Anthony V. D’Antoni

Anatomic Study of the Deltoid Ligament of the Ankle

Background: There is heterogeneity in the literature regarding the anatomy and number of ligamentous bands that form the deltoid ligament (DL). Anatomic knowledge of the DL and its variations are important for surgeons who repair ankle fractures. Methods: The DL was dissected in 33 ankles from 17 formalin-fixed cadavers (mean age at death, 76.6 years) to examine its morphology. The length, width, and thickness of its constituent bands were recorded with a digital caliper. Descriptive and correlational statistics were used to investigate the relationships between band size, age at death, and sex. A literature review was conducted to compare our data to those of previous studies. Results: The DL has superficial and deep layers with up to 8 different bands. Conclusion: The DL stabilizes the medial ankle and should be evaluated in flatfoot deformities and severe ankle fractures. Clinical Relevance: Anatomic knowledge of DL variations should aid the surgeon in repairing torn DLs.

Anatomico-radiologic study of the distribution of the suboccipital artery of Salmon

OBJECTIVES The frequency of suboccipital injections to treat headaches has increased. The third segment of the vertebral artery is located in the suboccipital triangle and its main muscular branch, the suboccipital artery of Salmon (SAS), supplies blood to the suboccipital muscles. The purpose of this study was to radiographically investigate the morphology and territory of distribution of SAS. PATIENTS AND METHODS Computed tomography angiographs of brains of 50 subjects (25 female, 25 men, mean age 70.2 years) were analyzed. RESULTS SAS was present in 48% of subjects. The vessel was present bilaterally in 37.1%, and had a mean (SD) luminal diameter of 1.71 (0.34)mm and mean (SD) length of 36.42 (17.1)mm. SAS was found to have two morphologic patterns: (1) a single main trunk with collateral branches (52.6%) and (2) a short common trunk that divided into two branches (48.4%). The SAS supplied the obliquus capitis inferior, semispinalis capitis, and splenius capitis muscles. When the SAS was absent, the suboccipital muscles were supplied by a branch of the occipital artery. No anastomoses were found between the SAS and occipital artery. CONCLUSION The suboccipital muscles are vascularized by the SAS and occipital artery. The detailed course of the SAS is important for clinicians and surgeons who perform procedures in the suboccipital region.

An aberrant cerebellar artery originating from the internal carotid artery.

The aberrant origin of the cerebellar arteries from anterior cerebral circulation is a quite rare vascular variation. Herein, we report a 52-year-old white female with angiographically occult subarachnoid hemorrhage. Left superior and anterior inferior cerebellar arteries were not detected. An aberrant cerebellar artery was noted to arise from the left cavernous internal carotid artery and terminated in the distribution of the ipsilateral superior and anterior inferior cerebellar arteries. This variant artery might likely have resulted from an abnormal regression of fetal anterior-to-posterior circulation connections, and may represent a fetal-type cerebellar artery. A review of the anatomy and clinical significance of the variant is presented.

Ligaments of the Costovertebral Joints including Biomechanics, Innervations, and Clinical Applications: A Comprehensive Review with Application to Approaches to the Thoracic Spine

Few studies have examined the costovertebral joint and its ligaments in detail. Therefore, the following review was performed to better elucidate their anatomy, function and involvement in pathology. Standard search engines were used to find studies concerning the costovertebral joints and ligaments. These often-overlooked ligaments of the body serve important functions in maintaining appropriate alignment between the ribs and spine. With an increasing interest in minimally invasive approaches to the thoracic spine and an improved understanding of the function and innervation of these ligaments, surgeons and clinicians should have a good working knowledge of these structures.

The zona orbicularis of the hip joint: anatomical study and review of the literature

Objectives: Although it is used as a landmark during various orthopedic procedures of the hip, few studies have focused on the anatomy of the zona orbicularis. Therefore, the purpose of the present research was to study its morphology to improve our understanding of its structure and potential variation. Methods: Ten adult cadavers (four males and six females) underwent dissection of the left and right hip joints to observe the morphology and location of the zona orbicularis. A digital caliper was used to measure the length and width of the zona orbicularis. Results: We found a zona orbicularis on all sides and that when present anteriorly, many of the inferior fibers of the zona orbicularis were confluent with the fibers of the iliofemoral ligament. The mean length for right sides was 35.95 mm and the mean length for left sides was 43.93 mm. The mean width for right sides was 3.74 mm and the mean width for left sides was 4.4 mm. There were no significant differences between the right and left sides for zona orbicularis length or width. There was no significant association between age and sex but a statistically significant correlation (r=0.959) between right and left zona orbicularis lengths (p=0.041). However, there was no significant correlation between the right and left zona orbicularis widths (p>0.05). The fibers of the zona orbicularis were found to be thicker and more visible along the posterior aspect of the femoral neck. Conclusion: Anatomically, the zona orbicularis is a consistent structure of the hip joint capsule. This structure can be seen on high resolution imaging such as MRI and magnetic resonance arthrography. The lengths of this structure may differ between sides, although based on our study, there were no differences between left and right side widths or between sexes or among ages.

A Chemical Application Method with Underwater Dissection to Improve Anatomic Identification of Cadaveric Foot and Ankle Structures in Podiatric Education

BACKGROUND Many cadaver-based anatomy courses and surgical workshops use prosections to help podiatry students and residents learn clinically relevant anatomy. The quality of these prosections is variable and dependent upon the methods used to prepare them. These methods have not been adequately described in the literature, and few studies describe the use of chemicals to prepare prosections of the cadaveric foot and ankle. Recognizing the need for better teaching prosections in podiatric education, we developed a chemical application method with underwater dissection to better preserve anatomic structures of the cadaveric foot and ankle. METHODS We used inexpensive chemicals before, during, and after each step, which ultimately resulted in high-quality prosections that improved identification of anatomic structures relevant to the practice of podiatric medicine. RESULTS Careful preservation of clinically important nerves, vessels, muscles, ligaments, and joints was achieved with these prosections. CONCLUSIONS Although this method required additional preparation time, the resultant prosections have been repeatedly used for several years to facilitate learning among podiatry students and residents, and they have held up well. This method can be used by educators to teach podiatry students throughout their medical training and even into residency.

Anatomo-radiologic study of the Suboccipital artery of Salmon

The frequency of suboccipital injections to treat cluster and chronic migraine headaches has increased in the last decade. The third segment of the vertebral artery is located in the suboccipital triangle and its main muscular branch, the suboccipital artery of Salmon (SAS), supplies blood to the suboccipital muscles and related tissues. The purpose of this study was to radiographically investigate the morphology of the SAS and its branches, and to document which muscles are supplied by this clinically-relevant blood vessel. Computed tomography angiographs of the brains of 50 subjects (25 female, 25 men) with a mean age of 70.2 years were analysed. The SAS was present in 48% of subjects. The vessel was present bilaterally in 37.1% of subjects, and had a mean (SD) luminal diameter of 1.71 (0.34) mm and mean (SD) length of 36.42 (17.1) mm. The SAS was found to have two morphologic patterns: 1) a single main trunk with collateral branches (52.6%) and 2) a short common trunk that divided into two branches (48.4%). The SAS supplied the obliquus capitis inferior, semispinalis capitis, and splenius capitis muscles. When the SAS was absent, the suboccipital muscles were supplied by a branch of the occipital artery. No anastomoses were found between the SAS and occipital artery. The suboccipital muscles are vascularised by the SAS and occipital artery. The detailed course of the SAS is important for clinicians and surgeons who perform procedures in the suboccipital region.