Anatomical basis for the selective block of the nerve to quadratus femoris by way of percutaneous techniques / Bases anatómicas para el bloque selectivo del nervio del músculo cuadrado femoral a través de técnicas percutáneas

SUMMARY: Hip joint chronic pain can severely compromise patients' life quality. Peripheral nerve blocks play an important role as diagnostic and therapeutic procedures. The aim of this work is to study the anatomy of the nerve to quadratus femoris (NQF) in view of the possibility of its percutaneous selective block. Forty-three gluteal cadaveric regions fixed in formaldehyde solution were dissected. The quadratus femoris, the obturator internus and superior and inferior gemellus were freed from their lateral insertion, exposing thus the posterior aspect of the hip joint. The NQF was identified, and the horizontal distance to the posterior edge of the greater trochanter at its upper, middle and lower thirds was registered. The number of the articular branches of the NQF was identified. Likewise, the horizontal distance to the posterior edge of the greater trochanter and the longitudinal distance to the line through the distal end of the posterior edge of the greater trochanter were measured. The distance between the NQF and the greater trochanter posterior edge at upper, middle and lower thirds was 46 mm, 41 mm and 35 mm, respectively. In most cases (85 %) the NQF presented one or two articular branches. The longitudinal distances between the line through the distal end of the posterior edge of the greater trochanter and the origin of the first, second and third articular branches of the NQF were 14.7 mm (-19.4 - 40), 16.4 mm (-9.3-42) and 27 mm (0-46), respectively. The distances to the posterior edge of the greater trochanter were 43.1 mm (16.3-66), 37.7 mm (6.5-53) and 39.8 mm (26-52), for the first, second and third articular branches, respectively. In conclusion, the articular branches of the nerve to quadratus femoris have a constant and predictable distribution. Our findings allow for generating a coordinate system for the selective block of the NQF by way of percutaneous techniques.

RESUMEN: El dolor crónico de la articulación coxal puede comprometer severamente la calidad de vida de los pacientes. Los bloqueos nerviosos periféricos juegan un papel importante como procedimientos diagnósticos y terapéuticos. El objetivo de este trabajo es estudiar la anatomía del nervio del músculo cuadrado femoral (NCF) en vista de la posibilidad de su bloqueo selectivo percutáneo. Se utilizaron 22 cadáveres fijados en solución de formaldehído. Fueron disecadas en total 43 regiones glúteas. Los músculos cuadrado femoral, obturador interno y los gemelos superior e inferior fueron liberados de su inserción lateral, exponiendo así la cara posterior de la articulación coxal. Se identificó el NCF y se registró la distancia horizontal al margen posterior del trocánter mayor en sus tercios superior, medio e inferior. Se identificó el número de ramas articulares del NQF. Asimismo, se midió la distancia horizontal al margen posterior del trocánter mayor y la distancia longitudinal a la línea que pasa por el extremo distal del margen posterior del trocánter mayor. La distancia entre el NCF y el margen posterior del trocánter mayor en los tercios superior, medio e inferior fue de 46 mm, 41 mm y 35 mm, respectivamente. En la mayoría de los casos (85 %) el NCF presentó una o dos ramas articulares. Las distancias longitudinales entre la línea que pasa por el extremo distal del margen posterior del trocánter mayor y el origen de la primera, segunda y tercera ramas articulares del NQF fueron 14,7 mm (-19,4 - 40), 16,4 mm (-9,3-42) y 27 mm (0-46), respectivamente. Las distancias al margen posterior del trocánter mayor fueron 43,1 mm (16,3-66), 37,7 mm (6,5-53) y 39,8 mm (26-52), para la primera, segunda y tercera ramas articulares, respectivamente. En conclusión, las ramas articulares del nervio al cuadrado femoral tienen una distribución constante y predecible. Nuestros hallazgos permiten generar un sistema de coordenadas para el bloqueo selectivo del NCF por medio de técnicas percutáneas.

Diagnostic value of MRI measurement in ischiofemoral impingement syndrome / 中国医学影像技术

Objective To investigate the diagnostic value of MRI in patients with ischiofemoral impingement syndrome (IFIS). Methods MRI data of 70 patients with IFIS (IFIS group) and 40 normal volunteers (control group) were analyzed retrospectively. The width of ischial femoral space (IFS) and quadratus femoris space (QFS) were measured on axial fat suppression T2WI, while the angle of sciatic bone was measured on axial T1WI, and the femoral neck shaft angle was measured on coronal T2WI, and then were compared between the two groups. The correlation between the width of IFS and the other three parameters was analyzed, and ROC curve was drawn to evaluate the diagnostic efficacy for IFIS. The degree of edema and fat infiltration of the quadratus femoris in IFIS group were evaluated, and the differences of IFS width among different grades were compared. Results In IFIS group, the IFS width, QFS width, ischium angle and femoral neck shaft angle was (11.76±2.22)mm, (8.33±2.20)mm, (132.59±1.39)° and 132.70(131.18,134.13)°, respectively, and the differences between the two groups were statistically significant (all P<0.001). The area under ROC curve in diagnosis of IFIS with IFS width, QFS width, ischium angle and femoral neck shaft angle was 1.000, 0.999, 0.996 and 0.975, respectively (all P<0.001). There was positive correlation between IFS width and QFS (r=0.743, P<0.001), negative correlation between IFS width and ischium angle and femoral neck shaft angle (r=-0.273, P=0.022; r=-0.332, P=0.005). The overall differences in IFS width among different grades of femoral quadratus edema and fat infiltration in IFIS patients were statistically significant (both P<0.05). Conclusion IFS and QFS of IFIS patients are obviously narrow. Edema and fat infiltration of quadratus femoris are common MRI findings in IFIS patients.

Clinics in diagnostic imaging (197). Left ischiofemoral impingement syndrome

A 48-year-old woman presented with progressive left hip pain over six months, along with left lower limb weakness for two weeks. Magnetic resonance imaging of the left hip showed narrowing of the left ischiofemoral space, oedema of the left quadratus femoris muscle and left sciatic nerve, and mild bone marrow oedema of the left ischial tuberosity. The diagnosis of left ischiofemoral impingement syndrome was made. The imaging features of ischiofemoral impingement syndrome and the associated aetiologies and complications are discussed.

Utility of False Profile View for Screening of Ischiofemoral Impingement / 대한고관절학회지

PURPOSE: Ischiofemoral 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 METHODS: Fifty-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. RESULTS: In 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). CONCLUSION: IFS on false profile view can be used as a screening tool for potential IFI.

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 / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To 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.</p><p><b>METHODS</b>Case-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.</p><p><b>RESULTS</b>Eight 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.</p><p><b>CONCLUSIONS</b>For 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.</p>

Ruptura del músculo cuadrado crural / Quadratus femoris muscle tear

Resumen: Antecedentes: La ruptura del músculo cuadrado crural es una lesión poco frecuente que se manifiesta por dolor en cadera y cuya incidencia se desconoce. El paciente puede manifestar dolor en región glútea y/o inguinal, su diagnóstico clínico es difícil por su rareza y porque el diagnóstico diferencial de problemas de cadera es amplio. Caso clínico: Masculino de 65 años con dolor en regiones glútea e inguinal derechas manifestadas durante la práctica de tenis, evaluado por neurología con resonancia magnética nuclear (RMN) lumbosacra (normal) y canalizado a rehabilitación. Se solicitó RMN de pelvis, la cual reveló ruptura del cuadrado crural derecho no sospechada previamente. Conclusión: La RMN por su capacidad para mostrar cortes multiplanares es el estudio de elección en problemas de tejidos blandos en cadera, ya que permite localización y auxilia en diagnóstico de problemas no sospechados.

Abstract: Background: Quadratus femoris tear is an uncommon injury that usually cause hip pain, it incidence is unknown. The patient can suffer of posterior gluteal pain or groin pain or both, which makes accurate diagnosis difficult, because the differential diagnosis of hip pain is broad. Clinical case: A 65 years old male, with gluteal and groin pain presented during tennis; evaluated by neurologist with lumbosacral magnetic resonance imaging (MRI) (normal) and referred to physical therapy, a pelvic MRI was required, finding an unsuspected quadratus femoris tear. Conclusion: MRI with its superior soft-tissue resolution and multiplanar capability is an excellent adjunct to physical examination because it shows the anatomic location of the abnormality, aiding the clinician to make unsuspected diagnoses.

Meta-analysis of quadratus femoris muscle pedicle bone flap transplantation in the repair of femoral neck fracture for young and middle-aged patients / 中华显微外科杂志

Objective To compare the efficacy of quadratus femoris muscle pedicle bone flap transplantation combined with hollow compression screw fixation versus hollow compression screw fixation in the repair of femoral neck fracture for young and middle-aged patients.Methods Case-controll studies comaring the quadratus femoris muscle pedicle bone flap transplantation with hollow compression screw fixation in the repair of femoral neck fracture were retrieved from CNKI,Chinese Biomedical Database,Wanfang Data and manually (from January,2005 to December,2014).Methodological quality of the trials was critically assessed,and relevant data were extracted.Statidtical software Revman 5.0 was used for data-analysis.Results Eight articles were included in the meta-analysis.The results showed that,compared the efficacy of quadratus femoris muscle pedicle bone flap transplantation combined with hollow compression screw fixation with hollow compression screw fixation,there were statidtical 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].Conclusion The transplantation of quadratus femoris muscle pedicle bone flap combined with hollow compression screw fixation is superior to the hollow compression screw fixation in the repair of femoral neck fracture for young and middle-aged patients in regards to the rate of fracture healing,the rate of good function of hip joint,the rate of femoral head necrosis,the time of fracture healing.