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Psoas over the brim lengthenings. Anatomic investigation and surgical technique
D L Skaggs1, C K Kaminsky, E Eskander-Rickards
1University of Southern California School of Medicine, Childrens Hospital of Los Angeles 90027, USA.
Insights
Psoas tendon lengthening in children is common for hip conditions. Neurovascular structures are closely located, sometimes only 4 mm away, requiring surgical awareness to prevent injury.
Area of Science:
- Pediatric Orthopedics
- Surgical Anatomy
Background:
- Psoas tendon lengthening is a frequent procedure for hip conditions like developmental dysplasia and neuromuscular contractures.
- Anecdotal reports suggest potential risks of injury to nearby neurovascular structures during this surgery.
Purpose of the Study:
- To investigate the precise anatomical relationship between the psoas tendon and critical neurovascular structures in children.
- To inform surgical techniques for psoas tendon lengthening and minimize complication risks.
Main Methods:
- Magnetic resonance imaging (MRI) analysis of 54 children under 10 years old.
- Detailed examination of the proximity of the femoral artery/vein, external iliac artery/vein, and femoral nerve to the psoas tendon.
Main Results:
- The mean distance between neurovascular structures and the psoas tendon in the "over the brim" position was 1 cm.
- In some cases, this distance was as close as 4 mm.
- At the tendon's insertion at the lesser trochanter, the mean distance was 3.1 cm.
Conclusions:
- Surgeons must be cognizant of the potential for major neurovascular structures to be as close as 4 mm to the psoas tendon during lengthening procedures.
- Awareness of this close proximity is crucial for safe surgical execution and prevention of iatrogenic injuries.
Abstract:
Lengthening of the psoas tendon commonly is performed for various conditions of the hip including developmental dysplasia and neuromuscular contractures and instability. Anecdotal reports of injury to surrounding neurovascular structures suggest an investigation of the local anatomy is warranted. Using magnetic resonance images from 54 children younger than 10 years, the authors examined the anatomic relationship between major neurovascular structures (femoral artery and vein, external iliac artery and vein, femoral nerve) and the psoas tendon. The mean distance between the neurovascular structures and the psoas tendon in the over the brim position is 1 cm, although it may be as close as 4 mm in a child. The mean distance is 3.1 cm at the tendon's insertion at the lesser trochanter. Surgeons performing psoas over the brim lengthenings should be aware that major neurovascular structures may be only 4 mm from the psoas tendon. The recommended surgical technique is presented.