Lower extremity fractures
David E. Wesson, Bindi Naik-Mathuria in Pediatric Trauma, 2017
Treatment of femur fractures in the 6- to 11-year-old age group is usually operative, using flexible nails (Figure 20.3.30) or a submuscular plate. Use of a rigid nail, as would be used in older adolescents and adults, requires a starting point for entry of the nail at the greater trochanter, putting the medial femoral circumflex artery at risk for injury. Iatrogenic avascular necrosis of the femoral head in children with open proximal femoral physes could result from injury to the medial femoral circumflex artery [39]. Because flexible nails do not provide rigid fixation, alternative fixation methods, such as submuscular plating, should be considered in “length unstable” fractures [40], such as comminuted fractures and long spiral fractures, which have a higher likelihood of shortening or angulation when treated with flexible nailing [32, 41, 42].
Musculoskeletal Ultrasound
John McCafferty, James M Forsyth in Point of Care Ultrasound Made Easy, 2020
The hip joint is a ball-and-socket joint, where the round head of the femur articulates with the acetabulum of the pelvis. A joint capsule encases the joint, which is lined by cartilage and synovium and contains a small volume of lubricating fluid. Several large muscles surround and support the hip joint, allowing multi-directional movement and enabling us to walk, run and jump. In two-legged mammals, the hips are the largest joints in the body, taking the weight of our upper body and distributing it evenly across our legs and feet. The most important anatomical landmark in ultrasound of the hip is the anterior recess – a ‘pocket’ between two layers of synovium at the anterior aspect of the femoral neck (see Figure 7.1).
Bones and joints
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings in McMinn’s Concise Human Anatomy, 2017
Femur - bone of the thigh, with the ballshaped head at the proximal end for the hip joint; it is joined to the shaft by the neck at an angle of about 125°. The greater trochanter is the large prominence located laterally at the junction of the shaft and neck; the lesser trochanter is the smaller cone-shaped projection at the distal part of the neck and adjacent shaft, facing medially and posteriorly. The expanded distal end has curved medial and lateral condyles for the knee joint and on either side palpable prominences known as the medial and lateral epicondyles. The epiphysis at the distal end usually begins to ossify in the ninth foetal month, a fact of possible medicolegal significance as an indication of maturity.
Anisotropic bone response based on FEM simulation and real micro computed tomography of bovine bone
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
S. Wronski, J. Kaminski, A. Wit, J. Tarasiuk, P. Lipinski
Figure 2 illustrates the predicted stress distribution for the three cases on a single central cross-section through the femur head. However, the observations mentioned below remain valid for any cross-section of the femur head. First of all, significantly different stored elastic energies were obtained. As it can be seen in Figure 2, these differences are due to notable changes in stress (and strain) fields. To help the comparison, the value of von Mises stress, at the point exhibiting the biggest differences, is indicated in the figure. The value of this stress varies from 14.2 to 27.5 MPa depending on the material model used. Case 1 gives the smallest value, case 2 the largest one. The principle stress directions are less influenced by the constitutive model handled because they are mainly related to applied external load, which is the same for all cases.
Understanding outcomes and toxicological aspects of second generation metal-on-metal hip implants: a state-of-the-art review
Published in Critical Reviews in Toxicology, 2018
Michael Kovochich, Brent L. Finley, Rachel Novick, Andrew D. Monnot, Ellen Donovan, Kenneth M. Unice, Ernest S. Fung, David Fung, Dennis J. Paustenbach
There are two general types of hip arthroplasty procedures: total hip replacement (THR) (also called total hip arthroplasty, THA) and hip resurfacing arthroplasty (HRA) (Figure 1) (AAOS (American Academy of Orthopaedic Surgeons) 2011a, 2011b). In THA, the damaged femoral head is removed and replaced with a metal stem that is inserted into the hollow center of the femur shaft. A metal or ceramic ball is positioned on the upper end of the stem to replace the femoral head. The damaged cartilage surface of the acetabulum (socket) is removed and replaced with a metal socket that can be held in position by screws, cement, or press-fitting (i.e. pressing the device into the reamed bone) (Charnley 1966; AAOS 2011b). The articulating surface of the acetabular component may be composed of plastic, metal, or ceramic (Figure 1).
Guided Bone Regeneration of Femoral Segmental Defects using Equine Bone Graft: An In-Vivo Micro-Computed Tomographic Study in Rats
Published in Journal of Investigative Surgery, 2019
Mohammed Awadh Binsalah, Sundar Ramalingam, Mohammed Alkindi, Nasser Nooh, Khalid Al-Hezaimi
Surgical procedures were performed under general anesthesia (GA) using intraperitoneal injection of ketamine hydrochloride (60–100 mg/kg body weight) (HIKMA Pharmaceuticals, Amman, Jordan) and xylazine hydrochloride (5–16 mg/kg body weight) (Laboratorios Calier S.A., Barcelona, Spain). Following GA the animal was positioned on its left lateral side and the skin over the right femur was shaved and disinfected using 10% povidone-iodine solution. The proximal and distal ends of the femur were palpated to mark and perform a skin incision. Following dissection through the fascial and intermuscular planes between the vastus lateralis and the biceps femoris muscles, the entire length of the femur was exposed. A 4-hole mini-osteosynthesis plate (1.0 mm thickness and 25 mm length)(KLS Martin, Tuttlingen, Germany) with span (7 mm) was fixed to the anterolateral aspect of the femur using 4 bicortical screws (1.5 mm dia × 7 mm length)(KLS Martin, Tuttlingen, Germany). The mini-plate span was approximated to the mid-diaphyseal shaft of the femur. A segmental CSD measuring 5 mm in length was marked in the mid shaft of the femur and was completed using a thin straight fissure bur on a rotary hand piece along with normal saline irrigation. Following completion, the size of the defect was confirmed using a graded probe.
Related Knowledge Centers
- Hindlimb
- Thigh
- Tibia
- Femoral Head
- Patella
- Long Bone
- Hip
- Knee
- Leg
- Femoral-Tibial Angle