Pelvis and perineum
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings in McMinn’s Concise Human Anatomy, 2017
The hip (innominate) bone - superiorly lies the crest of the ilium, which terminates anteriorly as the anterior superior iliac spine and just inferior to which is the anterior inferior iliac spine (Figs. 7.1, 7.2). On the inner aspect of the ilium, level with the acetabulum, lies an edge, the arcuate line. The pubic bone anteriorly has on its superior edge a swelling, the pubic tubercle, and two extensions projecting laterally - the superior and inferior rami. Posteriorly and inferior to the ilium lies the ischium, formed by a tubercle, on which we sit, a spine projecting medially and an inferior ramus. The large opening within is the obturator foramen, mostly closed by the obturator membrane, which has a small gap, the obturator canal, superiorly. Posteriorly between the ischium, ilium and sacrum lies the greater and lesser sciatic notches, turned into foramina by the sacro- spinous and sacrotuberous ligaments.
Revision ACDF at the same level
Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro in Revision Spine Surgery, 2019
After establishment of baseline neurologic functioning and intubation, positioning commences with placing a bolster under the shoulder blades to achieve cervical lordosis. Halo tongs or any other lordotic distraction device can also be used to facilitate interbody work and the maximization of lordotic alignment. The arms are padded at the elbows, where the ulnar nerve is most susceptible to neurapraxia. If iliac crest is intended for harvest, then the side of anterior superior iliac spine is elevated with a small bump to facilitate surgical exposure. Localization of incision and sagittal alignment may be assessed prior to sterile prep and drape with fluoroscopy. The shoulders can be taped and retracted caudally to improve radiographic exposure of the caudal part of the cervical spine. Gentle retraction of the shoulders is advised to avoid brachial plexus injury, which can be monitored by neurophysiology.
The Pelvis
Kenneth D Boffard in Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Pelvic fractures should be easily identified if Advanced Trauma Life Support® (ATLS) guidelines are followed, (i.e. clinical palpation of the pelvic brim from the SI joint to pubic symphysis and a routine chest x-ray and pelvic x-ray for any blunt injury in a patient unable to walk). In the absence of x-ray facilities, a clinical examination can be performed with gentle bimanual palpation of the brim of the pelvis from the SI joints to the pubic symphysis. Difference of height of the superior anterior iliac spine can be found in type C injuries. Any palpable defect or boggy swelling is indicative of a pelvic disruption. In the absence of these signs, gentle bimanual lateral and antero-posterior compression (not distraction!) of the pelvis can be performed. Any instability felt indicates the presence of major pelvic instability, associated with life-threatening blood loss, requiring appropriate measures. The absence of clinical instability does not, however, preclude an unstable pelvic fracture. One-third of such trauma victims with pelvic ring fractures sustain circulatory instability on arrival. Extended focused abdominal sonography for trauma (eFAST) is needed to exclude intra-abdominal bleeding in these patients. Pelvic fracture-related intra-abdominal bladder rupture results in free fluid in the abdominal cavity. However, ultrasound does not have the sensitivity to tell the difference between blood and urine.
Dexmedetomidine as an adjuvant to bupivacaine on combined posterior lumbar plexus and sciatic nerve blocks, is it effective?
Published in Egyptian Journal of Anaesthesia, 2019
Ghada Kamhawy, Ahmed El-Lilly, Mahmoud Yakout
For the psoas block, the patient was placed in the lateral position while the site of operation was upright. Thigh is flexed with flexed knee (Sim’s position). Intercristal line was determined through the two iliac crests (line 1). Lumbar spinous processes were connected by another line. The posterosuperior iliac spine was determined. Another line parallel to the lumbar spines through the posterosuperior iliac spine was drawn (line 2). We inserted our needle where the two lines (1 and 2) intersect. We prepared skin with povidone iodine and infiltrated 2 ml of lidocaine 2%, then a 21-G 15-cm insulated needle was put at the site where lidocaine was infiltrated perpendicularly, looking for a quadriceps muscle contraction. If a contraction was not found at the initial insertion, from the same skin point the needle was inserted to the same depth toward an imaginary point in 1-cm increments more medially. After contraction of the quadriceps was elicited at less than 0.5 mA, 25 ml of study drugs was given gradually. We confirmed the psoas block by sensory loss in anterolateral aspect of the thigh.
External iliac artery injury following total hip arthroplasty via the direct anterior approach—a case report
Published in Acta Orthopaedica, 2020
Ellen Burlage, Jasper G Gerbers, Bob R H Geelkerken, Wiebe C Verra
Severe vascular injury during total hip arthroplasty is a rare complication estimated at between 0.16% and 0.25% (Nachbur et al. 1979). More recent studies report an incidence of 0.04% in primary THA with an increase to 0.19% in revision arthroplasty (Abularrage et al. 2008). In general, regardless of the surgical approach, injuries have been reported in all the main vessels around the hip, the common femoral artery being the most reported damaged vessel and the external iliac artery thereafter (Shoenfeld et al. 1990, Lazarides et al. 1991). They are at risk because of their anatomical location (Bach et al. 2002, Kawasaki 2012). At the level of the anterior inferior iliac spine the external iliac vessels lie only 7 millimeters from the bone. In some cases they lie directly on the osseous surface as they leave the cavity of the pelvis (Rue et al. 2004, Kawasaki 2012).
Surgical anesthesia for revision total hip arthroplasty with quadratus lumborum and fascia iliaca block
Published in Baylor University Medical Center Proceedings, 2019
Johanna Blair de Haan, Nadia Hernandez, Sophie Dean, Sudipta Sen
The blocks were performed under ultrasound guidance with the patient in the supine position in the preoperative holding area. A high-frequency linear ultrasound transducer and a 21-gauge blunt-tipped echogenic needle were used for both blocks. The FI block was performed as described by Hebbard et al.3 Using the ultrasound transducer in a parasagittal plane, the anterior superior iliac spine was identified. The ultrasound probe was translated medially until the “bowtie” of the FI appeared over the iliacus muscle, bound cranially by the internal oblique muscle and caudally by the sartorius muscle. Following skin sterilization, the needle was advanced in plane in a caudal-to-cranial direction until normal saline was seen to spread underneath the FI over the iliacus muscle, and 20 mL of 0.5% bupivacaine hydrochloride was deposited in this location. We then performed the QL type 1 block as described by Blanco and McDonnell.4 The ultrasound probe was placed between the iliac crest and the lower costal margin in a transverse orientation, and the external oblique, internal oblique, and transverse abdominis were identified. The probe was translated posteriorly and laterally until the transverse abdominis muscle terminated superficial to the QL muscle. The skin was sterilized. The needle was advanced in plane from anterior to posterior until the tip was positioned between the QL and internal oblique, medial to the termination of the transverse abdominis, and 20 mL of 0.5% bupivacaine hydrochloride was injected.
Related Knowledge Centers
- Anterior Superior Iliac Spine
- Pelvis
- Ilium
- Anterior Inferior Iliac Spine
- Posterior Superior Iliac Spine
- Posterior Inferior Iliac Spine