Cadaveric Investigation Research Articles

Normal range of motion at the hip show different pressure behavior in the lateral and acetabular compartments: a cadaveric investigation

PurposeThe techniques used previously to assess intracapsular pressures did not allow the assessment of pressure variations in both compartments throughout the entire range of motion without puncturing the capsular tissue. Our hypothesis was that the intra-capsular pressure would be different in the lateral and acetabular compartment depending on the movement assessed.MethodsEight hip joints from four cadaveric specimens (78.5 ± 7.9 years) were assessed using intra-osseous tunnels reaching the lateral and acetabular compartments. Using injector adaptors, 2.7 ml of liquid were inserted in both compartments to simulate synovial liquid. Optic pressure transducers were used to measure pressure variations. We manually performed hip adduction, abduction, extension, flexion and internal rotation at 90° of flexion.ResultsHip extension and internal rotation show the highest intra-capsular pressures in the lateral compartment with increases of 20.56 ± 19.29 and 19.27 ± 18.96 mmHg, respectively. Hip abduction and hip internal rotation showed depressurisations of − 16.86 ± 18.01 and − 31.88 ± 30.71 mmHg in the acetabular compartment, respectively. The pressures measured in the lateral compartment and in the acetabular compartment were significantly (P < 0.05) different for the hip abduction, 90° of flexion and internal rotation. Pressure variations showed that maximum intracapsular fluid pressures in the lateral compartment occur at maximum range of motion for all movements.ConclusionAs an increase in pressure may produce hip pain, clinician should assess pain at maximum range of motion in the lateral compartment. The pressure measured in the acetabular compartment vary depending on the hip position. The movements assessed are used in clinical practice to evaluate hip integrity and might bring pain. The pressure variations throughout the entire range of motion are a relevant information during hip clinical assessment and might help clinicians to better understand the manifestations of pain.

Development of Ultrasound-Guided Technique for 4 Points Blockade of Manus in Dromedary Camel: A Cadaveric Investigation

The purposes of this study were to describe the most applicable approach of manus blockade in camel using ultrasound-guided techniques. The study was performed on 40 forelimbs of 20 apparently healthy mature freshly slaughtered camels. Limbs were randomly allocated into 3 phases of the study. Phase-I (n=8 limbs): dissection of both dorsal and palmar aspects to identify the topographical anatomy of the target nerves. Phase-II (n=8 limbs): dissection after US guided needle insertion to confirm the needle insertion position. Phase-III (n=24 limbs): US-guided methylene blue injection using one of three volumes (3, 5, or 7 mL) to establish the ideal injection volume. Our results revealed that the dorsal aspect of manus received its innervation from dorsal common digital nerves II and III (DCDN-II &amp; III) and dorsal common digital nerve IV (DCDN-IV). The palmar aspect of manus was received its innervation from the palmar common digital nerve IV (PCDN-IV) and the median nerve. Under Ultrasonographic guidance, the most applicable approach for blocking the DCDN-II &amp; III is at the dorsomedial aspect at about 8-10 c.m below the carpometacarpal joint (CMJ) and 2 cm medial to CDET. Blocking of the DCDN-IV is performed at the dorsolateral aspect at about 8-10 c.m below the CMJ and 2 cm lateral to CDET. Blocking the PCDN IV was performed at the lateral and palmar aspect at about 10-12 c.m below the accessory carpal bone (ACB) and 5 cm palmar to the imaginary line bisect the forelimb longitudinally from lateral to medial. Blocking the median nerve was performed at the proximal third of medial and palmar aspect of metacarpal bone at about 10-12 c.m below the ACB and about 5 cm palmar to the same imaginary line. In conclusion, four point blockade of the manus region in dromedary cadavers can be achieved by US-guided injection of the DCDN-II, III, DCDN-IV, PCDN-IV, and the median nerve.

The Effectiveness of Saline Load Test in Detecting Simulated Traumatic Elbow Arthrotomies: A Cadaveric Investigation.

BackgroundThe saline load test has not been well explored in the elbow. We aimed to determine 1) the saline infusion volume needed for 90%, 95%, and 99% sensitivity in detecting elbow arthrotomy; and 2) factors associated with higher volume at detection using sixteen forequarter upper extremity amputation cadavers.MethodsSixteen fresh-frozen forequarter upper extremity amputations were procured, and demographic data, including age, body mass index (BMI), and laterality, were recorded. The olecranon process, radial head, and the lateral epicondyle were palpated, and elbow arthrotomy was consistently performed at the direct lateral arthroscopic portal site. The elbow joint was loaded with saline mixed with methylene blue (concentration: 2 mg/300 mL) using an 18-gauge needle inserted just medial to the triceps tendon 2 cm superior to the olecranon.ResultsMean volume for extravasation was 12.2 mL ±6.26. Volume needed for 90%, 95%, and 99% sensitivities were 21 mL, 23 mL, and 25.4 mL. Linear regression demonstrated that increasing age was associated with lower volume to extravasation (OR: 0.67; 95% CI: 0.48-0.932; p=0.037), while BMI (p=0.571) and extremity laterality (p=0.747) did not affect the volume.ConclusionsThe saline load test can be effective in diagnosing the violation of the elbow joint in traumatic injuries. This test should be used in conjunction with the clinical examination and radiographs before operative decisions are made. We recommend using ≥26 mL to rule out traumatic elbow arthrotomy.

Innervation of the clavicle: a cadaveric investigation

BackgroundThis cadaveric study investigated the innervations of the clavicle and clavicular joints (ie, sternoclavicular and acromioclavicular joints).MethodsTwenty cadavers (40 clavicles) were dissected. A skin incision was made to permit exposure...

The prevalence and distribution of sternalis muscle: a meta-analysis of published literature of the last two hundredyears.

The sternalis muscle (SM) is an anatomical variant that lies subcutaneously and is superficial to the pectoralis major muscle or sternum. The present meta-analysis was conducted to analyze the prevalence, anatomical features, and variance of the SM in different population. In total, 98 studies were included for this meta-analysis. Eighty-two studies dealt with adult subjects, and sixteen studies with fetuses. The worldwide prevalence of SM was observed to be 6% or 0.06 [0.05-0.7, 95% CI] in 27,470 adults, whereas it was 0.29 [0.20-0.39, 95% CI] in 673 fetuses. In 259 anencephalic fetuses, the prevalence was 44% or 0.44 [0.26-0.63, 95% CI], while the same in 414 fetuses without anencephaly was 16% or 0.16 [0.06-0.27, 95% CI]. The reported prevalence rate in Asian mongoloid population (9.1% = 0.091) was three times that of the Asian Caucasian population (3.33% = 0.0333). The prevalence in European descent was 3.93%. Interestingly, the reported prevalence rates in North and South American populations were 3.44% and 3.66%, almost being equivalent. The cadaveric investigations revealed that the SM had an overall prevalence of 5.96% in adults based on 76 studies, which was higher than other modalities of investigations. The multi-detector computerized tomography (MDCT) had shown the prevalence of approximately 4.33%. The same was reported in surgical studies and mammographic studies as 0.47% and 0.02%, respectively. The SM is not an unusual variant of the chest wall musculature. MDCT could be a new method to precisely demonstrate the morphology, course, and size of the SM in vivo.

Cadaveric investigation of the minimum effective volume for ultrasound-guided suprainguinal fascia iliaca block

BackgroundThis cadaveric dose-finding study investigated the minimum effective volume of dye in 90% of cases (MEV90), required to stain the femoral, lateral femoral cutaneous and obturator nerves for ultrasound-guided suprainguinal...

The mobility of the superficial and deep midfacial fat compartments: An ultrasound-based investigation.

Understanding the mobility of the midface and the separate contributions of the superficial and deep fat compartments is essential for natural esthetic outcomes following soft tissue filler or fat grafting procedures. A study was designed that used ultrasound imaging to demonstrate in vivo visualization and quantification of distances and movements in the midface. A total of 48midfaces of 24healthy Caucasian volunteers, all naïve of esthetic procedures, (22 females; 46.85 (9.8) years; 22.83 (3.1) kg/m2 ) were scanned using 18MHz ultrasound imaging. Distances between bony landmarks (inferior orbital rim, infraorbital foramen) were used as markers to measure the cranial movement of the superficial (superficial nasolabial and superficial medial cheek fat compartment) and the deep (deep pyriform space, deep medial check fat compartment, deep lateral cheek fat compartment) midfacial fat compartments between resting and smiling facial position. The superficial midfacial fat compartment moved, on average, 3.7mm (p<0.001) cranially, whereas the deep midfacial fat compartments moved, on average, 0.1mm (p>0.05) during smiling. No gender differences in mobility were identified (p>0.05). The results obtained are in line with previous cadaveric investigations and revealed, in a highly statistically significant fashion, that the superficial midfacial fat compartments move in cranial direction whereas the deep fat compartment did not display similar positional changes. These results help to guide facial injectable treatments and to understand why, in the midface, a deep supraperiosteal approach should be favored when augmenting the deep midfacial fat compartments.

The Carotid Endarterectomy Cadaveric Investigation for Cranial Nerve Injuries: Anatomical Study.

Cerebral stroke continues to be one of the leading causes of mortality and long-term morbidity; therefore, carotid endarterectomy (CEA) remains to be a popular treatment for both symptomatic and asymptomatic patients with carotid stenosis. Cranial nerve injuries remain one of the major contributor to the postoperative morbidities. Anatomical dissections were carried out on 44 sides of 22 cadaveric heads following the classical CEA procedure to investigate the variations of the local anatomy as a contributing factor to cranial nerve injuries. Concurrence of two variations was found to be important in hypoglossal nerve injury: the presence of a direct smaller vein in proximity of the carotid bifurcation, and the intersection of the hypoglossal nerve (HN) with this vein. Based on the sample investigated, this variation was observed significantly higher on the right side. Awareness of possible anatomical variations and early ligation of any small veins can significantly decrease iatrogenic injury risk.

A Cadaveric Investigation to Advance the Understanding of Deltoid Vein

A Cadaveric Investigation to Advance the Understanding of Deltoid Vein

Ultrasound-Guided Fasciotomies of the Deep and Superficial Posterior Leg Compartments for Chronic Exertional Compartment Syndrome: A Cadaveric Investigation.

Chronic exertional compartment syndrome (CECS) is a type of leg pain related to elevated intracompartmental pressure with activity in one or more of the four compartments of the leg. Open fasciotomy is the definitive treatment for CECS but has a reported complication rate of up to 15.7% and return to full activity reported up to 16 weeks. Ultrasound-guided (USG) fasciotomy of the anterior and lateral compartments has been translated into clinical practice. To determine the safety and feasibility of a USG fasciotomy of the deep posterior compartment (DPC) and superficial compartment (SPC) of the leg in a fresh-frozen cadaveric model. Prospective, cadaveric laboratory investigation. Procedural skills laboratory at an academic institution. Ten fresh-frozen cadaveric knee-ankle-foot specimens from five female and five male donors aged 58 to 93 years (mean 77.4 years) with body mass indexes of 18.1 to 33.5kg/m2 (mean 25.1 kg/m2 ). One experienced operator performed 10 USG DPC and SPC fasciotomies. A clinical anatomist performed dissections of each. Achievement of target length and continuity of release was recorded. Target lengths of 10 cm for the superficial posterior compartment (SPC) and 15 cm for the deep posterior compartment (DPC) were established based on previous studies. Tendinous and neurovascular structures were assessed for damage. No tendon or neurovascular injuries were observed. In the SPC, target length was achieved in 90% and continuous release was observed in 80%. In the DPC, target length was achieved in 60% and continuity observed in 30%. These findings suggest that SPC USG fasciotomies using the technique described in this study are feasible, may be safe, and warrant further translational research; however, DPC USG fasciotomies are more challenging and require more technical refinement prior to clinical translation.

Feasibility, technique and accuracy of ultrasound-guided transurethral injections into the urinary sphincter of female cadavers: proof of concept

BackgroundThe injection of muscle precursor cells (MPC) into the external urinary sphincter muscle (EUS) is a promising therapeutic option for regenerative treatment of stress urinary incontinence (SUI). The objective of the present project was to conduct a pre-clinical trial to investigate the feasibility and accuracy of ultrasound (US) guided, transurethral injections into the EUS of female cadavers.MethodsThis is a prospective, anatomical, interventional and radiological cadaveric laboratory investigation. Two urologists performed transurethral US-guided injections to deliver nano-iron particles into the EUS. The intervention was performed in three unfixed, fresh female cadavers. Each cadaver received MRI before and CT as well as MRI of the pelvis after the injections.ResultsThe precision and accumulation of nano-iron particles in the EUS was compared using a rating scale to evaluate left versus right and anterior versus posterior distribution in axial and sagittal orientation with US, MRI and CT. The accuracy of our US-guided injections into the anterior target region yielded 4 points on the rating scale. Adequate precision and accumulation of particles in the left versus right EUS were also demonstrated (3 vs. 3.33 points, respectively). Signal intensity in MRI revealed a mean ratio of 0.33 before and after injection. CT scans showed no relevant artefacts impairing the assessment.ConclusionUS-guided, transurethral injection into the EUS is feasible and imaging reveals a precise accumulation in the target region. Our method provides an appropriate approach to deliver MPC in the EUS muscle for a regenerative treatment of SUI in the near future.

Evaluation of nerve capture using classical landmarks for genicular nerve radiofrequency ablation: 3D cadaveric study

Background and objectivesRadiofrequency (RF) denervation of the superolateral genicular nerve (SLGN), superomedial genicular nerve (SMGN) and inferomedial genicular nerve (IMGN) is commonly used to manage chronic knee joint pain. However,...

Validity of an instrumented knee brace compared to 3D motion navigation: A cadaveric investigation

The aim of this study was to test the accuracy and the reliability of 3-dimensional angular measurements of an instrumented knee brace compared to the gold standard navigation system optoelectronic cameras-based.Thirteen cadaveric bodies were used to calculate kinematic knee parameters. Three exercises were performed, 100° flexion (FLEX100), internal/external rotation with a 30° flexion (ROT30), and the pivot shift test (PS).The reliability was excellent with an ICC (95%) > 0.90. The agreement between the two systems showed excellent correlation in the F/E axis for FLEX100 and PS (σ (Flex/Ext) > 0.95) and strong correlation in the I/E axis for ROT30 (σ (Rot Int/Ext) > 0.939). The root mean square error (RMSE) was under 5° for all exercises considering the soft tissue artifact (STA) for the F/E axis.Consequently, the instrumented knee brace exposed high reliability and accuracy which could end up on clinical interpretations thanks to the previous measures.

Treatment of lumbar spinal stenosis with the HQ (Hernández and Quintana) interbody screw, with minimally invasive technique

Lumbar spinal stenosis is a frequent ailment that affects people over 50years. With previous studies by J. Zucherman, and the cadaveric investigations with maximum flexion and extension by W. Rauschning, it was demonstrated that the bulging of the posterior longitudinal ligament and the ligamentum flavum were the main causes of radicular compression; but, the key aspect was that once the interbody space was expanded, the compression was relieved. However, a posterior stabilization and an interbody arthrodesis must be performed.

Assessment of Surgical Procedural Time, Pedicle Screw Accuracy, and Clinician Radiation Exposure of a Novel Robotic Navigation System Compared With Conventional Open and Percutaneous Freehand Techniques: A Cadaveric Investigation.

Study Design:Cadaveric study.Objective:To evaluate accuracy, radiation exposure, and surgical time of a new robotic-assisted navigation (RAN) platform compared with freehand techniques in conventional open and percutaneous procedures.Methods:Ten board-certified surgeons inserted 16 pedicle screws at T10–L5 (n = 40 per technique) in 10 human cadaveric torsos. Pedicle screws were inserted with (1) conventional MIS technique (L2–L5, patient left pedicles), (2) MIS RAN (L2–L5, patient right pedicles), (3) conventional open technique (T10–L1, patient left pedicles), and (4) open RAN (T10–L1, patient right pedicles). Output included (1) operative time, (2) number of fluoroscopic images, and (3) screw accuracy.Results:In the MIS group, compared with the freehand technique, RAN allowed for use of larger screws (diameter: 6.6 ± 0.6 mm vs 6.3 ± 0.5 mm; length: 50.3 ± 4.1 mm vs 46.9 ± 3.5 mm), decreased the number of breaches >2 mm (0 vs 7), fewer fluoroscopic images (0 ± 0 vs 108.3 ± 30.9), and surgical procedure time per screw (3.6 ± 0.4 minutes vs 7.6 ± 2.0 minutes) (all P < .05). Similarly, in the open group, RAN allowed for use of longer screws (46.1 ± 4.1 mm vs 44.0 ± 3.8 mm), decreased the number of breaches >2 mm (0 vs 13), fewer fluoroscopic images (0 ± 0 vs 24.1 ± 25.8) (all P < .05), but increased total surgical procedure time (41.4 ± 8.8 minutes vs 24.7 ± 7.0 minutes, P = .000) while maintaining screw insertion time (3.31.4 minutes vs 3.1 ± 1.0 minutes, P = .650).Conclusion:RAN significantly improved accuracy and decreased radiation exposure in comparison to freehand techniques in both conventional open and percutaneous surgical procedures in cadavers. RAN significantly increased setup time compared with both conventional procedures.

Anatomical Study of Anterior Inferior Cerebellar Artery and Its Reciprocal Relationship with Posterior Inferior Cerebellar Artery Based on Angiographic Data

Anterior inferior cerebellar artery (AICA) can present with a myriad of variations. However, the previous studies of AICA anatomy were based on small-scale cadaveric investigation. In this study, we performed an angiographic study of AICA in 500 Chinese with Han nationality based on digital subtraction angiography (DSA). Patients admitted to our institution between 2015 and 2018 who had underwent DSA were potential candidates for this retrospective evaluation. The exclusion criteria were: a) patients with vascular diseases of the posterior circulation; b) ischemic diseases or moyamoya disease of the anterior circulation. Five hundred patients were identified. The patients ranged in age from 6 to 75 years. Two hundred thirty-seven (62.9%, 237 of 377) patients had bilateral AICAs at the same level, and 140 (37.1%, 140 of 377) had bilateral AICAs at different levels. The developing states of AICA were grade 0 in 31 (3.5%, 31 of 896), grade 1 in 373 (41.6%, 373 of 896), grade 2 in 313 (34.9%, 313 of 896), and grade 3 in 179 (20.0%, 179 of 896) hemispheres. Two hundred twenty-one (22.1%, 221 of 1000) presented with AICA-PICA common trunks. Thirty-one (3.1%, 31 of 1000) hemispheres showed no obvious AICA angiographically. AICA arose as a single trunk in 865 (86.5%, 865 of 1000) hemispheres, and as duplicate trunks in 104 (10.4%, 10 of 1000) hemispheres. Triplicate or more trunks were not seen. AICA originating from the basilar artery fenestration accounted for 4% (20 of 500) of the cases. This is the first attempt using DSA data to perform a large-scale investigation of AICA variations. The ever-growing need of endovascular intervention calls for more suitable anatomical explanation of the vascular structures.

Jean Talairach: a cerebral cartographer.

Although French psychiatrist-turned-neurosurgeon Jean Talairach (1911-2007) is perhaps best known for the stereotaxic atlas he produced with Pierre Tournoux and Gábor Szikla, he has left his mark on most aspects of modern stereotactic and functional neurosurgery. In the field of psychosurgery, he expressed critique of the practice of prefrontal lobotomy and subsequently was the first to describe the more selective approach using stereotactic bilateral anterior capsulotomy. Turning his attention to stereotaxy, Talairach spearheaded the team at Hôpital Sainte-Anne in the construction of novel stereotaxic apparatus. Cadaveric investigation using these tools and methods resulted in the first human stereotaxic atlas where the use of the anterior and posterior commissures as intracranial reference points was established. This work revolutionized the approach to cerebral localization as well as leading to the development of numerous novel stereotactic interventions by the Sainte-Anne team, including tumor biopsy, interstitial irradiation, thermal ablation, and endonasal procedures. Together with epileptologist Jean Bancaud, Talairach invented the field of stereo-electroencephalography and developed a robust scientific methodology for the assessment and treatment of epilepsy. In this article the authors review Talairach's career trajectory in its historical context and in view of its impact on modern stereotactic and functional neurosurgery.

Glenohumeral joint capsular tissue tension loading correlates moderately with shear wave elastography: a cadaveric investigation.

PurposeThe purpose of this study was to investigate changes in the mechanical properties of capsular tissue using shear wave elastography (SWE) and a durometer under various tensile loads, and to explore the reliability and correlation of SWE and durometer measurements to evaluate whether SWE technology could be used to assess tissue changes during capsule tensile loading.MethodsThe inferior glenohumeral joint capsule was harvested from 10 fresh human cadaveric specimens. Tensile loading was applied to the capsular tissue using 1-, 3-, 5-, and 8-kg weights. Blinded investigators measured tissue stiffness and hardness during loading using SWE and a durometer, respectively. Intraobserver reliability was established for SWE and durometer measurements using intraclass correlation coefficients (ICCs). The Pearson product-moment correlation was used to assess the associations between SWE and durometer measurements.ResultsThe ICC3,5 for durometer measurements was 0.90 (95% confidence interval [CI], 0.79 to 0.96; P<0.001) and 0.95 (95% CI, 0.88 to 0.98; P<0.001) for SWE measurements. The Pearson correlation coefficient values for 1-, 3-, and 5-kg weights were 0.56 (P=0.095), 0.36 (P=0.313), and -0.56 (P=0.089), respectively. When the 1- and 3-kg weights were combined, the ICC3,5 was 0.72 (P<0.001), and it was 0.62 (P<0.001) when the 1-, 3-, and 5-kg weights were combined. The 8-kg measurements were severely limited due to SWE measurement saturation of the tissue samples.ConclusionThis study suggests that SWE is reliable for measuring capsular tissue stiffness changes in vitro at lower loads (1 and 3 kg) and provides a baseline for the non-invasive evaluation of effects of joint loading and mobilization on capsular tissues in vivo.

Subperiosteal injections during facial soft tissue filler injections-Is it possible?

It can be hypothesized that safety during soft tissue filler injection could be enhanced if the product could be positioned between the periosteum and the bone surface i.e. subperiosteal. This study investigated the feasibilityof subperiosteal injections. We analysed 126 injection procedures performed in seven Caucasian body donors (4 males, 3 females) with a mean age of 75.29 ± 4.95 years [range: 70 - 87] and a mean body mass index of 23.53 ± 3.96 kg/m2 [range: 16.46 - 32.23]. The injection procedures were performed in the forehead, scalp, zygomatic arch and the mandible bilaterally. Injection procedures were conducted using 25G, 27G and 30G sharp-tip needles (TSK Laboratory, Tochigi, Japan) and at various angles from the bone surface measured with a goniometer: 90 degrees (perpendicular), 45 degrees and 10 degrees (as tangential as possible to bone surface). Cadaveric dissections of the injection sites showed that no product was located deep to the periosteum in any of the investigated regions. This indicates that all performed injection procedures positioned the product superficial to the periosteum (100%) with a zero-success rate of subperiosteal injections. In the setting of this cadaveric investigation, despite varying needle size and injection angle, subperiosteal injection could not be achieved. This indicates that the product can spread uncontrolled into more superficial layers yielding an increased risk for adverse aesthetic and vascular events.

Improvement in vertebral endplate engagement following anterior column reconstruction using a novel expandable cage with self-adjusting, multiaxial end cap

BackgroundDestabilization of the vertebral column – as seen in trauma and metastatic spine disease – often requires corpectomy and anterior column reconstruction. Stresses applied to the implant can lead to subsidence, ultimately requiring in surgical revision. Here we report a cadaveric investigation of a novel expandable corpectomy cage with a self-adjusting, multiaxial end cap. MethodsFour cadaveric T11-sacrum spines (mean 67.3 yr; 75% female) were treated with L2 corpectomy and T12-L4 pedicle screw fusion. Pressure sensors were applied to the L1 and L3 endplates and anterior column reconstruction was performed with either a standard expandable corpectomy cage (T2A), an expandable corpectomy cage with a self-adjusting, multiaxial end cap (T2S), or the latter cage with oblong, extended end caps (T2S + EE). Total contact area was compared pre- and post-reduction using ANOVA general linear model. ResultsPre-reduction, the T2S constructs had a trend of higher surface contact than the conventional T2A constructs, though the results were not significant (p = 0.068); however, T2S + EE constructs did produce significantly larger contact with vertebral endplates (p = 0.04). The difference was also significant for both conditions following compression (p < 0.01 for both constructs). ConclusionsThe use of an expandable corpectomy cage with a self-adjusting, multiaxial end cap produces significant increases in vertebral endplate contact area. These in vitro data suggest that the self-adjusting, multiaxial end cap may serve to decrease the risk of subsidence in patients undergoing anterior column resection and reconstruction. Clinical data would be required to confirm the relationship between endplate contact area and risk of subsidence.