A Cadaveric Limb Analysis of the Posterior Tibial Musculotendinous Junction to determine the feasibility of Interosseous Membrane Tendon Transfer.

The transfer of the posterior tibial tendon through the interosseous membrane is potentially an effective treatment to correct the deformity of the foot and ankle. Our study aimed to evaluate the anatomical feasibility of anterior transfer of the posterior tibial tendon through the interosseous membrane route using the musculotendinous junction (MTJ). Eighteen adult cadavers were used. The width and thickness of the tibial posterior MTJ, width of the interosseous membrane at the corresponding level, and the window size of the interosseous membrane were measured. Additionally, the distance between the distal end of the MTJ and the tip of the medial malleolus were recorded. The mean length of the posterior tibial tendon was 83.60 mm, the mean distance of the posterior tibial MTJ to medial malleolus tip was 45.48 mm and the mean length of MTJ was 31.74 mm. The mean width of distal end of MTJ was 7.76 mm, thickness of distal end of MTJ was 4.07 mm and the mean width of the interosseous membrane at the distal end of MTJ was 4.76 mm. We found the mean width of the proximal end of MTJ was 20.68 mm, the mean thickness of proximal end of MTJ was 5.52 mm, and mean width of interosseous membrane at the proximal end of MTJ was 8.76 mm. Our study has demonstrated that a 31 mm length incision made at approximately 45 mm from the proximal end of the medial malleolus can safely reach the MTJ. We recommend an opening length of the interosseous membrane of at least 20 mm.

Location of motor branches of tibialis posterior muscle and its relation in treatment of spastic equinovarus foot: a cadaveric study.

BACKGROUND AND OBJECTIVES: Nerve block or neurolysis is an important approach in the treatment of spastic equinovarus foot. To illustrate the accurate location of the nerve branch to the tibialis posterior muscle (TP) in clinical practice, 21 adult cadavers were dissected and 14 complete both lower limb specimens were obtained. A total of 28 lower limbs were included. METHODS: We measured the length of the motor branch nerve (LM) of the tibialis posterior muscle, the length of the fibula (LF), the vertical distance (D1) from the midpoint of LM to the fibula tip as well as the horizontal distance (D2) from the midpoint of LM to the inner edge of the fibula. RESULTS: The LM was higher (35.74 ± 7.28 mm) in male than in female (30.40 ± 6.88 mm) specimens but there was no significant correlation between LM and gender (p > 0.05). Additionally, among male specimens, the LM on the right side was longer than that on the left (p ≤ 0.05) while among female specimens, the D1 on the left side was longer than that on the right (p ≤ 0.05). The LF in male specimen was significantly longer than that in female (p ≤ 0.05). The midpoint of the nerve to the motor branch of the tibialis posterior muscle was about 50 mm distal to the fibular head and 10 mm at the inner edge of the fibula. CONCLUSION: Using this coordinate, the midpoint of the nerve branch to the TP could be accurately located.

Plasma parameters and risk factors of patients with post-stroke cognitive impairment.

BACKGROUND: It is high of the incidence of stroke and dementia with the advent of an aging society. Post-stroke cognitive impairment is one of the common complications of stroke, which not only seriously affects the life quality of patients, but also significantly reduces the survival time of stroke patients. Moreover, it also brings in heavy burden to the family and society. The development of vascular dementia could be reduced by early intervention after stroke. Management of vascular risk factors could be an effective way to prevent dementia. This study aimed to investigate the plasma biochemical parameters of post-stroke cognitive impairment (PSCI) and its potential risk factors. METHODS: Four hundred eighty-seven consecutive patients with ischaemic stroke were included and followed up for 3 years. Among these patients, 132 cases were diagnosed as PSCI. The cognitive impairment of patients with PSCI was assessed by the Mini Mental State Examination and Montreal cognitive assessment scale. The plasma biochemical parameters and blood coagulation, as well as computed tomography and magnetic resonance imaging of all the patients after admission, were measured. RESULTS: Multivariate analyses revealed that increased age, carotid plaque, cerebral atrophy, white matter lesions (WML), alcohol use, smoking and history of systolic blood pressure ≥170 mmHg was highly associated with PSCI (P<0.05). Elevated homocysteine, low-density lipoprotein (LDL), and uric acid were also highly associated with PSCI. Logistic regression analysis identified five risk factors correlated with PSCI including alcohol use [odds ratio (OR): 5.138, 95% confidence interval (CI): 1.014-26.04, P=0.048], history of high systolic blood pressure (OR: 12.171, 95% CI: 3.339-44.363, P=0.001), carotid plaque (OR: 1.692, 95% CI: 1.032-2.796, P=0.040), cerebral atrophy (OR: 2.280, 95% CI: 1.294-4.001, P=0.004), and WML (OR: 3.155, 95% CI: 1.868-5.324, P=0.001). Three plasma biochemical parameters were also associated with PSCI including homocysteine (OR: 1.018, 95% CI: 0.944-1.042, P=0.010), and LDL (OR: 0.83, 95% CI: 0.6-1.148, P=0.051), and uric acid (OR: 1.00, 95% CI: 0.998-1.002, P=0.007). The area under the receiver operating curve for the risk factors of PSCI was 0.821 with the sensitivity of 76.3% and specificity of 71.9%. CONCLUSIONS: Elevated homocysteine, LDL, and uric acid were highly related to PSCI, which may help predict PSCI. These plasma biochemical parameters together with vascular risk factors, may improve the sensitivity for early detection of PSCI.

Anatomical variations in the first extensor compartment: a cadaver study.

BACKGROUND: Anatomical variations in the first extensor compartment are associated with the pathogenesis of de Quervain's disease. Here, we report two novel anatomical variations of the first extensor compartment. METHODS: The wrists of two adult cadavers were dissected to reveal the anatomical variations in the first extensor compartment. RESULTS: In one of the cadavers, no septum was present in the first extensor compartment. However, the extensor pollicis brevis tendon and its proximal muscle belly were absent. The abductor pollicis longus (APL) tendon had multiple slips, and one of them inserted on the dorsal base of the proximal thumb phalanx. In another cadaver, a septum was present in the first extensor compartment. One of the multiple APL tendon slips ran into the septum alongside the extensor pollicis brevis tendon for 4 mm, which then exited the septum and inserted into the base of the first phalanx together with the APL tendon. CONCLUSION: Our findings may help to improve the awareness of the anatomical variations in the first extensor compartment.

A novel classification of the anatomical variations of the first extensor compartment.

The presence of a septum in the first extensor compartment is closely associated with the pathophysiology of de Quervain disease, and affects the efficacy of corticosteroid injection and surgical release. This study aimed to examine the incidence and length of the first extensor compartment septum.Forty sides of the wrists in 20 cadavers were used. The presence of a septum in the first extensor compartment was examined. The septum length was recorded with the radial styloid process as the reference point.The anatomical variations of the first extensor compartment were classified into 3 types. Type I compartment was found in 7 sides in males (29.2%) versus 6 sides in females (37.5%, P = .733), type II was found in 6 sides in males (25%) versus 1 side in females (6.25%, P = .21), and type III was found in 11 sides in males (45.8%) versus 9 sides in females (56.25%, P = .56). There was no significant difference in the septum length between males and females (5.3 ±â€Š2.3 vs 4.8 ±â€Š1.1 mm, P = .54).The incidence of a septum in the first extensor compartment is approximately 50%. The mean septum length is 5 mm. Injection at 5 mm proximal to the radial styloid process has a great chance of delivering the steroids into both subcompartments. Exposure to 5 mm proximal to the radial styloid process can avoid the overlook of subcompartment and achieve adequate decompression of the first extensor compartment.

Reduction of adhesion formation after knee surgery in a rat model by botulinum toxin A.

Adhesion of the knee is a major concern after knee surgery, the treatment of which is difficult. Botulinum toxin A (BTX-A) injection is demonstrated as efficient in treating knee adhesion after surgery. However, the treatment outcomes and the mechanism of action are not yet determined. The aim of the present study was to examine the effects and molecular mechanism of a BTX-A treatment in preventing adhesion of the knee. Twenty-four Wistar rats were randomly divided into a BTX-A treatment group and a control group. BTX-A or saline was injected into the cavity of the knee in the BTX-A treatment or control group respectively. Gross and histopathological examinations of interleukin 1 (IL-1) and fibroblast growth factor (FGF) levels, as well as fibroblast cell numbers, were assessed in the knee intra-articular adhesions in each group 6 weeks after recovery from the surgery. Macroscopic observations showed a significant reduction in adhesion severity in the BTX-A treatment group compared with the control group. In addition, the levels of IL-1 and FGF were lower and the number of fibroblasts was smaller in the BTX-A treatment group compared with those in the control group. BTX-A prevented intra-articular adhesion of knee in the rats, which might be associated with reduced expressions of IL-1 and FGF.