Quantifying the Relationship Between the Transverse Acetabular Ligament and the Radiographic Teardrop

BACKGROUND: The transverse acetabular ligament (TAL) has been described as an anatomic landmark to guide in the positioning of the acetabular component during total hip arthroplasty. On plain films, the radiographic teardrop (RT) has similarly been used as a measure of appropriate cup positioning. The goal of this study is to quantify the distance and location between the anatomic TAL and RT landmarks to aid in the positioning of acetabular component. METHODS: Sixteen randomly selected cadaveric pelvises (eight males, eight females) underwent dissection. Radiographic markers were placed bilaterally at the anteromedial insertions of the TAL, and true anteroposterior pelvic radiographs of the cadavers were obtained. Distances between the markers and the lateral borders of the RT were measured. RESULTS: The mean distance between the anteromedial insertion of the TAL and the lateral border of the RT in the male specimens was 11.8 (99% confidence interval, 11.4-12.2) mm. In the female specimens, the TAL to RT distance was shorter, with a mean of 8.4 (99% CI, 7.2-9.6) mm. There was a statistically significant difference between male and female cadavers (P \u3c .01). CONCLUSION: The distance between the RT and TAL differs between males and females. Understanding the distance between these anatomic and radiographic landmarks should aid surgeons in obtaining a more accurate degree of acetabular component medialization and can serve as a guide to minimize overmedialization in order to achieve more accurate and reproducible placement of acetabular components during a total hip arthroplasty

Rapid sequence induction

BACKGROUND Rapid sequence induction (RSI) is a standard procedure, which should be implemented in all patients with a risk of aspiration/regurgitation during anaesthesia induction. OBJECTIVE The primary aim was to evaluate clinical practice in RSI, both in adult and paediatric populations. DESIGN Online survey. SETTINGS A total of 56 countries. PARTICIPANTS Members of the European Society of Anaesthesiology. MAIN OUTCOME MEASURES The aim was to identify and describe the actual clinical practice of RSI related to general anaesthesia. RESULTS From the 1921 respondents, 76.5% (n=1469) were qualified anaesthesiologists. When anaesthetising adults, the majority (61.7%, n=1081) of the respondents preoxygenated patients with 100% O-2 for 3 min and 65.9% (n=1155) administered opioids during RSI. The Sellick manoeuvre was used by 38.5% (n=675) and was not used by 37.4%(n=656) of respondents. First-linemedications for a haemodynamically stable adult patient were propofol (90.6%, n=1571) and suxamethonium (56.0%, n=932). Manual ventilation (inspiratory pressure<12cmH(2)O) was used in 35.5% (n=622) of respondents. In the majority of paediatric patients, 3 min of preoxygenation (56.6%, n=817) and opioids (54.9%, n=797) were administered. The Sellick manoeuvre and manual ventilation (inspiratory pressure <12cmH(2)O) in children were used by 23.5% (n=340) and 35.9% (n=517) of respondents, respectively. First-line induction drugs for a haemodynamically stable child were propofol (82.8%, n=1153) and rocuronium (54.7%, n=741). CONCLUSION We found significant heterogeneity in the daily clinical practice of RSI. For patient safety, our findings emphasise the need for international RSI guidelines