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FIGURE 9.21. (A) Fluoroscopic images from the C-arm showing the progression of traction, release of the suction seal, and introduction of the Nitanol wire, and finally the introduction of the arthroscope. (B) Arthroscopic view of a left hip. The sequence shows the introduction of the 14-gauge intracath, following which the Nitanol wire has been introduced. The arthroscopic cannulated sheath with its trochar is introduced into the joint, and then a slotted cannula is introduced over a switching stick. Finally, introduction of a curved instrument is seen in the last image. (C) The introduction of a 14-gauge intracath and a switching stick that has been previously introduced. (D) Arthroscopic view of a Nitanol wire introduced through an intracath into the notch. (E) Arthroscopic view of the inferior pouch with the Nitanol wire being introduced through the in-tracath. Note the reflection of the iliopsoas and the femoral head seated in the socket with the transverse ligament in the distance.

FIGURE 9.22. (A) Arthro-scopic view of initial sweep of the 30-degree arthroscope. This image begins with the foveal view, noting the at-rophic fat pad. The femoral head is better viewed with the scope backed up. The scope is then rotated posteriorly, showing the labral structures and articular cartilage, and then brought laterally, showing the lateral portion of the labrum at the labral cartilaginous junction. The scope is then rotated anteriorly, showing the labral cartilaginous junction and the anterior labrum. Finally, the scope is swept anteriorly and medially, demonstrating the labral structures and the anterior sulcus. (B) Arthroscopic view anterior central with a 70-degree scope. (C) A 70-degree scope showing the posterior view of the femoral head and labrum. (D) A 70-degree arthroscope showing the anterolateral ac-etabulum and femoral head and anteromedial sulcus. (E) A 30-degree arthroscopic view showing anterior central position with fluid in the joint and the Nitanol wire in the fat pad. (F) Ar-throscopic view of the an-teromedial sulcus with the femoral head seated in the acetabulum, noting the anterior labrum and capsule with a reflection of the il-iopsoas. (G) Arthroscopic view in the anteromedial sulcus looking posteriorly. Note the transverse acetabu-lar ligament, femoral neck, and head junction.

cm). Insert a Nitanol wire through the catheter, and incise the skin with a no. 11 blade. Push the cannu-lated arthrosopic sheath over the wire and into the joint while advancing it concentrically over the wire to prevent kinking and wire breakage.

If it is difficult to advance into the joint, suspect the wire is going through the labrum. In such instances, it is best to start over and reposition to avoid labral avulsions or tears. In some cases with stiff hips, the anterior capsule is very thick and difficult to penetrate. For this situation, it is best to begin with the posterolateral portal or gently cut the capsule with a long Beaver blade through the arthroscopic sheath before advancing into the joint. Entry into the joint should always be controlled and gentle to avoid scuffing of the cartilage.

Introduce a 30-degree arthroscope and visually sweep the joint under air. Next, create the postero-lateral portal with the same technique with the added benefit of viewing the entry of the intracath and Ni-tanol wire and instruments while observing the cartilage and labrum. I believe this approach is much safer and reduces iatrogenic injury. The anterior portal is reserved for those cases requiring it and in many cases is not used.

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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