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Analgesia and Anaesthesia
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
A line drawn from the pubic tubercle to the anterior superior iliac spine marks the position of the inguinal ligament. The femoral artery can be palpated in the centre of this line, and the femoral nerve lies about 1 cm lateral to the artery just below the ligament. The needle is directed posteriorly and distally at a 45° angle. A ‘click’ may be felt as the needle pierces the fascia lata. Paraesthesia or pain may occur if the needle has penetrated the nerve, in which case the needle should be withdrawn slightly before injection in order to prevent neuronal damage. The total depth should be no more than 2.0–3.5 cm.
Miscellaneous Topics
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
Prateek Behera, Karthick Rangasamy, Nirmal Raj Gopinathan
The sciatic nerve is labeled by connecting the following three points: A point 2.5 cm laterally from the midpoint of the line joining the posterior superior iliac spine and ischial tuberosity.The second point is marked just medially to the midpoint of the line connecting the ischial tuberosity and the greater or outer trochanter.The third point is marked on the back of the thigh in the midline at the upper two-thirds and lower one-third junction (apex of popliteal fossa).8
Revision ACDF at the same level
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Fadi Al-Saiegh, George M. Ghobrial, James S. Harrop
After establishment of baseline neurologic functioning and intubation, positioning commences with placing a bolster under the shoulder blades to achieve cervical lordosis. Halo tongs or any other lordotic distraction device can also be used to facilitate interbody work and the maximization of lordotic alignment. The arms are padded at the elbows, where the ulnar nerve is most susceptible to neurapraxia. If iliac crest is intended for harvest, then the side of anterior superior iliac spine is elevated with a small bump to facilitate surgical exposure. Localization of incision and sagittal alignment may be assessed prior to sterile prep and drape with fluoroscopy. The shoulders can be taped and retracted caudally to improve radiographic exposure of the caudal part of the cervical spine. Gentle retraction of the shoulders is advised to avoid brachial plexus injury, which can be monitored by neurophysiology.
Sentinel lymph node biopsy based on anatomical landmarks and locoregional mapping of inguinofemoral sentinel lymph nodes in women with vulval cancer: an operative technique
Published in Journal of Obstetrics and Gynaecology, 2023
Fong Lien Kwong, Miski Scerif, Jason KW Yap
Surgical technique: We start by identifying the anterior superior iliac spine and pubic tubercle to map the course of the inguinal ligament. We then palpate the femoral artery to identify its location and a handheld Doppler may be used in obese women. Situated on its medial side in the femoral triangle is the femoral vein and the latter is joined on its medial side by the saphenous vein at the saphenofemoral junction. We make a 3-4cm incision inferior to and parallel to the inguinal ligament. The incision extends over the femoral vein and slightly above the saphenous vein (Figure 1). Radiolocalisation of the SLN was achieved after identifying and excising the node with the highest signal count using a handheld gamma counter. The groin was re-examined and dissection continued until there was no residual radioactivity. All histological specimens were analysed using ultrastaging with immunohistochemistry. Ipsilateral unilateral inguinal SLN biopsies were conducted for lateral tumour and bilateral excisions for central tumours. The long saphenous vein was preserved in all cases.
Recommended maximum holding time of common static sitting postures of office workers
Published in International Journal of Occupational Safety and Ergonomics, 2023
Somayeh Tahernejad, Mohsen Razeghi, Mohammad Abdoli-Eramaki, Hossein Parsaei, Mozhgan Seif, Alireza Choobineh
To adjust the trunk angles, the participant was first asked to maintain his/her lower back (lumbar spine) in a neutral position so that the angle between the thigh and the trunk was approximately 90°. Then, a point was marked on the iliac crest extending from the anterior superior iliac spine (ASIS) to the posterior superior iliac spine (PSIS). The proximal arm was placed along the imaginary line from the marked point, perpendicular to the chair seat. The distal arm was then rotated to the desired angles, and the participant was asked to bend so that the marked point was below the distal arm. To adjust the trunk angle in the lateral flexion position, the proximal arm was placed between the spinous process of the 12th thoracic vertebra (T12) and the beginning of the sacral curve perpendicular to the chair seat. The distal arm was then rotated to the desired angle and the subject was asked to bend so that the marked point was under the distal arm [29,30]. The examined trunk postures are shown in Figure 3.
The influence of musculoskeletal forces on the growth of the prenatal cortex in the ilium: a finite element study
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Peter J. Watson, Michael J. Fagan, Catherine A. Dobson
Another simplification regards the morphology of the prenatal structure. The morphometric reconstruction technique estimated the cartilaginous acetabulum using a template based on an adult pelvis (Figure 1). However, the geometry and location of the prenatal bones remained unchanged and the hip joint reaction force was applied in a radial direction over the inside of the acetabulum, so that the resultant force acted in the correct direction. The modelling of the cortex in small ROI results in step changes of thickness across the iliac surface. This causes some disruption to the strain distributions, as evident around the anterior superior iliac spine on the gluteal surface in Figure 5. Introducing a gradual change in thickness between each ROI would alter the proportion of the surface above the 100µε and 1500µε strain thresholds slightly, however this would not affect the observations made regarding the overall strain distributions.