Proximal Aspect Research Articles

Afterword

Afterword Elizabeth A. Povinelli It's rare that a volume of academic articles moves me; it's not that academic writings can't be harrowing. I can find theory devastating. Freud's The Ego and the Id (1961 [1923]) kills me every time I read it, so powerfully does he portray the pathos of the ego's attempt to survive the cruel space of its birth between the id and superego. Nor do I think my feelings flow from the topic of this special section of Anthropology Quarterly. Discussions of corporeal entanglements can be as dry as deserts and concepts as dull as can be. But in each of these articles are moments of profound commentaries of new forms of intimate proximity as they stretch the concept of love across regimes of governance. I was considering how to cluster these four articles, in the way one does when trying to contain and direct the endless possible directions a comment can take. I was musing, for instance, of dividing them according to a focus on sexuality and late liberal governance of intimacy, on the one hand (Weiss and Obadia), and intimate epistemologies of others, on the other (Rutherford and Crosson). But this way of sorting the texts is overwhelmed by the complex and multivalent settings in which the authors place their discussion. At stake in all of them is a question for our times—How do we become together differently when, as Lauren Berlant once said to me, nothing is more generic than our most intimate expressions, gestures, and languages? So, let me begin with Weiss. Any thought that her article would wind up proximate to Elaine Scarry's classic discussion of the body in pain was deeply misguided. The echoes of Scarry's work can be found in Berlant [End Page 1483] and Edelman's work on the unmaking of subjectivity in sex; or in a previous text of Candace Vogler published in a special issue of Critical Inquiry; and in the work of Leo Bersani. As Weiss notes, these theorists show that we do not come to know ourselves more deeply or profoundly in sexual encounters, rather they open us to the incoherency of self and identity. Weiss is, however, far less interested in understanding the self in sex, whether vanilla or rough, than in, quoting Eve Sedgwick, all the "loose ends and crossed ends" not contained in sex per se, or in the identities that have clustered around its acts. What about forms of intimacy outside sex, scientia sexualis as modernity's governing regime of subjectivity and truth? Did this science of sexuality overwhelm not a previous ars erotica nor even what Foucault called alliance, but something akin to kinship? If we turned away from sexuality and toward kinship and alliance, would we find coherence there, some clear algebra of human forms of relatedness and their obligated affects, albeit culturally defined? The center of Weiss's article might wind up in a BDSM dungeon, but it does not center on the dungeon. Fearing her sister's assault by a previous male partner in a BDSM bar, Weiss leads her sister into the dungeon. Once entering, Weiss conveys the stubborn threat of violence from a currently contained—but, the reader imagines, terrifying—stalker; the sounds a specific play of sexuality; its smells of "leather, latex, bleach, rubber, sex." What Weiss wants us to look at, feel, is not these smells, not "the naked man hung on a St. Andrews Cross, being flogged by a woman in a black corset and thigh high leather boots" (though, as if anticipating Rutherford, she is not asking us to look away from these either). Instead, the aspect of overwhelming proximity she wants us to consider is not in, what for some would be, overwhelming sexual altering, but in the supervalent thought—or forms of relatedness—that creates an intensity beyond the given elements in the actual scene. The boyfriend, the sister, the lover, the trans bouncer, the dungeon: each of these "thoughts" express a given ordering of the social field ("a field of enmeshment and imbrication") and release potentialities for a different ordering. Like Chandra Mohanty, Weiss comes to worry whether "through identitarian...

Utility of Coaxial Angioplasty-thrombectomy for Acute Tandem Occlusion of Intracranial and Extracranial Arteries.

We report a novel technique for acute occlusion of both intracranial and extracranial arteries (tandem lesions [TL]). A 67-year-old male was transferred to our hospital because of right hemiparesis and aphasia. MRA revealed occlusion of the left cervical internal carotid artery (ICA) and middle cerebral artery (MCA). A balloon guide catheter (BGC) was advanced into the left common carotid artery (CCA). A microcatheter was advanced over a microwire through the intracranial thrombus. A stent retriever (SR) was deployed from the MCA to the ICA through the microcatheter. Next, with the SR anchored to the thrombus, the microcatheter was withdrawn. The extracranial percutaneous transluminal angioplasty (PTA) balloon was coaxially advanced over the SR's delivery wire and angioplasty was performed. Then, an aspiration catheter was coaxially advanced to the proximal aspect of the intracranial thrombus over the delivery wire by pump aspiration. We removed the SR and the aspiration catheter as a single unit into the BGC, resulting in sufficient recanalization. The puncture to recanalization time was 29 minutes. This technique can lead to faster recanalization in cases of TL.

Intraosseous Regional Administration of Antibiotic Prophylaxis in Total Knee Arthroplasty.

Intraosseous Regional Administration of Antibiotic Prophylaxis in Total Knee Arthroplasty.

Description of ultrasound-guided quadratus lumborum block technique and evaluation of injectate spread in canine cadavers

ObjectiveTo describe a quadratus lumborum (QL) block technique in canine cadavers and the spread of injectate. Study designProspective, randomized, descriptive, experimental anatomic study. AnimalsA group of 12 adult canine cadavers. MethodsGross and ultrasound anatomy of the sublumbar musculature and the relationship with the spinal nerves was studied in two cadavers. Bilateral ultrasound-guided injections were performed in eight cadavers in the fascial plane between the QL and psoas muscle using a dye–lidocaine solution [low volume (LV) 0.15 mL kg–1 or high volume (HV) 0.3 mL kg–1]. The ultrasound transducer was positioned caudal and parallel to the proximal aspect of the last rib, and an insulated needle was introduced in-plane using a ventrolateral to dorsomedial approach. Dissections were performed to determine the number of spinal nerves successfully stained (>1 cm) and the presence of injectate in the epidural space or abdominal cavity. Additionally, two cadavers were transversally cryosectioned after QL injection. ResultsVentral branches of the last thoracic and first three lumbar spinal nerves ran between the bundles of the QL muscle and between the QL and psoas muscles. The target fascial plane was ultrasonographically identified and filled with the dye solution following all injections. Ventral branches of the thirteenth thoracic and first, second and third lumbar nerves were stained by 0.0%, 71.4%, 100%, 100%, and 25%, 100%, 100%, 100% using LV and HV, respectively. Multisegmental spread stained the lumbar sympathetic trunk on 0 (0–3) and 3 (0–4) vertebral levels with LV and HV, respectively. No abdominal or epidural spread was identified. Conclusion and clinical relevanceAlthough no significant differences were found, HV resulted in a higher percentage of stain on spinal nerves and sympathetic trunk than LV. Further studies are warranted to determine if the QL block provides somatic and visceral abdominal analgesia in dogs.

INFLUENCE OF WOOD STACKING LOCATION ON FOREST TRANSPORT COSTS

Given the importance of forest transportation planning due to its high contribution in wood final cost, the distance between forest plantation stands and the wood final destination should be optimized in order to reduce process cost. The relation between distance and transportation cost is known, yet, it is still necessary to evaluate how much the location of the wood piles inside the stand interferes with its final cost. Thus, we try to evaluate the influence of the wood stacking location on forest transportation costs. The vectorization of the general map of a property located in Minas Gerais state was performed through the QGIS software, by representing the planting areas by polygons, internal and external access roads by lines, and the possible wood-stacking location to be transported by points. In each stand, four wood-stacking sites were considered, each on one side of the stand. Considering this, optimal route simulations were performed based on the criterion of the shortest distance between each pile of wood and a carbonization plant. The results showed a 32% reduction in the final cost of transportation when the wood is stacked in places closer to the carbonization plant. Therefore, the results evidence that the choice of the ideal stacking point, in the aspect of closer proximity to the destination of the wood transportation, can generate savings in this process.

Ambient air pollution and lung cancer risk among never-smokers in the Women's Health Initiative.

Background:Ambient air pollution is classified as a human carcinogen by the International Agency for Research on Cancer (IARC). However, epidemiologic studies supporting this classification have focused on lung cancer mortality rather than incidence, and spatial and temporal resolutions of exposure estimates have varied considerably across studies.Methods:We evaluated the association of outdoor air pollution and lung cancer incidence among never-smoking participants of the Women’s Health Initiative (WHI) study, a large, US-based cohort of postmenopausal women (N = 65,419; 265 cases). We used geospatial models to estimate exposures to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) based on residential addresses at baseline and throughout follow-up. We also characterized exposures to traffic-related air pollution by proximity to major roadways. We estimated hazard ratios (HRs) for the risk of lung cancer in association with these exposure metrics using Cox proportional hazards regression models.Results:No compelling associations of PM2.5 and NO2 exposures with lung cancer risk were observed. An increased risk of lung cancer was observed when comparing those individuals with residences <50 versus ≥200 meters from a primary limited access highway (HR = 5.23; 95% confidence interval = 1.94, 14.13).Conclusions:Our results do not exclude lung cancer risk estimates observed in association with PM2.5 and NO2 exposures identified in previous studies. Our results suggest that residential proximity to major roadways may be a proxy for carcinogenic exposures not correlated with PM2.5 or NO2 levels. New studies of air pollution and lung cancer incidence should characterize additional aspects of proximity to major roadways.

Side‐to‐side supercharging nerve allograft enhances neurotrophic potential

Critical limitations of processed acellular nerve allograft (PNA) are linked to Schwann cell function. Side-to-side bridge grafting may enhance PNA neurotrophic potential. Sprague-Dawley rats underwent tibial nerve transection and immediate repair with 20-mm PNA (n = 33) or isograft (ISO; n = 9) or 40-mm PNA (n = 33) or ISO (n = 9). Processed acellular nerve allograft groups received zero, one, or three side-to-side bridge grafts between the peroneal nerve and graft. Muscle weight, force generation, and nerve histomorphology were tested 20 weeks after repair. Selected animals underwent neuron back labeling with fluorescent dyes. Inner axon diameters, g-ratios, and axon counts were smaller in the distal vs proximal aspect of each graft (P < .05). Schwann cell counts were greater, with a lower proportion of senescent cells for groups with bridges (P < .05). Retrograde labeling demonstrated that 6.6% to 17.7% of reinnervating neurons were from the peroneal pool. Bridge grafting positively influenced muscle recovery and Schwann cell counts and senescence after long PNA nerve reconstruction.

Ultrasound of the normal canine supraspinatus tendon: comparison with gross anatomy and histology

BackgroundThis study aimed to compare the ultrasonographic and histological features of the supraspinatus tendon (ST) and its peculiar appearance in contrast with the biceps brachii tendon.MethodsFor this purpose, 19 non-lame...

Site-dependent thenar compound muscle action potential: Comparison between surface and needle recordings

Within the thenar eminence, the median nerve innervates three muscles: abductor pollicis brevis (APB), flexor pollicis brevis (FPB), and opponens pollicis (OP). Of these muscles, APB was often considered as the sole contributor to the thenar compound muscle action potential (CMAP). To evaluate subcomponents of the thenar CMAP from the median nerve innervated muscles. Surface and needle CMAPs were recorded in normal human subjects from three recording sites: proximal (site-I), middle (site-II), and distal (site-III) aspects of the thenar eminence when the median nerve was activated at the wrist. In the site-I and -II, both the surface and needle CMAPs shared many similar characteristics although the needle CMAPs were larger (∼ 5 folds) and briefer (∼ 60%, needle/surface duration). In addition, on the surface recording, the CMAP was larger (by ∼ 1.9 mV) when recorded from the site-I comparing to that of the site-II. In the site-III, the surface recordings registered a delayed (by ∼ 3.8 ms) CMAP. The muscle fiber action potential (MFAP) study suggested a predominant FPB contribution in the site-III. The optimal recording site for APB derived thenar CMAP is the site-I and for FPB is the site-III. The CMAPs registered by the needle recordings are more robust than the surface ones.

Development of the human prepuce and its innervation

Development of the human prepuce was studied over the course of 9–17 weeks of gestation in 30 specimens. Scanning electron microscopy revealed subtle surface features that were associated with preputial development, namely the appearance of epidermal aggregates that appeared to be associated with formation of the preputial fold. Transverse and sagittal sections revealed that the epidermis of the glans is considerably thicker than that of the penile shaft. We described a novel morphogenetic mechanism of formation of the preputial lamina, namely the splitting of the thick epidermis of the glans into the preputial lamina and the epidermis via the intrusion of mesenchyme containing red blood cells and CD31-positive blood vessels. This process begins at 10–11 weeks of gestation in the proximal aspect of the glans and extends distally. The process is likely to be androgen-dependent and mediated via androgen receptors strategically localized to the morphogenetic process, but signaling through estrogen receptor may play a role. Estrogen receptor alpha (ESR1) has a very limited expression in the developing human glans and prepuce, while estrogen receptor beta (ESR2) is expressed more broadly in the developing preputial lamina, epidermis and urethra. Examination of the ontogeny of innervation of the glans penis and prepuce reveals the presence of the dorsal nerve of the penis as early as 9 weeks of gestation. Nerve fibers enter the glans penis proximally and extend distally over several weeks to eventually reach the distal aspect of the glans and prepuce by 14–16 weeks of gestation.

2154 In Situ Plastic Biliary Stents Causing Intestinal Perforation: A Case Series

INTRODUCTION: Intestinal perforation is a rare complication of plastic biliary stents which exclusively occurs in the setting of preceding stent migration. We present the first case series to our knowledge of four patients with intestinal perforation from non-migrated in-situ plastic biliary stents. CASE DESCRIPTION/METHODS: 1: A 65-year-old-woman with biliary stent placement for cholangiocarcinoma-related obstruction presented with acute right upper quadrant (RUQ) pain. She had tachycardia, RUQ tenderness, and elevated liver function tests (LFT). CT scan showed duodenal perforation, and on ERCP a stent was seen perforating through the opposite duodenal wall. Prior straight 10Frx12 cm plastic stent was exchanged for a similar stent with a full external pigtail and a ½ internal pigtail. Over the scope clip was used to close the defect. 2: A 69-year-old-man with biliary stent placement for malignancy-related biliary stricture presented with acute RUQ pain. He had tachycardia, RUQ tenderness, and leukocytosis. CT scan showed duodenal perforation from distal tip of biliary stent with proximal aspect still in the common bile duct (CBD) though ERCP showed no obvious defect. Prior straight 10Frx10 cm plastic stent was exchanged for a similar stent with a full external pigtail and a ¾ internal pigtail. 3: A 60-year-old man with metastatic colorectal carcinoma of the liver with hepatic arterial infusion pump associated biliary sclerosis and stent placement presented with acute RUQ pain. He had leukocytosis, RUQ tenderness, and an acute LFT elevation. ERCP showed biliary stent causing duodenal wall ulceration. Prior 10 F × 12 cm plastic stent was replaced with a similar stent with a full external pigtail and ¾ internal pigtail. 4: A 24-year-old man with NASH cirrhosis status post orthotopic liver transplant and stent placement for anastomotic biliary stricture presented with acute LFT elevation. On ERCP, three plastic biliary stents were seen penetrating duodenal wall with proximal tips in place. Prior straight 10Frx12 cm plastic stents were replaced with similar stents with full external pigtail and a ¾ internal pigtail. An over the scope clip was used to close duodenal defect. DISCUSSION: Complication by in-situ plastic biliary stents may be decreased with full external pigtail stents. Stent exchange was successful in all cases, except case 4. This may have been due to the benign etiology of obstruction compared to malignant etiologies for others. An over the scope clip may be used successfully to close duodenal defect.

1715 Esophageal Stent Causing Osteomyelitis: An Emerging Complication

INTRODUCTION: Esophageal stents are used to treat a wide variety of problems, most commonly malignant dysphagia as a form of palliation. Delayed complications include tumor ingrowth/overgrowth, stent migration, hemorrhage, and delayed perforation. We present a rare case of osteomyelitis secondary to a stent that was placed for the closure of a tracheoesophageal fistula. CASE DESCRIPTION/METHODS: A 55-year-old female presented with stage IV non-small-cell lung cancer with distant metastases. She was started on chemotherapy (gemcitabine and carboplatin) as well as immunotherapy (pembrolizumab). A bronchoscopy had revealed extensive cancer in the bronchial tree and detected a tracheoesophageal fistula, which required placement of an esophageal stent for closure. The stent had been repositioned twice for better location and patient comfort. Four months after the last stent, she presented with fevers, which was initially attributed to her malignancy. However, her symptoms eventually progressed to dysphagia, cough, chest and back pain. Serologic evaluation was notable for an elevated ESR at 112 and an elevated CRP of 105. Subsequent CT of the chest revealed erosive endplate changes at the T1-T2 vertebral level with soft tissue density adjacent to the proximal aspect of the stent. These findings were concerning for osteomyelitis in the setting of an esophageal stent erosion. The decision was made to reposition the stent endoscopically. EGD revealed that the proximal end of the stent was embedded into the esophageal wall without clear erosions or evidence of perforation. Attempt to reposition the esophageal stent was performed, but follow up CT revealed minimal change from endoscopic repositioning. No further endoscopic intervention was performed and she was treated for osteomyelitis with intravenous antibiotics. DISCUSSION: Few cases have reported osteomyelitis related to esophageal stent migration. Whether the stent-related osteomyelitis is potentiated by the effects of chemotherapy on the esophageal wall or related to pressure erosion caused by the stent is not entirely clear. With newer therapies for malignancies and increased life expectancies, new complications may emerge. The decision to perform endoscopic manipulation would largely depend on patients’ clinical status and a discussion of risks versus benefits in a case-based scenario. This case illustrates the importance of having a high index of clinical suspicion for osteomyelitis in a patient with previous esophageal intervention.

1744 Not an Ordinary Ulcer: A Case of an Aorto-Esophageal Fistula

INTRODUCTION: Hematemesis is a common manifestation of variceal and non-variceal upper gastrointestinal (GI) bleed with a broad differential. Aortoesophageal fistula (AEF) is a life-threatening and catastrophic cause of gastrointestinal bleeding, which is caused by the abnormal communication between the aorta and the esophagus. We are presenting a rare case aorto-esophageal fistula in a young patient who was found to have a benign appearing esophageal ulcer on endocscopy that subsequently was found to be an (AEF). CASE DESCRIPTION/METHODS: A 33-year-old Caucasian male presented to the hospital for fatigue, non-blood emesis and progressively worsening leg swelling. His history is significant for hypertension, seizure disorder, chronic kidney disease (due to pauci-immune glomerulonephritis), heart failure and a descending aortic transection due to an accident 12 years ago which was repair endovascularly. The patient reported usage of NSAIDs prior to admission for pain control but otherwise denied alcohol or other substance abuse. The patient was admitted for his progressive renal failure and was started on hemodialysis complicated with a DVT for which was started on warfarin. During his hospitalization, the patient had an episode of hematemesis with hemodynamic instability which prompted cessation of anticoagulation. An EGD revealed a 2-3 cm non-bleeding ulcer in the proximal esophagus. The patient had stabilized hematocrit and hemodynamics and was restarted on anticoagulation. A week later, the patient had another episode of massive hematemesis with hypotension. A chest x-ray showed widening of the aortic knob, suggested change in location of the thoracic stent. CT angiogram showed aortoesophageal fistula with a leaking pseudoaneurysm at the proximal aspect of the thoracic aortic endovascular stent. Surgery proceeded with endovascular aortic repair of thoracic pseudoaneurysm. Patient had multi-disciplinary management strategy for staged repair. DISCUSSION: AEF are classified as primary i.e. spontaneous erosion of the aortic wall into the esophagus or secondary caused by either esophageal malignancy, surgeries or foreign body. Exact incidence of the AEF is unknown. Early recognition is important to decrease mortality. Chiari et al described the triad of midthoracic pain, herald hemorrhage, and fatal hematemesis as usual presenting features. Endoscopy plays a significant role in the evaluation however it has a poor rate of detection for AEFs prompting the need of CT imaging with high clinical suspicion.

The TREATMENT OF ASTHIMAJJA VIDRADHI BY BHEDANA KARMA - CASE REPORT

In Ayurveda Sushruta explained the concept of Asthi Vidradhi in Sushrut Samhita Nidansthan -9/33,34. which can be resemble like Brodie’s Abscess. Asthi Vidradhi is developed anywhere in the bone due to asthi and majja dushti by vitiated dosha. A case of Asthi Vidradhi (Brodie’s abscess) at Vam Antarjranghasthi ( Brodie’s Abscess at Left Tibia proximal end anterior aspect). Brodie’s abscess is localized collection of pus in the metaphysis of bone. Brodies’s abscess is common at upper end of tibia. Brodie’s abscess usually cause by Staphylococcus. It can also develope due to tuberculosis, typhoid, syphilis also. Prevalance of osteo-articular tuberculosis is 1-3%. The character of the brodie’s abscess is during attack pain increase on walking and worsen in night which relieve on rest. It can lead to pathological fracture. This abscess has potential to develop osteogenic sarcoma. Slow evolution remain an essential factor in diagnosis delays. A 28 years old female presented with complaints of swelling at left knee joint anteriorly since 6 months. MRI Scan of left knee joint shows A well defined sub cortical infective erosive lesion in the proximal shaft of tibia . Overlying soft tissue shows an infective collection. Possibilities of Brodie’s abscess . Patient was operated for Curettage of Brodie’s abscess under spinal anaesthesia. Tuberculous Osteomyelitis was diagnosed from HPE reports. Patient take AKT (Anti-Koch’s Treatment) regimen for 9 months for tuberculous osteomyelitis and 3 months alternate day dressing, follow up wound healed well.

Long bone failure after intraosseous regional perfusion

SummaryA 5‐year‐old Australian Stock Horse gelding was initially referred to the Charles Sturt University Veterinary Clinical Centre (CSUVCC) for assessment of a penetrating laceration over the medial splint bone (second metacarpal bone) of the left foreleg. Clinical examination failed to reveal a communication with a synovial structure, but radiographs showed a palisading bone reaction on the proximal aspect of the medial splint bone which was thought to be a characteristic of infection. Soft tissue swelling precluded access to a peripheral vein, so a decision was made to use intraosseous regional limb perfusion. This was achieved through an access portal in the lateral diaphysis of the third metacarpal bone (McIII). Subsequently, the horse developed lameness and further investigation revealed a nondisplaced longitudinal fracture of McIII propagating from the intraosseous regional perfusion access portal.

Carpal tunnel ultrasound: is the "safe zone" on the ulnar side of the median nerve really avascular?

Numerous publications have studied the regional anatomy of the carpal tunnel to define a "safe zone" to reduce the risk of perioperative neurovascular complications. This zone, located between the ulnar neurovascular bundle and the median nerve, is considered to be safe mainly because of the absence of vascular structures. This study aims to assess the presence of arterioles within this area using superb microvascular imaging (SMI). The images from patients who underwent a bilateral routine wrist ultrasound with SMI, between January 28 and February 28, 2019, were retrospectively reviewed by two radiologists to evaluate the presence and location of arterioles in the safe zone. In addition, cadaveric wrists injected with intra-arterial red latex underwent dissection of the carpal tunnel. The images from 27 patients (54 wrists) were reviewed. In the safe zone, arterioles were seen superficial to the retinaculum in 36 wrists (36/54; 66.7%) and deep to the retinaculum in 21 wrists (21/54; 38.9%). The arterioles located deep to the retinaculum were more frequently found close to the median nerve (21/54; 38.9%) than to the ulnar artery (9/54; 16.7%). In five cadaveric wrists, arterioles were detected superficial to the retinaculum in 3 wrists (3/5; 60%) and deep to the retinaculum in 2 wrists (2/5; 40%). Arterioles can be seen in the safe zone both superficial and deep to the flexor retinaculum. Deep to the retinaculum, they are mainly observed in the proximal aspect of the carpal tunnel and more frequently close to the median nerve. • Superb microvascular imaging (SMI) enables the visualization of arterioles within the "safe zone" of the carpal tunnel (visible both superficial and deep to the flexor retinaculum). • Arterioles were more frequently observed in the proximal aspect of the carpal tunnel. • Deep to the retinaculum, arterioles were more frequently seen in proximity to the median nerve.

A Comparison between Oblique and Vertical Incisions on the Hamstring Tendon Harvesting in Anterior Cruciate Ligament Reconstruction and Infrapatellar Branch Injury of the Saphenous Nerve.

Objective The present study aimed to compare the oblique and vertical incisions in hamstring tendon harvesting in anterior cruciate ligament (ACL) reconstruction and in infrapatellar branch injury of the saphenous nerve. Methods The present study was conducted at a tertiary referral center for 12 months. Patients with an indication of reconstruction of ACL tear were included in the study, who were then randomized into two groups (vertical [VG] and oblique [OG] groups). After excluding a few cases, 92 patients were eligible for further analysis (VG: n= 44; OG: n = 48). They were followed-up for 9 months after the surgery, and loss of sensation over the knee and over the proximal aspect of the operated leg was recorded. Results The mean lengths of the incisions were 27 mm and 38 mm for the OG and VG groups, respectively. The total rate of hypoesthesia was 40% (27 patients). A total of 12 (25%) and 25 patients (56.8%) on the OG and VG groups, respectively, reported hypoesthesia symptoms. The presence of hypoesthesia in patients in the VG group was two times higher than in the OG group. No statistical correlation was observed between the nerve injury and age, gender, education, and delay from injury to reconstruction. Conclusion Oblique incision, which showed lower risk of nerve damage, might be more recommended for graft harvesting. Patients who underwent reconstruction of the ACL in the OG group had a lower incidence of peri-incisional hypoesthesia when compared to those in the VG group.

Anatomical course of the lateral femoral cutaneous nerve with special reference to the direct anterior approach to total hip arthroplasty

Objectives: To document the anatomical variation of the lateral femoral cutaneous nerve (LFCN) at the proximal aspect of the thigh and to determine its susceptibility to injury during total hip arthroplasty via a direct anterior approach (DAA).Methods: We obtained 64 thighs from formalin-preserved cadavers of 45 Japanese individuals. LFCN was identified at the level of the inguinal ligament. All nerve branches of the LFCN were carefully traced distally in the subcutaneous tissue. The branching pattern and distribution at the proximal aspect of the thigh were described. A safe zone to avoid LFCN injury in DAA was estimated for the skin incision.Results: The branching pattern of LFCN was highly varied. There were 37% of the anterior type, characterized by a thicker anterior branch, which coursed along the medial border of the tensor fascia lata (TFL) muscle with thinner branches. There were 63% of the posterior type, characterized by posterior branches thicker than or equal to the anterior branch. In 27 of 64 thighs (42%), the LFCN crossed the skin incision along the midline of the TFL muscle.Conclusion: LFCN showed anatomical variation of anterior and posterior branches and 42% were in danger of injury during DAA.

PROXIMAL BRACHIAL MONOMELIC AMYOTROPHY OR HIRAYAMA DISEASE: NO LONGER AN ALIAS? (case report)

Background. Brachial Monomelic Amyotrophy (BMMA) has been called as Hirayama disease (HD) when it is characterized by unilateral distal upper limb weakness and atrophy that shows progression for a limited period and is associated with typical features on MRI of cervical spine in flexion.&#x0D; Objective was to explore the differences when BMMA affects the proximal upper limb muscles with the help of case report.&#x0D; Methods. A case report of BMMA in an adult Indian male is represented.&#x0D; Results. A 30-year-old man presented to us with a history of weakness in the proximal aspect of his left upper limb that began four years ago. The weakness was progressive up until 6 months prior to his presentation since when the weakness had neither worsened nor improved. Cervical spine contrast enhanced MRI revealed mild loss of cervical lordosis, but no features of HD like localized cord atrophy, loss of attachment of dura from subjacent lamina on neutral position axial T2WI MRI, nor any presence of posterior epidural crescentic enhancing mass on flexion contrast sagittal T1WI MRI. The patient was managed with supportive therapy and has been under regular follow up ever since. His clinical status has been stable.&#x0D; Conclusions. We support the suggestion to consider proximal Brachial Monomelic Amyotrophy to be a separate entity and to be distinguished from Hirayama disease that should be reserved for patients with distal upper limb involvement with cervical MRI findings on flexion studies.

Repair of Tibial Plateau Fracture (Schatzker II).

Tibial plateau fracture is an injury commonly seen by those who treat trauma around the knee and/or sports-related injuries. In this video article, we present our protocol for surgical treatment of a tibial plateau fracture, which includes definitive fixation with use of a plate-and-screw construct, addressing of all associated soft-tissue injuries at the time of the surgical procedure, filling of any residual voids with bone cement, and early rehabilitation with weight-bearing beginning at 10 to 12 weeks postoperatively. The major steps of the procedure are (1) preoperative planning with digitally templated plates and screws, (2) patient positioning and setup, (3) anterolateral approach toward the proximal aspect of the tibia, (4) submeniscal arthrotomy, (5) booking open of the proximal aspect of the tibia at the fracture site, (6) tagging of the meniscus, (7) fracture reduction and placement of the Kirschner wire, (8) confirmation of reduction with C-arm image intensification, (9) internal fixation with a plate-and-screw construct, and (10) closure.