Corona mortis: clinical evaluation of prevalence, anatomy, and relevance in anterior approaches to the pelvis and acetabulum.

Autor: Schaible SF; Department of Orthopaedic Surgery and Traumatology, University Hospital Bern, Inselspital, University of Bern, CH-3010, Bern, Switzerland. samuel.schaible@icloud.com., Hanke MS; Department of Orthopaedic Surgery and Traumatology, University Hospital Bern, Inselspital, University of Bern, CH-3010, Bern, Switzerland., Tinner C; Department of Orthopaedic Surgery and Traumatology, University Hospital Bern, Inselspital, University of Bern, CH-3010, Bern, Switzerland., Bastian JD; Department of Orthopaedic Surgery and Traumatology, University Hospital Bern, Inselspital, University of Bern, CH-3010, Bern, Switzerland., Albers CE; Department of Orthopaedic Surgery and Traumatology, University Hospital Bern, Inselspital, University of Bern, CH-3010, Bern, Switzerland., Keel MJB; Department of Orthopaedic Surgery and Traumatology, University Hospital Bern, Inselspital, University of Bern, CH-3010, Bern, Switzerland.; Trauma Center Hirslanden, Clinic Hirslanden Zurich, Medical School University of Zurich, Witellikerstrasse 40, CH-8032, Zurich, Switzerland.
Jazyk: angličtina
Zdroj: European journal of orthopaedic surgery & traumatology : orthopedie traumatologie [Eur J Orthop Surg Traumatol] 2024 Apr; Vol. 34 (3), pp. 1397-1404. Date of Electronic Publication: 2024 Jan 10.
DOI: 10.1007/s00590-023-03808-3
Abstrakt: Purpose: To evaluate the clinical prevalence, characteristics, and relevance of the corona mortis (CM) in anterior approaches to the pelvis and acetabulum.
Methods: Retrospective analysis of 185 theater reports from patients (73 females; mean age 62.8 ± 17.2 years) who underwent surgeries for pelvic ring injuries, acetabular fractures, or combined injuries using anterior approaches (Modified Stoppa or Pararectus) at our institution between 01/2008 to 12/2022. During procedures, the CM was routinely identified, evaluated, and occluded. Bilateral exposure of the superior pubic branch in 25 cases led to 210 hemipelvises analyzed.
Exclusions: CM not mentioned in report and revisions via the initial approach.
Results: In the 210 hemipelvises examined, the prevalence of any CM vessel was 81% (170/210). Venous anastomoses were found in 76% of hemipelvises (159/210), arterial in 22% (47/210). Sole venous anastomoses appeared in 59% (123/210), sole arterial in 5% (11/210). Both types coexisted in 17% (36/210), while 19% (40/210) had none. A single incidental CM injury occurred without significant bleeding. In ten cases, trauma had preoperatively ruptured the CM, but bleeding was readily managed. Females had a significantly higher CM prevalence than males (p = 0.001).
Conclusion: Our findings show a CM prevalence aligning more with anatomical studies than prior intraoperative series. Although we observed one incidental and ten trauma-related CM injuries, we did not encounter uncontrollable bleeding. Our data suggest that in anterior pelvic approaches, when the CM is actively identified and occluded, it is not associated with bleeding events, despite its high prevalence.
(© 2024. The Author(s).)
Databáze: MEDLINE
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