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Table of Contents
LETTER TO EDITOR
Year : 2022  |  Volume : 71  |  Issue : 2  |  Page : 154-155

An Optimal Palpation Method to Locate the Pubic Tubercle


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Date of Submission19-Aug-2021
Date of Acceptance25-Mar-2022
Date of Web Publication30-Jun-2022

Correspondence Address:
Daghan Dagdelen
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jasi.jasi_143_21

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How to cite this article:
Dagdelen D, Benlier E. An Optimal Palpation Method to Locate the Pubic Tubercle. J Anat Soc India 2022;71:154-5

How to cite this URL:
Dagdelen D, Benlier E. An Optimal Palpation Method to Locate the Pubic Tubercle. J Anat Soc India [serial online] 2022 [cited 2022 Aug 17];71:154-5. Available from: https://www.jasi.org.in/text.asp?2022/71/2/154/349534



Pubis is an angulated bone. It comprises a body, superior, and inferior ramus. Superior ramus helps in the formation of acetabulum. The thickening on the superior border of the body is the pubic crest and the most lateral prominent swelling of the pubic crest is named pubic tubercle (PT).

PTs are insertion points for inguinal ligament which extends from the anterior superior iliac spine (ASIS). Furthermore, the anterior pelvic plane which is a practical reference plane for pelvic orientation in space is constituted by a tangent passing between two ASIS and PTs.[1] In an ideal body posture, this plane is expected to be perpendicular to the ground. This is also the anatomical position of the hip bone. In the clinical setting, PT is used as a landmark for planning of inguinal lymphadenectomy, open inguinal hernia repair, obturator nerve block, and elevation of superficial circumflex iliac artery perforator flaps.[2],[3]

Faulty posture and associated multiple musculoskeletal diseases have been related to nonideal pelvis position.[4] Asymmetry within the pelvic structures is believed to lead to a cascade of postural compensations predisposing the individual to numerous neuromusculoskeletal dysfunctions.[5] Displacement of the anterior pelvic plane in a horizontal axis is defined as pelvic tilt. In a normal, asymptomatic population, anterior pelvic tilt was found among 85% of male and 75% of female participants, the tilt degree was in the range of 6°–7° for both sexes.[6] If a patient has a pelvic tilt, the anterior pelvic plane cannot be aligned parallel to the table on which the patient is lying.

In 2016, it was estimated for the global adult population, 39% of males and 40% of females were to be overweight.[7] We have been observing a similar increase in body mass index (BMI) among our inpatients.

This tendency of increased BMI hinders the location of the bony prominences. In an operation scenario where the patient is positioned supine, if the patient has an asymptomatic anterior pelvic tilt and has increased BMI, the superficial fascial system and the subcutaneous fat within the periphery of the pelvis will be displaced in an anterior-inferior direction. Moreover, if PT will be used as a landmark in this patient, a finger palpation directed from inferior to superior to locate PT will probably be misleading, as there will be excessive subcutaneous fat between palpating finger and bony prominences due to the positional displacement [Figure 1]. To avoid this pitfall, we suggest, the palpation to be made along the superior border of pubis and directed laterally. The edge point of the superior margin will correlate with PT [Figure 2].
Figure 1: Typical palpation method oriented obliquely

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Figure 2: Proposed palpation method oriented transversely

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We argue that this is a reliable method to locate PT as the anterior pelvic tilt will most probably go unnoticed during preoperative patient examination.

Ethical statement

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or nonfinancial interest in the subject matter or materials discussed in this manuscript. Informed consent of the participant individual was obtained. The Local Research Ethics Committee has confirmed that no ethical approval is required as this study is based on observation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Digioia AM 3rd, Jaramaz B, Plakseychuk AY, Moody JE Jr., Nikou C, Labarca RS, et al. Comparison of a mechanical acetabular alignment guide with computer placement of the socket. J Arthroplasty 2002;17:359-64.  Back to cited text no. 1
    
2.
Al-Refaie WB, Ross MI. Inguinal lymphadenectomy for malignant melanoma. Oper Tech Gen Surg 2006;8:90-102.  Back to cited text no. 2
    
3.
Yoshimatsu H, Yamamoto T, Hayashi A, Iida T. Proximal-to-distally elevated superficial circumflex iliac artery perforator flap enabling hybrid reconstruction. Plast Reconstr Surg 2016;138:910-22.  Back to cited text no. 3
    
4.
Sahrmann SA. Movement System Impairment Syndromes of the Extremities, Cervical and Thoracic Spines. St. Louis: Mosby; 2010.  Back to cited text no. 4
    
5.
Juhl JH, Ippolito Cremin TM, Russell G. Prevalence of frontal plane pelvic postural asymmetry – Part 1. J Am Osteopath Assoc 2004;104:411-21.  Back to cited text no. 5
    
6.
Herrington L. Assessment of the degree of pelvic tilt within a normal asymptomatic population. Man Ther 2011;16:646-8.  Back to cited text no. 6
    
7.
World Health Organzaiton. Overweight and Obesity; April 01, 2020. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. [Last accessed on2020 Dec 23].  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]



 

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