Minimally invasive surgery in the posterior knee is high-risk for iatrogenic injury to popliteal neurovasculature structures. This study aimed to use reliable landmarks to define safe zones for arthroscopic portal placement into the posterior knee. Methods:Distances were measured between bony landmarks and neurovascular structures within the popliteal fossa using 45 formalin-embalmed cadavers: small saphenous vein (SSV), medial (MCSN) and lateral (LCSN) cutaneous sural nerves, tibial nerve (TN), common fibular nerve (CFN), popliteal vein (PV) and artery (PA). The structures were measured in relation to medial (MEF) and lateral (LEF) femoral epicondyle, medial (MCT) and lateral (LCT) tibial condyle and the midpoint between the landmarks.
Surgical access to the posterior knee poses a high-risk for neurovascular damage. The study aimed to define the popliteal fossa by reliable bony landmarks and comprehensively mapping the neurovascular structures for application in posterior knee surgery. Forty-five (20 male, 25 female) embalmed adult cadaveric knees were included. The position of the small saphenous vein (SSV), medial cutaneous sural nerve (MCSN) and lateral cutaneous sural nerv (LCSN), tibial nerve (TN) and common fibular nerve (CFN) nerves, and popliteal vein (PV) and popliteal artery (PA) were determined in relation to either medial (MFE) or lateral (LFE) femoral epicondyles, medial (MTC) and lateral (LTC) tibial condyles and the midpoint between the MFE and MTC and LFEF and LTC. The distance between the MFE and the PA, PV, TN, MCSN, and SSV was 38.4±12.1 mm, 38.4±12.9 mm, 39.4±10.2 mm, 39.2±14.0 mm and 37.6±12.5 mm respectively for males and 34.6±4.9 mm, 32.8±5.6 mm and 38.0±8.1 mm 38.8±10.1 mm and 37.9±8.2 mm respectively for females. The distance between LFE and the CFN and LCSN was 13.4±8.2 mm and 24.9±7.3 mm respectively for males and 8.4±9.1 mm and 18.4±10.4 mm respectively in females. This study defined the popliteal fossa by reliable bony landmarks and provided a comprehensive map of the neurovascular structures and will help to avoid injuries to the important neurovascular structures.
IntroductionPrevious studies including Welsh National Audit on management of Broncholitis have stimulated interest to assess appropriateness of CXR requests within Welsh paediatric departments. Basic standards of advice exist for bronchiolitis, viral induced wheeze and community acquired pneumonia. The current usage of CXR’s needs to be explored and appropriateness evaluated.AimsTo audit appropriateness of CXR requests in children presenting with bronchiolitis, community acquired pneumonia or viral induced wheeze, against national guidelines.MethodsProspective observational study performed from 13th October to 13th November 2014, across general paediatric departments in Wales. Structured questionnaires completed, with questions based upon: CXR request reasons, clinical diagnosis pre CXR and management plan pre and post CXR.Results9 hospitals participated. A total of 183 cases received, 76 of these were omitted as request reasons were outside the project remit, leaving a total of 107 cases. Table 2 illustrates the reasons for CXR requests. 16% of chest radiographs performed were indicated as per national guidance. Chest radiographs did not alter clinical management in 98% nor alter clinical diagnosis in 100%.ConclusionsA unique study involving CXR requests in doctors practising across Wales. This study highlights the overuse of chest radiographs as when used inappropriately do not alter clinical diagnosis or management. This has cost and radiation implications for the paediatric population. We recommend a quality improvement project aiming to decrease numbers of unnecessary CXR’s requested in general paediatric departments across Wales.Abstract G320 Table 1CXR request reasonsReason stated for CXRNumberLRTI70Focal signs42“baseline” CXR3Oxygen requirement7Respiratory distress8Pyrexia6Differentiate viral from bacterial aetiology6? Empyema due to clinical findings1Recurrent chest infections5 Broncholitis14Apnoea2Pyrexia3Crackles6Respiratory distress2Oxygen requirement1 Other15 Septic screen8Rule out bacterial cause7
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