Nandrolone decanoate in induced fracture nonunion with vascular deficit in rat model: morphological aspects.

BACKGROUND: The nonunion fracture is a relatively frequent complication in both human and veterinary medicine. Specifically, atrophic fracture nonunions are difficult to treat, with revision surgery usually providing the best prognosis. Anabolic steroids, such as nandrolone decanoate (ND), have been reported to have beneficial clinical effects on bone mass gain during osteoporosis; however, their utility in promoting regeneration in atrophic nonunions has not been documented. Our objective was to examine morphological changes induced by the ND in experimental fracture nonunion with vascular deficit in the rat model. METHODS: Fourteen adult Wistar rats had an atrophic fracture nonunion induced in the diaphysis of their left femur. Rats were allocated into two groups: control group and nandrolone decanoate group. Rats in the latter group were given nandrolone decanoate (1.5 mg/kg IM, once a week, during 4 weeks after confirmation of fracture nonunion radiographically). Radiographic and anatomopathological examination, micro-tomography and histological analysis were assessed to characterize the morphological changes promoted by the nandrolone decanoate use. RESULTS: Based on radiology, anatomopathological evaluation, computed micro-tomography and conventional microscopy, nandrolone decanoate promoted bone regeneration at the fracture nonunion site by increasing the cellularity at the fracture site. Percentage of collagen was not significantly different between groups, consistent with high-quality regenerated bone. CONCLUSION: The anabolic steroid nandrolone decanoate improved bone mass and regeneration without affecting collagen production and therefore has potential for improving outcomes for atrophic fracture nonunion.

A communicating branch between the dorsal and superficial ramus of the ulnar nerve (Kaplan's anastomosis): clinical and surgery discussion / Ramo comunicante entre los ramos dorsal y superficial del nervio ulnar (anastomosis de Kaplan): discusión clínica y quirúrgica

The Kaplan´s anastomosis represents the communication between the dorsal and superficial branch of the ulnar nerve distal to ulnar canal. In the present study, a case about this nerve communication, found in a male adult cadaver, is reported. Information about brachial plexus distal anastomosis is fundamental for interpretation of clinical and electrophysiological findings, in order to establish the precise diagnosis of neurological lesions at this level. Its relations with flexor carpi ulnaris muscle's tendon and with pisiform bone exposes it to iatrogenic lesions during surgery.

La anastomosis de Kaplan representa la comunicación entre la rama dorsal y superficial del nervio ulnar distal al canal ulnar. En el presente estudio se informa de un caso de esta comunicación nerviosa, encontrado en un cadáver adulto de sexo masculino. Información sobre el plexo braquial y sus anastomosis distales son fundamentales para la interpretación de los hallazgos clínicos y electrofisiológicos, a fin de establecer el diagnóstico preciso de las lesiones neurológicas a este nivel. Sus relaciones con el tendón del músculo flexor ulnar del carpo, como con el hueso pisiforme, pueden facilitar la ocurrencia de lesiones iatrogénicas durante la cirugía.

Output relations of humeral circumflex arteries and its variations / Relaciones de las arterias circunflejas humerales y sus variaciones

A large range of variability marks the branching pattern of the axillary artery. The knowledge of the anatomical variations and this pattern is essential to diagnostic and therapeutic approaches, including surgery, of the axillary region. The aim of this study was to observe the different possible origins of circumflex humeral arteries and to measure the length and diameter of each vessel. In our study, 24 armpits from adult cadavers (fixed in tamponed formalin 10%) were dissected. The data were analyzed with a digital caliper and the results expressed as Mean ± SD. In majority of specimens, posterior circumflex humeral artery (PCHA) arose from subscapular artery (SSA) (54.16%) and had an average diameter of 3.92±0.41 mm. The anterior circumflex humeral artery was a branch from axillary artery (AA) in the majority of the specimens (62.5%) with an average diameter of 1.83±0.68 mm. Circumflex humeral arteries can arise from SSA, deep brachial artery and AA. The result of this study is an interesting data for origin, length and diameter of these vessels, contributing to the knowledge of these variations occurrence.

Una amplia gama de variabilidad marca el patrón de ramificación de la arteria axilar. El conocimiento de las variaciones anatómicas de este patrón es esencial para enfoques de diagnóstico y terapéuticos, incluyendo la cirugía de la región axilar. El objetivo fue observar los diferentes orígenes posibles de arterias circunflejas humerales y medir la longitud y el diámetro de cada vaso. En el estudio se disecaron 24 axilas de cadáveres adultos (fijados en formalina tamponada al 10%). Los datos se analizaron con un calibrador digital y los resultados se expresaron como Media ± DS. En la mayoría de los especímenes, la arteria circunfleja humeral posterior surgió de la arteria subescapular (ASE) (54,16%) con un diámetro medio de 0,41±3,92 mm. En la mayoría de los especímenes (62,5%), la arteria circunfleja humeral anterior era una rama de la arteria axilar (AA) con un diámetro medio de 0,68±1,83 mm. Las arterias circunflejas humerales pueden surgir de la ASE, de la arteria braquial profunda y AA. El resultado de este estudio es un dato interesante para el origen, la longitud y el diámetro de los vasos, lo que contribuye al conocimiento de la ocurrencia de estas variaciones.

Novel rat model of nonunion fracture with vascular deficit.

Nonunion fractures occur frequently in humans, with profound implications (medical and non-medical). Although there are numerous animal models to study pathogenesis and treatment of nonunion fractures, there is apparently the lack of a definitive model for atrophic nonunion fracture. Therefore, the objective was to develop a low-cost rat model of nonunion fracture with a vascular deficit that enabled standardized quantitative analysis of bone growth and regeneration. The model was developed with two surgeries, performed apart. The first involved osteotomy of the femur diaphysis, removal of periosteum and endosteum, isolation of the fracture site using a latex artefact (Penrose drain tube), and reduction of the fracture using an intramedullary pin, whereas the second surgery was to remove the latex artefact. Based on radiographic imaging, micro-CT and histological analyses done 125 days after the fracture was induced, there was clear evidence of atrophic nonunion fracture, without pin migration or specimen loss. Perceived advantages of this model included low cost, ease of reproducibility, lack of specimen loss, and, finally, the potential to assess bone growth and regeneration under poor vascular conditions.

High Incidence of Complete Ossification of the Superior Transverse Scapular Ligament in Brazilians and its Clinical Implications / Alta Incidencia de Osificación Completa del Ligamento Escapular Transverso Superior en Brasileños y sus Implicancias Clínicas

The aim of this study was to verify the prevalence of the ossified superior transverse scapular ligament (STSL) on dry bones of scapulae. 221 dry bones were analyzed, (111 rights and 110 lefts), proceeding from Rio de Janeiro and of Santa Catarina, Brazil. As exclusion criterion, were not analyzed bones of children or damaged. For the quantitative analysis of the data, the software Graphad Instat was used. Fisher exact test was used considering the p ≤ 0,05 as significant. After analysis of the scapulae, 30,76% (68/ 221) presented the ossified STSL (p ≤ 0,0001) of which, 52,94% (36/68) were ossified on the right side and 47,05% (32/68) on the left one. The 153 scapulae that did not present the ossified STSL, it was observed in 19,6 % (30/153) of these bones, the superior edge varying in the transverse plan, increasing superior angulation and, modified the width and depth of the scapular incisure. This anatomical curiosity should be kept in mind by clinicians that approaches painful syndrome of the shoulder, as well as, this anatomical curiosity should be kept in mind by students that may manipulate this anatomical area.

El objetivo de este estudio fue verificar la prevalencia del ligamento escapular transverso superior (LETS) osificado, en huesos secos. 221 escápulas secas (111 derechas y 110 izquierdas) fueron analizadas procedentes de Río de Janeiro y de Santa Catarina, Brasil. No fueron analizados huesos de niños o dañados. El tratamiento estadístico de los datos fue realizado con el software Graphpad Instat, siendo seleccionado el test Fisher, con un p ≤ 0.05 como significativo. El 30.76% (68/221) de las escápulas presentaron el LETS osificado (p ≤ 0,0001) de ellos, el 52.94% (36/68) correspondían a escáulas derechas y 47.05% (32/68) a escápulas izquierdas. Las 153 escápulas que no presentaron el LETS osificado, se observó en el 19.6% (30/153) de estos huesos. El margen superior que variaba en el plano transversal, incrementaba la angulación superior y modificaba así el ancho y la profundidad de la incisura escapular. Esta variación anatómica la deben tener presente los clínicos debido al síndrome doloroso del hombro, como también, los estudiantes que manipulan esta área anatómica.

Triple Right Renal Vein: An Uncommon Variation / Vena Renal Derecha Triple: Una Variación Rara

We report an unilateral three renal veins the right kidney in an elderly male cadaver. They were three calibrous veins having independent courses up to the inferior vena cava. No other vascular anomalies were noted in this specimen. This anatomical curiosity should be kept in mind by clinicians and academics that may manipulate this anatomical area.

Presentamos una variación anatómica consistente en tres venas renales unilaterales presentes en el riñón derecho de un cadáver de un individuo adulto de sexo masculino. Las tres venas eran de calibre considerable, las cuales tenían cursos independientes hasta la vena cava inferior. No se observó ninguna otra variación vascular en este individuo. Tanto los clínicos como los académicos deben tener presente esta variación anatómica cuando se acceda a esta área anatómica.

A Rare Variation of the Retro-Aortic Left Renal Vein with Anastomotic Afluent from Inferior Mesenteric Vein / Una Variación Rara de la Vena Renal Izquierda Retro-Aórtica con un Afluente Anastomótico de la Vena Mesentérica Inferior

We report an uncommon anatomical variations of the left renal vein was found on dissected specimen in an elderly male cadaver: a retroaortic left renal vein. No other vascular anomalies were noted in this specimen. The anomaly result may be related to a particular pattern of left inferior vena cava. The abnormality have to be known for it may be undetected or be misleading in imaging. This anatomical curiosity should be kept in mind by clinicians and academics that may manipulate this anatomical area.

Relatamos una variación anatómica infrecuente de la vena renal izquierda, denominada vena renal retroaórtica, encontrada en un cadáver masculino disecado. No se observaron otras variaciones vasculares. Lavariación anatómica encontrada se puede relacionar con un patrón particular de la vena cava inferior izquierda. La variación debe ser conocida ya que puede pasar inadvertida o ser confundida en proyecciones de imágenes de la región. Los clínicos y académicos que actúen en la región, deben considerar esta eventual variación anatómica.