Femoral injury

Decreased intimal hyperplasia in femoral artery injury model seen with CCL2 deficiency. 

CCR2 deficiency results in decreased atherosclerosis in vessels of susceptible mice. 2. Decreased intimal hyperplasia in femoral artery injury model of atherosclerosis seen with CCR2 deficiency. CCR2 expression is increased in the monocytes of hypercholesterolemic patients. 

This model mimics a deep arterial injury since the adventitial surface is a non-endothelial tissue containing tissue factor and collagen. The rabbit model described here uses a carotid graft inserted into the femoral graft to avoid vasoconstriction often occurring in the inverted femoral segments. 

Since the work of Sibley and Fleisher (S22) made it plain that elevation of serum aldolase activity occurred quite characteristically in other diseases besides myopathy, such as in hemolytic anemia and in acute hepatitis, it would be most useful to know that in muscular dystrophy the increased serum aldolase was indeed derived from the diseased muscle. Direct demonstration of this origin has been provided (D14) by showing that in 5 of 10 patients with muscular dystrophy the femoral venous return had a higher serum aldolase activity than the femoral arterial supply to the diseased muscles of the lower limb. Further strong support is given by the discovery that serum contains two aldolases (S8) with different substrate requirements (H5) whereby colorimetric methods have been devised for the separate assay of each (S5). These are 1,6-diphosphofructoaldolase ( muscle aldolase) and 1-phosphofruc-toaldolase ( liver aldolase). The ratio in mammalian tissues of muscle to liver aldolase activity is 40 in skeletal and cardiac muscle, 12-25 in spleen, lung, and red cells, and only unity in liver and kidney (S6, S7). The serum activities of both are equally elevated in hepatitis, but in muscular dystrophy and in muscle crush injury only that of muscle aldolase is raised (S4, S6) indeed, the ratio of serum activity of muscle to liver aldolase has been reported as about unity in healthy individuals and in patients with virus hepatitis, but as about 26 in a series of 14... 

A 6-year-old boy sustained pelvic injuries and a femoral fracture. The first anesthetic he received consisted of thiopental, suxamethonium, isoflurane, and nitrous oxide. He also received two units of blood. He subsequently underwent four halothane anesthetics over 6 weeks for dilatation of a urethral stricture. Two days after the last anesthetic he was noted to be jaundiced. He had a negative viral screen but was positive for antitrifluoroacetyl IgG antibodies. He developed fulminant hepatic failure with grade 2 hepatic encephalopathy and underwent an auxiliary Uver transplantation 24 days after his last exposure to halothane. He died of septicemia 18 days later. Both at autopsy and on a previous hepatobiliary scan he was noted to have had extensive native Uver regeneration. 

Two case reports have highlighted the potential danger of injecting pethidine into the lateral thigh region, which can cause injury to the femoral nerve branch to the vastus lateralis, causing muscle atrophy (12). 

Eleven patients referred for neurological evaluation after cisplatin infusion into the internal or external iliac arteries for pelvic or lower limb tumors aU developed symptoms within 48 hours of nerve or plexus dysfunction within the territory supplied by the cannulated artery (108). The lumbosacral plexus was affected in nine patients, the femoral nerve in one, and the peroneal nerve in one. The doses of cisplatin ranged from 50 to 160 mg/m and they did not correlate with the severity or course of the neuropathy. Small-vessel injury and infarction or a direct toxic effect are likely explanations. 

As described before, chemokine inhibition may be a useful approach for the prevention of restenosis after coronary surgery or atherosclerosis. This concept has been further substantiated in vivo through the use of the broad spectrum vCKBP M3. Thus, systemic M3 expression from a transgene, or delivery of recombinant M3 protein, have been shown to reduce intimal hyperplasia after femoral artery injury [40] and aortic allograft transplantation [25], respectively. 

Plain radiographs provide many indications suggestive of acute ACL rupture avulsion fracture of the lateral tibial plateau, or Segond fracture, which is in fact an injury to the lateral joint capsule, avulsion of the Gerdy s tubercle and a lateral notch lesion, which is a compression fracture of the lateral femoral condyle of more than 2 mm seen on lateral radiograph. A tibial rim lesion on the posterolateral lip of the lateral tibial plateau can also be found alone or associated with the lateral notch lesion and is termed a kissing contusion. Joint effusions can also be detected on simple radiographs (Fig. 20.6). 

Fig. 10.6 The proposed noncontact ACL injury mechanism, (a) An unloaded knee, (b) When valgus loading is applied, the MCL becomes taut and lateral compression occurs, (c) This compressive load causes a lateral femoral posterior displacement, probably due to the posterior slope of lateral tibial plateau, and the tibia translates anteriorly and rotates internally, resulting in ACL rupture, (d) After the ACL is tom, the primary restraint to anterior translation of the tibia is gone. This causes the medial femoral condyle to also be displaced posteriorly, resulting in external rotation of the tibia...

Al-Saeed O, Brown M, Athyal R, Sheikh M (2013) Association of femoral intercondylar notch morphology, width index and the risk of anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 21(3) 678-682... 

Our surgical technique to ACL deficiency is what is called anatomic ACL reconstruction for most of the cases. The exception is the patients with wide open epiphysis and multiple-ligament reconstruction cases. For the patients with wide open epiphysis, we try to avoid the epiphyseal plate injury by approaching from outside-in technique for the femoral side that makes double-bundle reconstruction difficult (Fig. 24.1). For the cases with multiple-ligament reconstruction, we try to... 

Anterior cmciate ligament reconstruction (ACLR) is one of the most common sports injuries in active young people, requiring surgical reconstruction to allow patients to return to an active lifestyle and prevent secondary meniscus or cartilage injuries. However, inaccurate placement of either the femoral or the tibial tunnel... 

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