The tibiocalcaneal bundle of the deltoid ligament - Prevalence and variations.

INTRODUCTION: A precise understanding of the anatomy of the multiple bundles of the deltoid ankle ligament might have clinical impact. The most relevant deltoid anatomical series report a variable frequency of the tibiocalcaneal ligament, possibly the most important bundle to be reconstructed in medial ankle insufficiency. Our purpose was to access the deltoid's tibiocalcaneal ligament morphology in a large anatomical study as well as to perform a historical literature review on the reasons for its variable prevalence. MATERIALS AND METHODS: Forty-three ankle specimen were dissected to describe the prevalence of superficial and deep deltoid bundles, with special attention to the tibiocalcaneal ligament and its variants. RESULTS: All ankles had distinct deep and superficial bundles. In all 43 ankles the tibionavicular and tibiospring ligaments were clearly identified. The superficial posterior tibiotalar ligament was identified in 38 ankles (88%). The deep anterior tibiotalar bundle was identified in 35 ankles (81%). The deep posterior tibiotalar bundle was identified in all ankles. The tibiocalcaneal ligament was identified in 33 ankles (77%). In ten ankles there wasn't a direct bundle between the tibia and the sustentaculum tali. In all of these, however, we found some fibers spanning the gap between the tibiospring ligament and the sustentaculum tali. CONCLUSION: The tibiocalcaneal ligament is present in most specimens. In those in which we could not identify a direct bundle between the tibia and the calcareous we found a variant of the tibiospring ligament that connects to the sustentaculum tali.

The Os Peroneum incidence - A cadaveric study.

BACKGROUND: The Os Peroneum (OP) is a small sesamoid bone, which can be found in the Peroneus Longus Tendon (PLT) sheath, near the calcaneocuboid joint. Size and shape variability is quite common as well as a multipartite OP that can be found in some cases. Trying to explore and understand this variability, this study was carried out in order to provide us with answers about the presence and shape of OP in our specimens. METHODS: Twenty cadaveric lower extremities were obtained according to the body donation program of our institution. Dissections were performed to expose the OP (when present) starting proximally at the origin of the PLT and Peroneal Brevis Tendon (PBT) finalizing at the insertion of the PLT in the first metatarsal. RESULTS: In twenty feet, nine distinct OP were found, whilst six feet had a thickening of the tendon. On the remaining five foot, we did not identify an OP. CONCLUSIONS: In this study, 45% of the feet analyzed had an OP. The authors believe the variability of OP prevalence reported in the literature can be associated with differences in its definition.

Insertional anatomy of peroneal brevis and longus tendon - A cadaveric study.

BACKGROUND: Peroneal Tendon (PT) complex is formed by the Peroneus Longus Tendon (PLT) and Peroneus Brevis Tendon (PBT), their synovial sheath, the superior and inferior retinaculum, and the Os Peroneum (OP). Their insertion is associated with some anatomic variability. Knowing these variants helps to understand the PT pathology and it may support the decision-making concerning the operative approach. The purpose of this study was to assess anatomical variability in PT insertion. METHODS: Twenty fresh-frozen cadaveric feet were used. The lateral part of the ankle, foot and sole were dissected to expose PLT and PBT course and distal insertions. RESULTS: Concerning the PBT, eleven feet had a normal insertion in the base of the fifth metatarsal; the other nine had a variability. Regarding the PLT, thirteen out of twenty had the normal insertion in the first metatarsal; the remaining seven had anatomical variants. CONCLUSIONS: In this study, we found a great variability in the insertional anatomy of PBT and PLT. CLINICAL RELEVANCE: It is important that orthopedic surgeons are aware of the great variability of PT anatomical insertion when performing foot and ankle surgery, in order to avoid possible complications, for instance a PLT injury during preparation of tarso-metatarsal arthrodeses.

Servicios públicos domiciliarios: ¿derechos humanos o productos para la venta? Caso Medellín / Home utilities: are they human rights or products for sale? The Medellin Case

El presente artículo presenta los resultado de investigación encaminada a demostrar y visibilizar, en la ciudad de Medellín, las múltiples afectaciones a personas por la ausencia de servicios públicos domiciliarios en sus viviendas, aún y la capacidad técnica, operativa y financiera de la empresa prestadora de servicios en la ciudad: Empresa Públicas de Medellín (Epm E.S.P), lo que supone una inadecuada lectura de la realidad de la ciudad, principalmente en las zonas periféricas y zonas de alto riesgo. Esta situación lleva a que los ciudadanos recurran a las vías judiciales o a las vías de hecho para proveerse del servicio y en cualquiera de las dos vías se termina por generarle una serie de dificultades de orden jurídico, social y económico al Municipio que es, según la Ley 142 de 1994, el responsable de garantizar el derecho a los servicios públicos domiciliarios; situaciones que pudiesen contar con una solución más adecuada en tanto que ajustada a las realidad de la ciudad.

This current paper introduces the research results aiming at demonstrating and identifying, in the city of Medellin, the multiple effects to people by the lack of home utilities, still and the technical, operational, and financial capacities of the company providing services in the city: Public Companies of Medellin (EPM -ESP), which supposes an inadequate reading of the reality of the city, mainly on the outskirts and high-risk areas. This situation makes the citizens resort to the judicial routes or assault and battery in order for them to provide with the service, and in either of the two routes, a series of legal, social, and economic difficulties are derived, which becomes a problem to the Municipality, which according to the Law 142 as of 1994, is responsible for ensuring the people the right to home utilities, situations which could have a moreadequate solution to the extent that it can be adjusted to the reality of the city.