Lateral Cut Research Articles

Efficacy of the Coronoid Notch and Occlusal Plane As Predictable Landmarks for Determining the Medial Cut Height in Bilateral Sagittal Split Osteotomy: A Split-Mouth Observational Study.

This split-mouth observational study was conducted to assess the reliability and safety of using the coronoid notch and occlusal plane as landmarks to aid surgeons during bilateral sagittal split osteotomy(BSSO). Thirteen patients between the ages of 18 and 30 years, with class II and class III mandibular skeletal malocclusion requiring BSSO, were randomly selected and assigned to each of the study and control groups. A split-mouth study was chosen to conduct this research. Cone beam computed tomography (CBCT) imaging was conducted before the surgery to evaluate the anatomical structure, and three predefined points were marked at the superiormost point of the mandibular foramen, the inferiormost point of the mandibular foramen, and the deepest point of the sigmoid notch. A conventional sagittal split osteotomy was carried out in the control group. Preoperative values were obtained in the study group using the CBCT imaging technique by drawing an imaginary line from the inferiormost part of the mandibular foramen to the line corresponding to the occlusal plane that extended beyond the last molar. The lingual flap reflection was restricted to the internal oblique ridge. The posterior border of the mandible was not reflected. The measurements acquired via CBCT imaging were accurately transferred to the intraoperative surgical site using a vernier caliper. This facilitated the precise completion of the horizontal osteotomy, ascending ramus cuts, and vertical osteotomies. BSSO was performed, the mandibular setback or advancement was done with intermaxillary fixation, and the procedure was completed by rigid fixation. Types of lingual splits, types of lateral bone cut ends (LBCEs), any unfavorable split, and the time taken for the surgery (in minutes) were assessed. The surgery time in the control group (20.1538 ± 2.85325 min) was found to be higher than that in the study group (17.6154 ± 3.59487 min), with a p-value of 0.02. No significant differences were observed when assessing the presence of unfavorable splits in both groups (p = 0.500). Buccal LBCEs were the most prevalent, followed by inferior types. Type I lingual split was the most common in the study group (70%). This technique offers a dependable anatomical reference and significantly reduces surgical time for beginners. Additionally, the patterns of the lingual split were correlated with the types of lateral bone cut ends.

Sagittal Orientation and Variabilities of the Anatomical Insertional Footprint of the Achilles Tendon: A Cadaveric Study

Category: Hindfoot; Sports Introduction/Purpose: New surgical techniques for Achilles tendon insertional pathology are evolving rapidly. Whether via open surgery, minimally invasive, or endoscopic approaches, more information about the Achilles' insertional footprint is needed to help surgeons with decision making. This study investigated the footprints of the Achilles insertion in sagittal orientation to delineate the anatomical landmarks, safe zones for bone resection3-down surgeries in treating insertional Achilles tendinopathies. Methods: Twenty fresh frozen cadavers were selected excluding insertional Achilles tendon pathology on lateral view x-rays. The calcanei were dissected maintaining the Achilles tendon insertion intact. Dimensions of the posterior tuberosity were recorded and marked to plan for three sagittal cuts (medial, middle, and lateral) (Fig 1 A). Using an oscillating saw (Fig 1 B.), the posterior tuberosity was cut into four pieces (Fig 1 C,E). A trapezoid shape (Fig 1 D) was reconstructed demonstrating relative location of the footprints of the Achilles insertion compared to the boundaries of the tuberosity on each piece (A, most superior point in the posterior tuberosity; B, most superior point in the Achilles insertion; C, most inferior point in the Achilles insertion; D, most inferior point in the posterior tuberosity). Data regarding footprints of the Achilles tendon insertion in the sagittal orientation was analyzed and compared within each trapezoid region and among different regions. Results: AB (calcaneal tuberosity tip to the upper limit of the Achilles insertion) was shortest at the medial cut (9.35mm) and longest at the lateral cut (12.15mm). However, the tendon thickness at the insertion (the distance from the proximal to the distal limits) represented by BC was shortest at the lateral cut (13.19mm) and longest at the middle cut (14.04mm). AD, the distance from the highest to the lowest point of the calcaneal tuberosity, was the longest at the middle cut (41.20mm). AB:BC ratio was highest at the lateral cut and lowest at the medial cut, indicating the safe amount of bone to be resected at the Achilles insertion. Tendon thickness relative to the whole calcaneal tuberosity (BC:CD) was highest at the medial wall (Table1). Conclusion: The sagittal orientation and variability of the Achilles tendon insertion is an under-studied topic in the literature. It needs to be addressed given recent trends towards minimally invasive procedures in treating insertional Achilles pathology. This study precisely delineated the footprint in each region of the insertion by creating a trapezoid pattern to compare the coordinates across these areas. This could lead to future three-dimensional reconstruction of the Achilles insertional footprint and patient- specific instrumentation software directed towards optimizing the management of Insertional Achilles pathology.

Foot rotation and pelvic angle correlate with knee abduction moment during 180° lateral cut in football players

BackgroundLateral movements are challenging for 2D video-analysis and are therefore often omitted in functional tests for Anterior Cruciate Ligament (ACL) injury risk assessment. The purpose of the present study was to investigate the association between frontal and transverse plane angles obtained from 2D video-analysis and knee abduction moment (KAM) from gold standard 3D motion capture in a 180° lateral cut task. The hypothesis was that 2D angles other than the knee joint effectively explain variations in KAM. MethodsThirty-four healthy football players (age 22.8 ± 4.1 years) performed a series of 180° lateral cut (lateral shuffles) tasks. The peak KAM was collected through a 3D motion capture system. A 2D video-analysis movement assessment identified frontal and transverse plane joint kinematics: foot projection angle (FPA), Frontal Plane Knee Projection Angle (FPKPA), Pelvis tilt angle (PA), and Trunk tilt angle (TA). A forward stepwise regression model was used to assess significant 2D predictors of KAM (p < 0.05). ResultsFPA and PA were the only significant predictors (R2-ajdusted = 9.2%, p < 0.001), with external foot rotation and contralateral pelvic drop associated with higher KAM. Based on the regression model, the “High FPA & PA group” was defined and showed higher KAM than the rest of the cohort (p = 0.012, ES = 0.71). ConclusionsThe external foot rotation and the contralateral pelvic drop from 2D video-analysis were associated with higher peak KAM during the 180° lateral cut. A qualitative assessment of the 180° lateral cut could offer precious insights on ACL injury risk mitigation. Level of EvidenceDescriptive Laboratory Study.

The traction requirements of female and male basketball players

Despite basketball being a popular sport among both genders, basketball footwear is designed primarily based on men. This may be problematic for women as the footwear they utilize may not be optimized for female performance and excessive traction may increase the risk of lower extremity non-contact injuries. While there are known sex-associated differences in the execution of basketball-related movements, the traction requirements of women have yet to be determined. Therefore, the purpose of this study was to compare the traction requirements of women and men performing basketball-related movements. Twenty collegiate-level basketball players (10 women and 10 men) participated in this study performing five basketball-related movements (Cross Cut, Lateral Cut, Quick Start, Jump Stop and Side Shuffle). Women and men were found to have similar traction requirements across many of movements, but significant differences were found during phases of the Quick Stop, Lateral Cut and Cross Cut. Overall, while the traction requirements of women and men appear similar, subtle differences exist at specific time points, which may be utilized to optimize gender-specific outsole design.

Diode Effect in a Superconducting Hybrid Cu/MoN Strip with a Lateral Cut

Diode Effect in a Superconducting Hybrid Cu/MoN Strip with a Lateral Cut

Varus morphology and its surgical implication in osteoarthritic knee and total knee arthroplasty

BackgroundKnee varus alignment represents a notorious cause of knee osteoarthritis. It can be caused by tibial deformity, combined tibial–femoral deformity and/or ligament imbalance. Understanding malalignment is crucial in total knee arthroplasty to restore frontal plane neutral mechanical axis. The aim of this study was to determine which factor contributes the most to varus osteoarthritic knee and its related surgical implications in performing a total knee arthroplasty.MethodsWe retrospectively evaluated 140 patients operated for total knee arthroplasty due to a varus knee. Full-leg hip to ankle preoperative X-rays were taken. Radiological parameters recorded were: mechanical axis deviation, hip–knee–ankle, anatomical–mechanical angle, medial neck shaft angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), lateral proximal femoral angle, lateral distal tibial angle (LDTA), femoral bowing, and length of tibia and femur. We also determined ideals tibial and femoral cuts in mm according to mechanical alignment technique. A R2 was calculated based on the linear regression between the predicted values and the observed data.ResultsThe greatest contributor to arthritic varus (R = 0.444) was MPTA. Minor contributors were mLDFA (R = 0.076), JLCA (R = 0.1554), LDTA (R = 0.065), and femoral bowing (R = 0.049). We recorded an average of 7.6 mm in lateral tibial cut thickness to restore neutral alignment.ConclusionsThe radiological major contributor to osteoarthritic varus knee alignment is related to proximal tibia deformity. As a surgical consequence, during performing total knee arthroplasty, the majority of the correction should therefore be made on tibial cut.

Multidirectional basketball activities load different regions of the tibia: A subject-specific muscle-driven finite element study.

The tibia is a common site for bone stress injuries, which are believed to develop from microdamage accumulation to repetitive sub-yield strains. There is a need to understand how the tibia is loaded in vivo to understand how bone stress injuries develop and design exercises to build a more robust bone. Here, we use subject-specific, muscle-driven, finite element simulations of 11 basketball players to calculate strain and strain rate distributions at the midshaft and distal tibia during six activities: walking, sprinting, lateral cut, jumping after landing, changing direction from forward-to-backward sprinting, and changing direction while side shuffling. Maximum compressive strains were at least double maximum tensile strains during the stance phase of all activities. Sprinting and lateral cut had the highest compressive (-2,862±662 με and -2,697±495 με, respectively) and tensile (973±208 με and 942±223 με, respectively) strains. These activities also had the highest strains rates (peak compressive strain rate=64,602±19,068 με/s and 37,961±14,210 με/s, respectively). Compressive strains principally occurred in the posterior tibia for all activities; however, tensile strain location varied. Activities involving a change in direction increased tensile loads in the anterior tibia. These observations may guide preventative and management strategies for tibial bone stress injuries. In terms of prevention, the strain distributions suggest individuals should perform activities involving changes in direction during growth to adapt different parts of the tibia and develop a more fatigue resistant bone. In terms of management, the greater strain and strain rates during sprinting than jumping suggests jumping activities may be commenced earlier than full pace running. The greater anterior tensile strains during changes in direction suggest introduction of these types of activities should be delayed during recovery from an anterior tibial bone stress injury, which have a high-risk of healing complications.

Effect of Different Drying Parameters on Green Chili Nutritional Quality

This study was carried out to analyze the effect of different mechanical dryer with sun drying on different parameters of green chili powder. The green chili were longitudinal and lateral cut and Acetic acid (CH3COOH) and Potassium metabisulfite (K2S2O5) pretreatment were used for the experiments in different drying condition on different drying system. Cabinet drying at 55 ºC, 25% relative humidity shows the best quality in terms of the nutritional and sensory parameters after every drying technique. Pretreated by Potassium metabisulfite (K2S2O5) had higher overall acceptability than other treatments.

The Final Cut: Evolution of Cavernous Sinus Decompression Beyond the Dolenc Cut.

Meningiomas involving the cavernous sinus (CS) represent a formidable challenge to neurosurgeons. Because of high morbidity, aggressive tumor resection within the CS has been largely replaced by extracavernous tumor resection and decompression of the CS. The widely used Dolenc method involves blind dural transection over the oculomotor nerve, potentially placing the crossing trochlear nerve at risk. To provide a safer way for the decompression of the CS and at the same time, circumferential resection of the temporal lobe dura. Cadaveric dissection of 8 cadaveric heads (16 sides) was performed. Frontotemporal craniotomy with zygomatic osteotomy was performed. Extradural and intradural dissection of the lateral wall of the CS and free edge of tentorium was performed. Photographic documentation, artistic illustrations, and illustrative video cases are provided. Three tether points were released: anterior-the meningo-orbital band, lateral-dura over the V2 and V3, and medial-superficial layer of the free edge of tentorium. Transection of the superficial layer of the free edge of the tentorium along its edge, in conjunction with a lateral cut over the temporal convexity, constitutes the final cut, allowing a resection of the lateral CS wall and the circumferential resection of temporal lobe dura. Using the "final cut" technique allows for a circumferential resection of the temporal lobe dura and lateral CS wall while avoiding blind cuts that could put cranial nerves at risk. All dural transections are performed in anatomically separated layers under constant visualization.

Relation of the Sural Nerve and Medial Neurovascular Bundle With the Achilles Tendon in Children With Cerebral Palsy Treated by Percutaneous Achilles Tendon Lengthening.

One of the most common treatment options for a short Achilles tendon (AT) in cerebral palsy is percutaneous AT lengthening using 3 hemisections. Because of proximity of neurovascular structures around the tendon, iatrogenic injury to them have been a concern about this technique. The sural nerve (SN) is under risk of injury at the site of the lateral incomplete cut, especially if it is done proximally. The medial neurovascular bundle is under injury risk at medial cuts. The aim of the article was to study the anatomical relations of the SN and medial neurovascular bundle to the AT, and define dangerous levels for injury with the help of magnetic resonance imaging (MRI). Patients operated for percutaneous Achilles lengthening were called for MRI investigation of the SN and medial neruvascular bundle integrity and their anatomical relation with the AT. The distance of 5 mm was taken as the threshold for increased risk of injury. Measurements were done on MRI at each cm from the insertion of the tendon on both medial and lateral sides, and at the level of the middle cut. Thirty ankles operated and followed at least 1 year were included to the study. On the medial side, the tibial nerve, and the posterior tibial artery lied more than 5 mm away from the tendon at all levels in all patient. On the lateral side, the first 4 cm were relatively safe for the middle lateral cut, while increased risk of SN damage was detected in more proximal levels. Overall, 6 of 30 ankles had radiographically detectable SN injury. The first 4 cm of the AT on the lateral side was detected to be safe for the middle lateral directed cut, while whole tendon length were found to be safe for the first and the third cuts of the percutaneous Achilles lengthening surgery using 3 hemisections in children with cerebral palsy. Level III.

Fabrication of Microchannels in a Nodeless Antiresonant Hollow-Core Fiber Using Femtosecond Laser Pulses.

In this work, we present femtosecond laser cutting of microchannels in a nodeless antiresonant hollow-core fiber (ARHCF). Due to its ability to guide light in an air core combined with exceptional light-guiding properties, an ARHCF with a relatively non-complex structure has a high application potential for laser-based gas detection. To improve the gas flow into the fiber core, a series of 250 × 30 µm microchannels were reproducibly fabricated in the outer cladding of the ARHCF directly above the gap between the cladding capillaries using a femtosecond laser. The execution time of a single lateral cut for optimal process parameters was 7 min. It has been experimentally shown that the implementation of 25 microchannels introduces low transmission losses of 0.17 dB (<0.01 dB per single microchannel). The flexibility of the process in terms of the length of the performed microchannel was experimentally demonstrated, which confirms the usefulness of the proposed method. Furthermore, the performed experiments have indicated that the maximum bending radius for the ARHCF, with the processed 100 µm long microchannel that did not introduce its breaking, is 15 cm.

Lateral cut as management of late voiding dysfunction syndrome post sling: 'more than a cut' - video article.

The mid-urethral sling (MUS) is considered the gold standard for stress urinary incontinence (SUI). Nevertheless, this procedure is not excluded from postsurgical complications, which can be challenging for most clinicians. Hence, one of the main concerns about this procedure is late postoperative voiding dysfunction (LDS), defined as obstructive symptoms 6 weeks after surgery. Primary medical management regularly includes expectant management and rehabilitation, including the mid-urethral cut sling (MUCS) as an alternative when it fails. This video provides an anatomical illustration and detailed description of the surgical steps of the J-cut of the lateral sling. We set up a step-by-step surgical process and provided some advice for MUCS in a video; this material included how to position the sling, dissect, isolate the synthetic material, release adhesions and make a lateral cut of the MUS. Additionally, a case series of 30 patients from our institution is described to confirm the effectiveness of MUCS to manage delayed voiding dysfunction syndrome. MUCS in LDS was beneficial for our patients. Obstructive symptoms improved clinically from 75% to 100%, and urgency-related symptoms decreased from 57.9% to 26.3%, evidencing 20% SUI post-MUCS surgery. The lateral cut of the mid-urethral tape should be considered a surgical alternative for the resolution of post-sling late voiding dysfunction syndrome in patients who do not improve with expectant management.

Polymer Optical Fiber-Based Smart Garment for Impact Identification and Balance Assessment

This paper presents a development of the smart garment instrumented with polymer optical fiber (POF) sensors to identify the impact location during a perturbation protocol for balance assessment. The sensor system installed on the smart garment consists of 30 multiplexed sensors, and each sensor is composed of a light-emitting diode (LED) coupled to a lateral cut in the POF. The sensor's responses are acquired by four photodetectors and the data processing is made by a microcontroller. Two tests were performed to characterize the system. First, forces were applied on each sensor using a reference force sensor to characterize their sensitivities. Second, several perturbations on predefined body areas were performed. A technique based on the sensors' responses is proposed to identify impacts. Finally, the proposed system was applied on a perturbation protocol to assess the human balance under an instability condition. Results of the first test showed different sensor sensitivities due to differences provoked by the manufacturing process, and the sensors were normalized. Results of the second test showed the ability of identifying the impact region by using the impact location identification technique. Furthermore, results of the perturbation protocol showed the feasibility of the proposed system in the balance assessment, in which the identified impact regions combined with the trunk angles obtained by an inertial measurement unit (IMU) improved the balance assessment. The proposed system is portable, low cost, with simple signal processing and ease of implementation, with possibility of scalability, in which can be adapted for other impact detection protocols.

Effect of lateral crural cut overlay and medial crural cut and overlay in creating and maintaining tip projection and rotation: a randomised single-blind trial

Lateral crural cut and overlay (LCC) or medial crural cut and overlay (MCC) are two of the many techniques applied to ensure an adequate nasal tip projection and rotation, but little evidence supports their long-term efficacy. Fifty-four rhinoplasty candidates were studied prospectively in this randomised clinical trial. The subjects were randomly divided into two groups according to the use of LCC or MCC. The outcome measures were gaining and maintaining tip projection and rotation in the long term. Standardised photographs taken before and at three and 12 months after surgery were used to compare nasolabial angle and projection between groups. Patients’ satisfaction with the cosmetic results and nasal obstruction were evaluated using the Standardised Cosmesis and Health Nasal Outcomes Survey (SCHNOS). LCC and MCC were each used in 26 cases. Preoperatively, the nasolabial angle, tip projection, and other characteristics were not significantly different between the groups. There was no significant difference in tip rotation stability (p = 0.624) and projection (p = 0.329) between the groups postoperatively, but patients’ satisfaction with the cosmetic results was significantly higher in the MCC group (p = 0.046). It seems that both LCC and MCC are effective techniques in rhinoplasty. Compared with LCC, the use of MCC in qualified hands may increase the patients’ satisfaction with the cosmetic results.

A study of unfavorable splits in the sagittal ramus osteotomy with a short lingual cut

In the bilateral sagittal split osteotomy, a short lingual cut is made on the medial side of the ramus; however, in some cases, a true fracture occurs on the buccal side of the ramus. The purpose of this study was to evaluate the relationship between the splitting pattern of the mandible and the form of the mandible, the surgical technique used, and the postoperative occurrence of relapse after ‘unfavorable’ splits. The investigation examined 143 patients in whom a short lingual cut was attempted. The rate of unfavorable split was 14.7% (42/286). A strong correlation was observed between the reach of the lateral bone cut to the inferior border of the mandible and an unfavorable split. According to multivariate regression, the factors leading to an insufficient lateral bone cut were the degree of inward curvature of the ramus (P=0.001) and the position of the lateral bone cut (P=0.002). There was no significant difference in relapse between cases of unfavorable and normal splits. An unfavorable split does not affect the prognosis of the occlusion, but it is important to confirm the inward curvature of the ramus and set the position of the lateral bone cut adequately to avoid unfavorable splits.

ИССЛЕДОВАНИЕ ТЕПЛОФИЗИЧЕСКИХ ХАРАКТЕРИСТИК ТЕПЛОЗАЩИТНОГО МАТЕРИАЛА НА ОСНОВЕ СТЕКЛОПЛАСТИКА ПРИ ЕГО ДЕСТРУКЦИИ

When designing advanced samples of aviation and rocket and space technology, during the operation of which the temperature on the surface of the material can exceed the temperature of destruction, it is important to have an understanding of the values of thermophysical properties. The work investigates the thermophysical properties of fiberglass in the initial state and after the binder is burned out in a muffle furnace. The temperature dependences of thermal effects, heat capacity, thermal diffusivity and thermal conductivity were determined, density was measured, and thermogravimetric analysis was carried out. Using a stereomicroscope, the microstructure of the lateral cut of the samples was examined and its evolution was determined during the burning of the binder.

Endoscopic Lateral Osteotomy in Rhinoplasty.

The purpose of this study was to investigate the advantages of endoscopic lateral osteotomy, to evaluate the effects of the periosteal elevation on ecchymosis and to search the reasons for the ecchymosis and the intranasal mucosal tears. On a randomly chosen side a subperiosteal tunnel was elevated, on the other side a subperiosteal tunnel was not elevated. Bilateral lateral osteotomies were performed. Internal nasal packing was not used. The post-operative care was similar for all patients. The patients were evaluated on the third post-operative day. The intranasal mucosal tears, the lateral osteotomy cut on the periosteal elevation side were examined using endoscopes. The degree of ecchymosis was determined by 2 other surgeons, who were unaware of the elevated side, using the grading system adapted from Hoffman et al. The intranasal mucosal injury was seen in 16 of non-elevated side whereas it was 14 on the periosteal elevated side. Endoscopy showed the perforating arteries and elevation of the periosteum caused rupture and oozing from these arteries which might be a cause for ecchymosis. Ecchymosis was more severe on the side with subperiosteal tunnel in 6 patients; whereas only in 2 patients it was more severe on the side with no subperiosteal tunnel elevation while in 12 patients the degree of ecchymosis was the same on both sides. Endoscopy gives a great opportunity to visualize the lateral osteotomy site. Besides the lateral osteotomy cut, the arteries and the intranasal mucosal injury can be visualized. Periost elevation increases the severity of ecchymosis due to the rupture of the perforating arteries, not due to the trauma of the angular artery. Intramucosal tears do not increase the severity of the ecchymosis.

Effects of double-catheter epidural analgesia by lidocaine injection respectively on the delivery outcomes and maternal-infant complications for persistent posterior or lateral occipital position of protracted active phase

Objective: To evaluate the effect of dual-tube epidural segmental injection of lidocaine analgesia on the delivery outcome and maternal and infant complications of persistent posterior occipital position postpartum or lateral occipital position postpartum patients with protracted active phase. Methods: The full and single-term primiparas (n=216, 37 to 42 weeks gestation, 22 to 35 years) diagnosed as persistent posterior or lateral occipital position during the active period were selected from the Department of Obstetrics of Qingdao Municipal Hospital from January 2015 to October 2019. The subjects were randomly assigned into two groups: double-tube epidural block group (n=108) and single-tube epidural block group (n=108), 1% lidocaine was used for epidural analgesia respectively under ultrasound guidance. Senior midwife or obstetricians implement new partogram, and guide women to perform position management, and push or rotate the fetal head in a timely manner. Observation indicators: general condition, the use of non-pharmacological analgesic measures, analgesia related conditions and pain visual analogue scale (VAS) score, delivery-related indicator, cesarean section indication, anesthesia-related indicator, maternal and child complications. Results: (1) General condition: the age, weight, height, gestational age, the ratio of persistent lateral or posterior occipital position, cephalic score, and neonatal birth weight between the two groups of women were not statistically significant (all P>0.05). (2) The use of non-pharmacological analgesic measures: the women's Lamaze breathing method, Doula delivery companionship, percutaneous electrical stimulation, and other measures between two groups were compared, and there were not significant differences (all P>0.05). (3) Analgesia related conditions and VAS scores of women undergoing vaginal delivery: compared with the single-tube epidural block group (n=40), the second-partum time of the women in the double-tube epidural block group (n=59) was significantly shortened [(124±44) vs (86±33) minutes, P<0.01]; after 30 minutes of analgesia (4.4±0.5 vs 0.9±0.5, P<0.01), during forced labor in the second stage of labor (5.7±0.6 vs 1.3±0.4, P<0.01), the VAS scores of pain were also significantly reduced (P<0.01). (4) Labor-related indicators: compared with the single-tube epidural block group, the natural delivery rate (21.3% vs 49.1%) and the delivery experience satisfaction rate (51.9% vs 98.1%) of women in the double-tube epidural block group were significantly increased (all P<0.01), cesarean section rate (63.0% vs 45.4%), instrument assisted rate (15.7% vs 5.6%) decreased significantly (all P<0.05). (5) Cesarean section indications: compared with the single-tube epidural block group, the cesarean section rate caused by prolonged labor or protracted active phase of women in the double-tube epidural block group was significantly reduced (38.0% vs 22.2%； P<0.05), and the fetal distress, intrauterine infection, and social factors caused by cesarean section between the two groups were compared, while the differences were not statistically significant (all P>0.05).(6) Anesthesia related indexes: the block planes of the maternal upper tube administration in the double-tube epidural block group were mostly T7, T8, T9-L2 and L3,While,the block planes in the single-tube epidural block group were mostly T10, T11-S1, S2, S3, and the modified Bromage score were all 0. (7) Maternal and child complications: compared with the single-tube epidural block group, the postpartum hemorrhage rate (18.5% vs 7.4%), the perineal lateral cut rate (20.4% vs 5.6%), the neonatal asphyxia rate (12.0% vs 3.7%), ICU rate of transferred neonates (13.9% vs 4.6%) in the double-tube epidural block group were significantly reduced (all P<0.05). Soft birth canal injury rate, puerperal disease rate and neonatal birth rate between two groups were compared, and there were not statistically significant differences (all P>0.05). Conclusion: Dual-tube epidural segmental injection of lidocaine analgesia could increase the natural delivery rate of women with posterior occipital or lateral occipital position with active stagnation, reduce the rate of cesarean section and the rate of transvaginal instruments, and reduce the complications of mother and child.

Leg Injury - Football

HISTORY: A 12-year old male quarterback sustained a right leg injury while cutting back across the field. He was running across the field and made a lateral cut to change directions, as this happened he tripped over himself and fell without a twisting motion. He landed on his right lateral leg with immediate pain to the fibular head. There was no numbness, tingling, weakness or radiation of pain however he had a noticeable limp. He presented to clinic 2 days later and denied any prior injuries or trauma to the area. PHYSICAL EXAMINATION:2 days post injury (PCP office) — No deformity, normal knee and ankle exams, no bony tenderness, moderate postero-lateral edema of proximal right lower leg, painful/antalgic gait, TTP lateral gastrocnemius and soleus, negative Thompson's.4 days post injury (Sports Medicine Clinic) — Consistent with prior exam, new findings: point TTP just distal to fibular head, decreased edema, negative squeeze test, negative ER test. DIFFERENTIAL DIAGNOSIS: 1. R fibular contusion 2. R knee apophysitis 3. LCL sprain 4. Gastrocnemius contusion/strain 5. Distal Bicep Femoris strain TEST AND RESULTS: XR: R Tib/Fib AP and Lateral radiographs 2 days after injury — Bones/joints/soft tissue appear unremarkable. Repeat XR 13 days post injury — subtle irregularity along the lateral aspect of the proximal fibula physis with associated periostitis. Final XR 20 days post injury — Noted irregularity along the lateral aspect of the proximal fibula physis with increased benign periostitis. FINAL WORKING DIAGNOSIS: Salter-Harris II fracture of R proximal fibula physis TREATMENT AND OUTCOMES: 1. Cam walker boot 3 weeks with weekly exams/XRs 2. 20 days out from injury completely normal RLE exam, no pain, full ROM, XRs suggestive for healing SH2 fracture; patient was able to return to football as tolerated. DISCUSSION: In isolation this is a very rare injury. There was one reported case of a SH-3 fracture that presented with initial knee injury and ROM deficits that was treated non-operatively. Most injuries to the proximal physis of the fibula occur in combination with an interosseous membrane/syndesmotic and distal tibiofibular injury - must rule out a Maisonneuve injury. The presenting complaint was pain and edema in the region of the soleus this may have been a soleus traction injury to the apophysis vs direct trauma from the fall.

Use of Digitally Annotated and Printed 3D Models for Teaching the Pterygopalatine Fossa

Anatomically deep and geometrically complex regions are difficult for students to visualize in gross dissections, overly simplified in models, and not faithfully depicted in 2D images. One such region is the pterygopalatine fossa which communicates with the infratemporal region, middle cranial fossa, cranial base, nasal and oral cavities, and face via 7 osteological foramina or fissures. Given the geometric complexity of this space, we aimed to create a 3D based educational tool for students to use in their pre‐clinical, dissection‐free head and neck anatomy course.A cranium rendered from CT imaging was imported into Medium, a digital sculpting program, using the Oculus Virtual Reality (VR) system. The right half was removed, and the left half was divided into three sections via two parasagittal slices. The lateral parasagittal cut bisected the foramen rotundum and palatine canals, and the medial parasagittal cut bisected the left half of the nasal cavity. The only alterations to the morphology was an exaggeration of the palatine canal and the anterior and posterior openings of the Vidian canal to allow for the passage of wires during the lab exercise. The three sections of the cranium were then 3D printed. In addition to 3D printing, the model was annotated in Medium by drawing in the course of the maxillary artery and nerve and their branches, and the nerve of the Vidian canal in the pterygopalatine fossa and associated regions. The model showing the neurovasculature related to the pterygopalatine fossa was imported into Sketchfab, a 3D model publishing platform, where labels could be placed to identify structures and provide additional information. The labeled model was embedded into the digital lab manual for students to reference during the lab activity where they were directed to pass a wire through the various foramina and fissures in the region to understand the passage of the neurovasculature in and out of the pterygopalatine fossa.The annotated digital model allowed students to visualize the completed course of these nerves and arteries while the printed model gave appreciation for the location, size, and orientation of the canals and foramina through which the pterygopalatine fossa communicates with other regions. This intervention was applied in the 2019 Living Anatomy: Head and Neck course, where students did not perform dissection but did have access to prosected cadavers and plastinations.Student performance on the 2019 exam was statistically identical to the performance of previous cohorts in a traditional dissection‐based anatomy course (2018: 85.9%; 2019: 88.1%). The 2019 cohort on average scored lower on questions derived from the material from the lab that included this intervention compared to the 2018 cohort (2018: 84.82%; 2019: 80.76%). However, the pterygopalatine fossa question (97.09%) outperformed the nasal cavity (80.58%) and larynx/pharynx (78.5%) questions. Additionally, students ranked digitally annotated 3D models the 3rd highest activity or resource following faculty directed case studies and the prosected cadavers. Student exam results and feedback indicate a utility of providing physical objects with digital 3D reference material during anatomy instruction.