Neurovascular structures in human vastus lateralis muscle and the ideal biopsy site.

A density model of neurovascular structures was generated from 28 human vastus lateralis muscles isolated from embalmed cadavers. The intramuscular portion of arteries, veins, and nerves was dissected, traced on transparencies, and digitized before adjustment to an average muscle shape using Procrustes analysis to generate density distributions for the relative positions of these structures. The course of arteries, veins, and nerves was highly variable between individual muscles. Nevertheless, a zone of lower average neurovascular density was found between the tributaries from the lateral circumflex femoral and the deep femoral arteries. While the area with the lowest density was covered by the iliotibial tract and would therefore not be suitable for biopsies, another low-density area was located in the distal portion of vastus lateralis. This was just anterior to the iliotibial tract, in a zone that has been described as a good needle biopsy site. The reported complication rates of needle biopsies (0.1%-4%) are in the range of expectations when simulated based on this model. It is concluded that the optimal human vastus lateralis biopsy site is in the distal portion of the muscle, between ½ and ¾ of the length from the greater trochanter to the lateral epicondyle, just anterior to the iliotibial band.

Mobile data security: instant messaging in orthopaedics.

BACKGROUND: Instant messaging via WhatsApp is used within hospital teams. Group messaging can lead to efficient and non-hierarchical communication. Despite being end-to-end encrypted, WhatsApp is owned by Facebook, raising concerns regarding data security. The aims of this study were: (1) to record the prevalence of WhatsApp group instant messaging amongst clinical teams; (2) to ascertain clinician attitudes towards use of instant messaging and (3) to gauge clinicians' awareness of best practice regarding mobile data protection. METHODS: Over a two-week period in May 2018, clinical nurse specialists in the Auckland District Health Board Orthopaedic department retrospectively collected data from all five team WhatsApp group message threads recording quantity of messages sent and the nature of the messages. Concurrently individuals in these WhatsApp groups completed an anonymous survey of their use of WhatsApp and their awareness of local data security policies and practice. RESULTS: One thousand three hundred and sixty messages were sent via WhatsApp in a two-week period. 384 (28%) of the messages contained patient identifiable data. Thirty-six photos were shared. Participants rated use of WhatsApp at 9.1/10 - extremely beneficial. Sixty-five percent of clinicians reported they had not read or were unaware of the ADHB policies regarding mobile devices and information privacy and security. CONCLUSION: WhatsApp use is widespread within the Orthopaedic department and is the preferred platform of communication with many perceived benefits. Data security is a risk and implementation of appropriate guidelines to assist clinicians in achieving best practice is crucial to ensure patient data remains protected.