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Cada cirujano empieza su carrera profesional con el entrenamiento de la sutura cirúrgica. Dado que todos los cirujanos con experiencia tienen sus propios trucos, estilo y enfoque, la enseñanza y el aprendizaje de la técnica correcta pueden ser caóticos. Por esta razón, para los cirujanos residentes y los estudiantes de medicina les puede resultar difícil distinguir entre el enfoque de “evidence-based medicine” - el cuál ha de ser tomado, y los trucos personales de sus superiores, cuáles pueden ser modificados. Ofrecemos una revisión de los datos disponibles sobre la sutura cirúrgica, incluyendo las razones para el empleo de algunas técnicas especiales. En el texto presentamos los parámetros para la correcta sutura del piel, un guía práctico y las complicaciones que pueden surgir.

Objective: Integrating digital tools into traditional anatomical education can significantly enhance the learning experience. This study evaluates the benefits of using a 3D anatomical atlas alongside dissection, focusing on specific functionalities that have helped students the most. Methods: Over a four-year period, more than 600 medical and physiotherapy students utilized both traditional dissection and a 3D anatomical atlas in our department. The atlas featured detailed hierarchies of organs, interactive layered systems, visualization of related organs, and comprehensive muscle origin and insertion points. Student performance was assessed through practical exams and surveys. Results: The integration of the 3D anatomical atlas demonstrated substantial improvements in students' understanding and retention of anatomical structures. The hierarchical organization of organs helped students grasp the complex relationships within and between systems, enhancing their theoretical knowledge. The layer-by-layer feature allowed for in-depth exploration of each system, fostering a more comprehensive understanding of anatomy from the innermost to the outermost layers. Additionally, the ability to visualize related organs, such as blood supply and innervation, provided a deeper context for clinical correlations. The detailed depiction of muscle origins and insertions facilitated a better grasp of musculoskeletal anatomy, improving practical skills in identifying and understanding muscle functions. Conclusion: The use of a 3D anatomical atlas alongside traditional dissection significantly bridges the gap between theoretical knowledge and practical application. This hybrid approach not only enriches the educational experience but also better prepares students for clinical practice. [ABSTRACT FROM AUTHOR]

Objective: The aim of the research was to produce an extensive anatomical study of the newly defined structures (tuberositas interossea radii et ulnae) on dry bones and to compare our results with those of the Rougereau et al. (2021) who studied this tuberosity on radiographs, CT scans and cadavers, but they did not include dry bones in their study. Methods: Our research was divided into three main parts: osteometric, cadaveric and radiological. The osteometric part included the examination of 1125 radii and 753 ulnae of adult non-pathological dry bones. A Somet digital caliper was used to measure the dry bone. The cadaveric part consisted of four dissected forearms (two embalmed cadavers). The SIEMENS Somatom Definition Flash CT scanner was used for the radiological part of the study. Four dry bones were scanned and then the 3D reconstruction was performed using the Neoatom Alpha program. Results: As in the Rougereau et al. study, both tuberosities were present in 100% of the analysed bones. We divided both the tuberositas interossea radii et ulnae into pars anterior and pars posterior. Both structures serve forh the muscle origins and both tuberosities serve as attachment for the membrana interossea antebrachii. 3D reconstruction of the CT scans showed that it is possible to identify and measure both tuberosities. Conclusion: Tuberositas interossea radii et ulnae are constant anatomical structures and we can distinguish their main subparts: pars anterior and pars posterior. [ABSTRACT FROM AUTHOR]

Objective: This is a descriptive imaging study of the suprascapular canal MRI and sonographic anatomy with emphases on the difficulty of visualizing the suprascapular notch vicinity. Inaccurate information was encountered through the literature illustrating the suprascapular notch on MRI images. The matter of fact, the orientation of the suprascapular notch does not align with the captured MRI sections. In this study we illustrate more accurate anatomical description of the suprascapular notch and differentiating it form the other segments of the suprascapular canal. Methods: Forty retrospective MRI of healthy shoulder were collected. The sections were examined and labelled in accordance to our previous cadaveric study describing detailed anatomy of the suprascapular canal. Sonography of the superior shoulder region was bilaterally experimented on ten young healthy (six females and four males) volunteers of age ±21, with prior written consent. Results: The MRI visualization of the entire suprascapular notch borders at one image was not achieved. The passage of the suprascapular canal was well visible exposing the passing neurovascular bundle. The frontal plane was the optimum to examine the lateral margin of the suprascapular notch. The transverse plane was the optimum to visualize the course of the suprascapular canal. Conclusion: MRI is a useful modality for screening the surrounding tissues of the suprascapular canal for pathologies, while ultrasound has a greater potential for navigating suprascapular canal intervals because an observer can manipulate the transducer orientation. [ABSTRACT FROM AUTHOR]

Objective: The small saphenous vein and the sural nerve form a superficial neurovascular bundle on the posterior aspect of the leg. The sural nerve harvest can be complicated by the presence of side branches. The aim of our study was to reveal the mutual relationship the sural nerve and the small saphenous vein and to map their side branches. Methods: Fifty adult cadaveric legs (25 left and 25 right) obtained from 27 Central European cadavers were meticulously dissected. Results: We observed 15 cases where the sural nerve was medial and 35 cases where it was lateral to the small saphenous vein proximally but later crossed or overlapped it. The average number of sural nerve side branches in a single leg was 4.2±1.9. These side branches were categorized into six groups based on their location and course. The highest density of sural nerve side branches was found 2.1-6.0 cm above the lateral malleolus. The small saphenous vein received an average of 4.9±2.1 (3-9) tributaries. The most proximal tributary was 1.9±0.6 mm (0.7-2.8 m thick and was located 9.6±2.6 cm above the apex of the lateral malleolus, while the most proximal perimalleolar tributary was 1.7±0.5 mm thick and was situated 4.6±0.9 cm above the apex of the lateral malleolus. Conclusion: Our results can be used to predict the localization of separate incisions during the stair-step incisions technique for nerve harvest, and also for the small saphenous vein surgery, thereby reducing the risk of complications. [ABSTRACT FROM AUTHOR]

Objective: Surface and palpation anatomy, integral components of anatomical education, have gained popularity due to their practical relevance in clinical practice. Over the past decade, I and my team of lecturers has integrated these methods into the anatomy curriculum, providing physiotherapy students with hands-on experience to enhance their understanding of anatomical structures. Methods: We conducted a retrospective analysis of our anatomy teaching methods over the past ten years. The curriculum incorporated surface and palpation anatomy sessions, utilizing live models and cadaveric specimens with more than 200 palpating structures. Student feedback was collected through surveys and assessments to evaluate the effectiveness of these methods in improving anatomical knowledge and clinical skills. Results: Data from over 100 students indicated a significant improvement in anatomical understanding and clinical palpation skills. Students reported increased confidence in identifying anatomical landmarks and understanding their relevance in clinical scenarios. Conclusion: Our ten-year experience demonstrates that integrating surface and palpation anatomy into the medical curriculum significantly enhances students' anatomical knowledge and clinical skills. These methods provide a practical, hands-on approach that bridges the gap between theoretical knowledge and clinical practice. Continued emphasis on surface and palpation anatomy is recommended to further improve medical education and patient care outcomes. [ABSTRACT FROM AUTHOR]

Objective: The human eye is a complex optical system involving a variety of tissues, from connective to nervous. Implementation of individual layers and structures allows the biomechanical modelling of the istribution of tissue loading during selected loading events and can therefore be used to visualise changes in load and overload during injuries of selectable direction or intensity, as well as changes in the stability of the optical system following surgery or implantation of an artificial lens. Methods: The Abaquus program using finite element method (FEM) was used to create the model and simulate the loading. Additional structures relevant to the stability of the optical system of the eye under physiological conditions, in case of intraocular lens implantation and in case of blunt impact were implemented in the basic eye model. Results: A model of the eye was created that corresponds significantly better to its anatomical structure. The simulations demonstrated the loading of individual structures in various defined situations and described the risk of their mechanical failure in case of overloading, especially with regard to the time course of selected dynamic processes. Conclusion: We have verified the possibilities of biomechanical modelling of loaded anatomical structures in different situations. From a clinical point of view, this is important information that can be used not only in the diagnostic but also in the therapeutic process of various eye disorders, from changes due to simple ageing to post-operative changes or changes due to different types of trauma. [ABSTRACT FROM AUTHOR]

Objective: To assess the morphology of the jugular foramen (JF) bony configuration and redefine this rather long bony passage as a jugular canal (JC) based on its morphometric data. Methods: The JF was endocranially and exocranially observed and measured by digital Vernier caliper bilaterally in 302 dry skulls with opened cranial cavity. The PARAMETERS: 1) the external and internal width in the mediolateral dimension, 2) the external and internal length in the anteroposterior dimension. 3) the depth between the external plane and the internal plane of the JF. The classification based on appearance: A) The presence of an intrajugular process: No bony bridge, Intrajugular bridge, Intrajugular incomplete bridge. B) Based on the course of the jugular canal: Straight, Curved. Results: The length of the JC (right-12.2 mm, left-11.88 mm) seemed to be symmetrical. The external opening of the JF was found to be slightly larger (13.00 mm) than the internal opening (12 mm). The size of the JF is rather asymmetrical with a tendency to be larger on the right side. The fibrous bridge connecting the two counterpart intrajugular processes was ossified bilaterally in 33.11% and unilaterally in 36.75% of cases, exhibiting complete to incomplete bridging bony septum. Conclusion: The JF should be regarded clinically as a canal. It is composed of an internal and external opening where the jugular fossa resides in between. It takes three forms of a straight, semi-curved, and curved canal. The anatomical landmarks of the jugular canal intervals are usual guidance for skull base surgery and imaging navigation. [ABSTRACT FROM AUTHOR]

Vaclav Trnka from Křovice (1739-1791, in Latin: Wenzel Trnka Krzowitz) was a remarkable physician whose life serves as an example in the history of medicine by connecting major capital cities of Central Europe. In view of current geographical layout, he was born and brought up in the Czech Republic, graduated from University of Vienna in Austria, and was appointed Professor of the Anatomy at the newly established Faculty of Medicine of University of Nagyszombat, presently Trnava in Slovak Republic. When the University moved to Buda and later to Pest (today Budapest, Hungary), he was the fi rst educator to introduce anatomy as a medical subject to be taught in a Hungarian medical school. He also was elected the Dean of Faculty of Medicine three times and in 1786-1787 he acted as Rector of then the Royal University of Pest. During his life, he published twenty-seven monographs dealing with different areas of clinical medicine, such as malaria (intermittent fever), diabetes, and rickets. Based on these monographs we can proclaim that Václav Trnka was a co-founder of modern infectology, diabetology and ophthalmology in Central Europe. Nowadays, artificial intelligence and bioinformatics are inseparable parts of modern health care system which help the transformation of big data into valuable knowledge. In the 18th century, Professor Trnka owned more than 3,000 scientific books and had natural, innate intelligence and wisdom which made him a real "medical polymath". As a musician, Trnka also composed sixty-one canons, two of them long wrongly considered as Mozart's work. Despite the fact that Trnka is considered to be the founder of Hungarian anatomy education and a major medical fi gure of the eighteenth century Central Europe, no internationally acclaimed biographical record of his life or work has so far been published in English. Therefore, we would like to reintroduce Václav Trnka both as an anatomist and medical polymath, and to give an overview of the early days of anatomy teaching in present-day Slovakia and Hungary (Fig. 1, Ref. 27). Text in PDF www.elis.sk. [ABSTRACT FROM AUTHOR]

Background: Cross-sectional anatomy is a challenging yet a vital foundation to clinical practice. The traditional teachings of gross anatomy cadaveric dissections do not cover adequate training of recognizing anatomical structures on CT, MRI and sonographic cross-sections. New modern technologies are emerging as teaching tools in anatomy aiming to deliver visual interactive experience. The Visible Human Project provides a library of cross-sectional images compiled from cryosectioned body donors that was utilized by modern technologies such as the virtual dissection table (Anatomage) in constructing 3D software applications visualizing the internal composition of the human body virtually. Hereby, this article explores an integrative approach utilizing the Visible Human Project based applications and basic radiological modalities., Purpose: The purpose of our newly implemented teaching approach was to test and assure technology fitness to the medical curriculum and its potential influence on students' performance in learning gross as well as cross-sectional anatomy in much depth., Basic Procedures: A three years (2021-2024) observational study was conducted by implanting a practical cross-sectional anatomy optional course by selectively utilizing Anatmage interactively beside CT, MRI and ultrasound practice. The performance of 50 participants was evaluated in the form of a written test comprised of labeling of ten cross-sectional images and drawing of two cross-section schemes. Their optional course test scores were compared to their obligatory anatomy subject test scores; and to a non-participants control group of 50 retrospective obligatory anatomy subject test scores. In addition, the participants' attitude toward the training lessons was assessed through a survey focused on satisfaction level, competence and ability to recognize structures on radiological images., Main Findings: The participants reported a high level of practical engagement. The test scores in the anatomy obligatory subject were positively influenced by this implemented practical course. Students showed improved test scores in the standardized labeling keyword questions, while the scheme questions showed discrepancy., Principal Conclusions: Integrating Visible Human Project based applications with radiological modalities showed positive efficacy on the students' engagement and learning performance. Inevitably, cadaveric dissection and prosection remain the cornerstone of gross anatomy education. Integrating both modalities of teaching would excel students' practical skills in applied clinical anatomy., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (Copyright © 2024 Elsevier GmbH. All rights reserved.)

Unfortunately, the long-awaited revision of the official anatomical nomenclature, the Terminologia Anatomica 2 (TA2), which was issued in 2019 and after a referendum among the Member Societies officially approved by the General Assembly of the International Federation of Associations of Anatomists in 2020, is built on a new version of the Regular Anatomical Terminology (RAT) rules. This breaks with many traditional views of terminology. These changes in the Terminologia Anatomica of 1998 (TA98) met great resistance within many European Anatomical Societies and their members are not willing to use terms following the RAT rules. European anatomy teachers and scientists using traditional Latin in their teaching, textbooks and atlases will keep using the TA98. The German Anatomical Society (Anatomische Gesellschaft) recently announced the usage of the TA2023AG in curricular anatomical media such as textbooks and atlases, based on the TA98 and the Terminologia Neuroanatomica (TNA). We are preparing a more extensive improvement of the TA98, called Terminologia Anatomica Humana (TAH). This project is fully based on the noncontroversial terms of TA98, incorporating the recent digital version (2022) of the TNA from 2017. Further, it is completed with many new terms, including those in TA2, along with their definitions and relevant references, clinical terms, and correcting inconsistencies in the TA98. The TAH is still in process, but many chapters are already freely available at the IFAA Website in Fribourg ( https://ifaa.unifr.ch ) as is the digital version of the TNA., (© 2024. The Author(s), under exclusive licence to Japanese Association of Anatomists.)

Purpose: The accessory bones around the elbow are very rare variant structures, present in approximately 0.7% of cases. They can cause diagnostic problems and can be mistaken for pathological structures, especially when pain and limitation of elbow movements are present and a trauma can be traced in the patient's history. They are of different nature, either presenting within muscle tendons as sesamoids (brachialis and triceps brachii muscles) or presenting intra-articularly probably as separated or accessory ossification centres. The least common is the os supratrochleare anterius., Methods: We present a case of a young male, featuring chronic blocking and 20° limited flexion of his right elbow, which bothered him during his occupation as a locksmith. In history, he suffered minor trauma to the elbow 20 years ago. X-ray and CT showed a large ossicle in the coronoid fossa of the humerus., Results: The ossicle was surgically extracted in small pieces. The patient left satisfied with no mention of complaints., Conclusion: The os supratrochleare anterius is a very rare accessory bone of the elbow, located in the coronoid fossa of the humerus which can mimic many pathological states, and limit movements and causing pain around the elbow., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background and Objectives: En bloc sacrectomy is associated with sacral root transection causing loss of urinary bladder, rectum, and sexual function. The aim of the study was to determine the position of the pudendal branches (sensorimotor) and pelvic splanchnic nerves (parasympathetic) on the sacral roots relative to the sacrum, and the minimal and maximal defects in the sacral roots that can be reconstructed by grafting after various types of sacrectomy., Methods: Five cadaveric pelves were dissected bilaterally. The lengths and widths of the S1-S4 roots and their branches were measured. Then, the minimal and maximal defects between the proximal and distal stumps of the sacrificed roots were measured following 3 models of sacrectomy (below S2, below S1, and total sacrectomy)., Results: The mean distance of the splanchnic nerves from the S2 and S3 anterior sacral foramina was 17.7 ± 7.3 and 23.6 ± 11.1 mm, respectively, and the mean distance of the pudendal S2 and S3 branches was 36.8 ± 13.7 and 30.2 ± 10.8 mm, respectively. The mean widths of the S2 and S3 roots were 9.3 ± 1.9 and 5.4 ± 1.2 mm, respectively. The mean maximal defects in S2 and S3 roots after various types of sacrectomies were between 61.8 ± 16.3 and 100.7 ± 14.3 mm and between 62.7 ± 20.2 and 84.7 ± 25.1 mm, respectively. There were no statistically significant differences between sides or sexes for all obtained measurements., Conclusion: The reconstruction of the S2-S3 roots is anatomically feasible after partial or total sacrectomies in which the resection of the soft tissue does not extend further than approximately 1.5 to 2 cm ventrally from the sacrum., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Background: Together with an increased interest in minimally invasive lateral transpsoas approach to the lumbar spine goes a demand for detailed anatomical descriptions of the lumbar plexus. Although definitions of safe zones and essential descriptions of topographical anatomy have been presented in several studies, the existing literature expects standard appearance of the neural structures. Therefore, the aim of this study was to investigate the variability of the extrapsoas portion of the lumbar plexus in regard to the lateral transpsoas approach., Methods: A total of 260 lumbar regions from embalmed cadavers were utilized in this study. The specimens were dissected as per protocol and all nerves from the lumbar plexus were morphologically evaluated., Results: The most common variation of the iliohypogastric and ilioinguinal nerves was fusion of these two nerves (9.6%). Nearly in the half of the cases (48.1%) the genitofemoral nerve left the psoas major muscle already divided into the femoral and genital branches. The lateral femoral cutaneous nerve was the least variable one as it resembled its normal morphology in 95.0% of cases. Regarding the variant origins of the femoral nerve, there was a low formation outside the psoas major muscle in 3.8% of cases. The obturator nerve was not variable at its emergence point but frequently branched (40.4%) before entering the obturator canal. In addition to the proper femoral and obturator nerves, accessory nerves were present in 12.3% and 9.2% of cases, respectively., Conclusion: Nerves of the lumbar plexus frequently show atypical anatomy outside the psoas major muscle. The presented study provides a compendious information source of the possibly encountered neural variations during retroperitoneal access to different segments of the lumbar spine., (© 2024. The Author(s).)

Background: The sural nerve is a somatosensory nerve that provides sensation to the posterolateral aspect of the lower leg and the lateral part of the ankle and foot. Due to its location and anatomical properties, it is often used as an autologous nerve graft. However, the nerve harvest can be complicated by the presence of side branches. The objective of this study was to investigate the anatomy of the sural nerve and to map its side branches. This information can be used to predict the localization of separate incisions during the stair-step incisions technique for nerve harvest, thereby reducing the risk of complications., Methods: The study involved the dissection of 50 adult cadaveric legs (25 left and 25 right) obtained from 27 Central European cadavers. The focus of the dissection was to identify the sural nerve, small saphenous vein, and surrounding anatomical structures. Detailed measurements were taken on the side branches of the sural nerve, tributaries of the small saphenous vein, and their interrelationship., Results: The average number of sural nerve side branches in a single leg was 4.2±1.9. These side branches were categorized into six groups based on their location and course: mediodistal, medioproximal, lateroproximal, laterodistal, medial perpendicular, and lateral perpendicular. Specific patterns of combination of these side branches were also identified and described. The branching point of the sural nerve was found to be 5.8±2.7 cm proximal to the lateral malleolus, whereas the small saphenous vein branching point was located more distally, 4.5 ± 2.8 cm proximal to the lateral malleolus. The highest density of sural nerve side branches was found 2.1-6.0 cm above the lateral malleolus., Conclusion: This study presents valuable data about the relationship between the sural nerve and the surrounding anatomical structures in the distal part of the leg, including the identification of its side branches and their relevance during nerve harvest procedures. On the basis of the most frequent locations of side branches, a three-incision-technique for nerve harvest is proposed., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier GmbH. All rights reserved.)

Awareness of unique path of the superficial branch of the radial nerve and its unusual sensory distribution can help avoid potential diagnostic confusion. We present a unique case encountered during a routine dissection of a Central European male cadaver. An unusual course of the superficial branch of the radial nerve was found in the right forearm, where the superficial branch of the radial nerve originated from the radial nerve distally, within the supinator canal, emerged between the extensor digitorum and abductor pollicis longus muscles and supplied the second and a radial half of the third digit, featuring communications with the lateral antebrachial cutaneous nerve and the dorsal branch of the ulnar nerve. Due to dorsal emerging of the superficial branch of the radial nerve the dorsal aspect of the thumb was innervated by the lateral antebrachial cutaneous nerve. To our best knowledge such variation of the superficial branch of the radial nerve has never been reported before. This variation dramatically changes aetiology and manifestation of possible entrapment syndromes which clinicians should be aware of., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background: Many surgical strategies aim to treat the symptomatic neuroma of the superficial branch of the radial nerve (SBRN). It is still difficult to treat despite many attempts to reveal a reason for surgical treatment failure. The lateral antebrachial cutaneous nerve (LACN) is known to overlap and communicate with SBRN. Our study aims to determine the frequency of spreading of LACN fibers into SBRN branches through a microscopic dissection to predict where and how often LACN fibers may be involved in SBRN neuroma., Methods: Eighty-seven cadaveric forearms were thoroughly dissected. The path of LACN fibers through the SBRN branching was ascertained using microscopic dissection. Distances between the interstyloid line and entry of LACN fibers into the SBRN and emerging and bifurcation points of the SBRN were measured., Results: The LACN fibers joined the SBRN at a mean distance of 1.7 ± 2.5 cm proximal to the interstyloid line. The SBRN contained fibers from the LACN in 62% of cases. Most commonly, there were LACN fibers within the SBRN's third branch (59%), but they were also observed within the first branch, the second branch, and their common trunk (21%, 9.2%, and 22%, respectively). The lowest rate of the LACN fibers was found within the SBRN trunk (6.9%)., Conclusion: The SBRN contains LACN fibers in almost 2/3 of the cases, therefore, the denervation of both nerves might be required to treat the neuroma. However, the method must be considered based on the particular clinical situation., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

The middle colic artery usually arises from the superior mesenteric artery, but in rare cases it may arise from the coeliac trunk or its branches. The aim of this study was to investigate variant origins of the middle colic artery on computed tomography and anatomical dissection. Variant middle colic arteries were identified on computed tomography as part of an ongoing study investigating anatomical variations of vessels of the upper abdomen. Three-dimensional reconstructions were made to demonstrate the variant findings. Cadaveric dissections were performed as part of a routine dissection course. We report five cases of rare variant origins of the middle colic artery arising from the coeliac axis. Among these sites of origin were the coeliac trunk, the gastrosplenic trunk, the splenic artery, and the common hepatic artery. Four cases were identified on multi-detector computed tomography and one in a cadaver. In all cases, the vessels passed posterior to the body of the pancreas before entering the transverse mesocolon. Knowledge of middle colic artery variations is important to prevent inadvertent injury in digestive surgery, especially in the hepatopancreatic area. Variant origins of the middle colic artery are rare, and their knowledge is crucial to prevent unnecessary iatrogenic injury during abdominal surgery., (© 2023. The Author(s), under exclusive licence to Japanese Association of Anatomists.)

Introduction: The lateral antebrachial cutaneous nerve (LACN) is a somatosensory nerve coursing in the lateral portion of the forearm. The nerve is located in a close proximity to the cephalic vein (CV) all along its course with a danger of being injured during venipuncture. The LACN also overlaps and communicates with the superficial branch of the radial nerve (SBRN) in the distal forearm and hand, making the awareness of their relationship of great importance in the treatment of neuroma. The aim of the study was to observe the relationship of the LACN to surrounding structures as well as its branching pattern and distribution., Materials and Methods: Ninety-three cadaveric forearms embalmed in formaldehyde were dissected. The relationship of the LACN to surrounding structures was noted and photographed, and distances between the structures were measured with a digital caliper. The cross-sectional relationships of the LACN and SBRN to the CV were described using heatmaps., Results: The emerging point of the LACN was found distally, proximally or at the level of the interepicondylar line (IEL). The LACN branched in 76 cases (81.7 %) into an anterior and posterior branch at mean distance of 47.8 ± 34.2 mm distal to the IEL. The sensory distribution was described according to the relationship of the LACN branches to the medial border of the brachioradialis muscle. The LACN supplying the dorsum of the hand was observed in 39.8 % of cases. The LACN and the SBRN intersected in 86 % of upper limbs with communications noticed in 71 % of forearms. The LACN was stated as the most frequent donor of the communicating branch resulting in neuroma located distal to the communication and being fed from the LACN. The relationship of the LACN and the CV showed that the IEL is the most appropriate place for the venipuncture due to maximal calibers of the CV and deep position of the LACN. The LACN was adjacent to the cubital perforating vein and the radial artery in all cases. The medial border of the brachioradialis muscle was observed less than 1.8 mm from the LACN., Conclusion: The study provides morphological data on the LACN distribution, branching pattern and relationship to surrounding structures in a context of clinical use in different spheres of medicine. The branching pattern of the LACN appears to be more constant compared to data provided by previous authors. We emphasized the meaning of cross-sectional relationship of the LACN to the CV to avoid venipuncture outside the cubital fossa if possible. The posterior branch of the LACN was predicted as appropriate donor of the graft for a digital nerve. The LACN appeared to be in a close proximity within the whole length of the brachioradialis muscle what the orthopedic surgeons must be concerned of. The meaning of the donor-nerve of the communicating branch in neuroma treatment was also introduced., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier GmbH. All rights reserved.)

Background: In 2008, members of the TEPARG provided first insights into the legal and ethical framework governing body donation in Europe. In 2012, a first update followed. This paper is now the second update on this topic and tries to extend the available information to many more European countries., Methods: For this second update, we have asked authors from all European countries to contribute their national perspectives. By this enquiry, we got many contributions compiled in this paper. When we did not get a personal contribution, one of us (EB) searched the internet for relevant information., Results: Perspectives on the legal and ethical framework governing body donation in Europe., Conclusions: We still see that a clear and rigorous legal framework is still unavailable in several countries. We found national regulations in 18 out of 39 countries; two others have at least federal laws. Several countries accept not only donated bodies but also utilise unclaimed bodies. These findings can guide policymakers in reviewing and updating existing laws and regulations related to body donation and anatomical studies., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier GmbH.. All rights reserved.)

Purpose: Arterial variations of the upper limb may bear high importance for many clinical procedures, including the use of flaps in plastic surgery. We present a feasible way for visualization and confirmation of presence of these variations., Methods: All variations were detected by ultrasonography and confirmed by Color Doppler Imaging. Proper documentation was taken in order to present our findings., Results: We report a case of a 19-year-old female who showed two concomitant arterial variations of the forearm and the hand bilaterally. These two variations were the persistent median artery and the superficial dorsal branch of the radial artery which both significantly contributed to the blood supply of the hand. All examinations were performed by the same investigator and all findings were reviewed by an experienced sonographist., Conclusion: An unusual arrangement of the arterial system can be easily detected. We present a feasible way to prevent iatrogenic injuries and increase utilization of anatomical variants knowledge in surgery by using ultrasound prior to planning surgical procedures., (© 2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Purpose: Discrepancy between the morphology of the acetabular margin and the design of hemispheric acetabular cups used in total hip arthroplasty may produce postoperative hip pain due to an iliopsoas impingement at the iliopsoas notch. This study aimed to determine the anatomical features of the iliopsoas notch in the Central European sample, and to test whether the morphology of the proximal femur affects the size of the iliopsoas notch., Methods: The sample was composed of 40 matched pairs of dry hip bones and corresponding femora. The depth and length of the iliopsoas notch were measured and correlated with the available demographic data. The anthropometric parameters of the proximal femur were calculated using image-analysis software, and their association with the measurements of the iliopsoas notch was tested., Results: The iliopsoas notch was present in all specimens and featured four morphological configurations: curved (61.3%), angular (16.2%), irregular (16.2%), and straight (6.3%). Its size was found to be larger in males (P = 0.014 for depth, P < 0.001 for length). No significant difference existed between the sides. The height and age of the specimens did not correlate with the size of the iliopsoas notch. Furthermore, neither the femoral neck version, the lesser trochanteric version, nor the angle between the neck of the femur and the lesser trochanter influenced the dimensions of the iliopsoas notch., Conclusion: The iliopsoas notch is a consistent landmark of the acetabulum, although its anatomical appearance is widely variable. The iliopsoas notch arrangement cannot be predicted perioperatively based on the morphology of the proximal femur. The various shapes and sex-related differences detected in this study could be used for designing new hip implants or could be utilized during cup positioning in total hip arthroplasty., (© 2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Although the term articularis cubiti muscle is incorporated in the official anatomical nomenclature, only sparse data about its appearance are available. It is usually described as few fibres originating from the medial head of the triceps brachii muscle and inserting to the capsule of the elbow joint. However, the most recent observations regarding the morphological relations in the posterior elbow region point towards the absence of a well-defined muscle. Therefore, this study was designed to verify the existence of the articularis cubiti muscle in question and to compile more data on the topographical features of the subtricipital area near the posterior aspect of the elbow. To address these questions, 20 embalmed upper limbs were dissected, and seven samples were collected for histological analysis. The laboratory findings were then correlated with 20 magnetic resonance imaging (MRI) scans of the elbow. Consequently, a narrative review of literature was performed to gain more information on the discussed muscle in a historical context. Upon the anatomical dissection, muscular fibres running from the posterior aspect of the shaft of the humerus to the elbow joint capsule and olecranon were identified in 100% of cases. Histologically, the connection with the joint capsule was provided via winding bands of connective tissue. On MRIs, the muscular fibres resembled a well-demarcated thin muscle located underneath the medial head of the triceps brachii muscle. Combined with the review of literature, we concluded that the constant articularis cubiti muscle originates from the posterior shaft of the humerus and attaches indirectly to the posterior aspect of the elbow joint capsule and directly to the superior portion of the olecranon. The obtained results slightly differ from the modern description, but are in agreement with the original publication, which has become misinterpreted throughout time. Presumably, the misused description has led to questioning the existence of an independent muscle. Moreover, our findings attribute to the articularis cubiti muscle, a function in pulling on the posterior aspect of the elbow joint capsule to prevent its entrapment, and possibly also a minor role in extension of the forearm. The presented results should be taken into consideration when intervening with the posterior aspect of the elbow joint because the articularis cubiti muscle poses a consistently appearing landmark., (© 2023 The Authors. Journal of Anatomy published by John Wiley & Sons Ltd on behalf of Anatomical Society.)

Objective: To systematically assess available information about all variations of obturator vessels and to present the most surgically relevant types, their prevalence and calibre in order to provide a comprehensive overview for both anatomists and clinicians., Materials and Methods: A total of 2689 studies were found via searching the online databases. After applying exclusion criteria 44 studies were assessed. The cadaveric studies, CT angiographies, and clinical studies were included. Number of hemipelves, prevalence of each variation and calibre of identified vessels were studied. Each variation was classified as aberrant obturator artery/vein, aberrant accessory obturator artery/vein or anastomosis., Results: In included studies the average incidence of the variant obturator artery was 26% with the aberrant obturator artery being the most frequent type (with the mean calibre 2.10 mm, SD = 0.35 mm), while the overall incidence of the variant obturator vein was 55%. Presented venous structures had the mean calibre of 2.98 mm (SD = 0.56 mm)., Conclusions: According to reviewed studies, variant obturator vessels are present in a great number of patients. Due to their possible calibre larger than 3 mm they represent a structure of high clinical importance. It is important to unify the terminology and to stress out the significance to all clinicians., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier GmbH. All rights reserved.)

Objective: To investigate the relationship between osseous variations of the glenoid fossa and thinning of the overlaying articular cartilage., Materials and Methods: In total, 360 dry scapulae, comprising adult, children and fetal specimens, were observed for potential presence of osseous variants inside the glenoid fossa. Subsequently, the appearance of the observed variants was evaluated using CT and MRI (each 300 scans), and in-time arthroscopic findings (20 procedures). New terminology of the observed variants was proposed by an expert panel formed by orthopaedic surgeons, anatomists and radiologists., Results: Tubercle of Assaky was observed in 140 (46.7%) adult scapulae, and an innominate osseous depression was identified in 27 (9.0%) adult scapulae. Upon radiological imaging, the tubercle of Assaky was found in 128 (42.7%) CTs and 118 (39.3%) MRIs, while the depression was identified in 12 (4.0%) CTs and 14 (4.7%) MRIs. Articular cartilage above the osseous variations appeared relatively thinner and in several young individuals was found completely absent. Moreover, the tubercle of Assaky featured an increasing prevalence with aging, while the osseous depression develops in the second decade. Macroscopic articular cartilage thinning was identified in 11 (55.0%) arthroscopies. Consequently, four new terms were invented to describe the presented findings., Conclusion: Physiological articular cartilage thinning occurs due to the presence of the intraglenoid tubercle or the glenoid fovea. In teenagers, the cartilage above the glenoid fovea may be naturally absent. Screening for these variations increases the diagnostic accuracy of glenoid defects. In addition, implementing the proposed terminological updates would optimize communication accuracy., (© 2023. The Author(s).)

The interpubic cavity (cleft) is a narrow, slit-like, oval-shaped cavity which has frequently been described within the fibrocartilaginous interpubic disc. The aim of this article is to thoroughly analyze what is known about the interpubic cavity. The following three scientific databases (PubMed, Web of Science and Google Scholar) were systematically searched. Combinations of the search terms "interpubic cleft", "interpubic cavity", "symphysis pubis cleft", "symphysis pubis cavity" and "symphysis cleft sign" were used. All databases were searched from inception until August of 2022. Searching of the three databases resulted in 711 hits, of which 280 remained after checking for duplicates. In the first step, 152 studies were excluded due to irrelevant content. Thus, 128 proceeded to the second step, of which 23 were finally selected for meeting the objectives of this review. Until now the reason for the cavity forming remains unclear. The interpubic cavity is present in the anterior portion of the interpubic disc, within 2 mm from its anterior margin. There is no predilection in the craniocaudal dimension. The secondary cavity is usually called a "cleft sign". The results of our scoping review summarize information about the interpubic cavity. Its composition and morphology are still not well understood., (© 2023 American Association of Clinical Anatomists and British Association of Clinical Anatomists.)

The palmaris profundus muscle is a rare anatomical variation of the forearm muscles. It has been described in both cadaveric and clinical studies as a possible cause of carpal tunnel syndrome. We observed three cases of this variant in recent years and decided to perform a scoping review of this uncommon anatomical entity. Major databases were searched to identify all relevant clinical and anatomical studies containing anatomical descriptions of the muscle, including its origin, insertion, and concomitant presence of the proper palmaris longus muscle or the bifid median nerve. In clinical cases, we studied the surgical approach. Sixty-four articles met our inclusion criteria and contained 88 cases of palmaris profundus muscle. The most common origin was the ventral aspect of the radius in the area of insertion of the pronator teres muscle observed in 11 cases (12.5 %). We found 65 cases (73.3%) in which the tendon was inserted into the palmar aponeurosis or palmar fascia after entering the carpal canal. The concomitant presence of the proper palmaris longus muscle was described in 47 cases (53.4%). We identified 10 cases (10.8%) of the bifid median nerve. In 49 of 69 clinical cases (71%), the surgical approach was to resect the variant muscle. The importance of this variant should not be underestimated due to its potential to compress the median nerve. We found a significant disparity in the muscle origin sites, but uniformity of muscle insertion. In cases where the muscle is found during carpal canal surgery, it should be partially resected to ensure complete nerve decompression., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Differentiating the anatomical variations of the anterosuperior portion of the glenoid labrum from pathologies is important to avoid unnecessary iatrogenic complications resulting from inaccurate diagnosis. Additionally, the presence of several variations was reported to be conductive to lesions involving the glenoid labrum. Thus, the aim of this study was to state the prevalence rates of the sublabral recess, sublabral foramen, and the Buford complex, and to verify their association with labral lesions., Methods: Systematic search of electronic databases was conducted to gain potentially eligible literature. Suitable studies were selected in a two-round screening, and relevant data were subsequently extracted. Calculation of the pooled prevalence estimates, including sub-analyses on cohort size, study type, and geographical variance, was conducted. Pooled analysis of risk ratios (RR) was used to assess the conductive nature of the discussed variants to superior labrum anterior to posterior (SLAP) lesions., Results: The screening resulted in selection of 20 studies investigating the morphological features of the glenoid labrum, consisting of 7601 upper limbs. On the bases of random-effects meta-analysis the sublabral recess, sublabral foramen and Buford complex occur with a pooled prevalence of 57.2% (95% CI 30.0-84.4%), 13.5% (95% CI 8.2-18.9%), and 3.0% (95% CI 1.5-4.5), respectively. Moreover, individuals with Buford complex have RR 2.4 (95% CI 1.3-4.7) of developing SLAP lesions, especially type II (95.5%; 95% CI 86.1-100%), whereas such risk for sublabral recess and sublabral foramen was not statistically significant., Conclusion: Morphological variants of the glenoid labrum posing diagnostic confusion are frequently observed. Gradually, the Buford complex may be a predisposing factor for sustaining a SLAP lesion., (© 2023. The Author(s).)

Introduction: The superficial branch of the radial nerve (SBRN) and the lateral antebrachial cutaneous nerve (LACN) are sensory nerves coursing within the forearm in a close relationship. This high degree of overlap and eventual communication between the nerves is of great surgical importance. The aim of our study is to identify the communication pattern and overlap of the nerves, to localize the position of this communication in relation to a bony landmark, and to specify the most common communication patterns., Materials and Methods: One hundred and two adult formalin-fixed cadaveric forearms from 51 cadavers of Central European origin were meticulously dissected. The SBRN, as well as the LACN, were identified. The morphometric parameters concerning these nerves, as well as their branches and connections, were measured with a digital caliper., Results: We have described the primary (PCB) and secondary communications (SCB) between the SBRN and the LACN and their overlap patterns. One hundred and nine PCBs were found in 75 (73.53%) forearms of 44 (86.27%) cadavers and fourteen SCBs in eleven hands (10.78%) of eight cadavers (15.69%). Anatomical and surgical classifications were created. Anatomically, the PCBs were classified in three different ways concerning: (1) the role of the branch of the SBRN within the connection; (2) the position of the communicating branch to the SBRN; and (3) the position of the LACN branch involved in the communication to the cephalic vein (CV). The mean length and width of the PCBs were 17.12 mm (ranged from 2.33 to 82.96 mm) and 0.73 mm (ranged from 0.14 to 2.01 mm), respectively. The PCB was located proximally to the styloid process of the radius at an average distance of 29.91 mm (ranged from 4.15 to 97.61 mm). Surgical classification is based on the localization of the PCBs to a triangular zone of the SBRN branching. The most frequent branch of the SBRN involved in the communication was the third (66.97%). Due to the frequency and position of the PCB with the third branch of the SBRN, the danger zone was predicted. According to the overlap between the SBRN and the LACN, we have divided 102 forearms into four types: (1) no overlap; (2) present overlap; (3) pseudo-overlap; and (4) both present and pseudo-overlap. Type 4 was the most common., Conclusion: The patterns of communicating branch arrangements appeared to be not just a rare phenomenon or variation, but rather a common situation highlighting clinical importance. Due to the close relationship and connection of these nerves, there is a high probability of simultaneous lesion., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier GmbH. All rights reserved.)

Introduction: Anatomical variants observed during the posterior approach to the elbow joint require special attention due to their clinical relevance. We aim to present a compendious review of described variants potentially encountered during the posterior approach towards the elbow joint to the experts in the elbow surgery., Methods: A narrative review of surgical and anatomical textbooks, as well as search of scientific databases was carried out., Results: Variability of the subcutaneous nerves is important during incision planning. Accessory muscles such as dorsoepitrochlearis, chondroepitrochlearis, epitrochleoanconeus, subanconeus or supernumerary flexor carpi ulnaris may confuse even the senior surgeon during the dissection and possibly complicate the fracture reduction. Some bony variants such as supratrochlear foramen may lead to fracture or possibly interfere with the osteosynthesis placement. Accessory bones are also present in the region of the elbow joint. Those situated intra-articular may present with symptoms., Conclusion: Many variants can be encountered in the area of the elbow joint and their knowledge is essential to truly understand its anatomy. The presented review enables easier orientation in the current literature with the aim on the posterior approach towards the elbow joint., (© 2023. The Author(s).)

Background: The subclavius muscle runs underneath the clavicle. However, there have been a few reports of a duplicated subclavius muscle which is commonly referred to as subclavius posticus muscle due to its orientation being posterior to the proper subclavius muscle. Its occurrence seems to potentially create a narrowing interval at the superior thoracic aperture as it crosses over the brachial plexus. It might also have functional influence on the shoulder girdle., Purpose: To provide comprehensive gross anatomy description of the variant "subclavius posticus muscle" and to investigate its reported clinical implications with emphasis on its involvement in causing brachial plexus compression., Basic Procedures: A scoping review with meta-analysis of the gross anatomy of the subclavius posticus muscle was conducted along with investigating its correlation to the thoracic outlet syndrome. Forty-seven articles were pooled through two rounds of the selection process. The relevant information was extracted and meta-analyzed., Main Findings: The scoping review and meta-analysis of the 47 articles revealed a total prevalence of 11/2069 (4.9%); 10/1369 (5.1%) in cadaveric studies, and 1/700 (5.0%) in MRI studies. The subclavius posticus muscle is a short triangular muscle with an average length of 12 cm and an average width of 1 cm. It originates from the sternal end of the first rib in most cases with reported variants of one case originating from the costoclavicular ligament and one case where it was fused with the proper subclavius muscle. Its insertion is more variable: on the superior border of the scapula with variable length in 71.35%, on the coracoid process of the scapula in 25.42%, and on the clavicle in 0.90%. The subclavian nerve seems to be the dominant nerve supply with a 57.6% prevalence, while 25.8% are innervated by the suprascapular nerve. Other reported nerves were the nerve to the myolohyoid (4.5%), accessory phrenic nerve (4.5%), and a direct branch from the brachial plexus (2.0%). The blood supply was reported (only once) to be from the suprascapular artery. However, the venous drainage was not established at all., Principal Conclusions: The subclavius posticus muscle is a variant muscle occurring with a reported overall prevalence of 4.9%. It can compress the brachial plexus as it runs across at the space of the superior thoracic aperture with exquisite contact, and this can lead to a neurogenic thoracic outlet syndrome. It also can be involved in the vascular thoracic outlet syndrome. Lastly, it is important not to omit its potential influence in shoulder joint instability to some extent., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier GmbH. All rights reserved.)

There are many osseous variants that occur around the elbow joint such as supracondylar process, supratrochlear foramen, accessory ossicles, and others. Scientific databases were searched for variants around the elbow joint. Elbow radiographs from our center demonstrating some of these findings were included in the study. The aim of the present review was to provide comprehensive information on the terminology, prevalence, history, etiology, and clinical importance of these variants. These anatomical variants are important for radiologists while interpreting radiographs, computed tomography, and magnetic resonance imaging for trauma and orthopedic surgeons during osteosynthesis at the distal humerus, proximal ulna, and radius.

Purpose: Lumbrical muscles of the upper limb belong to the middle group of intrinsic hand muscles. Their anatomical variability has been extensively studied with heterogeneous findings. Therefore, the aim of this study is to provide a systematic review and a meta-analysis of the lumbrical muscles variations in the human hand., Methods: For this purpose, four major electronic databases were searched to identify eligible studies. Then, all relevant data were extracted, and statistical analysis performed. A new classification of lumbrical muscles variations is proposed to summarize and clearly define all described findings. We included 26 studies, making a total sample of 1340 dissected hands., Findings: The most common variations for each muscle were an accessory belly for the first lumbrical muscle, a variable origin for the second lumbrical muscle, a variable innervation for the third lumbrical muscle and a variable insertion for the fourth lumbrical muscle with the prevalence 3.8%; 7.7%; 12% and 5.8%, respectively., Conclusions: We believe that results of our statistical analysis are suitable for both hand surgeons and other medical professionals dealing with hand injuries or functional problems in their daily routine., Competing Interests: Conflict of interest The authors state that they have no conflict of interests., (Copyright © 2023 Elsevier GmbH. All rights reserved.)

Background: The superficial branch of the radial nerve (SBRN) is a sensory nerve innervating the dorsoradial part of the hand. It originates in the cubital fossa, runs under the belly of the brachioradialis muscle (BM), emerges from underneath in the distal third of the forearm and continues in the subcutaneous tissue towards the hand. There exist several anatomical variations of its branching and course, including a rare variation of its duplication combined with a duplication of the brachioradialis muscle belly. The aim of this study was to find out the prevalence of this variation on a sample of cadaveric human bodies which has not been reported yet., Materials and Methods: We have carefully dissected 208 cadaveric upper limbs (Central European population). All cases of limbs containing the variation of a double SBRN and/or a double BM belly were measured and documented., Results: We have identified 2 cases of a double SBRN combined with a double BM belly (0.96%). Both were present in the right forearm of a male donor and in both cases the nerve was impinged by muscle bundles connecting the 2 muscle bellies together. Moreover, we have encountered 1 case of a double SBRN without a double BM belly (0.48%), i.e. the total prevalence of a double SBRN was 1.44%., Conclusions: The duplicated SBRN with the duplicated BM is a relatively rare anatomical variation that might cause complications while performing various surgical procedures in the forearm, moreover it might be a rare cause of Wartenberg's syndrome.

Arterial blood to the human uterus is provided by a pair of uterine arteries (UA) and supported by terminal branches of ovarian (OA) and vaginal arteries (VA). Literature reports the existence of ipsilateral and contralateral anastomoses between these arteries and the UA, but data on the prevalence of such anastomoses are discrepant. The aim of this trial is to study whether contralateral and ipsilateral anastomoses exist. We studied nine human uterine specimens, which were obtained from (i) human cadavers (n = 6), (ii) uterine transplant recipients (n = 2), and (iii) one altruistic uterine donor (n = 1). We injected India ink into the graft through the UA of each specimen (n = 8) or OA (n = 1). We semiquantitatively observed and evaluated the extent of the injection on horizontal, vertical, and transmural levels. The dye permeated beyond the midline in 9/9 (100 %) cases. Near-complete/complete permeation to the contralateral side was observed in 6/9 (66 %) cases. The dye permeated ipsilaterally throughout all uterine levels in 8/8 cases (100 %) of UA injection. The entire wall of the myometrium was permeated in 2/9 (22 %) cases. In 7/9 (78 %) cases, the wall of the myometrium was permeated less than halfway through. In conclusion, the preliminary results of this study prove the existence of ipsilateral and contralateral anastomoses. Complete transmural injection was observed in only 22 % of cases; however, this finding does not provide information about the functional capacity of these anastomoses. More data and studies are necessary to make definitive conclusions.

Purpose: To report atypical anatomical variation of an osseous suprascapular canal, and to elaborate on its clinical significance as a potential anatomical factor that could obscure a direct posterior surgical approach and suprascapular nerve block., Methods: Osteological observational study of the scapula with emphasis on the suprascapular space. The pool of investigated sample size was collectively 768 specimens composed of 529 adult dry scapulae (240 paired, 289 un-paired), 54 children dry scapulae, 135 wet scapulae observed during cadaveric dissections, 47 retrospective 3D CT reconstructions, and 3 retrospective full sequence shoulder MRI. The two reported cases came from the 240 (120 skeleton) observed paired scapulae. Furthermore, the osseous suprascapular canal was examined by X-rays and its internal path was exposed by CT sections. A narrative review was conducted to investigate any relevant reports on the subject matter., Results: Two left dry bone scapulae with unilateral osseous suprascapular canal were found. The incidence of this atypical morphology of an osseous canal is probably five cases reported in three studies including this cases study., Conclusions: The reported cases aid in explaining additional possible anatomical factors that could lead to below threshold anesthetic effect in posterior suprascapular nerve block procedures. Therefore, it is more practical to visualize the suprascapular canal by some imaging method before attempting to blindly access the suprascapular nerve in nerve block or posterior surgical approach due to the rare potential existence of an ossified barrier hindering the procedure., Level of Evidence: V Basic Science Research., (© 2022. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Purpose: Dorsal closing wedge calcaneal osteotomy (DCWCO) is indicated in patients with insertional tendinopathy of the calcaneal (Achilles) tendon. The Chauveaus-Liet's (CL) angle is represented by the difference between the angle of verticalization (α) and morphological angle (β) of the calcaneus (CL angle = α - β). The purpose of the study was to assess whether the DCWCO affects the Chauveaus-Liet's angle., Methods: The study included 12 patients indicated to DCWCO. Three directions of close wedge osteotomy were designed for each patient-horizontal, vertical and in the middle type of osteotomy and a virtual osteotomy was created in each of them in the ABAQUS system in cooperation with Czech Technical University. The most used directions of osteotomy according to the available literature were used. We evaluated α and β angles before and after osteotomy, changes of the length plantar aponeurosis and the elevation of distal insertional point of the calcaneal tendon. The changes of grades, median and standard deviation were observed., Results: The change of the alfa angle was dependent on the direction of the osteotomy and the change of the beta angle was affected by the size of the osteotomy. The greatest elevation of the distal insertional point of the calcaneal tendon occurred in the horizontal type of the osteotomy., Conclusion: Our study shows that the more we want to reduce the tension in the calcaneal tendon, the more we have to perform an osteotomy horizontally. This study could serve as a preoperative guide for osteotomy planning., (© 2022. The Author(s).)

Introduction: The anatomy of the brachial plexus has been a subject of interest to many researchers over time resulting in an inconsistent amount of data. Previously, our team had published two evidence-based studies on the anatomical variations involving the brachial plexus, therefore the aim of this study was to analyze the findings regarding the infraclavicular part of the brachial plexus with the use of meta-analytic techniques to complete the comprehensive series., Material and Methods: Major scientific databases were extensively searched to compile anatomical studies investigating the morphology of the infraclavicular part of the brachial plexus. Extracted data were classified based on our proposed classification system and subsequently analyzed with the use of random effects meta-analysis to state the pooled prevalence estimates of the distinct variation patterns., Results: A total of 75 studies (4772 upper limbs) were selected for the meta-analysis. The branches of the lateral cord, including the lateral pectoral nerve and musculocutaneous nerve, resembled their usual origin in 76.8% (95% CI 50-96%) and 98.8% (95% CI 98-100%), respectively. The medial pectoral nerve, medial brachial cutaneous nerves, medial antebrachial cutaneous nerve and ulnar nerve emerging from the medial cord were observed originating from their usual origins in 90.9% (95% CI 68-100%), 90.7% (95% CI 73-100%), 87.9% (95% CI 67-99%) and 97.7% (95% CI 94-100%), respectively. Lastly, nerves branching from the posterior cord, including the superior and inferior subscapular nerves, thoracodorsal nerve, axillary nerve and radial nerve, originated as per textbook description in 90.7% (95% CI 80-98%), 76.1% (95% CI 61-89%), 90.1% (95% CI 84-95%), 79.8% (95% CI 68-90%) and 99.0% (95% CI 96-100%), respectively. Moreover, the usual origin of the median nerve from the lateral and medial cord via the corresponding roots was encountered in 89.7% (95% CI 84-95%) of cases., Conclusions: The nerves originating from the infraclavicular part of the brachial plexus exhibit a wide spectrum of possible origins. However, the usual patterns were significantly the most common types present in more than three quarters of cases. Especially clinicians might profit from the enhanced understanding of the brachial plexus anatomy presented herein, since we offer a strong guide for handling the anatomically challenging pathologies in this specific area., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier GmbH. All rights reserved.)

The anatomy of the biceps brachii muscle has been a subject of interest to many researchers. In particular, the presence of one or more accessory heads has been reported to be the most common variation of the biceps brachii muscle. In fact, contemporary knowledge is quite inconsistent and lacks a definitive summary. Taking this into account, the present study aims to investigate the overall prevalence of the accessory heads and related questions, such as their broad morphological features, population variance, sexual dimorphism, side distribution or the changes in prevalence rates over time. A literature search of major scientific databases was conducted and produced 78 eligible articles, including 10,603 upper limbs, for our study. Relevant data were extracted and consequently analysed with the use of random-effects meta-analysis. As a result, the accessory heads occur with an overall prevalence of 9.6% (95% CI 8-11%) and by far the most common is the presence of a single accessory head (8.4%; 95% CI 7-10%). Additional sub-analyses revealed that accessory heads appear more frequently unilaterally and in males. Differences between the occurrence on the right or left side were not significant. Moreover, a decreasing trend in prevalence rates over time was observed, pointing towards an evolutionary adaptation. The innervation and blood supply of the accessory heads are nearly identical to that of the normal biceps brachii muscle. Although the accessory heads are usually asymptomatic, their potential presence must be kept in mind while interpreting various conditions. In addition, their direct clinical importance is speculated and is thought that they might be conductive to several pathological processes around the shoulder girdle and brachial region. While many of the morphological and morphometric aspects of the accessory heads are well documented, their functional value is still a matter for future investigations., (© 2022 Anatomical Society.)

Introduction: The goal of this study was to investigate prevalence and morphometric parameters of pubic ligaments and the interpubic disk and its cavity using imaging methods for use in clinical medicine., Methods: Pubic symphysis morphology was investigated in 652 patients (348 women and 304 men), from which 449 CT scans and 203 MR scans were available. The average age of men was 48 years and women 39 years. Investigated parameters included dimensions of the interpubic disk, visibility and width of the reinforcing ligaments, and visibility, dimensions, and location of the symphysial cavity. The results were compared with MR scans of 20 healthy volunteers and 21 dissected anatomic specimens., Results: The craniocaudal, ventrodorsal, and mediolateral diameters of the pubic disk were 36 to 37.7, 14.8 to 15.2, and 2.2 to 4.2 mm in women and 42 to 42.3, 18.6 to 19, and 2.4 to 4.5 mm in men, respectively. Higher age correlated with shorter mediolateral diameter and larger craniocaudal and ventrodorsal diameters. The superior pubic ligament was visible in 93.1% of men (1.44 mm thick) and in 100% of women (1.7 mm); the inferior pubic ligament in 89.7% of men (1.74 mm) and 88% of women (1.95 mm), the anterior pubic ligament in 96.6% of men (1.5 mm) and 82% of women (1.34 mm); and the posterior pubic ligament in 65.5% of men (1.18 mm) and 63.7% of women (0.83 mm). A symphysial cavity was found in 24% of men and 22.9% of women, with craniocaudal, ventrodorsal, and mediolateral dimensions of 13, 10.7, and 3.2 mm in men and 9.5, 10.7, and 3 mm in women, respectively., Conclusion: The presented morphologic parameters provide an anatomic reference for diagnostics of pathologic conditions of the pubic symphysis. The following anatomic structures should be added to the official anatomic terminology: symphysial cavity (cavitas symphysialis), retropubic eminence (eminentia retropubica), anterior pubic ligament (ligamentum pubicum anterius), and posterior pubic ligament (ligamentum pubicum posterius)., Level of Evidence: II-III., (Copyright © 2022 by the American Academy of Orthopaedic Surgeons.)

Competing Interests: Conflict of Interest None declared.