The Journal of Bone and Joint Surgery, Vol 77, Issue 2 177-189, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
The anatomy of the pelvis in the exstrophy complex
PD Sponseller, LJ Bisson, JP Gearhart, RD Jeffs, D Magid and E Fishman
Department of Orthopaedic Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-0882.
We compared computerized tomography scans of the pelvis of twenty-four
patients who had exstrophy of the bladder with scans of age-matched
controls in order to analyze the pelvic deformity that accompanies the
variably severe manifestations of this condition. The patients who had
classic exstrophy of the bladder were found to have a mean of 12 degrees of
external rotation of the posterior aspect of the pelvis on each side,
retroversion of the acetabula, a mean additional 18 degrees of external
rotation and 30 per cent shortening of the pubic rami, and progressive
diastasis of the symphysis pubis. The foot-progression angle demonstrated
20 to 30 degrees of external rotation beyond the normal limits seen in
early childhood, but this improved with age. The patients who had exstrophy
of the cloaca and the bladder not only had all of these pelvic deformities
to a greater degree but also had asymmetry of measured parameters between
the right and left sides of the pelvis, malformation of the sacro-iliac
joints, and occasional dislocation of the hip. An understanding of the
pelvic anatomy that accompanies exstrophy is essential when corrective
approaches are planned. Such an understanding will improve the rate of
success of both closure of the bladder and control of urinary continence
postoperatively.
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