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Objective To compare structural findings between US, micro-CT (µCT) and histology in people with OA of the hands. Methods We analysed DIP and PIP joints of 31 fingers from 15 dissecting-room cadavers with OA of the hands. The occurrence of bone erosions and osteophytes were recorded by US, µCT and histology at 16 regions for each joint and compared for each method. Results In total, US (n  = 558, 56.2% of 992 examined regions) and µCT (n  = 493, 49.7%) detected a higher frequency of osteophytes at PIP and DIP joints than histology (n  = 161, 23.4% of 689 histological examined regions; P  = 0.01). We found a comparable number of erosions with each method [US, n  = 52 (5.2%); µCT, n  = 43 (4.3%); histology, n  = 35 (5.2%)]. Both imaging techniques correlated moderately with each other regarding the detection of osteophytes (r  = 0.54, P  = 0.002) and erosions (r  = 0.43, P  = 0.017). Neither US nor µCT correlated with histology regarding erosions or osteophytes. With histology as the reference, US had a sensitivity of 80% and a specificity of 32% to detect osteophytes, whereas µCT had a sensitivity of 73% and a specificity of 27%. For erosions, sensitivities (US 10% and µCT 6%, respectively) were much lower. Microscopically, erosions contained fibrous myxoid tissue extending from subcortical cavities through the breach of cortical bone. Conclusions The ability of US to identify osteophytes was comparable to that of µCT, yielding a good sensitivity when histology was used as the gold standard. The sensitivity of US and µCT to detecting erosions was low compared with histology. [ABSTRACT FROM AUTHOR]

Background: Understanding muscle and tendon anatomy is of tremendous importance to achieve optimal surgical execution and results in tendon transfers around the shoulder. The aim of this study was to introduce and describe an additional distal muscle slip of the teres major (TM).Methods: Sixteen fresh-frozen cadaver shoulders were dissected with the deltopectoral approach. The ventral latissimus dorsi (LD) tendon was harvested, and the shoulders were analyzed for the presence/absence of a distal teres major slip (dTMs) and its dimensions and relationship with the TM and LD tendons.Results: The dTMs was identified in 12 shoulders (75%). It was always distal to the TM tendon and visible during the deltopectoral approach. There was a clear separation between the TM proximally and dTMs tendon distally. At the humeral insertion, both tendons had a common epimyseal sheet around the teres major and inserted continuously at the humerus. The mean width of the dTMs tendon at the insertion was 13 ± 4 mm (range, 7-22 mm). The total lengths of the dTMs tendon and LD tendon were 40 ± 7 mm (range, 25-57 mm) and 69 ± 7 mm (range, 57-79 mm), respectively (p < 0.001). The dTMs muscle showed direct adhesions in ten shoulders (83%) with the LD muscle.Conclusions: This is the first macroscopic description of an additional distal slip of the teres major muscle. The dTMs has a separate (distal) but continuous (mediolateral) insertion at the humerus within a common epimyseal sheet around the TM. The dTMs tendon is visible during the deltopectoral approach and can therefore provide a lead structure, particularly in ventral LD transfers with the deltopectoral approach. [ABSTRACT FROM AUTHOR]

Introduction: Anatomic cruciate ligament reconstruction is known to be correlated with better clinical results. The aim of the study was to provide a simple method to enable anatomic results in the setting of PCL reconstruction. We, therefore, assessed the tibial and femoral insertion site of the posterior cruciate ligament (PCL) by the use of an objective coordinate system in an anatomical study. We also sought to show reproducibility of these measurements using intra- and inter-observer coefficients. Materials and methods: We studied 64 knees, previously preserved according to Thiel's technique. After proper preparation of the articular surfaces of both the tibiae and femora, photographs were taken according to a standardized protocol. PCL footprints were measured by the use of a coordinate system twice by two examiners. We evaluated these measurements by use of the Cohen's kappa inter- and intra-observer coefficient for two observers. Results: Tibial and femoral measurements of PCL footprints were generated with highly comparable inter- (k = 0.970) and intra-observer (k = 0.992) coefficients and may, therefore, be considered as highly reproducible. Conclusion: Our findings confirmed the reproducibility of defining PCL footprints using a coordinate system and may contribute to planning intraoperative graft-placement to ensure optimal conditions in the upcoming techniques for PCL reconstruction. [ABSTRACT FROM AUTHOR]

Osteosynthesis of metacarpal and phalangeal fractures with headless compression screws leads to a defect in the articular surface and possibly damage to the extensor tendons. This study aimed to quantify the articular surface defect and extensor tendon injuries after implant placement in cadaveric hands. Defect size was assessed with computed tomography. Extensor tendon injuries were assessed by direct visualization and measurement after dissection. In the middle phalanx, the defect size in relation to the joint surface was significantly smaller after anterograde screw placement when compared with retrograde placement. Also, a mini-open approach was found to cause significantly less tendon injury than a percutaneous approach, but there was no difference in tendon damage between retrograde and antegrade screw insertion into the middle phalanx. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the patellar tendon length (PTL) with focus on gender differences and possible correlations with the total leg length (TLL) and the long bones of the lower extremity. Materials and Methods: The sample involved 50 paired lower extremities from human adult cadavers. The TLL was measured between the medial malleolus and the apex of the greater trochanter. The femoral length (FL) was evaluated as the interval between the latter and the distal margin of the lateral epicondyle of the femur and the tibial length (TL) from the distal apex of the medial malleolus to the proximal border of the medial condyle of the tibia. The PTL was measured from the apex of the patella to its proximal insertion point at the tibial tuberosity. Results: The PTL was at a mean length of 4.29 ± 0.49 cm (right side) and 4.20 ± 0.55 cm (left side) in females and 4.42 ± 0.53 cm (right) and 4.32 ± 0.55 cm (left) in males. There were no differences regarding gender (p =.412). The left PTL was significantly shorter in both sexes (p =.022). The PTL correlated positively with FL, TL, and TLL in both sexes and sides. Conclusion: PTL correlates significantly positively with size without gender differences. [ABSTRACT FROM AUTHOR]

Purpose: Full or selective wrist denervation is an effective treatment for chronic wrist pain. In this cadaveric study, a volar approach for prophylactic denervation of the posterior interosseous nerve (PIN) and the anterior interosseous nerve (AIN) was assessed, which can simultaneously be performed during volar approaches for distal radius fracture fixation or in combination with metalwork removal. Materials and methods: In total 40 adult upper limbs, embalmed using Thiel's method, were investigated. Group 1 included 20 limbs of which the distances between AIN and PIN to the ulnar margin of radius were measured at levels 6, 8 and 10 cm proximal to the styloid process and the distance radial styloid process to proximal border of pronator quadratus which might be useful as an intraoperative landmark. Subsequently further additional 20 adult limbs (group 2) were used. Transection of the PIN via this volar approach at the evaluated best level of step 1 was performed and evaluated by dissection via a dorsal approach. Results: In group 1, the PIN runs within the interosseous membrane, from the ulnar border of the radius, 6.4 mm (SD 2.66) at 6 cm, 8.4 mm (SD 2.28) at 8 cm and 3.75 mm (SD 5.46) at 10 cm proximal to the radial styloid. The AIN runs within the interosseous membrane, from the ulna edge of the radius, 7.5 mm (SD 2.4) at 6 cm, 7.3 mm (SD 1.95) at 8 cm and 2.35 mm (3.42) at 10 cm proximal to the radial styloid. AIN and PIN were in close proximity at the 8-cm level which equals a 1-cm distance proximal to the pronator quadratus border. Group 2 showed a successful transection of the PIN through a single volar surgical approach in additional 18 out of 20 adult upper limbs. Conclusions: This study shows the local anatomy of the PIN, allowing denervation via a volar approach. [ABSTRACT FROM AUTHOR]

ABSTRACT Osteoarthritis (OA) of the hand is a common disease resulting in pain and impaired function. The pathogenesis of hand OA (HOA) is elusive and models to study it have not been described. Chondrocyte culture has been essential to understand cartilage degeneration, which is a hallmark of OA. We investigated the feasibility of human chondrocyte culture derived from proximal interphalangeal (PIP) finger joints. Hyaline cartilage of the PIP and knee joints was obtained from human cadavers. Chondrocytes harvested up to 236 h after death of the donors were viable and expressed chondrocyte-specific genes. Gene expression comparing chondrocytes from PIP and knee joints using Affymetrix GeneChip arrays resulted in a unique PIP-specific gene expression pattern. Genes involved in developmental processes including the WNT pathway were differentially expressed between the joints. These findings suggest that our knowledge on chondrocyte biology derived mainly from knee and hip joints may not apply to chondrocytes of the PIP joints and some of the distinctive features of HOA may be caused by the specific properties of PIP chondrocytes. Chondrocyte culture of PIP cartilage is a novel tool to study cartilage degeneration in HOA. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1569-1575, 2016. [ABSTRACT FROM AUTHOR]

Background: Anterior shoulder dislocation (ASD) is a common sports injury. The goal of this study was to evaluate a new procedure for reduction after ASD with respect to success rate, the need for medication for muscle relaxation, sedation, and application of pain medication and put it into context to a systematic literature review.Patients and Methods: We retrospectively evaluated the new method in 263 patients in an Austrian skiing area from December 2005 till April 2009. We included patients with unilateral ASD and excluded those with a combined trauma and consecutive admission to hospital.Results: The new procedure is performed in a supine position, the therapist takes the patients hand of the injured limb with his one hand and with his other hand counter holds against the acromion. Then he enhances the traction on the upper limp by using his trunk as a kind of fulcrum. With eye contact and instructions to relax, the therapist is able to detect the muscular tension, so that he can adjust the amount of traction accordingly. The presented procedure was successful in all reported cases. For 196 patients (74.5 %) no medication for muscle relaxation, sedation, or pain medication were needed.Conclusion: The new method is a promising option to popular techniques for reduction of anterior shoulder dislocations. The benefits of this protocol are a gentle and simple application of the procedure as well as an easy acquisition. [ABSTRACT FROM AUTHOR]

Objective: The lumbar sympathetic trunk's (LST) distance to two anatomical landmarks, the costal process and medial margin of the psoas muscle, was assessed due to its use as landmarks for lumbar sympathetic blocks: the costal process for fluoroscopic guided techniques and the psoas major for CT- and MRI-guided techniques. Based on the measurements, we evaluate the trunk's visibility in MR and CT images for accurate positioning of the needle. Methods: A total of 54 cadavers embalmed with Thiel's method were investigated. The LST's distances to the psoas major's medial margin and to the base of the lumbar vertebrae's costal process were measured on the levels L2/3, L3/4 and L4/5. The measurements were compared to MR and CT images of 20 anonymous patients to identify the LST. Results: LST's mean distance to the psoas major was 0.3 mm at L2/3, 3.1 mm at L3/4 and 4.6 mm at L4/5. The mean distance to the costal process was 31 mm at L2/3, 34 mm at L3/4 and 32.6 mm at L4/5. In both MR and CT imaging, a structure could be determined as the LST correlating to the measurements with decreasing possible identification from cephalad to caudad levels. Conclusions: The costal process is a usable landmark for fluoroscopic guidance and the psoas major for CT- and MRI-guided techniques. The LST is clearly visible in MR and CT images, which gives both techniques a decisive advantage over fluoroscopy concerning the block of the LST due to a visible target. [ABSTRACT FROM AUTHOR]