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Inguinal hernia, hydrocele, and other hernias of the abdominal wall
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Sophia Abdulhai, Todd A. Ponsky
A femoral hernia is a protrusion of preperitoneal fat or viscus through a defect in the femoral canal. It is not a common hernia in children but must be considered with a swelling in the inguinal region with the bulge inferior to the inguinal ligament. Femoral hernia may occasionally be confused with an enlarged swollen infected lymph node near the saphenofemoral junction (lymph node of Cloquet) just inferior to the inguinal ligament. Careful examination for a lower extremity focus of infection should be performed. Unfortunately, femoral hernias are often misdiagnosed and treated as inguinal hernias and therefore present following “recurrence.”
Amputations
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Heledd Havard, William Aston, Rob Pollock
The quadriceps muscle is divided, straight down to bone, in the line of the incision. The femoral canal is identified medial to the femur and the artery and vein ligated within it. These should be double tied proximally and if necessary a transfixion suture used. The periosteum is incised at the level of resection and the femur transected using a saw, ensuring protection of the soft tissues. A rasp is used to smooth the sharp edges of the cut bone and prevent high-pressure areas in the stump. The sciatic nerve is identified and transected, with a sharp blade under gentle traction, so that the end retracts proximally. Any cutaneous nerves encountered should also be transected in a similar fashion. The sciatic nerve has a significant artery running within it and therefore should be ligated, but this is not necessary for other nerves. The hamstring compartment is divided and the leg removed. The wound should be washed thoroughly and the tourniquet released to ensure adequate haemostasis.
General Surgery
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
Femoral hernias emerge through the femoral canal medially to the femoral vessels. Because of the position of the femoral canal, femoral hernias can be differentiated from inguinal hernias by the position of the pubic tubercle. Femoral hernias emerge below and lateral to the pubic tubercle, while inguinal hernias occur above and medial to the pubic tubercle.
De Garengeot hernias. Over a century of experience. A systematic review of the literature and presentation of two cases
Published in Acta Chirurgica Belgica, 2022
Michail Chatzikonstantinou, Mohamed Toeima, Tao Ding, Almas Qazi, Niall Aston
The femoral canal is the most medial compartment of the femoral sheath, which is bordered anterosuperiorly by the inguinal ligament, medially by the lacunar ligament, laterally by the femoral vein and posteriorly by the pectineal ligament. It contains fat lymphatics and the lymph node of Cloquet. A large mobile caecum that extends into the pelvis is the usual reason for the appendix to enter the hernia sac into the femoral ring [13–15]. The abnormal low position of the bowel creates a mass effect that pushes the appendix into the femoral canal, while an abnormal embryological rotation of the gut increases the probability of appendiceal herniation. Intraoperative findings of normal non-inflamed appendix favour the theory of herniation of the appendix and subsequent inflammation rather than incarceration of an already inflamed appendix. The tight rigid femoral ring acts as an entrance to an anatomically confined space for strangulation, inflammation and, eventually, vascular congestion, necrosis and perforation of the appendix.
Frequency of ischiofemoral space discrepancy when comparing magnetic resonance images of distinct institutions for the same patient
Published in Baylor University Medical Center Proceedings, 2021
Munif Hatem, RobRoy L. Martin, Scott J. Nimmons, Hal David Martin
In hips with a difference ≥4 mm in the IFS comparing the noncontrolled MRI and controlled MRI, the change in hip positioning was assessed by measuring the anteriorization/posteriorization and lateralization/medialization, as follows: 1) the axial images of the noncontrolled and controlled MRI were placed simultaneously in the same screen and 2) the anteriorization/posteriorization and lateralization/medialization of the hip were determined utilizing the center of the femoral canal and ischium tuberosity as reference points for both the noncontrolled MRI and controlled MRI (Figure 4a, 4b). Calculation using sine and cosine trigonometrical functions was performed to determine the contribution of hip internal rotation to lateralization and anteriorization of the femoral canal and the contribution of hip external rotation to medialization and posteriorization of the femoral canal (Figure 4c, 4d). Flexion, extension, abduction, adduction, and internal or external rotation were considered to contribute to the change in the IFS when they anteriorized or posteriorized the femoral canal >2 mm (Table 1). To determine the predominant cause of change on the IFS, the amount and direction of change provoked by hip rotation was subtracted or added to the changes related to abduction/adduction or flexion/extension.
In Asian women undergoing total knee arthroplasty, lower leg morphology in those with rheumatoid arthritis differed from those with osteoarthritis
Published in Modern Rheumatology, 2020
Shu Takagawa, Naoto Mitsugi, Yuichi Mochida, Naoya Taki, Kengo Harigane, Yohei Yukizawa, Yohei Sasaki, Masaki Tsuji, Kagayaki Sahara, Yutaka Inaba
The most important finding of the present study was that the leg morphology of RA patients undergoing TKA differed from that of the OA patients. The femurs in RA patients were significantly more medially bowed than those in OA patients. Furthermore, substantial medial femoral bowing was significantly more frequent in RA patients (OA: 5.5%, RA: 12.9%), whereas substantial lateral femoral bowing was significantly more frequent in OA patients (OA: 37.5%, RA: 14.3%). TKA is the standard treatment for knee joint dysfunction due to OA and RA, and conventional intramedullary devices are the most common femoral distal cutting methods used during the procedure. However, this device identifies femoral valgus correction angle indirectly during the operation and is restricted to the femoral shape. In particular, if the rod is not inserted far enough into the femoral canal, the resection angle is affected by the distal femoral shape. Furthermore, it is suspected that, in patients with substantial femoral bowing, it is especially difficult to sufficiently insert the rod into the proximal femoral canal. Distal femoral resection may have caused unintended varus in laterally bowing cases and caused unintended valgus in medially bowing cases. As a result, postoperative alignment would differ from the pre-operative planning alignment and several clinical outcome scales would be inferior [7].