Aims. Despite the expansion of arthroscopic surgery of the shoulder,
the open deltopectoral approach is increasingly used for the fixation
of fractures and arthroplasty of the shoulder. The
The piriformis muscle is an important landmark
in the surgical
Anterior cruciate ligament (ACL) reconstruction
is commonly performed and has been for many years. Despite this, the
technical details related to ACL anatomy, such as tunnel placement,
are still a topic for debate. In this paper, we introduce the flat
ribbon concept of the
The COVID-19 pandemic necessitated a pivot to online learning for many traditional, hands-on subjects such as
Novel immersive virtual reality (IVR) technologies are revolutionizing medical education. Virtual
Novel immersive virtual reality (IVR) technologies are revolutionizing medical education. Virtual
Introduction. Tibial nerve
Aims. The aim of this study was to compare robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) in order to determine the changes in the
Diagnostic interpretation error of paediatric musculoskeletal (MSK) radiographs can lead to late presentation of injuries that subsequently require more invasive surgical interventions with increased risks of morbidity. We aimed to determine the radiograph factors that resulted in diagnostic interpretation challenges for emergency physicians reviewing pediatric MSK radiographs. Emergency physicians provided diagnostic interpretations on 1,850 pediatric MSK radiographs via their participation in a web-based education platform. From this data, we derived interpretation difficulty scores for each radiograph using item response theory. We classified each radiograph by body region, diagnosis (fracture/dislocation absent or present), and, where applicable, the specific fracture location(s) and morphology(ies). We compared the interpretation difficulty scores by diagnosis, fracture location, and morphology. An expert panel reviewed the 65 most commonly misdiagnosed radiographs without a fracture/dislocation to identify normal imaging findings that were commonly mistaken for fractures. We included data from 244 emergency physicians, which resulted in 185,653 unique radiograph interpretations, 42,689 (23.0%) of which were diagnostic errors. For humerus, elbow, forearm, wrist, femur, knee, tibia-fibula radiographs, those without a fracture had higher interpretation difficulty scores relative to those with a fracture; the opposite was true for the hand, pelvis, foot, and ankle radiographs (p < 0 .004 for all comparisons). The descriptive review demonstrated that specific normal
Diagnostic interpretation error of paediatric musculoskeletal (MSK) radiographs can lead to late presentation of injuries that subsequently require more invasive surgical interventions with increased risks of morbidity. We aimed to determine the radiograph factors that resulted in diagnostic interpretation challenges for emergency physicians reviewing pediatric MSK radiographs. Emergency physicians provided diagnostic interpretations on 1,850 pediatric MSK radiographs via their participation in a web-based education platform. From this data, we derived interpretation difficulty scores for each radiograph using item response theory. We classified each radiograph by body region, diagnosis (fracture/dislocation absent or present), and, where applicable, the specific fracture location(s) and morphology(ies). We compared the interpretation difficulty scores by diagnosis, fracture location, and morphology. An expert panel reviewed the 65 most commonly misdiagnosed radiographs without a fracture/dislocation to identify normal imaging findings that were commonly mistaken for fractures. We included data from 244 emergency physicians, which resulted in 185,653 unique radiograph interpretations, 42,689 (23.0%) of which were diagnostic errors. For humerus, elbow, forearm, wrist, femur, knee, tibia-fibula radiographs, those without a fracture had higher interpretation difficulty scores relative to those with a fracture; the opposite was true for the hand, pelvis, foot, and ankle radiographs (p < 0 .004 for all comparisons). The descriptive review demonstrated that specific normal
Introduction. The treatment of posterior malleolar fractures is developing. Mason and Molloy (Foot Ankle Int. 2017 Nov;38(11):1229-1235) identified only 49% of posterior malleolar rotational pilon type fractures had syndesmotic instabilities. This was against general thinking that fixation of such a fragment would stabilize the syndesmosis. Methods. We examined 10 cadaveric lower limbs that had been preserved for dissection at the Human
Introduction. The constitutional knee
Introduction. Variation in resection thickness of the femur in Total Knee Arthroplasty (TKA) impacts the flexion and extension tightness of the knee. Less well investigated is how variation in patient
Primary total hip replacement (THR) in patients with abnormal/altered proximal femoral
Degeneration of the intervertebral disc (IVD), and subsequent low back pain, is an almost inevitable cause of disability. The underlying mechanisms are complex and current therapeutic strategies mainly focus on symptomatic relief rather than on the intrinsic regeneration of the IVD. This talk will provide an overview of special anatomical features and the composition of the IVD as well as its cellular microenvironment. Selected promising conceptional regenerative approaches will be discussed.
Introduction. The equine SDFT tendon is a complex hierarchal structure that transmits force from muscle to bone and stores energy through its stretching and recoiling action. It is a common site of pathology in athletic horses. Our aim was to describe the ultrastructural
Aims. Restoring the pre-morbid
There is an increasing acceptance that the clinical outcomes following posterior malleolar fractures are less than satisfactory. Current ankle classification systems do not account for differences in fracture patterns or injury mechanisms, and as such, the clinical outcomes of these fractures are difficult to interpret. The aim of this study was to analyse our posterior malleolar fractures to better understand the
Purpose. Clavicular
The inferior gluteal artery is described in standard
Background. Degeneration of the shoulder joint is a frequent problem. There are two main types of shoulder degeneration: Osteoarthritis and cuff tear arthropathy (CTA) which is characterized by a large rotator cuff tear and progressive articular damage. It is largely unknown why only some patients with large rotator cuff tears develop CTA. In this project, we investigated CT data from ‘healthy’ persons and patients with CTA with the help of 3D imaging technology and statistical shape models (SSM). We tried to define a native scapular
Background: To stimulate a debate as to whether neurological compromise as a result of spinal instrumentation is the result of direct or indirect cord injury of more the result of cord ischaemia due to the highly abnormal vascular
Despite the expansion of arthroscopic surgery
of the shoulder, the open deltopectoral approach to the shoulder
is still frequently used, for example in fracture fixation and shoulder
replacement. However, it is sometimes accompanied by unexpected
bleeding. The cephalic vein is the landmark for the deltopectoral
interval, yet its intimate relationship with the deltoid artery,
and the anatomical variations in that structure, have not previously been
documented. In this study the vascular
Introduction: Due to the diversity of the prosthetic implants for hip arthroplasty, a better matching between the implant and the intra and extra-medullary characteristic of the patient
Introduction. The aim of this study is to better understand the
Purpose: The
We studied the
Introduction. According to the literature, the gait does not return to normal after THA. However, the three-dimensional hip
Recently, gender-specific designs of total knee replacement have been developed to accommodate anatomical differences between males and females. We examined a group of male and female distal femora matched for age and height, to determine if there was a difference in the aspect ratio (mediolateral distance versus anteroposterior distance) and the height of the anterior flange between the genders. The Hamann-Todd Collection provided 1207 skeletally mature cadaver femora. The femoral length, the anteroposterior height, height of the lateral and medial flanges and the mediolateral width were measured in all the specimens. The mechanical axis of the femur, the cut articular width and the aspect ratio were assessed. Statistical analysis of the effect of gender upon the aspect ratio and the lateral and medial flanges was undertaken, controlling for age, height and race. The mean aspect ratio of male femora was 1.21 (. sd. 0.07) and of female femora it was 1.16 (. sd. 0.06) (p <
0.001). There was no significant difference between male and female specimens in the mean size of the lateral flange (6.57 mm (. sd. 2.57) and 7.02 mm (. sd. 2.36), respectively; p = 0.099) or of the medial flange (3.03 mm (. sd. 2.47) and 3.56 mm (. sd. 2.32), respectively; p = 0.67). Future work in the design of knee prostheses should take into account the overall variability of the
Shoulder Arthroscopy techniques may pose surgical risk to vascular structures that may cause active bleeding during surgery. The vascularity of the subacromial structures showed constant patterns of distribution and specific sources of bleeding were analyzed. Knowledge of the vascular
Introduction: morphological analysis of the general shape of the bones and of their particular variations according to the patient age, gender and pathology is an important step to improve the orthopedic management. We aimed to performed a gender specific analysis of the bi and tridimensional
Introduction: The importance of isolated gastrocnemius contracture in disorders of the foot and ankle has been established in recent years. The aim of this study is to describe the proximal anatomical approach to the medial and lateral heads of gastrocnemius and to compare the sizes of the medial and lateral heads of the gastrocnemius. Method: 15 cadaveric knees were dissected using a posterior approach 1cm below the level of the skin crease. Proximity of cutaneous nerves and major vessels was noted. The heads of the gastrocnemius were dissected from their origin and the cross sectional
The effect of rheumatoid arthritis on the
In this case report a four-year-old girl with ulnar dimelia is described. She had six digits without mirror symmetry in her right hand. The first pre-axial digit was excised and true pollicisation performed for the second pre-axial digit. The arterial
Purpose:. To determine the insertion of the different layers of the rotator cuff and apply it to rotator cuff tears. Anatomical insertion of the rotator cuff holds the key to a proper anatomical repair. Method:. A study of the rotator cuff insertion was done in conjunction with MSc student department
Acetabular bone structure is not the same in all patients and can be defined by the radiolucent triangle superior to the acetabulum. We ask if the acetabular
A good understanding of musculoskeletal pathologies not only requires a good knowledge of normal human
Humeral head size is defined by the radius of curvature and the thickness of the articular segment. This ratio of radius to thickness is within a narrow range with an average of 0.71. The articular surface of the normal humeral head measured within the AP plane is defined by three landmarks on the non-articular surface of the proximal humerus. The perfect circle concept can be applied for assessment of the anatomic reconstruction of the post-operative x-rays and more importantly can be used intra-operatively as a guide when choosing the proper prosthetic humeral head component. The humeral head is an elliptical shape with its AP dimension being approximately 2 mm less than the SI dimension. This shape contributes to the roll and translation of the normal shoulder but is not replicated by the spherical shape of the prosthetic humeral head. The glenoid vault has a consistent 3D shape and use of the vault model within 3D planning software can define the patient's pre-morbid
We hypothesized that the finger extensor mechanism has attachments along the dorsal surface of the entire length of the proximal phalanx and that this
We dissected 20 cadaver hips in order to investigate the
Introduction. The rabbit common calcanean (Achilles) tendon is a compound apparatus frequently used in studies considering novel interventions to facilitate tendon regeneration. These studies often employ complete surgical transection of the apparatus. Due consideration of the translational relevance to human tendinopathy is often lacking and refinement of this injury model, consistent with the principles of the 3Rs, has not been forthcoming. Materials and Methods. Wild rabbit cadavers (n=10) were obtained from a licensed game dealer. For gross
Purpose. The purpose of this study was to determine whether intra-operative identification of osseous ridge
Various classifications of scaphoid fractures have been based on plain radiography, but there are difficulties in defining the actual fracture line without an appreciation of the three-dimensional
Problem-based learning medical courses are now in the majority in the UK. This type of teaching, based on research by Barrow in the 1960s, seeks to integrate basic sciences and clinical teaching, leading to the acquisition of an integrated knowledge base that is readily recalled and applied to the analysis and solution of problems. We noticed an apparent difference in the core anatomical knowledge in a group of 4th year medical students during their orthopaedic placement, some of whom had been taught a traditional course and some a PBL course. We set out to quantify this difference. 60 simple
We carried out a cadaver study of 16 iliolumbar veins in order to define the surgical
Correct positioning of the femoral component in resurfacing hip arthroplasty (RHA) is an important factor in successful long-term patient outcomes. Computer-assisted navigation (CAS) shows potential to improve implant positioning and possibly prolong survivorship in total hip and knee arthroplasty. The purposes of CAS systems in resurfacing the femoral head are to insert the femoral head and neck guide wire with greater accuracy and to help in sizing the femoral component, thus reducing the risk of notching of the head and neck junction. Several recent studies reported satisfactory precision and accuracy of CAS in RHA. However, there is little evidence that computer navigation is useful in the presence of anatomical deformities of the proximal femur, which is frequently observed in young patients with secondary degenerative joint disease. The purpose of this in-vitro study was to determine the accuracy of an image-free resurfacing hip arthroplasty navigation system in the presence of two femoral deformities: pistol grip deformity of the head and femoral neck junction and slipped upper femoral epiphysis deformity. An artificial phantom leg with a simulated hip and knee joint was constructed from machined aluminum. Implant-shaft angles for the guide wire of the femoral component reamer were calculated, in frontal and lateral planes, with both a computer navigation system and an electronic caliper combined with micro-CT. With normal
The restoration of pain-free stable function in gleno-humeral arthritic cases in various situations such as rotator cuff deficiency, old trauma and failed total shoulder arthroplasty is a challenging clinical dilemma. The Bayley-Walker shoulder has been designed specifically for very difficult cases where surface replacement devices do not provide sufficient stability. This device is a fixed-fulcrum reversed
Purpose. Intramedullary fixation of clavicle fractures requires an adequate medullary canal to accommodate the fixation device used. This computer tomography anatomical study of the clavicle and its medullary canal describes its general
The primary source for the blood supply of the head of the femur is the deep branch of the medial femoral circumflex artery (MFCA). In posterior approaches to the hip and pelvis the short external rotators are often divided. This can damage the deep branch and interfere with perfusion of the head. We describe the