ABSTRACT
The standard dorsal portals are the most commonly used in wrist arthroscopy. This cadaveric study aims to determine safe zones, by quantitatively describing the neurovascular relationships of the dorsal wrist arthroscopy portals: 1-2, 3-4, midcarpal radial, midcarpal ulnar, 4-5, 6-radial and 6-ulnar. The neurovascular structures of twenty-one fresh frozen human cadaveric upper limbs were exposed, while the aforementioned portals were established with needles through portal sites. The minimum distance between portals and: dorsal carpal branch of radial artery, superficial branch of radial nerve, posterior interosseous nerve and dorsal branch of ulnar nerve, were measured accordingly with a digital caliper, followed by statistical analysis of the data. The median and interquartile range for each portal to structures at risk were determined and a safe zone around each portal was established. Free of any neurovascular structure safe zones surrounding 1-2, 3-4, midcarpal radial, midcarpal ulnar, 4-5, 6-radial and 6-ulnar portals were found at 0.46mm, 2.33mm, 10.73mm, 11.01mm, 10.38mm, 5.95mm and 0.64mm respectively. Results of statistical analysis from comparisons between 1-2, 3-4 and midcarpal radial portals, indicated that 1-2 was the least safe. The same analysis among 3-4, midcarpal radial, midcarpal ulnar and 4-5 portals indicated that midcarpal portals were safer, while 3-4 was the least safe. Results among midcarpal ulnar, 4-5, 6-radial and 6-ulnar portals indicated that 6-radial and specifically 6-ulnar were the least safe. This study provides a safe approach to the dorsal aspect of the wrist, enhancing established measurements and further examining safety of the posterior interosseous nerve.
Subject(s)
Arthroscopy , Cadaver , Wrist Joint , Humans , Arthroscopy/methods , Wrist Joint/surgery , Wrist Joint/anatomy & histology , Radial Nerve/anatomy & histology , Ulnar Nerve/anatomy & histology , Male , Radial Artery/anatomy & histology , Female , AgedABSTRACT
This is a report of an unusual anaplastic thyroid carcinoma case with capsule and long disease-free survival. This 74-year-old male, with an asymptomatic nodule in the mid-line neck for 5 years, was treated with total thyroidectomy. Light microscopy and immunohistochemistry showed an anaplastic carcinoma of the thyroid isthmus. There were no signs of carcinoma elsewhere either at the time of surgery or 35 months later, when the patient was last seen.