The determination of safe zones for arthroscopic portal placement into the posterior knee by mapping the courses of neurovascular structures in relation to bony landmarks

2021 ◽  
Author(s):  
Kelsi Greenwood ◽  
Reinette Van Zyl ◽  
Natalie Keough ◽  
Erik Hohmann
Keyword(s):  
Bony Landmarks ◽  
Safe Zones ◽  
Posterior Knee ◽  
Neurovascular Structures ◽  
Portal Placement

scholarly journals Safe Zone for Percutaneous Screw Fixation - Talonavicular Fusion

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0043
Author(s):  
Ashish Shah ◽  
Sung Lee ◽  
Sameer Naranje ◽  
Zachariah Pinter ◽  
Robert Stibolt ◽  
...  
Keyword(s):  
Medial Branch ◽  
Screw Insertion ◽  
Anterior Branch ◽  
Bony Landmarks ◽  
Medial Plane ◽  
Extensor Hallucis Longus ◽  
Hindfoot Deformities ◽  
Fresh Frozen ◽  
Optimal Fusion ◽  
Neurovascular Structures

Category: Hindfoot Introduction/Purpose: Talonavicular fusion has been established as a reliable intervention for degenerative, inflammatory, and traumatic joint lesions as well as hindfoot deformities. In order to achieve optimal fusion, various versions of the procedure have been introduced in literature and have remained a topic of contention, with the most common variation involving the insertion of 1 to 3 screws dorsomedially and dorsolaterally. Dorsolateral screw placements commonly cause neurovasculature injury. The purpose of our cadaveric study was first to establish the safety of the dorsolateral percutaneous screw insertion in relation to these dorsal neurovascular structures, and then subsequently to standardize the ideal placement of the dorsolateral screw by comparing two insertion sites based on consistent bony landmarks. Methods: Ten fresh-frozen cadaver legs amputated at the knee were used for this study. Percutaneous cannulated screws were inserted to perform isolated talonavicular arthrodesis. The screws were inserted at 3 consistent sites: “medial screw” at dorsomedial navicular where it intersected at the medial plane of the first cuneiform, “central screw” at the edge of dorsal navicular between medial and intermediate cuneiforms, and “lateral screw” at the edge of dorsal navicular between intermediate and lateral cuneiforms. Superficial and deep dissections were carried out to identify any injured nerves, arteries, and tendons. Results: The mean age at death in our sample of cadavers was 80.1 ± 7.5 years (range 68 to 92) and had the BMI of 21.8 ± 2.4 (range 18.1 to 25.1). There were 5 males (50.0%) and 5 females (50.0%). The medial screw injured the anterior tibialis tendon in 2 cases (20.0%), the central screw injured the extensor hallucis longus tendon in 3 cases (30.0%), and the lateral screw injured the anterior branch of SPN, lateral branch of SPN, and medial branch of DPN once each in a total of 3 cases (30.0%). Conclusion: TN fusion with central screw placement at the interspace between the medial and intermediate cuneiforms protects the neurovasculatures of the foot to a superior extent than lateral screws between the intermediate and lateral cuneiforms.

Quadrant anatomy of the articular pillars (lateral cervical mass) of the cervical spine

1995 ◽  
Vol 82 (6) ◽  
pp. 1011-1014 ◽  
Author(s):  
T. Glenn Pait ◽  
Phillip V. McAllister ◽  
Howard H. Kaufman
Keyword(s):  
Anatomical Landmarks ◽  
Cervical Mass ◽  
Content Type ◽  
Bony Landmarks ◽  
Fixation Devices ◽  
Human Cadavers ◽  
Lateral Mass Screws ◽  
Neurovascular Structures ◽  
Lateral Facet ◽  
Fine Print

✓ Knowledge of the relevant anatomy is important when developing a strategy for introducing screws into the lateral masses to secure internal fixation devices. This paper defines key bony landmarks and their relationship to critical neurovascular structures and identifies a location for safe placement of cervical articular pillar (lateral mass) screws. Measurements of anatomical landmarks in 10 spines from human cadavers aged 61 to 85 years were made by caliper and a metric ruler. Landmarks were the lateral facet line, rostrocaudal line, medial facet line, intrafacet line, and medial facet line—vertebral artery line. The average distances and ranges were recorded. Such great variance existed in measurements from spine to spine and within the same spine as to render averages clinically unreliable. Dissection revealed that division of the articular pillar into four quadrants leaves one, the superior lateral quadrant, under which there are no neurovascular structures; this may be considered the “safe quadrant” for placement of posterior screws and plates.

Anatomic Study of Arthroscopic Portal Sites of the Ankle

Foot & Ankle ◽  
1993 ◽  
Vol 14 (3) ◽  
pp. 142-147 ◽  
Author(s):  
Lawrence A. Feiwell ◽  
Carol Frey
Keyword(s):  
At Risk ◽  
Ankle Joint ◽  
Standard Technique ◽  
Joint Capsule ◽  
Anatomic Study ◽  
Fresh Cadaver ◽  
Relative Safety ◽  
Fresh Frozen ◽  
Neurovascular Structures ◽  
Portal Placement

Numerous anatomic structures are at risk when performing ankle arthroscopy through the more commonly utilized portals. The purpose of this paper was to demonstrate the relative safety of each of the arthroscopic portal and Acufex external ankle distractor pin sites by measuring their proximity to the neurovascular structures surrounding the ankle joint. Six fresh cadaver specimens and 12 fresh-frozen, be-low-knee amputations were utilized for this study. An Acufex ankle distractor was applied using the standard technique. Anteromedial, anterolateral, anterocentral, posterolateral, and posteromedial portals were placed using an 11-blade scalpel to make 5-mm longitudinal incisions. The joint capsule was penetrated and a 3-mm arthroscope was placed into the ankle joint. The skin surrounding each of the portals was carefully removed and the proximity of any nerves or vessels was measured with respect to the arthroscope. At least one incidence of contact or penetration of a nerve or vessel was noted for each site. The anterocentral portal was at greatest risk for nerve or vessel damage. The anterolateral, anteromedial, and posterolateral portals were the safest areas for portal placement, with no penetration of neurovascular structures in any case.

Quantitative research using computed tomographic scanning of beagle jaws for determination of safe zones for micro-screw implantation

2009 ◽  
Vol 191 (4) ◽  
pp. 379-388 ◽  
Author(s):  
Lixing Zhao ◽  
Zhenrui Xu ◽  
Zhi Yang ◽  
Jun Wang ◽  
Xing Wei ◽  
...  
Keyword(s):  
Quantitative Research ◽  
Computed Tomographic ◽  
Safe Zones

Percutaneous fixation of acetabular fractures: computer-assisted determination of safe zones, angles and lengths for screw insertion

2012 ◽  
Vol 132 (6) ◽  
pp. 805-811 ◽  
Author(s):  
Paul Puchwein ◽  
Natalie Enninghorst ◽  
Krisztian Sisak ◽  
Thomas Ortner ◽  
Thomas Armin Schildhauer ◽  
...  
Keyword(s):  
Acetabular Fractures ◽  
Computer Assisted ◽  
Percutaneous Fixation ◽  
Screw Insertion ◽  
Safe Zones

scholarly journals HYGIENIC REQUIREMENTS TO CONDITIONS OF THE APPLICATION OF TECHNICAL MEANS OF BLOCKING RADIO SIGNALS

2018 ◽  
Vol 97 (10) ◽  
pp. 894-898
Author(s):  
Larisa V. Pokhodzey ◽  
Yu. P. Paltsev
Keyword(s):  
Radio Lines ◽  
Preventive Actions ◽  
Radio Signals ◽  
Radio Frequency Signals ◽  
Individual Protection ◽  
Explosive Devices ◽  
The Impact ◽  
Production And Operation ◽  
Safe Zones

Introduction. Now radio lines of the management of explosions find more and more broad application for the execution of acts of terrorism. The special technical means which are powerful sources of EMP in the range of frequencies of 0.02 - 6.00 GHz by which workers in the course of their production and operation and also the population which has appeared in a radiation zone can be affected, are developed for the suppression of radio-frequency signals of control of explosive devices. Aim of the study. Scientific justification and development of hygienic requirements for the safe use of systems of suppression of radio lines of control of explosive devices (SS RCED). Material and methods. The calculation methods for determining the EMF intensities created by different types of SS RCED (1500 calculations) were used, more than 250 measurements were carried out at different distances from 5 types of SS RCED in the open area and in the offices. Results. Hygienic investigations have allowed to point out 5 categories of the irradiated contingents for which hygienic regulations of EMP on the basis of the analysis of the standard and methodical documents acting in the Russian Federation have been proved. Calculations and natural measurements of the EMP levels from various types of SS RCED in rooms and in the open territory are taken. The technique of forecasting of conditions of radiation taking into account their technical characteristics (range of frequencies, power, etc.), the time of the exposure and distances from sources is offered. The algorithm of carrying out a hygienic assessment of conditions of radiation of personnel and population from SS RCED and a complex of preventive actions are developed. Discussion. Protection of workers by production, service, and operation of SS RCED, has to be carried out by restriction of the time of the impact of EMP taking into account power expositions at different distances from a source, and the population - by determination of safe zones of stay taking into account categories of the irradiated contingents. The technical actions including the organization of remote control of SS RCED and application of means collective (shielding) and/or individual protection are offered. Conclusion. The conducted complex research allowed justifying hygienic requirements for the production and operation of SS RCED and developing the project of SanPiN 2.1.8/2.2.4.xxxx-18 «Sanitary rules and standards of safe use of systems of suppression of radio lines of management of explosive devices of the range of frequencies of 0,02-6,00 GHz».

scholarly journals Ultrasound-Guided Intervention for Treatment of Trigeminal Neuralgia: An Updated Review of Anatomy and Techniques

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Abdallah El-Sayed Allam ◽  
Adham Aboul Fotouh Khalil ◽  
Basma Aly Eltawab ◽  
Wei-Ting Wu ◽  
Ke-Vin Chang
Keyword(s):  
Trigeminal Nerve ◽  
Ultrasound Guidance ◽  
Myofascial Pain ◽  
Ultrasound Guided ◽  
Facial Bones ◽  
Target Region ◽  
Bony Landmarks ◽  
Injection Techniques ◽  
Trigeminal Nerves ◽  
Neurovascular Structures

Orofacial myofascial pain is prevalent and most often results from entrapment of branches of the trigeminal nerves. It is challenging to inject branches of the trigeminal nerve, a large portion of which are shielded by the facial bones. Bony landmarks of the cranium serve as important guides for palpation-guided injections and can be delineated using ultrasound. Ultrasound also provides real-time images of the adjacent muscles and accompanying arteries and can be used to guide the needle to the target region. Most importantly, ultrasound guidance significantly reduces the risk of collateral injury to vital neurovascular structures. In this review, we aimed to summarize the regional anatomy and ultrasound-guided injection techniques for the trigeminal nerve and its branches, including the supraorbital, infraorbital, mental, auriculotemporal, maxillary, and mandibular nerves.

The safe zones for endoscopic proximal hamstring repair: a cadaveric assessment of standard portal placement and their relationship to major neurovascular structures

2021 ◽  
pp. 112070002110341
Author(s):  
Charles A Su ◽  
Mark W LaBelle ◽  
Jason G Ina ◽  
Lakshmanan Sivasundaram ◽  
Shane Nho ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Secondary Outcome ◽  
Horizontal Orientation ◽  
Risk Of Injury ◽  
Direct Injury ◽  
Anatomical Relationship ◽  
Relationship Of ◽  
Safe Zones ◽  
Proximal Hamstring ◽  
Neurovascular Structures

Purpose: To define the anatomical relationship of the major neurovascular structures to the standard endoscopic portals used in endoscopic hamstring repair. A secondary outcome was to determine the safest angle of insertion from each standard portal. Methods: Endoscopic portals were established in the 3 standard locations (lateral, medial, and inferior) and Steinmann pins inserted at various angles. Each hip was dissected and the distance between the pins and the pertinent anatomy measured. Results: The lateral portal placed the sciatic and posterior femoral cutaneous (PFC) nerves at greatest risk: direct injury to the sciatic nerve was seen in 11/30 (37%) of the lateral portals sited. A lateral portal with an approach at 60° was the most dangerous orientation with a mean distance of 0.36 ± 0.49 mm and 4.30 ± 2.69 mm from the sciatic and PFC nerves, respectively ( p < 0.001). The 60° medial portal was the safest of all portals measured, at a mean distance of 67.37 ± 11.06mm (range, 47–78 mm) from the sciatic nerve and 58.90 ± 10.57 mm (range 40–70 mm) from the PFC nerve. Conclusions: While currently described techniques recommend establishing the standard lateral portal first, this study shows that it carries the highest risk of injury if used blind. We recommend that the standard medial endoscopic portal is established first to identify the neurovascular structures and minimise iatrogenic neurovascular injury. The inferior and lateral portals can then be established created under direct vision. The lateral portal should be inserted in a more horizontal orientation to decrease the risk of nerve injury.

An Ultrasonographic and Anatomical Study of Carpal Tunnel, with Special Emphasis on the Safe Zones in Percutaneous Release

2009 ◽  
Vol 34 (1) ◽  
pp. 66-71 ◽  
Author(s):  
T. -C. CHERN ◽  
I. -M. JOU ◽  
W. -C. CHEN ◽  
K. -C. WU ◽  
C. -J. SHAO ◽  
...  
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Anatomical Study ◽  
Comparison Study ◽  
Anatomical Dissection ◽  
Flexor Retinaculum ◽  
Bony Landmarks ◽  
Percutaneous Release ◽  
Invasive Techniques ◽  
Safe Zones

We examined 40 wrists of 12 embalmed and eight fresh cadavers and defined the relative position of the flexor retinaculum to the neurovascular structure, ultrasonographic markers and safe zones by ultrasonography and anatomical dissection. Both longitudinal and transverse ultrasonographic sections clearly depicted the flexor retinaculum, neurovascular bundles, median nerve, flexor tendons and bony boundaries of the underlying joints. Topographic measurement showed [i] good correlation between the actual extent of the flexor retinaculum and the ultrasonographically determined distance between bony landmarks in all hands, and [ii] the widths and lengths of well-defined safe zones. A comparison study confirmed the accuracy of ultrasonography. We conclude that these ultrasonographic landmarks can locate the flexor retinaculum and facilitate safe and complete carpal tunnel release with open or minimally invasive techniques.

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