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Contracture of Muscles of the Lower Limb – Quadriceps Contracture Secondary to Osteomyelitis of the Femur
Published in Benjamin Joseph, Selvadurai Nayagam, Randall T Loder, Anjali Benjamin Daniel, Essential Paediatric Orthopaedic Decision Making, 2022
Further release of the vastus lateralis was performed progressing distally till no further tightness was noted. Attention was now given to the vastus intermedius muscle; the tight fibrotic fibres were released right down to the distal femur (Figure 43.5). The rectus femoris was contracted, and it was released from its origin. The vastus medialis was not released as 80 degrees of passive flexion was achieved (i.e., 110 degrees of correction) at this point. The wounds were closed over a suction drain.
Lower Extremity Surgical Anatomy
Published in Armstrong Milton B., Lower extremity Trauma, 2006
Latham Kerry, Baez Marcelo Lacayo, Armstrong Milton B., Arias Efrain
Vastus lateralis originates at the intertrochanteric line, greater trochanter, gluteal tuberosity, and lateral intermuscular septum to then insert on the patella. It is a type I and measures 10 × 26 cm2. This muscle is the largest in the quadriceps group extensor. It is found between the biceps femoris and the vastus intermedius muscles and beneath the tensor fascia lata, it extends from the proximal femur to the patella. Its action is to extend the leg, and because there are three other extensors in the quadriceps extensor group it is considered expendable. Motor innervation is supplied by a muscular branch of the femoral nerve, which enters at the medial border of the proximal belly adjacent and inferior to the descending branch of LCFA, while sensory is supplied by the lateral femoral cutaneous nerve (L2–3). Blood is supplied to the superior one-third of this muscle by the descending branch of LCFA (major blood supply), the superior one-fourth deep surface is penetrated by the transverse branch of the LCFA (LCFA is off of the profunda femoral artery), and the inferior one-half of the posterior muscle by posterior branches of the profunda. Also, blood is supplied to the distal muscle by a superficial branch of the lateral superior genicular artery off of the popliteal artery, which courses deep to the bicep femoris around the lateral condyle of the knee.
Complete remission of a case of high-grade myxofibrosarcoma with lung metastases after modified MAID regimen chemotherapy
Published in Journal of Chemotherapy, 2020
Yunpeng Cui, Yuanxing Pan, Xuedong Shi
A 44-years-old man presented with a left thigh mass (approximately 3 cm in diameter) in September 2015 with no other clinical symptom. This mass had been growing gradually and the patient was admitted to our hospital on September 15th, 2017. Physical examination showed a huge mass in the left thigh. The mass was relatively immobile without tenderness. Electrocardiogram and blood chemistry were normal. Magnetic resonance imaging (MRI) showed a large mixed T1 and long T2 signal lesion at the middle and lower left thigh, with increased signal intensity on Diffusion-weighted imaging (DWI). The lesion measured 8.8 cm × 12.8 cm × 18.5 cm (transverse, antero-posterior, longitudinal, respectively). Vastus lateralis, vastus intermedius muscle, rectus femoris muscle and biceps femoris muscle were compressed by the mass. On fsT2WI, patchy bright spots with poorly defined boundaries were seen in the lateral femoral muscle near the proximal end of the lesion, intermuscular septum near the distal end of lesion and soft tissue near lateral parapatellar. The lesion did not invade femoral vascular, nerves and femur (Figure 1A). Chest computed tomography (CT) showed multiple nodules of lung, and the largest one was located in the basal segment of the right lower lobe, with a diameter of about 1.7 cm (Figure 1B). B-mode ultrasound guided percutaneous biopsy of the primary tumour in the left thigh showed spindle cells hyperplasia, accompanied by multinucleated giant cells and strange nuclear cells with mucus-like stroma. The pathological diagnosis was mesenchymal tumour, which is suspicious for malignancy.
Lower limb muscle magnetic resonance imaging in Chinese patients with myotonic dystrophy type 1
Published in Neurological Research, 2020
Jia Song, Jun Fu, Mingming Ma, Mi Pang, Gang Li, Li Gao, Jiewen Zhang
According to the previous studies, the lower legs were more severely affected than thighs in patients with DM1 [2,14]. Our study showed that the distal muscle groups of lower limbs were more severely affected than the proximal muscle groups in most of the patients, except in five patients, where two patients had mild involvement of both proximal and distal muscle groups, one patient had severe involvement of vastus medialis and vastus intermedius muscles (Figure 2(c and d)), one patient had severe involvement of posterior thigh compartment, adductor magnus and medial gastrocnemius muscles (Figure 2(k and l)), and the other patient with advanced clinical stage had severe involvement in both the proximal and distal muscle groups (Figure 2(i and j)). Hamano et al. [12] also reported that patients with severe weakness showed high-intensity signals not only in the distal part but also in the thigh. So, we hypothesized that at a certain stage of disease development, especially during the early or late stage of the disease, the lower legs might be affected not more severely than thighs, and this needs further confirmation by dynamic MRI study.
Lemierre’s syndrome with muscle necrosis and chronic osteomyelitis
Published in Baylor University Medical Center Proceedings, 2021
Azka Latif, Muhammad Junaid Ahsan, Amman Yousaf, Asim Tameezuddin, Akshat Sood, Joseph Thirumalareddy
The patient was placed on intravenous vancomycin (500 mg every 6 hours) and piperacillin/tazobactam (4.5 g every 8 hours) initially, which were later modified to meropenem (1 g every 8 hours), doxycycline (200 mg on day 1, then 100 mg/d), and vancomycin (500 mg every 6 hours). Moreover, he underwent incision and drainage of the right vastus intermedius muscle abscess. Computed tomography of the chest revealed markedly progressive multifocal pneumonic foci with cavitations and multiple scattered nodularities. A Doppler ultrasound for neck swelling showed a left internal jugular vein thrombus, confirming the diagnosis of LS. He progressively got better and was extubated after 1 week. Doppler ultrasound of the right leg showed deep vein thrombosis, and he was started on apixaban.