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The purpose of this study was to investigate different forms of the local application of TGF-beta(1) for augmentation of the anterior abdominal wall in an appropriate model of an incisional hernia. Sixty male Sprague-Dawley rats were divided into six groups. Artificial defects of the anterior abdominal wall were closed with one of the following methods: running Prolene suture, Vicryl mesh, prolene suture followed by an intramuscular injection of 1 mug TGF-beta(1), Vicryl mesh coated with 1 mug TGF-beta(1), and prolene suture coated with 1 mug TGF-beta(1). A control group did not receive any defect and treatment. Six weeks after operation, tensile strength, collagen content, gene expression of collagen I and III, blood vessels, and thickness of collagen fibres were evaluated. Tensile strength was strongest in the controls (14.2 (10.5-18 N)). There was no increase in tensile strength due to the administration of TGF-beta(1). On the contrary, bolus injection of the growth factor resulted in a significantly decreased strength of the wound tissue when compared to the groups 1, 4, 5, and 6 (9.1 (4.2-9.1 N)). These results correlated with the gene expression of collagen I and III. Local application of TGF-beta(1) did not augment the strength of the abdominal wall after 6 weeks. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate different forms of the local application of TGF-β1 for augmentation of the anterior abdominal wall in an appropriate model of an incisional hernia. Sixty male Sprague Dawley rats were divided into six groups. Artificial defects of the anterior abdominal wall were closed with one of the following methods: running Prolene suture, Vicryl mesh, prolene suture followed by an intramuscular injection of 1 μg TGF-β1, Vicryl mesh coated with 1 μg TGF-β1, and prolene suture coated with 1 μg TGF-β1. A control group did not receive any defect and treatment. Six weeks after operation, tensile strength, collagen content, gene expression of collagen I and III, blood vessels, and thickness of collagen fibres were evaluated. Tensile strength was strongest in the controls (14.2 (10.5-18 N)). There was no increase in tensile strength due to the administration of TGF-β1. On the contrary, bolus injection of the growth factor resulted in a significantly decreased strength of the wound tissue when compared to the groups 1, 4, 5, and 6 (9.1 (4.2-9.1 N)). These results correlated with the gene expression of collagen I and III. Local application of TGF-β1 did not augment the strength of the abdominal wall after 6 weeks. [ABSTRACT FROM AUTHOR]

Operative problems in the application of femoral locking nails are frequently related to an unfavourable entry point at the greater trochanter. Especially in more distally located fractures the nail is forced to follow the cortex abutted medullary canal. A wrong defined entry point either in the medio-lateral or dorso-ventral direction inevitably leads to tension between nail and femur. Forceful insertion in this situation may cause disastrous iatrogenic comminution at the fracture side or additional fractures at the proximal femur. To avoid tension between nail and femur the best suited entry point must be defined according to the natural medullary cavity.In 16 human cadaver femora, the natural medullary cavity was opened and after cleaning filled with a radio-opaque substance (barium sulphate). Twelve radiographs where taken from each bone starting with the anterior–posterior view and then turning the bone axially in steps of 15°. From these radiographs, the ideal entry point at the greater trochanter was calculated.In 88% of the specimen the ideal entry point for a straight nail was found constantly at the medial border of the greater trochanter overlaying the tendinous insertion of the piriformis muscle. The axis of the medullary cavity was in average 2.1 cm anterior to the dorsal border of the greater trochanter.In a second step the ideal entry point for bend nails was calculated. According to this calculation a bend nail with a radius of 100 cm needs an entry point 0.7 mm anterior to the dorsal edge of the greater trochanter. Overlaying the hook like shape of the posterior part of the trochanter. [Copyright &y& Elsevier]

Objective: To review the tensile strength of the different histological types of fibres in the linea alba and correlate the anatomical features of the anterior abdominal wall with the tensile strength of the linea alba to see whether the tensile strength of the linea alba might contribute to the development of midline incisional hernias. Design: Laboratory study. Setting: University hospital, Germany. Subjects: 46 cadavers in part one, and 9 freshly frozen and 38 formalin-fixed cadavers in part two. Interventions: In the first part of the study the histological examination was by binocular dissection microscopy, magnification ×10, but this was not sufficiently reproducible so in the second part we used an Olympus BX50 microscope, magnification ×20, and Optimas 5.22 picture processing software. Tensile strength was measured using a Loosenhausen ZHP 1-6 tensiometer. Main outcome measures: Correlation between anatomical features and tensile strength. Results: The method used in part one of the study failed to differentiate between the three types of fibres in the linea alba (weak, intermediate, and compact). In the second part of the study we found that the fibres were irregular, with no systematic crossing of the fibres of the aponeurosis. There was a significant correlation between the thickness and density of fibres in the linea alba and its tensile strength (r = 0.9). The thickness of fibres ranged from 21.9-38.2 µm and the density from 48% to 90%. The tensile strength ranged from 3-25 kp. Conclusion: A combination of low density and thin fibres in the linea alba could be a predisposing factor for development of midline incisional hernias. [ABSTRACT FROM AUTHOR]

The aim of the present morphologic investigation was to confirm that, besides the lumbrical muscles, the interosseous muscles have a key position in the developing and fixing of the hammer toe—a deformation which occurs in the second to the fifth toes. Some authors describe the topographic relation of the short muscles of the foot. The dorsal and plantar interosseous muscles in particular, as well as the dorsal aponeuroses, are described as stabilizing structures. Most of the toes investigated had interosseous muscles positioned plantarly of the joint axes in the region of the metatarsophalangeal joints; however, there was a difference between the left and the right side. The interosseous muscles of the foot also insert into the dorsal aponeurosis of the toes and have a stabilizing effect on the metatarsophalangeal joints. This study shows that dorsal shifts of the interosseous muscles point to an insufficiency of these muscles as well as to a loosening of the capsule and ligaments in the metatarsophalangeal joints. Both of these mechanisms lead to an inversion of the muscle's function, i.e. the support for the capsular and ligamentous structures of the metatarsophalangeal joint becomes more dorsally located. [ABSTRACT FROM AUTHOR]

Objective: Lingual nerve damage is a common complication during oral and maxillofacial surgery procedures to the third molar region. The anatomy of the lingual nerve is variable, therefore the precise knowledge of anatomy of this nerve is important for decreasing the damage risk. The purpose of this study was to determine the position and the shape of the lingual nerve in the third molar region using radiographic imaging. Setting: The Anatomy Department of Cologne University in Germany. Materials and Methods: Firstly, an anatomic dissection of the lingual nerve in the third molar region was done on 10 whole heads and one sagittal hemisection head specimen of adult cadavers. After marking the nerve, x-ray films were taken. Vertical and horizontal measurements were made from the radiographs with an electronic digital caliper. Results: The mean vertical and horizontal distances of the nerve to the lingual crista and lingual plate of the mandible were found to be 9.5 +/- 5.2 mm and 4.1 +/- 1.9 mm respectively. Additionally, of the 21 lingual nerves examined, 17 (81%) were round and 4 (19%) were flat. Conclusions: The results reflect the relationship of the nerve to this area and may help the clinician to avoid the damage risk. [ABSTRACT FROM AUTHOR]

Purpose: Distal humeral fractures are rare, but severe injuries, the treatment of which is often accompanied by serious complications and its outcome strongly depends on the quality of surgical therapy. Non-union is a common entity, compromising clinical results and requiring revision surgery. Osteonecrosis is an underestimated etiologic factor in the development of non-union. The present study aims to display the distribution patterns of the arterial vessels at the distal humerus, to correlate the displayed vessels with local nutrient foramina and to disclose an endangerment of these structures by common osteosynthetic implants. Methods: Eight plastinated fresh frozen upper extremities were digitally analyzed regarding the vascular density of the cancellous bone, by calculating the ratio of area comprised by arterial vessels and the area comprised by cancellous bone on sagittal cuts of the distal humerus. Possible differences in the vascular density of the medial epicondylar region, the lateral epicondylar region and a watershed area between the epicondyles and distal to the supracondylar region were investigated. On the basis of 200 macerated humeri, the distribution pattern of cortical nutrient foramina and their anatomic relation to properly applied common distal humerus plates were documented. Results: The data show a significantly higher density of vessels per cancellous bone in the epicondylar regions than in the watershed region ( p < 0.000, median 0.148 vs. 0.103). The analysis of the nutrient foramina showed distinct distribution patterns with a single foramen over the medial epicondyle (55 specimens, 27.5 %) and an area of several foramina at the posterior part of the lateral epicondyle (200 of the specimens, 100 %). In almost every specimen, the application of the osteosynthetic implants led to an overlay over the investigated nutrient foramina. Discussion: Osteonecrosis and non-union are severe complications in the surgical treatment of distal humeral fractures. The biology of the bone, especially the blood supply, has to be respected as much as possible during open procedures, to optimize bony healing. This has to be considered when performing periosteal stripping or applying osteosynthetic plates over the postero-lateral and medial epicondyle. The watershed area of the distal humerus has to be considered as being prone to minor arterial blood supply and thereby non-union is possible, if the arterial vessels coming from the epicondyles are destroyed. [ABSTRACT FROM AUTHOR]

Abstract: It appears still questionable whether fractures to the superior thyroid horns can be used for forensic reconstruction purposes regarding the functional mechanism causing compression of the neck soft tissues. Localisations and types of such fractures were documented in 118 cases of superior thyroid horn fractures caused by suicidal hanging. The placement of the ligature was above the larynx in 109 cases and in the remaining nine cases across the thyroid cartilage. As a secondary parameter the degree of ossification of thyroid cartilages and superior horns was used. Bone densities of typical cases (equidensities) were measured radiologically. Additionally, dummy tests were performed focused on two extreme shapes of superior thyroid horns to assess stress peaks using resin dummies and polarised light. Such peaks were located in the lower thirds of the horns close to their bases. With the larynx still cartilaginous, the base appears a typical location for fractures caused by suicidal hanging. An ossification pattern defined as “type 1” showed broad and osseous superior thyroid horns. If ossification was homogenous, fractures were located at the sites of maximum mechanical stress. In case of inhomogenous ossification, being the more common mode, the horn bases were more resistant to pressure and bending so that no fractures occurred. They were instead located at the sites of the greatest differences in density and distributed in an apparent random pattern. Narrow and deep insertions of the superior thyroid horns at the back surface of the upper thirds of the thyroid cartilages (posterior aspects) were classified as “type 2” ossification. Upon flexion, the long horns came into contact with the upper edges of the dorsal aspect creating a torque. Further flexion from an increasing impact by the ligature extended the long lever arm causing the base of the upper thyroid horn being broadly torn out of the dorsal aspect. The results suggest that localisations of fractures to the superior thyroid horns in connection with ossification patterns may be helpful for the reconstruction in suicidal hanging regarding the mechanics of the ligature in relation to its position around the neck. [Copyright &y& Elsevier]

Purpose: Displaced tibial eminence fractures require surgical fixation in order to obtain a stable knee joint. Suture fixation with FiberWire(®) seems to be the most favorable therapeutic option. Biomechanical studies show failure of this technique most commonly due to a suture cutout with subsequent fracture of the tibial eminence fragment. The goal of this study is to compare the biomechanical properties of three different techniques of suture fixation using FiberWire(®).Methods: Bone mineral density was evaluated in 18 human knee specimens by pqCT, and three similar groups were formed. A standardized anterior tibial eminence fracture was created, and suture fixation was performed using one of three different techniques in 6 specimens each. Cyclic and destructive testing was conducted.Results: Significant differences between the three techniques could be shown neither in the cycles needed to achieve a steady state nor in a failure load or initial stiffness. Almost all specimens failed by suture cutout.Conclusion: The presented modification of the existing technique for suture fixation of tibial eminence fractures did not lead to an increased initial stability nor did it lower the rate of suture cutout. All tested suture techniques showed comparable initial stiffness and failure load. [ABSTRACT FROM AUTHOR]

The mechanisms of injuries to the tibiofibular syndesmosis include isolated rupture and rupture in combination with ankle fractures. Current concepts of surgical treatment are fixation using bioabsorbable screws, syndesmotic stapling, syndesmotic hooks, and the widely used screw fixation. Postoperative care utilises passive motion of the ankle joint either with or without axial weight-bearing. The aim of our investigation was to quantify the motion of the mortise during axial load. Therefore, photoelastic tests, on the one hand, and biomechanical tests of cadaveric specimens, on the other, using axial loads of up to 2,000 N were used. Our photoelastic investigations showed force distribution through the screw into the cranial and caudal parts of the distal fibula. Biomechanical testing showed a progressive dehiscence in both ruptured and fixated specimens up to 2.89 (ruptured) and 2.42 mm (despite screw). Our findings strongly suggest a concept of partial weight-bearing at most to support regeneration of scar tissue and to prevent the appearance of instability in the ankle joint. [ABSTRACT FROM AUTHOR]

Muscle strain injuries are common in sports, and a high incidence is reported for the hamstring muscles, especially in the proximal region, where the long head of the biceps femoris muscle is most frequently affected. To look for some architectural peculiarities, which would make this muscle vulnerable, 101 legs of embalmed human cadavers were dissected and descriptively examined, morphometric data were obtained in the proximal region, and slices of plastinated specimens were microscopically examined. The 3 muscles composing the proximal hamstring complex are partly twisted around each other and possess common fibrous adhesions. Biceps femoris (BF) and semitendinosus (ST) muscles form a common head, to which the ST contributes the majority of fascicles extending 9 cm down from the ischiac tuberosity, thereby attaching to the common tendon at a remarkable pennation angle. The first BF fascicles origin from the common tendon only at 6 cm distance from the ischiac tuberosity. It is concluded that the high incidence of proximal BF strains may be a misinterpretation due to insufficient imaging and the complex architecture. It is suggested that the pennation angle at which the ST inserts to the common tendon makes this muscle especially vulnerable for strains during forced eccentric contractions. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The aim of the present study was to compare the primary fixation stability and initial fixation stiffness of two established fixation techniques, the tension band wiring technique and interfragmentary screw fixation, with a mini-screw fragment fixation system in a model of transverse patella fracture. It was hypothesised that the biomechanical loading performance of the fragment fixation system would not significantly differ from the loading characteristics of the two established methods currently investigated. Materials and methods: Ninety-six calf patellae were used in this biomechanical model. A standardized transverse patella fracture was induced and three different fixation methods, including the modified tension band wiring technique, interfragmentary screw fixation, and the mini-screw fragment fixation system, were used for fragment fixation. Specimens were mounted to a loading rig which was secured within a material testing machine. In each fixation group, eight specimens were loaded to failure at a simulated knee angle of either 0° or 45°. Another eight specimens were submitted to a polycyclic loading protocol consisting of 30 cycles between 20N and 300N at a simulated knee angle of 0° or 45°. The residual displacement between the first and the last cycle was recorded. Differences in the biomechanical performance between the three fixation groups were evaluated. Results: No significant differences between the three fixation groups were observed in the parameters maximum load to failure and linear fixation stiffness with monocyclic loading. Specimens being loaded at 45° showed significantly lower maximum failure loads and linear stiffness when compared with 0°. During polycyclic loading, no significant differences in the residual displacement were observed between the groups at 0° loading angle, while at 45°, residual displacement was significantly higher with tension band fixation when compared with interfragmentary screw fixation or the fragment fixation system. Conclusion: The biomechanical performance of the fragment fixation system was comparable to interfragmentary screw fixation and superior to the tension band wiring technique. Given the advantages of a system which provides interfragmentary compression and which simplifies fracture fixation after open or closed reduction, we believe the fragment fixation system to be an adequate alternative in the osteosynthesis of transverse patella fractures. [Copyright &y& Elsevier]

Side-to-side comparison of anatomical or functional parameters in the evaluation of unilateral pathologies of the human knee joint is common practice, although the amount of symmetry is unknown. The aim of this study was to test the hypothesis that there are no significant differences in the morphometric knee joint dimensions between the right and the left knee of a human subject and that side differences within subjects are smaller than intersubject variability. In 20 pairs of human cadaver knees, the morphometry of the articulating osseous structures of the femorotibial joint, the cruciate ligaments, and the menisci were measured using established measurement methods. Data were analyzed for overall side differences and the ratio between within-subject side differences and intersubject variability was calculated. In three out of 71 morphometric dimensions there was a significant side difference, including the posterior tibial slope, the anatomical valgus alignment of the distal femur, and the position of the femoral insertion area of the ACL. In two additional parameters, including the cross-sectional area of the ACL and PCL, within-subject side differences were larger than intersubject variability. In general, there was a positive correlation in morphometric dimensions between right and left knees in one subject. It is concluded that a good correlation in the morphometric dimensions of a human knee joint exists between the right and the left side. This study supports the concepts of obtaining morphometric reference data from the contralateral uninjured side in the evaluation of unilateral pathologies of the knee joint. [ABSTRACT FROM AUTHOR]

The purpose of this study was to develop a two-dimensional density distribution pattern of the subchondral cortical bone of the radial head using subtraction densitometry. The bone density of 32 normal specimens and five with macroscopic signs of osteoarthritis was measured before and after milling off the cortical bone surface. Electronic subtraction gave the density of the subchondral cortical bone. Twenty-one specimens had areas of high bone density in the ulnar-dorsal area, five specimens showed a ventral and ulnar density maximum and six had a density maximum in the center of the radial head joint surface. No density maximum was seen in the lateral part of the joint surface. The density maximum shifted towards the dorsal-ulnar part of the radial head with decreasing total subchondral bone density. Osteoarthritic radial heads had the same distribution as non-arthritic specimens. Eccentric subchondral bone density reflects eccentric radiohumeral force transmission. This could be a reason for development of radiohumeral arthritis or the failure of radial head prostheses. Bone density patterns correlate with the incidence of radial head fractures and fracture line may be positioned between areas of high and low densities. [ABSTRACT FROM AUTHOR]

To localize optimal donor regions for osteochondral graft transplantation, the chondral thickness and the radii of curvature of femoral condyles and the talar trochlea were determined. Optosil impressions of the articular surfaces of ten formaIin fixed distal femora and talar domes were prepared. Therefrom. 5-mm thick frontal sections were made in order to measure the radii of curvature. Femoral condyles and talar trochleas were sliced sagittally into 2-mm thick sections. Chondral thickness was measured on x-rays. Talar cartilage thickness measured 0.7 to 2.0 mm. Cartilage thickness of the femoral condyles was 0.7 mm to 3.1 mm. The smallest radial values of the talar surface were proximal and distal. Flattening of the medial and lateral talar margins and of the central articular surface was evident. For the femur, the curvature was greater in the edge areas than in the central region. For talar defects, the grafts should be taken from the condylar edges, where the chondral thickness is decreased. [ABSTRACT FROM AUTHOR]

The purpose of this study was to develop a two-dimensional density distribution pattern of the subchondral cortical bone of the radial head using subtraction densitometry. The bone density of 32 normal specimens and five with macroscopic signs of osteoarthritis was measured before and after milling off the cortical bone surface. Electronic subtraction gave the density of the subchondral cortical bone. Twenty-one specimens had areas of high bone density in the ulnar-dorsal area, five specimens showed a ventral and ulnar density maximum and six had a density maximum in the center of the radial head joint surface. No density maximum was seen in the lateral part of the joint surface. The density maximum shifted towards the dorsal-ulnar part of the radial head with decreasing total subchondral bone density. Osteoarthritic radial heads had the same distribution as non-arthritic specimens. Eccentric subchondral bone density reflects eccentric radiohumeral force transmission. This could be a reason for development of radiohumeral arthritis or the failure of radial head prostheses. Bone density patterns correlate with the incidence of radial head fractures and fracture line may be positioned between areas of high and low densities. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe the anatomy of the intramedullary canal of the radial neck for stem design of radial head prostheses. Radial neck measurement was performed from the proximal edge of the radial tuberosity to the distal border of the articular surface on 40 macerated proximal radii using X-rays and Optosil imprints of the intramedullary canal. Radial neck to shaft angle was measured under image intensification. The neck length was 13.3 mm (range 8.0–20.0 mm) measured on X-rays and 13.5 mm (range 9.9–18.8 mm) on Optosil imprints. Concerning the neck’s intramedullary canal we obtained a minimum diameter of 9.7 mm (range 6.3–16.4 mm) on X-ray. Corresponding Optosil imprints had a mean diameter of 11.6 mm (range 6.6–18.6 mm) at their proximal end, 10.5 mm (range 5.5–16.3 mm) in the middle and a minimum of 9.8 mm (range 6.0–16.9 mm) at the distal end. Differences between left and right sides were not significant between X-ray and Optosil imprints, nor between left X-ray and right imprints and vice versa at a P-level of 0.001. Radial neck to shaft angle was 167.8° (range 160.5–178°) measured under image intensification at a rotation angle of 58.6° (range 50–70°) supination. Geometry of the radial neck’s intramedullary canal has been described for stem design. The minimum diameter was seen at the distal end, just proximal to the radial tuberosity. A forearm rotation of 58.6° to full supination should be considered during implantation of monopolar prostheses. The wide variety of lengths and diameters complicates standard prosthetic design, but ipsilateral and contralateral X-rays can be useful for preoperative stem size calculation. [ABSTRACT FROM AUTHOR]

Exact anatomical description of the proximal radius is imperative for the development of radial head prostheses. The purpose of this study was to measure the anatomical parameters of the radial head. Optosil imprints of 18 pairs of proximal radii fixed with formalin were taken. All possessed their native cartilage joint surface free of any arthritic defects. After being cut into 3 mm slices, the diameter of each slice was measured in steps of 30° of rotation with the margo interosseous acting as a reference point. Maximum radial head diameter was seen from the 0 to the 9 mm slice at a rotation of 30° to full supination perpendicular to the proximal radioulnar joint. The diameter increased from the radiocapitular joint surface to the 6 mm slice, and then it decreased ( P < 0.001). At the level of 6 mm the maximum radial head diameter was 24.13 mm (range 21.2–27.3 mm). The minimum diameter was seen perpendicular to the maximum; it also increased from the radiocapitular joint surface to the 6 mm slice and then decreased. There was a significant difference between the minimum and maximum diameter of each slice at a P-level of P < 0.001. Left and right sides were not significantly different at a P-level of 0.01. Our data show that the radial head is neither round nor conical. It has a complex shape with an increasing size from the radiocapitular joint surface to the middle of the proximal radioulnar joint surface. No statistically significant differences could be observed between right and left radii. [ABSTRACT FROM AUTHOR]

Interbody fusion after anterior discectomy may lead to acceleration of degenerative changes at adjacent levels. Although the posterior approach preserves the motion segment, decompression of the nerve root is indirect if “hard disc prolaps” is the main cause. Recently, a technique of microsurgical anterior cervical foraminotomy for the treatment of radiculopathy with preservation of the segment mobility was published. In this study, we present this technique with several modifications. Thirteen patients – 5 men and 8 women with an average age of 49 years – with unilateral radiculopathy resistant to conservative treatment underwent microsurgical anterior foraminotomy via a small keyhole transuncal approach. The base of the uncinate process (UP) was directly drilled in the trajectory to the intervertebral foramen without destroying the disc tissue. The vertebral artery between the transverse process was not exposed. Furthermore, the functional anatomy of the uncovertebral joint remained largely intact. All patients experienced complete relief of radiating pain. A cervical collar was not used. Mean follow-up time was 19 months. The mobility of the operated segment was preserved in each patient. No instability of the cervical spine was seen. The microsurgical anterior foraminotomy via a small keyhole transuncal approach is safe, minimally invasive, and represents an effective method to treat unilateral cervical radiculopathy caused by disc prolaps and/or uncovertebral osteophytes. Additionally, the segment mobility is preserved and prevents the acceleration of degenerative changes at adjacent levels. [ABSTRACT FROM AUTHOR]

The present study was conducted to evaluate the influence of bone-plug length on the primary stability of patellar tendon-bone grafts, using a femoral press-fit fixation technique. Forty-eight human PTB grafts with a patellar bone-plug length of 15 mm and 25 mm were obtained from 24 human cadavers (mean age 72 years) and implanted to porcine femora in a press-fit fixation technique. Tensile loading was performed at 10 mm/s until failure at varying loading angles of 0 degrees, 30 degrees and 60 degrees. Compared to 25 mm, a significant decrease of primary graft stability was recorded in the testing of 15-mm bone plugs. For both plug lengths, the ultimate load to failure increased with rising the loading angles. While axial graft loading exclusively caused plug dislocation, the predominant mode of failure was tendon rupture at 60 degrees loading angle. We conclude that 15-mm bone plugs do not result in a sufficient stability for early aggressive rehabilitation and therefore 25-mm bone plugs are recommended for the femoral press-fit technique. [ABSTRACT FROM AUTHOR]

Bone vascularisation has gained increased interest in relation to the blood supply of bone fragments during treatment of fractures. In the current study the pattern of vascular supply of the proximal humerus was studied in six cadavers by the corrosion technique. Furthermore, the effect of fractures on the vascular supply was also investigated. In all preparations the intraosseous arteries of the humeral head arose from the circumflex arteries, which surrounded the humerus and dispatched branches towards the proximal end. The main vessel was the branch of the anterior circumflex artery, penetrating the major tubercle in six of six cases. Due to the intraosseous arch shape of this vessel it is referred to as the arcuate artery. Besides other smaller vessels, there was also a vascular network arising from the posterior circumflex artery. Their branches penetrated medially at the cartilage bone interface in five of six preparations. The medial bone arteries appear to gain distinctive importance in humeral head fractures by their impact on the vascularisation of the fracture fragments. After disruption of the arterial supply from the arcuate artery, the vascularisation of the head fragments is most likely ensured by this group of vessels. Therefore, necessary repositioning manoeuvres during open reduction of the fracture should be conducted with care in order to preserve these arteries. [ABSTRACT FROM AUTHOR]

The extent of soft tissue trauma in hindfoot injury (calcaneus fracture, talus fracture) is currently being underestimated. A standardization of magnetic resonance (MR) imaging of the hindfoot is necessary for better definition of pathological changes. Standardized MR imaging projections of the hindfoot were illustrated by anatomic analysis of specimen sections using the same sectional plane as in MR imaging. The plastinated sections were obtained from the same specimen that had been scanned previously. MR imaging of the hindfoot enables the assessment of the calcaneocuboid ligament, the interosseous talocalcaneal ligament, trauma of the foot sole, intraosseous and extraosseous vascularization, muscle compartments in the evaluation of compartment syndrome, chondral flake fractures, tendon dislocation, as well as tendon degeneration, and plantar fasciitis. These anatomical structures, which must be evaluated for preoperative planning, can be identified clearly by MR imaging. [ABSTRACT FROM AUTHOR]

Summary: The extent of soft tissue trauma in hindfoot injury (calcaneus fracture, talus fracture) is currently being underestimated. A standardization of magnetic resonance (MR) imaging of the hindfoot is necessary for better definition of pathological changes. Standardized MR imaging projections of the hindfoot were illustrated by anatomic analysis of specimen sections using the same sectional plane as in MR imaging. The plastinated sections were obtained from the same specimen that had been scanned previously. MR imaging of the hindfoot enables the assessment of the calcaneocuboid ligament, the interosseous talocalcaneal ligament, trauma of the foot sole, intraosseous and extraosseous vascularization, muscle compartments in the evaluation of compartment syndrome, chondrai flake fractures, tendon dislocation, as well as tendon degeneration, and plantar fasciitis. These anatomical structures, which must be evaluated for preoperative planning, can be identified clearly by MR imaging. [Copyright &y& Elsevier]