Orthopaedic Center

Four patients with femoral neck fracture following healed intertrochanteric fracture were evaluated retrospectively. This situation is a rare occurrence with a current literature review documenting only 15 cases. Patient charts and radiographs were retrospectively reviewed to evaluate the period from initial injury to definitive treatment for the femoral neck fracture. Emphasis was placed on associated risk factors and operative techniques. In case i, the femoral neck fracture appeared to be clearly a traumatic fracture as it occurred 11 years after the intertrochanteric fracture. In cases 2, 3, and 4, multiple factors were believed to play a role in the generation of the femoral neck fractures, which occurred within 6 months of the original fracture. The etiology of such fractures remains speculative. All four patients were elderly, women with substantial medical comorbidities. Osteoporosis may be the most important single contributing factor to these fractures. Because management of this patient subgroup is notably more complex, surgeons need to be aware of the difficulties and prepared to deal with them.

Four patients with femoral neck fracture following healed intertrochanteric fracture were evaluated retrospectively. This situation is a rare occurrence with a current literature review documenting only 15 cases. Patient charts and radiographs were retrospectively reviewed to evaluate the period from initial injury to definitive treatment for the femoral neck fracture. Emphasis was placed on associated risk factors and operative techniques. In case i, the femoral neck fracture appeared to be clearly a traumatic fracture as it occurred 11 years after the intertrochanteric fracture. In cases 2, 3, and 4, multiple factors were believed to play a role in the generation of the femoral neck fractures, which occurred within 6 months of the original fracture. The etiology of such fractures remains speculative. All four patients were elderly, women with substantial medical comorbidities. Osteoporosis may be the most important single contributing factor to these fractures. Because management of this patient subgroup is notably more complex, surgeons need to be aware of the difficulties and prepared to deal with them.

We assessed the relationship between leg length discrepancy (LLD) and the load distribution across the sacro-iliac joint (SIJ). A finite element model of the spine-pelvis was developed with different amounts of LLD by increasing the length of the right femur in the model. Peak stresses and contact loads across the SIJ were computed for different amounts of LLD (1, 2, and 3 cm). The load and the peak stresses across the SIJ articular surfaces progressively increased with the increase in the LLD. Trying to offset the LLD surgically by lengthening of the short side, shortening or stunting the growth (epiphysiodesis) of the long side, or by shoe lifts should decrease the load across the SIJ and should theoretically decrease SIJ pain. ß

We assessed the relationship between leg length discrepancy (LLD) and the load distribution across the sacro-iliac joint (SIJ). A finite element model of the spine-pelvis was developed with different amounts of LLD by increasing the length of the right femur in the model. Peak stresses and contact loads across the SIJ were computed for different amounts of LLD (1, 2, and 3 cm). The load and the peak stresses across the SIJ articular surfaces progressively increased with the increase in the LLD. Trying to offset the LLD surgically by lengthening of the short side, shortening or stunting the growth (epiphysiodesis) of the long side, or by shoe lifts should decrease the load across the SIJ and should theoretically decrease SIJ pain. ß

The object of this study was to identify the best approach for exposing the radioulnar interosseous membrane while protecting the posterior interosseous n. (PIN). Twenty paired upper limbs were used to obtain measurements of the PIN and expose the distal two-thirds of the interosseous membrane in the forearm through a dorsoradial approach. The length of the PIN from the radial head to the arcade of Frohse (AF) was 26.5 ± 1.6 mm in males and 25.3 ± 1.1 mm in females. The length of the PIN between the radial head and the point where the PIN exits from the supinator was 66.7 ± 4.7 mm in males and 64.0 ± 2.5 mm in females. The length of the PIN covered by the supinator was 44.0 ± 0.5 mm in males and 37.0 ± 0.5 mm in females. The distance between the point where the PIN exits from the supinator and the lateral margin of the radius was 15.0 ± 0.9 mm in males and 14.5 ± 0.9 mm in females. The distance between the exit point of the PIN from the supinator and the lateral margin of the ulna was 18.2 ± 0.6 mm in males and 17.9 ± 0.7 mm in females. The distance from the point where the most lateral branch of the PIN entered the abductor pollicis longus (APL) to the lateral margin of the radius was 3.5 ± 0.5 mm. In 20 cadaveric upper limbe, the middle and distal portions of the interosseous membrane were exposed through the interval between the extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC) m., after the origine of the extensor pollicis brevis (EPB), and extensor pollicis longus (EPL) mm. had been elevated from the lateral margin of the radius. The present study suggests that usina dorsoradial approach facilitates exposure of the middle and distal portions of the interosseous membrane.

The object of this study was to identify the best approach for exposing the radioulnar interosseous membrane while protecting the posterior interosseous n. (PIN). Twenty paired upper limbs were used to obtain measurements of the PIN and expose the distal two-thirds of the interosseous membrane in the forearm through a dorsoradial approach. The length of the PIN from the radial head to the arcade of Frohse (AF) was 26.5 ± 1.6 mm in males and 25.3 ± 1.1 mm in females. The length of the PIN between the radial head and the point where the PIN exits from the supinator was 66.7 ± 4.7 mm in males and 64.0 ± 2.5 mm in females. The length of the PIN covered by the supinator was 44.0 ± 0.5 mm in males and 37.0 ± 0.5 mm in females. The distance between the point where the PIN exits from the supinator and the lateral margin of the radius was 15.0 ± 0.9 mm in males and 14.5 ± 0.9 mm in females. The distance between the exit point of the PIN from the supinator and the lateral margin of the ulna was 18.2 ± 0.6 mm in males and 17.9 ± 0.7 mm in females. The distance from the point where the most lateral branch of the PIN entered the abductor pollicis longus (APL) to the lateral margin of the radius was 3.5 ± 0.5 mm. In 20 cadaveric upper limbe, the middle and distal portions of the interosseous membrane were exposed through the interval between the extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC) m., after the origine of the extensor pollicis brevis (EPB), and extensor pollicis longus (EPL) mm. had been elevated from the lateral margin of the radius. The present study suggests that usina dorsoradial approach facilitates exposure of the middle and distal portions of the interosseous membrane.

Morphometric evaluation of 54 dry cervical spines from C3 to C7 (a total of 270 cervical vertebrae) was performed to determine the bony boundaries of the uncinate process for resection of the uncinate process for access to posterolateral osteophytes or herniated disks at the time of anterior cervical diskectomy. The uncinate processes were significantly higher (p < 0.01) at the C4 -C6 levels (5.8 ± 1.1 mm to 6.1 ± 1.3 mm) than at the C3 or C7 levels. The distance between the medial and lateral margins of the base of the uncinate process was significantly smaller (p < 0.01) at the C3 level (4.9 ± 0.7 mm) than at the C7 level (6.3 ± 0.7 mm). The anteroposterior diameter of the medial margin of the uncinate process decreased gradually from the C5 (12.5 ± 1.5 mm) to C7 levels (11.6 ± 1.3 mm) (p < 0.05). The inter-uncinate distance widened from the C3 (19.2 ± 1.5 mm) to the C7 (24.6 ± 2.

Morphometric evaluation of 54 dry cervical spines from C3 to C7 (a total of 270 cervical vertebrae) was performed to determine the bony boundaries of the uncinate process for resection of the uncinate process for access to posterolateral osteophytes or herniated disks at the time of anterior cervical diskectomy. The uncinate processes were significantly higher (p < 0.01) at the C4 -C6 levels (5.8 ± 1.1 mm to 6.1 ± 1.3 mm) than at the C3 or C7 levels. The distance between the medial and lateral margins of the base of the uncinate process was significantly smaller (p < 0.01) at the C3 level (4.9 ± 0.7 mm) than at the C7 level (6.3 ± 0.7 mm). The anteroposterior diameter of the medial margin of the uncinate process decreased gradually from the C5 (12.5 ± 1.5 mm) to C7 levels (11.6 ± 1.3 mm) (p < 0.05). The inter-uncinate distance widened from the C3 (19.2 ± 1.5 mm) to the C7 (24.6 ± 2.

Direct measurements and measurements from images of axial cross-sections on 20 cadaveric sacra that had been scanned on computer were used in this study. The measurements, including parameters from the vertebral body, lateral mass and spinal canal of the second sacral vertebra (S2) were performed. The length of the screw path and the optimal angulation of the screw placement for dorsal sacral internal fixation were also included. The mean values of height, anteroposterior diameter, width and breadth of the S2 were 25.0 mm, 13.5 mm, 29.4 mm and 83.0 mm, respectively. The mean values of the mid-sagittal diameter, maximum transverse diameter and area of the S2 spinal canal were 10.3 mm, 23.1 mm and 162.4 mm 2 , respectively. The mean transpedicular screw length of the S2 and optimal medial angle were 25.2 mm and 30.0ƒ, respectively. The mean lateral mass screw length of the S2 and optimal lateral angle were 32.8 mm and 22.0ƒ, respectively. The present study provides quantitative anatomic data of the second sacral vertebra. All parameters indicate that, compared with our previous study, S2 is smaller than S1. When S2 lateral mass screw fixation is intended, anchoring the anterior cortex may violate the iliac vessels or lumbosacral trunk; therefore, understanding the unique anatomy of the S2 is imperative.

Direct measurements and measurements from images of axial cross-sections on 20 cadaveric sacra that had been scanned on computer were used in this study. The measurements, including parameters from the vertebral body, lateral mass and spinal canal of the second sacral vertebra (S2) were performed. The length of the screw path and the optimal angulation of the screw placement for dorsal sacral internal fixation were also included. The mean values of height, anteroposterior diameter, width and breadth of the S2 were 25.0 mm, 13.5 mm, 29.4 mm and 83.0 mm, respectively. The mean values of the mid-sagittal diameter, maximum transverse diameter and area of the S2 spinal canal were 10.3 mm, 23.1 mm and 162.4 mm 2 , respectively. The mean transpedicular screw length of the S2 and optimal medial angle were 25.2 mm and 30.0ƒ, respectively. The mean lateral mass screw length of the S2 and optimal lateral angle were 32.8 mm and 22.0ƒ, respectively. The present study provides quantitative anatomic data of the second sacral vertebra. All parameters indicate that, compared with our previous study, S2 is smaller than S1. When S2 lateral mass screw fixation is intended, anchoring the anterior cortex may violate the iliac vessels or lumbosacral trunk; therefore, understanding the unique anatomy of the S2 is imperative.

Twenty adult cadaveric cervical spines were sectioned longitudinally through the midline to display longitudinal sections of the vertebral bodies and disc spaces from C3 to T1. Computerassisted anatomic images were obtained for measurements of the disc spaces and vertebral bodies. Anteroposterior (AP) depth gradually increased from 16.56 _+ 2.21 mm at C3 to 19.32_+ 2.30 mm at C7. Greater values of AP depth at the inferior endplate were found at C5 (20.75 _+ 2.87 mm) and C6 (20.56 _+ 2.31 mm) compared with the values at C3 (18.26 _+ 1.82 ram), C4 (19.27 _+ 2.88 mm) and C7 (19.21 + 3.22 mm). The AP depth at the superior endplate was greater than that at the inferior endplate. The height of the disc space was found to be lowest at the posterior disc space from C2-3 to C7-T1 (2.95 + 0.86 mm at C2-3, 2.78 + 0.93 mm at C3-4, 2.45 _+ 0.79 mm at C4-5, 2.92 + 0.64 mm at C5-6, 2.46 _+ 0.59 mm at C6-7, 2.93 _+ 1.05 mm at C7-T1), when compared to the height of the disc space at the anterior disc space from C2-3 to C7-T1 (4.07 _+ 0.85 mm at C2-3, 4.34 + 1.18 mm at C3-4, 3.95 + 1.37 mm at C4-5, 3.55 _+ 1.37 rnm at C5-6, 3.55 +_ 0.76 mm at C6-7, 3.67 _+_ 1.17 mm at C7-TI). The mid-axis of the disc space was

Twenty adult cadaveric cervical spines were sectioned longitudinally through the midline to display longitudinal sections of the vertebral bodies and disc spaces from C3 to T1. Computerassisted anatomic images were obtained for measurements of the disc spaces and vertebral bodies. Anteroposterior (AP) depth gradually increased from 16.56 _+ 2.21 mm at C3 to 19.32_+ 2.30 mm at C7. Greater values of AP depth at the inferior endplate were found at C5 (20.75 _+ 2.87 mm) and C6 (20.56 _+ 2.31 mm) compared with the values at C3 (18.26 _+ 1.82 ram), C4 (19.27 _+ 2.88 mm) and C7 (19.21 + 3.22 mm). The AP depth at the superior endplate was greater than that at the inferior endplate. The height of the disc space was found to be lowest at the posterior disc space from C2-3 to C7-T1 (2.95 + 0.86 mm at C2-3, 2.78 + 0.93 mm at C3-4, 2.45 _+ 0.79 mm at C4-5, 2.92 + 0.64 mm at C5-6, 2.46 _+ 0.59 mm at C6-7, 2.93 _+ 1.05 mm at C7-T1), when compared to the height of the disc space at the anterior disc space from C2-3 to C7-T1 (4.07 _+ 0.85 mm at C2-3, 4.34 + 1.18 mm at C3-4, 3.95 + 1.37 mm at C4-5, 3.55 _+ 1.37 rnm at C5-6, 3.55 +_ 0.76 mm at C6-7, 3.67 _+_ 1.17 mm at C7-TI). The mid-axis of the disc space was

The anterior tibial artery (ATA) is at risk of injury during high tibial osteotomy, Ilizarov wire placement, pin placement in external fixation, or proximal locking screw insertion, as the artery is not visualized intraoperatively. The ATA is anchored to the oval foramen of the interosseous membrane on the proximal tibia by the deep fascia and recurrent genicular vascular branches. Segment 1 (from the bifurcation of the popliteal artery to the level of the interosseous foramen) and the proximal part of segment 2 (from the interosseous foramen to the level where the artery crosses the anterior border of the tibia) may be damaged when pin, wire or screw placement is directed posterolaterally at that level. Distally, a straight mediolateral pin or Ilizarov wires may lacerate the artery. Segment 2 of the ATA descends against the interosseous membrane in its proximal part, which is projected on the posterior third of the tibia relative to the sagittal plane; in its middle part, it runs close to the lateral cortex of the tibia, it is projected on the middle third of the tibia; in its distal part it runs gradually towards the anterior third of the tibia and contacts with the anterior third of the tibial cortical surface. This information may help reduce risk of injury to the ATA during high tibial osteotomy, external fixation and pin placement or insertion of locking screws.

The anterior tibial artery (ATA) is at risk of injury during high tibial osteotomy, Ilizarov wire placement, pin placement in external fixation, or proximal locking screw insertion, as the artery is not visualized intraoperatively. The ATA is anchored to the oval foramen of the interosseous membrane on the proximal tibia by the deep fascia and recurrent genicular vascular branches. Segment 1 (from the bifurcation of the popliteal artery to the level of the interosseous foramen) and the proximal part of segment 2 (from the interosseous foramen to the level where the artery crosses the anterior border of the tibia) may be damaged when pin, wire or screw placement is directed posterolaterally at that level. Distally, a straight mediolateral pin or Ilizarov wires may lacerate the artery. Segment 2 of the ATA descends against the interosseous membrane in its proximal part, which is projected on the posterior third of the tibia relative to the sagittal plane; in its middle part, it runs close to the lateral cortex of the tibia, it is projected on the middle third of the tibia; in its distal part it runs gradually towards the anterior third of the tibia and contacts with the anterior third of the tibial cortical surface. This information may help reduce risk of injury to the ATA during high tibial osteotomy, external fixation and pin placement or insertion of locking screws.

Posterior sternoclavicular dislocation is an uncommon injury and often remains initially undiagnosed due to variable clinical presentation and inadequate visualization of the joint on plain radiographs. It is frequently associated with serious and life-threatening injuries involving the trachea, esophagus, or great vessels.