Alp Bayramoglu

Variations in anatomy at the suprascapular notch possibly causing suprascapular nerve entrapment: an anatomical study

The purpose of the study was to determine anatomical variations at the suprascapular notch for better understanding of possible predisposing factors for suprascapular nerve entrapment. We dissected 32 shoulders of 16 cadavers between the ages of 39 and 74 years. We observed abnormally oriented superior fibers of the subscapularis muscle in five shoulders of the 16 cadavers, which were covering the entire anterior surface of the suprascapular notch and significantly reducing the available space for the suprascapular nerve. We also detected anterior coracoscapular ligament in six of the 32 shoulders, and calcified superior transverse scapular ligament in four of the shoulders. In this study, we classified the variations for the superior transverse scapular ligament. In conclusion, knowing the anatomical variations in detail along the course of the suprascapular nerve might be important for better understanding of location and source of the entrapment syndrome, especially for individuals who are involved in violent overhead sports activities such as volleyball and baseball. To our knowledge, close relationship of subscapularis muscle with the suprascapular nerve as a possible risk factor for suprascapular nerve entrapment has not been mentioned previously.

Infective agents in fixed human cadavers: A brief review and suggested guidelines

Cadavers remain a principal teaching tool for anatomists and medical educators teaching gross anatomy. Infectious pathogens in cadavers that present particular risks include Mycobacterium tuberculosis, hepatitis B and C, the AIDS virus HIV, and prions that cause transmissible spongiform encephalopathies such as Creutzfeldt‐Jakob disease (CJD) and Gerstmann‐Straussler‐Scheinker syndrome (GSS). It is often claimed that fixatives are effective in inactivation of these agents. Unfortunately cadavers, even though they are fixed, may still pose infection hazards to those who handle them. Specific safety precautions are necessary to avoid accidental disease transmission from cadavers before and during dissection and to decontaminate the local environment afterward. In this brief review, we describe the infectious pathogens that can be detected in cadavers and suggest safety guidelines for the protection of all who handle cadavers against infectious hazards. Anat Rec (New Anat) 269:194–197, 2002.

Risk of Superior Gluteal Nerve and Gluteus Medius Muscle Injury During Femoral Nail Insertion

BACKGROUND Abduction weakness and limping is a well-recognized complication of closed antegrade insertion of femoral nails. Iatrogenic injuries to the superior gluteal nerve and the gluteus medius muscle are the most likely contributing factors. The purpose of this study of cadavers was to assess the risk of nerve and muscle injury with various lower-limb positions used during nail insertion. METHODS We studied thirteen hips of ten formalin-fixed adult cadavers. With the cadaver in the full lateral position, a 9-mm reamer was introduced in a retrograde fashion from the intercondylar notch and passed through the gluteus medius muscle. The distance between the point of entry of the reamer into the undersurface of this muscle and the inferior main branch of the superior gluteal nerve (the nerve-reamer distance) and the distance between the entry and exit points of the reamer in the gluteus medius muscle (the intramuscle distance) were measured in three different hip positions: 15 degrees of flexion and 15 degrees of adduction (Position 1), 30 degrees of flexion and 30 degrees of adduction (Position 2), and 60 degrees of flexion and 30 degrees of adduction (Position 3). RESULTS In Position 1, the average nerve-reamer distance was 7 mm and the average intramuscle distance was 24 mm. In three hips the reamer injured the nerve directly, and in two other hips the distance was <or=5 mm. In Position 2, the average nerve-reamer distance was 21 mm and the average intramuscle distance was 18 mm. In Position 3, the average nerve-reamer distance was 33 mm and the average intramuscle distance was 11 mm. None of the reamers in this position came closer than 20 mm to the nerve. CONCLUSIONS The risk of injury to the superior gluteal nerve and the gluteus medius muscle during closed antegrade insertion of a femoral nail is lessened by increasing the amount of hip flexion and adduction. CLINICAL RELEVANCE The risk of injury to both the superior gluteal nerve and the gluteus medius muscle is higher with limited degrees of hip flexion and adduction, such as are possible in the supine position on a fracture table, than it is with greater degrees of hip flexion and adduction, which are possible in the lateral position on a fracture table or in the so-called sloppy lateral position on an ordinary table. Therefore, insertion of a femoral nail with the hip in increased flexion and adduction might help to lower the risk of injuries to the superior gluteal nerve and the gluteus medius muscle.

Minimally invasive plating of the distal tibia: do we really sacrifice saphenous vein and nerve? A cadaver study.

Objective: To investigate the risk of saphenous nerve (SN) and great saphenous vein (GSV) injury during percutaneous screw placement of the 3.5/4.5 LCP Distal Tibial Metaphyseal Plate and the 3.5-mm LCP Medial Distal Tibia Plate with tab in distal tibias of cadaver extremities. Methods: Thirty-one unpaired (1 fresh and 30 formalin fixed) adult cadaveric lower extremity specimens were dissected. Using the principles of minimally invasive plating, a 3.5/4.5 LCP Distal Tibial Metaphyseal Plate was implanted in 16 extremities and a 3.5-mm LCP Medial Distal Tibia Plate with tab in the remaining 15 extremities. Injuries to or any evidences of direct contact with the SN or GSV were recorded. Additionally, the shortest distances of each hole to the main branches of these anatomic structures were measured. Results: The risk of injury to the SN and GSV was higher in holes 4, 5, and 6 when using the 3.5/4.5 LCP Distal Tibial Metaphyseal Plate and in holes 3, 5, and 8 when using the 3.5-mm LCP Medial Distal Tibia Plate. Conclusions: The SN and GSV are at high risk for injury during percutaneous screw placement of the 3.5/4.5 LCP Distal Tibial Metaphyseal Plate and the 3.5-mm LCP Medial Distal Tibia Plate at the distal tibia. Careful dissection in the stab incisions down the plate, atraumatic placement of the drill sleeves, and protection of the soft tissues during screw insertion might decrease the risk of injury to the SN and GSV.

Recesses along the posterior margin of the infrapatellar (Hoffa’s) fat pad: prevalence and morphology on routine MR imaging of the knee

The objective is to evaluate the prevalence and morphology of recesses along the posterior margin of the infrapatellar fat pad on routine MR imaging of the knee. MR images of 213 knees in 204 consecutive individuals were evaluated with regard to the prevalence and morphology of recesses (a “suprahoffatic” recess close to the inferior border of the patella and the previously described “infrahoffatic” recess anterior to the inferior portion of the infrapatellar plica). The recesses were analyzed with regard to synovial effusion and the condition of the anterior cruciate ligament (ACL). Anatomic dissection was made in 29 knees in 16 cadavers to verify the presence of the suprahoffatic recess. The infrahoffatic recess was present in 45% of the knees and mostly linear in shape (44%). The suprahoffatic recess was detected in 71% of the knees (45% in cadavers). Very weak to moderate positive correlation was found between the synovial effusion or the condition of the ACL and the presence and dimensions of the recesses. An awareness of the recesses in the infrapatellar fat pad is important in order to distinguish between pathology and anatomic variants on routine MR imaging of the knee.

Drainage patterns of middle lobe vein of right lung: an anatomical study

OBJECTIVE The purpose of the present study was to determine the variations in the drainage patterns of middle lobe vein of the right lung. METHODS Right lungs of 30 formalin fixed cadavers, were dissected carefully to expose the variations in the venous drainage of their middle lobes. After identifying the pulmonary veins for each lobe, middle lobe vein (MLV) drainage patterns were followed to their openings. The diameters of the MLV and its lateral and medial parts were measured with a caliper. The length of the MLV trunk was also evaluated. RESULTS Five different types of venous drainage patterns were observed. Type-I: Union of medial and lateral parts to form MLV as a trunk and opening of this vein to the right superior pulmonary vein (RSPV) (53.3%). Type-II: Opening of medial and lateral parts to the RSPV separately (16.6%). Type-III: Union of medial and lateral parts to form the MLV trunk and opening of this vein into the left atrium (16.6%). Type-IV: Opening of medial and lateral parts into the left atrium separately (10%). Type-V: Union of medial and lateral parts to form MLV trunk and opening of this vein to the right inferior pulmonary vein (3.3%). CONCLUSION The venous drainage patterns of right middle lobe reveals great number of variations. Knowing the frequency of different types of drainage patterns classified in this study is extremely important for the surgeons performing pulmonary surgery, atrial fibrillation and imaging techniques.

Rotator interval dimensions in different shoulder arthroscopy positions: A cadaveric study

The rotator interval was defined as a triangular structure, where the base of the triangle was the coracoid base, the upper border was the anterior margin of the supraspinatus, and the lower border was the superior margin of the subscapularis muscle-tendon unit. We evaluated the rotator interval dimensions in 15 shoulders from 10 lightly embalmed adult cadavers in 3 shoulder arthroscopy positions: 0 degrees of abduction and 30 degrees of flexion (beach chair [BC]), 45 degrees of abduction and 30 degrees of flexion (lateral decubitus 1), and 70 degrees of abduction and 30 degrees of flexion (lateral decubitus 2). In each shoulder position, measurements were made in neutral rotation (NR), 45 degrees of external rotation (ER), and 45 degrees of internal rotation (IR). The coracoid base lengthened with IR in all positions and shortened in ER in the lateral decubitus position but not in the BC position. Abduction significantly lengthened the coracoid base, which was shortest in the BC position with ER (24 +/- 4 mm) and longest in the lateral decubitus 2 position with IR (33 +/- 5 mm). The coracoid base, where sutures are placed during plication of the interval, was observed to lengthen and, therefore, loosen with IR and abduction. To prevent postoperative ER restriction, plication should be made in ER or neutral rotation when operating in the BC position and the degree of abduction should be decreased and the shoulder held in ER when operating in the lateral decubitus position.