PMC7378598_01
(a) X-ray image of patient's injury; (b) open reduction and internal fixation RIF of intertrochanteric left femur fracture with dynamic hip screw.
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fig1
Imaging revealed a transcervical fracture of the left proximal femur with lateral displacement of the distal femoral segment (Figure 1(a)). The final location of implants was confirmed on anterior-posterior and lateral X-ray imaging before irrigation and closure (Figure 1(b)).
(a) Visualization of the psoas muscle, femoral artery, and anterior inferior iliac spine (AIIS), iliopubic eminence (IPE), and the superior pubic (SP) ramus on sonoanatomy with identification. (b) Sonoanatomy.
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fig2
The probe was then rotated counterclockwise, aligned with the pubic ramus to visualize the AIIS, iliopubic eminence (IPE), femoral artery, psoas muscle, and the superior pubic ramus (Figure 2).
Echogenic needle isolation following contact with the iliopubic eminence. FA: femoral artery; FN: femoral nerve. Arrow represents the needle placement.
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Under direct visualization, a 22-gauge (G), 80 mm echogenic needle was advanced in-plane, lateral to medial between the psoas tendon and pubic ramus until the needle made contact with the IPE (Figure 3).
(a) PENG catheterization and corresponding sonoanatomy with isolation of the proximal portion of the peripheral nerve catheter positioned above the iliopubic eminence. Arrow presents the catheter; (b) PENG catheter placement.
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fig4
Similarly, a 22 G, 80 mm echogenic needle was advanced in-plane (Figure 4).