N. P. Tesch

Morphometric Analysis of Lister's Tubercle and Its Consequences on Volar Plate Fixation of Distal Radius Fractures

PURPOSE The objective of this study was to measure the size and shape of Listers tubercle and the depth of the extensor pollicis longus (EPL) groove to assess the risk of injury to the EPL tendon when performing volar plating of distal radius fractures. METHODS The length and height of Listers tubercle and the depth of the EPL groove were measured in 100 cadavers. RESULTS The size of Listers tubercle varied from 2 to 6 mm (average, 3.6 mm) in height radial to the tubercle and from 6 to 26 mm (average, 18.3 mm) in length. The depth of the EPL groove varied from 1 to 5 mm (average, 2.8 mm), with 63% being greater than 2 mm in depth. The height between the depth of the groove and the tip of the tubercle varied between 4 and 10 mm (average, 7.1 mm). No correlation was found with gender or right-side or left-side specimens. CONCLUSIONS The individual and combined height of Listers tubercle and the depth of the EPL groove are considerable. This fact needs to be considered when performing volar plating of distal radius fractures because of the possibility that it might be difficult to determine precisely the presence and amount of past-pointing of the distal screws.

Various Circular Arc Radii of the Distal Volar Radius and the Implications on Volar Plate Osteosynthesis

The purpose of this anatomical study was to explore the different circular arc radii of the distal volar radius and provide more detailed anatomic information that will further the understanding of volar plate osteosynthesis. The profiles of the volar distal radii of 100 cadaver specimens were measured with a common profile gauge. Profiles were copied onto paper and then matched to a best-fit circular arc template to determine the radius of curvature on the radial and ulnar sides of the distal volar radius. The mean circular arc radius of the distal volar surface was 2.6 cm (+/-1 cm, 1-6 cm) on the radial side and 2.3 cm (+/-1 cm, 1-6 cm) on the ulnar side. A significant difference (P<.01) was noted in the radii of curvature of the distal radius in 55% of the study population. In 37% of these cases, the circular arc radius flattens toward the ulnar side. In 63%, it flattens toward the radial side. This characteristic may lead to a false rotation position of the distal fracture fragment following volar plate osteosynthesis. In addition, suboptimal or incorrect plate position may result due to the discrepancy between the plate radius of curvature and the radius of curvature of either the radial or ulnar volar radius.

Musculo-tendinous junction of the flexor carpi ulnaris muscle. An anatomical study

The aim of the study was to evaluate the occurrence of the anatomical variations of the musculotendinous junction of the flexor carpi ulnaris (FCU) muscle and the variations of its insertion onto the pisiform. One hundred cadaver specimens preserved according to Thiel’s method were assessed. Following careful dissection, the distance between the musculotendinous junction and the pisiform and the width of the muscle belly were determined. Three typical anatomical variations were found 1) a large muscle belly running distally almost to the insertion onto the pisiform 2) the muscle belly ending more proximally, with some large fibres running parallel to the tendon and almost reaching the pisiform 3) the musculotendinous junction ending more proximally, with only single fibres continuing distally. The length of the tendon was greater than 10 mm. A number of variations of the distal region of FCU were observed. The presence of muscle fibres almost reaching the insertion point onto the pisiform have to be considered when interpreting MRI or ultrasound findings of this region.

The risk of injury to the anterior tibial artery in the posterolateral approach to the tibia plateau: a cadaver study.

Background: Posterolateral tibial plateau shear fractures often require buttress plating, which can be performed through a posterolateral approach. The purpose of this study was to provide accurate data about the inferior limit of dissection. Methods: Forty unpaired cadaver adult lower limbs were used. The anterior tibial artery was identified because it coursed through the interosseous membrane. The perpendicular distance from the lateral joint line and fibula head to this landmark was measured. Results: The anterior tibial artery coursed through the interosseous membrane at 46.3 ± 9.0 mm (range 27–62 mm) distal to the lateral tibial plateau and 35.7 ± 9.0 mm (range 17–50 mm) distal to the fibula head. Conclusions: Displaced posterolateral tibial plateau fractures require anatomic reduction and stabilization with a buttress plate. This can be achieved by gaining access to the posterolateral tibial cortex. The distal limit of this dissection can be as little as 27 mm distal to the lateral tibial plateau. Dissection in this region should be carried out with caution.

Anatomical variations of the flexor hallucis longus muscle and the consequences for tendon transfer. A cadaver study

The aim of this study was to evaluate the occurrence of anatomical variations of the musculotendinous junction of the flexor hallucis longus muscle. Eighty cadaver specimens preserved according to Thiel’s method were assessed. Following careful dissection, the distance between the musculotendinous junction and the bone–cartilage border of the distal tibia was determined. Three typical anatomical variations were found: (1) a long lateral and shorter medial muscle belly; (2) equal-length medial and lateral muscle bellies; (3) a long medial and shorter lateral muscle belly. As a special variation in two cases only one lateral muscle belly was found. When planning a flexor hallucis longus transfer, preoperative magnetic resonance tomography (MRT) should be carried out in order to guarantee sufficient coverage of an existing soft tissue defect. These anatomical characteristics have also to be considered when interpreting ultrasonic or MRT findings in this region.

Sonographie beim Trauma: Ellenbogen und Hand

ZusammenfassungHochfrequenzultraschalluntersuchungen spielen heutzutage eine wichtige Rolle in der Diagnose posttraumatischer Beschwerden des Ellenbogen- und Handgewebes bei Kindern und Erwachsenen.Durch die Möglichkeit der dynamischen Untersuchung stellen sie Ergänzungen dar zur klinischen Untersuchung, der Standardröntgenuntersuchung und anderen bildgebenden Methoden. Als nichtinvasive Methode kann man posttraumatische Veränderungen feststellen, posttraumatischen Schmerz abklären, Fremdkörper entdecken und sie auch bei der Metallentfernung einsetzen.Durch die Möglichkeit der bildlichen Darstellung von Knorpelgewebe mittels Ultraschall ermöglichen sie auch die Diagnose posttraumatischer Verletzungen des kindlichen Ellenbogens wie z. B. suprakondyläre Frakturen, Epiphysiolysen und Frakturen der Epikondylen.AbstractUltrasonography with high-frequency transducers nowadays plays an important role in diagnosing post-traumatic complaints of the elbow and hand tissue in children as well as in adults. We see it as an addition to clinical examination, standard X-ray, and other radiological methods. As a noninvasive procedure we can investigate post-traumatic changes and postoperative pain, detect foreign bodies, and also use it for postoperative metal removal.The possibility of imaging cartilage structures with ultrasound also enables us to diagnose post-traumatic injuries in childrens elbows such as supracondylar fractures, epiphysiolyses, and fractures of the epicondyles.

Sonoanatomie und -pathologie des Ellbogengelenks beim Kind und beim Erwachsenen

ZusammenfassungZiel dieser Studie ist es, die Sonoanatomie des erwachsenen und kindlichen Ellbogengelenkes darzustellen und die Indikationen zur Ultraschalluntersuchung nach Trauma exemplarisch vorzustellen. Die Untersuchungen erfolgten an isolierten Gelenkspräparaten, Muskelpräparaten und Leichenextremitäten sowie in einer klinischen Serie unter Verwendung hochauflösender Linearschallköpfe der Frequenz 7,5–12 MHz. Bei der Beurteilung der Standardschnitte muß die Position des Ellbogengelenkes in der Frontalebene ebenso berücksichtigt werden wie die Position des Unterarmes bei Pro- und Supinationsbewegungen. Die seitenvergleichende dynamische Untersuchung kann besonders bei kindlichen Ellbogengelenken mit der Möglichkeit der Darstellung knorpeliger Strukturen als besonderer Vorteil der Methode angesehen werden.SummaryThe aim of this study was to evaluate the sonographic anatomy of the elbow joint in children and adults and to point out the indications for an ultrasound examination after elbow joint trauma. The study was carried out using isolated joint specimens, muscle specimens and cadaver limbs. Additionally, a clinical trial was performed using high-resolution ultrasound probes (7.5–12 MHz). When assessing standard sections, one has to consider both the position of the elbow joint in the frontal plane and the position of the forearm during pro- and supination. The outstanding advantage of this method, especially in children, is the possibility ofa dynamic examination with evaluation of the articular cartilage and with a comparison to the healthy contralateral elbow joint.

Capsular attachment to the distal radius for extracapsular placement of pins

Abstract The aim of this study was to evaluate the anatomy of the wrist joint capsule on the distal radius. As such the extent of the joint capsule and the limits of attachment in relation to the articular surface were determined. Furthermore, the study also determined whether there was any reflection of the capsule onto the distal radius. Fifty cadaveric specimens, preserved according to Thiel’s method, were assessed. After careful dissection the distance between the chondral line of the carpal articular surface and three defined points on each of the palmar and dorsal aspects of the radius were measured. In none of the specimens was there any variation in the course and extent of the joint capsule. Using external fixators for managing fractures of the distal radius, pins and wires can be placed subchondrally close to the articular capsule. The risk of intraarticular infection, due to pin tract infection in intraarticularly positioned pins, is very low.

Morphology of the tibialis anterior muscle and its implications in minimally invasive plate osteosynthesis of tibial fractures.

We examined the variation in the origin of the tibialis anterior muscle from the lateral aspect of the tibial shaft and interosseous membrane as well as the variation in the morphology of its musculotendinous junction. Forty cadaveric lower leg specimens (20 right and 20 left) were dissected to reveal the anterior compartment. The origin of the tibialis anterior muscle and its relation to the lateral tibial shaft and interosseous membrane were determined. The position of the musculotendinous junction relative to the medial malleolus was also measured. Tibial length ranged from 29.5 to 45 cm (mean, 36.5+/-3.1 cm). The distal limit of the muscle origin was 5.9 to 20.5 cm (mean, 12.1+/-3.3 cm) from the tip of the medial malleolus. The distance between the musculotendinous junction and the medial malleolus ranged from 1.4 to 10.8 cm (mean, 6.1+/-1.9 cm). The attachment of the muscle belly ends between 15.3 and 31.8 cm (mean, 24.4+/-4.1 cm) distally from the joint line at the knee. There was no statistical correlation between tibial length and muscle morphology.This variation warrants consideration in the percutaneous insertion of screws in the distal end of long plates, as the neurovascular bundle may be injured in patients with a shorter muscle belly. We advocate an open distal approach to protect the neurovascular bundle during insertion of the plate and distal screws.

[Ultrasound diagnosis in trauma: elbow and hand].

ZusammenfassungHochfrequenzultraschalluntersuchungen spielen heutzutage eine wichtige Rolle in der Diagnose posttraumatischer Beschwerden des Ellenbogen- und Handgewebes bei Kindern und Erwachsenen.Durch die Möglichkeit der dynamischen Untersuchung stellen sie Ergänzungen dar zur klinischen Untersuchung, der Standardröntgenuntersuchung und anderen bildgebenden Methoden. Als nichtinvasive Methode kann man posttraumatische Veränderungen feststellen, posttraumatischen Schmerz abklären, Fremdkörper entdecken und sie auch bei der Metallentfernung einsetzen.Durch die Möglichkeit der bildlichen Darstellung von Knorpelgewebe mittels Ultraschall ermöglichen sie auch die Diagnose posttraumatischer Verletzungen des kindlichen Ellenbogens wie z. B. suprakondyläre Frakturen, Epiphysiolysen und Frakturen der Epikondylen.AbstractUltrasonography with high-frequency transducers nowadays plays an important role in diagnosing post-traumatic complaints of the elbow and hand tissue in children as well as in adults. We see it as an addition to clinical examination, standard X-ray, and other radiological methods. As a noninvasive procedure we can investigate post-traumatic changes and postoperative pain, detect foreign bodies, and also use it for postoperative metal removal.The possibility of imaging cartilage structures with ultrasound also enables us to diagnose post-traumatic injuries in childrens elbows such as supracondylar fractures, epiphysiolyses, and fractures of the epicondyles.