Medial Oblique Research Articles

Effects of adding neuromuscular electrical stimulation to functional training on muscle recruitment, pain reduction, and knee joint function in patellofemoral pain syndrome patients.

Impaired lower extremity motor function and knee pain are common concerns in patients with patellofemoral pain syndrome (PFPS). It is essential to plan therapeutic techniques to therapy PFPS. The objective of this study was to determine the effect of neuromuscular electrical stimulation (NMES) combined with functional training on pain, lower extremity function and muscle recruitment in patients with PFPS. Twenty-four PFPS patients (male-13, female-11) were selected to conduct this study finally. Two groups were formed: the control group (n = 12) which included functional training only and the experimental group (n = 12) which functional training along with NMES-in both groups interventions were performed for 45 minutes/session, 3 days/weeks for 6 weeks. The functional training consisted of warm-up activities, strength training, balance training, and relaxation activities. All patients were evaluated with surface electromyography testing system for the root mean square and integrated electromyography of vastus medial oblique (VMO), vastus lateralis (VL), and VMO/VL ratio, visual analog scores (VAS) for pain, and Kujala functional score for knee joint function before and after 6 weeks. Normality was tested for all outcome variables using Shapiro-Wilk test. Nonparametric (Mann-Whitney U test and Wilcoxon signed-rank test) tests were used to analyze data. A 2-way analysis of variance with repeated measures (group*time) was applied to analyze the data. A significant increases (P < .001) root mean square and integrated electromyography of VMO, VMO/VL ratio, and Kujala score in both groups, For VAS scores, significant decreases was observed in both groups. When both groups were compared, greater improvement (P < .05) was observed in the experimental group in comparison the control group for both knee pain, lower extremity function and muscle recruitment. However, there was no difference in VL muscle recruitment between the 2 groups. Functional training and NMES combined with functional training are helpful to improve pain, knee function and muscle recruitment of PFPS patients. NMES combined with functional training was more effective compared to the control group. This may help clinical trialists to use different NMES to synchronize other interventions in future studies to enhance rehabilitation efficacy in PFPS patients through passive training versus active stimulation.

Comparison of Three Different Approaches to Ultrasound Guided Internal Jugular Vein Cannulation: A Randomised Clinical Study

Introduction: The standard approaches to ultrasound-guided central line insertion by Short Axis (SAX) and Long Axis (LAX) have limitations. The Medial Oblique Axis (M-OAX) approach allows visualisation of the length of the needle in real-time along with both the artery and vein. Aim: To compare the three approaches for ultrasound-guided right Internal Jugular Vein (IJV) cannulation with respect to ease of access and complications. Materials and Methods: A total of 171 patients scheduled to undergo right IJV cannulation were divided equally into three groups-SAX (Group-1), LAX (Group-2), and M-OAX (Group-3). They were compared with respect to first pass success, Venous Access Time (VAT), guide wire insertion time, catheterisation time, and complications. Continuous variables were compared with Analysis of Variance (ANOVA) test. Categorical variables were analysed using the Chi-square test. The p-value &lt;0.05 was considered significant. Results: First pass success was 55 (96.49%), 53(92.98%), and 54 (94.74%) in groups 1, 2, and 3, respectively. The VAT, guidewire insertion time, and catheterisation time were significantly lesser in Groups 1 and 3 compared to 2 (p&lt;0.001). Two cases of carotid artery puncture were noted in Group-2, though statistically not significant (p&gt;0.05). Conclusion: The medial oblique approach to IJV cannulation combines the advantages of both LAX and SAX and is a safer alternative with easier and faster venous access.

Reliability of Gordon Lateral Rotation Percentage and Prabhakar Percentage of Metaphyseal Overhang for Pediatric Supracondylar Humerus Fracture; Is it Clinically Reliable for John Hopkins Classification Coronal Fracture Subtypes?

Rotational malalignment is a common problem in pediatric supracondylar humerus fractures (SCHF). Several techniques have been described to evaluate the true rotation value. Although the Prabhakar and Gordon techniques are used frequently, their superiority to each other in terms of measurement quality is unknown. The aim of this study was to investigate the clinical compatibility of the 2 techniques and to evaluate whether they are suitable for all subtypes. This cross-sectional study included 40 patients with SCHF (including subtypes; Typical, Medial Oblique, Lateral Oblique, and High fracture pattern). The Gordon lateral rotation percentage and Prabhakar percentage of metaphyseal overhang were measured twice by 4 experienced Orthopedics and Traumatology surgeons at 8-week intervals. The interobserver and intraobserver reliability were examined using the intraclass correlation coefficient. The interobserver reliability for Gordon and Prabhakar technique was 0.816 and 0.762 for the first measurement and 0.811 and 0.811 for the second measurement, respectively.The medial oblique fracture pattern was determined to have the best interobserver agreement among the subtypes. The result was excellent for the medial and lateral oblique subtypes, good for the typical fracture pattern, and fair for the high fracture pattern. The intraobserver reliability for Gordon and Prabhakar technique was excellent, 0.924 and 0.922, respectively. The main finding of this study was that the Gordon and Prabhakar techniques have similar interobserver and intraobserver reliability. Although the Gordon technique tends to have higher interobserver reliability, the difference was clinically insignificant. These measurements should not be relied upon in cases of SCHF with a high fracture pattern because of the different anatomic features of that region. Level III.

Is radiological rotation measurement affected by the fracture pattern in pediatric supracondylar humeral fractures?

In supracondylar humerus fractures (SCHF), the most frequently used method to calculate rotation is the Gordon lateral rotation percentage (GLRP) defined by Gordon et al. However, this technique includes only typical fractures (49%-80% of all fractures) from the Johns Hopkins (J-H) fracture classification system. The aim of the study was to investigate (1) is Gordon criteria useful for John Hopkins subgroups of supracondylar fractures and (2) is Gordon criteria affected by internal and external rotation. This study was designed using four pediatric left humerus bones obtained from the Sawbone© company. For each bone, an osteotomy was made to mimic each of the J-H coronal fracture patterns. The cut bones were placed in a wooden rotation apparatus. The GLRP measurements were taken by five blinded observers. In the repeated measurements of the observers, <20° rotation typical and <30° medial oblique and lateral oblique fracture pattern were measured as within the limits of an acceptable amount of rotation according to the Gordon criteria. However, for high fracture pattern (HFP), ≤30° internal rotation and <60° external rotation were determined to be within the acceptable rotation criteria according to the Gordon criteria. All fracture patterns have different characteristics; however, based on the data of this study, the Gordon criteria can be used safely for typical, medial oblique, and lateral oblique fracture patterns but it is necessary to lower the acceptable rate of 50% for HFP.

Dynamic Evaluation of Skin Displacement by the Frontalis Muscle Contraction Using Three-Dimensional Skin Displacement Vector Analysis.

Understanding the muscle actions and resultant skin movement can enable more safe and effective botulinum toxin injection for the treatment of forehead wrinkles. We aimed to investigate skin displacement patterns of the forehead and adjacent skin due to frontalis muscle contraction using three-dimensional skin vector displacement analysis. Thirty healthy individuals were enrolled. Photographs of the face were taken at rest and during maximal contraction of the frontalis muscle. Each expression image was aligned to its respective static image to compute the differences in the skin position. When frontalis muscle contracts, forehead skin displacement vectors were mostly vertical (63.4%), followed by lateral oblique (33.3%) and medial oblique (3.3%). In 53.3%, only the lower part of the forehead moved upward, while 40.0% showed bidirectional skin movement with transition line at a mean distance of 59.4 mm above the pupil. Moreover, 86.7% showed asymmetric skin displacement, and 83.3% showed both glabellar and eyebrow skin displacement. Frontalis muscle contraction also induced medial 2/3 (50.0%) or entire (33.3%) skin movement of the temple. Botulinum toxin injection into the forehead can be individualized by considering the vector and asymmetry of skin displacement. Vertical or medial vector requires more centrally located injections, while laterial vector requires more laterally located injections. The presence and location of the vertical transition line are important for preventing ptosis when treating forehead lines with botulinum toxin. Glabellar movement during frontalis contraction suggests the need for a concomitant injection into the glabella to prevent glabella wrinkle accentuation.

Ultrasound Probe Positions for Internal Jugular Vein Cannulation: A Prospective Study of Different Techniques.

We compared sonoanatomy of the internal jugular vein (IJV) the high (HA), conventional (CA) and the medial oblique approach (MA) to identify the best approach and head position for IJV cannulation. Total of 45 volunteers aged 18-65 years were included in this study. The degree of overlap in percentage, depth of IJV from skin, antero-posterior (AP) and transverse diameters (TD) of IJV were measured in real time with ultrasound (US). Measurements were taken in the HA, CA and MA in neutral and 30° head rotation on both the right and left side of the neck. The HA had lower percentage of overlap when compared to CA and MA in neutral and 30° head rotation (p= 0.002 to ≤0.001). The IJV was more shallow in the CA and MA. The AP and TD of the IJV were larger in the MA when compared to HA (p=<0.001) and CA (p =0.026 to < 0.001) and the right IJV has a larger AP and TD in all approaches. The HA had the least percentage of overlap compared to CA and MA, therefore the risk of accidental ICA puncture can be reduced. The apparent overlap seen in MA may not reflect the actual scenario because of the way the US beam cuts the vessel. The AP and TD of IJV were significantly increased in the MA, which would ease CVC. We conclude and recommend the medial oblique probe position with 30° head rotation provides optimal real time sonographic parameters for US guided IJV cannulation.

Mechanical stability study of three techniques used in the fixation of transverse and oblique metaphyseal-diaphyseal junction fractures of the distal humerus in children: a finite element analysis

BackgroundManagement of distal humerus metaphyseal-diaphyseal junction (MDJ) region fractures can be very challenging mainly because of the higher location and characteristics of the fracture lines. Loss of reduction is relatively higher in MDJ fractures treated with classical supracondylar humerus fractures (SHFs) fixation techniques.MethodsThree different fracture patterns including transverse, medial oblique and lateral oblique fractures were computationally simulated in the coronal plane in the distal MDJ region of a pediatric humerus and fixated with Kirschner Wires (K-wires), elastic stable intramedullary nails (ESIN), and lateral external fixation system (EF). Stiffness values in flexion, extension, valgus, varus, internal, and external rotations for each fixation technique were calculated.ResultsIn the transverse fracture model, 3C (1-medial, 2-lateral K-wires) had the best stiffness in flexion, varus, internal, and external rotations, while 3L (3-divergent lateral K-wires) was the most stable in extension and valgus. In the medial oblique fracture model, EF had the best stiffness in flexion, extension, valgus, and varus loadings, while the best stiffness in internal and external rotations was generated by 3MC (2-medial, 1-lateral K-wires). In the lateral oblique fracture model, 3C (1-medial, 2-lateral K-wires) had the best stiffness in flexion and internal and external rotations, while ESIN had the best stiffness in extension and valgus and varus loadings.ConclusionThe best stability against translational forces in lateral oblique, medial oblique, and transverse MDJ fractures would be provided by ESIN, EF, and K-wires, respectively. K-wires are however superior to both ESIN and EF in stabilizing all three fracture types against torsional forces, with both 2-crossed and 3-crossed K-wires having comparable stability. Depending on the fracture pattern, a 3-crossed configuration with either 2-divergent lateral and 1-medial K-wires or 2-medial and 1-lateral K-wires may offer the best stability.

Variants of stomach position in different types of congenital diaphragmatic hernia in the fetus

Purpose – to present detailed description for typical variants of the stomach location in left-sided congenital diaphragmatic hernia in the fetus in relation to the main topographic landmarks of the chest and abdomen, and to determine the relationship between the position of the stomach and anatomical variants of pathology. Material and methods. Analysis of the data from 235 ultrasound examinations of 157 fetuses in patients with left-sided diaphragmatic hernia, which were referred in 2007-2020. Results. In 3 cases (1.91 %) identification of the stomach and its location was impossible. In the remaining 154 cases, the following typical variants of stomach position were identified: intra-abdominal (22.73 %), intra-thoracic medial (12.99 %) and medial oblique (4.55 %), mid-ventral (21.43%), transverse ( 16.23 %), mid-dorsal (5.19 %), retrocardiac (5.84 %), paravertebral (2.6 %), left paracostal (1.3 %), and left pseudoanatomical (7.14 %) . With the abdominal localization of the stomach there was a shift of its pyloric part down to the bladder in 74.3 %, and in 17.1 % of cases stomach position was changed for intra-thoracic. Liver herniation was registered in 14.3% of cases with intra-abdominal stomach position, in 87.5% of mid-dorsal, and in 100% of cases with central-ventral, transverse, retrocardiac, paravertebral and left paracostal position. The liver was not detected in the thorax in cases with medial stomach position, and its identification was complicated in cases with oblique medial position. Conclusions. Typical anatomical variants of the stomach and other herniated abdominal organs location in the thorax of fetuses with left-sided diaphragmatic hernia were determined. The proposed classification system of anatomical variants of left diaphragmatic hernia with an emphasis on the stomach position will allow to improve the accuracy of prenatal ultrasound diagnosis, as well as individual prediction of postnatal outcome. Key words: congenital diaphragmatic hernia, congenital malformations, liver herniation, stomach position.

Müller Weiss Disease: Radiological Evaluation and Proposed Treatment Algorithm

Category:Midfoot/ForefootIntroduction/Purpose:Müller Weiss disease is becoming increasingly recognized and is of unknown etiology. Maceria et al. formulated a classification based upon the Méary-Tomeno talo-first metatarsal angle and coined the term ‘paradoxical pes planus varus’ proposing hallmark deformities. Acknowledging there is no gold standard for treatment, various surgical modalities have been advocated in the literature e.g. isolated lateral displacement calcaneal osteotomy as sole treatment. The question subsequently arises; which joints to fuse in Muller-Weiss disease? Although no consciences prevails, one must postulate fusion should include those affected. For the purpose of establishing an algorithm in the surgical treatment of Muller-Weiss disease, we therefore set out to study its clinical and radiographic features, including pathoanatomy and metabolism as determined by SPECT- CT.Methods:We studied 63 consecutive feet presenting with Muller-Weiss disease (15 to 86 years, 18 men, 26 women). History and examination by consultant in all cases. Plain radiographs included standing anteroposterior both ankles, hindfoot alignment views, lateral standing of both ankles and feet, medial oblique both feet and dorsoplantar standing and SPECT-CT.Surgery performed on significantly symptomatic feet unresponsive to minimum of six months conservative measures.Méary’s talo-first metatarsal angles measured. On dorsoplantar radiographs the anteroposterior thickness of the navicular was measured at each naviculo-cuneiform joint perpendicular to transverse axis of the medial pole of the navicular. The percentage compression was calculated at each joint and the degree of extrusion of the medial pole. Hindfoot alignment measured using method of Saltzmann.Study approved by our local research and ethics department and in accordance with General Data Protection Regulation guidelines. Statistical analysis was performed using SPSS software.Results:Using R2 coefficient of determination we found no correlation at any level between extrusion and the degree of compression. With respect to hindfoot alignment and Méarys angle there was no significant correlation (R2=0.003) Shapiro-Wilk test demonstrates a normal distribution of extrusion in both unilateral and bilateral cases. In 95.2% of unilateral cases extrusion significantly greater on affected side (P<0.001 Fisher exact test), in bilateral cases extrusion greater on the side with more compression 55.6%.Degree of extrusion significantly greater in bilateral than in unilateral cases (P=0.004 unpaired T-test) ‘Paradoxical pes planus varus’ present in 27% with heel valgus and Méary’s negative in 47% cases. Almost half of patients treated conservatively consistent with literature with surgical intervention specific to involved joints from clinical and radiological parameters.Conclusion:Lack of correlation between Méary angle and degree of compression or extrusion invalidates principle classification; it fails to reflect the severity of compression of the lateral navicular and amount of extrusion of the medial pole and has no prognostic value. It provides no guide as to what joints to fuse. Proposed hallmark deformities only present in 27% of advanced disease therefore caution advised with surgical modality. SPECT-CT influenced operative planning and authors advocate its use.We observed greater incidence of fracture with advanced disease and subclinical degenerative changes. With failed non-operative management figure 1 is our proposed treatment algorithm.

A novel radiographic projection for the detection of sagittal plane slab fracture of the equine third carpal bone.

Some sagittal plane fractures of the equine third carpal bone are difficult to detect with conventional radiographic projections. To describe a novel radiographic projection for the detection of sagittal plane slab fractures of the equine third carpal bone. Retrospective study of radiological records. From a first opinion Thoroughbred racehorse caseload, cases were included for analysis if sagittal fracture of the third carpal bone was evident on a dorsoproximal lateral-palmarodistal medial oblique (DPrL-PDiMO) projection of the distal row of carpal bones and not visible on the standard dorsoproximal-dorsodistal oblique (DPr-DDiO) projection. Eight cases in which radiological identification of fracture was dependent on the DPrL-PDiMO projection were identified from August 2013 to August 2017. Unblinded study. Conventional radiographic projections can fail to detect some serious fractures of the equine third carpal bone. The DPrL-PDiMO projection has a role in the investigation of suspected carpal injury in racehorses.

PENAMBAHAN KINESIOLOGY TAPE PADA PELATIHAN CLOSED KINETIC CHAIN (CKC) DAN STRETCHING LEBIH BAIK DALAM MENURUNKAN EXCESSIVE Q-ANGLE PADA WANITA

Background: Q-angle is the angle between the quadriceps and patellar tendon and showing the angle of the quadriceps muscle tension. Pelvic widening in women does not occur in men who lead the Q-angle in women begins to enlarge during adolescence than men. Purpose: The purpose of this study was to compare the addition of kinesiology tape on CKC training and stretching without additional kinesiology tape on CKC training and stretching in women. Methods: This research was a randomized experimental design with pre-test and post-test group design. The sample contain by 24 people divided into two groups of 12 people each. Treatment group with the addition of kinesiology tape on CKC training and stretching, while the control group only CKC training and stretching. This research was conducted for 8 weeks, 2 times in a week. The data collected by the Q-angle measured using a goniometer at the time before and after treatment. Result: The results of data analysis using the Wilcoxon Signed Ranks Test, Q-angle was obtained with p = 0.002 for the different treatment groups with an average of 12.25 and in control group acquired Q-angle, with p = 0.002 with 6.416 average difference, and different 47.59% with treatment group. Mann-Whitney test results the average of difference of decreasing of treatment group is 18.5 and the average of difference of control group is 6.5 different 64.86% with treatment group, showed that there were significant differences in the decrease in Q-angle between the two groups with the result p = 0.001 (p &lt;0.05). Conclusion: Conclusions of research are: the addition of kinesiology tape on the training of Closed Kinetic Chain (CKC) and stretching better in reducing excessive Q-angle in women. Suggestion: For the next research suggest to add dependent variables as: muscle strength, functional and speed of muscle contraction of Vastus Medial Oblique (VMO), individual addressing treatment, and use x-ray as measurement tool.

Comparative Sonoanatomy of Classic “Short Axis” Probe Position with a Novel “Medial-oblique” Probe Position for Ultrasound-guided Internal Jugular Vein Cannulation: A Crossover Study

BackgroundUltrasound (US)-guided short-axis approach for internal jugular vein (IJV) cannulation does not fully protect patients from inadvertent carotid artery (CA) puncture. Carotid puncture is not rare (occurring in up to 4% of all IJV cannulations) despite the use of US. ObjectivesCompare the sonoanatomy of the “medial-oblique approach” probe position with the classic US-guided “short-axis” probe position, specifically: relation of internal CA and IJV; vertical and horizontal diameter of IJV; and degree of overlapping of IJV with CA. MethodsOne hundred consecutive patients between the ages of 18 and 50 years, both male and female, and American Society of Anesthesiologists Physical Status classification system (ASA PS) I–II undergoing elective surgery under general anesthesia were recruited in this prospective, randomized, crossover, parallel-group study. ResultsThe transverse diameter of the IJV was found to be significantly higher in the medial-oblique probe position (p = 0.000, mean difference 0.43 cm; 95% confidence interval [CI] 0.34–0.52). The percentage of overlap was also significantly lower in the medial-oblique probe position (48.7 ± 10.7% in short-axis vs. 36.3 ± 13.2% in medial-oblique probe position; p = 0.000; mean difference 12.4%, 95% CI 9.1–15.8). However, there was no statistically significant difference in the anteroposterior diameter of the IJV between the two probe positions (1.11 ± 0.26 cm in short axis vs 1.07 ± 0.25 cm in medial oblique; p = 0.631). ConclusionThe medial-oblique probe position for IJV cannulation provides sonoanatomic superiority over the classic short-axis probe position. Further randomized, controlled trials may confirm the medial-oblique view's clinical benefit in the future.

A Method for Measurement of the Hypertrophic First Metatarsal Medial Eminence on Foot Radiographs—A Reliability Study with Surgical Implications

Background: It has been suggested that hypertrophic eminence on the medial head of the first metatarsal is a component of the patho-anatomy of hallux valgus. However, research findings in this area are inconsistent, possibly due to differences in methods in identifying and measuring the medial eminence. To date, reliability of any method of measurement has not been reported. The purpose of this study was to determine the reliability of measurement of the medial eminence on medial oblique and dorsoplantar radiographs using a previously described geometric technique. Methods: To evaluate the reliability of a method of measurement of the medial eminence of the first metatarsal duplicate standardized dorsoplantar and medial oblique radiographs were taken of one foot of 15 subjects. The feet included both rectus feet and subjects with hallux valgus. The medial eminence was measured on the digital images using Inteleviewer 2.5 (Intelerad medical systems incorporated, Montreal, Quebec) software. Observer 1 measured one randomly selected image from each subject to determine inter-observer reliability. Observer 2 measured all images to determine the overall intraobserver reliability. Reliability was calculated using intra-class correlation coefficients (ICC). Results: The mean projection of the medial eminence ranged from 0.39 to 0.44 cm in both views. The ICCs were calculated for the dorsoplantar view and the 2 medial oblique view measures between observers. They ranged from 0.76 intra-rater and 0.86 interrater in the dorsoplantar view to 0.80 intra-rater and 0.90 inter-rater in the medial oblique view indicating good reliability in all measures. The average of the 4 oblique views also showed a high level of reliability with a coefficient of 0.96. Conclusions: The medial eminence can be reliably measured in the medial oblique and dorsoplantar view using the described technique. The medial oblique and the dorsoplantar views are valuable and reliable projections for visualising the dorso medial aspect of the first metatarsal.

Radiographic Assessment of the Safe Zone for Medial Oblique Opening Wedge High Tibial Osteotomy

To compare different cephalocaudal angles of the X-ray beam in measuring internal rotation of the proximal tibia that best demonstrates the safe zone. 10 pairs of embalmed, disarticulated knee joints from 10 cadavers were used. Soft tissues around the proximal tibia and the proximal tibiofibular joint (PTFJ) were dissected to reveal the articular cartilage. A narrow area between the end of the articular cartilage of the posterolateral proximal tibia and of the PTFJ was identified as the safe zone with a U-shape metal used as a radiographic marker. Translation of the proximal tibia was controlled during internal rotation of the proximal tibia. Internal rotation of the proximal tibia that best demonstrated the safe zone (the U-shape metal at its most outermost point) was measured at 0º, 5º, 10º, 15º, 20º, and 25º cephalocaudal angles of the X-ray beam. The mean internal rotation of the proximal tibia that best demonstrated the safe zone at 0º, 5º, 10º, 15º, 20º, and 25º cephalocaudal angle of the X-ray beam were 50º, 45º, 37º, 32º, 23º, and 19º, respectively. The safe zone was best demonstrated with 50º and 45º internal rotation of the proximal tibia at 0º and 5º cephalocaudal angles of the X-ray beam, respectively.

Distribution of Myosin Heavy Chain Isoform in Human Extraocular Muscles

Purpose: To provide quantitative data on the distribution of MyHCeom and compare the proportion of myosin heavy chain (MyHC) isoforms between the central and peripheral regions of human extraocular muscles (EOMs). Methods: Medial rectus, lateral rectus, superior rectus, inferior rectus, superior oblique, and inferior oblique muscle samples were taken from three men with brain death. To examine the longitudinal distribution of myosin isoforms, the muscles were divided into central and peripheral portions of equal length. Electrophoresis and densitometry were used to quantify the distribution of MyHC isoforms. Results: Electrophoresis of whole-muscle extracts of sampled EOMs revealed four MyHC bands that were identified as MyHCI, MyHCeom, MyHCIIa, and MyHCIIx. The proportion of MyHCeom was higher in the central region, whereas the proportion of MyHCIIa was higher in the peripheral region. The relative proportions of MyHCI, MyHCeom, and MyHCIIa were not significantly different among the EOMs. There was a tendency for higher levels of MyHCIIx in the inferior rectus muscle. Conclusions: The proportion of MyHCeom was higher in the central region of human EOMs. Further studies are needed to investigate the consequences of this distributional difference on the function of EOMs.

Patterns of Pediatric Supracondylar Humerus Fractures

The Wilkins-modified Gartland classification of pediatric supracondylar humerus fractures does not consider coronal or sagittal obliquity. The purposes of our study were (1) to identify and describe fracture characteristics with unique properties and (2) to propose a fracture classification system that can be reproduced reliably. We retrospectively studied 203 consecutive displaced pediatric extension-type supracondylar humerus fractures treated operatively from January 1998 to January 2003. Fracture characteristics (eg, coronal and sagittal obliquity, postoperative alignment), type of surgical treatment, outcome, and complications were assessed and analyzed statistically with Student t test and a receiver operating characteristic curve. Significance was defined as P < 0.05. We incorporated significant cutoff values for fracture obliquity into our classification scheme and tested the classification's interobserver and intraobserver reliability. We identified 4 coronal (typical transverse, medial oblique, lateral oblique, and high fractures) and 2 sagittal (low sagittal and high sagittal) subtypes with significantly different characteristics and outcome. Compared with fractures with coronal obliquity of less than 10 degrees, fractures with coronal obliquity of 10 degrees or greater were associated with significantly more comminution and rotational malunion. Compared with fractures with sagittal obliquity of less than 20 degrees, fractures with sagittal obliquity of 20 degrees or greater were associated with a significantly higher incidence of additional injuries and were more likely to result in extension malunion. Analysis of the interobserver and intraobserver reliability for our system identified correlation coefficients ranging from 0.772 to 0.907 and 0.860 to 0.899, respectively. Because pediatric extension-type supracondylar humerus fractures vary significantly in terms of characteristics, identification of sagittal oblique and coronal oblique angles may have an important role in surgical decision making and may impact outcomes.

Avaliação ultraestrutural do colágeno do ligamento colateral medial associado ao ligamento oblíquo da articulação do cotovelo de cão SRD após ensaio de tração

Ultrastructural evaluation of the collagen of the mongrel dog medial collateral ligament associated to the oblique ligament after strain. The present work aimed to observe the disposition of the collagen fibres of the medial collateral ligament of the elbow joint of the dog, when associated to the oblique ligament. Thus, 18 articulations were used, divided in three groups. A group had the medial collateral ligament collected and not stretched, other group had the collateral medial ligament stretched separately and the other group had both ligaments (medial collateral and oblique) stretched associately. The medial collateral ligament examined by scanning electron microscopy presented a wavy and reticular pattern of the collagen fibres when not submitted to strain, which was not totally destroyed when it was associated to the oblique ligament. When stretched separately, the medial collateral ligament after strain totally loses the reticular pattern, demonstrating the waste of the fibres to resist to the tension

Medial oblique compression fracture of the coronoid process of the ulna

The most widely recognized coronoid fractures have been described as occurring in the coronal plane according to the amount of process detached from the ulna. Over the last few years, we have recognized that the coronoid fracture is a much more complex injury than originally thought. This report calls attention to an oblique, medial compression fracture of the coronoid, a fracture so subtle as to be missed by routine assessment but sometimes associated with joint subluxation or dislocation. The currently accepted classification system based on a simple fracture pattern in the coronal plane may be too simplistic to characterize fractures of the coronoid fully.

2003 William J. Stickel Bronze Award. Radiographic anatomy of the talus.

Detailed radiographic anatomy of the entire talus bone has not been previously described in the literature. We used radiopaque wire markers to identify 17 articular and nonarticular anatomical landmarks of the talus. Standard radiographic views of the foot and ankle were obtained: lateral (foot and ankle); anteroposterior, mortise, medial oblique, and lateral oblique (ankle); and dorsoplantar, medial oblique, and lateral oblique (foot). The resultant two-dimensional images are correlated to the three-dimensional anatomical specimen, and normal radiographic anatomy is described. Additionally, useful radiographic views for each anatomical landmark are identified. Composite figures of each useful view are presented as a pictorial atlas.

Localization of motoneurons innervating the extraocular muscles in the chameleon (Chamaeleo chameleon).

The topography and localization of motoneurons innervating the six extraocular muscles in the chameleon (Chamaeleo chameleon) was studied following HRP injection in each of these individual muscles. Four muscles were innervated ipsilaterally: medial rectus, inferior rectus, inferior oblique and lateral rectus. The medial rectus muscle was innervated by the dorsomedial part of the oculomotor nucleus. The innervation to the inferior rectus muscle arose from the lateral part of the intermediate oculomotor subnucleus, which extended to the lateral part of the dorsal subdivision. The lateral rectus muscle was innervated by the abducens nucleus, which was composed by two subgroups of labeled cells, respectively observed in the principal and accessory abducens subnuclei, whereas efferents to the inferior oblique muscle originated from both the ventral and intermediate oculomotor subnuclei. The contralateral pattern consisted of motoneurons innervating the superior rectus and the superior oblique that were located respectively in the caudal portion of the ventral oculomotor nucleus and in the trochlear nucleus. These results confirmed data reported in most vertebrate species, and were discussed from a comparative and functional point of view.