Lateral Head Research Articles

Fabella Syndrome of Bilateral Knee with Common Peroneal Nerve Compression Neuropathy

Fabella syndrome is a rare, often underdiagnosed cause of recurrent posterolateral knee pain. It can disrupt the common peroneal nerve because of its anatomical location at the lateral head of the gastrocnemius at the lateral femoral condyle, where the nerve typically passes. Far East Asians have been shown to have a higher prevalence of fabella syndrome attributed to their genetic predisposition combined with mechanical causes. Failure to adequately identify a common peroneal nerve neuropathy associated with fabella syndrome can lead to recurrent visits, unnecessary examinations, and surgical procedures. Here, we present a case of a patient presenting with recurrent posterolateral knee pain and a slapping gait. Therefore, a high index of suspicion for fabella syndrome is warranted by a physician to diagnose this condition for the best outcome for the patient.

Fabella Syndrome of Bilateral Knee with Common Peroneal Nerve Compression Neuropathy

Fabella syndrome is a rare, often underdiagnosed cause of recurrent posterolateral knee pain. It can disrupt the common peroneal nerve because of its anatomical location at the lateral head of the gastrocnemius at the lateral femoral condyle, where the nerve typically passes. Far East Asians have been shown to have a higher prevalence of fabella syndrome attributed to their genetic predisposition combined with mechanical causes. Failure to adequately identify a common peroneal nerve neuropathy associated with fabella syndrome can lead to recurrent visits, unnecessary examinations, and surgical procedures. Here, we present a case of a patient presenting with recurrent posterolateral knee pain and a slapping gait. Therefore, a high index of suspicion for fabella syndrome is warranted by a physician to diagnose this condition for the best outcome for the patient.

The effects of environmental stressors on gonad biomarkers of a sentinel marine bivalve, Mytilus galloprovincialis

ABSTRACT The aim of this work is to investigate the effects of environmental stressors on male reproductive biomarkers in sentinel species of bivalves inhabiting Annaba estuaries, considered to be reservoirs receiving industrial, agricultural, and domestic discharges. Male Mytilus galloprovincialis were collected in four seasons from a non-polluted site (S1) and two other locations receiving untreated sewage (S2) and a mixture of contaminants (S3). Testicular sperm concentration, motility, velocity, the amplitude of lateral head displacement (ALH), the beat cross frequency (BCF), spermatozoan DNA fragmentation, and histological profiles were evaluated. Individuals from S2 and S3 have diminished sperm concentration, motility, velocity, ALH and BCF, along with a significantly increased spermatozoan DNA fragmentation that was much higher in S3. Testicular tissues demonstrated histo-pathological alterations in mussels subjected to anthropogenic activities during the four seasons. In conclusion, reproductive biomarkers of male mussels were both spatially and temporally variable, which is probably correlated to pollution types and the changing seasonal stressors.

Plate osteosynthesis combined with bone cement provides the highest stability for tibial head depression fractures under high loading conditions

Older patients sustaining tibial head depression fractures often cannot follow the post-operative rehabilitation protocols with partial weight-bearing of the affected limb, leading to osteosynthesis failure, cartilage step-off and arthritis development. Therefore, the aim of this study was to analyse the biomechanical performance of different types of osteosyntheses alone and in combination with bone cement simulating cyclically high loading conditions of tibial head depression fractures. Lateral tibial head depression fractures (AO: 41-B2.2; Schatzker type III) were created in synthetic bones and stabilized using three different osteosyntheses alone and in combination with a commonly used bone cement (chronOS™): 2 screws, 4 screws in the jail technique and a lateral angle-stable buttress plate. After fixation, the lateral tibial plateau was axially loaded in two, from each other independent testing series: In the first test protocol, 5000 cycles with 500 N and in the end load-to-failure tests were performed. In the second test protocol, the cyclic loading was increased to 1000 N. Parameters of interest were the displacement of the articular fracture fragment, the stiffness and the maximum load. The osteosyntheses revealed a higher stiffness in combination with bone cement compared to the same type of osteosynthesis alone (e.g., 500 N level: 2 screws 383 ± 43 N/mm vs. 2 screws + chronOs 520 ± 108 N/mm, increase by 36%, p < 0.01; 4 screws 368 ± 97 N/mm vs. 4 screws + chronOS 516 ± 109 N/mm, increase by 40%, p < 0.01; plate: 509 ± 73 N/mm vs. plate + chronOs 792 ± 150 N/mm, increase by 56%, p < 0.01). Bone cement reduced the displacement of the plate significantly (500 N level: plate: 8.9 ± 2.8 mm vs. plate + chronOs: 3.1 ± 1.4 mm, reduction by 65%, p < 0.01; 1000 N level: 16.9 ± 3.6 mm vs 5.6 ± 1.3 mm, reduction by 67%, p < 0.01). Thus, the highest stiffness and lowest displacement values were found when using the plate with bone cement in both loading conditions (500 N level: 2 screws + chronOs 3.7 ± 1.3 mm, 4 screws + chronOs 6.2 ± 2.4 mm; 1000 N level: 2 screws + chronOs 6.5 ± 1.2 mm, 4 screws + chronOs 5.7 ± 0.8 mm). From a biomechanical perspective, plate osteosynthesis of tibial head depression fractures should always be combined with bone cement, provides higher stability than 2-screw and 4-screw fixation and is a valid treatment option in cases where extraordinary stability is required.

Sperm selection techniques in cattle: Microfilter device versus conventional methods

Microfluidics and microfilter devices have been developed to mimic the characteristics of the female reproductive tract, minimizing the risk of sperm damage. This study aimed to compare the use of a microfilter device versus conventional methods for sperm selection used in in vitro fertilization (IVF). For selecting spermatozoa, the pooled samples were processed in a microfilter device, swim-up and mini-Percoll gradient. Kinematic and morphometric parameters, vitality and DNA damage were analysed before and after sperm selection. After selection, 10,000 motile spermatozoa per oocyte were used in IVF drops. Embryos were assessed at three (cleavage rate) and seven (blastocyst rate) days post-IVF. Results of sperm kinematic parameters including average path velocity, velocity straight line, curvilinear velocity, linearity, lateral head displacement with the microfilter device were superior to density gradient (p < 0.05), but similar to swim-up method. Likewise, sperm DNA damage was significantly reduced using the microfilter device and swim-up method. Regarding the total sperm recovery rate post selection, results with the microfilter device (17.64%) and mini-Percoll gradient (18.27%) were higher than with swim-up method (6.52%). However, the cleavage and blastocyst rates were the lowest using the microfilter device. In conclusion, sperm selection using the microfilter device and swim-up method can improve kinematic parameters, although the mini Percoll gradient was the most efficient method for embryo production.

Location of Ulnar Nerve Branches to the Flexor Carpi Ulnaris during Surgery for Cubital Tunnel Syndrome.

Cubital tunnel syndrome, the most common ulnar nerve entrapment neuropathy, is usually managed by simple decompression or anterior transposition. One of the concerns in transposition is damage to the nerve branches around the elbow. In this study, the location of ulnar nerve branches to the flexor carpi ulnaris (FCU) was assessed during operations for cubital tunnel syndrome to provide information to reduce operation-related complications. A personal series (HJY) of cases operated for cubital tunnel syndrome was reviewed. Cases managed by transposition and location of branches to the FCU were selected for analysis. The function of the branches was confirmed by intraoperative nerve stimulation and the location of the branches was assessed by the distance from the center of medial epicondyle. There was a total of 61 cases of cubital tunnel syndrome, among which 31 were treated by transposition. Twenty-one cases with information on the location of branches were analyzed. The average number of ulnar nerve branches around the elbow was 1.8 (0 to 3), only one case showed no branches. Most of the cases had one branch to the medial head, and one other to the lateral head of the FCU. There were two cases having branches without FCU responses (one branch in one case, three branches in another). The location of the branches to the medial head was 16.3±8.6 mm distal to the medial epicondyle (16 branches; range, 0 to 35 mm), to the lateral head was 19.5±9.5 mm distal to the medial epicondyle (19 branches; range, -5 to 30 mm). Branches without FCU responses were found from 20 mm proximal to the medial condyle to 15 mm distal to the medial epicondyle (five branches). Most of the branches to the medial head were 15 to 20 mm (50% of cases), and most to the lateral head were 15 to 25 mm (58% of cases). There were no cases of discernable weakness of the FCU after operation. In most cases of cubital tunnel syndrome, there are ulnar nerve branches around the elbow. Although there might be some cases with branches without FCU responses, most branches are to the FCU, and are to be saved. The operator should be watchful for branches about 15 to 25 mm distal to the medial epicondyle, where most branches come out.

Value and imaging findings of the magnetic resonance in the posterolateral corner complex injuries of the knee

BackgroundMRI is considered the key tool for evaluation of knee injuries, notably the posterolateral corner, due to its complexity and multi-ligament involvement. This prospective study was conducted from September 2020 to September 2021 aiming to clarify the value and possible MRI findings in assessing the posterolateral corner (PLC) knee injuries which can subsequently result in an improvement in the management of these cases, preventing devastating consequences.ResultsThe current study was conducted on 30 patients (11 females and 19 males) whose mean age was 42 years. Imaging by a closed magnet (1.5 T) MRI was applied to 30 patients with traumatic history to the knee using: axial, sagittal, coronal T1WI, T2WI, and proton density fat sat sequences. The lateral collateral ligament (LCL) was the most commonly affected ligament. Grade I injuries were the most common form of injuries. Twenty-four (80%) patients suffered from LCL injury, popliteal complex injuries were in 21 (70%) patients, 10 (33.3%) patients had biceps femoris tendon injury, while injury to the popliteofibular ligament was seen in 8 (26%) patients. The arcuate ligament was poorly defined in 6 (20%) patients, indicating that it had torn, lateral head of gastrocnemius injury was seen in 5 (16.7%) patients and 4 (13.3%) patients showed injury to the iliotibial band. Correlation with arthroscopic findings was considered the gold standard of the results whenever available. That was applied to 16 cases who had clinically significant knee injuries and arthroscopy was requested.ConclusionsMRI is a key tool for determining a correct pre-surgical evaluation and diagnosis. It is critical to have a thorough understanding of the radiological PLC anatomy, as well as the presence of various pathologies on MRI. It allows the determination of whether the tendons and ligaments are partially or completely torn, besides any related injuries preventing possible poor consequences after the restoration of the cruciate ligaments.

Predicting Early Vestibular and Motor Function in Congenital Cytomegalovirus Infection.

Congenital cytomegalovirus (cCMV) can affect vestibular function, which is an important cornerstone for early motor development. This study aims to identify risk factors for early vestibular dysfunction with severe repercussions on the motor outcome. This prospective cohort study included 169 cCMV-patients with complete vestibular assessment (lateral video Head Impulse Test and cervical Vestibular Evoked Myogenic Potentials) before the age of 18 months (mean 8.9, standard deviation 3.27 months). Motor results using the Alberta Infant Motor Scale were collected in 152 of these patients. Logistic and linear regression models were applied to identify risk factors for the vestibular and motor outcomes, respectively. The odds of developing early vestibular dysfunction were 6 times higher in patients presenting with hearing loss at birth compared to those born with normal hearing (p=.002). Within the latter group, significant predictors for vestibular dysfunction were (delayed-onset) hearing impairment at the time of vestibular testing (p=.003) and the presence of periventricular cysts on magnetic resonance imaging (p=.005). Remarkably, none of the patients infected during the third trimester of pregnancy (n=14) developed early vestibular dysfunction. On average, vestibular-impaired patients had a z-score on the Alberta Infant Motor Scale that was 1.17 points lower than patients without vestibular deficit (p < .001). Early vestibular loss can have a significant adverse effect on motor development. Hearing and cranial imaging findings could facilitate the widespread implementation of a (targeted) vestibular assessment approach in the cCMV-population. 3 Laryngoscope, 133:1757-1765, 2023.

An Acute Hip Injury Correlated With An Exacerbation Of Urinary Symptoms In A Dancer

HISTORY23-year-old female dancer sustained an acute right hip/groin injury during a rond-de-jambe movement (requiring a combination of hip abduction, extension and external rotation). She had a sensation of a pop at the time of injury, followed by difficulty with external rotation as she attempted to continue to dance. Subsequent days were characterized by bruising to the inner groin and progressive medial thigh discomfort. She concurrently experienced a significant worsening of pre-existing urinary dysfunction characterized by episodes of urge incontinence and a sensation of incomplete voiding. She then developed secondary lateral hip, sacroiliac and low back discomfort. PHYSICAL EXAMShe presented to our office 6 weeks after the initial injury. She had a normal gait and symmetric hip range of motion. Right hip exam with pain at end range of passive hip flexion, and pain also with resisted testing of hip adduction, internal rotation and external rotation. She had tenderness over the anterior hip flexor tendons and at the proximal medial thigh just inferior to the pubic ramus. She was not tender to the pubic ramus. Thomas test was negative bilaterally, but she had significant tightness of quadriceps bilaterally noted on Ely’s test. An internal exam separately completed by her urogynecologist identified tightness of the pelvic floor musculature. DIFFERENTIAL DIAGNOSIS adductor muscle strain, strain of deep hip rotator muscles (obturator externus, obturator internus), hip flexor tendonitis (as primary or secondary diagnosis), labral tear, pelvic floor muscle strain/tear/dysfunction, primary or secondary tightness of pelvic floor musculature, hormonal and/or bladder irritants affecting urinary function TESTS AND RESULTS 1. Xray pelvis/hip series: Well-formed acetabula, slight predisposition to CAM type FAI 2. Hip MRI: Shallow right acetabulum with mild uncovering of lateral femoral head, signs of possible labral tear, small partial intramuscular tear of the R obturator externus, strain of R iliopsoas muscle 3. Dynamic hip ultrasound - pending FINAL WORKING DIAGNOSIS 1.Obturator externus strain with comorbid strain of iliopsoas muscle 2.Pelvic floor dysfunction TREATMENT AND OUTCOMES 1. Dance specific PT for core and peri-pelvic stabilization 2. Pelvic floor physical therapy 3. Gradual return to dance

Operative Approaches to the distal radioulnar Joint and distal Ulna

At the distal radioulnar joint (DRUJ) and the ulnocarpal joint several anatomical structures are in a limited space. Therefore, the operative approach has to consider the pathology to be treated. The DRUJ may be approached from the dorsal or the palmar side. Procedures to treat the arthrotically destroyed DRUJ involving bone resection of the ulnar head and destabilizing ligamentous injuries of the triangular fibrocartilage complex (TFCC) are best approached from the dorsal side. This approach allows excellent visualization of the ulnar head and the ulnar and radial attachment of the TFCC. The arthroscopic, half open refixation of the ulnar avulsion of the TFCC may be performed using a variety of limited and small approaches over the dorsal or lateral ulnar head. Pathologies with an origin at the palmar aspect of the DRUJ as the palmar dislocation of the ulnar head in the DRUJ or the shrinkage and scaring of the palmar capsule with consecutive pronation contracture require a palmar approach. Reduction and osteosynthesis of fractures in the area of the ulnar head are preformed using a lateral approach along the styloid process and the ulnar head between the flexor and the extensor carpi ulnaris tendons. Along the ulnar shaft elective ulnar shortening osteotomy as well as fracture reduction and osteosynthesis are best performed from an ulno palmar approach.

Surgical Treatment of Parsonage Turner Syndrome With Primary Nerve Transfers: A Case Series and Cadaver Dissection.

Parsonage Turner syndrome (PTS) is the development of severe, spontaneous pain with subsequent nerve palsy. Unfortunately, many patients never achieve full functional recovery, and many have chronic pain. The use of nerve transfers in PTS has not been reported in the literature. We present 4 cases of PTS treated surgically with primary nerve transfer and neurolysis of the affected nerve following the absence of clinical and electrodiagnostic recovery at 5 months from onset. In addition, we present a cadaver dissection demonstrating an interfascicular dissection of the anterior interosseous nerve (AIN) into its components to enable a fascicular transfer in partial AIN neuropathy. Two patients with complete axillary neuropathy underwent a neurorrhaphy between the nerve branch to the lateral head of the triceps and the anterior/middle deltoid nerve branch of the axillary nerve. Two patients with partial AIN neuropathy involving the FDP to the index finger (FDP2) underwent a neurorrhaphy between an extensor carpi radialis brevis nerve branch and the FDP2 nerve branch. All patients had neurolysis of the affected nerves. All subjects recovered at least M4 motor strength. The cadaver dissection demonstrates 3 separate nerve fascicles of the AIN into FPL, FDP2, and pronator quadratus that can be individually selected for reinnervation with a fascicular nerve transfer. Functional recovery for patients with PTS with neurolysis alone is variable. Surgical treatment with neurolysis and a nerve transfer to improve functional recovery when no recovery is seen by 5 months is an option.

Reliability of a New Indentometer Device for Measuring Myofascial Tissue Stiffness.

Changes in tissue stiffness are associated with pathological conditions such as myofascial pain and increased risk of muscle injury. Furthermore, they have been shown to modify performance indicators such as running economy or jump height. Indentometry is an affordable way to assess tissue stiffness. However, to date, there is a paucity of studies examining the measurement properties of available devices. With this trial, we aimed to evaluate the reliability of the “IndentoPro”. Two investigators repeatedly measured the stiffness of the lateral head of the gastrocnemius muscle in healthy participants (N = 35), using 5 and 10 mm indentation depths. Intraclass Correlation Coefficients (ICC) revealed moderate inter-rater reliability (5 mm: ICC3,1 0.74, 95%CI = 0.54 to 0.86, p < 0.001; 10 mm: ICC3,1 0.59, 95%CI = 0.27 to 0.78, p < 0.001) and good intra-rater reliability (5 mm: ICC3,1 0.84, 95%CI = 0.71 to 0.92, p < 0.001; 10 mm: ICC3,1 0.83, 95%CI = 0.69 to 0.91, p < 0.001). No correlations between age, height, weight, BMI, skinfold thickness and myofascial tissue stiffness were observed (p > 0.5). In conclusion, the IndentoPro is reliable in assessing calf tissue stiffness, but the predictors of stiffness remain unclear.

Motion characteristics and plasma integrity evaluation of Murrah buffalo semen

Buffalo semen collected from Murrah bull were cryopreserved and evaluated for different motility parameter, kinematics and plasma membrane integrity. Buffalo bulls were maintained uniform standard management and nutritional practices. Semen was collected regularly twice a week semen collection schedule from four (04) Murrah bull. Collected semen was immediately transported to laboratory and evaluated for different macroscopic parameter (color, volume and thickness). Fresh semen was then diluted with saline solution and evaluated for sperm concentration, motility, sperm kinematics and morphology. Semen samples that fill all the standard were selected for freezing and diluted with Tris-egg yolk citrate diluter. Diluted semen was equilibrated, cryopreserved and finally evaluated for post thaw sperm quality. Different motility parameter (total, progressive, static and slow motility) varied significantly (p&lt;0.01) irrespective of different freezing stages. Significantly higher progressive sperm motility and viability of buffalo spermatozoa were observed at fresh semen whereas lower progressive sperm motility and viability was found at post thaw stage. Total and progressive motility reduced by 2.5 and 2.12% following equilibration, whereas following cryopreservation, total and progressive motility reduced by 35.7 and 28.51% and static motility increases accordingly (35.4%). Significantly higher plasma membrane integrity of sperm was observed at fresh semen followed by pre freeze and post thaw semen. Following freezing, integrity of plasma membrane reduces at the rate of 10.81% and 26.7% at pre freezing and post thaw stages. Significantly higher average path velocity (VAP), straight line velocity (VSL), curvilinear velocity (VCL), straightness (STR), amplitude of lateral head displacement (ALH) and beat cross frequency (BCF) were found for fresh semen followed by pre-freeze and post-thaw semen. Frozen buffalo semen with higher progressive motility and motion characteristics may be produced if motility losses can be reduced during freezing stage as this stage results higher motility losses. Asian Australas. J. Biosci. Biotechnol. 2022, 7(2), 75-81

Simultaneous calf reduction and contouring with customized differential subtotal gastrocnemius resection and muscle transposition: Analysis of 200 cases

Oversized muscular calves can cause severe emotional distress. Total, partial, and subtotal resections of the gastrocnemius muscle for calf reduction have been described. However, the amount of muscle resected may be inappropriate, and the resultant leg contour may not be straight or esthetically pleasing enough. This study aimed to describe a technique of customized differential subtotal gastrocnemius resection and muscle transposition. A total of 200 patients who underwent customized differential subtotal gastrocnemius resection and muscle transposition for hypertrophic muscular calves from July 2013 to June 2016 were included in the study. A total of 148 patients underwent subtotal resection of both heads, and calf reduction ranged from 3.2 to 7.2 cm (mean 14.8%). Forty-two patients underwent subtotal resection of the medial head alone, and calf reduction ranged from 2.8 to 5.5 cm (mean 9.2%). Ten patients underwent subtotal resection of the lateral head alone, and calf reduction ranged from 1.2 to 2.1 cm (mean 4.6%). The medial gastrocnemius muscle was subtotally resected in 190 (95%) patients. In 130 (65%) patients, the preserved medial gastrocnemius muscle was transposed superomedially to achieve a straighter medial contour. None of the patients complained that their legs were too thin because of over-reduction. Cybex test showed that near-total muscle strength recovery was achieved within 6 months. Customized differential subtotal gastrocnemius resection together with muscle transposition resulted in enhanced calf reduction with straighter leg contour, without any impairment of the leg function. This approach may be more appealing to both patients and surgeons.

Estudio piloto: Medidas mandibulares en población infantil

Introducción: El propósito del presente estudio es estimar el promedio de valores cefalométricos de niñas y niños mexicanos de 8 años de edad, residentes en la ciudad de México y comparar la información obtenida con estándares extranjeros. Métodos: Se determinaron los valores promedio de cuatro medidas mandibulares y doce del análisis de McNamara, se utilizaron 50 cefalogramas laterales de niños y 50 de niñas de 8 años de edad con oclusión clase I de Angle, sin tratamiento ortodóncico ni ortopédico. Resultados: Las muestras de los niños resentan mayor tamaño en sus estructuras óseas; el espacio faríngeo superior e inferior es mayor en las niñas. Hay diferencias estadísticamente significativas entre niños y niñas en la longitud mandibular total, la longitud del cuerpo mandibular, la altura del tercio facial inferior y la proyección anterior del mentón. Conclusiones: El presente estudio demuestra que existen diferencias cefalométricas significativas entre niños y niñas, así como entre las muestras italiana, americana y mexicana.

Semen parameters are seriously affected in acephalic spermatozoa syndrome

BackgroundPrevious studies have reported that some patients with headless spermatozoa have poor semen quality, but there has been no published systematic analysis of semen quality in patients with different proportions of headless spermatozoa in semen. We aimed to explore the association of acephalic spermatozoa syndrome and semen quality in men with distinct proportions of headless spermatozoa.Material and methodsSemen parameter values in patients for whom headless spermatozoa were found in the ejaculates was studied and compared to that of 413 age-matched prenatal examination patients. All semen samples were analyzed following the same methodology in a single laboratory.ResultsAll semen parameter values except semen volume were negatively (P < 0.05) correlated with the proportion of headless spermatozoa. The semen samples were divided into four groups on the basis of the proportion of headless spermatozoa (PHS) as follows: 0 < PHS ≤ 5% (n = 172, Group A1); 5 < PHS ≤ 10% (n = 76, Group A2); 10 < PHS ≤ 20% (n = 71, Group B); and PHS > 20% (n = 71, Group C). In Group A1, only one semen parameter value (progressive motility) was lower than those of the control group, but in Group A2, this increased to five (sperm vitality, normal sperm morphology, sperm motility, VCL (curvilinear velocity) and ALH (amplitude of lateral head displacement)). Worse still, all semen parameter values were significantly lower in Group B and Group C than in the control group (P < 0.05).ConclusionsSemen samples containing headless spermatozoa tend to have lower quality than samples without headless spermatozoa. Increases in the proportion of headless spermatozoa in semen are associated with decreased semen quality. We suggest that headless spermatozoa should be seriously assessed and accurately counted in semen analysis, especially for ejaculate in which the proportion of headless spermatozoa exceeds 5%.

Protective effect of rosiglitazone on microscopic and oxidative stress parameters of ram sperm after freeze-thawing

The purpose of this study was to investigate the effects of rosiglitazone on ram semen after cryopreservation on the quality of thawed sperm. Sperm motility, membrane functionality, viability, total abnormality, acrosome membrane integrity, mitochondrial activity, reactive oxygen species production, ATP content and apoptotic features were assessed after thawing. Rosiglitazone at concentration of 60 µM resulted in the highest (P < 0.05) total motility, progressive motility and straight-line velocity. The percentages of average path velocity and curvilinear velocity were greater in the 60 µM group. Different concentrations of rosiglitazone did not have significant effects on amplitude of the lateral head displacement, linearity and straightness. The highest amounts of membrane functionality and mitochondrial activity after freeze-thawing were observed in groups containing 60 µM. By increasing the rosiglitazone level to 80 µM, no positive effect was observed in most of the evaluated parameters. The lowest ROS concentration was recorded in 60 µM rosiglitazone group (P < 0.05). The group containing 60 µM rosiglitazone also produced the lowest significant percentage of apoptosis-like changes and dead sperm. A greater (P < 0.05) percentage of acrosome integrity in frozen-thawed spermatozoa was observed in the 60 µM rosiglitazone group. There was no significant difference between 40 and 60 µM rosiglitazone in intact acrosome of ram thawed semen. The result showed that supplementation in ram semen extender with rosiglitazone had a positive role in the regulation of ram sperm motility and had strong protective effect on the sperm membrane and acrosome integrity.

Intraoperative Fluoroscopy Allows the Reliable Assessment of Deformity Correction during Periacetabular Osteotomy.

We aimed to determine the accuracy and reliability of measures characterizing anterior, lateral, and posterior acetabular coverage on intraoperative fluoroscopic images compared to postoperative radiographs when performing periacetabular osteotomies (PAOs). A study involving 100 PAOs was initiated applying a standardized intraoperative imaging protocol. Coverage was determined by the lateral center edge angle (LCEA), the Tönnis angle (TA), and the anterior and posterior wall index (AWI, PWI). An intraclass correlation coefficient (ICC) model was used to assess interrater (ICC (3,2)) and intrarater (ICC (2,1)) reliability. The ICC (2,2) between analyses obtained from intraoperative fluoroscopy and postoperative radiographs and the corresponding 95% confidence interval (CI) were determined and complemented by Bland–Altman analysis, the mean difference, and 95% limits of agreement (LOA). The ICCs were 0.849 for the LCEA (95% CI 0.783–0.896), 0.897 for the TA (95% CI 0.851–0.930), 0.864 for the AWI (95% CI 0.804–0.907), and 0.804 for the PWI (0.722–0.864). The assessed interrater reliability was excellent except for the AWI, which was graded good (ICC = 0.857, 95% CI 0.794–0.902). Interrater agreement was generally good and fair for the AWI (ICC = 0.715, 95% CI 0.603–0.780). For each postoperative radiograph, interrater reliability was good with ICCs ranging from 0.813 (TA) to 0.881 (PWI). Intrarater reliability was good for all measurements and excellent for the preoperative TA (ICC = 0.993, 95% CI 0.984–0.997) and PWI (ICC = 0.954, 95% CI 0.919–0.97). In summary, we confirm the validity and reliability of intraoperative fluoroscopy as an alternative imaging modality to radiography to evaluate acetabular fragment orientation during PAO. We affirm the LCEA and TA as precise measures for lateral head coverage, and show the suitability of the AWI and PWI to steadily assess acetabular version.

Radial Nerve Fascicular Transfer Preserving Long Head through Anterior Incision for Transhumeral Targeted Muscle Reinnervation

Summary:New developments in targeted muscle reinnervation promise better options for treatment of neuropathic pain and improved prosthetic control. For transhumeral amputations, the traditional approach involves an anterior incision to access the median and ulnar nerves and a second posterior incision to access the radial nerve. This is necessitated as exposure of motor branches of the radial nerve distal to the branch to the long head of the triceps is difficult from the anterior approach. Herein, we describe a technique for transferring the radial nerve proper distal to the long head branch to a motor branch to the medial or lateral head of the triceps through internal neurolysis and fascicular transfer. This allows all surgical steps to be performed through a single incision while preserving native motor branches to the biceps and triceps muscles.

Anatomy of Profunda Brachial Artery in the Axilla and Its Relationship With the Radial Nerve: Fresh-Cadaver Anatomical Study and Clinical Observations

Dissection of the radial nerve in the axilla and upper portion of and posterior aspect of arm may be necessary for brachial plexus reconstruction, in axillary nerve paralysis, and in radial nerve injuries. The radial nerve is in intimate contact with the profunda brachial artery (PBA). The authors sought to describe the relationship of the PBA with the radial nerve. We dissected the PBA and the radial nerve bilaterally in 20 upper limbs from 10 fresh cadavers after subclavian artery injection with green latex. We studied the relationship of the PBA with the radial nerve, its branching patterns, and its diameters. In addition, we performed surgery on 5 patients with brachial plexus, radial, or axillary nerve injury in whom we dissected the PBA. The PBA was present in all dissections, originating from the brachial artery (n= 19 specimens) close to the latissimus dorsi tendon or from the subscapular artery (n= 1 specimen). In 15 dissections, the PBA bifurcated into an anterior (AB) and a posterior (PB) branch. In one dissection, the AB was absent. The AB traveled toward the triceps medial head. The PB flanked the radial nerve posteriorly and traveled around the humerus, with the radial nerve passing between the medial and the lateral head of the triceps. The AB and PB were longer than the PBA and measured on average 53 mm (SD ± 33 mm) and 39 mm (SD ± 26 mm), respectively. Intraoperatively, the radial nerve could be exposed in the upper arm by pulling the triceps medial head anteriorly together with the AB. The PB was lateral to the radial nerve in the posterior arm approach. In the upper arm, the radial nerve was not flanked by a single branch as postulated in anatomical textbooks but by 2 branches resulting from the bifurcation of the PBA. Awareness of PBA anatomy is essential during radial nerve dissection from the anterior or posterior arm approach.