Lateral femoral cutaneous nerve: an anatomic study.

The purpose of our study was to determine the location of the lateral femoral cutaneous nerve and its branches at the inguinal ligament and proximal thigh. We think that further defining the location of the nerve and its branches based on certain measurements from known anatomic landmarks would enable us to determine a danger zone that could aid in preventing iatrogenic injury to the lateral femoral cutaneous nerve. The anatomic course of the lateral femoral cutaneous nerve was studied in 29 cadaver specimens and distances from various landmarks were recorded. In addition, the branching pattern of the nerves was recorded. We observed variability in the course and branching patterns of the lateral femoral cutaneous nerve. The lateral femoral cutaneous nerve was found to potentially be at risk as far as 7.3 cm medial to the anterior superior iliac spine along the inguinal ligament and as much as 11.3 cm distal on the sartorius muscle from the anterior superior iliac spine. As many as five branches of the lateral femoral cutaneous nerve were found and in 27.6% of cases the lateral femoral cutaneous nerve branched before traversing the inguinal ligament. We used this information to describe a danger zone, which could be used as a guide to help prevent unnecessary injury during certain procedures.

The failed total knee arthroplasty: evaluation and etiology.

Evaluation of a patient with a failed total knee arthroplasty begins with a detailed history of the index knee arthroplasty and with the patient's medical history. The nature of the complaint after arthroplasty can help determine the etiology of failure. The primary causes of failure of total knee arthroplasty are pain, postoperative stiffness, and instability. Pain associated with weight bearing is most often mechanical and is caused by loosening, component failure, or patellar dysfunction. Continuous pain can be associated with infection or complex regional pain syndrome. Persistent postoperative stiffness may be caused by inadequate rehabilitation or improper balancing of flexion and extension spaces. However, loss of motion after satisfactory mobility has been achieved may be associated with infection, synovitis, tendinitis, or component loosening. Instability after total knee arthroplasty results from improper balancing, inappropriate component size, and component failure. Posterior instability generally occurs during flexion. Medial-lateral instability can result from either improper balancing of components or incompetent collateral ligaments. Radiographs can detect loosening and osteolysis, as well as component wear, fracture, and malposition. Nuclear scans can aid in detecting loosening and infection. If infection is suspected, aspiration is mandatory to attempt to confirm the diagnosis and identify an organism.

Bone transport in the management of posttraumatic bone defects in the lower extremity.

BACKGROUND: The aim of this study was to evaluate the clinical and functional outcomes of traumatic bone defects of the lower extremity managed by internal bone transport using the Ilizarov technique. METHODS: We retrospectively reviewed 19 patients who underwent internal bone transport for traumatic bone defects in the lower extremity. Mean follow-up was 68.7 months (5.7 years). Eighteen cases were open: grade IIIA, 10 cases; grade IIIB, 4 cases; and grade IIIC, 4 cases. RESULTS: Clinical outcome was 2 excellent, 11 good, 4 fair, and 2 poor. Eighteen of 19 patients reported being satisfied. The results of the SF-36 Health Survey showed a significant difference between the population norm and the mean of the study group in Physical Functioning, Bodily Pain, and Role-Emotional. The mean length of time in external fixation for all patients was 13.8 months. The mean length of regenerate was 5.7 cm (range, 0.8-20.4 cm). The total number of complications was 39 (20 minor and 19 major). Major complications included two transtibial amputations and four fractures at the docking site. CONCLUSION: Although the number of complications was high, the patients in this study were satisfied to have their limbs preserved. The SF-36 Health Survey showed that patients suffer mainly from physical and emotional consequences after these major injuries. Their general, social, and mental health is usually not affected. Infection significantly increased the healing index. The limb should be protected for a long time, with careful evaluation to avoid fracture at the docking site after fixator removal.