Estudio morfológico y biométrico de los vínculos de los tendones de los músculos flexores superficial y profundo de los dedos de la mano humana / Anatomic and biometric study of the vincula of the tendons of flexor digitorum superficialis and profundus muscles of the human hand

Los vínculos son estructuras especializadas inherentes a los tendones flexores de los dedos, y tienen gran importancia en la nutrición de los mismos, además de facilitar la flexión de los dedos después de una transección distal del tendón (es), permitiendo que éste (os) actuen indirectamente a través de las articulaciones interfalángicas. El presente estudio tuvo como objetivo revisar aspectos morfofuncionales de los vínculos largos y cortos de los músculos flexores de los dedos de la mano. El trabajo fue realizado en 60 manos de cadáveres formolizados de individuos adultos, brasileños, con una edad promedio de 53,1±17,8 años. Los vínculos cortos fueron encontrados en 100 % de los casos, tanto en los músculos flexores superficiales de los dedos como en los profundos, siempre en número de uno en cada tendón y su localización siempre estuvo en la extremidad del tendón, antes de la inserción de éste en la articulación interfalángica proximal. Los vínculos largos presentaron gran variación morfológica, con una presencia promedio de 61,3 % en los tendones del músculo flexor superficial y de 77,9 % en el músculo flexor profundo. El número de vínculos por tendón varió aún más, no siendo posible identificar un patrón independientemente del músculo. En relación a la localización de los vínculos largos, en los tendones del músculo flexor superficial de los dedos, están insertos en la vaina fibrosa de la falange proximal, con un trayecto oblicuo y próximo a la articulación interfalángica proximal; los vínculos de los tendones del músculo flexor profundo estaban localizados en su mayoría (86,7 %) entre los tendones a nivel de la articulación interfalángica proximal, presentando un trayecto rectilíneo entre esos dos tendones, mientras que en 13,3 % estuvieron localizados muy próximos a la abertura del tendón del músculo flexor superficial para el paso del tendón del músculo flexor profundo. Los vínculos son estructuras escenciales en la mantención de la nutrición y de los movimientos de los dedos aún en presencia de lesiones, por lo tanto, es importante tener una comprensión clara de ellos para una correcta evaluación clínica pensando en la reparación, reconstrucción y rehabilitación de las disfunciones de la mano.

The vincula are specialized structures inherent in the flexor tendons of the fingers, and are of great importance in their nutrition. In addition they facilitate flexion of the fingers following a distal transection of this tendon, allowing it to operate indirectly across the interphalangeal joints. The aim of the present study was to describe anatomic and biometric aspects of the long and short vincula of the flexor muscles of the fingers. The work was carried out in hands of 60 adult Brazilian corpses, of both sexes, with an average age between 17.8±53.1 years. The short vincula were found in 100 % of cases of flexor digitorum superficialis tendons and flexor digitorum profundus muscles, and only one in each tendon, with its location always at the extremity of the tendon, prior to insertion in the proximal interphalangeal joint. The long vincula presented great morphological variation, with an average presence of 61.3 % in tendons of the flexor digitorum superficialis and 77.9 % in the flexor digitorum profundus muscle. Furthermore, the number of vincula per tendon changed, and it was not possible to identify a pattern independently of the muscle. With respect to the location of the long vincula, in the flexor superficial tendons they are inserted in the fibrous sheath of the proximal phalanx, with an oblique course and next to the proximal interphalangeal joint. The vincula of the tendons of the flexor digitorum profundus were located (86.7 %) between both tendons to level of the proximal interphalangeal joint, presenting a rectilinear course between these two tendons, whereas in 13.3 % they were located very close to the opening of the flexor superficialis muscle tendon for passage of the flexor digitorum profundus muscle tendon. The vincula are essential structures in nutrition and finger motion even when injuries are present. It is therefore, important to have a clear understanding of these structures forproper clinical evaluation in the repair, reconstruction and rehabilitation of hand dysfunctions.

Anatomy of the left atrioventricular valveapparatus in landrace pigs

The aim of this study was to describe the structures and variations of the left atrioventricular valve apparatus in pigs’ hearts. The valve apparatus elements were investigated using morphometric criteria such as the implantation base width, maximum cuspid depth and fibrous ring circumference, and using morphological criteria such as the numbers and sites of the cuspids, tendon cords and papillary muscles. We concluded that morphometric criteria such as the implantation base width and greater cuspid depth could be used to characterize the cuspids of the left atrioventricular valve apparatus; and that morphological criteria such as the number of papillary muscles, fibrous ring circumference and number of tendon cords were generally not associated with the variations in the number of cuspids. We can state that the number of cuspids in the left atrioventricular valve in pigs is variable and that commissural cuspids are frequently present.

Morphometric analysis of the angle of the femoral trochlea

The possible association between disorders of the femoropatellar joint and geometrical anatomical variations in the patellar facet and femoral sulcus motivated us to conduct a morphometric study on the angle of the femoral sulcus and to correlate this with possible variation factors, such as: length, width at the midpoint of the femur, femur inclination angle, distance between condyles and depth of the patellar facet. The material consisted of 56 dry femurs of both sexes and various ages: 24 from the right side and 32 from the left side. The patellar facets were photographed at three positions: a) start level; b) middle level; and c) end level. The angle formed in each of these positions was measured using graphical tools in CorelDraw X4. To analyze the results, the statistical tests used were chi-square and Student’s t-test for correlations. The results obtained were: a) angle of the patellar facet: mean for start level of the patellar facet = 129°01; mean for middle level = 131°35 and mean for end level = 132°14; b) mean distance between condyles = 50.29  mm; c) mean depth of the patellar facet = 9.55 mm; d) mean for Ficat and Bizou’s condylar depth index = 5.45. We concluded that the angle of the femoral sulcus increased from the start of the patellar facet to its end, and that its variability was weakly influenced by the length, width, femur inclination angle and side, according to the t-test (significance of 5%) for the correlation coefficients found.

Neurovascular pedicles of the tibialis anterior muscle in children / Pedículos neurovasculares del músculo tibial anterior en niños

The importance of the tibialis anterior muscle in infantile orthopedic transposition surgeries, as in myelomemngoceles, it bases this research about the neurovascular pedicles of the tibialis anterior muscle. The study was conducted on 34 legs of human cadavers that were one year old or younger at the time of death. It was observed that the tibialis anterior muscle most frequently presented from 7 to 10 arterial branches (52.4 percent). In 97.1 percent of cases these branches were derived from the anterior tibial artery. In one case the anterior tibial artery was missing and the muscle was supplied by the fibular artery. Thirty-nine and seven tenths percent of arterial branches entered the superior third of the muscle; the middle third received 40.1 percent of the branches and the inferior third received 20.2 percent of the branches. The deep fibular nerve exclusively supplied the innervation, which in91.2 percent of cases, gave off from 2 to 4 branches to the muscle, mainly to the superior (46.2 percent) and middle third (43.0 percent). Most frequently, there were two neurovascular pedicles supplying the superior third and one supplying the middle third.

La importancia del músculo tibial anterior en cirugías de transposición ortopédica en niños, así como en casos de mielomeningocele, fundamenta su estudio respecto a sus pedículos neurovasculares. El estudio se realizó en 34 miembros inferiores de cadáveres de niños de un año o menos de edad. Se observó que el músculo tibial anterior presentaba con frecuencia 7 a 10 ramas arteriales (52,4 por ciento). En 97,1 por ciento de los casos estos ramos eran derivados de la arteria tibial anterior. En dos casos, la arteria tibial anterior estaba ausente y el músculo suplió su irrigación con la arteria fibular. En relación a la entrada de las ramas, 39,7 por ciento lo hacen en el tercio superior del músculo. El tercio medio recibe 40,1 por ciento de las ramas y el tercio inferior recibe 20,2 por ciento de ellas. El nervio fibular profundo es la fuente principal de inervación, en 91,2 por ciento de los casos provee 2 a 4 ramos para el músculo, de ellos el 46,2 por ciento termina en el tercio superior y el 43 por ciento en el tercio medio. Con mayor frecuencia, existen dos pedículos neurovasculares supliendo el tercio superior y uno supliendo el tercio medio del músculo tibial anterior.

Estudo das cordas tendineas das valvulas comissurais da valva mitral. / A study of the chordae tendineae of the comissural valvules of the mitral valve

Os autores realizam um estudo anatomico de cordas tendineas das valvulas comissurais ou suplementares da valva mitral. Foram motivados a esta pesquisa pelas citacoes da literatura abordando patologias da valva mitral associados a comprometimento nas cordas tendineas de suas valvulas e a presenca de pequenas valvulas comissurais.No mateiral estudado, constando de 32 valvulas, procurou-se principalmente verificar o numero, distribuicao e localizacao das cordas tendineas. Os resultados obtidos demonstraram nao existir diferenca de numero e de localizacao dessas cordas tendineas nas valvulas comissurais em relacao as demais valvulas, a tal ponto que pudessem justificar possibilidade de patologias estarem associadas a um deficiente posicionamento dessas cordas tendineas