Extracapsular proximal femur fractures
Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth in Musculoskeletal Trauma in the Elderly, 2016
The lateral approach is used. The incision can be extended proximally to accommodate a trochanteric stabilizing plate. A straight incision is made parallel to the femoral axis. The fascia lata is incised in line with the skin incision and in line with its fibers. The vastus lateralis fascia is incised. The vastus lateralis muscle may be split in line with its fibers or elevated from the posterior leaflet of the fascia and retracted anteriorly. Elevating the vastus lateralis minimizes bleeding. To avoid bleeding, tie off or clip any perforating vessels encountered. A cob elevator is used to expose the footprint of the side plate. Bennett retractors are then placed anterior and posterior to the femur to allow visualization. If necessary for placement of a trochanteric stabilization plate or for open reduction of the fracture, the incision can be extended proximally to the greater trochanter. A pointed reduction clamp can be used to obtain reduction.
Does Fascia Stretch?
David Lesondak, Angeli Maun Akey in Fascia, Function, and Medical Applications, 2020
The 2008 article previously mentioned appeared to provide valid evidence for the case against certain kinds of fascia—plantar fascia and fascia lata—being able to be therapeutically stretched for permanent treatment effect. However, that article also stated at the outset that “palpable tissue release could result from deformation in softer tissues”.4 Research that “investigated the potential importance of uniaxial tension in a variety of therapies involving mechanical stretch” was considered.4 This fact—that less dense or “softer” connective tissues could indeed get the release effect from tissue deformation that many practitioners observe—was largely missing from the many articles and blogs that this author came across that questioned or advised whether stretching is necessary.
Lower Extremity Surgical Anatomy
Armstrong Milton B. in Lower extremity Trauma, 2006
The leg covered in superficial fascia under the subcutaneous tissue is made of loose connective tissue and is continuous with scarpa’s fascia. In certain areas, this superficial fascia splits into two layers to accommodate the passage of superficial vessels such as the lesser saphenous vein, greater saphenous vein, and superficial inguinal lymph nodes. The femoral sheath, which is an extension of deep abdominal wall fascia (transversalis and iliacus) is continuous with the cribiform fascia, which makes up the deep fascia of the thigh in the area of the saphenous opening. The greater saphenous vein perforates this in the proximal thigh to enter the femoral vein here. The deep fascia of the thigh or fascia lata is a strong, broad, thick layer that invests the thigh muscles. It encases the tensor fascia lata muscle and is thickened laterally contributing to the iliotibial tract. In the leg the deep fascia is called the crural fascia. It does not completely invest all the muscles; instead it is attached to the anterior and medial borders of the tibia and is contiguous with the periosteum. The crural fascia is thick proximally and laterally it thins distally but thickens again to form the superior and inferior retinaculum. The superior extensor retinaculum passes from the fibular to the tibia, and it binds the extensor tendons to prevent bow stringing. The Y-shaped inferior extensor retinaculum attaches laterally to the calcaneus and keeps the peroneus and EDL in position. The compartments of the leg are divided by the interosseous membrane, the crural intermuscular septum, and the tibia and fibula.
Treatment of CSF leakage and infections of dural substitute in decompressive craniectomy using fascia lata implants and related anatomopathological findings
Published in British Journal of Neurosurgery, 2021
Giorgio M. Callovini, Andrea Bolognini, Tommaso Callovini, Marco Giordano, Roberto Gazzeri
The successful repair of infected alien dura mater materials and CSF leakage control depends on the ability to achieve sufficient debridement and a watertight seal using well-vascularized tissue14. Fascia lata is a validated autograft and the most commonly-used graft adopted across different surgical fields in reconstructive procedures; ophthalmology, digestive-tract surgery, ENT surgery, and skull-base surgery, especially the repair of CSF leakage15. The fascia lata is the material whose biological characteristics are most similar to those of the dura, especially in terms of its negligible host response, eliciting a minimal inflammatory response16, and its non-immunogenicity, not to mention its lack of cost17. Further characteristics that contribute to making this material excellent in terms of dealing with infection issues at the surgery site are good manipulability, resistance to scarring and inflammation, and its ability to provide a scaffold for integration between the dura and the implant. In addition, fascia lata is a flexible material, which allows it to be sutured to the entire circumference of the dural defect in a watertight fashion. The successful control of infection and of CSF leak lie principally in the use of autologous material, in obtaining a watertight seal and in using well-vascularized tissue.
Gluteus medius tears of the hip: a comprehensive approach
Published in The Physician and Sportsmedicine, 2019
Collin LaPorte, Marci Vasaris, Leland Gossett, Robert Boykin, Travis Menge
Open repair of the gluteus medius involves a lateral approach to the greater trochanter through an incision on the lateral hip. The fascia lata is incised longitudinally, exposing the trochanteric bursa, which is then typically excised. The gluteus medius tendon is evaluated and its edges are debrided to healthy tissue. Next, the greater trochanteric insertion site is identified and debrided to bleeding bone. Depending on the extent of the tear, either a single or double row of suture anchors are employed to fixate the gluteus medius tendon back to its footprint on the greater trochanter. For partial thickness tears, a single row of suture anchors is often adequate for strong repair. If a full thickness tear with retraction is present, a double row suture bridge technique has been proposed to ensure optimal repair strength and biomechanics [18]. The benefits of an open repair include greater exposure of the tendon insertion, and it is much less technically challenging compared to arthroscopic techniques
Trunk and lower extremity long-axis rotation exercise improves forward single leg jump landing neuromuscular control
Published in Physiotherapy Theory and Practice, 2022
John Nyland, Ryan Krupp, Justin Givens, David Caborn
The rationale behind the improved LE neuromuscular control that was observed in this study may be best explained using kinesiological concepts. The gluteus maximus muscle possesses a thick fascial insertion to the iliotibial tract (Shiraishi et al., 2018). During locomotion, the gluteus medius and gluteus minimus muscles and the tensor fascia lata of the stance LE balance the weight of the body, and that of the non-weightbearing LE (Cho et al., 2018; Neumann, 2010). At knee flexion angles less than 30°, the ACL is the primary tibial internal rotation restraint, but at greater knee flexion angles the gluteus maximus and tensor fascia lata muscles provide a synergistic secondary restraint through the iliotibial band (Cibulka and Bennett, 2020; Kaplan and Jazrawi, 2018; Kline et al., 2018; Matsumoto, 1990; Suero et al., 2013) as the gluteus medius muscle helps control frontal and transverse plane pelvis and femoral alignment directly through the hip joint (Neumann, 2010).
Related Knowledge Centers
- Deep Fascia
- Tensor Fasciae Latae Muscle
- Thigh
- Tibia
- Fascial Compartments of Thigh
- Medial Intermuscular Septum of Thigh
- Lateral Intermuscular Septum of Thigh
- Iliotibial Tract
- Gluteus Maximus
- ADDuctor Muscles of The Hip