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Building a vertebra: Development of the amniote sclerotome. J Morphol 2024; 285:e21665. [PMID: 38100740 DOI: 10.1002/jmor.21665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/13/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
In embryonic development, the vertebral column arises from the sclerotomal compartment of the somites. The sclerotome is a mesenchymal cell mass which can be subdivided into several subpopulations specified by different regulatory mechanisms and giving rise to different parts of the vertebrae like vertebral body, vertebral arch, ribs, and vertebral joints. This review gives a short overview on the molecular and cellular basis of the formation of sclerotomal subdomains and the morphogenesis of their vertebral derivatives.
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Thumb Metacarpophalangeal Joint Kinematics and Elongation of the Ulnar Collateral Ligament. J Hand Surg Am 2024; 49:8-14. [PMID: 37978963 DOI: 10.1016/j.jhsa.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/23/2023] [Accepted: 10/04/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE The purpose of the study was to determine if the sphericity of the thumb metacarpophalangeal (MCP) joint influences the joint's rotational axis (RA) and elongation patterns of the ulnar collateral ligament (UCL). METHODS Ulnar collateral ligament origins and attachments of 28 fresh-frozen cadaveric thumbs were marked with a radiopaque marker. Lateral radiographs were obtained in neutral and 20°, 40°, and 60° of flexion. The dorsal and palmar joint gap and the length of four different UCL portions were digitally measured in all flexion states. The RA was determined by the intersection of the midshaft axis of the proximal phalanx in neutral and flexion states. Sphericity of the MCP joint was assessed using morphometric parameters. Joints were grouped as round or flat. Differences in all measured parameters between groups were analyzed. RESULTS During flexion, the dorsal joint gap increased by 322% in flat joints and 163% in round joints. The palmar joint gap decreased to 45% in flat joints and to 87% in round joints. The RA was at 29% of metacarpal height and 96% of metacarpal length in flat joints and at 40% of height and 86% of length in round joints. Maximum UCL elongation (111%) was noted at 40° flexion in the dorsal proper UCL in flat joints and at 60° flexion in the accessory UCL (117%) in round joints. CONCLUSIONS In flat MCP joints, the RA is more dorsal and distal in the metacarpal head compared to round joints, resulting in a hinged flexion motion. Elongation of the UCL is highest at end flexion in round joints and highest at midflexion in flat joints. CLINICAL RELEVANCE The different kinematics of flat and round MCP joints may contribute to the understanding of the pathophysiology of UCL ruptures. The propensity of this injury and the position in which they occur may be affected by the MCP joint morphology.
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Morphometrics of the coronoid process and the radial notch of the ulna: implications for fracture assessment. Surg Radiol Anat 2023; 45:1587-1592. [PMID: 37837464 PMCID: PMC10625508 DOI: 10.1007/s00276-023-03249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/25/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE A comprehensive analysis of the morphology of fractures of the coronoid process (CP) can aid diagnosis and guide treatment. The involvement of the radial notch of the ulna (RN)-e.g., in anterolateral facet fractures and transverse fractures of the CP-may influence the biomechanical conditions of the proximal radioulnar joint. However, the morphometric relation between the CP and the RN and the extent to what the proximal radioulnar joint can be affected in these types of fractures is unknown. METHODS A total of 113 embalmed, cadaveric ulnae were dissected. All soft tissue was removed. Strictly lateral, high-resolution photographs were taken and digitally analyzed. The height of the CP and its relation to the RN was measured. Sex differences and correlations between measured parameters were calculated. RESULTS Mean height of the CP was 16 mm (range: 12-23 mm; SD: 2). Mean height of the RN was 16 mm (11-25 mm; 2.2). The 50% mark of the CP corresponded to 18% (0-56%; 11.2) of the height of the RN. No significant differences were found between male and female specimens. CONCLUSION The RN of the ulna extends only to a small part to the CP. Transverse or anterolateral fractures of less than 50% of the coronoid process may involve only a small portion of the proximal radioulnar joint.
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Thumb metacarpophalangeal joint morphology and reconstruction of the ruptured ulnar collateral ligament. J Hand Surg Eur Vol 2023; 48:768-772. [PMID: 37005740 DOI: 10.1177/17531934231164260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Studies on graft reconstruction techniques for ruptured thumb metacarpophalangeal (MCP) ulnar collateral ligaments (UCL) do not consider the variety of MCP joint morphology. Optimal reconstruction method for flat MCP joints is therefore unclear. Twenty-four fresh-frozen, human thumbs were tested for flexion, extension and valgus stability of the MCP joint. After resection of the UCL, four reconstruction methods, differing in the metacarpal origin and phalangeal attachment, were performed on each specimen, which were then tested again in the same way. Specimens were grouped as 'round' or 'flat' depending on morphometric parameters and group differences were analysed. In flat joints, only the non-anatomical Glickel reconstruction and a modified Fairhurst reconstruction maintained normal mobility and stability. In round joints, only the Glickel reconstruction maintained normal mobility and stability. The original Fairhurst method and a modification with the origin palmar in the metacarpus were disadvantageous in both flat and round joints.
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Anatomical investigations on the upper airway in premature and newborn babies. Clin Anat 2023; 36:42-49. [PMID: 36177789 DOI: 10.1002/ca.23955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/22/2022] [Accepted: 09/21/2022] [Indexed: 12/14/2022]
Abstract
Safe intubation of newborns remains a challenge. This investigates the upper airway anatomy of (pre-)term infants was investigated to improve airway management and the development of airway devices. Angles and diameters of both oral and nasal intubation pathways of 22 cadavers of premature and term stillborn infants were measured, relative to their gestational age (GA) and tested for statistical significance. The systematic influence of sex on the distribution of values was examined. Cast models of the oral and nasal intubation pathway were (produced using a silicone dental impression material) 3D-scanned. No significant correlation with GA was seen in the angles studied. However, four distances around the hard and soft palate did show statistically significant positive correlations with GA. Regarding differences between the sexes, only the angle between the entrance of the trachea and the esophagus was greater for male cadavers. The angles of the ventilation pathway of (pre-)term infants do not depend systematically on GA. Anatomically, laryngeal masks might therefore also be well-suited ventilators for preterm infants. Alterations in the size but not the shape of laryngeal masks for small preterm infants is recommended. The data obtained may thus be used as a basis for the development of airway devices and airway simulators for medical education and clinical training.
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Development of ribs and intercostal muscles in the chicken embryo. J Anat 2022; 241:831-845. [PMID: 35751554 PMCID: PMC9358761 DOI: 10.1111/joa.13716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/06/2022] [Accepted: 06/06/2022] [Indexed: 11/27/2022] Open
Abstract
In the thorax of higher vertebrates, ribs and intercostal muscles play a decisive role in stability and respiratory movements of the body wall. They are derivatives of the somites, the ribs originating in the sclerotome and the intercostal muscles originating in the myotome. During thorax development, ribs and intercostal muscles extend into the lateral plate mesoderm and eventually contact the sternum during ventral closure. Here, we give a detailed description of the morphogenesis of ribs and thoracic muscles in the chicken embryo (Gallus gallus). Using Alcian blue staining as well as Sox9 and Desmin whole‐mount immunohistochemistry, we monitor synchronously the development of rib cartilage and intercostal muscle anlagen. We show that the muscle anlagen precede the rib anlagen during ventrolateral extension, which is in line with the inductive role of the myotome in rib differentiation. Our studies furthermore reveal the temporary formation of a previously unknown eighth rib in the chicken embryonic thorax.
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The effect of long calcar screws on the primary stability of 3-part, varus impacted proximal humeral fractures compared to short calcar screws: a real fracture simulation study. Arch Orthop Trauma Surg 2022; 143:2485-2491. [PMID: 35635575 PMCID: PMC10110638 DOI: 10.1007/s00402-022-04473-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 04/27/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Complex proximal humeral fracture ranks among the most common fracture types, especially in elderly patients. In locked plate fixation of proximal humerus fractures, the calcar is deciding for screws providing further medial column support. To date, the biomechanical effect of the length of these calcar screws is not well known. The purpose of this study was to analyze the effect of long calcar screws on fresh frozen prefractured cadaveric specimens. METHODS In the present biomechanical study, 8 pairs of cadaveric proximal humeri were fractured identically using a custom-made fracture simulator. ORIF was performed using a locking plate (PHILOS; Fa. Synthes). The specimens were tested in a biomechanical setup under increased axial load without any calcar screws installed, with short calcar screws and long calcar screws installed. Strain gages (4-wire-120 Ohm, Fa. Vishay) mounted on the locking plate were used to evaluate the fixation strain and to give an estimate for primary stability.. RESULTS The measured strain of the locking plate without calcar screws (804,64 µm/m) at maximum load (200 N) was significantly higher than with short (619,07 µm/m; p = 0.02) or long calcar screws (527,31 µm/m; p = 0.007). Additionally, strain with short calcar screws was noticeably higher in comparison to long calcar screws (619,07 µm/m vs. 527,31 µm/m; p = 0.03). CONCLUSION Use of calcar screws improves the stability of realistically impacted 3-part varus humeral fractures. Long calcar screws that are positioned as close as possible to the joint provide further primary stability compared to short calcar screws. LEVEL OF EVIDENCE Basic science study.
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Anatomic evaluation of the triceps tendon insertion at the proximal olecranon regarding placement of fracture fixation devices. Surg Radiol Anat 2022; 44:627-634. [PMID: 35301578 PMCID: PMC8960582 DOI: 10.1007/s00276-022-02921-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 03/03/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Olecranon fractures, especially with a small proximal fragment, remain a surgical challenge. Soft tissue irritation and affection of the triceps muscle bear a risk of complications. In order to find an area for a soft-tissue sparing placement of implants in the treatment of olecranon fractures, we aimed to define and measure the segments of the proximal olecranon and evaluate them regarding possible plate placement. METHODS We investigated 82 elbow joints. Ethical approval was obtained from the local ethics committee, After positioning in an arm holder and a posterior approach we described the morphology of the triceps footprint, evaluated and measured the surface area of the triceps and posterior capsule and correlated the results to easily measurable anatomical landmarks. RESULTS We found a bipartite insertional footprint with a superficial tendinous triceps insertion of 218.2 mm2 (± 41.2, range 124.7-343.2), a capsular insertion of 159.3 mm2 (± 30.2, range 99.0-232.1) and a deep, muscular triceps insertion area of 138.1 mm2 (± 30.2, range 79.9-227.5). Olecranon height was 26.7 mm (± 2.3, range 20.5-32.2), and olecranon width was 25.3 mm (± 2.4, range 20.9-30.4). Average correlation between the size of the deep insertion and ulnar (r = 0.314) and radial length (r = 0.298) was obtained. CONCLUSIONS We demonstrated the bipartite morphology of the distal triceps footprint and that the deep muscular triceps insertion area by its measured size could be a possible site for the placement of fracture fixations devices. The size correlates with ulnar and radial length.
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Abstract
INTRODUCTION Pelvic organ prolapse is a common problem in urogynecological surgery. Abdominal and laparoscopic sacrocolpopexy is currently considered to be the gold standard of treatment. The main problem remains the anatomical point of fixation as well as how sutures are placed. We evaluated the biomechanical difference between an in-line ligament suture versus an orthogonal ligament suture and a single suture versus a continuous suture at the anterior longitudinal ligament in an in-vitro, sacrocolpopexy model. METHODS Biomechanical in-vitro testing was performed on human, non-embalmed, female cadaver pelvises. An Instron test frame (tensinometer) was used for load/ displacement analysis. The average patient age was 75 years. Ligament preparation yielded 15 ligaments available for testing. Recorded parameters were the ultimate load, failure displacement, and stiffness. RESULTS This in-vitro analysis of different suturing methods showed the difference between an orthogonal and an in-line approach to be the ultimate load. Orthogonal sutures displayed an ultimate load of 80 N while in-line suturing yielded only 57 N (p < 0.05). For the anterior longitudinal ligament, this study demonstrated that continuous suture is significantly superior to a single suture regarding failure displacement (p < 0.05). CONCLUSION We established baseline biomechanical parameters for the sacrospinous ligament and anterior longitudinal ligament. An orthogonal suture is superior to an in-line suture in an in-vitro model. A continuous suture is superior to a single suture at the anterior longitudinal ligament. Clinical trials might be able to evaluate whether any clinical significance can be established from these findings.
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Finding alternative sites for intraosseous infusions in newborns. Resuscitation 2021; 163:57-63. [PMID: 33862177 DOI: 10.1016/j.resuscitation.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/17/2021] [Accepted: 04/01/2021] [Indexed: 02/04/2023]
Abstract
AIM Intraosseous (IO)-access plays an alternative route during resuscitation. Our study in preterm and term stillborns was performed to find alternative IO puncture sites beside the recommended proximal tibia. METHODS The cadavers used were legal donations. 20 stillborns (mean: 29.2weeks, IQR 27.1-39.6) were investigated. Spectral-CT were analysed to calculate the diameter and circumferences of: i) proximal humerus ii) distal femur iii) proximal tibia iv) diaphyseal tibial. Contrast medium was applied under video documentation to investigate the drainage into the vascular system. RESULTS In term newborns, diameter of the cortex of the proximal humeral head is 12.1 ± 1.8 mm, distal end of the femur 11.9 ± 3.4 mm and the proximal tibial bone 12.0 ± 2.4 mm with cross-sectional diameter of 113.5 ± 19.7 mm2, 120.6 ± 28.2 mm2 and 111.6 ± 29.5 mm2, respectively. Regarding the preterm groups, there is a strong age-related growth in diameter and cross -sectional size. The diaphyseal area is the smallest in all measured bones with an age-dependent increase and is about half of that of metaphyseal diameters (proximal and distal) and about one third of that of metaphyseal cross sectional areas. The proximal femoral head region has the largest diameter of all measured bones with an egg-shaped formation with an extensive joint capsula. All investigated metaphyseal areas lack a clearly enclosed bone marrow cavity. Infusion of contrast medium into the distal femoral end and the proximal humerus head demonstrate the drainage of contrast medium into the central venous system within seconds. CONCLUSION Proximal humeral head and distal femoral end might be alternative IO areas which may lead to further IO puncture sites in neonates.
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The role of the transversal ligament on the atlantoaxial complex - Bending forces at C1/2 flexion limits in the elderly. Clin Biomech (Bristol, Avon) 2021; 84:105329. [PMID: 33765570 DOI: 10.1016/j.clinbiomech.2021.105329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/16/2021] [Accepted: 03/16/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Biomechanical functionality as well as trauma mechanisms of the atlantoaxial complex are still an issue of controversy. The transverse atlantal ligament is the strongest stabilizator. The present study aimed to analyze the bending forces of the transverse atlantal ligament and of the base of the odontoid in elderly specimens. METHODS In this biomechanical study five cadaveric specimen with a mean age of 72 at death and bone mineral density measuring for 555.3 Hounsfield units on average were used. To analyze the strain of the transverse atlantal ligament and the dense base, strain gauges were used. A custom biomechanical setup was used to test each specimen at C1/2 flexion and the strain of the transverse atlantal ligament and the dens base (μm/m) were measured. FINDINGS In four out of five, a rupture of the transverse atlantal ligament was observed, the mean force required for the ligament to fall was 175 N (min. 99.8 N; 249.2 N; SD 64.7) by a mean strain of 2102.9 μm/m (min. 1953.5 μm/m; max. 2272.3 μm/m; SD 189.7). In one specimen with the lowest Hounsfield units (155), the dens base fractured before the transverse atlantal ligament ruptured and no strain could be measured at the transversal ligament during movement afterwards. INTERPRETATION The transverse atlantal ligament fails at an average of 175 N in the elderly, which is less than the value reported previously. In osteoporotic specimen the generated force to rupture the transverse atlantal ligament can fracture the dens itself.
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Development of the amniote ventrolateral body wall. Dev Dyn 2020; 250:39-59. [PMID: 32406962 DOI: 10.1002/dvdy.193] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 12/16/2022] Open
Abstract
In vertebrates, the trunk consists of the musculoskeletal structures of the back and the ventrolateral body wall, which together enclose the internal organs of the circulatory, digestive, respiratory and urogenital systems. This review gives an overview on the development of the thoracic and abdominal wall during amniote embryogenesis. Specifically, I briefly summarize relevant historical concepts and the present knowledge on the early embryonic development of ribs, sternum, intercostal muscles and abdominal muscles with respect to anatomical bauplan, origin and specification of precursor cells, initial steps of pattern formation, and cellular and molecular regulation of morphogenesis.
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Protein expression pattern of the molecular chaperone Mdg1/ERdj4 during embryonic development. Histochem Cell Biol 2020; 154:255-263. [PMID: 32377843 PMCID: PMC7502036 DOI: 10.1007/s00418-020-01881-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2020] [Indexed: 12/12/2022]
Abstract
The vertebrate-specific co-chaperone Mdg1/ERdj4, which is localized in the endoplasmic reticulum, controls the folding and degradation of proteins. We characterized its protein pattern during chick embryonic development. During early development, Mdg1/ERdj4 protein is present in mesenchymal and epithelial cells. In mesenchymal cells, it has a salt and pepper pattern. In contrast, during epithelial tissue differentiation, Mdg1/ERdj4 marks the basal and/or apical compartment of epithelial linings. The distinct protein pattern in epithelial tissue might point to its role in organizing and maintaining the epithelial structure. This could be achieved, e.g. by controlling folding and secretion of membrane-bound receptors or by inhibiting the IRE1α-Xbp1s-SNAI1/2-induced mesenchymalization. High Mdg1/ERdj4 protein levels are maintained in tissue with sustained secretory activity as in ependymal cells or enterocytes, substantiating its important role for secretion. We conclude that the transient elevation of Mdg1/ERdj4 protein levels controls the differentiation of epithelial linings while constitutive high levels are closely linked to secretory activity.
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Anatomical investigation of the segmental vessels for the right-sided anterior surgical approach to the thoracic spine: a human cadaver study. Surg Radiol Anat 2020; 42:961-968. [PMID: 32125486 DOI: 10.1007/s00276-020-02446-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 02/14/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Anterior surgical approaches to the thoracic spine are common procedures for the treatment of many diseases of the thoracic spine. Purpose of this anatomic study is to investigate the course of the segmental vessels of the thoracic spine for the anterior and lateral transthoracic approach from the right side. METHODS 26 formalin-fixed human cadavers (20 femaless/6 male) with an average age of 84.9 ± 8.3 (range 67-97) were included. The segmental arteries and veins of the right thoracic cavity coursing between the third and twelfth thoracic vertebral body have been investigated. To define the localization of the vessels in accordance with the associated vertebral bodies, the distance between the endplates and vessels was measured in the ventral, middle and dorsal parts. RESULTS The results of the study reveal that not only one, but also two segmental arteries and veins may course over the right hemi-vertebral body, especially in the upper and middle thoracic spine. Furthermore, in the middle and lower thoracic spine (T7-T12) the vessels course over the middle and lower third of the craniocaudal extent of the vertebral body. On the contrary, in the upper thoracic spine (T3-T6), the vessels may course over the entire extent of the vertebral body. CONCLUSION Due to these common anatomic variations and variability of the course of the segmental vessels, spinal surgeons should remain careful in the identification of the segmental vessels in order to minimize risk of vascular injury in case of right-sided anterior and lateral approach to the thoracic spine.
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The Radioulnar Distance at the Level of the Radial Tuberosity. Clin Anat 2019; 33:661-666. [PMID: 31576589 DOI: 10.1002/ca.23483] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/05/2019] [Accepted: 09/15/2019] [Indexed: 11/08/2022]
Abstract
Ruptures of the distal biceps brachii tendon are generally treated operatively due to their loss of supination and flexion force. A mechanical impingement at the insertion of the tendon at the radial tuberosity is discussed to play a role in the etiology of this injury. The aim of this study was to present a detailed, three-dimensional anatomical analysis of the radioulnar space at the radial tuberosity. A total of 166 imprints of the radioulnar space in neutral rotation and pronation from 84 cadaveric specimens of both arms using silicone impression material were produced for this study. Imprints were cut in slices of 3 mm and digitally measured after picture acquisition using a high-resolution digital camera. Distances were grouped into a proximal, central, and distal groups and used for correlation to morphometric data at the elbow (radial head diameter, ulna and radius length) as well as volume calculation. The mean radioulnar distance was 8.8 ± 4.0 mm in neutral rotation and 7.8 ± 3.9 mm in pronation. In pronation, the central zone was the smallest whereas in neutral rotation the proximal zone was the smallest. The volume of the radioulnar space did not reduce significantly during pronation. Little space is provided for the insertion of the distal biceps brachii tendon especially during pronation. This could play a role in the etiology of distal biceps brachii tendon ruptures and should be considered in the fixation after rupture of the tendon. Clin. Anat., 33:661-666, 2020. © 2019 Wiley Periodicals, Inc.
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Irreparable Rotator Cuff Tears: A Biomechanical Comparison of Superior Capsuloligamentous Complex Reconstruction Techniques and an Interpositional Graft Technique. Orthop J Sports Med 2019; 7:2325967119864590. [PMID: 31489328 PMCID: PMC6709439 DOI: 10.1177/2325967119864590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Irreparable rotator cuff tears lead to superior translation of the humeral
head. Numerous surgical management options are available to treat the
condition. Purpose: To compare superior capsule stability among different types of patch grafting
in irreparable rotator cuff tears. Methods: Six cadaveric shoulders were tested in a custom-designed shoulder testing
system. Superior translation of the humerus and subacromial contact pressure
were quantified in an intact condition (condition 1), after cutting the
supraspinatus tendon (condition 2), and after additionally cutting the
superior capsuloligamentous complex (condition 3). The results were compared
among 3 types of patch grafting, in which capsule reconstruction was
achieved by glenoidal 3-point (condition 4) or 2-point (condition 5)
fixation or by affixing a graft below the acromion (condition 6). Results: No significant difference in subacromial pressure was measured by
reconstruction with 2 or 3 anchors compared with conditions 1 and 2
(P > .05). However, with 3-point fixation, lower
levels of pressure were measured than with 2-point fixation. Moreover,
superior translation values were lower with 3-point fixation; the same
applied for values of the preserved capsule as compared with the torn
capsule. In condition 6, a significant increase in pressure in the neutral
position was documented (P < .05). Conclusion: The superior capsuloligamentous complex plays an important role in
stabilizing the glenohumeral joint. The results suggest that with additional
medial anchoring at the coracoid base, the depressing and centering effect
of the superior complex can probably be regained in a more physiological way
compared with a reconstructed capsule with 2 glenoid attachments or with an
interpositional graft below the acromion.
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Peroneal nerve location at the fibular head: an anatomic study using 3D imaging. Arch Orthop Trauma Surg 2019; 139:921-926. [PMID: 30737594 DOI: 10.1007/s00402-019-03141-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Injuries to the peroneal nerve are a common complication in operative treatment of proximal tibial or fibular fractures. To minimize the risk of iatrogenic injury to the nerve, detailed knowledge of the anatomy of the peroneal nerve is essential. Aim of this study was to present a detailed description of the position and branching of the peroneal nerve based on 3D-images to assist preparation for surgical approaches to the fibular head and the tibial plateau. METHODS The common peroneal nerve, the deep and the superficial peroneal nerve were marked with a radiopaque thread in 18 formalin-embalmed specimens. Three-dimensional X-ray scans were then acquired from the knee and the proximal lower leg in full extension of the knee. In 3D-reconstructions of these scans, distances of the common peroneal nerve and its branches to clearly defined osseous landmarks were measured digitally. Furthermore, the height of the branching of the common peroneal nerve was measured in relation to the landmarks. RESULTS The mean distance of the common peroneal nerve at the level of the tibial plateau to its posterior osseous limitation was 7.92 ± 2.42 mm, and 1.31 ± 2.63 mm to the lateral osseous limitation of the tibia. In a transversal plane, distance of the common peroneal nerve branching was 27.56 ± 3.98 mm relative to the level of the most proximal osseous extension of fibula and 11.77 ± 6.1 mm relative to the proximal extension of the tibial tuberosity. The deep peroneal nerve crossed the midline of the fibular shaft at a distance of 22.14 mm ± 4.35 distally to the most proximal extension of the fibula, the superficial peroneal nerve at a distance of 33.56 mm ± 6.68. CONCLUSION As the course of the peroneal nerve is highly variable in between individuals, surgical dissection for operative treatment of proximal posterolateral tibial or fibular fractures has to be done carefully. We defined an area were the peroneal nerve and its branches are unlikely to be found. However, specific safe zones should not be utilized due to the individual anatomic variation.
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Abstract
Somites are epithelial segments of the paraxial mesoderm. Shortly after their formation, the epithelial somites undergo extensive cellular rearrangements and form specific somite compartments, including the sclerotome and the myotome, which give rise to the axial skeleton and to striated musculature, respectively. The dynamics of somite development varies along the body axis, but most research has focused on somite development at thoracolumbar levels. The development of tail somites has not yet been thoroughly characterized, even though vertebrate tail development has been intensely studied recently with respect to the termination of segmentation and the limitation of body length in evolution. Here, we provide a detailed description of the somites in the avian tail from the beginning of tail formation at HH-stage 20 to the onset of degeneration of tail segments at HH-stage 27. We characterize the formation of somite compartment formation in the tail region with respect to morphology and the expression patterns of the sclerotomal marker gene paired-box gene 1 (Pax1) and the myotomal marker genes MyoD and myogenic factor 5 (Myf5). Our study gives insight into the development of the very last segments formed in the avian embryo, and provides a basis for further research on the development of tail somite derivatives such as tail vertebrae, pygostyle and tail musculature.
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Abstract
Striated muscle is the most abundant tissue in the body of vertebrates and it forms, together with the skeleton, the locomotory system required both for movement and the creation of the specific body shape of a species. Research on the embryonic development of muscles has a long tradition both in classical embryology and in molecular developmental biology. While the gene networks regulating muscle development have been discovered mostly in the mouse through genetics, our knowledge on cell lineages, muscle morphogenesis and tissue interactions regulating their formation is to a large extent based on the use of the avian model. This review highlights present knowledge of the development of skeletal muscle in vertebrate embryos. Special focus will be placed on the contributions from chicken and quail embryo model systems.
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Insertional anatomy of the anterior medial collateral ligament on the sublime tubercle of the elbow. J Shoulder Elbow Surg 2019; 28:555-560. [PMID: 30391185 DOI: 10.1016/j.jse.2018.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 07/31/2018] [Accepted: 08/05/2018] [Indexed: 02/01/2023]
Abstract
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.
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The dominant nutrient foramen at the clavicular midshaft: an anatomical study. Surg Radiol Anat 2018; 41:361-364. [DOI: 10.1007/s00276-018-2169-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
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Double electroporation in two adjacent tissues in chicken embryos. Dev Dyn 2018; 247:1211-1216. [DOI: 10.1002/dvdy.24674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/22/2018] [Accepted: 09/12/2018] [Indexed: 11/07/2022] Open
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Biomechanical Comparison of Fixation With a Single Screw Versus Two Kirschner Wires in Distal Chevron Osteotomies of the First Metatarsal: A Cadaver Study. J Foot Ankle Surg 2018; 57:95-99. [PMID: 29268910 DOI: 10.1053/j.jfas.2017.08.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Indexed: 02/03/2023]
Abstract
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.
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Anatomical investigations on intraosseous access in stillborns - Comparison of different devices and techniques. Resuscitation 2018; 127:79-82. [PMID: 29627398 DOI: 10.1016/j.resuscitation.2018.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/24/2018] [Accepted: 04/03/2018] [Indexed: 11/18/2022]
Abstract
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.
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Investigation of umbilical venous vessels anatomy and diameters as a guideline for catheter placement in newborns. Clin Anat 2017; 31:269-274. [PMID: 29044713 DOI: 10.1002/ca.22998] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 09/28/2017] [Accepted: 10/13/2017] [Indexed: 11/10/2022]
Abstract
Umbilical cord catheters (UCC) are important for the primary care of critically ill newborns. To analyze anatomical variations of the umbilical vein (UV) and its further course, we performed abdominal spiral-CT examinations on stillborns. The aim of the study was to explore the high incidence of mal-positioned UCCs and to improve their positioning. Eighteen stillborns were investigated (29.2 weeks ± 6.7 weeks (IQR)). CTs were performed using either air or contrast medium injection into the UV. We measured the diameter at the narrowest points of (i) the umbilical vein, (ii) the segmental portal vein, (iii) the left portal vein, (iv) the umbilical recess, and (v) the ductus venosus. The branching angles between (a) the umbilical vein and intrahepatic veins and (b) the ductus venosus and umbilical recess were measured. The diameter of the UV increases from 3.4 to 11 mm (median [IQR]:4.6 mm [4.2-6.9]: r2 = 0.64). The left portal vein has a larger diameter (3.6 mm [2.6-4.55]; r2 = 0.43) than the left segmental portal vein (2.3 mm [1.8-2.75]; r2 = 0.23). The diameter of the ductus venosus (2.5 mm [1.6-3.4]; r2 = 0.59) is half that of the umbilical recess (5.1 mm [3.3-6.2]; r2 = 0.43). The most obtuse angle is formed by the junction between the umbilical recess and ductus venosus (151° [133-159]; r2 = 0.001). The branch angle from the outgoing UV into the left portal vein is more obtuse (128° [123-144]; r2 = 0.0001) than that of the segmental portal vein (115° [105-119]; r2 = 0.0001). To avoid mal-positioning, our data suggest the use of a soft catheter. The UV and its extensions are wide enough to admit a 4 Fr. catheter without complete obstruction. Clin. Anat. 31:269-274, 2018. © 2017 Wiley Periodicals, Inc.
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Anastomotic patterns of the facial parotid plexus (PP): A human cadaver study. Ann Anat 2017; 213:52-61. [DOI: 10.1016/j.aanat.2017.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 06/02/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
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Concomitant injury of the annular ligament in fractures of the coronoid process and the supinator crest. J Shoulder Elbow Surg 2017; 26:604-610. [PMID: 27863927 DOI: 10.1016/j.jse.2016.09.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/28/2016] [Accepted: 09/07/2016] [Indexed: 02/01/2023]
Abstract
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.
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The pericardial reflection and the tip of the central venous catheter - topographical analysis in stillborn babies. Pediatr Radiol 2016; 46:1528-31. [PMID: 27350379 DOI: 10.1007/s00247-016-3659-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 06/15/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Central venous cannulation is widely used in neonatal critical care. Pericardial tamponade caused by vessel wall perforation can occur if the catheter tip induces extravasation at the level of the pericardium. OBJECTIVE To investigate the level of the superior pericardial reflection in stillborn babies. MATERIALS AND METHODS We dissected 20 bodies (11 female, mean gestational age 33 6/7 weeks, range 25-43 weeks), with careful opening of the thoracic area. After injecting contrast medium into the pericardial sac, we introduced a catheter through the right internal jugular vein. We then took radiographs to analyse the relationship between visual osseous landmarks and the pericardium. RESULTS Mean distance between the pericardial reflection at its upper end and the first thoracic vertebra was 1.3 cm (standard deviation [SD]: 0.3 cm) and did not extend over the 3rd intercostal space. The mean distance from the entry of the superior vena cava into the pericardial sac and the 1st thoracic vertebra was 2.3 cm (SD: 0.5). CONCLUSION The upper end of the pericardial reflection in neonates at autopsy lies below the middle of the 3rd thoracic vertebra. The tip of an upper inserted catheter should not extend below the level of the 3rd intercostal space.
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[The bare area of the proximal ulna : An anatomical study on optimizing olecranon osteotomy]. DER ORTHOPADE 2016; 45:887-94. [PMID: 27600569 DOI: 10.1007/s00132-016-3332-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Olecranon osteotomy is an established approach for the treatment of distal humerus fractures. It should be performed through the bare area of the proximal ulna to avoid iatrogenic cartilage lesions. OBJECTIVES The goal of this study was to analyze the anatomy of the proximal ulna with regard to the bare area and, thereby, to optimize the hitting area of the bare area when performing olecranon osteotomy. MATERIALS AND METHODS The bare areas of 30 embalmed forearm specimens were marked with a radiopaque wire and visualized three-dimensionally with a mobile C‑arm. By means of 3D reconstructions of the data sets, the following measurements were obtained: height of the bare area; span of the bare area-hitting area in transverse osteotomy; ideal angle for olecranon osteotomy to maximize the hitting area of the bare area; distance of the posterior olecranon tip to the entry point of the transverse osteotomy and the ideal osteotomy. RESULTS The height of the bare area was 4.92 ± 0.81 mm. The hitting area of the transverse osteotomy averaged 3.73 ± 0.89 mm. The "ideal" angle for olecranon osteotomy was 30.7° ± 4.19°. The distance of the posterior olecranon tip to the entry point was 14.08 ± 2.75 mm for the transverse osteotomy and 24.21 ± 3.15 mm for the ideal osteotomy. The hitting area of the bare area in the ideal osteotomy was enhanced significantly when compared to the transverse osteotomy (p < 0.0001). CONCLUSIONS This study provides guide values for correct osteotomy of the olecranon. Moreover, a 30° angulation of the osteotomy can significantly increase the hitting area of the bare area.
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Abstract
Development of somites leading to somite compartments, sclerotome, dermomyotome and myotome, has been intensely investigated. Most knowledge on somite development, including the commonly used somite maturation stages, is based on data from somites at thoracic and lumbar levels. Potential regional differences in somite maturation dynamics have been indicated by a number of studies, but have not yet been comprehensively examined. Here, we present an overview on the developmental dynamics of somites at occipital and cervical levels in the chicken embryo. We show that in these regions, the onset of sclerotomal and myotomal compartment formation is later than at thoracolumbar levels, and is initiated simultaneously in multiple somites, which is in contrast to the serial cranial- to- caudal progression of somite maturation in the trunk. Our data suggest a variant spatiotemporal regulation of somite development in occipitocervical somites.
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Inframammary Fold Reconstruction: A Biomechanical Analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e634. [PMID: 27257564 PMCID: PMC4874278 DOI: 10.1097/gox.0000000000000568] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 10/28/2015] [Indexed: 11/25/2022]
Abstract
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.
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Signaling filopodia in vertebrate embryonic development. Cell Mol Life Sci 2016; 73:961-74. [PMID: 26621670 PMCID: PMC11108401 DOI: 10.1007/s00018-015-2097-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/28/2015] [Accepted: 11/16/2015] [Indexed: 12/11/2022]
Abstract
Next to classical diffusion-based models, filopodia-like cellular protrusions have been proposed to mediate long range signaling events and morphogen gradient formation during communication between distant cells. An increasing wealth of data indicates that in spite of variable characteristics of signaling filopodia in different biological contexts, they represent a paradigm of intercellular crosstalk which is presently being unraveled in a growing literature. Here, we summarize recent advances in investigating the morphology, cellular basis and function of signaling filopodia, with focus on their role during embryonic development in vertebrates.
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Abstract
Introduction Pectopexy, a laparoscopic method for prolapse surgery, showed promising results in recent literature. Further improving this approach by reducing surgical time may decrease complication rates and patient morbidity. Since laparoscopic suturing is a time consuming task, we propose a single suture /mesh ileo-pectineal ligament fixation as opposed to the commonly used continues approach. Methods Evaluation was performed on human non-embalmed, fresh cadaver pelves. A total of 33 trials was performed. Eight female pelves with an average age of 75, were used. This resulted in 16 available ligaments. Recorded parameters were ultimate load, displacement at failure and stiffness. Results The ultimate load for the mesh + simplified single “interrupted” suture (MIS) group was 35 (± 12) N and 48 (± 7) N for the mesh + continuous suture (MCS) group. There was no significant difference in the ultimate load between both groups (p> 0.05). This was also true for displacement at failure measured at 37 (± 12) mm and 36 (±5) mm respectively. There was also no significant difference in stiffness and failure modes. Conclusion Given the data above we must conclude that a continuous suture is not necessary in laparoscopic mesh / ileo-pectineal ligament fixation during pectopexy. Ultimate load and displacement at failure results clearly indicate that a single suture is not inferior to a continuous approach. The use of two single sutures may improve ligamental fixation. However, overall stability should not benefit since the surgical mesh remains the limiting factor.
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Elbow Positioning and Joint Insufflation Substantially Influence Median and Radial Nerve Locations. Clin Orthop Relat Res 2015; 473:3627-34. [PMID: 26152782 PMCID: PMC4586229 DOI: 10.1007/s11999-015-4442-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 06/29/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND The median and radial nerves are at risk of iatrogenic injury when performing arthroscopic arthrolysis with anterior capsulectomy. Although prior anatomic studies have identified the position of these nerves, little is known about how elbow positioning and joint insufflation might influence nerve locations. QUESTIONS/PURPOSES In a cadaver model, we sought to determine whether (1) the locations of the median and radial nerves change with variation of elbow positioning; and whether (2) flexion and joint insufflation increase the distance of the median and radial nerves to osseous landmarks after correcting for differences in size of the cadaveric specimens. METHODS The median and radial nerves were marked with a radiopaque thread in 11 fresh-frozen elbow specimens. Three-dimensional radiographic scans were performed in extension, in 90° flexion, and after joint insufflations in neutral rotation, pronation, and supination. Trochlear and capitellar widths were analyzed. The distances of the median nerve to the medial and anterior edge of the trochlea and to the coronoid were measured. The distances of the radial nerve to the lateral and anterior edge of the capitulum and to the anterior edge of the radial head were measured. We analyzed the mediolateral nerve locations as a percentage function of the trochlear and capitellar widths to control for differences regarding the size of the specimens. RESULTS The mean distance of the radial nerve to the lateral edge of the capitulum as a percentage function of the capitellar width increased from 68% ± 17% in extension to 91% ± 23% in flexion (mean difference = 23%; 95% confidence interval [CI], 5%-41%; p = 0.01). With the numbers available, no such difference was observed regarding the location of the median nerve in relation to the medial border of the trochlea (mean difference = 5%; 95% CI, -13% to 22%; p = 0.309). Flexion and joint insufflation increased the distance of the nerves to osseous landmarks. The mean distance of the median nerve to the coronoid tip was 5.4 ± 1.3 mm in extension, 9.1 ± 2.3 mm in flexion (mean difference = 3.7 mm; 95% CI, 2.04-5.36 mm; p < 0.001), and 12.6 ± 3.6 mm in flexion and insufflation (mean difference = 3.5 mm; 95% CI, 0.81-6.19 mm; p = 0.008). The mean distance of the radial nerve to the anterior edge of the radial head increased from 4.7 ± 1.8 mm in extension to 7.7 ± 2.7 mm in flexion (mean difference = 3.0 mm; 95% CI, 0.96-5.04 mm; p = 0.005) and to 11.9 ± 3.0 mm in flexion with additional joint insufflation (mean difference = 4.2 mm; 95% CI, 1.66-6.74 mm; p = 0.002). CONCLUSIONS The radial nerve shifts medially during flexion from the lateral to the medial border of the inner third of the capitulum. The median nerve is located at the medial quarter of the joint. The distance of the median and radial nerves to osseous landmarks doubles from extension to 90° flexion and triples after joint insufflation. CLINICAL RELEVANCE Elbow arthroscopy with anterior capsulectomy should be performed cautiously at the medial aspect of the joint to avoid median nerve lesions. Performing arthroscopic anterior capsulectomy in flexion at the lateral aspect of the joint and in slight extension at the medial edge of the capitulum could enhance safety of this procedure.
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Peri-implant failure in dual plating of the distal humerus-A biomechanical analysis with regard to screw and plate positioning. Injury 2015; 46:2142-5. [PMID: 26300104 DOI: 10.1016/j.injury.2015.08.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/03/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this biomechanical study was to analyse the influence of plate and screw positioning on peri-implant failure in dual plate osteosynthesis. We hypothesized that screw positioning rather than plate configuration influences the risk of peri-implant fractures. METHODS Twenty macerated humerus specimens were available. 5 groups of 4 were built according to specimen size. Locking dual plates (Medartis, Switzerland) were randomly applied to the distal humerus of the specimens in 4 types of configuration: Bending forces were applied using a universal testing machine until peri-implant fracture occurred. RESULTS Mean failure loads for respective configuration types were as follows: P1: 428.7 (±84.2) N, A1: 410.0 (±54.7) N, A0: 297.8 (±48.3) N, P0: 261.0 (±65.0) N. Configurations with positioning of the most proximal screws at different levels (P1, A1) reached significantly higher failure loads when compared to screw placement at the same level (P0, A0) (0.01≤p≤0.03). Altering the plate configuration did not significantly influence failure loads (0.34≤p≤0.58). CONCLUSIONS The results of this study suggest that placement of the most proximal screws rather than the configuration of the plates is critical regarding the predetermined risk of peri-implant failure in dual plate osteosynthesis of the distal humerus. Varying levels of the outermost screws of corresponding double plates seem to be crucial to avoid complications related to the osteosynthesis.
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Radial nerve location at the posterior aspect of the humerus: an anatomic study of 100 specimens. Arch Orthop Trauma Surg 2015; 135:1527-32. [PMID: 26254580 DOI: 10.1007/s00402-015-2300-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Indexed: 01/04/2023]
Abstract
PURPOSE Radial neuropathy represents a devastating complication in a posterior approach to the distal humerus. This study aimed to propose "safe zones" regarding the radial nerve (RN) location at the posterior aspect of the humerus to minimize the risk of iatrogenic injury. METHODS In 100 embalmed specimens, the distances of the proximal edge of the olecranon fossa (OF) to the radial nerve at the medial edge (R1), at the center (R2) and at the lateral edge (R3) of the posterior aspect of humeral shaft were measured. Humeral length (HL) and transcondylar width (TW) were evaluated and correlated to R1, R2 and R3. RESULTS R1 was 15.0 (±2.1; 10.6-19.5) cm, R2 averaged 12.7 (±1.6; 8.9-15.7) cm, R3 was 10.6 (±1.3; 7.6-13.7) cm. HL was 30.8 (±1.9) cm. TW averaged 6.3 (±0.6) cm. TW and HL correlate with R1, R2, R3 (r = 0.451-0.565 [95% CI 0.279-0.685]). The mean ratio was 2.3 (±0.18) for HL/R1, 2.6 (±0.23) for HL/R2 and 3.1 (±0.31) for HL/R3. The ratio averaged 2.2 (±0.20) for R1/TW, 1.9 (±0.18) for R2/TW and 1.6 (±0.15) for R3/TW. CONCLUSIONS We present the OF as an osseous landmark to reduce the risk of iatrogenic radial neuropathy. HL and TW can be reliably used to estimate the RN location. The consistent "safe zones" of the RN in relation to the OF are 10.5 cm at the medial edge, 9 cm at the center and 7.5 cm at the lateral edge of the posterior aspect of the humeral shaft.
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Communication between distant epithelial cells by filopodia-like protrusions during embryonic development. Development 2015; 142:665-71. [PMID: 25617437 DOI: 10.1242/dev.115964] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Long-range intercellular communication is essential for the regulation of embryonic development. Apart from simple diffusion, various modes of signal transfer have been described in the literature. Here, we describe a novel type of cellular extensions found in epithelial cells of the somites in chicken embryos. These filopodia-like protrusions span the subectodermal space overlying the dorsal surface of the somites and contact the ectoderm. We show that these protrusions are actin- and tubulin-positive and require Rac1 for their formation. The presence of glycophosphatidylinositol-anchored proteins and net retrograde trafficking of the transmembrane Wnt-receptor Frizzled-7 along the protrusions indicate their role in signal transport and distribution. Taken together, our data suggest a role of filopodia-like protrusions in mediating signaling events between distant epithelial cells during embryonic development.
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Development of somites, muscle, and skeleton is independent of signals from the wolffian duct. Dev Dyn 2013; 242:941-8. [DOI: 10.1002/dvdy.23986] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 04/16/2013] [Accepted: 05/01/2013] [Indexed: 11/09/2022] Open
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Abstract
Secreted signaling molecules of the Wnt family have been found to play a central role in controlling embryonic development of a wide range of taxa from Hydra to humans. The most extensively studied Wnt signaling pathway is the canonical Wnt pathway, which controls gene expression by stabilizing beta-catenin, and regulates a multitude of developmental processes. More recently, noncanonical Wnt pathways, which are beta-catenin-independent, have been found to be important developmental regulators. Understanding the mechanisms of Wnt signaling is essential for the development of novel preventive and therapeutic approaches of human diseases. Limb development is a paradigm to study the principles of Wnt signaling in various developmental contexts. In the developing vertebrate limb, Wnt signaling has been shown to have important functions during limb bud initiation, limb outgrowth, early limb patterning, and later limb morphogenesis events. This review provides a brief overview on the diversity of Wnt-dependent signaling events during embryonic development of the vertebrate limb.
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Abstract
Postmitotic neurons were generated from the human NT2 teratocarcinoma cell line in a novel cell aggregate differentiation procedure. Approximately a third of the differentiated neurons expressed cell markers related to cholinergic neurotransmission. To examine whether this human cell model system can be directed toward a motoneuronal fate, postmitotic neurons were co-cultured with mouse myotubes. Outgrowing neuronal processes established close contact with the myotubes and formed neuromuscular junction-like structures that bound alpha-bungarotoxin. To determine how grafted precursor cells and neurons respond to embryonic nerve tissue, NT2 cells at different stages of neural development were injected into chick embryo neural tube and brain. Grafted NT2 neurons populated both parts of the nervous system, sometimes migrating away from the site of injection. The neural tube appeared to be more permissive for neurite extensions than the brain. Moreover, extending neurites of spinal grafts were approaching the ventral roots, thus resembling motoneuronal projections.
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Ectodermal Wnt6 is an early negative regulator of limb chondrogenesis in the chicken embryo. BMC DEVELOPMENTAL BIOLOGY 2010; 10:32. [PMID: 20334703 PMCID: PMC2859743 DOI: 10.1186/1471-213x-10-32] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Accepted: 03/25/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Pattern formation of the limb skeleton is regulated by a complex interplay of signaling centers located in the ectodermal sheath and mesenchymal core of the limb anlagen, which results, in the forelimb, in the coordinate array of humerus, radius, ulna, carpals, metacarpals and digits. Much less understood is why skeletal elements form only in the central mesenchyme of the limb, whereas muscle anlagen develop in the peripheral mesenchyme ensheathing the chondrogenic center. Classical studies have suggested a role of the limb ectoderm as a negative regulator of limb chondrogenesis. RESULTS In this paper, we investigated the molecular nature of the inhibitory influence of the ectoderm on limb chondrogenesis in the avian embryo in vivo. We show that ectoderm ablation in the early limb bud leads to increased and ectopic expression of early chondrogenic marker genes like Sox9 and Collagen II, indicating that the limb ectoderm inhibits limb chondrogenesis at an early stage of the chondrogenic cascade. To investigate the molecular nature of the inhibitory influence of the ectoderm, we ectopically expressed Wnt6, which is presently the only known Wnt expressed throughout the avian limb ectoderm, and found that Wnt6 overexpression leads to reduced expression of the early chondrogenic marker genes Sox9 and Collagen II. CONCLUSION Our results suggest that the inhibitory influence of the ectoderm on limb chondrogenesis acts on an early stage of chondrogenesis upsteam of Sox9 and Collagen II. We identify Wnt6 as a candidate mediator of ectodermal chondrogenic inhibition in vivo. We propose a model of Wnt-mediated centripetal patterning of the limb by the surface ectoderm.
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03-P040 Development of the avian aortic wall. Mech Dev 2009. [DOI: 10.1016/j.mod.2009.06.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Cystathionine gamma-lyase (CSE) is a key enzyme in the trans-sulphuration pathway for the biosynthesis of cysteine from methionine and catalyses the hydrolysis of cystathionine into cysteine. It has been reported to be expressed in mammalian liver and kidney but so far no comprehensive developmental expression analysis of CSE has been available. We cloned a 600 bp fragment of chick CSE cDNA and analysed its expression pattern during avian embryonic development until embryonic day 13. We found CSE expression in various developing organs including the notochord, eye, neural tube, limb bud mesenchyme and sclerotomal compartment of the somites. Notably, prominent expression was found in renal epithelia throughout kidney development, i.e. in the tubular structures of pronephros, mesonephros and metanephros. Our data introduce CSE as a novel marker gene to study avian kidney development.
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Abstract
The dorsal aorta is the earliest formed intraembryonic blood vessel. It is composed of an inner lining consisting of endothelial cells and an outer wall consisting of smooth muscle cells (SMCs) and fibrocytes. Aortic SMCs have been suggested to arise from several developmental lineages. Cephalic neural crest provides SMCs of the proximal part of the aorta, and SMCs of the distal part are derived from the paraxial mesoderm. Here, we show by using quail-chick chimerization that in the avian embryo, SMCs in the wall of the dorsal aorta at trunk level arise from the sclerotome. Our findings indicate a two-step process of aortic wall formation. First, non-paraxial mesoderm-derived mural cells accumulate at the floor of the aorta. We refer to these cells as primary SMCs. Second, SMCs from the sclerotome are recruited to the roof and sides of the aorta, eventually replacing the primary SMCs in the aortic floor.
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Abstract
Vasohibin is an angiogenesis inhibitor that is induced in endothelial cells in an autocrine manner. In this study, we cloned a 500-bp fragment of chick Vasohibin cDNA and analyzed its expression pattern by in situ hybridization during chick development. From HH-stage 3, expression of Vasohibin is observed in the area opaca and it is expressed throughout the primitive streak during later stages. At HH-stage 11, Vasohibin is expressed in head paraxial mesoderm, in the vitelline vein, dorsal neural tube, intermediate and lateral plate mesoderm, Wolffian duct, and blood islands at the caudal part of the embryo. In epithelial somites, expression is seen in the region around the somitocoel, and after somite maturation, expression is observed in the myotome, which becomes stronger with development. Expression is detected in fore and hind brain, also in the retina and lens vesicle of the developing eye. In the early limb bud, expression is initiated in the mesenchyme and becomes stronger during later stages. Expression in the limb mesoderm remains strong at the margins but decreases in the central mesenchyme. At day 7, expression is seen in interdigital grooves of the digits and digit-demarcating regions. During organogenesis, expression is seen in the anlagen of the esophagus, trachea, duodenum, lungs, liver, heart, and gut. Our analysis shows that Vasohibin is expressed in a wide range of tissues and organs suggesting that Vasohibin acts as a physiological regulator of vascular development during chick embryogenesis.
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Abstract
Notch and Delta signaling regulates cell-fate decisions in a variety of tissues in diverse organisms through cell-to-cell interactions. In this study we isolated a 696 bp fragment of chick Delta-like 4 (Dll4) cDNA and analyzed its expression pattern during chick development by in situ hybridization. We report a detailed description of cDll4 expression from HH-stage 8-30. Expression is seen in extraembryonic tissues and in the dorsal aorta throughout development but is absent from venules. Dll4 is expressed in the embryonic blood vessels, heart, somites, neural tube, limb, pharyngeal arches, esophagus, and in the developing eye. In accordance with the report from mice, cDll4 is a marker of the arterial type of endothelial cells. These analyses show that Dll4 is expressed in a wide range of tissues and organs suggesting its role in vascular development during chick embryogenesis.
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