The significance of the clavicle on shoulder girdle function

Opportunities and pitfalls of social media research in rare genetic diseases: a systematic review

PURPOSE

Social media may be particularly valuable in research in rare genetic diseases because of the low numbers of patients and the rare disease community's robust online presence. The goal of this systematic review was to understand how social media is currently used in rare disease research and the characteristics of the participants in these studies.

METHODS

We conducted a systematic review of six databases to identify studies published in English between January 2004 and November 2020, of which 120 met inclusion criteria.

RESULTS

Most studies were observational (n = 114, 95.0%) and cross-sectional (n = 107, 89.2%), and more than half (n = 69, 57.5%) utilized only surveys. Only 101 rare diseases were included across all studies. Participant demographics, when reported, were predominantly female (70.1% ± 22.5%) and white (85.0% ± 11.0%) adult patients and caregivers.

CONCLUSION

Despite its potential benefits in rare disease research, the use of social media is still methodologically limited and the participants reached may not be representative of the rare disease population by gender, race, age, or rare disease type. As scholars explore using social media for rare disease research, careful attention should be paid to representativeness when studying this diverse patient community.

Vascularized Clavicular Bone With Supraclavicular Artery Island Flap for Oromandibular Reconstruction

OBJECTIVE

To explore the feasibility of an original surgical technique for head and neck oncologic reconstruction utilizing a pedicled osteocutaneous supraclavicular artery island flap (SCAIF) in a cadaver model.

METHOD

Cadaver dissection, Review of literature.

DESCRIPTION

Two fresh frozen cadavers, 1 male and 1 female, were used for the dissection. Prior to dissection, measurements were taken on length of clavicle and distance between clavicular articulations and mandibular landmarks with the head in a neutral position. The SCAIF flap was raised in a subfascial plane and a 4.0 cm partial thickness clavicular bone graft was harvested attached to the flap. The pedicle was identified and the length of the supraclavicular artery was noted. The skin paddle was tunneled into the floor of mouth and the bone was placed into a pre-cut 4.0 cm mandibular body defect and fixated with a 1.7 mm Stryker mandibular reconstruction plate.

RESULTS

The male cadaver clavicle measured 16.4 cm in length. The distance from the sternoclavicular joint (SC) to the angle and symphysis of the mandible was 15.3 cm and 15.0 cm, respectively. In this cadaver, the bony graft and the vascular pedicle was not of sufficient length to reach the mandibular defect after tracing the vascular pedicle to the thyrocervical trunk (TCT), which was 13.3 cm from the mandibular angle (MA). The female cadaver had an average clavicular length of 15.0 cm, SC to angle 10.5 cm and SC to symphysis 8.1 cm. The bony graft and the vascular pedicled effortlessly reached without tension, with TCT only 7.8 cm from the MA and allowed sufficient bone graft mobility for plating.

CONCLUSION

In this cadaveric model, a novel approach utilizing an osteocutaneous SCAIF was shown as a feasible reconstruction option for oromandibular defects in selected patients. This technique is limited by the anatomical relationship between the neck and vascular pedicle length. Viability could be determined by pre-operative measurements, where the clavicular length should be significantly greater than the distance from SC to MA.

The morphometric anatomy of the delto-fulcral triangle: A 3D CT-based reconstruction study

This study introduced the new delto-fulcral triangle (DFT), the first anatomical model of its kind. As seen from the orthopaedician's supraspinatus-outlet view, the antero-superior point of the coracoid process along with the lateral- and posterior-most acromial landmarks form the boundaries of the DFT. Since these osseous scapular landmarks accounted for both dynamic and static stabilisers of the glenohumeral joint, knowledge of the anatomical features of the DFT may prove beneficial to the orthopaedic surgeon. This study thus aimed to investigate the morphometry of the new DFT. The bony surfaces of one-hundred and sixty-nine (n = 169) normal and pathological (Omarthrosis and Cuff-Tear Arthropathy) shoulders from the hospital's CT scan database were reconstructed (Mimics^®: Materialise, Leuven, Belgium). Statistical significance was observed between all three groups for Side 2 (LACPF: distance between most lateral and most posterior points of the acromion) and angles α (angle between sides 1 and 3) and β (angle between sides 1 and 2) of the DFT. It was postulated that although pathological cases present with a smaller lateral acromial distance (LACPF), their lateral acromion landmark is more posteriorly placed from the scapular plane than that of a normal case. As the aspects of the morphometric anatomy of the DFT presented with levels of statistical significance, it may provide a means to evaluate the anatomy of normal and pathological cases. Additionally, the three osseous scapular landmarks that create the DFT are clearly visualised and palpable, therefore they are easily reproducible from both X-ray images and CT scans.