Quadratus Femoris Research Articles

Sciatic Nerve variation: case report

IntroductionThe Sciatic Nerve(SN) is the largest nerve in the human body. It arises from the Sacral Plexus, formed from the ventral and dorsal branches of the ventral rami of L4 to S3 spinal nerves. It exits the pelvic cavity passing through the Greater Sciatic Foramen, below the Piriformis Muscle(PM), between the Ischial Tuberosity and the Greater Trochanter of the Femur. On its course, the SN gives lateral branches, which are responsible for the movement and sensitivity of the posterior part of the lower limb. The terminal bifurcation, the Common Fibular Nerve(CFN) and the Tibial Nerve(TN), can occur at different height, from the Sacral Plexus to the lower part of the Popliteal Region, most common.BackgroundSince the beginning of the XX century, many anatomical variations have been reported by several authors such as Cruveilhier, Testut and Le Double. The most comprehensive approach is the Beaton and Anson's classification, which consists of 6 types of relations of the SN with the PM in the pelvic cavity, Type 1: Undivided nerve below undivided PM; Type 2: Divisions of the nerve between and below undivided muscle; Type 3: Divisions above and below undivided muscle; Type 4: Undivided nerve between heads; Type 5: Divisions between and above heads; Type 6: Undivided nerve above undivided muscle. It has served as a reference for medical doctors to characterize their cases. A different interpretation suggests the variations of the height as a result of a low formation of the nerve, rather than a high terminal division. Several cases of SN variations were reported according to the height of the division. In one of them, the SN was dividing just at the upper border of the Quadratus Femoris Muscle in the Gluteal Region, as in our specimen.ResultsIn our case, the lower limb of a Brazilian male cadaver with no evidence of previous pathologic disorders, traumatic condition or surgical intervention, was dissected, which the gluteus maximus and the medium were sectioned vertically, parallel to the Sacrum, and reflected, to obtain a clear view of the SN. SN was coursing down for 7,93cm (from the lower border of the Greater Sciatic Foramen). It divides into CFN and TN below the border of PM, at the caudal border of the Quadratus Femoris Muscle. We characterized this variation as a high division. Three palpable points were used to localize the division. We present the distance from the bifurcation to each point (Figs. 1A, 1B, 1C): I.Iliac Crest, 17,3cm; II. Greater Trochanter, 6,7cm; III. Ischial Tuberosity, 3cm. Therefore, the anatomical relationship between the SN and the PM was recorded and classified according to the Beaton and Anson classification as type I.Discussion and ConclusionThe knowledge of the variation of the SN, its location and course is fundamental in daily medical practice of Neurology, Orthopedics, Rehabilitation, Sports Medicine, Surgery and Anesthesiology. These studies have critical importance due to common pathologies such as Piriformis Syndrome, defective block anesthesia and any kind of therapeutic intervention of the area. Great knowledge is required for optimal clinical outcomes.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Preoperative rehabilitation care in total hip joint replacement by rapid recovery approach in Slovakia

Relevance of research: Hip fractures and arthrosis are currently one of the serious illnesses presenting as a serious health problem faced by the aging population. The health problem is not just the wound itself or arthrotic changes accompanied by severe pains and difficulties to get up and walk on the affected lower limb, but also the risk of inadequate healing after surgery. Also, significant disability and reduced ADL performance may continue despite the immense advances in surgical techniques, nursing care and rehabilitation. Nowadays, which is primarily aimed at reducing the cost of health care, it is necessary to ensure that this reduction in costs is not at the expense of the quality of health care and future medical success. In general, physiotherapy for total hip joint replacement is considered to be a routine matter that deals mainly with mobility training, increased muscular strength, and basic day-to-day activities such as bed-to-chair transition, standing and walking. In addition to these attributes, physiotherapists also need the patient's own experiences and psychological responses such as anxiety and fear. Goal and methods of research: The aim of the thesis is to point out the importance of preoperative preparation of the patient for total replacement of the hip joint and its impact on the reduction of recovery after surgery. As a method, a case study of the 33 year patient indicated for total hip replacement was selected. The patient underwent a comprehensive preoperative three-month preoperative treatment (from the moment of indication to surgery to performance itself) and subsequent post-operative rehabilitation treatment of three and a half months. Results: A comprehensive rehabilitation program was developed taking into account the patient's health and Rapid recovery recommendations in preoperative and postoperative care. During the preparatory phase of the operation, the patient was modified by motor stereotype walking, strengthened lower limb muscles, especially musculus quadratus femoris and pelvis stabilizers. Lower limb circumference values increased by 2 cm, hip muscle strength increased from grade 3 to grade 4 of the Janda muscle tests, and shortened muscles iliopsos were released on the affected side. Taking into account the operational complications and subsequent comprehensive care according to Rapid Recovery recommendations, the stay in the hospital was reduced from 12 days to 5 and the patient returned to normal working life from 6 months to 4 months. Conclusion: Rapid recovery program requires the development of a new culture not only in normal orthopedic outpatient clinics but also in hospitals. In the past, and nowadays in some regions of the world, slow recovery with extended acute hospitalization for several weeks has been thought to be the best way for patients to recover and achieve a good result after complete replacement of either the hip or knee joint. The results of total hip joint surgery studies showed a significant reduction in hospital stay without increasing the remission rate. Subsequently, patient satisfaction increased, accompanied by a reduction in health care costs and a faster return to normal daily life.

ISCHIOFEMORAL IMPINGEMENT IN ADOLESCENTS: FROM CLINICAL PRESENTATION TO RETURN TO SPORTS

Background: Ischiofemoral impingement is an often unrecognized cause of hip pain in adolescents. It is caused by abnormal contact between the proximal femur and the ischium. The aim of our work is to describe clinical presentation, imaging findings and functional outcomes of ischiofemoral impingement in adolescents. Methods: We performed a retrospective study. Clinical files were reviewed (age, sex, type and duration of symptoms and hip physical examination). Imaging findings were evaluated in pelvis radiographs (presence of coxa profunda, acetabular protrusio, Wiberg angle, femoral neck shaft angle and acetabular retroversion) and in MRI (quadratus femoris edema, measurement of ischiofemoral and quadratus femoris space). Lower extremity functional scale (LEFS) were used to measured response to a physiotherapy protocol. Also relapse and time to sports return were recorded. Results: 24 hips, two bilateral in 20 female patients and 2 male patients, with 13 years-old on average (9-18) were obtained. Main symptom was hip pain with latency to consultant of 9 days on average (2-14). All patients practiced school sports, the most frequent was gymnastics. Positive FADIR test, ischiofemoral impingement test and pain on palpation of the ischium and gluteus medius were found in everyone. The median of Wiberg angle was 37º (25-48), femoral shaft angle 138º (128-144), and coxa profunda was present in 5 hips. MRI showed 13 hips with quadratus femoris edema, one with muscle atrophy, ischiofemoral space was 20 mm on average (16-25) and quadratus femoris space 17 mm on average (13-21). Our physiotherapy protocol was followed for all patients with a median of 18 sessions (10-30). LEFS improved from 56.4% (30-93) to 92% (80-100) (p=0,02). Time to turn asymptomatic was 6 months on average (3-13). With 2 years follow up, 2 hips had recurrence of symptoms. Time to sports return was 5 months on average (3-7). Conclusions: Ischiofemoral impingement is cause of hip pain in active female adolescents. X-rays are inespecific and MRI shows typically quadratus femoris edema. Conservative treatment with physiotherapy is an effective method that allows sports return in few months. This is the first report in the literature regards ischiofemoral impingement in pediatric population including results of treatment and return to sports.

Evaluation of the ischiofemoral space: a case-control study.

ObjectiveTo determine the size of the ischiofemoral space (IFS) and quadratus femoris space (QFS) in patients with and without ischiofemoral impingement (IFI).Materials and MethodsCase-control study including consecutive patients submitted to magnetic resonance imaging (MRI) of the hip joint during a three-month period. Patients with deep gluteal pain who tested positive for IFI on at least one clinical test and showed signal changes in the quadratus femoris muscle on MRI were categorized as having a confirmed diagnosis of IFI.ResultsFinal sample comprised 50 patients submitted to unilateral MRI of the hip joint. The mean age was 47.3 ± 14.0 years (range, 22-76 years), and 33 (66%) of the patients were women. A diagnosis of IFI was made in 6 patients (12%), all of whom were female. On average, IFS and QFS were significantly smaller in IFI group than in control group (11.1 ± 2.7 mm versus 27.5 ± 6.5 mm and 5.3 ± 1.8 mm versus 18.8 ± 4.8 mm, respectively; p < 0.001 for both).ConclusionResults of specific clinical tests and MRI findings indicate that the IFS and QFS are significantly reduced in patients with IFI.

Quercetin Glycosides Improve Motor Performance and Muscle Weight in Adult Mice

Male C57BL/6J (B6) mice aged 24 weeks were provided two concentrations (1.5 or 3.0 g/L) of quercetin glycosides (QG) in drinking water over the subsequent 24 weeks. The objective was to determine if QG could improve motor function during early stages of aging. No sustained significant differences in body composition or food intake were noted to confirm the safety of QG treatment. Treated mice had significantly improved performance in grip strength and rotarod tests but not in treadmill performance. The functional benefits were reflected in muscle morphology with increased wet weights of a selected group of muscles (quadratus femoris, gastrocnemius, tibialis anterior, and soleus) in treated mice. Thus, it would appear that long-term oral treatment with QG can safely and effectively improve selected elements of motor performance and increase muscle mass during the early stages of aging.

Applications and critical evaluation of fascia iliaca compartment block and quadratus lumborum block for orthopedic procedures.

SUMMARYAnterior section of the hip joint capsule is innervated by femoral nerve and obturator nerve, and posterior section is innervated by the nerve to quadratus femoris muscle and occasionally by the superior gluteal (posterolateral region) and sciatic nerve (posterosuperior region). One of the regional anesthesia options for hip surgery is the fascia iliaca compartment block (FICB) that affects nerves important for hip innervation and sensory innervation of the thigh - femoral, obturator and lateral femoral cutaneous nerve. FICB can be easily performed and is often a good solution for management of hip fractures in emergency departments. Its use reduces morphine pre-operative requirement for patients with femoral neck fractures and can also be indicated for hip arthroplasty, hip arthroscopy and burn management of the region. Quadratus lumborum block (QLB) is a block of the posterior abdominal wall performed exclusively under ultrasound guidance, with still unclarified mechanism of action. When considering hip surgery and postoperative management, the anterior QLB has shown to reduce lengthy hospital stay and opioid use, it improves perioperative analgesia in patients undergoing hip and proximal femoral surgery compared to standard intravenous analgesia regimen, provides early and rapid pain relief and allows early ambulation, thus preventing deep vein thrombosis and thromboembolic complications etc. However, some nerve branches responsible for innervation of the hip joint are not affected by QLB, which has to be taken into consideration. QLB has shown potential for use in hip surgery and perioperative pain management, but still needs to be validated as a reliable treatment approach.

Evaluation of Ishiofemoral Space and Quadratus Femoris Space by Magnetic Resonance Imaging

Evaluation of Ishiofemoral Space and Quadratus Femoris Space by Magnetic Resonance Imaging

Utility of False Profile View for Screening of Ischiofemoral Impingement.

PurposeIschiofemoral impingement (IFI)-primarily diagnosed by magnetic resonance imaging (MRI)-is an easily overlooked disease due to its low incidence. The purpose of this study was to evaluate the usefulness of false profile view as a screening test for IFI.Materials and MethodsFifty-eight patients diagnosed with IFI between June 2013 and July 2017 were enrolled in this retrospective study. A control group (n=58) with matching propensity scores (age, gender, and body mass index) were also included. Ischiofemoral space (IFS) was measured as the shortest distance between the lateral cortex of the ischium and the medial cortex of lesser trochanter in weight bearing hip anteroposterior (AP) view and false profile view. MRI was used to measure IFS and quadratus femoris space (QFS). The receiver operating characteristics (ROC), area under the ROC curve (AUC) and cutoff point of the IFS were measured by false profile images, and the correlation between the IFS and QFS was analyzed using the MRI scans.ResultsIn the false profile view and hip AP view, patients with IFI had significantly decreased IFS (P<0.01). In the false profile view, ROC AUC (0.967) was higher than in the hip AP view (0.841). Cutoff value for differential diagnosis of IFI in the false profile view was 10.3 mm (sensitivity, 88.2%; specificity, 88.4%). IFS correlated with IFS (r=0.744) QFS (0.740) in MRI and IFS (0.621) in hip AP view (P<0.01).ConclusionIFS on false profile view can be used as a screening tool for potential IFI.

Quadratus femoris muscle: spectrum of MR imaging findings in 51 patients presenting with painful hip

Purpose: To provide an overview of magnetic resonance (MR) imaging findings related to quadratus femoris muscle (QFm) pathologies in symptomatic patients. Material and Methods: MR imaging studies from 51 patients, who were retrospectively recruited within a 2-year period, in 5 health care centers were reviewed. Inclusion criteria included: (i) hip pain; (ii) QFm abnormal signal; (iii) identification of other pathology in the QFm anatomical area. Exclusion criteria included: (i) other symptomatic hip/pelvic pathology; (ii) incomplete MR examination. The presence/location of QFm oedema and configuration of QFm fibers were evaluated and classified. Hamstring tendons were assessed for tendinosis/tear. Ischiofemoral impingement syndrome (IFIs) was indicated by QFm oedema and restriction of ischiofemoral space (IFS)/quadratus femoris space (QFS). QFm tears were categorised as complete/partial/chronic. Fisher’s exact test was used for statistical analysis. Results: IFIs diagnosis, related to various aetiologies, was suggested in 39 patients. The absence of severe QFm oedema and crowded configuration of QFm fibers correlated with IFIs diagnosis (p<0.05). In 18/39 (46.2%) of patients, restriction of the IFS/QFS was due to an underlying pathology. QFm tears were diagnosed in 5 patients. QFm oedema, usually mild, located at the myotendinous junction, was revealed in 4/5 patients. In 7 patients various pathologies related to the QFm were disclosed, which broadly included neoplastic disorders, myositis and bursitis. Conclusions: MR imaging can depict and characterise various QFm pathologies including IFIs, traumatic lesions, myositis and neoplastic disorders. Detailed analysis of the oedema pattern and the configuration of muscular fibers matched with clinical findings can lead to precise diagnosis.

Extra-articular Hip Impingement: Anterior Inferior Iliac Spine/Subspine Impingement, Ischiofemoral, and Anterior and Lateral Greater Trochanteric-Pelvic Impingement

AbstractAlthough femoroacetabular impingement (FAI) is traditionally considered an intra-articular phenomenon, the result of abutment between the femoral head and/or neck and the acetabular rim, there are unique and relatively uncommon patterns of pathologic extra-articular hip impingement that can mimic the clinical presentation and clinical findings of traditional FAI. Anterior inferior iliac spine (AIIS) or “subspine” impingement may occur as a consequence of an abnormally anterior or distal prominence of the AIIS that may be developmental, posttraumatic, or the result of high range of motion (ROM) activities. This type of impingement can crush the capsule, labrum, and rectus femoris between the AIIS and distal femoral neck in straight hip flexion. Greater trochanteric/pelvic impingement is quite complex and can be further divided into three unique anatomic patterns. Anterior greater trochanteric–pelvic impingement is the result of impingement between the anterior hip soft tissue structures or the anterior facet/greater trochanter and anterolateral rim/lateral AIIS and pelvis when the hip is flexed, internally rotated, and abducted. This can occur in association with a prominent greater trochanter, short femoral neck, relative femoral retrotorsion, and high ROM activities. Lateral greater trochanteric–pelvic impingement is the result of impingement between an abnormally prominent or a high riding greater trochanter with a short femoral neck and the lateral pelvis when the hip is abducted. This type of impingement is characteristic of a Perthes-like hip and, in extreme cases, can be associated with severe leg length discrepancy (and abductor muscle dysfunction). Posterior greater trochanteric–pelvic/ischiofemoral impingement is the result of impingement of the quadratus femoris and/or proximal hamstring tendons between the lesser trochanter or posterior proximal femur and intertrochanteric line and the ischial tuberosity when the hip is extended and external rotated (ER). This can occur in association with deformities of the ischial tuberosity caused by prior avulsion fractures, lesser trochanteric overgrowth, extreme coxa valga, femoral antetorsion, complex proximal femoral developmental deformities, and activities requiring high degrees of extension and external rotation. A thorough understanding of these unique patterns of impingement, their clinical presentations, and complex treatment options can help in optimizing outcomes and minimizing complications in this very challenging patient population.

Narrowing of ischiofemoral and quadratus femoris spaces in pediatric ischiofemoral impingement.

To correlate MRI findings of quadratus femoris muscle edema (QFME) with narrowing of the ischiofemoral space (IFS) and quadratus femoris space (QFS) in children, and to identify threshold values reflecting an anatomic architecture that may predispose to ischiofemoral impingement. A case-control retrospective MRI review of 49 hips in 27 children (mean, 13years) with QFME was compared to 49 hips in 27 gender and age-matched controls. Two radiologists independently measured IFS and QFS. Generalized linear mixed-effects models were fit to compare IFS and QFS values between cases and controls, and adjust for correlation in repeated measures from the same subject. Receiver operating characteristic (ROC) analysis determined optimal threshold values. Compared to controls, cases had significantly smaller IFS (p < 0.001, both readers) and QFS (reader 1: p < 0.001; reader 2: p = 0.003). When stratified as preteen (<13) or teenage (≥ 13), lower mean IFS and QFS were observed in cases versus controls in both age groups. Area under ROC curve for IFS and QFS was high in preteens (0.77 and 0.71) and teens (0.94 and 0.88). Threshold values were 14.9mm (preteens) and 19mm (teens) for IFS and 11.2mm (preteens) and 11.1mm (teens) for QFS. IFS and QFS were modestly correlated with age among controls only. Pediatric patients with QFME had significantly narrower QFS and IFS compared with controls. IFS and QFS were found to normally increase in size with age. Optimal cutoff threshold values were identified for QFS and IFS in preteens and teenagers.

A 37 Year Old Female Dance Instructor with Leg and Buttock Pain

HISTORY: A 37 year old female dance instructor with a history of stable multiple sclerosis presented with a 5 year history of left buttock and posterolateral thigh pain with radiation to the plantar surface of her foot that began during pregnancy. Pain was minimal at rest and aggravated by prolonged sitting and activities such as dancing, bicycling, and hiking. Pain progressed and now markedly limited activity. She reported tingling of the posterolateral calf and plantar surface of the foot. She denied weakness. Chiropractic care provided no relief. Previously obtained lumbar spine MRI was unremarkable and the patient completed 6 months of physical therapy without improvement. PHYSICAL EXAMINATION: There was no appreciable deformity, malalignment, or rotation of the lumbar spine, hips, or knees. She walked with a non-antalgic gait, including normal heel and toe walking. Palpation of deep left gluteal muscles reproduced pain with radiation down the left lower limb. Range of motion of the lumbar spine and hips was grossly normal. Manual muscle testing of the lower limbs was normal. Passive hip flexion, abduction, and external rotation, as well as flexion, adduction, and internal rotation of the left hip reproduced pain. Remainder of provocative lumbar spine and hip maneuvers, including straight leg raise, were normal. She was neurovascularly intact. DIFFERENTIAL DIAGNOSIS: Chronic Piriformis Strain Lumbosacral Radiculopathy Hip Osteoarthritis Multiple Sclerosis Flare Sciatic, Tibial, or Peroneal Neuropathy TEST AND RESULTS:FigureMRI Lumbosacral Plexus: 2.8 X 2.5 X 3.0 cm mass along the left sciatic nerve between the gluteus maximus and quadratus femoris with extension into the ischiofemoral space, consistent with cystic schwannoma FINAL WORKING DIAGNOSIS: Left sciatic nerve tumor, concern for cystic schwannoma TREATMENT AND OUTCOMES: Neurosurgery evaluation Underwent surgical resection of mass 16 weeks after surgery, reported 100% resolution of her symptoms

Deep External Rotator Muscles of the Hip: An Anatomical and Architectural Study

The arrangement of sarcomeres within a muscle (referred to as the muscle architecture) can be used to predict a muscle's functional capability. Parameters that are measured when studying muscle architecture are muscle fascicle length, sarcomere length, and the mass of the contractile tissue. Using these measured values, physiological cross‐Sectional Area (PCSA, representative of sarcomeres arranged in‐parallel) and normalized fascicle length (LFn, representative of sarcomeres arranged in‐series) can be calculated. PCSA is currently the best predictor of the relative force production capability of a muscle, and LFn is the best predictor of the excursion potential of a muscle. Additionally, based on the well‐known force‐length relationship for human muscle, sarcomere length at a given posture can be used to predict the percentage of maximal force generating capability that the muscle can produce.In this study, the architectural parameters of six deep external rotator muscles of the hip (Piriformis, Quadratus Femoris, Obturator Internus, Obturator Externus, Gemellus Superior and Gemellus Inferior) were measured, and each muscle's anatomical pathway was photographed using high quality digital imaging. These muscles are primarily external rotators and stabilizers of the hip joint, and may be affected during hip surgery if the anatomical attachments or pathways are altered. Previously, there had been no detailed architectural data measured for these six deep hip external rotator muscles. The six muscles were removed from 12 embalmed cadavers on one side of the body (n=12, 6 male and 6 female, age 56–88 years). Each muscle was carefully removed from the cadaver using dissection hand tools and had all external fat, fascia and tendon removed. Muscle mass was measured using a digital scale. Three fascicles were isolated from different locations on the muscle and fascicle length was measured using a digital caliper. Three small biopsies were taken from each fascicle and were subjected to laser diffraction to measure sarcomere length. Table 1 shows all measured and calculated results. Obturator Internus is predicted to have the highest force generating capability (based on PCSA), and Piriformis is predicted to have the highest excursion potential (based on LFn). All of the six deep hip external rotator muscles have an average sarcomere length, measured in the neutral cadaveric posture, ranging between 2.41 um – 2.54 um. This suggests an ability for the muscles to produce 91 – 95% of their maximal force, on the ascending limb of the force‐length curve, in this posture. These data, in conjunction with modelling software, can be used to predict force generating capabilities throughout the hip range of motion, and will be valuable to predict changes in the muscles' behavior after being displaced from their respective anatomical attachments during hip surgery.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Surgical therapy of ischiofemoral impingement by lateralizing intertrochanteric osteotomy

Lateralizing, derotating intertrochanteric varus osteotomy to increase the ischiofemoral space to counter painful impingement of the lesser trochanter and the os ischium with resulting entrapment of quadratus femoris muscle. Symptomatic ischiofemoral impingement (IFI) caused by Coxa valga et antetorta, Coxa valga or Coxa antetorta, or ashort femoral neck. Anatomic configuration suggestive of IFI in asymptomatic patients. Symptomatic IFI caused by another underlying pathology. Valgus deformity of the knee. Measurement of femoral antetorsion. Planning of the osteotomy, lateralization, varus angle for correction, rotation and offset correction, leg length change, and osteosynthesis plate. General or spinal anesthesia in supine or lateral position. Skin incision (15 cm) beginning lateral of the greater trochanter tip, distally along the axis of the femur. Preparation onto the femur by L‑shaped dissection of the vastus lateralis from the bone. AKirschner(K-)wire is then positioned along the anterior femoral neck to designate the femoral neck antetorsion. Atriangle set on the lateral femoral cortexis is used to determine the osteotomy angle. In the thus determined angle, asecond K‑wire is shot centrally along the femoral neck axis just inferior to its cranial cortex. About 5 mm distal to the second wire, the entry for the blade is prepared using adrill. Using the blade setting instrument, the blade is introduced into the femoral neck, then slightly pulled back. The rotation is then marked on the anterior femoral cortex proximal and distal to the planned osteotomy and the osteotomy is performed. Ablade plate without displacement is impacted. The osteotomy is then reduced, the distal fragment pulled laterally onto the plate, and the screws inserted after compression of the osteotomy with atension device. Touch-toe bearing for 6weeks, then radiological assessment of osteotomy healing before an increase in weight bearing (15 kg/week). Hip flexion limited to90° for 6weeks. Elective implant removal after 12-18months. Studies of this lateralizing varus osteotomy have not been published. The 25-year results of the conventional derotating intertrochanteric varus osteotomy technique show good functional results and low complication rates, with non-union being the most common. Arthroscopic resection of the lesser trochanter has been reported as asurgical alternative in the treatment of IFI in case reports and small series. Advantages of the osteotomy are the restoration of biomechanics and preservation of iliopsoas tendon insertion.

Relación entre medidas radiológicas y morfología de cadera en individuos con parálisis cerebral: serie de casos

BackgroundIn cerebral palsy (CP), there are different processes and muscle forces that affect the biomechanical developmental behaviour of the hip joint. This study aims to present the differences between radiological measurements as regards peri-articular hip musculature and the bone morphology. Materials and methodsDescriptive, observational and cross-sectional study of 14 individuals, aged between 6 and 10 years, with CP at levels IV and V of the Gross Motor Function Classification System (28 hips). Radiological measurements were performed on the gluteus medius, gluteus minimus, quadratus femoris, and pectineus. Reimer's migration percentage and neck-shaft angle for each of the hips were also evaluated. ResultsA direct relationship was observed between distances as regards the gluteus medius and minimus, with respect to pectineus, and an inverse one of all with respect to quadratus femoris. The neck shaft angle showed an inverse relationship with the proportions for the quadratus femoris, both in proportion to the gluteus medius and pectineus. DiscussionIn the studied population, there is an association between an adequate length of the pelvic-trochanteric musculature with respect to the abductor and adductor and near-normal neck shaft angles, with measurements of shortening of the quadratus femoris being negative. Evidence levelIV.

Magnetic Resonance Imaging in Symptomatic Children With Hereditary Multiple Exostoses of the Hip.

Magnetic resonance imaging (MRI) is useful in evaluating nontraumatic hip pain. It provides information about associated injuries like labral/chondral tears or ischiofemoral impingement (IFI). However, in hereditary multiple exostoses (HME) there has been no report about MRI findings in symptomatic children with hip involvement. Records of children with HME and hip osteochondromas, who had hip MRI/magnetic resonance arthrography, were reviewed. The presence of chondral lesions and labral tears, as well the presence of IFI, was recorded. IFI was defined as edema or fatty replacement/atrophy in the quadratus femoris muscle or decrease of the space for this muscle between the ischium and the proximal femur. The measurements used to determine the space included the ischiofemoral space, the quadratus femoris space, and the minimum ischiofemoral space (MIFS). All measurements were performed on axial T1-weighted images. Ten children were included (4 males, 6 females). In 2 patients, MRI was unilateral, therefore a total of 18 hips were analyzed. The indication for MRI was hip pain. Mean age, when MRI was performed, was 11.7 years. Labral tears were found in 44% (8/18) and chondral lesions in 33% (6/18) of the hips. The mean ischiofemoral space was 17.2 mm (SD, 7.3), the mean quadratus femoris space was 14.9 mm (SD, 5.3), and the mean MIFS was of 12.8 mm (SD, 5.9). IFI was seen in 44% (8/18) of hips. Two patients had bilateral IFI. MIFS was <10 mm in all hips with IFI (8/8). Of these hips, 88% (7/8) had edema of the quadratus femoris muscle and 38% (3/8) had fatty replacement/atrophy in the muscle. Osteochondromas were seen in the lesser trochanter in all hips with IFI (8/8) and in the ischium in 50% of them (4/8). In symptomatic children with HME of the hip, MRI is helpful in detecting the source of pain. A high percentage of these children have IFI and intra-articular lesions. These findings can play an important role in the indication and planning of the surgical approach. Level IV-diagnostic study.

Radiologic Correlation Between the Ischiofemoral Space and Morphologic Characteristics of the Hip in Hips With Symptoms of Dysplasia.

The purpose of this study was to investigate radiologic correlation between the ischiofemoral space and morphologic findings in the hip in patients with symptomatic developmental dysplasia of the hip (DDH), borderline DDH, and femoroacetabular impingement (FAI). In 84 patients undergoing hip arthroscopic surgery, 108 hips were divided into three groups according to lateral center-edge angle (LCEA): DDH group (LCEA < 20°; 18 hips), borderline DDH group (20° ≤ LCEA < 25°; 26 hips), and FAI group (LCEA ≥ 25°; 64 hips). Ischiofemoral distance was evaluated by radiography and ischiofemoral space and quadratus femoris space by MRI. Software was used to measure the radiographic parameters LCEA, femoral neck-shaft angle, and femoral neck anteversion on preoperative CT scans. Ischiofemoral distance, ischiofemoral space, and quadratus femoris space were significantly smaller in the DDH and borderline DDH groups than in the FAI group. The prevalence of hips with ischiofemoral space < 17 mm was significantly higher in the DDH (10 of 18 patients [56%]) and borderline DDH (8 of 26 patients [31%]) groups than in the FAI group (4 of 64 patients [6%]). In addition, the prevalence of hips with a quadratus femoris space < 8 mm was significantly higher in the DDH (2 of 18 patients [11%]) and borderline DDH (3 of 26 patients [12%]) groups than in the FAI (0 of 64 patients [0%]) group. Femoral neck-shaft angle and femoral neck anteversion were significantly greater in the DDH group than in the FAI group. Ischiofemoral impingement syndromes can be considered more likely in patients with DDH than in those with FAI.

The Posterior Capsular Ligamentous Complex Contributes to Hip Joint Stability in Distraction

BackgroundLaxity of soft tissues after total hip arthroplasty is considered to be a cause of accelerated wear of bearing surfaces and dislocation. The purpose of this study is to assess the contribution of the anterior and posterior capsular ligamentous complexes and the short external rotators, except the quadratus femoris, on the stability of the hip against axial traction. MethodsThe study subjects comprised 7 fresh cadavers with 12 normal hip joints. In 6 hips, soft tissues surrounding the hip joint were resected in the following order to simulate the anterior approach: anterior capsule, posterior capsule, piriformis, conjoined tendon, and external obturator. In the remaining 6 hips, soft tissues were resected in the following order to simulate the posterior approach: piriformis, conjoined tendon, external obturator, posterior capsule, and anterior capsule. Soft tissue tension was measured by applying traction amounting to 250 N with joints in the neutral position. ResultsThe separation distance between the femoral head and acetabulum during axial leg traction significantly increased from 4.0 to 14.5 mm on average after circumferential resection of the capsule via the anterior approach. Subsequent resection of the short external rotators increased the separation distance up to 19.0 mm, but the differences did not reach statistical significance. Resection of the short external rotators via the posterior approach did not significantly increase the separation distance; it significantly increased from 6.0 to 11.4 mm after the resection of the anterior capsule and further to 20.5 mm after the resection of the posterior capsule. ConclusionThe posterior capsule, in addition to the anterior capsule, significantly contributes to hip joint stability in distraction regardless of whether the short external rotators, except the quadratus femoris, were preserved or resected.

Quadratus femoris muscle pedicle bone flap transplantation in the treatment of femoral neck fracture for Chinese young and middle-aged patients: A systematic review and meta-analysis

PurposeTo compare the efficacy of quadratus femoris muscle pedicle bone flap transplantation combined with hollow compression screw fixation versus AO hollow compression screw fixation in the treatment of femoral neck fracture for Chinese young and middle-aged patients. MethodsCase-controlled studies (CCTs) were used to compare the two operative methods in the treatment of femoral neck fractures. Data were retrieved from the Cochrane Library, Pubmed Database, CNKI, Chinese Biomedical Database.Wanfang Data published during the period of January 2005 to December 2014. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical Software Revman 5.0 was used for data-analysis. ResultsEight articles were included in the meta-analysis. The results showed that there was statistical significance in the rate of fracture healing [OR = 5.43, 95% CI (2.89, 10.20), p < 0.05], the rate of good function of hip joint [OR = 5.12, 95% CI (3.21, 8.17), p < 0.05], the rate of femoral head necrosis [OR = 4.21, 95% CI (2.02, 8.76), p < 0.05], the time of fracture healing [WMD = −46.85, 95% CI (−65.13, −28.56), p < 0.05] between the two groups. ConclusionsFor the treatment of femoral neck fractures, the transplantation of quadratus femoris muscle pedicle bone flap combined with hollow compression screw; fixation is superior to the AO hollow compression screw fixation in terms of the rate; of fracture healing, the rate of good function of hip joint, the rate of femoral head; necrosis and the time of fracture healing.

How to address ischiofemoral impingement? Treatment algorithm and review of the literature.

Ischiofemoral impingement (IFI) is a rare cause of hip pain defined by a narrowing of the space between the lateral aspect of the os ischium and the lesser trochanter of the femur. Several underlying anatomic, functional and iatrogenic pathologies have been identified for symptomatic IFI in native hip joints and after total hip arthroplasty. Clinical symptoms vary but most commonly consist of pain of the lower buttock and groin including the inner thigh, and a snapping or clunking phenomenon is often reported. Symptoms may be provoked by a combined extension, adduction and external rotation during physical examination and during long-stride walking. Radiographs of the pelvis and an axial or false-profile-view of the hip as well as magnetic resonance imaging (MRI)-scans should be obtained to strengthen the diagnosis. On MRI, the quadratus femoris muscle signal and the space confined by the anatomic structures surrounding the muscle, the quadratus femoris space, are to be assessed. Targeted infiltration of the muscle can be helpful both diagnostically and therapeutically. The literature on differential diagnoses and treatment options for IFI is limited; therapeutic suggestions are offered only in case reports and series. With this work, we aim to give a systematic approach to the non-surgical and surgical treatment options for IFI based upon the current literature and the authors’ personal experience.