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Background: Acute injuries to the anterior medial collateral ligament (AMCL) can occur due to valgus trauma or during other dislocating events to the elbow. AMCL lesions are often associated with bony lesions, such as radial head fractures or fractures of the coronoid process. We analyzed the insertion of the AMCL on the sublime tubercle in relation to surrounding osseous structures. We aimed to increase the understanding of the involvement of the AMCL in bony lesions to the sublime tubercle., Methods: We investigated 86 elbows from 43 embalmed human specimens. We measured the most ventral extensions of the AMCL at the sublime tubercle in relation to a clearly defined and reproducible landmark. We used as our landmark a horizontal line (baseline) originating on the lesser sigmoid notch in a right angle to the ulnar ridge., Results: The mean distance of the coronoid process tip to the baseline was 4.0 mm (standard deviation [SD], 1.3 mm; range, 1.4-6.7 mm). The mean distance of the ventral extension of the AMCL to the horizontal line was 3.7 mm (SD, 2.6 mm; range: 9.4-2.2 mm). The mean horizontal distance between the ventral aspect of the AMCL and the coronoid tip was 13.7 mm (SD, 2.5 mm; range, 7.7-20.5 mm)., Conclusions: We present a detailed description of the insertional anatomy of the AMCL at the sublime tubercle. These values could be helpful for classifications of coronoid fractures and to estimate the involvement of the AMCL in fractures of the sublime tubercle., (Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Aim: Intraosseous (IO)-access plays an alternative route during resuscitation. Our study was performed to investigate the successful rate of IO-access in preterm and term stillborns using different devices and techniques., Methods: The cadavers used were legal donations. 16 stillborns, median: 29.2 weeks (IQR 27.2-38.4) were investigated. Two different needles (a: Butterfly needle, 21G, Venofix ® Fa.Braun; b: Arrow ® EZ-IO ® 15G, Teleflex, Dublin, Ireland) were used. Needles were inserted i: manually, using a Butterfly needle; ii: manually, using EZ-IO ® needle or iii: using a battery-powered semi-automatic drill (Arrow ® EZ-IO ® ). Spectral-CT's were performed. The diameter of the corticalis was determined from the CT-images. Successful hit rates with 95% confidence intervals (CI) and odds ratios between the three methods were estimated using a generalised linear mixed model (GLMM)., Results: Estimated success rate was 61.1% (95%CI:39.7%-78.9%) for the Butterfly needle, 43.0% (95%CI:23.4%-65.0%) for hand-twisted EZ-IO ® screwing and 39.7% (95%CI:24.1-57.7%) for the semi-automatic drill (Arrow ® EZ-IO ® ), all referring to an average diameter of the corticalis of 1.2 mm. The odds of a correct position were 2.4 times higher (95%CI:0.8-7.6) when using the Butterfly needle than with the drill. In contrast, the odds of correct positioning when inserting the needle by hand were not significantly different from using the drill (odds ratio 1.1, 95%CI: 0.4-3.3). Neither of these effects nor the diameter of the corticalis with an odds ratio near one were significant in the model. Median diameter of the bone marrow cavity was 4.0 mm [IQR 3.3-4.7]., Conclusion: Intraosseous access for premature and neonatal infants could be best achieved by using a manually twisted Butterfly needle., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Distal chevron osteotomy is a common procedure for surgical correction of hallux valgus. Osteosynthesis with 1 screw or 2 Kirschner wires has been commonly used. We compared the stability of the 2 techniques in distal chevron osteotomy. Sixteen first metatarsals from fresh-frozen human cadaver feet (9 different cadaveric specimens) were used. A standardized distal chevron osteotomy was performed. One first metatarsal from each pair was assigned to group 1 (3.5-mm cortical screw; n = 8) and one to group 2 (two 1.6-mm Kirschner wires; n = 8). Using a materials testing machine, the head of the first metatarsals was loaded in 2 different configurations (cantilever and physiologic) in succession. In the cantilever configuration, the relative stiffness of the osteosynthesis compared with intact bone was 59% ± 27% in group 1 and 68% ± 18% in group 2 (p = .50). In the physiologic configuration, it was 38% ± 25% in group 1 and 35% ± 7% in group 2 (p = .75). The failure strength in the cantilever configuration was 187 ± 105 N in group 1 and 259 ± 71 N in group 2 (p = .21). No statistically significant differences were found in stability between the 2 techniques. The use of 1 screw or 2 Kirschner wires had no significant differences in their biomechanical loading capacity for osteosynthesis in distal chevron osteotomies for treatment of hallux valgus., (Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Details of the human facial parotid plexus (PP) are not readily accessible during ordinary anatomical teaching because of insufficient time and difficulties encountered in the preparation. For parotid and facial nerve surgery however, precise knowledge of PP is of crucial importance. The aim of this study was therefore to provide more details of PP in anatomic specimens. Following anatomical dissection, its location, syntopy and morphology were analyzed in 158 cervico-facial halves of 95 cadavers. The facial nerve (FN) divides into a larger temporo-facial and a smaller cervico-facial trunk. Both trunks branch, form PP, and thus form connections along six distinctive anastomotic types. These anastomoses may explain why accidental or essential severance of a supposed terminal facial branch fails to result in the expected muscle weakness. However, whereas earlier anatomical and clinical studies report connections between both trunks in 67-90% of the cases, our data indicate the presence of anastomoses only in 44%. One reason for this difference may be found in our microscope-assisted dissection in infratemporal regions from which the parotid gland has been removed. Thereby we tracked both FN-trunks in both directions - distally and proximally - and determined the exact origin of all terminal FN branches. This lower rate of occurrence of connections between both trunks reduces the chances of luckily preserved muscle innervation and enhances the risk of facial palsy after transection of a terminal branch. Accordingly, precise anatomical knowledge on PP should be renewed and transection of facial nerve branches avoided., (Copyright © 2017 Elsevier GmbH. All rights reserved.)

Background: Fractures of the coronoid process or the supinator crest, as well as arthroscopic resection of osteophytes around the coronoid process, can endanger the attachment of the annular ligament (AL) to the proximal ulna. The purpose of this study was to investigate the corresponding insertional areas of the AL within this context., Methods: In 30 embalmed human cadaveric elbow specimens, the insertional area of the AL at the anterior and posterior margin of the sigmoid notch was characterized. The distances and relations of the AL insertion anteriorly to the coronoid surface, the coronoid tip, and the depth of the coronoid process, as well as posteriorly to the supinator crest, were evaluated macroscopically., Results: The mean distance of the anterior insertion area was 1.9 ± 0.6 mm (range, 1.0-3.1 mm) to the coronoid articular surface and 6.2 ± 1.7 mm (range, 2.9-10.2 mm) to the tip of the coronoid. The distance of the anterior insertion in relation to the depth of the coronoid process was 44% ± 11% (range, 30%-69%). The distance of the posterior insertion area to the level of the sigmoid notch measured from 3.5 ± 1.5 mm (range, 0.5-6.5 mm) to 17.7 ± 2.9 mm (range, 13.1-25.4 mm)., Conclusions: Coronoid fractures involving 44% or more of the coronoid process and anterolaterally oriented fractures where one-third of the anterolateral facet is affected are accompanied by a complete anterior bony disruption of the AL. Arthroscopic resection of the coronoid tip should be limited to 1 mm distal to the coronoid articular surface to avoid injury to the AL. Fractures of the upper half of the supinator crest place the AL at risk at its posterior insertion., (Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Inframammary fold reconstruction has scarcely been evaluated in literature. No biomechanical analyses have been performed comparing different reconstructive methods. This evaluation compares the gold-standard suture reconstruction with an intrarib anchor system (Micro BioComposite SutureTak, Arthrex)., Methods: Three analysis groups were compared including 8 Sawbone blocks, 22 embalmed cadaver, and 27 regular cadaver specimens (N = 57). Transient mechanical analysis was performed at 5 N/s using an Instron 5565 test frame., Results: Ultimate load favored the anchor system (compared with the gold-standard suture) by a factor of 9.8 (P < 0.0001) for the regular cadaver group and a factor of 1.7 (P < 0.038) for the embalmed cadaver group. A similar statistically significant benefit was shown for stiffness and load at 2-mm displacement., Conclusions: This analysis showed an anchor system to be the biomechanically superior fixation method in terms of ultimate load, fixation stiffness, and displacement at failure when compared with the gold-standard suture method in inframammary fold reconstruction. Because of superior stability in every aspect, an anchor system may be considered for inframammary fold reconstruction.

Background: Ligament reconstruction with a circumferential graft represents an innovative technique for treatment of multidirectional elbow instability. This biomechanical study compared the stability of the intact elbow joint with the circumferential graft technique and the conventional technique., Methods: Seven fresh frozen cadaveric elbows were evaluated for stability against valgus and varus/posterolateral rotatory forces (3 Nm) over the full range of motion. Primary stability was determined for intact specimens, after sectioning of the collateral ligaments, after applying the circumferential graft technique (box-loop), and after conventional collateral ligament reconstruction. Cyclic loading (1000 cycles) was performed to assess joint stability and stiffness of the native ligaments and the tendon grafts., Results: Primary stability of both reconstruction techniques was equal to the native specimens (P = .17-.91). Sectioning of the collateral ligaments significantly increased joint instability (P < .001). The reconstruction techniques provided equal stability after 1000 cycles (P = .78). Both were inferior to the intact specimens (P = .02). Cyclic loading caused a significantly lower increase in stiffness of the native ligaments compared with the tendon grafts of either reconstruction technique (P = .001-.008). Significantly better graft stiffness was retained with the circumferential graft technique compared with conventional reconstruction (P = .04)., Conclusion: Neither reconstruction technique fully reproduces the biomechanical profile of the native collateral ligaments. The circumferential graft technique seems to resist cyclic loading slightly better than the conventional reconstruction technique, yet both reconstruction techniques provide comparable stability., (Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

The segmental organization of the vertebrate body is most obviously visible in the vertebral column, which consists of a series of vertebral bones and interconnecting joints and ligaments. During embryogenesis, the vertebral column derives from the somites, which are the primary segments of the embryonic paraxial mesoderm. Anatomical, cellular and molecular aspects of vertebral column development have been of interest to developmental biologists for more than 150 years. This review briefly summarizes the present knowledge on early steps of vertebral column development in amniotes, starting from sclerotome formation and leading to the establishment of the anatomical bauplan of the spine composed of vertebral bodies, vertebral arches, intervertebral discs and ribs, and their specific axial identities along the body axis., (Copyright © 2015 Elsevier Ltd. All rights reserved.)