LCF in 2024 (June) Publications about the LCF 2024.
Ariyaratne, S., Nischal, N., Patel, A., Botchu, R., Davies, A.M. (2024). Tumors and Tumor-like Lesions. (. In: Medical Radiology. Springer, Berlin, Heidelberg. [i] link.springer.com
Alrashdi, N., Motl, R., Aguiar, E., Lein Jr, D., Perumean-Chaney, S., Ryan, M., & Ithurburn, M. (2024). Pre-and Post-Operative Pain Intensity and Physical Activity Levels in Individuals with Acetabular Dysplasia Undergoing Periacetabular Osteotomy: A Prospective Cohort Study. International Journal of Sports Physical Therapy, 19(6), 692. [ii] ijspt.scholasticahq.com
Powell, J., Kent, T., & Hanson, C. (2024). Dysfunction, Evaluation,
Diagnosis, and Treatment of the Hip Complex: Nonsurgical and Surgical. In:
Wallmann, H., & Donatelli, R. (Ed). Foundations of Orthopedic Physical
Therapy. Taylor & Francis, 211-236. [iii] books.google
SEN., E., SEVER, S. N., TURHAN, B., CİRAK, M. T., & GOLPİNAR, M.
(2024). A comprehensive morphometric and morphological analysis of fovea
capitis femoris and femoral head parameters according to gender. Research
Square, (Preprint) [iv] researchsquare.com
Hamilton-Cave, M. A., Al-Dulaimi, R., McDonald, J. S., Ringler, M. D.,
& Tiegs-Heiden, C. A. (2024). Utilization trends for MR arthrography of the
hip and shoulder: a retrospective cross-sectional analysis of 20-year data from
a tertiary care academic medical center. Skeletal Radiology, 03 June 2024,
1-7. [v] link.springer.com
Ziran, N. M., & Matta, J. M. (2024). Primary Total Hip Arthroplasty
Using the Hana Table. In: Bal, B., Rubin, L., & Keggi, K. (Eds). The Direct
Anterior Approach to Hip Reconstruction. CRC Press, Chapter 4. [vi] books.google
Gerscovich, D., Unger, A. S., Smith, E., Keggi, K. J., & Rubin, L.
E. (2024). Specialized Instruments for the Direct Anterior Approach. (pp.
161-173). CRC Press. In: Bal, B., Rubin, L., & Keggi, K. (Eds). The Direct
Anterior Approach to Hip Reconstruction. CRC Press, Chapter 13. [vii] books.google
Zagumennova, I. Y., & Kuzminova, E. S. (2024) Method for correcting
the neck-shaft angle of the femur. Cervical-diaphyseal angle of the hip joint
in children Cervical-diaphyseal angle. Chapter 1. [viii]
kingad.ru
Tripathy, S. K., Sethy, S. S., & Sen, R. K. (2024). Femoral Head Fractures. (pp. 423-441). In Orthopaedics and Trauma: Current Concepts and Best Practices. Cham: Springer International Publishing. [ix] link.springer.com
Morris, W. Z., & Sucato, D. J. (2024). Developmental Dysplasia of the Hip. (pp. 871-880). In Orthopaedics and Trauma: Current Concepts and Best Practices. Cham: Springer International Publishing. [x] link.springer.com
Laboudie, P., & Beaulé, P. E. (2024). Cam-type Femoroacetabular Impingement (FAI). (pp. 1497-1504). In Orthopaedics and Trauma: Current Concepts and Best Practices. Cham: Springer International Publishing. [xi] link.springer.com
Barla, J. D. (2024). Acetabular Fractures. (pp. 411-422). In Orthopaedics and Trauma: Current Concepts and Best Practices . Cham: Springer International Publishing. [xii] link.springer.com
Oñativia, J. I., & García-Mansilla, A. (2024). Hip Biomechanics.
In Orthopaedics and Trauma: Current Concepts and Best Practices. (pp.
1411-1415). Cham: Springer International Publishing. [xiii]
link.springer.com
Yang, D., Ouyang, H., Zhou, Z., & Wang, Z. (2024). Chondroblastoma
of the femoral head: Curettage without dislocation. Research Square,
(Preprint). [xiv] researchsquare.com
Ranawat, A. S., Rebolledo, B. J., & Brady, J. M. (2024). Hip
arthroscopy frontiers and limitations. (pp.
269-280). In: Meyers, W. C. (Ed.). Introducing the core:
demystifying the body of an athlete. New York: Routledge. [xv] taylorfrancis.com
Philippon, M. J., Mook, W. R., & Briggs, K. K. (2024). Complex
core-hip considerations in the athlete: From “lighting the lamp” to “getting
your face washed”. In: Meyers, W. C. (Ed.). (2024). Introducing the
core: demystifying the body of an athlete. New York: Routledge. [xvi] books.google
Meyers, W. C., Philippon, M. J., Zoga, A. C., Poor, A. E., Roedl, J. B.,
McCrossin, J., ... & Gordon, R. (2024). The Other Muscles Hip and Core
Stability. (pp. 147-155). In: Meyers, W. C.
(Ed.). Introducing the core: demystifying the body of an
athlete. New York: Routledge. [xvii] books.google
Pentland, A. H., Poropat, S. F., Duncan, R. J., Kellner, A. W., Bantim,
R. A., Bevitt, J. J., ... & Grice, K. (2024). Haliskia peterseni, a new
anhanguerian pterosaur from the late Early Cretaceous of Australia. Scientific
Reports, 14(1), 11789. [xviii] nature.com
Jekinakatti, K. M., Manjunatha, D. R., Vilas, D., Balappanavar, B. R., Rajashailesha,
N. M., GK, C. K., ... & Ramya, M. N. (2024). Evaluation of Handmade Toggle
Pin Technique for the Repair of Coxofemoral Luxation in Dogs. Indian Journal
of Veterinary Sciences and Biotechnology, 20(4), 115-118. [xix] acspublisher.com
Tang, Z., Li, R., Lu, C., Ma, N., Xie, R., Kang, X., ... & Zhou, Y.
(2024). Risk factors for avascular necrosis of the femoral head after
developmental hip dislocation reduction surgery and construction of Nomogram
prediction model. BMC Musculoskeletal Disorders, 25(1),
464. [xx]
link.springer.com
Yin, C., Wen, H., Chen, Z., & Zhang, B. (2024). Exploring the
clinical value of direct anterior approach THA for short-term hip function
improvement: A single-center retrospective analysis of short-term
outcomes. Medicine, 103(24), e38479. [xxi] journals.lww.com
Coleman, K. A. (2024). Femoral Head and Neck Ostectomy (FHO). (pp.
516-528). In: Coleman, K. A. (Ed). Techniques in Small Animal Soft Tissue,
Orthopedic, and Ophthalmic Surgery, John
Wiley & Sons, Inc. [xxii] onlinelibrary.wiley.com
Chen, C. L., Hixon, L. P., & Viani, E. C. (2024). Arthrocentesis. (pp.
604-618). In: Coleman, K. A. (Ed). Techniques in Small Animal Soft Tissue,
Orthopedic, and Ophthalmic Surgery, John
Wiley & Sons, Inc. [xxiii] onlinelibrary.wiley.com
Yin, X. Y., Liu, Y., Liu, W. G., & Yin, Q. F. (2024). Arthroscopic
Fixation With Absorbable Suture Anchors for Pipkin Type I Femoral Head
Fractures—Letter V Technique. Arthroscopy Techniques, 103090. [xxiv] arthroscopytechniques.org
Hassan, S. A. M., & Basha, W. A. A. (2024). Macro‐anatomical
investigations on the skeleton of the Egyptian hedgehog (Hemiechinus auratus aegyptius). Anatomia,
Histologia, Embryologia, 53(4), e13076. [xxv] onlinelibrary.wiley.com
Sifi, N., & Bouguenna, R. (2024). Relevance of the Watson-Jones
anterolateral approach in the management of Pipkin type II
fracture-dislocation: a case report and literature review. Journal of
Trauma and Injury. 37(2):161-165. [xxvi] jtraumainj.org
Dorobek, T. R., Golden, M. V., Kirchmeier, A. K., Moua, J. G., &
Spiker, A. M. (2024). A Bibliometric Review of the Top 100 Most-Cited Articles
in Hip Preservation Literature. Arthroscopy, Sports Medicine, and
Rehabilitation, 100958. [xxvii] sciencedirect.com
Scaife, T. W. (2024). Pathology and Osteological Observations of
Early Pliocene Rhinoceros, Teleoceras aepysoma (Perissodactyla, Rhinocerotidae)
from Gray Fossil Site, Tennessee. (Doctoral
dissertation, East Tennessee State University). [xxviii] researchgate.net
Turen, C., & Furey, A. J. (2024). I Have a 40-Year-Old With an
Anterior Fracture of the Femoral Head and Incongruity of the Hip Joint. How
Would You Treat This?. (pp.
71-74). Virkus, W. W. (Ed.). Curbside Consultation in Fracture Management:
49 Clinical Questions. Boca
Raton: CRC Press. [xxix]
taylorfrancis.com
Abrams, G. D., Harris, J. D., & Safran, M. R. (2024). Portal
Placement in Hip Arthroscopy: Anatomic Considerations and Access to the
Central, Peripheral, and Peritrochanteric Spaces (pp. 103-112). In: Byrd, J.
W., Bedi, A., & Stubbs, A. (Eds). The Hip: AANA Advanced Arthroscopic Surgical
Techniques. Boca Raton: CRC Press. [xxx] taylorfrancis.com
Nadeem, I. A. S. U., Imran, M., ul Haq, J., uz Zaman, A., Saddiq, S.,
& Aziz, A. (2024). A Comparison of Radiological Outcome of Open Reduction
in Unilateral VS Bilateral DDH. Journal of Pakistan Orthopaedic
Association, 36(02), 05-10. [xxxi] jpoa.org.pk
Vowell M. P.,
Roller C. L. (2024) Function and Movement of the Lower Extremity. In: Sain S.,
Roller C. L. (Eds). Kinesiology for the Occupational Therapy Assistant:
Essential Components of Function and Movement. New York: Routledge. [xxxii] taylorfrancis.com
Lahrach, E. M., Jaafar, A., Al Idrissi, N., & Najib, A. (2024).
Surgical Management and Reconstruction of Dedifferentiated Chondrosarcoma in
the Proximal Femur: -A Case Report. Cureus, 16(6).
[xxxiii] cureus.com
NB! Fair practice / use: copied for the purposes of criticism, review, comment, research and private study in accordance with Copyright Laws of the US: 17 U.S.C. §107; Copyright Law of the EU: Dir. 2001/29/EC, art.5/3a,d; Copyright Law of the RU: ГК РФ ст.1274/1.1-2,7
[i] Most tumors infiltrated the joint through spread along the ligamentum teres.
[ii] Prior to PAO [Periacetabular osteotomy], all participants received hip arthroscopy to address intra-articular pathology, including labral tears, ligamentum teres tears, and cam deformities, as well as to confirm that articular cartilage quality was sufficient to proceed with a PAO.
[iii] It has been postulated that ligamentum
teres functions to distribute synovial fluid within the hip joint via a «windshield
wiper» effect. …
Ligamentum teres appears to have a role in stabilization, supplementing the work of the capsular ligaments in addition to functioning as a sling around the femoral head. This ligament and its associated structures may also serve a proprioceptive role and be a source of intra – articular hip pain.
[iv] INTRODUCTION
Fovea capitis femoris (FCF) is an area on the femoral head, usually located in
the posteroinferior of the femoral head. It provides attachment sites for the
ligamentum teres, which is also known as the ligamentum capitis femoris or
round ligament of the hip [1]. The transverse acetabular ligament, a
non-cartilaginous extension of the labrum at the inferior side of the hip, is
where the ligamentum teres inserts after emerging from the FCF. Although role
of the ligamentum teres in maintaining hip stability is debatable, isolated
damage to the ligament may be the cause of hip pain. It was stated that
generally, 4–15% of sports-related injuries occur in the ligamentum teres. The
ligament's lesions include fractures at the attachment site to the FCF and the
congenital absence of the ligament [2–4]. The ligamentum teres can be located
nearly to the fovea capitis femoris. That's why FCF is clinically important in
the pre-surgical diagnosis of ligamentum teres lesions [2].
Some previous
studies found that patients with hip dislocation could have a tear of the
ligamentum teres, but there could have been isolated cases of intact or
partially torn ligamentum teres on arthroscopy after dislocation. In one way or
another, dislocations typically cause disruptions to the arterial supply of the
head. The femoral head can be perfused by 2–4 arteries, which arise from the
deep branch of the medial femoral circumflex artery. Mostly, the head is
supplied by the lateral circumflex femoral artery. The profunda femoris artery
contributes to the medial femoral circumflex artery, supplying the main blood
supply to the femoral head [5–7]. The obturator artery, a branch of the
anterior division of the internal iliac artery, travels down and forward along
the lateral pelvic wall and passes through the obturator canal to form iliac,
vesical, and pubic branches within the pelvis. It then divides into anterior
and posterior branches that supply the medial compartment of the thigh. The
acetabular branch entering the hip joint originates from the posterior branch
[8]. The foveolar artery, also known as the ligamentum teres artery, is a small
artery that arises from the obturator artery and only perfuses the perifoveal
region. In adults, it usually remains vestigial and makes a negligible contribution
[6]. The ligamentum teres artery attaches itself to the fovea after descending
from the posterior branch of the obturator artery [9].
There are also
other structures, such as nutrient foramina, which are located in the FCF and
the entrance to the arteries that supply the femoral head. Avascular necrosis
is one of the causes of the negative development and formation of the femoral
head in cases that affect the FCF. In addition, an excess of nutrient foramina
reduces the likelihood of developing osteonecrosis [6]. Hip dysplasia and
osteoarthrosis have been related to modifications in the morphometric structure
and location of the FCF in the hip joint [10–12]. As the femoral head is
supplied by vessels that travel through the FCF, the features of the anatomical
structures on the head of the femur are considered potential factors in
avascular necrosis. FCF is regarded as a significant anatomical structure for
arthroscopic procedures, surgical interventions, radiological examination of
the hip joint, and morphometric and morphological properties of the proximal
femur [13, 14].
Several studies evaluating the vascular structures of the ligamentum teres and femoral head were conducted [12–14, 16]. The morphological and morphometric features of the FCF by gender and its relationship with femoral parameters have not been extensively studied in the literature. In this study, it was aimed to analyze gender-dependent morphometric and morphological characteristics of the FCF to determine its precise position, size, morphological types, and relationship with the parameters of the proximal femur by gender. (This work is licensed under a Creative Commons Attribution 4.0 International License.)
[v] For the hip, MRA has been employed in the workup of the labrum, articular cartilage, ligamentum teres, femoroacetabular impingement, …
[vi] If the head does not come out, a 0.75-inch curved osteotome can be used to cut the ligamentum teres. Head dislocation can be difficult.
[vii] Jorgensen-type scissors or a long, curved thoracic Mayo scissors are particularly useful for helping cut the ligamentum teres for femoral head extraction during DAA THA.
[viii] In group 2 of patients, the cervical artery, vessels of the growth
plate, round ligament and capsule of the hip joint were identified in 100% of
cases. In group 3, these vessels were identified only in 74% of children.
Significant changes were determined in children of group 4. When diagnosis is
made in the first 6 months. life, blood flow in the head of the femur was
weakened, cervical arteries were detected in 100% of cases. In patients of the
2nd half of the year, the vessels of the growth plate and round ligament were
not identified; blood flow in the cervical vessels was determined in 26.6% of
cases. Apparently, changes in blood flow may be associated with changes in
individual components of the hip joint and their spatial relationships. On the
other hand, in some cases there may be a vicious development of the vascular
system.
…
The rate of venous
outflow in them decreased significantly. In the area of the round ligament,
growth plate and cervical vessels, hemodynamic parameters decreased. We
interpreted such changes as a decrease in perfusion in the femoral head, which
could lead to ischemic processes in it.
…
In the area of the round ligament, growth plate and cervical vessels in children in the first six months of life, hemodynamic parameters decreased. After 6 months the vessels of the growth zone and round ligament were not identified. The identified changes, in our opinion, indicated an aggravation of the processes of ischemia of the femoral head.
[ix] The hip joint was dislocated anteriorly and the femoral head fragment was detached after excising the ligamentum teres. … The ligamentum teres is excised and the femoral head fragment is detached from the acetabular fossa ...
[x] Developmental Dysplasia of the Hip ... a constricted hour-glass shaped capsule, a thickened cartilaginous limbus consisting of acetabular cartilage and labrum, the iliopsoas tendon, hypertrophied ligamentum teres, a thickened transverse acetabular ligament, and fibrofatty tissue known as pulvinar within the acetabulum.
[xi] Many graft options are available and can be either autograft (iliotibial band, ligamentum teres) or allograft.
[xii] With flexion, external rotation of the limb (and after cutting-off the ligamentum teres), the hip can now dislocate anteriorly.
[xiii] The ligamentum teres, which connects the femoral head to the acetabular fossa, does not contribute to the hip’s inherent stability, and its role in hip biomechanics is still a matter of controversy; however, it acts as a conduit for small vessels …
[xiv] In recent years, Liu et al. have put forward the modified trapdoor procedure. The difference between this surgery and the traditional trapdoor procedure was that ligamentum teres was used to close the window on the cartilage surface. Of the 13 children, one child developed necrosis of the femoral head four months postoperatively, another exhibited heterotopic ossification, while the remaining children had a favorable prognosis during the follow-up period [15]. We believe that the modified trapdoor procedure exhibits a favorable therapeutic outcome; however, it is not suitable for the lesions on the edge of the femoral head surface. Additionally, surgical excision of the ligamentum teres of the femoral head can compromised the blood supply to the femoral head, thereby elevating the risk of femoral head necrosis. Ganz et al. have previously demonstrated that the blood supply to the femoral head primarily originates from the deep branch of the medial femoral circumflex artery (MFCA) [13]. However, numerous authors have reported the existence of ligamental arteries and their significant contribution to the blood supply of the femoral head [16, 17]. The role of the ligamentum teres remains controversial. We tend to preserve the ligamentum teres, which we believe will result in a more favorable prognosis for children. The smooth texture of the ligamentum teres does not match the articular cartilage found on the femoral head surface. Furthermore, the potential for developing secondary osteoarthritis among children who were treated with the modified trapdoor procedure remained uncertain when compared to other surgical options, especially in long-term follow-up studies. Articular cartilage primarily receives its nutritional supply from synovial fluid, and numerous successful instances of osteochondral transplantation have unambiguously established the viability of articular cartilage replantation [18-20]. Therefore, in our treatment, we recommend autologous articular cartilage replantation to ensure the smoothness of the femoral head surface. (This work is licensed under a Creative Commons Attribution 4.0 International License.)
[xv] One should not necessarily underplay the likelihood that the ligamentum teres contributes to stabilization of the native adult hip. … When there is both dysplasia and gross instability, the ligamentum teres is often torn. The ligament is traditionally sacri ficed in open hip surgery. In contrast, arthroscopic reconstruction of the ligamentum teres may well aid with hip stabilization.
[xvi] Instability is another, and it can arise from shaving too much bone, in addition to unrecognized dysplasia, capsular insufficiency, and a ligamentum teres injury.
[xvii] Finally, the ligamentum teres must supply some degree of stability, albeit minor.
[xviii] The femoral head is constricted, as in other pterosaurs [50,54], and medially deflected by 20° relative to the diaphysis, which is relatively straight. The deflection of the femoral head differs from that of Anhanguera piscator [54] but is similar to an isolated specimen from the Winton Formation (AODF 2297) [24]. A proximodistally short, deep groove on the femoral head is regarded here as the fovea capitis of ligamentum teres. Although the femur has been anteroposteriorly flattened, the head is clearly hemispherical, as in Anhanguera spielbergi [50] and Anhanguera piscator [54].
[xix] Intra-operative and post-operative complications were not observed with respect to reluxation, toggle pin breakage and nylon thread breakage. Post-operative radiographic evaluation revealed proper alignment and anatomical configuration of coxofemoral joint, toggle pins were in position, no arthritic changes were observed in the acetabulum and femoral head. All dogs showed excellent weight bearing and limb usage on 30th post-operative day onward. In conclusion clinical results were excellent in dogs and handmade toggle pin technique was found to be easy, simple, economical and practical method for the repair of coxofemoral luxation in dogs.
[xx] All patients underwent OR through a medial approach. During the operation, the joint capsule was incised in a “T” shape, the transverse ligament was transected, and the enlarged round ligament was resected. The hypertrophic adipose tissue in the acetabulum was also removed.
[xxi]
Excess acetabular labrum, transverse acetabular ligament, round ligament, and surrounding synovium are excised with meticulous hemostasis. …
A 10 mm gap is preserved for femoral neck osteotomy, and subsequent removal of the femoral head is conducted, followed by excision of the round ligament with meticulous hemostasis. Full exposure of the acetabulum is achieved, excess acetabular labrum, round ligament, and other tissues are excised, and the acetabulum is reamed to the appropriate size.
[xxii] Following either partial deep gluteal tenotomy or retracting it dorsally, the coxofemoral joint capsule is incised, the round ligament is transected (if still intact), and the femoral head is luxated to allow for improved visualization.
[xxiii] The three primary stabilizers of the hip joint include the ligament of the head of the femur, the joint capsule, and the dorsal acetabular rim. The ligament of the head of the femur extends from the fovea capitis of the femoral head to the acetabular …
[xxiv] A 30° arthroscope is placed
through the anterolateral portal to reach the extracapsular space of the hip,
and then instruments are introduced through the midanterior portal to expose
the iliofemoral ligament and the anterior capsule. Longitudinal outside-in
capsulotomy is performed with the technique we previously proposed.8 A
longitudinal capsular incision is made along the direction of iliofemoral
ligament fiber parallel to the axis of femora neck, and the fluoroscopy would
be helpful in guiding for capsulotomy if necessary. The incision is extended to
the labrum proximally and femoral neck distally. Thereafter, a comprehensive
arthroscopic exploration of the central and peripheral compartment of hip joint
is performed to reveal the concomitant-free osteochondral fragments and
ligamentum teres injury. All free osteochondral fragments are completely
removed and the torn ligamentum teres are debrided with a 4.5-mm curved shaver
(Smith & Nephew, Andover, MA) (Fig 3 A and B).
Fig 3. Arthroscopic views of the right hip from the anterolateral portal with a 30° scope showing the main procedures and intraoperative findings during arthroscopic management of femoral head fracture. (A) Arthroscopic view showing injury labrum (white arrow). (B) Arthroscopic view showing torn ligamentum teres (white arrow). (C) Arthroscopic view showing displacement of fracture (white arrow showing the fracture line). (D) Arthroscopic view showing the displaced fracture fragments are well reduced with a probe (VP: AL, OP: DALA). (E) Arthroscopic view showing 2 medial anchors implanted penetrating the bone fragment (VP: AL, OP: DALA). (F) Arthroscopic view showing the pre-drilling place of lateral anchor (VP: AL, OP: DALA). (G)Arthroscopic view showing the lateral anchor placed on the opposite side (VP: AL, OP: DALA). (H) Arthroscopic view showing suture bridge on the surface of femoral head formed the shape of letter V. (Ac, acetabulum; AL, anterolateral; DALA, distal anterolateral; FF, fracture fragment; FH, femoral head; L, labrum; LT, ligamentum teres; OP, operating portal; VP, viewing portal.) (right). (CC BY-NC-ND 4.0)
[xxv] The femoral head was hemispheric. The fovea capitis was absent.
[xxvi] A 44-year-old woman was involved in a road traffic accident, resulting in an isolated and closed trauma to her left hip. Clinical examination revealed a malposition of the left lower limb, characterized by hip flexion, adduction, and internal rotation, with palpation of the femoral head in the gluteal region (Fig. 1). No signs of sciatic nerve injury were evident, and distal pulses were present. Radiological assessment revealed a posterior iliac dislocation of the hip, associated with a fracture of the femoral head. This fracture detached a fragment, constituting approximately one-third of the sphere and encompassing the fovea of the round ligament. The injury was classified as a Pipkin type II fracture (Fig. 2). Due to the size of the detached fragment and the risk of incarceration preventing reduction, we avoided external orthopedic reduction maneuvers. Such a procedure could have exposed this young patient to the risk of iatrogenic fracture of the femoral neck, complicating treatment and increasing the risk of avascular necrosis (AVN) of the femoral head. Instead, we opted for the Watson-Jones anterolateral approach, positioning the patient in lateral decubitus under general anesthesia. Our approach passed between the retracted tensor fascia lata muscle, positioned medially, and the gluteus medius and minimus muscles, situated laterally. After reducing the dislocation, we dislocated the distal fragment of the femoral head via flexion and external rotation maneuvers of the lower limb to precisely assess the injury. The proximal fragment was confirmed to be viable and exhibited bleeding during the wire test. We repositioned the femoral head in alignment with its proximal fragment, which was left in place and attached to the round ligament. Our reduction was stabilized with two Kirschner wires. Notably, some surgeons opt to cut the round ligament to facilitate interfragmentary reduction.
[xxvii] №86*
Gray, A. J. R., & Villar, R. N. The ligamentum teres of the hip: An
arthroscopic classification of its pathology. Arthroscopy: The Journal of
Arthroscopic & Related Surgery 1997;13(5):575–578
Country England, Total Citations 199, Excluding Self-Citations 195, Last 5 Years 192
[xxviii] Fig. 26 Fossil and Modern
Innominate bones. ETMNH 601 and ETMNH 609 (Teleoceras aepysoma from Gray Fossil
Site, Washington Co., Tennessee).
... 5) a shallow depression
consistent with the insertion point of the ligamentum teres
The right innominate has a cavity
dorsal of the center of the acetabulum (~13.46 mm anteroventralposterodorsal,
~8.31 mm anterodorsal-posteroventral, and ~4.71 mm deep), as well as a series
of three irregularly shaped pits/avulsions around exposed cancellous bone at
the anteroventral corner (the theoretical insertion point of ligamentum teres;
due to curved internal surface of acetabulum measurements (especially depth)
may not be 100% precise; left main pit (~3.64 mm across, ~3 mm deep), left
antipodal pit (~4.82 mm long, ~2.07 mm wide, ~2 mm deep); right pit (~4.58 mm
long, ~2.81 mm wide, ~2 mm deep)).
Of note, the insertion point of the
ligamentum teres tends to be located ventroposteriorly in the acetabulum
(Cerezal et al. 2010). This places the acetabulum pathologies proximate to the
ligamentum teres, suggesting the ligaments involvement with these pathologies.
The rim of the cavity on the left acetabulum of ETMNH 601 is raised, suggesting
an avulsion (Yu and Yu 2015), likely caused by a hip subluxation or some
similar physical stressor to the ligamentum teres (Delcamp et al. 1988; Cerezal
et al. 2010, figure 11, page 1646). Furthermore, the left acetabulum of ETMNH
601 has a shallow extension in the anteroventral/longest direction, suggesting
an earlier, less severe or healed injury. The left innominate of ETMNH 609
appears to have had an avulsion fracture (Cerezal et al. 2010) that healed,
either by refusion of the fractured plug or infilling of new bone (Fig. 26).
The right innominate has multiple small pits (Fig. 26), likely indicating
something similar to a partial avulsion fracture. Both acetabula of ETMNH 609
exhibit a cavity surrounded 131 by rugose bone part way across the surface from
the assumed insertion point of the ligamentum teres. A similar pathology is
seen in humans suffering from ligamentum teres with degenerative fraying
(Cerezal et al. 2010, figure 11c page 1646). Such injuries to the ligamentum
teres in humans has largely been attributed to over extension/exertion of the
joint during strenuous activity, as observed the increase frequency of such
injuries in athletes (Byrd and Jones 2004).
Data on trauma instances in modern graviportal mammals inhabiting steep/mountainous terrain and/or areas of closed forests could provide relevant comparisons for interpretations of the hip and hind limb pathologies in ETMNH 601 and ETMNH 609, especially the presence or absence of traumas relating to the ligamentum teres.
[xxix] The association
between these injuries and a posterior hip dislocation often results in an
anteromedial fracture fragment of the femoral head, which may or may not be
attached to the ligamentum teres. The femoral head may also have an
accompanying impaction injury.
[xxx] Thus, the central compartment is where the ligamentum teres and labral and articular cartilage injuries are identified and treated, whereas the peripheral compartment is where resection of a cam lesion may be performed.
[xxxi] Hip joint capsule was released entirely from medially, superiorly and laterally. T-shaped capsulotomy of the hip joint was done and sutures applied for later capsulorrhaphy. Ligamentum teres was cut and followed up to the true acetabulum. Transverse acetabular ligament was also cut.
[xxxii] Ligamentum teres: Helps to stabilize the head of the femur to the acetabulum and may provide some blood …
[xxxiii] The round ligament is cut flush with the acetabula, and the piece is removed.
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