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Blocks of Nerves of the Sacral Plexus Supplying the Lower Extremities
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand
The sciatic nerve emerges from the pelvis through the greater sciatic foramen and runs towards the back of the thigh between the greater trochanter of the femur and the ischial tuberosity (Figures 2.29A and 2.31). Below the piriformis muscle, it lies within the sub-gluteal space, over the posterior aspect of the ischial bone, deep to the gluteus maximus muscle and is accompanied (medially or posteriorly) by the posterior cutaneous nerve of the thigh and the inferior gluteal artery. Then it crosses the obturator internus, the gemelli and obturator externus muscles (the latter separating it from the hip joint), and passes over the adductor magnus (Figure 2.32).
The Thigh (Anterior and Medial Compartments)
Published in Gene L. Colborn, David B. Lause, Musculoskeletal Anatomy, 2009
Gene L. Colborn, David B. Lause
Reflect the pectineus from the pubis and then identify the obturator artery and nerve at their appearance from the obturator foramen. Also identify the obturator externus muscle. Reflect the proximal part of the adductor magnus, if necessary, to expose the obturator externus adequately. The tendon of this muscle passes posterior to the neck of the femur and inserts in the trochanteric fossa. It rotates the thigh laterally.
A case of hip joint septic arthritis due to haematogenous infection, which was misdiagnosed sternoclavicular joint septic arthritis as SAPHO syndrome
Published in Modern Rheumatology Case Reports, 2021
Yasushi Wako, Masaaki Sakamoto, Tomoyuki Rokkaku, Hiroyuki Motegi, Hitoshi Watanabe, Toshiyuki Yamada, Takeshi Yamaguchi, Kenta Inagaki, Juntaro Maruyama, Toru Ueta
Radiography of the left hip and SC joint at the family doctor 10 days before admission did not reveal any notable findings (Figure 1). Radiography on admission has revealed narrowing of the left hip joint space (Figure 2). Computed tomography (CT) and MRI showed left hip joint swelling and an isodense area in the left obturator externus muscle, suggesting an abscess (Figures 3 and 4). CT showed swelling and an osteolytic lesion of the right SCJ (Figure 5). Arthrocentesis of the left hip and right sternoclavicular joints was performed, both revealing purulent synovial fluid. She was later diagnosed with septic arthritis of the left hip joint and SCJ. Surgical debridement of the left hip joint and aspiration of the SCJ were performed on hospital day 2. Methicillin-sensitive Staphylococcus aureus (MSSA) was cultured from blood and synovial fluid from the hip joint and SCJ. Intravenous cefazolin was administered for 2 weeks and then changed to oral levofloxacin 500 mg/day. Clinical symptoms were seen to markedly improve, and she was discharged on hospital day 24. ここにCRPの推移 (Figure 6) Prednisolone was tapered to continue for 8 weeks, and oral antibiotics were continued for 6 months. Although slight pain remained in her left hip joint and SCJ, she was able to walk without aid but with a limp, and she continued her activities of daily living. From onset to the last visit, she had no dermatologic manifestations.
Survival analysis for all-cause revision following primary total hip arthroplasty with a medial collared, triple-tapered primary hip stem versus other implants in real-world settings
Published in Current Medical Research and Opinion, 2020
Abhishek S. Chitnis, Jack Mantel, Jill Ruppenkamp, Anh Bourcet, Chantal E. Holy
The design rationale for this MCTT stem, a triple taper in conjunction with a collar, is to improve initial stability of the stem and to offer treatment to broader range of patient anatomies.10,22 The stem is tapered in three separate planes. It is tapered from proximal to distal in the anterior-posterior plane, proximal to distal in the medial lateral plane and lateral to medial in the transverse or axial plane. The third taper (lateral to medial in the transverse plane) is intended to enhance the load distribution in the medial calcar region, in order to reduce the risk of stress shielding and bone resorption.22 To enable tissue sparing surgical approaches, such as the Anterior Approach, the MTCC stem was designed with a reduced lateral shoulder to aid in stem insertion by helping avoid the Obturator Externus muscle and other short external rotators that attach to the medial aspect of the greater trochanter. The natural loading of the femur with the MCTT medial collar should provide greater initial stability for early post-surgery weight bearing, and potentially reduce risks of subsidence and occurrence of femur fracture. However, the collar may also limit the degree of press‐fit fixation, that could result in failure or calcar impingement in cases of stem subsidence.15,16,23 Although there is limited direct comparative literature on the benefits of collared stems, some studies and national registries have shown that the collared stem lowered the risk of loosening or fracture when compared to the collarless stem.24