Surgical anatomy of the lateral circumflex femoral artery branches: Contribution to the blood loss control during hip arthroplasty.

BACKGROUND: The lateral circumflex femoral artery (LCFA) branches encountered during anterior and lateral hip approaches; although vessels' haemostasis is suggested in surgical textbooks, literature is scarce regarding their topography. The current study defines the exact location of the LCFA and its branches, based on osseous landmarks, as well as their size and possible variants, providing helpful information for intraoperative identification and demonstrating the magnitude of potential haemorrhage during hip surgery. METHODS: Twenty-three human cadavers (46 lower limbs) were dissected. The LCFA branching pattern was recorded. The distances of the LCFA origin and its first branch from the anterior superior iliac spine (ASIS) were measured. Length and width of the LFCA, LCFA ascending and transverse branches (LCFAab and LCFAtb) were calculated and compared to the ipsilateral ulnar artery (UA) width, which was served as a comparative guide. RESULTS: The LFCA origin was located 106.9 ± 17.5 mm distal and 65.6 ± 14.7 mm medial to the ASIS, while the LFCA first branch origin was 115.1 ± 24.3 mm distal and 48.2 ± 14.3 mm medial to the ASIS. The mean lengths of the LCFA, LCFAab and LCFAtb were 23.2 ± 12.6 mm, 44.8 ± 14.9 mm and 42.3 ± 13.6 mm, respectively. Their mean widths were 4.3 ± 1.0 mm, 2.9 ± 0.9 mm and 2.7 ± 0.7 mm, respectively, while the mean UA width was 2.7 ± 0.4 mm. CONCLUSION: The surgeon may detect the LCFA and its branching, at a mean distance of 110 mm (range 100-126 mm), distal to the ASIS. The LCFAab and LCFAtb widths are similar to the UA width. Meticulous knowledge of the branching pattern topography and vessels' size may contribute to a successful management of the intraoperative blood loss.

Technical Considerations of Complex Primary Total Hip Arthroplasty in a Rare Case of Combined Achondroplasia and Hereditary Multiple Exostosis Syndromes.

INTRODUCTION: Combined achondroplasia and hereditary multiple exostosis (HME) syndrome is a rare autosomal dominant inherited skeletal dysplasia. We report, for the 1sttime, a complex primary hip arthroplasty in a patient with combined achondroplasia and HME syndrome. We emphasize to the femoral and acetabular surgical concerns and difficulties of the surgical exposure and soft tissue balancing for this complex procedure. CASE REPORT: An ambulatory 66-year-old female Caucasian with achondroplasia and HME presented with the left hip pain, progressive walk disability and limited range of hip motion due to severe hip osteoarthritis. Full cemented primary total hip arthroplasty (THA) with an impaction grafting technique was performed; posterior lip augmentation device was implanted to improve stability. At 5 years follow-up, the patient remains ambulatory and pain-free with improved range of hip motion. No signs of aseptic loosening are present. CONCLUSIONS: Cemented THA could be an efficient option to reconstruct the complex hip anatomy in patients with skeletal dysplasia.

Two large processes at the acromial end of a clavicle: a case report.

BACKGROUND/AIM: The present study describes two unusual and large bony processes which were found at the acromial end of a dried human clavicle, due to their rarity and impressive appearance. DESCRIPTION OF THE CASE: At the anterior border of right dried clavicle we noticed a quadrilateral process having an articular surface at its free end, which probably articulated with the humeral head. At the posterior part of the clavicle inferior surface there was a large conoid process, which replaced the conoid tubercle. The conoid process did not appear any articular surface at its free end to be considered as a coracoclavicular joint. CONCLUSION: Although the conoid process of the clavicle may be congenital and usually articulates with the coracoid process of the scapula, in our case the conoid process was acquired and presented a rough and slightly sharp tip, without any joint surface. It was very interesting that the quadrilateral process found at the anterior border of the same clavicle was probably forming an accessory joint between the clavicle and the humeral head.