Anteromedial Surface Research Articles

Biomechanical comparison of gourd-shaped LCP versus LCP for fixation of comminuted tibial shaft fracture

The purpose of this study was to compare monotonic biomechanical properties of gourd-shaped LCP fixation with LCP fixation of human tibial shaft in gap fracture mode. Twenty paired fresh cadaveric human tibias were randomly divided into 4 groups (5 pairs each): (1) axial loading single cycle to failure testing, (2) torsion single cycle to failure testing, (3) 4-point bending single cycle to failure testing, and (4) dynamic 4-point bending testing. A 7-hole 4.5 mm gourd-shaped LCP was secured on the anteromedial surface of 1 randomly selected bone from each pair, respectively, using 6 locking screws in the 1st, 2nd, 3rd, 5th, 6th and 7th hole with the middle hole unfilled and just located at the mid-diaphysis of the tibia. A 7-hole 4.5 mm LCP was secured on the other bone with the same method. Standard AO/ASIF techniques were used. After fixation finished, a 10 mm gap in the mid-diaphysis of tibia was created, centrally located at the unfilled hole. The axial, torsional, and bending stiffness and failure strengths were calculated from the collected data in static testings and statistically compared using paired Student's t-test. The 4-point bending fatigue lives of the two constructs were calculated from the dynamic testing data and also statistically compared using paired Student's t-test. Failure modes were recorded and visually analyzed. P<0.05 was considered significant. Results showed that the axial, torsional and bending stiffness of gourd-shaped LCP construct was greater (4%, 19%, 12%, respectively, P<0.05) than that of the LCP construct, and the axial, torsional and bending failure strengths of gourd-shaped LCP construct were stronger (10%, 46%, 29%, respectively, P<0.05) than those of the LCP construct. Both constructs failed as a result of plate plastic torsional deformation. After axial loading and 4-point bending testings, LCP failed in term of an obvious deformation of bent apex just at the unfilled plate hole, while the gourd-shaped LCP failed in term of a deformation of bent arc between the 3rd and 5th holes, which indicated a more consistent stress distribution on gourd-shaped LCP. Fatigue life of gourd-shaped LCP construct was significantly greater than LCP construct (153 836±2 228 vs. 132 471±6 460 cycles, P<0.01). All constructs failed as a result of fracture of the plate through the compression hole of the unfilled combination screw hole. The biomechanical testing showed that gourd-shaped LCP can provide greater stiffness and strength, and longer fatigue life than LCP. The gourd-shaped LCP may be more advantageous mechanically and may reduce the plate breakage rate clinically.

Rapid growth of supracondylar process

The supracondylar process, a bony, beak-like spur on the anteromedial surface of the distal humerus, is a rare congenital abnormality. We present a rare case of a 20-month-old child showing rapid growth of the supracondylar process over 16 months that required surgical excision. A supracondylar process in a young patient may show a tendency for rapid growth.

English

Biceps brachii is a double headed muscle. In terms of number and morphology of its head, it is one of the most variable muscles in the human body. Most common variation is third head, but four, five or even seven heads have been reported. In the present case report third head of biceps brachii was found on the flexor compartment of left arm of an adult female cadaver .The third head of biceps brachii originated from the anteromedial surface of the humerus below the insertion of coracobrachialis and which descended and merged with the other two heads to form common tendon and was inserted on to the radial tuberosity . Third heads might be significant in producing the strong flexion as well as supination of forearm. They may cause compression of neurovascular structures because of their close relationship to brachial artery and median nerve. Variant biceps brachii may confuse a surgeon who performs procedures on the arm and may lead to iatrogenic injuries. The surgeons and traumatologists have to keep such muscular variations in mind.

A Study on the Nutrient Foramina of Adult Humerii

It is not uncommon to see the non union of the fractures in the long bones. Among the various reasons for the nonunion of the fractured bones, the nutrient artery plays an important role. This study was aimed at analyzing the nutrient foramina in dry adult humerii ,with regards to the number, size and the location of the nutrient foramen with respect to the surfaces and the zones and its distance from the mid point of the humerus. This was an analytical study. All the humerii from various medical colleges of the Vinayaka Missions University in Salem were included in the study. Those which were damaged and those which had pathological abnormalities were excluded. The following parameters were noted; namely, the length of the humerus, the number and the size of the nutrient foramen and the location of the nutrient foramen with respect to the surfaces and the zones of the humerus and its distance from the mid-point of the humerus were analyzed. The length of the humerus and the mid point of the humerus were measured by using the osteometric board, whereas the size of the nutrient foramen was measured by using various size of hypodermic needles. When more than one foramen was found, the larger one was taken as the dominant foramen and its size was measured. All the data were noted and the statistical analysis was done by calculating the mean, the range and the standard deviation. Totally, 258 adult dry humerii were studied. The mean length of the humerii was 27.96 cm, with a SD of 2.18. The mean size of the nutrient foramen was 0.828 mm, with a SD of 0.26. The mean distance of th dominant nutrient foramen from the mid point of the humerus was 2.31 cm, with a SD of 1.25 cm. In majority of the humerii (86.43%), the nutrient foramen was located in the middle 1/3(rd) of the bone and in 13.57% of the bones, it was located in the lower 1/3(rd) of the bone. The location of the nutrient foramen in the anteromedial surface was 89.92%, that in the posterior surface was 8.53% and that in the anterolateral surface was 1.55%.

Postcranial anatomy of the hyperodapedontine rhynchosaur Teyumbaita sulcognathus (Azevedo and Schultz, 1987) from the Late Triassic of Southern Brazil

ABSTRACT Teyumbaita sulcognathus is a peculiar endemic Brazilian rhynchosaur that remained somewhat obscure until recently, when its skull anatomy was described and a new generic name was assigned to this highly autapomorphic taxon. Here, the postcranial skeleton of Teyumbaita sulcognathus is for the first time fully described based on the holotype and the two more complete referred specimens. Rhynchosaur postcranial anatomy has usually been considered to be rather conservative, but T. sulcognathus shows unforeseen morphological variation. Autapomorphic traits were added to the diagnosis of T. sulcognathus and intraspecific variation was also identified. In addition, six new phylogeneticaly informative postcranial characters were recognized. Some of these represent apomorphies of clades such as Rhynchosauridae (axis with ventral keel, crest on the anteromedial surface of tibial shaft) and Hyperodapedontinae (postaxial cervical vertebrae with ventral keel, supinator process composed of a low supinator ridge and the ligament groove), revealing new support for their monophyly. The rhynchosaur diversity of the Otter Sandstone Formation (England) was also evaluated based on a phylogenetic analysis. The results suggest that the postcranium EXEMS 79/1992 is more likely related to Fodonyx spenceri than to Bentonyx sidensis. SUPPLEMENTAL DATA—Supplemental materials are available for this article for free at www.tandfonline.com/UJVP

The Third Head of Biceps Brachii Muscle in Korean: Anatomical Study

The goal of this study was to investigate the incidence of third head of biceps brachii (THBB) for understanding unexpected cases in clinical practice. The sample consisted of 214 upper extremities from 107 adult cadavers donated to science (70 males and 37 females; age, 51-87 years). Cases with pathological changes or trauma to the upper limbs were excluded. THBB was found in 14 of the 214 upper extremities. The incidence of variation was approximately 6.5%. THBB was found in 10 male limbs and 4 female limbs, and none of the cases was bilateral. THBB was a flat muscular belly-like structure that originated from the anteromedial surface of the humerus between the insertion of the coracobrachialis and the origin of the brachialis. This finding may be clinically important because the musculocutaneous nerve is subjected to compression by the bulky third head.

English

BACKGROUND: Supracondylar process, in human, is a rare, anomalous, beak-like bony process on the anteromedial surface of the humerus. It represents the embryologic vestigial remnant of climbing animals and seen in many reptiles, most marsupials, cats, lemurs and American monkeys. Aim is to study the supracondylar process of humerus. MATERIALS AND METHODS: 80 adult dry humeri were collected from Anatomy Department, Gauhati Medical College and were examined. RESULTS: Out of 80 humeri, we found one humerus of left side with a bony projection from antero- medial surface of its distal shaft. The bone was then examined, studied, photographed and its dimensions were recorded. CONCLUSION: Knowledge of this variation may be of great importance to anatomists and anthropologists, because of possible link to the origins and relations of the human races.

V-Y and Rotation Flap for Reconstruction of the Epicanthal Fold

Epicanthoplasty is commonly performed on Asian eyelids. Consequently, overcorrection may appear. The aim of this study was to introduce a method of reconstructing the epicanthal fold and to apply this method to the patients. A V flap with an extension (eagle beak shaped) was designed on the medial canthal area. The upper incision line started near the medial end of the double-fold line, and it followed its curvature inferomedially. For the lower incision, starting at the tip (medial end) of the flap, a curvilinear incision was designed first diagonally and then horizontally along the lower blepharoplasty line. The V flap was elevated as thin as possible. Then, the upper flap was deeply undermined to make it thick. The lower flap was made a little thinner than the upper flap. Then, the upper and lower flaps were approximated to form the anteromedial surface of the epicanthal fold in a fashion sufficient to cover the red caruncle. The V flap was rotated inferolaterally over the caruncle. The tip of the V flap was sutured to the medial one-third point of the lower margin. The inferior border of the V flap and the residual lower margin were approximated. Thereafter, the posterolateral surface of the epicanthal fold was made. From 1999 to 2011, 246 patients were operated on using this method. Among them, 62 patients were followed up. The mean intercanthal distance was increased from 31.7 to 33.8 mm postoperatively. Among the 246 patients operated on, reoperation was performed for 6 patients. Among the 6 patients reoperated on, 3 cases were due to epicanthus inversus, 1 case was due to insufficient reconstruction, 1 case was due to making an infold, and 1 case was due to reopening the epicanthal fold.This V-Y and rotation flap can be a useful method for reconstruction of the epicanthal fold.

A study of nutrient foramina in dry adult humeri of South Indian subjects

Abstract Background : Vascular insults to the humerus either during fracture dislocation or during surgical correction of fracture may result in delayed healing or non-union of fracture. It is worth to find the number and size of nutrient foramina. The know ledge regarding the nutrien foramina helps to protect them during conservative operative procedures of the bone, thus to concentrate upon the viability of the fractured fragments. Objectives: To observe the location of nutrient foramina with reference to the different segments of shaft of humerus,to note variations in number, direction and size of the nutrient foramina. Further to examine if a correlation exists between the length of humerus and number of vascular foramina and nutrient foramina. Materials and methods : The study was undertaken on 200 dry normal dult humerus bones. Observations were made using Hepburn's osteometric board and hypodermic needles of different gauges. Statistical methods (SPSS) were used to analyze these observations. Results: The location of nutrient foramen was more in the middle 113rd of antero-medial surface. Majority of humeri showed one nutrient foramen, whereas there were 2 to 3 foramina in few humeri. Conclusion: This study will help in planning the surgical treatment of fracture of humerus which will possibly reduce the post-operative complications.

Articularis Genus: An Anatomic and MRI Study in Cadavers

The articularis genus muscle is closely associated with the anterior aspect of the knee joint and may act to elevate or retract the suprapatellar bursa. Its form and function are poorly understood. The purpose of this study was to define the morphology of the articularis genus and its relationship to the suprapatellar bursa. The articularis genus muscle was investigated in twenty-two human lower limbs obtained from eleven donors (six men and five women; mean age at death, eighty-three years). Eighteen of these limbs underwent magnetic resonance imaging (MRI) followed by dissection. The number, length, physiological cross-sectional area, attachment sites, and orientation of individual fascicles, muscle bundles, and whole muscles were recorded. The remaining four limbs underwent immunohistochemical analysis to determine muscle fiber types. The articularis genus comprised multiple layered muscle bundles originating from the anterior, anterolateral, and/or anteromedial surfaces of the distal third of the femur. Distal attachment sites included the proximal and/or posterior wall of the suprapatellar bursa, the deep surface of the distal tendon of the vastus intermedius, and the medial and lateral aspects of the knee joint capsule. On dissection, the muscle was observed to consist of a mean of seven muscle bundles (range, four to ten), but only a mean of four bundles were observed on MRI scans (p &lt; 0.0001). The mean cross-sectional area of the articularis genus (and standard deviation) was 1.5 ± 0.7 cm2, and its mean fascicular length and bundle physiological cross-sectional area were 5.9 ± 1.0 cm and 0.2 ± 0.1 cm2, respectively. The articularis genus displayed a mixed fiber type, with the proportion of type-I fibers varying among specimens (range, 39.9% to 76.4%). These findings highlight the complex and variable anatomy of the articularis genus, particularly with respect to the number of bundles and the distal attachment sites. Distinguishing the superficial bundles of the articularis genus from the vastus intermedius on MRI can be difficult. Given its relationship to the anterior aspect of the knee joint and its association with the suprapatellar bursa, the articularis genus may be a neglected cause of undifferentiated anterior knee pain.

Juxta Cortical Tibia Metastatic Deposition in Gastric Cancer: A Case Report

We report a 41 years old man with rapidly growing and tender lump on the anteromedial surface of tibia. The patient had the history of gastrectomy and gastrojejunostomy due to gastric carcinoma. On admission, the Simple X-ray of lower extremity disclosed a slight thinning of the anterior cortex of tibia without cortical destruction. The whole-body bone scan with 99mTC MDP revealed activity of lesion in all 3 phases. The histopathological evaluation showed an infiltration of bone with tumor cells. Review No the literature revealed in previous cases of skeletal metastasis from gastric cancer in the tibia like this.

Obturator Nerve Block Using Ultrasound-guided Intraneural Alcohol Injection in Patient with Hip Adductor Spasticity

Objective: To investigate the effects of obturator nerve blocks with ultrasound guided intraneural alcohol injection. Method: Nine quadriplegic patients suffering hip adductor spasticity were included in this study. The obturator nerve was identified at just below inguinal ligament area on anteromedial surface of upper leg at supine position. An 23 G needle was inserted into anterior branch of obturator nerve under real time ultrasonography. The 50% alcohol solution was injected 3∼5 ml at a time within the epineurium of the anterior branch of obturator nerve until the expanding nerve was visualized. We examed modified Ashworth scale (MAS) of hip adductor and passive range of movement of hip abduction at supine position at study entry, 1, 4, and 12 weeks after ultrasound guided intraneural injection. Results: There were statistically significant improvement was seen in MAS of hip adductors and hip abduction angle at 1, 4, and 12 weeks after ultrasound guided intraneural injection, compared with parameters measured at previous injection (p<0.05). Conclusion: Ultrasound guided intraneural alcohol injection into anterior branch of obturator nerve for treatment of hip adductor spasticity in patients with quadriplegia is an effective and safe procedure for relieving localized spasticity of the hip adductors. (Brain & NeuroRehabilitation 2012; 5: 82-86)

An Aberrant Flexor Digiti Minimi Brevis Manus Muscle

During routine anatomical dissection in the right volar wrist region of a 43-year-old female cadaver, we discovered a unique flexor digiti minimi brevis (manus) muscle. The aberrant muscle arose from the medial edge of the flexor carpi radialis tendon and passed obliquely, distally and ulnarward, crossing over the median nerve and then the ulnar artery and nerve at the Guyon canal. The aberrant muscle inserted to the anteromedial surface of the base of the fifth proximal phalanx. The deep branch of the ulnar nerve innervated this muscle. The potential clinical implications of the variant flexor digiti minimi brevis muscle are briefly described.

Case Report: Lower Extremity Sparganosis in a Bursa

Sparganosis is a rare parasitic infection caused by the plerocercoid tapeworm larva of the genus Spirometra. We report the case of a 67-year-old man with a mass over the anteromedial surface of the proximal extremity of the tibia. We surgically excised a bursa containing Spirometra larvae. Sparganosis is a rare parasitic infection. We found no cases of lower extremity sparganosis combined with bursitis reported in the literature. Sparganosis should be considered in the differential diagnosis of soft tissue tumors, especially among patients who frequently have consumed mountain water or raw snakes or frogs.

The skull of &lt;em&gt;Postosuchus kirkpatricki&lt;/em&gt; (Archosauria: Paracrocodyliformes) from the Upper Triassic of the United States

The skull of Postosuchus kirkpatricki Chatterjee 1985 is known from the holotype and paratype specimens along with disassociated skull elements from several Triassic localities in the southwestern and eastern United States. Recent preparation of the holotype skull allows for more careful examination of the cranial elements and comparison with related taxa. This description indicates that Postosuchus shares several previously unrecognized synapomorphies with crocodylomorphs, including fossae and foramina in the dermatocranium that are not present in other basal pseudosuchians. The sutural arrangements of the skull of Postosuchus presented in this paper differ considerably from previous descriptions, due in part to the reassignment of what was previously considered the prefrontal to the palpebral bone. Also, further preparation of skull elements revealed morphologies that differ from previous descriptions. This new description also indicates a close relationship with Polonosuchus silesiacus Sulej 2005. The only autapomorphic characters of the skull are a distinct, rounded lateral ridge on the maxilla and a foramen present in a large fossa on the anteromedial surface of the maxilla.

Anterior Cruciate Ligament Reconstruction of the Knee

Anterior cruciate ligament (ACL) injuries affect more than 175,000 patients annually. Located in the center of the knee joint, the ACL is the major stabilizing ligament of the knee. If the ACL is injured, then the knee becomes unstable and can buckle when the person pivots. Surgeons can use autograft or allograft tissue to accomplish ACL reconstruction by using a single-bundle or double-bundle type of repair. The surgeon performs the reconstruction arthroscopically, using two ports and a small incision over the anteromedial surface of the tibia to facilitate passage of the graft and for distal fixation of the graft. Correct placement of the tibial and femoral tunnels is the most important technical aspect of the procedure. After reconstruction, the patient must undergo intense physical therapy starting one or two days after surgery. If diligent with physical therapy, then the patient can return to full activity as soon as four months after surgery.

Glishades ericksoni, a new hadrosauroid (Dinosauria: Ornithopoda) from the Late Cretaceous of North America

A new genus and species of hadrosauroid dinosaur, Glishades ericksoni, is described based on paired partial premaxillae collected from the Upper Cretaceous Two Medicine Formation of Montana, in the Western Interior of the United States of America. This taxon is diagnosed on the basis of a unique combination of characters: absence of everted oral margin, arcuate oral margin with wide and straight, obliquely oriented, and undeflected anterolateral corner, grooved transversal thickening on ventral surface of premaxilla posterior to denticulate oral margin, and foramina on anteromedial surface above oral edge and adjacent to proximal end of narial bar. Maximum parsimony analysis positioned G. ericksoni as a derived hadrosauroid. Exclusion of G. ericksoni from Hadrosauridae was unambiguously supported by the lack in AMNH 27414 of a dorsomedially reflected premaxillary oral margin. Furthermore, the maximum agreement subtree positioned G. ericksoni as the sister taxon to Bactrosaurus johnsoni. This position was unambiguously supported by posteroventral thickening on the ventral surface of the premaxilla (independently derived in saurolophid hadrosaurids and Ouranosaurus nigeriensis) and having foramina on each premaxilla on the anterior surface, adjacent to the parasagittal plane of the rostrum (reconstructed as independently derived in Brachylophosaurus canadensis, Maiasaura peeblesorum, and Edmontosaurus annectens).

Ultrasound demonstration of Struthers' ligament

The supracondylar process is a bony spur at the anteromedial surface of the distal humerus. It is associated with the Struthers' ligament, running from its apex to the medial epicondyle. Symptoms may occur due to fracture and entrapment of nerves (most frequently the median nerve) and/or blood vessels underneath the structures. We report a case in which we used MRI and high-frequency ultrasound to investigate the supracondylar process, the Struthers' ligament, and its surrounding structures. Ultrasound is a useful alternative to MRI during the workup of potential entrapment syndromes.

An Anatomical Basis for Blocking of the Deep Cervical Plexus and Cervical Sympathetic Tract Using an Ultrasound-Guided Technique

A selective blocking method for the cervical plexus and the cervical sympathetic trunk has not yet been established. We performed a detailed examination of the neck anatomy using 28 cadavers. The pattern of local anesthetic distribution after injection in 2 healthy volunteers was imaged using computed tomographic scan. The deep cervical plexus was located in the groove between the longus capitis and scalenus medius muscles. The cervical sympathetic trunk was located on the anteromedial surface of the longus capitis. Although anesthetic injected into the longus capitis was confined to the muscle, it infiltrated into neighboring structures including the C2 to C5 roots and sympathetic trunk. The longus capitis muscle is a suitable landmark for blocking the cervical plexus and trunk.

Comparative larval morphology of eight species of Hypsiboas Wagler (Amphibia, Anura, Hylidae) from Argentina and Uruguay, with a review of the larvae of this genus

We studied the external and oral cavity morphology of the tadpoles of eight species of Hypsiboas in the H. albopunctatus, H. faber, H. punctatus and H. pulchellus species groups. After a review of the available information about larval external and oral cavity morphology, no character state seems to be synapomorphic for Hypsiboas. The presence of a fleshy projection in the inner margin of the nostrils and rounded vacuities of the anteromedial surface of the choanae (pending the confirmation of the latter in Hyloscirtus and Myersiohyla) seems to be synapomorphic for the tribe Cophomantini, as previously noticed by other authors. Some putative synapomorphies are suggested for some species groups of Hypsiboas, but a denser sampling is needed to study the taxonomic distribution of these character states, in order to determine which clades they may support. The presence of lateral flaps with labial teeth in the oral disc is a variable feature of many species in the H. faber and H. pulchellus groups. A spiracular tube free from the body wall is present in some species, mostly in the H. albopunctatus group, but also in the H. rufitelus, H. faber and H. pulchellus groups. Unique ventrolateral cumules of neuromasts are present in H. faber, and also in some species of other groups of Hypsiboas and of the sister genus Aplastodiscus. Our results highlight the importance of studying the taxonomic distribution of many character states that were sometimes overlooked in tadpole descriptions but seem relevant to test phylogenetic hypothesis.