Infantile hip arthroscopy: the relationship between neurovascular anatomy and the portal pathway.

OBJECTIVE: In the past, studies of hip arthroscopy portal path relate with extra-articular structures were done in adults. This study was investigated in the infantile group. MATERIAL AND METHOD: 10 hips of fresh infantile cadavers. K-wire diameter 2.4 mm. are representing scope pathway. Three portals (anterior, anterolateral and posterolateral) in supine position without traction were chose to used in this study. RESULTS: One cadaver was female and four were male. The mean age and weight when death occurred was 74 days and the mean weight was 3584.4 gm. At the anterior portal, the most lateral branch of LFCN was frequently injured. The average distant of femoral nerve to the K-wire was 11.2 (7-14) mm. Transverse branch of lateral femoral circumflex artery had an average distant 8.5(6-14) mm and the terminal branch could be identified in four hip and average distance was 1 mm. At the anterolateral portal two, greater trochanter were injured by K-wire. In the posterolateral portal the average distant from K-wire to sciatic nerve was 13.2 mm. CONCLUSION: From this pilot study, the distance of major neurovascular structure as related to hip scope path is nearly a centimeter on average.

Restoration of winged scapula in upper arm type brachial plexus injury: anatomic feasibility.

BACKGROUND: The patients who have C5-C6 root avulsion in brachial plexus injury, suffered from loss of elbow flexion, shoulder abduction and winged scapula. The purpose of study is to provide anatomic feasibility of thoracodorsal nerve (medial and lateral branches) and long thoracic nerve for restoration of the shoulder function caused by winged scapula. MATERIAL AND METHOD: To study the length of thoracodorsal nerve and long thoracic nerve from the apex of the posterior axillary line to the insertion of the latissimus dorsi muscle and the serratus anterior muscle respectively, 10 fresh cadavers were dissected. The distance between the thoracodorsal nerve and long thoracic nerve, and the numbers of fascicles and axon were measured by histomorphometry. We transferred the lateral branch of the thoracodorsal nerve to the long thoracic nerve in order to restore the serratus anterior muscle function. RESULTS: The mean length of the thoracodorsal nerve from apex of posterior axillary line to bifurcation before separation to medial and lateral branches was 31.5 mm. The average length of the thoracodorsal nerve and long thoracic nerve from bifurcation to the insertion of the latissimus dorsi muscle and the serratus anterior muscle were 10.3, 82.2, and 99.5 mm, respectively. The distance between the lateral branch of the thoracodorsal nerve and long thoracic nerve was 33.4 mm. The mean number of myelinated nerve fiber of the thoracodorsal nerve medial and lateral branches and long thoracic nerve were 973.8, 1843.3 and 1135.3 axons, respectively. CONCLUSION: The anatomic study of the thoracodorsal nerve and long thoracic nerve showed that the lateral branch of the thoracodorsal nerve is proper in the length and numbers of axon to transfer to the long thoracic nerve for restoration of shoulder function caused by the winged scapula.

Nerve transfer to serratus anterior muscle using the thoracodorsal nerve for winged scapula in C5 and C6 brachial plexus root avulsions.

PURPOSE: To report the results of nerve transfer to the serratus anterior muscle using the thoracodorsal nerve for winged scapula in C5 and C6 brachial plexus avulsion. METHODS: Five patients with a mean age of 27 years with loss of shoulder abduction due to upper brachial plexus injuries and with winged scapula had nerve transfer using 1 branch (1 medial and 4 lateral) of the thoracodorsal nerve to the long thoracic nerve. The spinal accessory nerve and the nerve to the long head of the triceps were used simultaneously for nerve transfer to the suprascapular nerve and the axillary nerve, respectively. The follow-up period ranged from 24 to 33 months (mean, 28 months). RESULTS: All patients recovered serratus anterior muscle function. Two patients had no winged scapula, whereas 3 patients had mild winged scapula after the surgery at the last follow-up evaluation. The result was excellent for 2 patients, good for 2 patients, and fair for 1 patient. The mean arcs of motion of shoulder abduction and external rotation were 134 degrees and 124 degrees , respectively. No notable weakness of shoulder adduction was observed. CONCLUSIONS: Use of the branch of the thoracodorsal nerve ensured adequate return function of the serratus anterior muscle by decreasing or correcting winged scapula in upper brachial plexus injury. We recommend nerve transfer for winged scapula for achieving optimum shoulder function. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.