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Examination of Hip Joint in a Child
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
Nirmal Raj Gopinathan, Reet Mukopadhya, Karthick Rangasamy, Ramesh Kumar Sen
The ASIS is the anterior end of the iliac crest and is marked by identifying the point where the finger starts dipping into soft tissue while palpating anteriorly along the iliac crest. The other way of marking ASIS is palpation along the inguinal ligament laterally and the first bony resistance that is felt is the ASIS. The pubic tubercle is a small bony prominence on the pubis just lateral to the pubic symphysis. The inguinal ligament is attached to both the ASIS and pubic tubercle. To locate the anterior joint line, the femoral arterial pulsation is localized medial to the midpoint of the inguinal ligament (Figure 9.7). The anterior joint line is palpable inferior and lateral (2 cm in an older child but less than that in younger children) to the point of palpation of the femoral artery.
Lumps and bumps
Published in Tjun Tang, BV Praveen, MRCS Picture Questions, 2018
A 45-year-old male presented to A&E with this lump in his right groin, which was irreducible and had no cough impulse. On examination it was found to be below and lateral to the pubic tubercle.
Single Best Answer Questions
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
Arising below and lateral to the pubic tubercle. Select the single most likely diagnosis.Direct inguinal herniaIndirect inguinal herniaObturator herniaFemoral herniaEpigastric hernia
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.
Tipp versus the Lichtenstein and Shouldice techniques in the repair of inguinal hernias – short-term results
Published in Acta Chirurgica Belgica, 2021
Aleksandar Djokovic, Samir Delibegovic
In the case of a direct hernia, the preperitoneal space is dissected through the dilated transverse fascia. We begin dissection above the pubic tubercle and push the peritoneum upwards and medially. In order to position the mesh well, the dissection must be made right up to Cooper’s ligament and the pubic bone must be felt. During this preparation, any non-diagnosed femoral hernia may be identified and treated using the same procedure. Dissection of the hernia sac and funiculus must be performed up to the point where the sperm duct and the blood vessels divide, so that the tunica of funiculus may be easily closed. Placing the mesh is facilitated by a memory ring patch (Polysoft, Davol Inc., C.R. Bard Inc., Crowley, UK). First, it is placed medially behind the Cooper’s ligament and then laterally up to the internal ring (Figure 2) [14].
Anatomical course of the lateral femoral cutaneous nerve with special reference to the direct anterior approach to total hip arthroplasty
Published in Modern Rheumatology, 2020
Masahiko Sugano, Junichi Nakamura, Shigeo Hagiwara, Takane Suzuki, Takayuki Nakajima, Sumihisa Orita, Tsutomu Akazawa, Yawara Eguchi, Yohei Kawasaki, Seiji Ohtori
The following dissection protocol was applied. Each cadaver was first placed on a dissection table in a supine position. Along the inguinal ligament, an incision was made from the anterior superior iliac spine (ASIS) to the pubic tubercle, followed by longitudinal dissection of the center of the anterior thigh from the center of the inguinal ligament. The LFCN and its branches were identified by their origin from the pelvis at the level of the inguinal ligament. All nerve branches of the LFCN were carefully traced distally in the subcutaneous tissue of the proximal aspect of the thigh. The following distances of Ropars et al. [12] were measured using a ruler (Figure 1). (a) The distance from the midpoint of the ASIS to the LFCN at the level of the inguinal ligament. When the nerve divided proximally to the inguinal ligament into two main femoral and gluteal branches their distance from the ASIS was measured. Whether each nerve passed through or under the inguinal ligament was recorded. (b) The distance from the midpoint of the ASIS to the points where the LFCN branches crossed the anterior margin of the TFL was recorded and the distance from the ASIS to this point was measured. (c) The distance from the lateral epicondyle of the femur to the lateral malleolus of the ankle (lower leg length) was measured.