Evaluation of radiographic fracture position 1 year after variable angle locking volar distal radius plating: a prospective multicentre case series.

Treatment with a variable angle locking plate can, in theory, maintain near anatomic reduction of intra-articular distal radius fractures, but it is unknown to what extent reduction is maintained as measured by computed tomography. We assessed changes in radiographic fracture position 1 year post-operatively. We included 73 patients of whom 66 patients (90%) had radiographs available for review at 1 year post-operatively. We found a small (less than 2 mm or 2°) but statistically significant change in several measures. Accounting for inter-observer variability, this is probably within measurement error. We found no difference in change in fracture position or range of motion, grip strength or patient-reported outcome between the use of one or two distal rows of screws. Our results show that minimal changes in reduction can be expected after volar plate fixation in most patients. We recommend using only one screw row routinely, limiting costs, surgical time and the risk of misplacement of screws. LEVEL OF EVIDENCE: IV.

Variations in the branching of the internal pudendal artery in the ischioanal fossa.

The branches of the ischiorectal part of the internal pudendal artery include the inferior rectal artery and small branches to the obturator internus muscle. For our research we had 164 embalmed half pelves, the arteries of which has been injected by the Thiel method. After the dissection of the ischioanal fossa the arteries were documented. Four types of branching of the inferior rectal artery were found. I. (43%) One artery on each side. II. (31%) Two arteries on one side. III. (4%) Three arteries on one side. IV. (22%) Two arteries or more on each side. In the specimens examined we found one branch to the obturator internus muscle in 31%, two branches in 43% and three branches in 11%. In 15% of cases this branch was absent. In seven cases two branches formed an anastomosis parallel to the internal pudendal artery.

[New definition of the proximal perichondrium in hip sonography]. / Neudefinition des proximalen Perichondriums und des Perichondriumloches im Hüftsonogramm.

As a result of the improvement in the resolution of diagnostic sonography equipment it is possible to depict sonographic echoes of structures in the area of the preformed cartilage acetabular roof, especially in the region of the proximal perichondrium, perichondrial gap and the joint capsule that up to now have not been anatomically identified. Therefore, the question arises as to which anatomical structures these newly observed sonographic echoes can be classed with. Hip-joint NMR images of corpses were made and compared to anatomical specimen, anatomical sections and sonograms of high-resolution ultrasound equipment.Through this comparative study it was possible to demonstrate that the echo of the proximal perichondrium is anatomically consistent with the proximal perichondrium itself, parts of the joint capsule and the insertion of the musculus rectus femoris tendon. Identification of the ligamentum ischiofemorale and its separation from the labrum acetabulare, the joint capsule and the musculus rectus femoris tendon leads to better interpretation of the perichondrial gap in the sonogram.Common terms, such as "proximal perichondrium" and "perichondrial gap" obtain a new anatomical assessment. These terms, taken as a basis for knowledge of the anatomical structures, can be used as usual. There are no consequences for hip sonography today if the definition of the distinction between type III and type IV, and of the standard section is used further as the basis of sonography even if these terms have received a new anatomical classification.

Technical complications during removal of locking screws from locking compression plates: a prospective multicenter study.

PURPOSE: To assess the risk for technical complications in patients undergoing removal of locking compression plates (LCP) with head locking screws. METHODS: A total of 205 patients who were scheduled for implant removal surgery after a healed fracture of the femur, tibia, humerus, distal radius, or clavicle in nine Austrian clinics were prospectively included in the study, all of whom had previously undergone fracture fixation by plates, with titanium implants used in 98 % of the patients. Intraoperative technical complications and the methods used to solve them were documented by the surgeon. RESULTS: During the course of this study, a total of 1,462 locking screws were removed from 204 LCPs. While 95 % of these screws could be removed without difficulties, technical complications were reported for 41 patients with 78 screws which could not be removed with standard screwdrivers and required the use of additional instruments. The estimated risk for the occurrence of at least one technical complication during implant removal surgery was 20.1 %. The most frequently observed complications were screws that could not be loosened because they were jammed in the LCP, screws with a damaged recess in which the screwdriver turned freely, as well as a combination of both events. The majority of these screws could be removed with the use of a conical extraction screw or by drilling off the screw head. In one patient, an intraoperative refracture of the humerus occurred during plate removal. Even though there is a rate of 20 % for technical complications when removing the implants, only a few patients experience a clinical impact. CONCLUSIONS: Titanium LCPs are prone to technical complications during implant removal, but the majority of the issues can be solved using special techniques.

Differences in length and cross-section of semitendinosus and gracilis tendons and their effect on anterior cruciate ligament reconstruction: a cadaver study.

The purpose of this anatomical study was to explore the morphological variations of the semitendinosus and gracilis tendons in length and cross-section and the statistical relationship between length, cross-section, and body height. We studied the legs of 93 humans in 136 cadavers. In 43 specimens (46.2%) it was possible to harvest the tendons from both legs. We found considerable differences in the length and cross-section of the semitendinosus and the gracilis tendons with a significant correlation between the two. A correlation between the length of the femur, reflecting height, and the length of the tendons was only observed in specimens harvested from women. The reason for this gender difference was unclear. Additionally, there was a correlation between the cross-sectional area of the tendons and the length of the femur. Surgeons should be aware of the possibility of encountering insufficient length of tendon when undertaking reconstructive surgery as a result of anatomical variations between patients.

[Redefinition of the proximal perichondrium and perichondrial gap in hip ultrasound imaging]. / Neudefinition des proximalen Perichondriums und des Perichondriumloches im Hüftsonogramm.

As a result of the improvement in the resolution of diagnostic sonography equipment it is possible to depict sonographic echoes of structures in the area of the preformed cartilage acetabular roof, especially in the region of the proximal perichondrium, perichondrial gap and the joint capsule that up to now have not been anatomically identified. Therefore, the question arises as to which anatomical structures these newly observed sonographic echoes can be classed with. Hip-joint NMR images of corpses were made and compared to anatomical specimen, anatomical sections and sonograms of high-resolution ultrasound equipment. Through this comparative study it was possible to demonstrate that the echo of the proximal perichondrium is anatomically consistent with the proximal perichondrium itself, parts of the joint capsule and the insertion of the musculus rectus femoris tendon. Identification of the ligamentum ischiofemorale and its separation from the labrum acetabulare, the joint capsule and the musculus rectus femoris tendon leads to better interpretation of the perichondrial gap in the sonogram. Common terms, such as "proximal perichondrium" and "perichondrial gap" obtain a new anatomical assessment. These terms, taken as a basis for knowledge of the anatomical structures, can be used as usual. There are no consequences for hip sonography today if the definition of the distinction between type III and type IV, and of the standard section is used further as the basis of sonography even if these terms have received a new anatomical classification.