Rudin, J Bone Joint Surg Am 2016 - The Anatomical Course of the Lateral Femoral Cutaneous Nerve with Special Attention to the Anterior Approach to the Hip Joint

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The Anatomical Course of the Lateral Femoral Cutaneous Nerve with Special Attention to the Anterior Approach to the Hip Joint

Rudin, Grob, et al.·J Bone Joint Surg Am·2016·129 citations·Anatomic study

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Background

Injury to the lateral femoral cutaneous nerve (LFCN) is a risk during the operative anterior approach to the hip joint. Although several anatomical studies have described the proximal course of the nerve in relation to the anterior superior iliac spine (ASIS) and the inguinal ligament, the distal course of the LFCN in the proximal aspect of the thigh has not been sufficiently studied. The aim of this cadaveric study was to examine the branching pattern of the nerve, with special consideration to the anterior approach to the hip joint.

Methods

28 cadaveric hemipelves from 18 donors (10 paired and 8 unpaired specimens) were dissected.
The LFCN branches were localized proximal to the inguinal ligament and traced distally into the area of the proximal aspect of the thigh.
Distribution patterns of the nerve with respect to its relationship to the ASIS and the internervous plane of the anterior approach to the hip joint were recorded.

Results

We found 3 different branching patterns of the LFCN: sartorius-type (in 36% of the specimens), characterized by a dominant anterior nerve branch coursing along the lateral border of the sartorius muscle with no, or only a thin, posterior branch; posterior-type (in 32%), characterized by a strong posterior nerve branch; and fan-type (in 32%), characterized by multiple spreading nerve branches of equal thickness.
In 50% of the specimens, the LFCN divided into ≥2 branches superior to the inguinal ligament.
62 percent of the LFCN branches entered the proximal aspect of the thigh medial to the ASIS; 27%, above; and 11%, lateral to the ASIS.
The LFCN consistently coursed within the deep layer of the subcutaneous fat tissue.

Conclusions

Injury to branches of the LFCN cannot be avoided in approximately one-third of surgical dissections that use the anterior approach to the hip joint. To protect the anterior branch of the LFCN, the skin incision should be as lateral as possible. The posterior branch of the LFCN is most vulnerable in the proximal aspect of the anterior approach to the hip joint, where it can be expected to course within the deep layer of the subcutaneous tissue.

Copyright remains with the authors and publisher.

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Gustilo, Williams, et al.J Trauma19842,361 citationsRetrospective cohort

Neer Award 2005: The Grammont Reverse Shoulder Prosthesis: Results in Cuff Tear Arthritis, Fracture Sequelae, and Revision Arthroplasty.

Boileau, Hovorka, et al.J Shoulder Elbow Surg20061,115 citationsProspective cohort

A System for the Surgical Staging of Musculoskeletal Sarcoma.

Enneking, Goodman, et al.Clin Orthop Relat Res19802,112 citationsRetrospective cohort

Fracture Fixation in the Operative Management of Hip Fractures (FAITH): An International, Multicentre, Randomised Controlled Trial.

Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) InvestigatorsLancet2017310 citationsRCT

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Goutallier, Voisin, et al.Clin Orthop Relat Res19942,669 citationsProspective cohort

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Lewinnek, Zimmerman, et al.J Bone Joint Surg Am19782,549 citationsRetrospective cohort

Morphologic Study of the Glenoid in Primary Glenohumeral Osteoarthritis.

Walch, Khoury, et al.J Arthroplasty19991,142 citationsRetrospective cohort

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DenisSpine (Phila Pa 1976)19832,566 citationsRetrospective cohort

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A New Classification of Thoracolumbar Injuries: The Importance of Injury Morphology, the Integrity of the Posterior Ligamentous Complex, and Neurologic Status.

Vaccaro, Oner, et al.Spine (Phila Pa 1976)2005866 citationsConsensus statement

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FLOW Investigators, Guyatt, et al.N Engl J Med2015347 citationsRCT

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Weinstein, PonsetiJ Bone Joint Surg Am1983641 citationsRetrospective cohort

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Burkhart, De BeerArthroscopy20001,884 citationsCase series

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Baumgaertner, Keggi, et al.J Bone Joint Surg Am19951,441 citationsRetrospective cohort

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O'Driscoll, Morrey, et al.J Bone Joint Surg Am1991997 citationsCase series

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O'Sullivan, Zee, et al.Lancet20021,587 citationsRCT

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Arnoczky, WarrenAm J Sports Med19821,227 citationsAnatomic study

Metastatic Disease in Long Bones. A Proposed Scoring System for Diagnosing Impending Pathologic Fractures.

MirelsClin Orthop Relat Res19891,222 citationsRetrospective cohort

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Fehlings, Rampersaud, et al.PLoS One20121,200 citationsProspective cohort

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Gerber, Vinh, et al.J Bone Joint Surg Am1990441 citationsAnatomic study

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Snyder, Friedman, et al.Arthroscopy19901,264 citationsCase series

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NeerJ Bone Joint Surg Am19701,283 citationsRetrospective cohort

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NeerJ Bone Joint Surg Am1972536 citationsCase series

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Griffin, FASHIoN Study Group, et al.Lancet2018542 citationsRCT

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Dejour, Guier, et al.Knee Surg Sports Traumatol Arthrosc19941,987 citationsCase-control study

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Judet, Letournel, et al.J Bone Joint Surg Am1964980 citationsCase series

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Neer, FosterJ Bone Joint Surg Am1980934 citationsCase series

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Glassman, Schwab, et al.Spine (Phila Pa 1976)20051,878 citationsRetrospective cohort

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Harms, MelcherSpine (Phila Pa 1976)20011,528 citationsCase series

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SwansonJ Hand Surg Am1976429 citationsReview article

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PipkinJ Bone Joint Surg Am1957445 citationsCase series

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Anderson, Park, et al.J Bone Joint Surg Am1975416 citationsCase series

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Herring, Browne, et al.J Bone Joint Surg Am2004143 citationsProspective cohort

The Role of the Scapula in Athletic Shoulder Function.

KiblerAm J Sports Med19981,240 citationsReview article

The SLAC Wrist: Scapholunate Advanced Collapse Pattern of Degenerative Arthritis.

Watson, BalletJ Hand Surg Am19841,138 citationsRetrospective cohort

Classification and an Algorithmic Approach to the Reconstruction of Femoral Deficiency in Revision Total Hip Arthroplasty.

Valle, PaproskyJ Bone Joint Surg Am2003199 citationsRetrospective cohort

The Tibial Plateau Fracture. The Toronto Experience 1968--1975.

Schatzker, Bruce, et al.Clin Orthop Relat Res19791,029 citationsRetrospective cohort

Surgical Dislocation of the Adult Hip a Technique with Full Access to the Femoral Head and Acetabulum without the Risk of Avascular Necrosis.

Ganz, Berlemann, et al.J Bone Joint Surg Br20011,367 citationsCase series

Predictors of Humeral Head Ischemia after Intracapsular Fracture of the Proximal Humerus.

Hertel, Leunig, et al.J Shoulder Elbow Surg2004837 citationsProspective cohort

Early versus Delayed Stabilization of Femoral Fractures. A Prospective Randomized Study.

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Fisher, Fourney, et al.Spine (Phila Pa 1976)20101,224 citationsConsensus statement

Surgical vs. Nonsurgical Treatment of Adults with Displaced Fractures of the Proximal Humerus: The PROFHER Randomized Clinical Trial.

Rangan, PROFHER Trial Collaborators, et al.JAMA2015540 citationsRCT

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WeberSpine (Phila Pa 1976)19831,149 citationsRCT

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The Anatomical Course of the Lateral Femoral Cutaneous Nerve with Special Attention to the Anterior Approach to the Hip Joint

Rudin, Grob, et al.·J Bone Joint Surg Am·2016·129 citations·Anatomic study

Free Full Text·DOI·PubMed

|

Background

Injury to the lateral femoral cutaneous nerve (LFCN) is a risk during the operative anterior approach to the hip joint. Although several anatomical studies have described the proximal course of the nerve in relation to the anterior superior iliac spine (ASIS) and the inguinal ligament, the distal course of the LFCN in the proximal aspect of the thigh has not been sufficiently studied. The aim of this cadaveric study was to examine the branching pattern of the nerve, with special consideration to the anterior approach to the hip joint.

Methods

28 cadaveric hemipelves from 18 donors (10 paired and 8 unpaired specimens) were dissected.
The LFCN branches were localized proximal to the inguinal ligament and traced distally into the area of the proximal aspect of the thigh.
Distribution patterns of the nerve with respect to its relationship to the ASIS and the internervous plane of the anterior approach to the hip joint were recorded.

Results

We found 3 different branching patterns of the LFCN: sartorius-type (in 36% of the specimens), characterized by a dominant anterior nerve branch coursing along the lateral border of the sartorius muscle with no, or only a thin, posterior branch; posterior-type (in 32%), characterized by a strong posterior nerve branch; and fan-type (in 32%), characterized by multiple spreading nerve branches of equal thickness.
In 50% of the specimens, the LFCN divided into ≥2 branches superior to the inguinal ligament.
62 percent of the LFCN branches entered the proximal aspect of the thigh medial to the ASIS; 27%, above; and 11%, lateral to the ASIS.
The LFCN consistently coursed within the deep layer of the subcutaneous fat tissue.

Conclusions

Injury to branches of the LFCN cannot be avoided in approximately one-third of surgical dissections that use the anterior approach to the hip joint. To protect the anterior branch of the LFCN, the skin incision should be as lateral as possible. The posterior branch of the LFCN is most vulnerable in the proximal aspect of the anterior approach to the hip joint, where it can be expected to course within the deep layer of the subcutaneous tissue.

Copyright remains with the authors and publisher.

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