The Journal of Bone and Joint Surgery (American). 2008;90:2114-2118.
doi:10.2106/JBJS.G.00277
© 2008 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the activity for this article:
 CME 4: October, November, December 2008 (publication date January 5, 2009; ...
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow Rights and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Garras, D. N.
Right arrow Articles by Olson, S. A.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Garras, D. N.
Right arrow Articles by Olson, S. A.
Related Collections
Right arrow Adult Trauma
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Facebook   Add to Technorati   Add to Twitter  
What's this?

Single-Leg-Stance (Flamingo) Radiographs to Assess Pelvic Instability: How Much Motion Is Normal?

David N. Garras, MD1, Joshua T. Carothers, MD1 and Steven A. Olson, MD1

1 Division of Orthopaedic Surgery, Duke University Medical Center, Box 3389, Durham, NC 27710. E-mail address for S.A. Olson: olson016{at}mc.duke.edu

Investigation performed at Duke University Medical Center, Durham, North Carolina

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Chronic pelvic instability is a relatively uncommon cause of pelvic and low-back pain. Patients present with feelings of instability and mechanical symptoms. Static radiographs are often inadequate to detect abnormal relative motion between the hemipelves consistent with chronic pelvic instability; dynamic views of the pelvis are required. We assessed the amount of physiologic motion present at the pubic symphysis in normal adult men and nulliparous and multiparous women with alternating-single-leg-stance radiographs.

Methods: Forty-five asymptomatic adult volunteers (fifteen in each group) were evaluated with a standing anteroposterior pelvic radiograph as well as with anteroposterior pelvic radiographs made with the subjects assuming both right and left single-leg stance. The subjects completed a questionnaire to determine their eligibility for participation in the study, and an examination was performed to exclude certain physical anomalies that might alter the radiographic findings.

Results: The mean total translation (and standard deviation) at the pubic symphysis, as measured by three blinded observers, was 1.4 ± 1.0, 1.6 ± 0.8, and 3.1 ± 1.5 mm for the men, nulliparous women, and multiparous women, respectively. With the numbers available, we found no significant difference between the translation in the men and that in the nulliparous women (p = 0.63). The multiparous women had significantly more translation than did either the nulliparous women (p = 0.002) or the men (p = 0.0005). There was a significant positive association between the number of pregnancies and the total translation (p < 0.0001).

Conclusions: The use of anteroposterior pelvic radiographs made with the subject alternating between right and left single-leg stance demonstrated, with high interobserver reliability, that multiparous women had a significantly different physiologic range of pubic translation as compared with men and nulliparous women. The ranges of physiologic motion at the pubic symphysis measured on the single-leg-stance radiographs in this study can be used to identify pathologic amounts of motion at this site.

Clinical Relevance: This investigation suggests that up to 5 mm of physiologic motion can occur at the pubic symphysis in asymptomatic individuals, as demonstrated by alternating-single-leg-stance radiographs.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Facebook Facebook   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 JBJSHome page
A. H. Schmidt and A. A. Jahangir
What's New in Orthopaedic Trauma
J. Bone Joint Surg. Am., August 1, 2009; 91(8): 2055 - 2066.
[Full Text] [PDF]