Accuracy of talonavicular injection using ultrasound versus anatomical landmark: a cadaver study.

BACKGROUND: Intra-articular injections have diagnostic and therapeutic roles in foot and ankle pathologies due to complex anatomy, small size, diverse bones, and joints with proximity in this region. Conventionally, these injections are carried out using anatomical landmark technique and/or fluoroscopic guidance. The small joint space and needle size make the injection challenging. Fluoroscopy is not readily available in the clinical setting; ultrasound-guidance for injections is therefore increasingly being used. We compared the accuracy of intra-articular talonavicular injections using the anatomical landmark technique versus the ultrasound-guided method. PURPOSE: To determine whether ultrasound guidance yields superior results in intra-articular injections of the talonavicular joint compared to injections using palpatory method guided by anatomical landmarks. MATERIAL AND METHODS: The feet of 10 cadaveric specimens were held in neutral position by an assistant while a fellowship-trained foot-ankle orthopedic surgeon injected 2 cc of radiopaque dye using anatomical landmarks and palpation method in five specimens and under ultrasound guidance in the remaining five. The needles were left in situ in all specimens and their placement was confirmed fluoroscopically. RESULTS: In all five specimens injected under ultrasound guidance, the needle was found to be in the joint, whereas all five injected by palpation only were out of the joint, with one in the naviculo-cuneiform joint, showing ultrasound guidance to significantly increase the accuracy of intra-articular injections in the talonavicular joint than palpatory method alone. CONCLUSION: Ultrasound-guided injections not only confirm correct needle placement, but also delineate any tendon and/or joint pathology simultaneously.

Primary synovial chondromatosis of the subtalar joint: case report and review of the literature.

Primary synovial chondromatosis is a rare benign condition of uncertain etiology manifested by synovial proliferation. In the radiology literature, there is only 1 prior case report of primary synovial chondromatosis involving the subtalar joint with only partial description of the imaging appearance. We present a 28-year-old female with primary synovial chondromatosis of the subtalar joint and conduct a literature review of the imaging features of primary synovial chondromatosis presenting in the feet.

Descriptive anatomy of the insertion of the biceps femoris muscle.

The biceps femoris is the most lateral component of the so-called hamstring muscles. Classically, this muscle's insertion into the head of the fibula has been described but further details of its anatomy have not been universally appreciated. Additional insertions into the crural fascia and tibia have been described. We dissected 56 cadavers paying especially close attention to the insertion of the biceps femoris muscle. The tendon of this muscle was found to have both medial and lateral slips each with an anterior and posterior component. Further, we found an attachment not only into the lateral condyle of the femur but also the popliteus tendon and arcuate popliteal ligament. Our study has found that the tendon of insertion of the biceps femoris muscle is more complex than described previously and suggests that this tendon may be far more important in knee stability based on the multiple attachment sites found. We hypothesize that there may be a synergistic effect between the biceps femoris and the popliteus muscles based on our findings of an additional attachment of the biceps femoris tendon into the popliteus tendon. This study provides new detailed nomenclature for the description of the tendon of insertion of the biceps femoris muscle and indicates that the current description of the insertion of the tendon of the biceps femoris muscle should be revised. The clinician must have a thorough understanding of this anatomy before correct therapeutic maneuvers can be implemented.

Crecimiento in vitro de periostio

A partir de 1987, en la Universidad del Valle, se comienzan a implementar técnicas de cultivo celular y de análisis histológico, en microscopio de luz y en microscopio de barrido, para el estudio de muestas de periostio. Se emplearon conejos Nueva Zelanda y ovejos africanos como animales de experimentación. Se observó crecimiento de fibroblastos y de células mesenquimatosas. Cuando estas células eran mantenidas durante períodos mayores a dos semanas en el mismo medio de cultivo, presentaban fenómenos de envejecimiento, debido al déficit regional de sustratos. Su reactivación con obtención de la morfología inicial, fue posible mediante siembras sucesivas, a partir de una monocapa del cultivo saturado. El principal riesgo de inhibición del crecimiento o muerte celular, se relaciona con la contaminación micótica y/o bacteriana. Las técnicas de cultivo celular, se constituyen en un elemento útil y abren nuevas perspectivas en la reparación de lesiones osteoarticulares preexistentes de origen traumático, infeccioso, degenerativo o congénito