Hemipelvectomy | |
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Other names | Hindquarter amputation, pelvic resection |
Specialty | Orthopedic surgery |
Hemipelvectomy, also known as a pelvic resection, is a surgical procedure that involves the removal of part of the pelvic girdle. This procedure is most commonly performed to treat oncologic conditions of the pelvis. [1] [2] Hemipelvectomy can be further classified as internal and external hemipelvectomy. [1] [2] An internal hemipelvectomy is a limb-sparing procedure where the innominate bone is resected while preserving the ipsilateral limb. [1] [2] An external hemipelvectomy involves the resection of the innominate bone plus amputation of the ipsilateral limb. [1] [2]
Hemipelvectomy is generally reserved for the treatment of pelvic neoplasms. [1] [2] Examples of malignancies that are treated with hemipelvectomy include osteosarcoma, chondrosarcoma, and Ewing's sarcoma. [1] Rarely, hemipelvectomy is performed in settings of traumatic injury and osteomyelitis. [1] Indications for external hemipelvectomy include neoplastic extension into the sciatic nerve, where loss of function of the lower extremity is anticipated. [1] Internal hemipelvectomy is preferred when complete resection of the tumor is possible without sacrificing the lower extremity. [1] If external hemipelvectomy cannot provide a greater degree of tumor resection compared to internal hemipelvectomy, internal hemipelvectomy is recommended. [1] Internal hemipelvectomy must only be considered when the surgical approach can ensure the preservation of critical neurovascular structures in the region. [1]
As with any surgical procedure, risks include infection, blood loss, damage to surrounding structures, cardiac/pulmonary complications, and adverse reactions to anesthesia.
Complications of external hemipelvectomy include: [1] [2]
Complications of internal hemipelvectomy include: [1] [2]
Prior to performing a hemipelvectomy, surgeons must possess detailed knowledge of the pelvic anatomy and its relation to the pelvic tumor. [1] Imaging studies such as conventional radiography, computed tomography, and magnetic resonance imaging help the surgeon visualize the anatomy and its relationship to the local pathology. [1] Surgical oncology techniques are utilized when resecting tumors of the pelvis. [1] Such techniques ensure that adequate resection margins are obtained at the time of surgery to minimize tumor recurrence. [1]
The Enneking and Dunham classification system was developed in 1978 to aid surgeons in characterizing pelvic resections. [1] [3] [4] This classification scheme breaks down pelvic resections into 3 subtypes: Type I, Type II, and Type III. [1] [3] [4] Type I resections involve removal of the ilium. [1] [3] [4] Type II resections involve removal of the peri-acetabular region. [1] [3] [4] Type III resections involve removal of the ischial and/or pubic region. [1] [3]
Resection of pelvic bone typically requires subsequent reconstruction to ensure stability of the hip joint, particularly in internal hemipelvectomy. [1] Examples of pelvic reconstruction include the use of an allograft, autograft, or prosthesis to bridge the remaining ends of pelvic bone following resection. [1] [4] Arthrodesis is a technique that can be used in internal hemipelvectomy to fix the proximal femur to a segment of pelvic bone for the purposes of stabilizing the lower extremity. [1] [4]
A bone tumor is an abnormal growth of tissue in bone, traditionally classified as noncancerous (benign) or cancerous (malignant). Cancerous bone tumors usually originate from a cancer in another part of the body such as from lung, breast, thyroid, kidney and prostate. There may be a lump, pain, or neurological signs from pressure. A bone tumor might present with a pathologic fracture. Other symptoms may include fatigue, fever, weight loss, anemia and nausea. Sometimes there are no symptoms and the tumour is found when investigating another problem.
Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.
Eye surgery, also known as ophthalmic surgery or ocular surgery, is surgery performed on the eye or its adnexa. Eye surgery is part of ophthalmology and is performed by an ophthalmologist or eye surgeon. The eye is a fragile organ, and requires due care before, during, and after a surgical procedure to minimize or prevent further damage. An eye surgeon is responsible for selecting the appropriate surgical procedure for the patient, and for taking the necessary safety precautions. Mentions of eye surgery can be found in several ancient texts dating back as early as 1800 BC, with cataract treatment starting in the fifth century BC. It continues to be a widely practiced class of surgery, with various techniques having been developed for treating eye problems.
Hemicorporectomy is a radical surgery in which the body below the waist is amputated, transecting the lumbar spine. This removes the legs, the genitalia, urinary system, pelvic bones, anus, and rectum. It is a major procedure recommended only as a last resort for people with severe and potentially fatal illnesses such as osteomyelitis, tumors, severe traumas and intractable decubiti in, or around, the pelvis. By 2009, 66 cases had been reported in medical literature.
Chondrosarcoma is a bone sarcoma, a primary cancer composed of cells derived from transformed cells that produce cartilage. A chondrosarcoma is a member of a category of tumors of bone and soft tissue known as sarcomas. About 30% of bone sarcomas are chondrosarcomas. It is resistant to chemotherapy and radiotherapy. Unlike other primary bone sarcomas that mainly affect children and adolescents, a chondrosarcoma can present at any age. It more often affects the axial skeleton than the appendicular skeleton.
External fixation is a surgical treatment wherein Kirschner pins and wires are inserted and affixed into bone and then exit the body to be attached to an external apparatus composed of rings and threaded rods — the Ilizarov apparatus, the Taylor Spatial Frame, and the Octopod External Fixator — which immobilises the damaged limb to facilitate healing. As an alternative to internal fixation, wherein bone-stabilising mechanical components are surgically emplaced in the body of the patient, external fixation is used to stabilize bone tissues and soft tissues at a distance from the site of the injury.
Prostatectomy is the surgical removal of all or part of the prostate gland. This operation is done for benign conditions that cause urinary retention, as well as for prostate cancer and for other cancers of the pelvis.
Osteochondromas are the most common benign tumors of the bones. The tumors take the form of cartilage-capped bony projections or outgrowth on the surface of bones (exostoses). It is characterized as a type of overgrowth that can occur in any bone where cartilage forms bone. Tumors most commonly affect long bones about the knee and in the forearm. Additionally, flat bones such as the pelvis and scapula may be affected.
Bone grafting is a surgical procedure that replaces missing bone in order to repair bone fractures that are extremely complex, pose a significant health risk to the patient, or fail to heal properly. Some small or acute fractures can be cured without bone grafting, but the risk is greater for large fractures like compound fractures.
Sacrococcygeal teratoma (SCT) is a type of tumor known as a teratoma that develops at the base of the coccyx (tailbone) and is thought to be primarily derived from remnants of the primitive streak. Sacrococcygeal teratomas are benign 75% of the time, malignant 12% of the time, and the remainder are considered "immature teratomas" that share benign and malignant features. Benign sacrococcygeal teratomas are more likely to develop in younger children who are less than 5 months old, and older children are more likely to develop malignant sacrococcygeal teratomas.
Rotationplasty, commonly known as a Van Nes rotation or Borggreve rotation, is a type of autograft wherein a portion of a limb is removed, while the remaining limb below the involved portion is rotated and reattached. This procedure is used when a portion of an extremity is injured or involved with a disease, such as cancer.
A pelvic fracture is a break of the bony structure of the pelvis. This includes any break of the sacrum, hip bones, or tailbone. Symptoms include pain, particularly with movement. Complications may include internal bleeding, injury to the bladder, or vaginal trauma.
Ollier disease is a rare sporadic nonhereditary skeletal disorder in which typically benign cartilaginous tumors (enchondromas) develop near the growth plate cartilage. This is caused by cartilage rests that grow and reside within the metaphysis or diaphysis and eventually mineralize over time to form multiple enchondromas. Key signs of the disorder include asymmetry and shortening of the limb as well as an increased thickness of the bone margin. These symptoms are typically first visible during early childhood with the mean age of diagnosis being 13 years of age. Many patients with Ollier disease are prone to develop other malignancies including bone sarcomas that necessitate treatment and the removal of malignant bone neoplasm. Cases in patients with Ollier disease has shown a link to IDH1, IDH2, and PTH1R gene mutations. Currently, there are no forms of treatment for the underlying condition of Ollier disease but complications such as fractures, deformities, malignancies that arise from it can be treated through surgical procedures. The prevalence of this condition is estimated at around 1 in 100,000. It is unclear whether the men or women are more affected by this disorder due to conflicting case studies.
The hip bone is a large flat bone, constricted in the center and expanded above and below. In some vertebrates it is composed of three parts: the ilium, ischium, and the pubis.
Fractures of the acetabulum occur when the head of the femur is driven into the pelvis. This injury is caused by a blow to either the side or front of the knee and often occurs as a dashboard injury accompanied by a fracture of the femur.
The pelvis is the lower part of an anatomical trunk, between the abdomen and the thighs, together with its embedded skeleton.
Limb-sparing techniques, also known as limb-saving or limb-salvage techniques, are performed in order to preserve the look and function of limbs. Limb-sparing techniques are used to preserve limbs affected by trauma, arthritis, cancers such as high-grade bone sarcomas, and vascular conditions such as diabetic foot ulcers. As the techniques for chemotherapy, radiation, and diagnostic modalities improve, there has been a trend toward limb-sparing procedures to avoid amputation, which has been associated with a lower 5-year survival rate and cost-effectiveness compared to limb salvage in the long-run. There are many different types of limb-sparing techniques, including arthrodesis, arthroplasty, endoprosthetic reconstruction, various types of implants, rotationplasty, osseointegration limb replacement, fasciotomy, and revascularization.
The following outline is provided as an overview of and topical guide to trauma and orthopaedics:
Bone malrotation refers to the situation that results when a bone heals out of rotational alignment from another bone, or part of bone. It often occurs as the result of a surgical complication after a fracture where intramedullary nailing (IMN) occurs, especially in the femur and tibial bones, but can also occur genetically at birth. The severity of this complication is often neglected due to its complexity to detect and treat, yet if left untreated, bone malrotation can significantly impact regular bodily functioning, and even lead to severe arthritis. Detection throughout history has become more advanced and accurate, ranging from clinical assessment to ultrasounds to CT scans. Treatment can include an osteotomy, a major surgical procedure where bones are cut and realigned correctly, or compensatory methods, where individuals learn to externally or internally rotate their limb to compensate for the rotation. Further research is currently being examined in this area to reduce occurrences of malrotation, including detailed computer navigation to improve visual accuracy during surgery.