scholarly journals Safe Operative Planning For Extensive Neurogenic Heterotopic Ossification (NHO) at the Hip

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0001
Author(s):  
Liew Mei Yi ◽  
Rajesh Rampal ◽  
Gandhi Nathan Solayar ◽  
Abdul Rauf Ahmad
Keyword(s):  
Functional Ability ◽  
Plain Radiograph ◽  
Surgical Excision ◽  
Ischial Tuberosity ◽  
Medial Aspect ◽  
Greater Trochanter ◽  
Pubic Ramus ◽  
Bone Bridge ◽  
Operative Planning ◽  
Reduce Risk

Objectives: Patients_with_traumatic_brain_or_spinal_cord injury are at risk of developing peri-articular NHO most frequently affecting the hip; with resulting ankyloses and functional limitations1. Surgical excision aims to improve functional ability and facilitate nursing care2. It is technically challenging as NHO development maybe multi-focal and multi-directional around the joint involving important neuro-vascular structures2. Plain_radiographs often provide sub-optimal_information_required_for_surgical planning Methods: An_18-year-old_male_presented to us with pain and immobility of his right hip 18-months following a traumatic brain injury. The joint was completely ankylosed and he was unable to walk. Plain radiograph showed extensive NHO from medial aspect of right proximal femur to ischial tuberosity (Figure_1). A CT scan with 3D reconstruction more clearly defined the NHO as extending posteriorly from the greater trochanter to ipsilateral pubic ramus and ischial tuberosity (Figures 2a & 2b). We therefore opted_for_a_Kocher-Langenback approach and performed selective excision to achieve satisfactory_range of motion. RESULTS: The_Kocher-Langenbeck_approach_enabled_us to visualise and access a major segment of the bone bridge. Excision of NHO began at the proximal end of the femur with aim to break the bone bridge between the femur and pelvis to enable hip movement (Figure 3). Limited excision was performed until satisfactory range of motion of hip is achieved as assessed intraoperatively. This is to reduce risk of iatrogenic sciatic nerve injury. 3 months following_surgery, the_patient is now weight bearing_with_80_degrees_of_hip_flexion_with good_internal_and_external_rotation. Conclusion: CT_scanning_with_3D reconstruction should be performed prior to excision of hip NHO as it aids the surgeon in planning the appropriate approach and avoid iatrogenic injury to_adjacent_structures.

scholarly journals Persistent Atraumatic Knee Pain in a Teenage Female with Bony Protuberance Secondary to Hook-Shaped Osteochrondroma

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Adityanarayan Rao ◽  
Joshua Pryor ◽  
Jaclyn Otero ◽  
Molly Posa
Keyword(s):  
Medical History ◽  
Knee Pain ◽  
Conservative Management ◽  
Plain Radiograph ◽  
Surgical Excision ◽  
Initial Presentation ◽  
Medial Aspect ◽  
Skin Changes ◽  
The Right

A 13-year-old female presented at her pediatrician’s office with a complaint of sharp, intermittent, right-sided knee pain that had been present for the previous three days without any known trauma and no association with activity. Her medical history was significant for fractures, and on physical exam, there was a hard mass palpated on the medial aspect of her distal thigh that was nontender, nonmobile, and without overlying skin changes. The plain radiograph findings were consistent with a hook-shaped osteochondroma of the right medial distal metaphysis. Orthopedics recommended conservative management with continued ibuprofen for pain and six-week follow-up with repeat radiograph to evaluate for progression. The follow-up radiograph showed no interval growth. However, due to continued pain, the patient had surgical excision of the osteochondroma six months after initial presentation, allowing her to finish her current soccer season. The surgery was successful, and the patient did well after operation with no residual pain.

A Cadaveric Study on the Variation in the Level of Division of Sciatic Nerve in Nepalese Population

2020 ◽  
Vol 9 (1) ◽  
pp. 12-16
Author(s):  
Diwakar Kumar Shah ◽  
Sanzida Khatun
Keyword(s):  
Sciatic Nerve ◽  
Ischial Tuberosity ◽  
Lower Limbs ◽  
Pelvic Cavity ◽  
Terminal Branch ◽  
Middle Region ◽  
Common Site ◽  
Greater Trochanter ◽  
Cross Sectional ◽  
Medical College

Background: Sciatic nerve, the thickest nerve of our body (around 2cm wide at its origin), leaves the pelvic cavity from the greater sciatic foramina below the piriformis muscle and between the greater trochanter of femur and ischial tuberosity. As variations have been reported in the level of division of sciatic nerve into its terminal branches, the current study aims to determine the most common site of division of sciatic nerve in Nepalese population. Materials and Methods: The current study is a cross-sectional and descriptive study which was carried out in the Department of Anatomy, Nobel Medical College, where twenty-three cadavers were used and both the lower limbs were examined. Depending upon the level of division of the sciatic nerve into its terminal branches, it was categorized into six different groups (A-F). Results: It was seen that the sciatic nerve had already divided into its terminal branches before its exit into the gluteal regionin 23.91% extremities. The second commonestsite for the termination of sciatic nerve into its terminal branch was found to be at the middle region of the back of the thigh in 19.57% followed by its division in the popliteal fossa in 17.39%. Conclusion: From the current study we conclude that the level of division of sciatic nerve was variable and it is wise to go for other means to find out the level of termination of sciatic nerve before performing any procedure in that area.

Popliteal artery pseudoaneurysm due to femur exostosis

2017 ◽  
Vol 27 (1) ◽  
pp. 39-41
Author(s):  
Wahid Syed ◽  
Mohd Akbar Bhat ◽  
Hakeem Zubair Ashraf ◽  
Farooq Ganie ◽  
Feroze Ahmad
Keyword(s):  
Popliteal Artery ◽  
Vascular Complications ◽  
Surgical Excision ◽  
Left Thigh ◽  
Lower Limbs ◽  
Patch Repair ◽  
Medial Aspect ◽  
Artery Pseudoaneurysm ◽  
Multiple Exostoses ◽  
Popliteal Artery Pseudoaneurysm

Vascular complications of femur exostoses are rare, with popliteal pseudoaneurysm being the most common. After establishing the diagnosis, surgical treatment is mandatory. A 35-year-old woman presented with a painful pulsatile swelling in the lower medial aspect of the left thigh. Investigations revealed a pseudoaneurysm arising from the left popliteal artery adjacent to femur exostoses. Skeletal survey revealed multiple exostoses involving the upper and lower limbs. Surgical excision of the pseudoaneurysm was followed by ePTFE patch repair of the defect and excision of the exostoses. The patient was discharged after 5 days and followed up for 6 months with excellent results.

scholarly journals An Approach to Posterior Femoral Cutaneous Nerve Block

1986 ◽  
Vol 14 (4) ◽  
pp. 350-351 ◽  
Author(s):  
P. J. Hughes ◽  
T. C. K. Brown
Keyword(s):  
Nerve Block ◽  
Gluteus Maximus ◽  
Ischial Tuberosity ◽  
Cutaneous Nerve ◽  
Deep Fascia ◽  
Greater Trochanter ◽  
Medial Border ◽  
Femoral Cutaneous Nerve ◽  
Gluteal Fold ◽  
Posterior Femoral Cutaneous Nerve

An approach to blocking the posterior femoral cutaneous nerve at the point where its branches emerge from below the medial border of gluteus maximus is described. This is located by inserting the needle at a point one quarter of the distance from the ischial tuberosity to the greater trochanter in the gluteal fold and then feeling two distinct losses of resistance as superficial and deep fascia are penetrated with a short-bevelled needle.

scholarly journals Traumatic obturator–anterior type dislocation of the hip with an ipsilateral ischial tuberosity and greater trochanter fractures: Case report

2020 ◽  
pp. 221049172097898
Author(s):  
Juan Manuel Concha ◽  
Humberto Gonzalez ◽  
Andrea C Montero ◽  
Nelsy B Mueses ◽  
Heydy Y Muñoz ◽  
...  
Keyword(s):  
Hip Dislocation ◽  
Femoral Fractures ◽  
High Energy ◽  
Ischial Tuberosity ◽  
Harris Hip Score ◽  
Acetabular Fractures ◽  
Functional Evaluation ◽  
Greater Trochanter ◽  
Anterior Hip Dislocation ◽  
Trochanter Fracture

Anterior hip dislocation is a rare orthopedic emergency, usually following high-energy trauma. This injury is occasionally associated with acetabular fractures, femoral head fractures, or diaphyseal femoral fractures. However, the combination between the anterior hip dislocation and the ipsilateral ischial tuberosity and greater trochanter fractures is extremely rare, and very sparsely reported in the literature. This paper reports a case of an obturator type of anterior hip dislocation associated with a concomitant ipsilateral ischial tuberosity and greater trochanter fracture. The hip dislocation was reduced by closed means under general anesthesia, and the greater trochanter fracture was reduced and internally fixed with tension band in a second stage. Radiological and functional evaluation at 12 months after surgery, using the Harris Hip Score (HHS), was good.

scholarly journals Pattern and Risk Assessment of Bedsore in Hospitalized Patients

2014 ◽  
Vol 13 (2) ◽  
pp. 12-16 ◽  
Author(s):  
Md Ruhul Amin ◽  
Md Monoarul Haque ◽  
Pradip Kumar Saha ◽  
Sumaiya Zabin Eusuf Zai ◽  
Sarder Mahmud Hossain ◽  
...  
Keyword(s):  
Risk Factors ◽  
Iliac Crest ◽  
Cross Sectional Study ◽  
Age Group ◽  
Sectional Study ◽  
Medial Aspect ◽  
Greater Trochanter ◽  
Cross Sectional ◽  
Cord Injury ◽  
Common Area

Objective: This descriptive type of cross sectional study was conducted to assess pattern and risk factors of bedsore in hospital admitted patients in Dhaka city with a sample size of 114.Methods: A pretested, modified, questionnaire was used to collect the data. All the data were entered and analyzed by using Statistical Package of Social Science 16.0 versions. Results: Study found that 17.5%, 41.2%, 27.2% and 14% of the respondents belonged to age group of 1-20 years, 21-40 years, 41-60 years and 61-80 years respectively with mean age 37.97 +16.909 years.  Responsible diseases for bedsore were spinal cord injury (41.2%), fracture (30%), stroke (24%), unconsciousness (7.2%) and GBS (2.8%) respectively. Study revealed that common area of bedsore were back of the sacrum (57%), back of the scapula (34.2%), medial aspect of knee joint (22.8%), malleoli (21.1%), greater trochanter of femur (15.8%), external occipital protuberance (14%), olecranon process of ulna (9.6%), above the coccyx (9.6%), iliac crest (7%), spine of the scapula (3.5%), posterior superior iliac joint (2.6%) and sacro-iliac joint (1.8%) respectively. Study also found that superficial and deep type of bedsore were 58.8% and 41.2% consecutively. Besides study revealed that 26.3% of the respondents were diabetic, 31.6% obese, 28.1% suffering from malnutrition, 61.4% did not use pneumatic bed and 7.2% patients did not maintain proper positioning 2 hourly and these were the risk factors of this study. Significant association was found between type of bed sore and use of pneumatic bed (P=0.000<0.05) as well as nutritional status (P=0.004<0.05).Conclusions: Changing position and use of pneumatic bed was best methods of prevention of bedsore.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i2.21049

Calcifying Aponeurotic Fibroma of the Hallux

2018 ◽  
Vol 108 (1) ◽  
pp. 68-73 ◽  
Author(s):  
Reem N. Sheikh ◽  
Kristina Karlic
Keyword(s):  
Surgical Excision ◽  
Incisional Biopsy ◽  
Imaging Findings ◽  
Resonance Imaging ◽  
Medial Aspect ◽  
Complete Excision ◽  
Complete Surgical Excision ◽  
Fibrous Tumor ◽  
Histopathologic Findings ◽  
Calcifying Aponeurotic Fibroma

Calcifying aponeurotic fibroma is a rare benign fibrous tumor predominantly seen in children and adolescents younger than 20 years. This tumor is often treated with complete surgical excision, although the recurrence rate is approximately 50%. The distal upper and distal lower extremities are most commonly involved, with only three cases published to date involving pedal digits. We discuss a case of calcifying aponeurotic fibroma in a 25-year-old woman localized to the medial aspect of the distal hallux. Clinical, radiographic, and magnetic resonance imaging findings are described. After an incisional biopsy and histopathologic findings confirmed that the lesion was benign, a complete excision was performed, and diagnosis was established for calcifying aponeurotic fibroma. At 6 months, the patient had healed uneventfully, and no recurrence has been noted. Malignant transformation is rare but has been documented, warranting concern for clinicians and patients.

scholarly journals A rare case of intraosseous lipoma of distal tibia – A case report and review of literature

2021 ◽  
Vol 7 (1) ◽  
pp. 29-33
Author(s):  
Kuenzang Wangdi ◽  
Sonam Choden
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Histopathological Examination ◽  
Osteolytic Lesion ◽  
Plain Radiograph ◽  
Distal Tibia ◽  
Medial Aspect ◽  
Intraosseous Lipoma ◽  
Male Predominance ◽  
The Right

Introduction: Intraosseous lipoma is a very rare neoplasm accounting for < 0.1 % of primary bone tumors. Pain is the leading symptom in majority of the reported cases but it can be asymptomatic. There is slight male predominance in occurrence of this lesion. The plain radiological findings are not specific and requires differential diagnosis. The lesion is mostly diagnosed by histopathological examination. Case report: A 31-year-old male presented with localized pain around the medial aspect of right ankle joint for one week. Examination revealed mild tenderness over the distal part of the right tibia over the medial aspect. Plain radiograph of the right leg showed well-defined expansile osteolytic lesion with sclerotic rim and calcified matrix at metaphysis of distal tibia. MRI showed enhancing T1-weighted hypo intense and T2-weighted hyperintense lesion. For this case, radiological impression was giant cell tumor with differential diagnosis of aneurysmal bone cyst and fibrous dysplasia. However, the histopathological examination showed intraosseous lipoma, consistent with stage II of Milgram’s classification. Conclusions: Although the diagnosis of intraosseous lipoma can be very challenging due to its rarity and indistinct plain radiograph findings, combination of computed tomography or magnetic resonance imaging may be useful by being able to show the presence of fat within the lesion. However, the clinicians, surgeons and radiologist should be familiar and be aware of these findings to be able to come to a correct diagnosis since not all cases need surgery and can be managed conservatively.

Radiographic study of the development of the pelvis and hip and the femorotibial joints in domestic cats

2019 ◽  
Vol 22 (6) ◽  
pp. 476-483
Author(s):  
Fernanda G Miranda ◽  
Izabela P Souza ◽  
Flávia M Viegas ◽  
Tábata T Megda ◽  
Anelise C Nepomuceno ◽  
...  
Keyword(s):  
Skeletal Development ◽  
Ischial Tuberosity ◽  
Domestic Cat ◽  
Skeletal Maturation ◽  
Radiographic Examination ◽  
Radiographic Evaluation ◽  
Domestic Cats ◽  
Greater Trochanter ◽  
Growth Plates ◽  
Ossification Centers

Objectives The aims of the present study were to monitor, by radiographic examination, the skeletal development of the pelvis and the femorotibial joints of the domestic cat from the first week of life until the closing of the growth plates. Methods Radiographic examinations were collected from 15 domestic cats at weekly intervals during the first month and every 2 weeks from the second to the fourth month of age. After that, examinations were performed monthly until the age of 18 months. Results The ischiopubic growth plate closed at 2 months of age, followed by the fusion of the iliopubic, ilioischial, proximal femoral, greater trochanter and proximal fibular growth plates. The distal femur and proximal tibial growth plates were the last to close, with fusion occurring at 18 months. The mean time to closure of the iliopubic, ilioischial and distal femoral growth plates was shorter in females. The ossification centers first appeared, in ascending order, beginning with the lesser trochanter, followed by the greater trochanter, proximal fibular epiphysis, tibial tuberosity, patella, ischial tuberosity and lateral sesamoid of the popliteus muscle. Conclusions and relevance The complete closure of the growth plates of domestic cats occurs at approximately 18 months of age. Skeletal maturation at approximately 18 months of age is an important parameter to be considered in radiographic evaluation of certain skeletal changes, evolution of fractures and nutritional imbalance.

Extra-articular Hip Impingement: Anterior Inferior Iliac Spine/Subspine Impingement, Ischiofemoral, and Anterior and Lateral Greater Trochanteric-Pelvic Impingement

2018 ◽  
Vol 02 (03) ◽  
pp. 126-134
Author(s):  
Ira Zaltz ◽  
Christopher Larson
Keyword(s):  
Femoral Neck ◽  
External Rotation ◽  
Treatment Options ◽  
Rectus Femoris ◽  
Ischial Tuberosity ◽  
Anterior Inferior Iliac Spine ◽  
Leg Length ◽  
Greater Trochanter ◽  
Avulsion Fractures ◽  
Hip Impingement

AbstractAlthough femoroacetabular impingement (FAI) is traditionally considered an intra-articular phenomenon, the result of abutment between the femoral head and/or neck and the acetabular rim, there are unique and relatively uncommon patterns of pathologic extra-articular hip impingement that can mimic the clinical presentation and clinical findings of traditional FAI. Anterior inferior iliac spine (AIIS) or “subspine” impingement may occur as a consequence of an abnormally anterior or distal prominence of the AIIS that may be developmental, posttraumatic, or the result of high range of motion (ROM) activities. This type of impingement can crush the capsule, labrum, and rectus femoris between the AIIS and distal femoral neck in straight hip flexion. Greater trochanteric/pelvic impingement is quite complex and can be further divided into three unique anatomic patterns. Anterior greater trochanteric–pelvic impingement is the result of impingement between the anterior hip soft tissue structures or the anterior facet/greater trochanter and anterolateral rim/lateral AIIS and pelvis when the hip is flexed, internally rotated, and abducted. This can occur in association with a prominent greater trochanter, short femoral neck, relative femoral retrotorsion, and high ROM activities. Lateral greater trochanteric–pelvic impingement is the result of impingement between an abnormally prominent or a high riding greater trochanter with a short femoral neck and the lateral pelvis when the hip is abducted. This type of impingement is characteristic of a Perthes-like hip and, in extreme cases, can be associated with severe leg length discrepancy (and abductor muscle dysfunction). Posterior greater trochanteric–pelvic/ischiofemoral impingement is the result of impingement of the quadratus femoris and/or proximal hamstring tendons between the lesser trochanter or posterior proximal femur and intertrochanteric line and the ischial tuberosity when the hip is extended and external rotated (ER). This can occur in association with deformities of the ischial tuberosity caused by prior avulsion fractures, lesser trochanteric overgrowth, extreme coxa valga, femoral antetorsion, complex proximal femoral developmental deformities, and activities requiring high degrees of extension and external rotation. A thorough understanding of these unique patterns of impingement, their clinical presentations, and complex treatment options can help in optimizing outcomes and minimizing complications in this very challenging patient population.

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