title: Ischial and pubic osteotomies performed by medial approach during periacetabular osteotomies: an anatomical study.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopedics and Traumatology, Taksim Training and Research Hospital, İstanbul, Turkey. doktorfb2001@yahoo.com
authors.forename: Fuat
authors.initials: F
authors.lastname: Bilgili
authors.forename: Ilke Ali
authors.initials: IA
authors.lastname: Gürses
authors.forename: Ufuk
authors.initials: U
authors.lastname: Ökaya
authors.forename: Özcan
authors.initials: Ö
authors.lastname: Gayretli
authors.forename: Atilla Sancar
authors.initials: AS
authors.lastname: Parmaksizoğlu
authors.forename: Ayşin
authors.initials: A
authors.lastname: Cetiner Kale
mesh_terms: D000077:Acetabulum / Q000033:anatomy & histology / Q000601:surgery*; D002102:Cadaver; D005260:Female; D006615:Hip / Q000033:anatomy & histology / Q000098:blood supply / Q000294:innervation; D006801:Humans; D066298:In Vitro Techniques; D007512:Ischium / Q000033:anatomy & histology / Q000601:surgery*; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011630:Pubic Bone / Q000033:anatomy & histology / Q000601:surgery*