To describe the normal anatomy of the finger flexor tendon pulley system, with anatomic correlation, and to define criteria to diagnose pulley abnormalities with different imaging modalities.
Three ...groups of cadaveric fingers underwent computed tomography (CT), magnetic resonance (MR) imaging, and ultrasonography (US). The normal anatomy of the pulley system was studied at extension and flexion without and with MR tenography. Pulley lengths were measured, and anatomic correlation was performed. Pulley lesions were created and studied at flexion, extension, and forced flexion. Two radiologists reviewed the studies in blinded fashion.
MR imaging demonstrated A2 (proximal phalanx) and A4 (middle phalanx) pulleys in 12 (100%) of 12 cases, without and with tenography. MR tenography showed the A3 (proximal interphalangeal) and A5 (distal interphalangeal) pulleys in 10 (83%) and nine (75%) cases, respectively. US showed the A2 pulley in all cases and the A4 pulley in eight (67%). CT did not allow direct pulley visualization. No significant differences in pulley lengths were measured at MR, US, or pathologic examination (P: =.512). Direct lesion diagnosis was possible with MR imaging and US in 79%-100% of cases, depending on lesion type. Indirect diagnosis was successful with all methods with forced flexion.
MR imaging and US provide means of direct finger pulley system evaluation.
Osseous anatomy of the scapula VON SCHROEDER, Herbert P; KUIPER, Scott D; BOTTE, Michael J
Clinical orthopaedics and related research,
02/2001, Letnik:
383, Številka:
383
Conference Proceeding, Journal Article
Recenzirano
Detailed anatomy and morphometry of the scapula were obtained to provide information for surgical procedures such as hardware fixation, drill hole placement, arthroscopic portal placement, and ...prosthetic positioning. Twenty-six measurements were made in 15 pairs of scapulas from cadavers. The average length of the scapulas from the superior to the inferior angle was 155 +/- 16 mm (mean +/- standard deviation). The thickness of the medial border 1 cm from the edge was 4 +/- 1 mm. The superior border was sharp and thin, and the suprascapular notch was present as a foramen in two scapulas. The distance from the base of the suprascapular notch to the superior rim of the glenoid was 32 +/- 3 mm. The length of the spine from the medial edge of the scapula to the lateral edge of the acromion was 134 +/- 12 mm. The anteroposterior width of the spine at 1 and 4 cm from the medial edge was 7 +/- 1 and 18 +/- 3 mm, respectively; the width at the lateral edge (spinoglenoid notch) was 46 +/- 6 mm. The acromion measured 48 +/- 5 mm x 22 +/- 4 mm and was 9 +/- 1 mm thick. The acromial shape was flat in 23%, curved in 63%, and hooked in 14% of scapulas. The distance from the glenoid to the acromion was 16 +/- 2 mm. The glenoid dimensions were 29 +/- 3 mm (anteroposterior) x 36 +/- 4 mm (superoinferior) and faced posterior by 8 +/- 4 degrees. Anteroposterior thickness of the head of the scapula 1 cm from the surface was 22 +/- 4 mm. The thickness of the coracoid was 11 +/- 1 mm. The average length of the coracoacromial ligament was 27 +/- 5 mm. Scapulas from male cadavers were significantly larger than scapulas from female cadavers in 19 measurements.
BackgroundThe purpose of our study was to quantify the dimensions of a surgically safe zone along the proximal part of the radius, from the posterolateral aspect.MethodsThe posterolateral approach ...between the anconeus and the extensor carpi ulnaris was performed in thirty-two cadaveric specimens, and the posterior interosseous nerve was exposed. Forearms were measured from the radial styloid process to the radiocapitellar joint. The distance from the capitellum to the point where the posterior interosseous nerve crossed the radial shaft and the angle between the nerve and the shaft were measured with forearms in pronation and supination.ResultsPronation of the forearm allowed safe exposure of at least the proximal thirty-eight millimeters of the lateral aspect of the radius, with an average proximal safe zone of 52.0 ± 7.8 millimeters. Supination decreased this proximal safe zone to as little as twenty-two millimeters and an average of 33.4 ± 5.7 millimeters. The angle formed by the posterior interosseous nerve and the radial shaft in supination averaged 47.4 6.8 degrees; this decreased to 27.8 ± 6.7 degrees with pronation.ConclusionsApproaching the lateral aspect of the proximal part of the radius is safest in pronation.
To evaluate the ultrasonographic (US) findings in patients with a referring diagnosis of tennis leg and to explore the relative importance of the plantaris tendon and gastrocnemius muscle in the ...pathogenesis of this condition.
A cadaveric study was performed to outline the normal anatomy of the posterosuperficial compartment of the calf. Magnetic resonance (MR) imaging and US were performed, followed by gross anatomic correlation. US findings in 141 patients referred with a clinical diagnosis of tennis leg were retrospectively reviewed by means of consensus of two radiologists. Images were analyzed with respect to the integrity of the lower-leg musculotendinous units, presence of fluid collection, and deep venous thrombosis.
MR imaging and US enabled distinction of the musculotendinous unit of the plantaris from the remaining muscles of the lower extremity in cadaveric specimens. US findings in the 141 patients included rupture of the medial head of the gastrocnemius muscle in 94 patients (66.7%), fluid collection between the aponeuroses of the medial gastrocnemius and soleus muscles without muscle rupture in 30 patients (21.3%), rupture of the plantaris tendon in two patients (1.4%), and partial rupture of the soleus muscle in one patient (0.7%). Deep venous thrombosis was seen in isolation in 14 patients (9.9%).
In patients with clinical findings of tennis leg who undergo US, abnormalities of the medial gastrocnemius muscle appear to be more common than those of the plantaris tendon.
The vascular patterns of the palmar arches and their interconnecting branches present a complex and challenging area of study. Improvements in microsurgical techniques have made a better ...understanding of vascular patterns and vessel diameters more important. Forty-five fresh limbs from cadavers were amputated at the level of the midhumerus. Ward's red latex or Batson's compound was injected under pressure to visualize the arterial system in the hand. After hardening of the injected material, the skin, subcutaneous tissues, and tendons were removed. The specimens were digested in concentrated potassium or sodium hydroxide leaving the bony elements and a cast of the arterial system. The superficial palmar arch is most easily classified into two categories: complete or incomplete. An arch is considered to be complete if an anastomosis is found between the vessels constituting it. An incomplete arch has an absence of a communication or anastomosis between the vessels constituting the arch. Complete superficial palmar arches were seen in 84.4% of specimens. In the most common type, the superficial arch was formed by anastomosis between the superficial volar branch of the radial artery and the ulnar artery. This was seen in 35.5% of specimens. In 31.1%, the arch was formed entirely of the ulnar artery. Incomplete superficial arches were seen in 15.5% of specimens. In 11.1%, the ulnar artery forms the superficial arch but does not contribute to the blood supply to the thumb and index finger. The deep palmar arch was found to be less variable with 44.4% formed by an anastomosis between the deep volar branch of the radial artery and the inferior deep branch of the ulnar artery. Injection followed by chemical debridement allows direct visualization and measurement of the arches and the smaller arterial branches that are visualized poorly with other techniques. Based on the vessel measured, vessels of the superficial and deep arches are of sufficient size to allow microvascular repair, although repair of the communicating branches, the dorsal carpal rete, and its branches, probably is not feasible because of their small size.
To evaluate the normal anatomy of the structures supporting the proximal portion of the fifth metatarsal bone and investigate the pathogenesis of fractures in this region.
In two cadaveric feet, the ...region of the lateral component of the plantar aponeurosis (PAL), short peroneal muscle (SPM) tendon, and third peroneal muscle (TPM) tendon was dissected. These two foot specimens and four nondissected foot specimens were studied at magnetic resonance (MR) imaging. Two of the six specimens were studied at computed tomography (CT). Sectioning the nondissected foot specimens enabled anatomic correlation. In two additional specimens, simulation of the presumed mechanism of fifth metatarsal bone fracture was attempted. The radiographic, CT, and MR images obtained in 13 patients with fractures of the proximal portion of the fifth metatarsal bone were evaluated.
Anatomic, CT, and MR imaging studies revealed broad insertion of the PAL into the plantar aspect of the proximal portion of the fifth metatarsal bone in all specimens. The SPM tendon was consistently attached more distally and to the lateral side of the tuberosity, blending with the PAL fibers. The TPM tendon was inconsistently identified inserting anteriorly to the SPM tendon. No fracture was created in the specimens subjected to attempted injury. Frequent attachment of the PAL and the SPM tendon to the avulsed fragment was confirmed in clinical cases.
The pathogenesis of fractures of the proximal portion of the fifth metatarsal bone appears to be related to avulsion injury of PAL and SPM tendon fibers.
Nitrate (NO
3
−) contamination of surface- and groundwater is an environmental problem in many regions of the world with intensive agriculture and high population densities. Knowledge of the sources ...of NO
3
− contamination in water is important for better management of water quality. Stable nitrogen (
δ
15N) and oxygen (
δ
18O) isotope data of NO
3
− have been frequently used to identify NO
3
− sources in water. This review summarizes typical
δ
15N- and
δ
18O-NO
3
− ranges of known NO
3
− sources, interprets constraints and future outlooks to quantify NO
3
− sources, and describes three analytical techniques (“ion-exchange method”, “bacterial denitrification method”, and “cadmium reduction method”) for
δ
15N- and
δ
18O-NO
3
− determination. Isotopic data can provide evidence for the presence of dominant NO
3
− sources. However, quantification, including uncertainty assessment, is lacking when multiple NO
3
− sources are present. Moreover, fractionation processes are often ignored, but may largely constrain the accuracy of NO
3
− source identification. These problems can be overcome if (1) NO
3
− isotopic data are combined with co-migrating discriminators of NO
3
− sources (e.g.
11B), which are not affected by transformation processes, (2) contributions of different NO
3
− sources can be quantified via linear mixing models (e.g. SIAR), and (3) precise, accurate and high throughput isotope analytical techniques become available.
BackgroundPrevious studies have demonstrated higher infection rates following orthopaedic procedures on the foot and ankle as compared with procedures involving other areas of the body. Previous ...studies also have documented the difficulty of eliminating bacteria from the forefoot prior to surgery. The purpose of the present study was to evaluate the efficacy of three different surgical skin-preparation solutions in eliminating potential bacterial pathogens from the foot.MethodsA prospective study was undertaken to evaluate 125 consecutive patients undergoing surgery of the foot and ankle. Each lower extremity was prepared with one of three randomly selected solutionsDuraPrep (0.7% iodine and 74% isopropyl alcohol), Techni-Care (3.0% chloroxylenol), or ChloraPrep (2% chlorhexidine gluconate and 70% isopropyl alcohol). After preparation, quantitative culture specimens were obtained from three locationsthe hallux nailfold (the hallux site), the web spaces between the second and third and between the fourth and fifth digits (the toe site), and the anterior part of the tibia (the control site).ResultsIn the Techni-Care group, bacteria grew on culture of specimens obtained from 95% of the hallux sites, 98% of the toe sites, and 35% of the control sites. In the DuraPrep group, bacteria grew on culture of specimens obtained from 65% of the hallux sites, 45% of the toe sites, and 23% of the control sites. In the ChloraPrep group, bacteria grew on culture of specimens from 30% of the hallux sites, 23% of the toe sites, and 10% of the control sites. ChloraPrep was the most effective agent for eliminating bacteria from the halluces and the toes (p < 0.0001).ConclusionsThe use of effective preoperative preparation solution is an important step in limiting surgical wound contamination and preventing infection, particularly in foot and ankle surgery. Of the three solutions tested in the present study, the combination of chlorhexidine and alcohol (ChloraPrep) was most effective for eliminating bacteria from the forefoot prior to surgery.Level of EvidenceTherapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.
An effective presurgical preparation is an important step in limiting surgical wound contamination and preventing infection. The purpose of this study was to evaluate residual bacterial skin ...contamination after surgical skin preparation in foot and ankle surgery to determine if current techniques are satisfactory in eliminating harmful pathogens. Fifty consecutive patients having surgical procedures of the foot and ankle were studied. Each lower extremity was prepared randomly with either a one-step povidone-iodine topical gel or a two-step iodophor scrub followed by a povidone-iodine paint. After preparation and draping, cultures were obtained at three locations: the hallux nailfold, web space between the second and third, and fourth and fifth toes, and the anterior ankle (control). In the gel group, positive cultures were obtained from 76% of halluces, 68% of toes, and 16% of controls. In the scrub and paint group, positive cultures were obtained from 84% of halluces, 76% of toes, and 28% of controls. Numerous pathogens were cultured, with Staphylococcus epidermidis being the most prevalent. Based on the findings of the current study, presurgical skin preparation with a povidone-iodine based topical bactericidal agent is not sufficient in eliminating pathogens in foot and ankle surgery. The unique environment of the foot and its resident organisms may play a role in the higher infection rates associated with surgery of the foot and ankle.
Regan and Morrey proposed a 3-type coronoid fracture classification observing that the incidence of concommitant elbow dislocation was proportional to fragment size. Elbow instability associated with ...coronoid fractures presumably is related to disrupted bony architecture and ineffective stabilizers attached to the free fragment. Twenty cadaveric elbows were dissected, measuring medial collateral ligament, anterior capsule, and brachialis muscle insertion loci on the coronoid. Radiographs were taken after radiopaque labeling of the stabilizer insertions. The anterior bundle of the medial collateral ligament insertion averaged 18.4 mm dorsal to the coronoid tip. Only in Type III fractures would it be attached to the free fragment. The capsule inserted an average of 6.4 mm distal to the coronoid tip. Rarely should Type I fractures result from a capsular avulsion, because only 3 of 20 specimens had the capsule inserting on the tip. The brachialis had a musculoaponeurotic insertion onto the elbow capsule, coronoid, and proximal ulna. The bony insertion averaged 26.3 mm in length, with its proximal margin averaging 11 mm distal to the coronoid tip. In only Type III fractures is the fragment large enough to include the brachialis bony insertion.
