Graphic Representation of Intraosseous and Extraosseous Talus Blood Supply. Illustrated Anatomy

BACKGROUND

The vascular anatomy of the talus attracts intense research being not always easy to understand. The high intraosseous variability together with the anatomical characteristics makes some areas of the talus more prone to vascular compromise. The aim of this study is to describe the vascularization of the talus, both intraosseous and extraosseous.

MATERIAL AND METHODS

From the literature reviewed, we have developed a graphic scheme that allows easy observation of the irrigation distribution. To this end, nineteen anatomical dissections of human cadaveric feet have been carried out. Fifteen fresh-frozen slices have been cut in different planes and prepared using the modified Spalteholz technique and latex injection with blue and black ink to visualize the vascular network. In addition, the study has been complemented with a comprehensive literature review on this subject.

RESULTS

The findings allowed us to conclude that the posterior tibial artery provides the most important blood supply to the neck and body of the talus through the tarsal canal artery and the deltoid branch. The anterior tibial artery splits in the dorsal pedis artery, for the head and neck, and the lateral tarsal artery which throughout anastomoses breeds the tarsal sinus artery. The perforating peroneal artery branches out from the peroneal artery, creating an intraosseous anastomosis for the body and the posterior process.

CONCLUSION

The results obtained have contributed to develop a graphical representation that we present in this study, which allows a simple understanding of the intraosseus and extraosseus vascularization of the talus.

Flexor carpi radialis brevis. Implicaciones clínicas

El Flexor Carpi Radialis Brevis (FCRB) es un músculo accesorio, presente en el 2.9% de la población. Con un vientre muscular localizado en el plano más profundo del tercio distal del antebrazo y un tendón distal insertado en la cara anterior de la base del segundo metacarpiano, este músculo accesorio potencia la acción del Flexor Carpi Radialis Brevis. Proximalmente, el FCRB puede originarse en el borde lateral de la epífisis del radio (FCRB largo) o en la cara anterior de la metáfisis distal del radio ocupando el espacio donde normalmente se inserta la porción superficial del músculo Pronator Quadratus (FCRB corto). La presencia de un FCRB largo apenas tiene implicaciones clínico-quirúrgicas. El FCRB corto, en cambio, se acompaña de una serie de cambios morfológicos locales que pueden confundir al cirujano en su abordaje palmar a la epífisis distal del radio. En este artículo se describe un caso de FCRB corto, hallado en el curso de una disección anatómica y se revisa la literatura a fin de conocer la incidencia e implicaciones clínicas de esta variante muscular.

A possible mechanism of direct injury to the EPL tendon at Lister's tubercle during falls with the wrist fully extended

We present three cases of pathology of the extensor pollicis longus tendon at the level of Lister's tubercle after falls with the wrist fully extended. A small anatomical study demonstrates the possibility of the base of the third metacarpal impacting this area in hyperextension. This mechanism of injury to the tendon may explain the clinical findings.

Variaciones anatómicas de la muñeca y mano en imágenes

Dada la complejidad de la cirugía en la mano y la frecuente aparición de variaciones anatómicas en este territorio, que se apartan de las descripciones de los clásicos atlas o libros de texto, pretendemos mostrar en imágenes y describir distintas variaciones anatómicas de la muñeca y mano en disecciones realizadas y fotografiadas durante los últimos 10 años en la sala de disección del Departamento de Anatomía y Embriología Humana (Facultad de Medicina, Universidad de Barcelona) en 100 especímenes. Las variaciones se han clasificado según su componente anatómico: arterias, nervios, tendones y músculos. Se ha realizado una descripción breve de la variación. La intención es llamar la atención sobre la posibilidad de la existencia de variaciones anatómicas a nivel de los diferentes componentes de la mano, para así evitar posibles lesiones durante los abordajes de la muñeca y de la mano.

Superior gluteal nerve: safe area in hip surgery

Injuries to the superior gluteal nerve are very bad complications in hip surgery. An exact knowledge of its course may be helpful in avoiding such problems. Nineteen half pelvises from ten male and female adult cadavers were dissected. Dissections revealed that the nerve divided into two (89.48%) or three (10.52%) branches after leaving the pelvis. The more caudal branch was responsible for innervation of tensor fascia latae. The distance and the angle from the entry points of all branches of the superior gluteal nerve into the deep surface of the gluteus medium and minimus muscles to the mid-point of the superior border of the greater trochanter were measured. The branch that innerved the tensor fascia latae was also followed. These data were subjected to several statistical tests. Based on these findings, and in order to prevent nerve damage, we propose to define a 2-3 cm safe area above the great trochanter.

The axillopectoral muscle (of Langer): report of three cases

The axillopectoral muscle, usually called Langer's axillary arch instead of Langer's arm arch, is a supernumerary muscle and is the principal anatomic variation of the axilla. Three cases of the muscle were observed originating from latissimus dorsi crossing over the axillary neurovascular bundle and inserting deep to the insertion of pectoralis major or into the coracoid process. Clinicians should be aware of its existence as it can give rise to different pathologies. It should be recognised and excised to expose the axillary artery and vein in patients with trauma and to perform axillary lymphadenectomy or axillary bypass. It should be considered in the differential diagnosis of axillary masses or in a history of intermittent axillary vein obstruction. If the muscle causes problems its excision should be curative.

Subclavius posticus muscle: supernumerary muscle as a potential cause for thoracic outlet syndrome

During routine dissection a subclavius posticus muscle was found on the left side of a male cadaver. This muscle arose from the upper margin of the scapula and transverse scapular ligament, inserted in the superior side of the first rib cartilage, and was innervated by a small branch from the suprascapular nerve. The anatomical relationships of the supernumerary muscle with the brachial plexus and the subclavian artery is suggestive of a possible cause of the thoracic outlet syndrome and therefore of clinical significance.