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Abstract Background Evidence suggests that tibialis posterior muscle plays an important role in equinovarus foot deformity in patients who had suffered a stroke and it is one of the most frequently injected lower-extremity muscles for the management of spasticity. Our aim was to assess if a needle accurately and safely penetrates the tibialis posterior muscle during the application of dry needling. Methods We conducted a cadaveric descriptive study. Needling insertion of the tibialis posterior was conducted in 11 cryopreserved cadavers with a 70 mm needle. The needle was inserted using two common approaches, at midpoint (posterior/medial approach) and at upper third (anterior approach) of the leg towards the tibialis posterior. The needle was advanced into the tibialis posterior based upon clinician judgement. Cross-sectional anatomical dissections were photographed and analyzed by photometry. Safety was assessed by calculating the distances from the tip and the path of the needle to proximate neurovascular structures. Results Accurate needle penetration of the tibialis posterior muscle was observed in all cadavers with both approaches. In general, distances from the needle to the neurovascular bundles were larger with the posterior/medial approach than with the anterior approach, reaching statistically significance for needle tip to nerve (mean difference: 0.6 cm, 95%CI 0.35 to 0.85 cm) and vascular bundle (mean difference: 0.55 cm, 95%CI 0.3 to 0.8 cm) distances (P

Abstract Background The treatment of complex 3- and 4-part proximal humeral fractures has been controversial due to numerous postoperative complications. With the further study of medial support and blood supply of humeral head, new techniques and conception are developing. The study aims to illustrate the medial approach of the proximal humeral fracture through cadaver autopsy. Method Upper limbs from 19 cadavers have been dissected to expose the shoulder joint. We selected the coracoid process as the bony reference. Vernier caliper will be used to measure the following data, including distance from coracoid process to circumflex brachial artery, distance between anterior humeral circumflex artery (ACHA) and posterior circumflex brachial artery (PCHA) and their diameters. Assessment included the characteristics of the vascular supply around the humeral head, identification of the structures at risk, quality of exposure of the bony structures, and feasibility of fixation. Results The medial approach is appropriate in 86.84% anatomical patterns. Between the lower part of the shoulder capsule and the insertion of conjoined tendon, the bony surface exposed was limited by the interval between ACHA and PCHA. An interval of 2 to 3 cm (24.29 ± 3.42 mm) was available for medial plate. ACHA (49.35 ± 8.13 mm, 35.14–68.53 mm) and PCHA (49.62 ± 7.82 mm, 37.67–66.76 mm) were about 5 cm away from the coracoid process. Risk structures including ACHA and PCHA originate in common, PCHA originated from the deep brachial artery (DBA), the presence of perforator vessels, musculocutaneous nerve intersects with ACHA, the diameter of PCHA: ACHA

Abstract Background The coracoid process plays an important role in maintaining the stability of the elbow joint. A fracture of the coronoid process is often treated via surgical approaches, including open reduction and internal fixation, which aim to regain a stable, flexible, and loadable joint. In this study, we compared the anterior, medial, and posterior approaches of internal fixation in the repair of fractures of the coronoid process of the ulna. Methods In this retrospective study, 147 patients with fractures in the coronoid process of the ulna were recruited and classified into the anterior group (n = 73), the medial group (n = 32), and the posterior group (n = 42) according to the surgical approach used for internal fixation. These patients were assessed with respect to incision, operative time, estimated blood loss, fracture healing, and postoperative complications. The Mayo Elbow Performance Score was used to evaluate any form of disability associated with elbow injuries. Multivariate logistic regression analysis was performed to investigate the factors influencing the efficacy of fractures of the coronoid process of the ulna. Results In the medial approach group, the operative time was longer, and perioperative blood loss and postoperative drainage volume were obviously increased compared with the anterior and posterior groups. The anterior group exhibited a better postoperative recovery compared with the medial, and posterior groups. Compared with the anterior group, fracture-healing time in the posterior group was further reduced, whereas elbow joint flexion extension and forearm rotation degree improved. Complications were significantly reduced in the posterior approach group compared with the anterior and medial groups. The factors influencing the efficacy of fractures of the coronoid process of the ulna included the Regan–Morrey classification, perioperative blood loss, and the internal fixation approach. Conclusion In summary, the approach used influences fracture healing or the outcome after osteosynthesis. The posterior internal fixation method produced satisfactory functional outcomes in patients with fractures of the coronoid process of the ulna.