Femoral Cutaneous Nerve Research Articles

Rapid recovery after total hip arthroplasty: direct anterior approach combined with PENG block and lateral cutaneous femoral nerve block

Introduction The "gold" standard for the treatment of late stages of coxarthrosis is total hip arthroplasty. Direct anterior approach (DAA) refers to minimally invasive surgical interventions in orthopaedics. Extended anesthetic measures in combination with low-traumatic surgical techniques may reduce postoperative pain and accelerate patient's recovery.The purpose of the study was to compare the recovery times of patients after hip arthroplasty using DAA in combination with PENG block, lateral cutaneous femoral nerve (LCFN) block and without extended anesthetic measures.Materials and methods A prospective randomized comparative clinical study was performed, which involved 62 patients divided into two groups: the study one (n = 29) and the control one (n = 33). In both groups, arthroplasty was performed using DAA. Patients of the study group underwent PENG block and LCFN block. The patients in the control group did not receive extended anesthesia. The evaluation criteria were pain assessment using the visual analogue scale (VAS), administration of painkillers, patient’s mobility and the length of hospital stay.Results The VAS score for pain in the study group were lower than in the control group after 6 hours — 3.7 (3.4; 4.1) and 4.3 (4.2; 4.8); 24 hours after surgery — 3.5 (3.3; 3.6) and 4.1 (3.9; 4.5) (p < 0.001). After 48 hours, the indices were comparable: 3.5 (3.1; 4.1) and 3.7 (3.6; 3.9) (p = 0.19). The rate of requests for pain relief in the first 24 hours was lower in the study group than in the control group: 2 (1; 2) and 3 (2; 3) cases (p = 0.003). The results of the manual muscle test after 6 hours and 24 hours were comparable (p > 0.05). The time interval between the end of the operation and the first walking on crutches was shorter in the study group — 3.1 hours (2.9; 3.4) and 3.98 hours (3.8; 4.2) (p < 0.001). The length of hospital stay was shorter in the study group: 1.5 (1.2; 2) and 2.5 (2; 3) days (p < 0.001).Discussion Lower postoperative pain allows faster activation of patients, thus improving the results of the early rehabilitation period.Conclusion The use of PENG block and LCFN block in arthroplasty with the use of DAA has clinical effectiveness in the first 24 hours, and helps to accelerate the postoperative recovery of patients.

Cryoanalgesia in Knee Replacement Surgery

This is cryoanalgesia, a new technology where we can effectively create an ice cube under the skin, which shuts the nerve off. If we target some of the sensory nerves around the knee and then the femoral cutaneous nerves and then the branches of the saphenous nerve, then we can shut those nerves down and that pain goes away until those nerves regrow.

Direct anterior approach hip arthroplasty: How to reduce complications - A 10-years single center experience and literature review.

BACKGROUNDThe direct anterior approach for total hip arthroplasty (DAA-THA) is increasing in popularity due to some advantages such as less surgical trauma, minimal dissection of soft tissues, shorter rehabilitation times, faster return to daily activities, lower incidence of dislocation. On the other hand, the literature reports a high rate of intraoperative complications, with many different rates and complication types in the published papers. AIMTo analyze our complications comparing results with the literature; to report measures that we have taken to reduce complications rate.METHODSAll DAA-THA patients with one year minimum follow up who were operated at a single high-volume centre, between January 2010 and December 2019 were included in this retrospective study. All surgeries were performed using cementless short anatomical or straight stems and press fit cups. Patients’ follow-up was performed, at 6 wk, 3 mo, then annually post-surgery with clinical and radiological evaluation. Primary outcomes were stem revision for aseptic loosening and all-cause stem revision. Second outcome was intra-operative and post-operative complications identification.RESULTSA total of 394 patients underwent DDA-THA from January 2010 and December 2019, for a total of 412 hips; twelve patients lost to follow-up and one patient who died from causes not related to surgery were excluded from the study. The average age at the time of surgery was 61 years (range from 28 to 78 years). Mean follow-up time was 64.8 mo (range 12-120 mo). Seven stems were revised. One cortical perforation, one trochanteric and lateral cortical wall intraoperative fracture, one diaphyseal fracture, three clinically symptomatic early subsidence and one late aseptic loosening. We also observed 3 periprosthetic fractures B1 according to the Vancouver Classification. Other minor complications not requiring stem revision were 5 un-displaced fractures of the calcar region treated with preventive cerclage, one early infection, one case of late posterior dislocation, 18 case of asymptomatic stem subsidence, 6 cases of lateral cutaneous femoral nerve dysesthesia.CONCLUSIONDAA is associated to good outcomes and lower incidence of dislocation. Complication rate can be reduced by mindful patient selection, thorough preoperative planning, sufficient learning curve and use of intraoperative imaging.

Direct application of ropivacaine-soaked gauze to sciatic nerve after necrotizing fasciitis exposes underlying muscles and nerves.

Necrotizing fasciitis is a rapidly progressive infection of the subcutaneous tissue and fascia with significant morbidity and mortality. There is a paucity of literature published on the benefits of regional anaesthesia in patients with necrotizing fasciitis of the extremities. This study demonstrates novel approaches to management of pain in a patient with necrotizing fasciitis of the lower extremity. A 47-year-old male with polysubstance use disorder was found to have necrotizing fasciitis of the lower extremity. Surgical debridement included 15% of his total body surface area and resultant exposure of his sciatic nerve. A ropivacaine-soaked gauze was applied directly to the exposed sciatic nerve. Femoral and lateral cutaneous nerve blocks were performed to facilitate necessary surgical dressing changes and physical therapy. This report details techniques used in postoperative pain management to facilitate surgical dressing changes after extensive debridement of an extremity for necrotizing fasciitis. The use of local anaesthetic-soaked gauze may be a useful adjunct in certain scenarios.

Complications of Acute Acetabular Fractures Surgical Treatment: Systematic Review

Background.The combination of classical anterior and posterior approaches, as well as their modifications, is recognized as the most effective in acetabular fractures surgical treatment. The use of classical and modified approaches is accompanied by serious intra- and postoperative complications associated primarily with the duration of surgery, significant blood loss, tissue trauma, surgical site infection. The aim of review — to determine the main and most frequent complications associated with surgical approaches to the acetabulum. material and methods. Access to literature sources is carried out in the information systems and databases PubMed/Medline, Embase, Scopus, Сochran Library, eLibrary, Wiley Online Library. Keywords: acetabular fractures, surgical treatment, approach to the acetabulum, total hip replacement.Results. The most common intraoperative complications are incorrect fragments reduction, sciatic nerve injury, less often — intraarticular implant position, damage to the superior gluteal artery and other vessels, among the early postoperative complications - wound infection, both superficial and deep, less often — venous thrombosis. Late postoperative complications are mainly represented by the development of heterotopic ossification, post-traumatic coxarthrosis, less often revealed aseptic necrosis of the femoral head, residual protrusion and secondary femoral head lesion. Conclusion. The main approach to the acetabulum are the ileo-inguinal and the Kocher-Langenbeck approach, as well as their combination.Complications were more common using two approaches, especially in cases of simultaneous use. The main intraoperative complications are the sciatic nerve and the superior gluteal artery injury with posterior approaches, the femoral lateral cutaneous nerve with expanded ilio-femoral approach, and the obturator nerve with anterior approaches.

Peripheral nerve block (FLOS block) for intraoperative anesthesia in total knee arthroplasty: An observational study

Background: Peripheral nerve blocks (PNBs) are generally used to provide postoperative analgesia after total knee arthroplasty (TKA) and other lower extremity procedures; these blocks are used rarely for intraoperative anesthesia. We present here, the patients who underwent TKA under PNBs (FLOS Block). FLOS block is nothing but femoral, lateral cutaneous femoral nerve, obturator, and sciatic nerve block. Materials and Methods: A total of 41 patients participated in the study for TKA using PNB, FLOS block. All the patients received standardized anesthesia and analgesia upon hospitalization. Outcome evaluations included the visual analog scale (VAS) scores during surgery, activity at rest, postoperative blood pressure, and heart rate, also the sedation for femoral, lateral cutaneous femoral nerve obturator and sciatic nerve (FLOS) blocks. Compared with neuraxial (spinal/epidural) anesthesia, PNB (FLOS Block) minimizes hypotension, minimizes urinary retention, improves patient satisfaction, ambulation restrictions, and eliminates the risk of spinal hematoma and infection. Results: The finding suggests a decreased requirement of opioids in the PNB technique (FLOS Block). Pain scores, assessed by subjective VAS scale, were accurately handled in all the patients reviewed, with good pain control with PNB (FLOS Block). PNB (FLOS Block) provided stable hemodynamic, prolonged, and better postoperative analgesia. Intraoperative anesthesia was very satisfactory for surgery. The requirement of total doses of rescue analgesics, VAS score peroperatively for 48 h, the incidence of side effects, and complications were very few and acceptable. Conclusion: A femoral, sciatic nerve block with obturator and lateral femoral cutaneous nerve block may be an option to the spinal epidural anesthesia in the patients undergoing TKA. PNB (FLOS Block) showed similar patient satisfaction and postoperative analgesia to spinal-epidural anesthesia.

ANATOMICAL VARIABILITY OF CUTANEOUS NERVES OF ANTERIOR FEMORAL REGION IN HUMAN FETUSES

The aim: Is to find out the features of innervation of the skin of the anterior femoral region and the fascia lata during the fetal period of human development. Materials and methods: The study was carried out on 64 preparations of the lower extremities of human fetuses of 4-10 months using macromicroscopic preparation and morphometry. Macropreparations of the skin nerves of the lower extremities of different age fetuses with anatomical variants were subject to photo documentation. Results: The features of cutaneous nerve fetal topography of the anterior femoral region and the broad fascia of the femur were revealed, their connections were established, and their layering was determined. It was found that in human fetuses, not only the lateral cutaneous femoral nerve but in most cases the branches of other nerves of the lumbar plexus, except for the obturator nerve, are directed to the skin of the anterior-lateral femur surface. The innervation of the medial femur surface is provided by the following nerve complex: obturator, femoral, saphenous and genitofemoral nerves. Conclusions: Taking into account the fact that the terminal branches of adjacent cutaneous nerves of the femoral region intersect and overlap, innervation bypasses are formed, due to which, in case of possible damage to one of the nerves, its insufficiency is compensated to a certain extent. Anastomoses were found between the cutaneous nerves, in the form of loops of various shapes and sizes, namely: between the cutaneous-fascia branches of the femoral and ilioinguinal nerves and the femoral and obturator nerves.

Cutaneous nerve fields of the anteromedial lower limb-Determination with selective ultrasound-guided nerve blockade.

BackgroundThis study aimed to determine the peripheral cutaneous nerve fields (CNF), their variability, and potential overlap by selectively blocking the intermediate (IFCN) and medial (MFCN) femoral cutaneous nerves and the infrapatellar branch of the saphenous nerve (IPBSN) in healthy volunteers.MethodsIn this prospective study, ultrasound‐guided nerve blockades of the IFCN, MFCN, and IPBSN in 14 healthy volunteers were administered. High‐frequency probes (15–22 MHz) and 1 ml of 1% lidocaine per nerve were used. The area of sensory loss was determined using a pinprick, and all fields were drawn on volunteers' skin. A three‐dimensional (3D) scan of all lower limbs was obtained and the three CNF and their potential overlap were measured.ResultsThe mean size of innervation areas showed a high variability of peripheral CNF, with 258.58 ± 148.26 mm2 (95% CI, 169–348.18 mm2) for the IFCN, 193.26 ± 72.08 mm2 (95% CI, 124.45–262.08 mm2) for the MFCN, and 166.78 ± 121.30 mm2 (95% CI, 94.1–239.46 mm2) for the IPBSN. In 11 volunteers, we could evaluate an overlap between the IFCN and MFCN (range, 4.11–139.68 ± 42.70 mm2), and, in 10 volunteers, between the MFCN and IPBSN (range, 11.12–224.95 ± 79.61 mm2). In only three volunteers was an overlap area found between the IFCN and IPBSN (range, 7.46–224.95 ± 88.88 mm2). The 3D‐scans confirmed the high variability of the peripheral CNF.ConclusionsOur study successfully determined CNF, their variability, and the overlap of the MFCN, IFCN, and IPBSN in healthy volunteers. Therefore, we encourage physicians to use selective nerve blockades to correctly determine peripheral CNF at the anteromedial lower limb.

Pedicle screw internal fixation versus subcutaneous anterior pelvic internal fixation in treatment of pelvic anterior ring fractures

Objective To compare pedicle screw internal fixation (PSIF) and subcutaneous anterior pelvic internal fixation (APIF) in the treatment of pelvic anterior ring fractures. Methods A retrospective study was conducted of a consecutive series of 46 patients who had undergone surgery for anterior ring pelvic fractures at Department of Orthopaedic Surgery, The People’s Hospital of Henan Province from January 2014 to September 2018. Of them, 20 were treated by PSIF and 26 by APIF. In the PSIF group, there were 12 males and 8 females with an age of 47.8±2.4 years, and 6 cases of B1, 9 cases of type B2, 4 cases of type B3 and one case of type C1 by the Tile’s classification; in the APIF group, there were 16 males and 10 females with an age of 49.6±1.2 years, and 9 cases of B1, 8 cases of type B2, 5 cases of type B3, 2 cases of type C1 and 2 cases of type C2 by the Tile’s classification. The 2 groups were compared in terms of surgical or postoperative complications (including iatrogenic nerve injury, infection, implant failure and fracture nonunion), fracture reduction and therapeutic efficacy at the final follow-up. Results There were no significant differences between the 2 groups of patients in their preoperative general data, indicating they were compatible(P>0.05). The 46 patients were followed up for 9 to 18 months (mean, 13.5 months). In the PSIF and APIF groups, the incidences of injury to the lateral femoral cutaneous nerve were 5.0%(1/20) and 7.7%(2/26), those of infection 5.0%(1/20) and 3.8%(1/26), and those of skin discomfort 5.0% (1/20) and 7.7%(2/26), respectively. According to the Matta criteria, the fracture reduction at the last follow-up was evaluated as excellent in 7, as good in 11 and as fair in 2 in the PSIF group, giving an excellent and good rate of 90.0%, and as excellent in 9, as good in 13 and as fair in 4 in the APIF group, giving an excellent and good rate of 84.6%. According to the Majeed criteria, the pelvic function at the final follow-up was evaluated as excellent in 10, as good in 7, as fair in 2 and as poor in one in the PSIF group, giving an excellent and good rate of 85.0%, and as excellent in 13, as good in 10, and as fair in 3 in the APIF group, giving an excellent and good rate of 88.5%. There were no significant differences between the 2 groups in all the comparisons above (P>0.05). The incidence of femoral nerve parasthesia was 0(0/20) for the PSIF group, significantly lower than that for the APIF groups (3.8%, 1/26) (P<0.05). Conclusion As both PSIF and APIF lead to similar clinical efficacy in the treatment of pelvic anterior ring fracture, either of them can be selected as an appropriate surgical procedure depending on the patient’s situation and surgeon’s experience. Key words: Pelvis; Fractures, bone; Fracture fixation, internal; Bone plates; Surgical procedures, minimally invasive

A comparison of peri-operative effects of modified Bikini minimally invasive approach versus direct lateral approach for total hip arthroplasty

Objective To compare the perio-perative effects of modified bikini minimally invasive approach versus direct lateral approach for total hip arthroplasty(THA). Methods A total of 60 patients(70 hips), including 45 males(49 hips)and 15 females(21 hips)aged(54.9±6.1)years(range from 38 to 63 years)who underwent THA for the first time at joint surgery department of our hospital were retrospectively analyzed from October 2015 to May 2017.Thirty patients(34 hips)underwent modified bikini approach THA(the modified bikini group), and 30 patients(36 hips)received direct lateral approach THA(the direct lateral group). The comparisons were performed between the two groups in the orthopaedic pelvic films, disease stages, Harris scores before and after operation, intra-operative blood loss, postoperative drainage, blood transfusion rate, 24-h visual analog scale(VAS)scores for pain after operation, operation time and incision length.The straight leg elevation time, recovery time of hip abduction muscle strength, average hospitalization days and subjective satisfaction of patients were evaluated.Relevant surgical complications were recorded. Results Postoperative X-ray examinations showed that the position of prosthesis was good in both groups.There were no statistically significant difference between the two groups in operation time, intraoperative blood loss, postoperative drainage, blood transfusion rate, straight leg elevation time and subjective satisfaction(P>0.05). There were statistically significant differences between the modified bikini group and the direct lateral group in the incision length[(9.2±1.9) cm vs.(18.5±3.3) cm], recovery time of hip abductor muscle strength[(1.6±0.8) d vs. (12.1±3.9) d], Harris scores[(87.1±5.9) vs.(86.8±7.1)], 24-hour VAS scores[(4.6±2.3) vs.(7.0±3.6)]and average hospitalization days[(7.4±1.8) vs.(10.8±2.4)]after operation between the modified bikini group and the direct lateral group(P<0.05). One case with lateral femoral cutaneous nerve injury and 1 case of posterior cortical perforation of proximal femur were found in the modified bikini group, and 1 case of dislocation of hip prosthesis was observed in the direct lateral group. Conclusions Both of the modified bikini minimally invasive approach and direct lateral approach for THA can achieve better postoperative effect, while the modified bikini approach achieves faster recovery. Key words: Arthroplasty; Replacement, hip; Surgical procedures, minimally invasive

Treatment of complex quadrilateral surface fractures of the acetabulum by internal fixation with dynamic anterior plate-screw system

Objective To explore the clinical efficacy of internal fixation with dynamic anterior plate-screw system for quadrilateral area(DAPSQ) in the treatment of complex acetabular fractures involving the quadrilateral surface. Methods Between January 2005 and January 2017, a series of 143 patients with complex quadrilateral surface fracture of the acetabulum were treated at Department of Orthopaedics, General Hospital of Central Theater Command. They were 86 males 57 females, with a mean age 46.6 years (range, from 19 to 77 years). By the Letournel-Judet classification, there were 38 anterior column plus posterior hemitransverse fractures, 26 T-shaped fractures and 79 double column fractures. They were all closed. The delay from injury to surgery averaged 9.6 days(range, from 3 to 21 days). All the cases were treated with DAPSQ internal fixation via the ilioinguinal approach. Their operation time, intraoperative bleeding volume, quality of fracture reduction, hip function and complications were recorded. Results The operation time for this series ranged from 2.5 to 5.0 hours, averaging 3.8 hours. The intraoperative blood bleeding ranged from 400 to 2,500 mL, with an average of 680 mL. By the Matta criteria for fracture reduction, 76 cases were rated as excellent, 51 as good and 16 as poor, giving an excellent and good rate of 88.8%. The 143 patients were followed up from 4 months to 10 years (mean, 4.1 years). The clinical fracture union was achieved after 2 to 4 months (mean, 3 months). By the modified Merle d’Aubigne & Postel criteria, the affected hips scored 9 to 18 points (mean, 16.3 points) at the final follow-ups, with 64 excellent, 52 good, 19 fair and 8 poor cases, giving an excellent and good rate of 81.1%. The postoperative complications included lesion of lateral femoral cutaneous nerve in 7 cases, urinary tract infection in 15 ones, traumatic osteoarthritis in 20 ones 5 of whom had to receive total hip arthroplasty, and heterotopic ossification (Brooker Grade Ⅰ) in 5 ones. Conclusion Internal fixation with DAPSQ is safe and effective for the treatment of complex acetabular fractures involving the quadrilateral surface. Key words: Acetabulum; Fractures, bone; Fracture fixation, internal; Bone plates; Bone nails

An iliac-crest-preserving iliac wing bone graft harvesting technique

Objective To evaluate the clinical application effects of an iliac-crest-preserving iliac wing bone graft harvesting technique and the bone regenerative ability of the donor site after harvesting. Methods From January 2016 to June 2017, a series of 39 patients including 28 men and 11 women aged between 16 and 59 y (35±13 y in average) were prospectively collected to treat bone defects using the iliac-crest-preserving iliac wing bone graft harvesting technique. The patient cohort included 38 ipsilateral and 1 bilateral bone harvests taken from 15 femoral fracture non-unions, 8 tibial fracture non-unions, 11 femoral head necroses (hip preserving surgery), 1 tuberculosis deriving hip arthritis with bone defect (total hip arthroplasty), 2 hip prosthesis loosenings (revision), and 2 proximal femoral benign tumors. All patients were treated through comprehensive surgeries containing autologous iliac bone grafting. The surgical time, blood loss, bone graft volume, 24 h post-operative visual analogue scale (VSA) at the iliac surgical site, complications, and bone regeneration of the donor site were documented and evaluated. Results In the 39 patients (40 sides), the average surgical time was 25±4 min, average blood loss was 79±23 ml, average bone graft volume was 27±6 cm3. The average 24 h post-operative VAS at the iliac surgical site was 1.8±0.7 points. The VSA at the 6 week later and thereafter were 0 in all patients. The iliac incisions in 38 patients (39 sides) were healed uneventfully. However, seroma at the iliac surgical site emerged in 1 patient at the 6th post-operative day in the manner of serous exudation and was treated successfully with non-operative measures. None infections and lateral femoral cutaneous nerve injuries took place. Iatrogenic non-displaced iliac crest fractures happened in the very first 2 patients when taking the crest as a pivot to pry up the graft, which united without special cure at the 3 month post-operative. This complication was completely avoided when shifting the pivot to the anterior pillar containing the anterior iliac spines. None pelvic fractures and heterotopic ossifications took place. Post-operative radiographical examinations revealed that the bone defects at the donor site shrank through bone regeneration, that mamillary or canine-tooth-shaped bone formation occurred in some of the cases, and that none complete bone regeneration took place to eliminate the bone defect at the donor. There were 12 patients in whom pre- and post-operative computed tomographic scans necessitated by the disease were prescribed, which facilitated the measuring of the bone defect at the donor site. The measurement of 13 sides revealed that the bone defects were decreased more or less: the average immediate post-operative bone defect was 25.7±6.5 cm2, the average 12 month post-operative bone defect was 12.7±5.3 cm2. Conclusion The iliac wing bone graft harvesting technique suggested here is safe and less invasive, in the premise of preserving the iliac crest and retaining the figure of the surgical site, it can harvest a large amount of iliac wing bone graft and reserve the bone regenerative ability of the donor site Key words: Ilium; Tissue and organ harvesting; Bone transplantation; Bone regeneration

Complications following minimally invasive internal fixation for anterior pelvic ring injury: a Meta-analysis

Objective To summarize the complications and their incidences following Anterior Sub-cutaneous Internal Pelvic Fixation(ASIPF). Methods A comprehensive search was conducted of PubMed Library, Cochrane Library, Web of Science, SinoMed, Wanfang Data and China National Knowledge Internet for all articles addressing the postoperative complications of ASIPF published in English and Chinese from January 2009 to November 2018. A proportion Meta-analysis across the studies was performed for the complications after ASIPF (lateral femoral cutaneous nerve irritation, femoral nerve palsy, heterotopic ossification, infection and implant failure) using R software. Results This meta-analysis included 29 clinical studies involving a total of 825 patients. The complications following ASIPF were lateral femoral cutaneous nerve irritation, femoral nerve palsy, heterotopic ossification, infection and implant failure; their incidences were respectively 12% (95%CI: from 7% to 19%), 3% (95%CI: from 2% to 4%), 30% (95%CI: from 22% to 39%), 4% (95%CI: from 3% to 6%) and 4% (95%CI: from 3% to 6%). Conclusions Lateral femoral cutaneous nerve irritation and heterotopic ossification are common complications following minimally invasive internal fixation for anterior pelvic ring injury. High-quality clinical research is needed into the factors leading to the complications and into their preventive countermeasures. Key words: Pelvis; Fractures, bone; Fracture fixation, internal; Surgical procedures, minimally invasive; Complications

Minimally invasive treatment for anterior pelvic ring injuries with modified pedicle screw-rod fixation: a retrospective study

BackgroundPelvic ring injuries constitute only 2 to 8% of all fractures; however, they occur in 20% of polytrauma patients. High-energy pelvic fractures often result in mechanical instability of the pelvic ring. Successful treatment of unstable pelvic ring fractures remains a challenge for orthopedic surgeons. This study presents a novel internal fixation method for stabilizing unstable anterior pelvic ring fractures using a minimally invasive modified pedicle screw-rod fixation (MPSRF) technique.MethodsThis retrospective study included six patients with unstable pelvic ring injuries who underwent MPSRF, with or without posterior fixation. Intraoperative parameters such as blood loss, operative time, complications, and quality of reduction (Matta criteria) were recorded and evaluated by a blinded reviewer.ResultsIn the present clinical series, the mean operative times and mean blood loss for unilateral versus bilateral anterior ring fixations were 176.0 min versus 295.6 min, and 153.3 mL versus 550.0 mL, respectively. No iatrogenic neuropraxia of the lateral femoral cutaneous nerve or femoral nerve palsy occurred. The reduction quality, graded by the Matta criteria, was excellent in five patients and good in one patient.ConclusionsThere were no infections, delayed unions, nonunions, or loss of reductions during the follow-up period. Only one patient suffered from a broken rod at 4 months postoperatively. The modified technique represents a novel, minimally invasive procedure for the treatment of anterior pelvic ring fractures and offers a reliable and effective alternative to currently available surgical techniques.

Endoscopic treatment of sciatic nerve entrapment in deep gluteal syndrome: Clinical results

IntroductionDeep gluteal syndrome (DGS) is characterised by compression, at extra-pelvic level, of the sciatic nerve within any structure of the deep gluteal space. The objective was to evaluate the clinical results in patients with DGS treated with an endoscopic technique. MethodsRetrospective study of patients with DGS treated with an endoscopic technique between 2012 and 2016 with a minimum follow-up of 12 months. The patients were evaluated before the procedure and during the first year of follow-up with the WOMAC and VAIL scales. ResultsForty-four operations on 41 patients (36 women and 5 men) were included with an average age of 48.4±14.5. The most common cause of nerve compression was fibrovascular bands. There were two cases of anatomic variant at the exit of the nerve; compression of the sciatic nerve was associated with the use of biopolymers in the gluteal region in an isolated case. The results showed an improvement of functionality and pain measured with the WOMAC scale with a mean of 63–26 points after the procedure (p<0.05). However, at the end of the follow-up, one patient continued to manifest residual pain of the posterior cutaneous femoral nerve. Four cases required revision at 6 months following the procedure due to compression of the scarred tissue surrounding the sciatic nerve. ConclusionEndoscopic release of the sciatic nerve offers an alternative in the management of DGS by improving functionality and reducing pain levels in appropriately selected patients.

Research progress in complications of hip arthroscopy

Hip arthroscopy has become a routine treatment for the localized hip lesions. With the rapid development of arthroscopy, the number of surgeries has increased greatly. Though hip arthroscopy is considered as low risk operation, its complications have been constantly reported and noted. There are two major types in hip arthroscopy surgeries: conventional operative complications and special complications. Conventional operative complications include venous thromboembolism, hemorrhage, and pain. Special complications are associated with arthroscopic techniques and local anatomical structures of the hip, such as the perineal nerve, the lateral femoral cutaneous nerve, the acetabular labium or the iatrogenic injury of the cartilage surface of the femoral head. Hip arthroscopy has obvious advantages such as small surgical wound and rapid recovery, but its complications can not be ignored. Joint surgeons must fully recognize it and keep vigilant so as to avoid complications as much as possible. This review will systematically elaborate the complications of hip arthroscopic surgery from general and special aspects so as to provide ideas for reducing the occurrence of complications in hip arthroscopic surgery. Key words: Arthroscopy; Hip injuries; Complications

Manejo endoscópico del atrapamiento del nervio ciático en el síndrome de glúteo profundo: resultados clínicos

IntroductionDeep gluteal syndrome (DGS) is characterized by compression, at extra-pelvic level, of the sciatic nerve within any structure of the deep gluteal space. The objective was to evaluate the clinical results in patients with DGS treated with endoscopic technique. MethodsRetrospective study of patients with DGS treated with an endoscopic technique between 2012 and 2016 with a minimum follow-up of 12 months. The patients were evaluated before the procedure and during the first year of follow-up with the WOMAC and VAIL scale. ResultsForty-four operations on 41 patients (36 women and 5 men) were included with an average age of 48.4±14.5. The most common cause of nerve compression was fibrovascular bands. There were two cases of anatomic variant at the exit of the nerve; compression of the sciatic nerve was associated with the use of biopolymers in the gluteal region in an isolated case. The results showed an improvement of functionality and pain measured with the WOMAC scale with a mean of 63 to 26 points after the procedure (P<.05). However, at the end of the follow-up one patient continued to manifest residual pain of the posterior cutaneous femoral nerve. Four cases required revision at 6 months following the procedure due to compression of the scarred tissue surrounding the sciatic nerve. ConclusionEndoscopic release of the sciatic nerve offers an alternative in the management of DGS by improving functionality and reducing pain levels in appropriately selected patients.

No effect of double nerve block of the lateral cutaneous nerve and subcostal nerves in total hip arthroplasty

Background and purpose — The use of local infiltration anesthesia (LIA) has become one of the cornerstones of rapid recovery protocols in total knee arthroplasty patients during the past decade. In total hip arthroplasty (THR), however, the study results are more variable and LIA has therefore not yet been generally accepted. There is no consensus on which structure should be infiltrated and the cutaneous nerves are generally neglected. Hence, we hypothesized a pain-reducing effect of specifically blocking these nerves.Patients and methods — We performed a single-center randomized placebo-controlled trial in 162 subjects to evaluate the infiltration of the lateral cutaneous femoral and subcostal nerve with ropivacaine in patients undergoing total hip arthroplasty via a straight lateral approach. The primary endpoint was pain at rest after 24 hours. Patients were followed up to 6 weeks postoperatively.Results — After correction for multiple testing, no statistically significant differences in pain scores were found between the ropivacaine compared with the placebo group after surgery. In addition, no differences were observed in the use of escape pain medication, complications, and the length of hospital stay.Interpretation — We found no clinically meaningful differences in pain scores between placebo and ropivacaine patients in the postoperative period after THA performed via a straight lateral approach under spinal anesthesia and a multimodal pain regimen. Moreover, our primary endpoint, pain reduction after 24 hours, was not met. Further research should focus on the composition and volume of the LIA suspension, the optimal localization of the infiltration, and should be evaluated for every surgical approach separately.

Ultrasound-guided supra-acetabular pin placement in pelvic external fixation: description of a surgical technique and results

IntroductionPelvic fracture in trauma patients can lead to hemodynamic instability. External fixation is a treatment capable of stabilizing these injuries in the context of damage control surgery. Supra-acetabular pin offers the greater biomechanical stability but requires the use of intraoperative fluoroscopy. The aim of this study was to analyze our results for an ultrasound-guided supra-acetabular pinning. Material and methodsCross-sectional study with cadaveric specimens. Ultrasound-guided pin placement assessed by fluoroscopy and dissection. ResultsFourteen ultrasound-guided supra-acetabular pins were placed in seven cadaveric specimens. Excellent placement in all cases, evaluated with radiological control. Good qualitative bone fixation after dissection. One femoral cutaneous nerve was not found during anatomic dissection and was assumed injured. ConclusionUltrasound-guided supra-acetabular pin placement is a feasible and effective technique. Our study indicates that pin placement without intraoperative fluoroscopy is feasible without compromising the reliability of its placement.

Treatment of elderly patients with acetabular fracture involving medial displacement of the quadri-lateral surface using internal fixation with dynamic anterior plate-screw system for quadrilateral area

Objective To investigate the clinical efficacy of open reduction and internal fixation with dynamic anterior plate-screw system for quadrilateral area (DAPSQ) in the treatment of elderly patients with acetabular fracture involving medial displacement of the quadrilateral surface. Methods Between January 2007 and December 2014, a series of 18 senile patients with acetabular fractures involving medial displace-ment of the quadrilateral surface were treated at our department. They were 13 men 5 women, with a mean age 67.8 years (range, from 61 to 78 years). By the Judet-Letournel classification, there were 4 anterior column fractures, 5 anterior column plus posterior hemitransverse fractures, 8 double column fractures and one T-shaped fracture. The delay from injury to surgery averaged 6.5 days. All were treated with the technique of DAPSQ. Screw internal fixation of the quadrilateral area followed plate moulding via a single ilioinguinal ap-proach. Fixation with lag screws for the posterior column was added if necessary. Results The 18 pa-tients were followed up for 12 to 35 months (mean, 26 months). By the Matta criteria for fracture reduction, 9 cases were rated as excellent, 6 as good and 3 as poor. Bone healing was achieved within 2 to 4 months (mean, 3.5 months). By the modified Merle d’Aubigne & Postel criteria, the affected hips scored 9 to 18 points (mean, 16.3 points) at the final follow-ups, giving 7 excellent, 7 good, 2 fair and 2 poor cases. By the Harris evaluation, the affected hips scored 58 to 98 points (mean, 87.6 points), giving 7 excellent, 8 good, one fair and 2 poor cases. The postoperative complications included urinary tract infection in one, lesion of lateral femoral cutaneous nerve in one, heterotopic ossification (Brooker Grade Ⅰ ) in one, and traumatic osteoarthritis in 5 cases 2 of whom had to receive total hip arthroplasty. Conclusion The technique of DAPSQ is suitable for the treatment of acetabular fractures involving medial displacement of the quadrilateral surface in elderly patients, because it can provide and maintain stable fixation of the fracture in the quadri-lateral area and preserve hip joint function, leading to fine outcomes. Key words: Acetabulum; Fractures, bone; Fracture fixation, internal; Bone plates; Aged