Posterior Corner Research Articles

A New Species of Pontella Dana, 1846 and New Record of Pontella surrecta Wilson (1950) (Copepoda, Calanoida, Pontellidae) from Indonesian Waters, with Notes on Their Species-Groups

A new species of Pontella Dana, 1846 from Indonesian waters is herein described. Pontella mayalibit n. sp. is distinguishable in the female by having a small posterodorsal beak-like process on the left side of Ur1, the extremely asymmetrical CR and the form of the P5; in the male by the Ur1 naked, the slender thumb of the chela and the elongated and slender shape of the finger of the right P5. Pontella surrecta is recorded for the first time in Indonesia and an expanded description is provided based on topotypic specimens. The female is distinguishable by having a very large posterodorsal beak-like process of Ur1, the asymmetrical CR and the form of the P5; while the male by the long posterior corners of Pdg5, the elongated thumb of the chela and the very slender shape of the finger of the right P5.

Reducing the Wallacean and the Haeckelian Deficits in Apobaetis Day, 1955 (Ephemeroptera: Baetidae).

During an ongoing project aiming to understand the dynamics of Ephemeroptera biodiversity in the Doce River Basin after the disaster, an unusual large number of Apobaetis Day, 1955 were analyzed. The occurrence of Apobaetis is quite relevant, since the combination of factors such as its small body size and its habitat preferences makes their collection difficult and its presence often neglected. For the first time in science, adults of Apobaetis irai De Lima, Massariol, Cruz & Hamada, 2022 and Apobaetis fiuzai Salles & Lugo-Ortiz, 2002 are described and diagnosed. Apobaetis irai can be easily distinguished, among other characteristics by turbinate portion of compound eyes touching each other along midline; abdominal terga II-III and V-VII with well-marked lines on lateral and posterior margins; posterior margin of subgenital plate with projection broadly rounded to slightly truncate. Apobaetis fiuzai are diagnosed by turbinate portion of compound eyes touching each other posteriorly; mesothorax brown, except for broad cream marks on anterior margin of PSp and SLS, SSLi tinged with white, posterior corner of SMS with a red spot; abdominal terga II-VI translucent orangish-brown, terga VII-X brown, terga II-III and VI with conspicuous red medial mark; posterior margin of subgenital plate with subtriangular projection, apex narrowly truncate; forceps base wider at base, inner irregular edges. The new records of A. irai and A. fiuzai extend the distribution of Apobaetis within Minas Gerais and Espírito Santo States, Brazil. Furthermore, it is reported for the first time cases of gynandromorphs for Apobaetis.

The Usefulness of Posterior Shiny Corner Lesions in the Early Diagnosis of Medial Meniscus Posterior Root Tears.

Posterior shiny corner lesions (PSCLs) have been reported to be useful for the early diagnosis of medial meniscus posterior root tears (MMPRTs) in surgical patients. However, the usefulness of PSCLs in outpatients, particularly regarding the optimal timing of magnetic resonance imaging (MRI) examinations after injury, remains unknown. We hypothesized that PSCLs would normally be observed in patients with MMPRTs within one month of injury. This study included 144 patients with knee pain who visited our hospital between January 2021 and May 2023. MRI findings within and after one month were examined. Fisher's exact test was performed for PSCLs, cleft signs, ghost signs, radial tear signs, bone cysts, and medial meniscus extrusion (MME), which are findings used for the diagnosis of MMPRTs. Time-dependent receiver operating characteristic (ROC) curve analysis was performed for each MRI finding. A binomial logistic regression analysis was performed for age, sex, PSCL, ghost sign, and MME. PSCLs were observed on 82.6% of the MRI scans within one month, but the positivity rate decreased after one month. After one month, a high percentage of patients had cleft signs and ghost signs. The results of a time-dependent ROC curve analysis showed that the PSCL had better diagnostic ability than the cleft sign, ghost sign, radial tear sign, and MME at a relatively early stage. Additionally, the area under the curve (AUC) of PSCL peaks around 35 days and then declines, reaching 0.8 or less around 40 days. On the other hand, the AUC of the cleft sign and ghost sign began to increase around 30 days after injury, and it exceeded 0.8 after approximately 100 days. The results of the binomial logistic regression analysis revealed significant PSCLs and ghost signs. Independent associations between the PSCL, or ghost sign, and the MMPRT were demonstrated. This study suggests that PSCLs have a superior diagnostic capability for MMPRT during the early stages of injury compared with other MRI findings in outpatients. In particular, PSCLs have a high positivity rate within one month after injury and a high diagnostic capacity up to 40 days after injury.

Anterior Cruciate Ligament Rupture Combined with Complete Radial Tear of the Posterior Horn of the Lateral Meniscus: Suture or Resection?

Anterior cruciate ligament (ACL) rupture often presents with a tear of the posterior horn of the lateral meniscus. There is no clear preference between ACL reconstruction with suture and resection of the meniscus. We aimed to compare the clinical efficacy of ACL reconstruction with suture versus resection in patients presenting with arthroscopic ACL rupture and radial complete tear of the posterior corner of the lateral meniscus. We retrospectively analyzed 157 patients with ACL rupture and complete radial tear of the posterior horn of the lateral meniscus. Between May 2010 and April 2015, 86 of 157 patients underwent ACL reconstruction and meniscus suture (study group, 54.78%) and 71 of 157 patients underwent ACL reconstruction and meniscus resection (control group, 45.22%) in our department. All patients were monitored over the 12 to 72-month follow-up period. The primary evaluation indices were the Lysholm scores, the International Knee Documentation Committee (IKDC) scores, pivot shift test, the Barret criteria, and magnetic resonance imaging (MRI) findings of meniscal healing. The majority of 157 patients were relatively young men (29.64 ± 7.79 years) with low body mass index (BMI) (23.79 ± 2.74). The postoperative Lysholm and IKDC scores of the two groups were significantly improved over the corresponding preoperative scores (p < 0.05). The clinical results and excellent and good rates were significantly better for the study group than for the control group (both, p < 0.05). MRI showed that the meniscal healed rate of the study group was 96.51%. There was no significant difference in BMI between subgroups for any functional outcome. For patients with ACL rupture and complete radial tear of the posterior horn of the lateral meniscus, ACL reconstruction and both simultaneous suture and resection of the posterior horn of the lateral meniscus were found to be safe and effective. There was no association between outcomes and BMI. However, the former was associated with a superior long-term clinical effect and may restore the integrity of the meniscus and is particularly recommended for young patients.

Investigating the impact of cartilaginous endplate herniation on recovery from percutaneous endoscopic lumbar discectomy

ObjectiveThis study aimed to evaluate the influence of herniation of cartilaginous endplates on postoperative pain and functional recovery in patients undergoing percutaneous endoscopic lumbar discectomy (PELD) for lumbar disc herniation (LDH).MethodsA retrospective analysis was conducted on 126 patients with LDH treated with PELD at the Third Hospital of Hebei Medical University from January 2021 to January 2022. Whether cartilaginous endplates had herniated was identified by analyzing these specific findings from MRI scans: posterior marginal nodes, posterior osteophytes, mid endplate irregularities, heterogeneous low signal intensity of extruded material, and Modic changes in posterior corners and mid endplates. Patients were assessed for postoperative pain using the Visual Analogue Scale (VAS) and functional recovery using the Oswestry Disability Index (ODI) and Modified MacNab criteria. Statistical analyses compared outcomes based on the presence of herniation of cartilaginous endplates.ResultsPatients with herniation of cartilaginous endplates experienced higher pain scores early postoperatively but showed significant improvement in pain and functional status over the long term. The back pain VAS scores showed significant differences between the groups with and without herniation of cartilaginous endplates on postoperative day 1 and 1 month (P < 0.05). Leg pain VAS scores showed significant differences on postoperative day 1 (P < 0.05). Modic changes were significantly associated with variations in postoperative recovery, highlighting their importance in predicting patient outcomes. In patients with herniation of cartilaginous endplates, there were statistically significant differences in the back pain VAS scores at 1 month postoperatively and the ODI functional scores on postoperative day 1 between the groups with and without Modic changes (P < 0.05). There were no significant differences in the surgical outcomes between patients with and without these conditions regarding the Modified MacNab criteria (P > 0.05).ConclusionHerniation of cartilaginous endplates significantly affect early postoperative pain and functional recovery in LDH patients undergoing PELD. These findings emphasize the need for clinical consideration of these imaging features in the preoperative planning and postoperative management to enhance patient outcomes and satisfaction.

New deep-water species of Augaptilidae (Multicrustacea, Copepoda, Calanoida) from the Arctic Ocean.

Two new species of the calanoid copepod family Augaptilidae are described from specimens collected from bathypelagic depths of the Arctic Ocean. The female of Euaugaptilus verae sp. nov. can be distinguished from other congeneric species by 1) the Md tooth arrangement, 2) the structure of Mx1, and 3) the lack of external spines on Re2 and 3 of the female P5. The female of Alrhabdus antjeboetiusae sp. nov. can be distinguished from the only species of this genus, A. johrdeae Grice, 1973, by 1) the shape of the rostrum, 2) absence of paired spinal protrusions at the posterior corners of the last pedigerous somite, 3) position of spermatheca on the genital double-somite, 4) the Md tooth arrangement, and 5) P5 endopod 1-2 lacking modified medial setae. Both species were collected in the deepest regions of the Eurasian and Canadian Basins of the Arctic Ocean in the water layers between 1000 m and the seafloor.

The effect of dynamic neuromuscular stabilization on trapezius muscle activation during shoulder exercises in individuals with rounded shoulder posture: a pilot study

Aims: The aim of this pilot study is to investigate the impact of dynamic neuromuscular stabilization (DNS) technique on the activation of the upper, middle, and lower parts of the trapezius muscle during commonly used shoulder exercises in individuals with rounded shoulder posture. Methods: The study was conducted with 15 individuals exhibiting rounded shoulder posture. The determination of rounded shoulder posture was based on measuring the distance in centimeters between the posterior corner of the lateral acromion prominence and the bed in a supine position. If this distance was 2.5 cm or more, it was considered as rounded shoulder posture. Participants were taught three different shoulder exercises and the DNS respiratory technique, a component of Dynamic Neuromuscular Stabilization. The exercises were randomly performed with and without DNS, and the activation of the upper (UT), middle (MT), and lower (LT) parts of the trapezius muscle was measured separately using an 8-channel surface electromyography (EMG) system (Noraxon Ultium, Scottsdale, USA). Results: The activation of all parts of the trapezius muscle was found to be higher when exercises were performed with DNS compared to without DNS (p&lt;0.05). Additionally, the UT/MT and UT/LT activation ratios were compared during the exercises with and without DNS. It was observed that only during the 1st exercise, the UT/LT activation ratio was higher when exercises were performed with DNS (p&lt;0.05), while in all other cases, it was similar (p&gt;0.05). Conclusion: The primary findings of the study suggest that the activation of all parts of the trapezius muscle is higher when exercises are performed with DNS. This implies that DNS may contribute to more effective exercise performance in terms of the activation of the relevant muscle group, indicating potential positive effects of DNS in rehabilitation programs. However, the participant profile in our study is limited to individuals with rounded shoulder posture. Further research in different populations is needed to generalize the obtained results.

The lateral stability of the knee, A review of the clinical Anatomy of the Popliteal hiatus and its clinical pathologies

As a modified hinge joint, the knee joint facilitates the erect posture and greater mobilization of the human body. Varusvalgus angulation, external-internal rotation, and anteriorposterior stability are primarily maintained by the tibial bony eminences, menisci, and the congruencies of the femoral and tibial articular surfaces. The primary restrainer for the valgus angulation is the medial collateral ligament (MCL). The primary restrainer for varus angulation is the lateral collateral ligament (LCL). Even though the LCL is the principal lateral stabilizer for the knee, it is supported by the surrounding ligaments, muscles, and tendons. Non -uniformity in the nomenclature of these structures and complexity in the anatomical arrangements lead to complexity of understanding and clinical interpretation. The popliteus is a very small muscle but a unique muscle to the knee with specialized functions. It is highly vulnerable to injuries during trauma with posterior lateral corner injuries of the knee. Proper history of the injury and clinical assessment will help in a proper diagnosis. However acute pain in the knee may interfere with a proper clinical diagnosis. During total knee arthroplasty, special care should be taken to minimize the iatrogenic popliteal ligament injuries during bone cuts and lateral release in soft tissue gap balancing.

Widening Access: Sterile Tourniquets for Surgery to the Distal Humerus.

Purpose of the study The use of tourniquets during surgery of the distal humerus can improve visibility and reduce surgical time. However, the available operating field can be limited due to the size and placement of the tourniquet. This proof-of-concept study aimed to determine if sterile tourniquets can provide a wider surgical field compared to non-sterile tourniquets for procedures around the distal humerus. Methods Volunteers (n = 5) were positioned to simulate access to the distal humerus. The distance from the posterior corner of the acromion to the tip of the olecranon was measured. Participants were draped according to the standard protocol for the use of a non-sterile or sterile tourniquet for distal humerus and humeral shaft fractures. Two non-sterile pneumatic tourniquets (standard and narrow) and two sterile tourniquets (pneumatic and elastic exsanguination) were tested. The surgical field was measured from the sterile drape or tourniquet proximallyto the tip of the olecranon. A one-way repeated measures ANOVA was conducted to examine the effect of each tourniquet on the surgical field. Results The sterile elastic exsanguination tourniquet had the largest available field with a mean of 24.4 cm (71% of arm available for incision after application), followed by the sterile pneumatic tourniquet of 20.0 cm (58%), narrow non-sterile pneumatic of 19.2 cm (55%), and standard non-sterile pneumatic of 17.0 cm (49%). Repeated measures ANOVA determined that mean surgical field length is statistically significant between tourniquet devices (F (1.729, 6.914) = 21.783, p = .001). The surgical field length was statistically significantly increased from a non-sterile standard tourniquet to a sterile elastic tourniquet (7.4 (95% CI, 2.9-11.9) cm, p = .008)but not the other two tourniquet devices tested. Conclusion The use of certain types of sterile tourniquets can provide a wider surgical field compared to non-sterile tourniquets for procedures around the distal humerus, specifically the sterile elastic exsanguination tourniquet providing a statistically significant mean gain of 7.4 cmfrom the non-sterile tourniquets. These findings suggest that the use of sterile tourniquets should be considered more frequently in surgery of the distal humerus, and a sterile exsanguinating tourniquet could be considered for midshaft humeral fractures, facilitating safer exposure of the radial nerve and reduced blood loss.

Intervertebral disc degeneration and vertebral end plate damage in acute lumbar disc herniation

Abstract Background: Although microtrauma, gene polymorphisms, or subclinical infection could initiate lumbar disc herniation (LDH), the final pathway culminating in herniation can involve two possible trajectories—degeneration of nucleus pulposus or vertebral end plate (EP) damage. We performed a retrospective case–control study to understand the relative role played by disc degeneration (DD) and EP changes in acute LDH. Materials and Methods: MRI of 300 consecutive patients with acute LDH (&lt;6 weeks) was evaluated for the type of LDH, severity of DD by Pfirrmann’s grading, and EP Modic changes (MC) for its type, distribution, and location in EPs. Among the1500 discs evaluated in 300 patients, 308 had disc herniation (cases) and 1192 acted as controls. Results: 98.8% of LDH had grade ≥3 DD (P &lt; 0.001). The mean DD was higher in herniated discs (P &lt; 0.05). From a mean 1.98 in normal discs, it increased to 3.31 in disc bulges, 3.73 in disc protrusions/extrusions, and 3.83 in sequestrations. Herniated discs had more MCs than normal discs (38.3%, 118/308) (P &lt; 0.001). Although in normal discs, only 7.7% had MC, herniated disc subtypes showed a progressive increase in the incidence of MC (26.2% in disc bulges, 37.5% in disc protrusion/extrusions, and 58.3% in sequestrations). MC on both EP was strongly associated with LDH (odds ratio = 9.76). Posterior corner MC had a significant association with LDH (72.72%, P &lt; 0.001). Conclusion: DD seems to be a common thread in all patients (98.8%) with LDH, whereas EP damage seems to be specific pathway in a subset (38.3%). The study showed a significant degeneration of nucleus pulposus in most (98.8%) herniated discs. Compared with nonherniated discs, vertebral MC had a higher incidence in herniated discs (38%), and interestingly these were of subacute fatty type 2.

STUDY OF THE INFLUENCE OF THE POSITION OF THE TENDON GRAFT HAMSTRING MUSCLE ON THE STABILITY OF THE KNEE JOINT UNDER THE CONDITIONS OF PLASTICITY OF THE STRUCTURES OF THE POSTEROLATERAL ANGLE

Damage to the posterolateral angle of the knee joint is an injury that occurs occasionally and can be isolated or combined with tears of the posterior or anterior cruciate ligaments. The key link of damage to the posterior lateral corner is the rupture of the tendon of the hamstring muscle, mained stabilizer of excess external rotation lower legs. Objective. Determine the optimal fixation position tendon graft on the posterior surface of the tibia subject to recovery of the hamstring muscle which ensuring the greatest stability of the lower leg during external rotation. Methods. Models of the knee joint were built with different attachment points of the popliteal graft muscle in the ANSYS software environment. The criteria for evaluating the effectiveness of selecting the fixation point of the transplant were chosen as the degree of movement of the finite parts elements of the model. Results. The smallest movements in all directions received in the case when the transplant fixed as far as possible outwards and upwards, near the joint surface. Maximum — in the direction of the coordinate axes, as well as full movement were recorded for the control model, in the absence of the hamstring tendon The nature of the distribution of displacement fields in all models p graft and control were identical. Biggest there were additional displacements in the direction of the x axis (outward). on the front border of the platform, and the largest negative (so far redins) on the back. The largest additional shifts to the sides the y (front) axes are fixed at the leftmost limit and the largest negative (back) — to the rightю Conclusions. In view of the stability of the lower leg during rotational loading, the most effective is fixation of the hamstring graft on the back surface of the fibula is as late as possible and closer to its cardiac surface, finished in this case, the dimensions are found to be the smallest in all directions. The greatest displacement in all directions obtained in the control model for less tendon hamstring muscle.

Is Kambin's Triangle Safe or Not for Percutaneous Endoscopic Transforaminal Oblique Fixation from the Posterior Corner in the Lumbar Spine: A Neuroimaging Anatomic Assessment.

Nerve root injury and dural tears are important complications in endoscopic spine techniques. Whether Kambin's triangle is safe or not is unknown for percutaneous endoscopic transforaminal oblique fixation from the posterior corner (PETOFPC) in lumbar spine. This study aimed to verify neural safety of PETOFPC and to define and evaluate the ideal operating target and actual safe working area in Kambin's triangle for PETOFPC. Lumbar magnetic resonance imaging was performed in 60 outpatients. The distances from the working targets to exiting nerve roots and dural sac/traversing nerve roots in the coronal and sagittal planes (c1-c6, s1-s6) and the distances from the exiting roots to the dural sac/traversing nerve roots in the upper and lower endplate planes (d1 and d2) were measured and statistically analyzed. All coronal planes (c1-c6) first increased and then decreased; they gradually increased from L1-2, maximized in L4-5, and decreased slightly in L5-S1. In L1-2 through L5-S1, d1 and d2 gradually increased (F= 249.7, P < 0.0001; F= 511.7, P < 0.0001), d2 > d1 (P < 0.05). Values of d1 and d2 were smallest in L1-2 (6.71 ± 2.10 mm and 11.89 ± 2.55 mm) and largest in L5-S1 (13.37 ± 4.09 mm and 22.05 ± 3.96 mm). With the outward shift of the targets in the sagittal plane, both s1, s3, s5 and s2, s4, s6 gradually decreased (s1 > s3 > s5, s2 > s4 > s6). We calculated the ideal operating target and actual safe area and further proved that Kambin's triangle is safe enough for PETOFPC. PETOFPC is a promising technology and may have great clinical significance.

Widening Aging Eyes and Ending Outdoor Tearing with Retrobulbar Injections of Dermal Fillers.

Retrobulbar injections of 3.5-mL high-viscous dermal fillers (Bellafill or Radiesse) pushed the eyeballs forward, aligned the bulbus with the conjunctiva, and closed the wind trap behind the lateral canthus. Magnetic resonance imaging confirmed the filler material in the posterior lateral corner of the orbit. The effect was immediate: the patient's constant outdoor tearing had resolved after the first treatment of his senile enophthalmos. In addition, the narrow palpebral fissure had widened by 2 mm and rejuvenated his aging eyes. An eyeball that has receded with age can be pushed forward with a retrobulbar injection of a long lasting dermal filler to reattach to the eyelids.

Proposal of simplified CT syndesmophyte score (sCTSS) and comparison with CTSS in patients with ankylosing spondylitis

The CT syndesmophyte score (CTSS) can evaluate spinal progression more precisely than mSASSS in ankylosing spondylitis (AS); however, it is complex and time consuming. Here, we propose a simplified CTSS (sCTSS) for measuring spinal structural changes in AS. Patients with AS were recruited from a single tertiary hospital. Baseline and 2-year follow-up whole spine CT images were used to calculate CTSS and sCTSS. The sCTSS used the anterior and posterior vertebral corners, and ranged 0–184. Intraclass correlation coefficients (ICC) were calculated, as well as the smallest detectable changes. Fifty AS patients were included. For reader 1, the mean sCTSS at baseline and 2-year follow-up were 11.7 ± 14.6 and 15.8 ± 16.1, whereas those for reader 2 were 12.0 ± 12.5 and 15.8 ± 15.7, respectively. The ICCs for CTSS at baseline and at 2-year follow-up were 0.97 (95% confidence interval [CI] 0.96–0.99) and 0.98 (0.97–0.99), respectively, and that for changes over the 2 years was 0.48 (95% CI 0.23–0.67). For sCTSS, the ICCs were 0.96 (95% CI 0.92–0.97), 0.97 (95% CI 0.94–0.98), and 0.58 (95% CI 0.36–0.74), respectively. Detection rates for syndesmophyte progression were comparable between CTSS and sCTSS. The detection rate for syndesmophytes on only lateral side was 13.2 and 11.4%, and 11.4 and 15.2% at baseline and 2-year follow-up (reader 1 and 2). sCTSS and CTSS showed similar detection rates for syndesmophyte progression. sCTSS may be a reliable method for evaluating spinal structural damage in AS.

A new species of Pseudodiaptomus (Copepoda, Calanoida, Pseudodiaptomidae) from off Tanjung Merah, Bitung, North Sulawesi, Indonesia

Abstract A new species of the demersal copepod genus Pseudodiaptomus is described from Sulawesi, Indonesia. This species is definitely assigned to the Nudus species group. Pseudodiaptomus kleini n. sp. is distinguishable in the female by the posterior corners of its Pdg5 with 3 spine-like processes, the symmetrical CR, the Ur1 without any processes, and the form of the P5; in the male by the Ur1 naked, and the form of the P5.

Novel Posterior Anchoring Method Associated With Medial Meniscus Posterior Root Repair

Introduction: Transtibial pullout repair is the gold standard surgical treatment for medial meniscus (MM) posterior root tear. However, posteromedial extrusion of the MM during knee flexion may remain a problem postoperatively. Materials and Methods: We used a novel posterior anchoring technique to help reduce posteromedial extrusion, applying two cinch sutures (TCSs) to the MM posterior horn and creating a bone tunnel at the center of the posterior root attachment to pullout the suture. Another bone tunnel was created at the posterior corner of the medial tibial plateau in the externally rotated knee flexion. The first anchor of an all-inside meniscal repair device was inserted through the inferior surface of the MM posterior horn with tensioning TCS and the second anchor into the bone tunnel. Tibial fixation of pullout sutures was performed using a bioabsorbable screw in 30 degrees knee flexion. Conclusions: Our posterior anchoring method, combined with conventional pullout repair with TCS, helped reduce posteromedial extrusion in patients with a MM posterior root tear.

СРЕДНЕДЕВОНСКИЕ КОККОСТЕИДНЫЕ ПАНЦИРНЫЕ РЫБЫ ВОРОНЕЖСКОЙ ОБЛАСТИ (ЖИВЕТ ПАВЛОВСКОГО КАРЬЕРА) ПО МАТЕРИАЛАМ В КОЛЛЕКЦИИ МУЗЕЯ ЗЕМЛЕВЕДЕНИЯ МГУ

Remains of coccosteid placoderm fishes (Placodermi: Euarthrodira: Coccosteidae) from the Ardatovka Beds (Givetian, Middle Devonian) of the Pavlovsk Quarry, Voronezh Region (the territory of the Central Devonian field) are briefly described. This material is currently stored at the Earth Science Museum of Moscow State University. Only disparate data on coccosteids and their close relatives (determinations at a level of high taxa), known from this territory, appeared in the literature to date. Bones and their fragments of the trunk armour are mainly presented in the collection. Only one fragment of the nuchal (occipital) bone of the head armour is exhibited. The coccosteid bones from Middle Devonian of the Pavlovsk Quarry are morphologically closer to plates of Livosteus (Gross), known from the Givetian of the Main Devonian field; but there are some differences, such as a ventral sensory groove on the anterior medio-ventral bone, a slightly developed posterior lateral corner of the posterior ventro-lateral and others. These remains are preliminary identified as Livosteus aff. L. grandis (Gross). These new materials supplement the data on the morphology and distribution of coccosteids from the East European platform.

Experience in diagnosis and treatment of KD- ⅢM dislocation of knee joint

To explore the effectiveness of one-stage posterior medial corner (PMC) repair or reconstruction combined with anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction in treating KD-ⅢM dislocation. The clinical data of 15 patients with knee KD-ⅢM dislocation who met the selection criteria between January 2016 and July 2019 were retrospectively analyzed. There were 9 males and 6 females, aged 22-61 years (mean, 40.3 years). Injuries were caused by violence of flexion, valgus, and external rotation, including 10 cases of traffic accident injuries, 3 cases of crush injuries, 1 case of winch injury, and 1 case of explosion injury. The time from injury to operation ranged from 3 days to 6 months, with an average of 18.5 days. PMC repair combined with PCL+ACL reconstruction was performed in 10 cases in acute stage (within 3 weeks after injury), including 3 cases of irreducible dislocation. PMC+PCL+ACL reconstruction was performed in 5 cases with chronic dislocation. Before operation and at last follow-up, the knee joint function was evaluated by Lysholm score and International Knee Documentation Committee (IKDC) 2000 score. KT-3000 was used to evaluate the forward stability of the knee (calculated the difference of tibial anterior displacement of both knees), the X-ray films of the stress position of the knee joint was used to evaluate the valgus of the knee (calculated the difference of medial joint space width of both knees) and the backward stability (calculated the difference of tibial posterior displacement of both knees), and the internal and external rotation stability was evaluated by knee flexion 30° tibial external rotation and knee flexion 90° tibial internal rotation tests (calculated the difference of tibial internal rotation and the difference of tibial external rotation of both knees). The operation time was 120-240 minutes, with an average of 186.5 minutes. Patients were followed up 24-48 months, with an average of 27.4 months. There was no complication such as infection, deep vein thrombosis, vascular injury, or heterotopic ossification. At last follow-up, the Lysholm score, IKDC2000 score, the difference of tibial anterior displacement of both knees, the difference of medial joint space width of both knees, the difference of tibial posterior displacement of both knees, the difference of tibial internal rotation and the difference of tibial external rotation of both knees significantly improved when compared with preoperative ones ( P<0.05). According to the IKDC2000 valgus stability grading standard, there were 3 cases of grade C and 12 cases of grade D before operation, and 10 cases of grade A and 5 cases of grade B at last follow-up, which was significantly improved when compared with that before operation ( Z=-4.930, P=0.000). At last follow-up, the pivot shift tests of 15 patients were negative. The anterior and posterior drawer tests of 10 patients were negative, 5 patients had mild instability, both the anterior and posterior drawer tests were positive. KD-ⅢM dislocation of the knee joint can lead to the posterior medial and anterior instability. Acute dislocation combined with "dimple sign" requires surgical reduction as soon as possible to repair PMC and reconstruct PCL and ACL. In chronic patients, PMC is difficult to repair, it is recommended to reconstruct PMC, PCL, and ACL at one stage to improve knee joint stability. The early and middle effectiveness are satisfactory.

One Stage Reconstruction of the Posterior Cruciate Ligaments Ruptures with Posterior Lateral Corner Injury Using the Autologous Hamstring Tendons All Inside

One Stage Reconstruction of the Posterior Cruciate Ligaments Ruptures with Posterior Lateral Corner Injury Using the Autologous Hamstring Tendons All Inside

Peripheral Nerve Stimulator for Treating Sural and Posterior Tibial Neuralgias – Case Report

BACKGROUND: Sural neuralgia is persistent pain in the distribution of the sural nerve that provides sensation to the lateral posterior corner of the leg, lateral foot, and fifth toe. Sural neuralgia is a rare condition, but can be challenging to treat and cause significant limitations. Posterior tibial neuralgia, also known as tarsal tunnel syndrome, is an injury or stretch affecting the tibial nerve at the medial border of the ankle and heel. We present one case of sural neuralgia complicated by superimposed posterior tibial neuralgia resistant to conservative management that were effectively treated with a peripheral nerve stimulator placement. CASE REPORT: A 60-year-old man developed sural and posterior tibial neuralgias after a motorcycle accident resulting in severe injury of his left lower extremity. He underwent surgery for his open left distal tibia fracture. The patient continued to have pain which was not alleviated with physical therapy and conservative management. Six years after the initial injury and failing conservative management, he underwent successful sural and posterior tibial nerve blocks followed by placement of a peripheral nerve stimulator with improvement in pain and daily function. CONCLUSIONS: Peripheral nerve stimulators may be a safe and effective treatment for both sural and posterior tibial neuralgias that do not respond to conservative therapy. However, large scale studies are needed to elucidate its effectiveness and safety profile. KEY WORDS: Peripheral nerve stimulator, posterior tibial neuralgia, sural neuralgia