may assist surgeons in performing anatomic reattachment of this tendon., Clinical Relevance: Our data will assist surgeons in performing anatomic repair of proximal hamstrings avulsions., (Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

The iliofemoral, pubofemoral, and ischiofemoral ligaments are major structures that stabilize the hip joint. We have sought evidence on which to base more effective hip stretching positions. The purpose of this study was to measure strains on these ligaments and to observe them. Eight fresh/frozen translumbar cadaver specimens were used. Clinically available stretching positions for these ligaments were adopted. Strain on each ligament was measured by a displacement sensor during passive torque to the hip joint. Hip motion was measured using an electromagnetic tracking device. The strained ligaments were captured on clear photographs. Significantly, high strains were imposed on the superior iliofemoral ligament by external rotation of the hip (3.48%); on the inferior iliofemoral ligament by maximal extension and 10° or 20° of external rotation with maximal extension (1.86%, 1.46%, 1.25%); on the pubofemoral ligament by maximal abduction and 10°, 20°, or 30° of external rotation with maximal abduction (3.18%, 3.28%, 3.11%, 2.99%); and on the ischiofemoral ligament by 10° or 20° of abduction with maximal internal rotation (7.11%, 7.83%). Fiber direction in each ligament was clearly identified. Significantly, high strains on hip ligaments corresponded with the anatomical direction of the ligament fibers. Positions were identified for each ligament that imposed maximal increase in strain on it., (© 2014 Wiley Periodicals, Inc.)

A new ankylosaurid, Chuanqilong chaoyangensis gen. et sp. nov., is described here based on a nearly complete skeleton from the Lower Cretaceous Jiufotang Formation of Baishizui Village, Lingyuan City, Liaoning Province, China. Chuanqilong chaoyangensis can be diagnosed on the basis of two autapomorphies (glenoid fossa for quadrate at same level as the dentary tooth row; distally tapering ischium with constricted midshaft) and also a unique combination of character states (slender, wedge-like lacrimal; long retroarticular process; humerus with strongly expanded proximal end; ratio of humerus to femur length  = 0.88). Although a phylogenetic analysis places Chuanqilong chaoyangensis as the sister taxon of the sympatric Liaoningosaurus near the base of the Ankylosauridae, the two taxa can be distinguished on the basis of many features, such as tooth morphology and ischial shape, which are not ontogeny-related. Chuanqilong chaoyangensis represents the fourth ankylosaurid species reported from the Cretaceous of Liaoning, China, suggesting a relatively high diversity in Cretaceous Liaoning.

Objective: The aim of this study was to determine whether the ratio between the femoral head diameter and pelvic height in a Chinese population is the same as that found in Westerners., Materials and Methods: Standard pelvic radiography was performed on a group of 187 Chinese adult subjects consisting of 81 males and 106 females with a mean age of 40 years (21-68 years). Femoral head diameter (vertical distance from the femoral head-neck junction to the highest point of the femoral head) and pelvic height (vertical distance from the highest point of the iliac crest to the edge of the ischial tuberosities) were measured., Results: There were significant differences between males and females (p < 0.001), and between persons of high height versus low height (p = 0.011) and medium height (p = 0.039). There were no significant differences between persons of different age (p = 0.244), body mass index (p = 0.091), or between persons of low- and medium-height groups (p = 0.69). The overall mean ratio between the femoral head diameter and pelvic height was 0.215 (0.173-0.249) with a 95 % CI = 0.214-0.217. The mean ratios in males and females were 0.221 (0.194-0.249) and 0.211 (0.173-0.238), respectively., Conclusion: The mean ratio in Chinese population was similar to the reported ratio in a western population (about 1:5). We suggest that Chinese surgeons may be able to use the Crowe classification to classify patients with hip dysplasia.

Background: Great emphasis is placed on the skeletal medio-lateral to maintain the normal adduction of the remnant femur and to ensure coronal plane stability in an ischial containment socket. Given the invasiveness of the skeletal medio-lateral measurement, an alternative approach using prediction based on non-invasive measures would be welcomed., Objectives: Determine the accuracy with which the skeletal medio-lateral dimension could be predicted using sex, stature, anterior-posterior dimension and iliofemoral angle., Study Design: Cross-sectional., Method: Anthropometric measurements on 77 persons were recorded and used as input data into a standard multiple regression., Results: The regression model explained 59% of the variance in skeletal medio-lateral (r(2) = 0.59) that was statistically significant (F(4,72) = 25.37, p = 0.000). Only sex contributed significantly to the prediction of skeletal medio-lateral (β = 0.67, t = 6.15, p = 0.00). The degree of error associated with the regression model (sum of squared errors = 0.009) indicated that the actual skeletal medio-lateral could be predicted within ±18 mm in 95% of the cases., Conclusion: The regression model is not sufficiently accurate to predict skeletal medio-lateral for clinical purposes. Accuracy of the prediction could be improved with more accurate input data from computed tomography scans and use of other independent variables that explain the unique variance not already described by the participants' sex. Clinical relevance This pilot study demonstrates potential for the skeletal medio-lateral to be predicted using non-invasive anthropometric measurements. Given this proof of concept, future investigators should use more accurate input data from computed tomography scans and identify alternative independent variables that explain the variance in the skeletal medio-lateral not attributable to sex.

There is little information about the age at which the ischiopubic ramus fuses derived from dry bone observations. This study documents the age ranges for union of the ischiopubic ramus in a sample of 148 known sex and age skeletons from Portugal, with ages ranging from birth to 20 years, using a three-stage scheme. The oldest female with an unfused ramus is 11 years old and the oldest male is 8 years old. The youngest male with a completely fused ramus is 7 years old, and the youngest female is 5 years old. Despite the relatively large sample size, partial fusion was a rare event to record as only two individuals were at this stage and these seemed relatively older than expected (12 and 14 years of age). The likely age interval for partial union of the ramus was subsequently estimated from logistic regression, for both sexes separated and combined. In the sex-pooled sample, the inter-quartile range (25th-75th percentile) for the median age of fusion is 7-11 years and the 10th-90th percentile range is 4-15 years. The scarcity of data on the age of ischiopubic fusion may be related to biases in the sample or to fusion occurring rapidly in this anatomical location. Additional studies may be required to assess the accuracy of the ages reported here, but at present this study provides the most comprehensive assessment of timing of fusion at the ischiopubic ramus from observations of dry bone specimens., (Copyright © 2013 Elsevier GmbH. All rights reserved.)

Introduction and Aim: The investigation of new anatomical criteria and revalidation of existing ones in sex determination for different populations are among main research foci of forensic anthropometry. In that context, the pelvis is the most extensively studied bone. A number of qualitative classifications, dimensional measurements and indices have been proposed for investigative anthropometry and forensic studies. Independent use of these parameters generally provided an accuracy rate of 70-75%. In this study, the accuracy rate of the subpubic angle in sex determination was investigated in living Anatolian Caucasians., Material and Method: The subpubic angle was identified and measured on three-dimensional computed tomographic images of pelves. Data were obtained using 64-detector computed tomography (MDCT) with an isotrophic resolution of 500 μm. The sample included 66 males (41.6 ± 14.9 years of age) and 43 females (41.1 ± 14.2 years of age). Measurements were taken on a dedicated three-dimensional image analysis workstation. The subpubic angle was electronically measured. The technique and methodology was validated on a standard skeletal model. Intraobserver agreement was analyzed with intraclass correlation coefficient, and intraobserver variability was evaluated with technical error of measurement (inter- and intra-observer TEM), relative technical error of measurement (rTEM) and coefficient of reliability (R) measures. The subpubic angle for the study group and for both sexes was reported as minimum-maximum (mean ± SD). Independent-Samples T Test for equality of means was used to determine the difference between the two sexes regarding the subpubic angle. The correlation between the subpubic angle and the age of subjects were using Pearson Correlation Coefficients in males and in females. Logistic regression model was used to classify subjects according to their sex. Receiver operating characteristic curve analysis was performed to determine a cut-off value for further studies and to test the performance of the binary classification test., Results: Intraclass correlation for the subpubic angle (0.990), TEM (1082), rTEM (1.492), and R (0.990) represented almost complete reliability and accuracy of the measurement method. The subpubic angle was between 48° and 81° (65.9° ± 7.2°) in males and was between 64° and 100° (82.6° ± 7.7°) in females. Statistically significant difference was found between males and females regarding the subpubic angle (p < 0.0001). The subpubic angle was not significantly correlated with age in males (p = 0.953), or in females (r = 0.975). The accuracy of the subpubic angle in sex determination was 90.8%. With a cut-off value of 74°, sensitivity of subpubic angle to detect female phenotype was 88% and its specificity was 95%., Conclusion: The subpubic angle is an accurate parameter in sex determination with high sensitivity and specificity., (Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

This article examines the utility of the ischium-pubic index (IPI), a sexing technique that compares the lengths of pubis and ischium. The ratio was adapted by Washburn from a primate index devised by Schultz and was tested by Washburn on documented remains from the Hamann-Todd Human Osteological Collection. The IPI is used by forensic investigators, and indeed, the method is found in standard forensic textbooks and thus appears to be valid to early-stage researchers. However, its reliability has been questioned by physical anthropologists almost from its inception due to the intrinsic subjectivity of locating the base point from which both lengths are taken. In addition, at least one variation of the original technique is found in the literature, which alters the base point profoundly. To explore both the original method and the ramifications of altering the base point, in this article the IPI is calculated from os coxae recovered from the Mary Rose, a 16th-century English warship lost in a documented disaster; the sample is assumed to be from males. Using the original index, 20.4% of individuals (11 of 54) or, viewing the remains as commingled, 15.5% of individual pelves (15 of 97) were misclassified. Results with the base point shifted were disastrous: 95.5% (21 of 22) individuals and 91.4% (32 of 35) pelves were misclassified. Accuracy may be influenced by the technician's expertise; however, when the original methodology is altered, the results become meaningless. This article aims to promote more careful reading of our sources and to suggest that the IPI is not appropriate as a tool for sexing forensic remains., (Copyright © 2013 Wayne State University Press, Detroit, Michigan 48201-1309.)

Here we describe the pelvis from the holotype specimen of Pierolapithecus catalaunicus (IPS-21350), a middle Miocene (11.9 Ma [millions of years ago]) stem hominid from Barranc de Can Vila 1 in Abocador de Can Mata (Catalonia, Spain) for which a partial skeleton is preserved. This skeleton includes the oldest known great ape pelvic materials, which have implications for reconstructing the basal hominid body plan from which later hominids evolved. The P. catalaunicus pelvis is composed of a fragment from the ilium (IPS-21350.38) and one from the ischium (IPS-21350.39). Although the P. catalaunicus ischium consists of just a small fragment from the caudal acetabulum, the preserved morphology is consistent with the basal hominoid Proconsul nyanzae. The ilium is similar to Pr. nyanzae in its concave gluteal surface and linea arcuata form, which suggests much of the iliac and pubic form was primitive. However, the ilium was relatively more flaring than Pr. nyanzae and most monkeys, and could be within the range of extant lesser apes. In addition, the iliac tuberosity width was probably intermediate between extant great apes and monkeys, although maximum and minimum estimates could be accommodated within either group. The P. catalaunicus ilium reflects incipient modifications of the basal hominoid torso for the more frequent use of orthograde behaviors described for this taxon on the basis of other preserved anatomical regions, and also supports claims that extant ape pelvic morphology could be homoplastic given the hypothesized phylogenetic positions of Pierolapithecus., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: To estimate the chronological age of Han teenagers in Sichuan by the epiphyses development characteristics of iliac crest and ischial tuberosity in X-ray digital images., Methods: According to TW2 classification principle, combining with the age range of our subjects and epiphyses development regularity, the degree of epiphyses development of iliac crest and ischial tuberosity had been divided into 8 grades (0-7) and 7 grades (0-6), respectively. Based on the degrees, the pelvic X-rays digital images of 691 samples of 16-20 aged teenagers were read and statistically analyzed by SPSS 19.0 software. The multiple linear regression equation was established by skeletal age (Y), development degree of iliac crest epiphyses (X1) and ischial tuberosity epiphyses (X2)., Results: There were no statistical differences between two sides of epiphyses development of iliac crest and ischial tuberosity (P>0.05). There were no statistical difference between genders (P>0.05). The re-substitution method of the samples showed that the accuracy of equation as Y=15.269+0.444X1+0.236 X2 was high. The result of the re-substitution method showed a high accuracy of the equation., Conclusion: The multiple linear regression equation could be used to identify the skeletal age for providing the scientific basis to identify the 18-year-old Han population in Sichuan.

Objective: The aim of this study was to identify the anatomic landmarks of ischial and pubic osteotomies performed as part of Bernese periacetabular osteotomy, measure the distances of these landmarks to the main neurovascular structures and determine whether these osteotomies can be performed and visualized using a medial approach., Methods: The study included 20 hemipelvises of 10 formaldehyde-fixed cadavers. A medial surgical approach between the adductor longus and pectineus muscles was used, while protecting the obturator artery and nerve. The superior pubic ramus was subperiostally exposed to identify the anterior border of the anterior obturator tubercle and the projection point of the highest point of the obturator sulcus on the obturator crest as the two landmarks of pubic bone osteotomy. The line connecting the inferior border of the posterior obturator tubercle and the highest point of the ischial spine on the ischial bone was determined as the osteotomy line. Posterior dissection was carried out to measure the distance from the ischial osteotomy to the pudendal neurovascular structures. All measurements were performed using a digital caliper., Results: The mean distance from the obturator sulcus to the obturator nerve was 15.3 (range: 8.1 to 30.5) mm. The mean distance from the anterior obturator tubercle to the obturator nerve was 34.3 (range: 27.1 to 49.5) mm and to the obturator artery was 38.5 (range: 29.4 to 51.1) mm. The mean distance from the ischial osteotomy to the pudendal neurovascular structures was 13.6 (range: 11.2 to 17.6) mm., Conclusion: The "pubic osteotomy line" connecting the anterior obturator tubercle and obturator crest, and the inferior border of the posterior obturator tubercle (the starting point of the ischial osteotomy line) can be approached and visualized safely using a medial incision in Bernese periacetabular osteotomy.

Unlike most tetrapods, in extant crocodylians the acetabulum is formed by only two of the three skeletal elements that constitute the pelvis, the ilium, and ischium. This peculiar arrangement is further confused by various observations that suggest the crocodylian pelvis initially develops from four skeletal elements: the ilium, ischium, pubis, and a novel element, the prepubis. According to one popular historical hypothesis, in crocodylians (and many extinct archosaurs), the pubis fuses with the ischium during skeletogenesis, leaving the prepubis as a distinct element, albeit one which is excluded from the acetabulum. Whereas the notion of a distinct prepubic element was once a topic of considerable interest, it has never been properly resolved. Here, we combine data gleaned from a developmental series of Alligator mississippiensis embryos, with a revised interpretation of fossil evidence from numerous outgroups to Crocodylia. We demonstrate that the modern crocodylian pelvis is composed of only three elements: the ilium, ischium, and pubis. The reported fourth pelvic element is an unossified portion of the ischium. Interpretations of pelvic skeletal homology have featured prominently in sauropsid systematics, and the unambiguous identification of the crocodylian pubis provides an important contribution to address larger scale evolutionary questions associated with locomotion and respiration., (Copyright © 2012 Wiley Periodicals, Inc.)

The coxa of palaeognaths including extinct aepyornithid species was compared by means of osteology, computed tomography (CT) imaging and macroscopic anatomy. The pre-acetabular area of the ilium was proportionally much larger in width and height in aepyornithid species than in other extant palaeognaths. The post-acetabular area of the ilium, ischium and pubis was relatively short and bilaterally extended in aepyornithid species. Although the Aepyornis species might have produced egg with a major axis exceeding 300 mm in major axis, the short post-acetabular coxa and widely opened ischium and pubis would not have been able to stably hold the eggs in the posterior space of the pelvic cavity unlike the situation in the ostrich. As aepyornithid species resembled the kiwi in measurement ratios of length and width in the pre-acetabular area, a functional-morphological model of the coxa in the aepyornithid species can be proposed based on that of the kiwi. From our data, we suggest that the extinct species of Aepyornis and Mullerornis species effectively used the anterior space of the pelvic cavity to support their extraordinary large egg., (© 2011 Blackwell Verlag GmbH.)

Forensic anthropologists frequently use measurements of the human skeleton to determine sex and ancestry. Since the establishment of the Daubert criteria of admissibility of scientific evidence to court, methodologies used by anthropologists came under severe scrutiny. It is therefore important to ensure that the osteometric standards that are used in skeletal analyses are clearly explained, repeatable and reliable. Adams and Byrd (2002) found that measurements of the pelvis that originated from a point inside the acetabulum could not be repeated accurately. The purpose of this paper was to use three different sets of pubic and ischial measurements to establish whether they can be repeated with high precision between four different observers, and also by the observers themselves. Generally, high levels of repeatability were obtained, with intra-class correlations (ICC) above 0.8. Pubic and ischial measurements using a point in the acetabulum as origin performed the worst (ICC values of 0.82 and 0.79 respectively for inter-observer repeatability), whereas other methods performed better with ICC values above 0.9. It is advised that pubic and ischial measurements should be taken using the origin of the iliac blade as landmark., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

The fossil record of the hominin pelvis reflects important evolutionary changes in locomotion and parturition. The partial pelves of two individuals of Australopithecus sediba were reconstructed from previously reported finds and new material. These remains share some features with australopiths, such as large biacetabular diameter, small sacral and coxal joints, and long pubic rami. The specimens also share derived features with Homo, including more vertically oriented and sigmoid-shaped iliac blades, greater robusticity of the iliac body, sinusoidal anterior iliac borders, shortened ischia, and more superiorly oriented pubic rami. These derived features appear in a species with a small adult brain size, suggesting that the birthing of larger-brained babies was not driving the evolution of the pelvis at this time.

The goal of this experiment was to investigate changes in the thickness of the soft tissue overlying the ischial tuberosity (IT) due to changes in hip flexion angle and the addition of a sitting load. Eleven healthy subjects were tested. An apparatus constructed from foam blocks and an air bladder was used to position the subjects in different postures within an MRI tube. MRI images of the buttocks and thigh were obtained for four postures: Supine, 45° Hip Flexion, Non-Weight-Bearing 90° Hip-Flexion, and Weight-Bearing 90° Hip-Flexion. The thickness of muscle, adipose tissue, and skin was measured between the IT tip and skin surface, perpendicular to the cushion placed beneath the thighs. The tissue overlying the IT was found to be significantly (P < 0.001) thinner in 90° Hip-Flexion (73.8 ± 9.0 mm) than in the supine position (135.9 ± 8.1 mm). Muscle thickness decreased significantly from Supine to Non-Weight-Bearing 90° Hip-Flexion (59.1 ± 8.5%, P < 0.001), and further decreased from Non-Weight-Bearing to Weight-Bearing 90° Hip-Flexion (46.2 ± 7.9%, P < 0.001). Under Weight-Bearing 90° Hip-Flexion, the muscle tissue deformed significantly (P < 0.001) more than the adipose tissue and skin. We concluded that the tissue thickness covering the IT significantly decreased with hip flexion, and further decreased by nearly half during loading caused by sitting. In addition, the muscle tissue experienced the largest deformation during sitting. The results of this study may improve our understanding of risk factors for pressure ulcer development due to changes in tissue padding over the IT in different postures., (Copyright © 2011 Wiley-Liss, Inc.)

Introduction and Hypothesis: This study aims to introduce a new pelvic reconstructive procedure and assess its safety and efficacy., Methods: Anatomic dissection was performed on ten Chinese female cadavers. The fascia 1 cm horizontally lateral to the ischial spine was firm and strong with no major vessels or nerves in the area. Thirty-two patients with stage III uterine prolapse underwent ischial spinous fascia fixation procedure. Objective and subjective results were observed in follow-up evaluations., Results: No severe complications were observed. The objective success rate was 94% at 1-year follow-up while two patients (6.3%) showed recurrence. There were significant improvements in Aa, Ba, Ap, Bp, and C (p < 0.001) by pelvic organ prolapse quantification. Two patients suffered from lower back pain and right thigh pain, respectively, while three complained a sensation of a foreign body in the vagina., Conclusion: As a treatment of vaginal fornix prolapse, ischial spinous fascia fixation is found to be safe and efficacious.

Background: Blockade of the sciatic nerve is necessary for complete analgesia of the lower extremity using peripheral nerve blocks. We identified the sciatic nerve in relation to the ischial tuberosity in fresh cadaver dissections as well as in patients to compare sciatic nerve blockade using the conventional approach versus our experimental approach. Specifically, we tested the hypothesis that in patients in the prone position, our novel approach (changing the point of needle insertion to 3 cm lateral from the ischial tuberosity) requires fewer needle passes and less time., Methods: The location of the sciatic nerve in relation to the ischial tuberosity was identified in 20 cadavers; this information was used to devise an alternative approach to the sciatic nerve. In a randomized, controlled, crossover patient study, we compared a prone subgluteal approach (conventional approach, n = 19) with an experimental approach with the insertion point 3 cm lateral to the midpoint of ischial tuberosity with patients in prone position (n = 20). We recorded the number of passes and the time taken to obtain an initial sciatic nerve twitch at a current of 1.5 mA and a twitch at <0.5 mA., Results: The sciatic nerve averaged 2.8 +/- 0.4 cm from the midpoint of ischial tuberosity in cadavers in prone position. When needles were inserted from surface landmarks, those inserted through the experimental insertion point consistently transected the sciatic nerve. In contrast, needles inserted through the conventional approach were 2.27 +/- 0.47 cm lateral to the sciatic nerve. Clinically, our experimental approach required fewer passes to obtain a sciatic nerve twitch than the conventional approach. We were unable to obtain a twitch in 55% of patients with the conventional approach and converted them to the experimental approach. In patients originally assigned to the experimental approach and those switched to the experimental approach after failure with the conventional approach, we obtained the first sciatic nerve twitch in 1 pass in 45% of the patients and in 3 passes in 85%., Conclusions: We describe a landmark that is more effective for identifying the location of the sciatic nerve than that used for the prone subgluteal approach.

Introduction and Hypothesis: An anatomical study on fresh cadavers was done to determine the vulnerability of the dorsal nerve of the clitoris to injury during "outside-in" transobturator sling procedures., Methods: The dorsal nerve of the clitoris was identified bilaterally in ten fresh cadavers. Transfixing needles marked the inferomedial border of the obturator foramen. The distance between the foramen border and the nerve was measured., Results: The nerve ran medially in close approximation to the ischiopubic ramus and inferior to the obturator foramen in all specimens. In no instance did the nerve follow an aberrant course traversing the obturator foramen. The mean distance between the inferomedial border of the obturator foramen and the nerve was 9.3 mm, range 3-14 mm., Conclusions: When the "outside-in" technique is used, the introducer cannot come into contact with the dorsal nerve of the clitoris because the introducer would have to pass through the ischio-pubic ramus. This is not anatomically possible.

The femur and pelvis of Ardipithecus ramidus have characters indicative of both upright bipedal walking and movement in trees. Consequently, bipedality in Ar. ramidus was more primitive than in later Australopithecus. Compared with monkeys and Early Miocene apes such as Proconsul, the ilium in Ar. ramidus is mediolaterally expanded, and its sacroiliac joint is located more posteriorly. These changes are shared with some Middle and Late Miocene apes as well as with African apes and later hominids. However, in contrast to extant apes, bipedality in Ar. ramidus was facilitated by craniocaudal shortening of the ilium and enhanced lordotic recurvature of the lower spine. Given the predominant absence of derived traits in other skeletal regions of Ar. ramidus, including the forelimb, these adaptations were probably acquired shortly after divergence from our last common ancestor with chimpanzees. They therefore bear little or no functional relationship to the highly derived suspension, vertical climbing, knuckle-walking, and facultative bipedality of extant African apes.

Objective: The study was to explore the safety, firmness and convenience of the fascia around the ischial spine as a new fixation site for the vaginal fornix., Methods: Between June 2007 and January 2008, detailed dissections and related measurements of the regions around the ischial spine were performed on 10 Chinese female cadavers (3 unembalmed and 7 embalmed cadavers). At the same time, the sacrospinous ligament, the fascia on the ischial spine, the iliococcygeus fascia as well as the vaginal fornix were exposed and the pull-out strength sequentially tested using a digital push-pull force gauge., Results: The fascia on the ischial spine was firm and strong, with a thickness of 3 about mm. No major vessels or nerves were observed on the ischial spine. The greatest pullout strengths of the sacrospinous ligament, the fascia on the ischial spine, the iliococcygeus fascia as well as the vaginal fornix were (102 +/- 26), (64 +/- 15), (33 +/- 8) and (32 +/- 6) N, respectively., Conclusion: The fascia at 1 cm from anterior lateral ischial spine, free of major vessels and nerves, is safe and strong and could be used as a new site for suspension in vaginal prolapse.

Pudendal neuralgia (PN) involves severe, sharp pain along the course of the pudendal nerve, often aggravated with sitting. Current therapies include medication management, nerve blocks, decompression surgery, and neuromodulation. The ideal management for PN has not been determined. We present a case of a female with 1.5 years of sharp, burning pain of the left gluteal and perineal regions. She could not sit for longer than 10 to 15 minutes. Sacroiliac joint, epidural, and piriformis injections did not improve her pain. She had tried physical therapy, occupational therapy, massage, and acupuncture but the pain persisted. Medication treatment with oxycodone-acetaminophen, extended release morphine sulfate, amitriptyline, and gabapentin provided only minor relief and she had failed other multianalgesic therapy. She had been unable to work at her desk job for over a year. She had a positive response to 2 diagnostic pudendal nerve blocks with lidocaine that provided pain relief for several hours. This patient elected to undergo pulsed radiofrequency (PRF) of the left pudendal nerve in hopes of achieving a longer duration and improved pain relief. PRF was carried out at a frequency of 2 Hz and a pulse width of 20 milliseconds for a duration of 120 seconds at 42 degrees Celsius. After the procedure she reported tolerating sitting for 4 to 5 hours. Her multianalgesic therapy was successfully weaned. At 5 months follow-up she felt motivated to return to work. One and a half years after the procedure the patient is only taking oxycodone-acetaminophen for pain relief and still has good sitting tolerance. There were no procedure-related complications. To our knowledge PRF for the treatment of PN has not been reported elsewhere in the literature. PRF is a relatively new procedure and is felt to be safer than continuous radiofrequency. Current literature suggests that PRF delivers an electromagnetic field, which modifies neuro-cellular function with minimal cellular destruction. We conclude that PRF of the pudendal nerve offers promise as a potential treatment of PN that is refractory to conservative therapy.

Published studies of the human hip make frequent reference to the normal pelvis and acetabulum. However, other than qualitative descriptions we found no clinically applicable published references describing a normal pelvis and acetabulum; such information is important for designing certain kinds of implants (eg, reconstruction cages). We describe a method to quantify, average, and apply data gathered from normal human specimens to create a standard representation of the ilium and ischium. One hundred healthy hemipelves from 50 human skeletons were evaluated. We measured angles and distances between major anatomic landmarks in the pelvis. The data collected were analyzed for variance and averaged to create a normal topographic map. Finally, we examined several commercially available acetabular reconstruction cages to determine the fit to the anatomically determined normal pelvis. These results provide a representation of true acetabular geometry and may serve as the basis for future acetabular reconstruction cage design.

Objective: To develop a geometric model from computed tomographic (CT) images in non-pregnant women that would objectively reflect clinical head station in laboring patients, against which to test the accuracy of digital examinations., Method: CT scans were performed in 70 non-pregnant women to determine, using a geometric model, which angle in a mid-sagittal transperineal ultrasound (TPU) image best coincided with the mid-point of a line drawn between the ischial spines (zero station). Using a geometric algorithm, TPU angles were then assigned for other clinical stations (-5 to + 5). Finally, clinical station was assessed by digital examination and simultaneous TPU assessments in 88 laboring patients to see how closely the clinical examination correlated with the station calculated from the above geometric model., Results: The mean angle between the long axis of the symphysis pubis and the mid-point of the line connecting the two ischial spines for the 70 non-pregnant subjects was 99 degrees . The geometric model developed allowed us to build an algorithm to assign a specific set of theoretical angles to each computed station. Relationships between digitally assessed fetal head station, TPU angle for each station, and the geometrical model created with CT data, are reported. Clinical digital assessment of station correlated poorly with computed station, especially at stations below zero, where it could have greater clinical impact., Conclusion: The TPU angle of 99 degrees correlated with zero station, and each station above or below this station could be assigned a specific corresponding angle for reference., ((c) 2009 ISUOG. Published by John Wiley & Sons, Ltd.)

Purpose: For some people with leg disorders, the alternative to becoming bedridden is sitting in a wheelchair for long periods of time. The purpose of this study was to investigate the relation between the backrest of a chair and the position of the pelvis on the maximum pressure at the ischium and the estimated shear force encountered while sitting in a chair., Methods: Ten healthy males aged 22.4 +/- 2.3 years without pathologies in the leg and/or trunk participated in this study. The subjects were instructed to sit in a chair and the pressure and shear forces were measured under three sitting conditions: In the standard position, a 5 cm forward position and a 10 cm forward position. The effects of the positions of the pelvis on the maximum pressure at the ischium were measured by an instrument for measuring pressure distribution and the shear forces were estimated using an experimental model proposed by us., Results: Comparisons were made among the three sitting positions; the range of displacement of the maximum pressure point was not significant. The estimated shear force on the seat was 15.5 +/- 12.4 N in the standard position, 34.4 +/- 8.5 N in the 5-cm forward position, and 53.2 +/- 16.7 N in the 10 cm forward position. There were significant differences among the three values (p < 0.01)., Conclusions: Displacing the pelvis forward and leaning against the backrest tends to increase the shear force and raise the risk of decubitus ulcers.

Introduction: The purpose of this study was to investigate the influence of gender, power, hand position, and ischial tuberosity (IT) width on saddle pressure during seated stationary cycling., Methods: Twenty-two experienced cyclists (11 males and 11 females) were fitted to an adjustable stationary bicycle and pedaled at 100 and 200 W in both the tops and drops hand positions. An instrumented pressure mat was used to record saddle pressure distribution. Normalized force, maximum sensor pressure, and center of pressure were computed for anterior and posterior regions of the saddle., Results: When increasing power from 100 to 200 W, there were significant reductions in normalized force in all saddle regions and maximum pressure in the posterior region. When moving from the tops to drops hand position, centers of pressure in all regions moved forward, normalized force and maximum pressure on the posterior region decreased, and females (but not males) exhibited an increase in normalized force and maximum pressure in the anterior region. Male centers of pressure were farther forward in the anterior and total saddle regions than they were for females. Females exhibited a larger IT width than males. Interindividual differences in IT width were significantly correlated with the posterior center of pressure fore-aft location on the saddle in the tops and drops hand positions and with the width between the posterior left and right centers of pressure in the tops hand position., Conclusions: There are significant gender-related differences in saddle loading which are important to consider when designing saddles. These differences are especially important when riders are in the handlebar drops and more weight is supported on the anterior pelvic structures.

Background: Avulsion of the proximal origin of the hamstrings has become a more frequently recognized athletic injury. Most orthopaedic surgeons rarely operate in this anatomic area. The purpose of the present study was to define the anatomy of the proximal origin of the hamstrings and its relationship to neurovascular and muscular structures encountered during a repair of a complete avulsion., Methods: Fourteen fresh-frozen hip-to-foot human cadaveric specimens were dissected in the prone position. The proximal origin of the hamstrings and its relationship to the surrounding neurologic and muscular structures were documented and measured with use of digital calipers., Results: Six of the fourteen specimens were from female donors. The average age of the donors at the time of death was 68 +/- 13 years. The average height of the donors was 66 +/- 3.5 in (167 +/- 8.9 cm), and the average weight was 142 +/- 39 lb (64 +/- 17.7 kg). The semitendinosus and biceps femoris have a common tendinous site of origin on the ischium. A number of measurements were obtained. The musculotendinous junctions of the semitendinosus and biceps femoris separated at an average of 9.9 +/- 1.5 cm from the most proximal origin site on the ischium. The average distance from the proximal border of the semitendinosus/biceps femoris origin to the inferior border of the gluteus maximus was 6.3 +/- 1.3 cm. At the lateral border of the ischium, the average distance from the inferior gluteal nerve and artery to the inferior border of the gluteus maximus was 5.0 +/- 0.8 cm. The sciatic nerve was an average of 1.2 +/- 0.2 cm from the most lateral aspect of the ischial tuberosity. The site of origin of the semitendinosus/biceps femoris was oval, with average measurements of 2.7 +/- 0.5 cm from proximal to distal and of 1.8 +/- 0.2 cm from medial to lateral. The site of origin of the semimembranosus was crescent-shaped, with average measurements of 3.1 +/- 0.3 cm from proximal to distal and of 1.1 +/- 0.5 cm from medial to lateral., Conclusions: The semitendinosus and biceps femoris have a common tendon of origin on the ischium, and the semimembranosus originates just laterally. The proximal origin of the hamstrings has intimate relationships with the inferior gluteal nerve and artery and the sciatic nerve, which may be at risk during surgical dissection and retraction.

Study Design: A descriptive study of the sacral anatomic orientation (SAO) and its association with pelvic incidence (PI)., Objective: To introduce the concept of SAO, establish a method for measuring it, and evaluate its association with pelvic orientation., Summary of Background Data: Pelvic orientation (PO) is considered a key factor in spinal shape and balance. Sacral slope (SS), PI, and pelvic tilt (PT) are the most frequently used parameters for evaluating PO. Nevertheless, the association between the anatomic orientation of the sacrum and these parameters has never been established. The aim of the present study is to define the anatomic orientation of the sacrum, to establish a reliable method for measuring it, and to examine its association with PI., Methods: SAO was defined as the angle created between the intersection of a line running parallel to the superior endplate surface of the sacrum and a line running between the anterior superior iliac spine (ASIS) and the anterior-superior edge of the symphysis pubis. Methods for measuring SAO and PI on both skeletal populations and living individuals are described. The study was carried out on 424 skeletons (articulated pelves) using a three-dimensional digitizer and on 20 adult individuals using CT three-dimensional images (volume-rendering method). Reliability (intratester and intertester) was assessed using intraclass correlation test. A regression analysis was carried out to evaluate the association between the two measurements., Results: The mean SAO and PI in the human skeletal population were found to be 48.46 degrees +/- 10.17 degrees and 54.08 degrees +/- 12.64 degrees , respectively and of the living individuals (CT) 52.76 degrees +/- 10.31 degrees and 57.14 degrees +/- 13.08 degrees , respectively. SAO and PI measurements were highly correlated (r = -0.824, and r = -0.828, P < 0.001 for skeletal material and living individuals, respectively). PI can be predicted via SAO, i.e., PI = [-0.971 x SAO] + 101.16 degrees ., Conclusions: The newly suggested parameter (SAO) may be an important tool in defining the sagittal shape of the spine and understanding its association with spinal diseases.