Distribution of nerve endings in human thumb interphalangeal joint.

This study aims to quantitatively analyze the distribution of encapsulated nerve endings in the human thumb interphalangeal (IP) joint capsule. There are three types of nerve endings. Type-I nerve endings (Ruffini-like ending) sense pressure changes, Type II (Pacini-like ending) nerve endings contribute to the kinesthetic sense, and Type III (Golgi-like ending) nerve ending provides proprioceptive information. We dissected five right thumbs IP joints from freshly frozen cadavers (5 men). The mean age of the cadavers at the time of death was 63.4 years (55-73). Sections were stained with the hematoxylin-eosin and antiprotein gene product 9.5 (PGP9.5) to identify encapsulated nerve endings. Transverse sections were cut and divided into volar, dorsal, and then into two equal parts, proximal and distal. The density of encapsulated nerve endings compared to volar versus dorsal and proximal versus distal regions was examined. This study showed that type 1 nerve endings were more common in the distal parts of the IP joint (p < 0.05). Also, type 3 nerve endings were observed in the thumb IP joint. There was no difference between regions in type II and type III nerve endings. The current study demonstrates that the distribution of encapsulated nerve endings in the IP joint is different from the PIP and DIP joints. Moreover, further studies are required to understand the thumb's physiology.

Single versus double plate fixation of humeral shaft nonunion.

INTRODUCTION: Humeral shaft fractures are common fractures of the diaphysis of the humerus. The aim of this study was to evaluate factors affecting the clinical outcomes of humeral nonunions surgically treated with open reduction and single- versus double-plate fixation with grafting. MATERIALS AND METHODS: A total of 31 patients with nonunion treated with single- or double-plate screw fixation with bone grafting were retrospectively analysed. The patients were divided into two groups according to the treatment method as Group 1 (single-plate, n = 14) and Group 2 (double-plate, n = 17). Data including demographic and clinical characteristics of the patients, initial and final treatment, type of nonunion and localisation, graft use, shortening, follow-up, time to union, Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) scores, and patient-reported cosmetic outcomes were recorded. RESULTS: Of the patients, eight were males, and 23 were females, with a mean age of 47.6 ± 15.8 (range, 20-86) years. Initial treatment was conservative treatment (Sarmiento brace) in seven patients, plate fixation in 22 patients, and intramedullary nailing in two patients. The mean follow-up was 31.0 ± 16.9 months in Group 1 and 25.4 ± 15.6 months in Group 2. There was one nonunion in Group 1 and three in Group 2. There were no significant differences in the union rate and time to union (p = 0.378 and p = 0.262, respectively). The mean Quick-DASH scores and cosmetic results were similar between the groups (p = 0.423 and p = 0.165, respectively). Radial nerve palsy developed in three patients in Group 2, and all these patients recovered completely during follow-up. CONCLUSIONS: Although the double-plate fixation technique has similar clinical, radiological, and functional results to single-plate fixation, it is a more invasive and expensive technique with a longer operation time. Therefore, it should not be used as the first-line treatment option for all humeral shaft nonunion. Nevertheless, the double-plate technique may be preferred to achieve in cases requiring high stability, such as hypertrophic nonunion, osteopenia and comminuted fractures.

Comparison of curettage vs. trephination technique for harvesting anterior iliac crest bone graft: A cadaveric study.

PURPOSE: The purpose of this cadaveric study was to compare the volume and weight of bone graft harvested using the curettage vs. the trephination technique from the anterior iliac crest. METHODS: Embalmed cadavers were studied in this experimental research. The right hemipelvis of each cadaver was used for the trephine bone harvesting technique, whereas the left hemipelvis was used for the conventional curettage technique. The weight and the volume of the harvested bone were measured and statistically compared between the 2 sides. The Wilcoxon Signed-Rank test was employed to compare the graft volume and weight obtained from the right and left sides of the hemipelvis. RESULTS: Ten embalmed adult cadavers were used in this study. All subjects were Caucasian males with a mean age of 59.8 years (range 44 - 73 years) at the time of death. A total of 81 cylindrical bone grafts were harvested from the right iliac crest. In 9 out of 81 (11.1 %), the cortex of the ilium was penetrated by the chisel. The mean weight of the bone graft harvested with the trephine technique (26.97 ± 2.32) g was heavier than the curettage technique (23.74 ± 2.09) g (p = 0.007). Similarly, the volume of the bone graft was higher in the trephine technique (8.40 ± 0.84) cm3 compared to the curettage technique (6.60 ± 1.26) cm3 (p = 0.011). The trephination technique lasted a mean of (12.76 ± 1.87) min (range 10.30-16.10 min), while the curettage technique lasted a mean of (14.53 ± 0.89) min (range 13.50-16.00 min) (p = 0.028). CONCLUSION: Harvesting anterior iliac crest bone graft with the trephine technique provides a higher bone volume and weight than the conventional curettage technique. The trephine technique might be advocated over the curettage technique, especially when a large amount of autologous bone graft is required. However, a meticulous harvesting technique should be followed to prevent complications, particularly the three-dimensional anatomy should be kept in mind, and the depth of trephination should be well-controlled. CLINICAL TRIAL REGISTRATION: Institutional Review Board registration: 2022/499.

Collateral circulation develops in stenosis of the celiac trunk and superior mesenteric artery.

PURPOSE: Mesenteric circulation is provided by the celiac trunk (CT), superior mesenteric artery (SMA), and inferior mesenteric artery (IMA). The collateral circulation between CT and SMA and between SMA and IMA plays a protective role against intestinal ischemia in case of narrowing or occlusion of the mesenteric vessels. In our study, it is aimed to determine the CT and SMA stenosis rates in patients with CT and SMA stenosis from angiography images, the occurrence of the collateral variations, and the frequency of these variations. METHODS: A total of 408 non-selective or selective CT and SMA angiographic images were taken of 215 patients (130 males, 85 females) who were admitted to Akdeniz University Hospital with symptoms of chronic mesenteric ischemia (CMI) were included. The angiography images were analyzed in regards to CT and SMA stenosis rates, and the collateral variations between mesenteric vessels. RESULTS: Stenosis of CT was observed in 14 patients, whereas the stenosis of the SMA was observed in 12 patients. The most common collateral vessel in these patients was the gastroduodenal artery. Both stenoses of CT and SMA were found in 9 patients. The Riolan arch was the most common type of collateral vessel in these patients. CONCLUSION: It was observed that mesenteric circulation was mainly provided by gastroduodenal artery in patients with isolated CT or SMA stenosis or occlusion while in patients with stenosis or occlusion of both CT and SMA, mesenteric circulation was mainly provided by the Riolan arch. A significant increase was observed in the prominence of collateral vessels in patients with stenosis of more than 70%.

Relationship of Recurrent Laryngeal Nerve with Inferior Horn of Thyroid Cartilage, Berry's Ligament and Zuckerkandl's Tubercle.

During neck surgery; Zuckerkandl's tubercle, Berry's ligament, the inferior horn of thyroid cartilages have become crucial anatomical landmarks in order to protect the integrity of the recurrent laryngeal nerve. Forty-two male postmortem human cadavers were used. The proximal part of the recurrent laryngeal nerve, before the inferior thyroid artery arises from its source has been observed in 87% inside the tracheoesophageal groove and in 13% running laterally to the trachea. The recurrent laryngeal nerve was encountered passing behind and through the branches of the inferior thyroid artery in 92% and 8% respectively. At all sides; the nerve was piercing the larynx 0.6 ± 0.1 mm below the inferior horn of thyroid cartilage, passing next to the inner-lower side of Berry's ligament and running under the lower middle part of Zuckerkandl's tubercle. These landmarks and their upper mentioned distances to the laryngeal nerve can be taken into consideration as important surgical guides.

Sex estimation with morphometric and morphological characteristics of the crista galli.

PURPOSE: The purpose of the present study was to analyze the dimensions of the crista galli (CG) in preserved skulls, and to examine the role of the morphometry and morphology of the CG on the sex estimation. METHODS: Anteroposterior, superoinferior, and laterolateral diameters of the CG were measured of 207 preserved adult skulls of Anatolia origin with known sex (108 males, 99 females) in the Anatolian population. CG were morphologically classified into three types according to the dimensions. The success of CG dimensions in sex determination was evaluated with ROC analysis, and univariate and multivariate binary logistic regression analysis. The relationship between morphological types of the CG and sex was analyzed with the Chi-square test. RESULTS: The anteroposterior and superoinferior diameters of the CG significantly were longer in males than females while the laterolateral diameter of the CG was wider in females (p < 0.001). Superoposterior diameter (88.4%) of the CG showed higher sex classification accuracy for sex estimation compared to the laterolateral (82.6%) and anteroposterior diameters (80.6%). When all three parameters were used together, the sex classification accuracy rate was 94.2%. The presence of ossified and tubular types of CG identified the male sex with 85% and 74.6% accuracy rates, respectively while teardrop type CG identified female sex with a 72.2% accuracy rate. CONCLUSION: CG exhibits sexual dimorphism both morphometrically and morphologically. The height, length, and width measurements and the morphological types of CG can be used in sex determination directly from the skull with high accuracy rates.

Importance of measurement methods and demographic characteristics in evaluating ulnar variance: A retrospective comparative study.

OBJECTIVE: This study aimed to compare 2 methods of ulnar variance (UV) measurement (the perpendicular method and the circular method) and to determine whether UV changed based on the demographic characteristics (sex and age). METHODS: UV was measured on bilateral wrist radiographs of 124 patients (62 men, 62 women; mean age=48.5 years; range=18-79 years) who had no history of trauma, congenital wrist anomaly, previous wrist surgery, and wrist osteoarthritis by a single radiologist with 4 years of experience. All measurements were made on standardized radiographic images using 2 methods: the perpendicular method and the circular method. All the patients were then divided into groups based on sex and age, and the study population was determined by selecting a similar number of patients for each sex and age group. RESULTS: The mean UV of the right and left wrists was measured as 0.33 (range=-4.3 to 5.7) mm by the perpendicular method and as 0.034 (range=-5 to 5.7) mm by the circular method. A significant difference was determined between the 2 measurement methods (p<0.001). There was a statistically significant difference between sex and UV values in the left wrist measurements by both methods (p<0.05). A significant correlation was found between the UV and age in both right and left side measurements, indicating a statistically significant difference between the methods (p<0.001). CONCLUSION: The results of our study demonstrated significant differences in the UV measurement between the 2 methods. Furthermore, UV measurement may change based on age and sex. These differences should be considered in the treatment planning of patients with wrist disorders. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Risk of Injury to the Neurovascular Structures in the Pararectus Approach Used in Acetabular Fractures: A Cadaver Study.

OBJECTIVES: Complex acetabular fractures involving the quadrilateral plate may necessitate infrapectineal buttress plating, which can be performed through the pararectus approach. The aim of this cadaveric study was to identify the anatomical guide points to protect neurovascular structures at the risk of injury during the pararectus approach. METHODS: Six fresh frozen cadavers (12 hemipelves) were dissected in this study. Location of the inferior epigastric artery (IEA), obturator nerve and corona mortis (CM) was measured using common anatomic landmarks, namely, anterior superior iliac spine, symphysis pubis (SP), and sacroiliac (SI) joint. RESULTS: In the superficial dissection of the abdominal wall, the mean distance between the IEA and anterior superior iliac spine was 106.7 ± 5.2 (range, 99.2-116.4) mm, and the mean distance between IEA and SP was 77.9 ± 3.5 (range, 70.6-82.2) mm. In deep dissection, the mean distance between the SI joint and the SP was 133.1 ± 5.7 (range, 126.0-142.0) mm. The mean distance between the SI joint and ON was 37.3 ± 2.8 (range, 31.0-41.0) mm. The CM was unable to be detected in 2 cadavers, 1 on the right and 1 on the left hemipelves. The mean distance between the CM and SP was 47.7 ± 3.9 (range, 43.0-55.0) mm. CONCLUSIONS: A pararectus approach is a useful approach which allows infrapectineal plating in the treatment of complex acetabular fractures; however, the preservation of critical neurovascular structures is essential during dissection. This study is helpful to identify the structures at risk according to commonly used anatomic landmarks. These data might be a necessary guideline for hip and trauma surgeons.

Scaphotrapeziotrapezoid Arthrodesis Using Limited Wrist Fusion Plates in Kienböck's Disease.

PURPOSE: The purpose of this study was to evaluate the clinical and radiological results of scaphotrapeziotrapezoid (STT) arthrodesis with a limited wrist fusion plate in patients with Stage IIIB Kienböck's disease (KD). MATERIALS AND METHODS: A retrospective review was performed on nine patients with Stage IIIB KD who underwent STT arthrodesis between 2014 and 2017 at our institution. Clinical evaluations of the patients were made using the shortened quick version of the Disabilities of the Arm, Shoulder, and Hand (Q-DASH) Outcome Measure score (Institute for Work and Health, Toronto, ON, Canada) and grip strength measurements before surgery and at the final follow-up examination. All patients underwent computed tomography (CT) scan to confirm the union of the arthrodesis. RESULTS: A complete union was obtained in all patients. The Q-DASH score was changed from 57.8 ± 8.2 points (range: 47.7 - 70.5) to 32.3 ± 17.3 points (range: 13.6 - 54.5) (p = 0.008). Similarly, the grip strength was improved significantly (p = 0.007). CONCLUSIONS: The use of limited wrist fusion plates for STT arthrodesis in KD is a safe and effective treatment method that provides a high rate union and acceptable functional results.

Diabetes mellitus accelerates fatty degeneration of the supraspinatus muscle after tendon tear: An experimental study in rats.

OBJECTIVES: This study aims to evaluate the effect of diabetes mellitus (DM) on intramuscular fatty degeneration after a full-thickness supraspinatus (SS) tendon tear in rats. MATERIALS AND METHODS: The study included 24 adult male Wistar Albino rats (age, 18 to 24 weeks; weighing, 320-380 g) randomized into a sham group (n=6), control group (n=6) and experimental group (n=12). Rats with fasting blood glucose levels ≥250 mg/dL at each measurement after an injection of streptozotocin were accepted to have DM. On the seventh day of the study, the SS muscles of the rats in the experimental and control groups were cut from the insertion. All animals were performed euthanasia four weeks after the surgical procedure and SS muscles were excised completely. Fatty degeneration in the SS muscle was assessed histologically and immunohistochemically with oil red O and peroxisome proliferator-activated receptor gamma (PPAR-γ) staining using histological score (H-score) and quantitative methods. RESULTS: More intense oil red O and PPAR-γ staining was observed in all regions of the SS muscles of the experimental group compared to control and sham groups (p<0.05). CONCLUSION: The results of this study showed that DM accelerates intramuscular fatty degeneration after SS tendon tears. Fatty degeneration should be monitored closely in diabetic patients with rotator cuff tear who were selected for conservative treatment and early surgical treatment should be considered as an option.

Occipital artery arising from the internal carotid artery: a case report.

Variations of the branches of the external carotid artery have been well documented in the available literature. However, variation of the occipital artery arising from the internal carotid artery is extremely rare case. A 42-year-old man patient who suffered from subarachnoid hemorrhage with suspicious vascular anomalies was found to have this variation on the right side by angiography during selective catheterisation of main carotid artery for vascular mapping. Our literature searches revealed that there was rare case such variations. We think that this variation should contribute to literature and should be kept in mind during surgical, radiological and diagnostic procedures.