Representación gráfica del aporte vascular intraóseo y extraóseo del astrágalo. Anatomía ilustrada / Graphic Representation of Intraosseous and Extraosseous Talus Blood Supply. Illustrated Anatomy

Introducción: La anatomía vascular del astrágalo ha sido motivo de investigación por parte de muchos autores, la complejidad de su análisis ha llevado a que no siempre sea fácil de comprender. Sus características anatómicas hacen que algunas áreas sean más susceptibles de sufrir daños y compromisos vasculares tras lesiones traumáticas. El objetivo de este estudio es describir la vascularización del astrágalo, tanto a nivel intraóseo como extraóseo, para obtener una representación gráfica que permita fácilmente conocer su red de irrigación vascular. Material y métodos: Se han realizado las disecciones y los análisis de 19 piezas anatómicas de cadáver humano. Quince de esas piezas se han seccionado en diferentes planos, y se han preparado utilizando la técnica de Spalteholz modificada con inyección de látex con tinta azul y negra para visualizar la red vascular. Además, el estudio se ha complementado con una revisión bibliográfica exhaustiva sobre el tema. Resultados: Los hallazgos han permitido concluir que la arteria tibial posterior aporta la irrigación más importante al cuello y cuerpo del astrágalo a través de la arteria del canal tarsiano y la rama deltoidea. La arteria tibial anterior se divide en la arteria dorsal del pie para la cabeza y el cuello, y la arteria tarsal lateral que a través de las anastomosis origina la arteria del seno del tarso. La arteria peronea perforante, procedente de la arteria peronea, crea una anastomosis intraósea para el cuerpo y el proceso posterior. Conclusión: Los resultados obtenidos han permitido elaborar una representación ilustrada de las áreas de irrigación propias y comunes, que permite comprender de forma gráfica y sencilla la vascularización intraósea y extraósea del astrágalo.(AU)

Background: The vascular anatomy of the talus attracts intense research being not always easy to understand. The high intraosseous variability together with the anatomical characteristics makes some areas of the talus more prone to vascular compromise. The aim of this study is to describe the vascularization of the talus, both intraosseous and extraosseous. Material and methods: From the literature reviewed, we have developed a graphic scheme that allows easy observation of the irrigation distribution. To this end, nineteen anatomical dissections of human cadaveric feet have been carried out. Fifteen fresh-frozen slices have been cut in different planes and prepared using the modified Spalteholz technique and latex injection with blue and black ink to visualize the vascular network. In addition, the study has been complemented with a comprehensive literature review on this subject. Results: The findings allowed us to conclude that the posterior tibial artery provides the most important blood supply to the neck and body of the talus through the tarsal canal artery and the deltoid branch. The anterior tibial artery splits in the dorsal pedis artery, for the head and neck, and the lateral tarsal artery which throughout anastomoses breeds the tarsal sinus artery. The perforating peroneal artery branches out from the peroneal artery, creating an intraosseous anastomosis for the body and the posterior process. Conclusion: The results obtained have contributed to develop a graphical representation that we present in this study, which allows a simple understanding of the intraosseus and extraosseus vascularization of the talus.(AU)

[Translated article] Graphic representation of intraosseous and extraosseous talus blood supply. Illustrated anatomy / Representación gráfica del aporte vascular intraóseo y extraóseo del astrágalo. Anatomía Ilustrada

Introducción: La anatomía vascular del astrágalo ha sido motivo de investigación por parte de muchos autores, la complejidad de su análisis ha llevado a que no siempre sea fácil de comprender. Sus características anatómicas hacen que algunas áreas sean más susceptibles de sufrir daños y compromisos vasculares tras lesiones traumáticas. El objetivo de este estudio es describir la vascularización del astrágalo, tanto a nivel intraóseo como extraóseo, para obtener una representación gráfica que permita fácilmente conocer su red de irrigación vascular. Material y métodos: Se han realizado las disecciones y los análisis de 19 piezas anatómicas de cadáver humano. Quince de esas piezas se han seccionado en diferentes planos, y se han preparado utilizando la técnica de Spalteholz modificada con inyección de látex con tinta azul y negra para visualizar la red vascular. Además, el estudio se ha complementado con una revisión bibliográfica exhaustiva sobre el tema. Resultados: Los hallazgos han permitido concluir que la arteria tibial posterior aporta la irrigación más importante al cuello y cuerpo del astrágalo a través de la arteria del canal tarsiano y la rama deltoidea. La arteria tibial anterior se divide en la arteria dorsal del pie para la cabeza y el cuello, y la arteria tarsal lateral que a través de las anastomosis origina la arteria del seno del tarso. La arteria peronea perforante, procedente de la arteria peronea, crea una anastomosis intraósea para el cuerpo y el proceso posterior. Conclusión: Los resultados obtenidos han permitido elaborar una representación ilustrada de las áreas de irrigación propias y comunes, que permite comprender de forma gráfica y sencilla la vascularización intraósea y extraósea del astrágalo.(AU)

Background: The vascular anatomy of the talus attracts intense research being not always easy to understand. The high intraosseous variability together with the anatomical characteristics makes some areas of the talus more prone to vascular compromise. The aim of this study is to describe the vascularization of the talus, both intraosseous and extraosseous. Material and methods: From the literature reviewed, we have developed a graphic scheme that allows easy observation of the irrigation distribution. To this end, nineteen anatomical dissections of human cadaveric feet have been carried out. Fifteen fresh-frozen slices have been cut in different planes and prepared using the modified Spalteholz technique and latex injection with blue and black ink to visualize the vascular network. In addition, the study has been complemented with a comprehensive literature review on this subject. Results: The findings allowed us to conclude that the posterior tibial artery provides the most important blood supply to the neck and body of the talus through the tarsal canal artery and the deltoid branch. The anterior tibial artery splits in the dorsal pedis artery, for the head and neck, and the lateral tarsal artery which throughout anastomoses breeds the tarsal sinus artery. The perforating peroneal artery branches out from the peroneal artery, creating an intraosseous anastomosis for the body and the posterior process. Conclusion: The results obtained have contributed to develop a graphical representation that we present in this study, which allows a simple understanding of the intraosseus and extraosseus vascularization of the talus.(AU)

[Translated article] Graphic representation of intraosseous and extraosseous talus blood supply. Illustrated anatomy.

BACKGROUND: The vascular anatomy of the talus attracts intense research being not always easy to understand. The high intraosseous variability together with the anatomical characteristics makes some areas of the talus more prone to vascular compromise. The aim of this study is to describe the vascularisation of the talus, both intraosseous and extraosseous. MATERIAL AND METHODS: From the literature reviewed, we have developed a graphic scheme that allows easy observation of the irrigation distribution. To this end, nineteen anatomical dissections of human cadaveric feet have been carried out. Fifteen fresh-frozen slices have been cut in different planes and prepared using the modified Spalteholz technique and latex injection with blue and black ink to visualise the vascular network. In addition, the study has been complemented with a comprehensive literature review on this subject. RESULTS: The findings allowed us to conclude that the posterior tibial artery provides the most important blood supply to the neck and body of the talus through the tarsal canal artery and the deltoid branch. The anterior tibial artery splits in the dorsal pedis artery, for the head and neck, and the lateral tarsal artery which throughout anastomoses breeds the tarsal sinus artery. The perforating peroneal artery branches out from the peroneal artery, creating an intraosseous anastomosis for the body and the posterior process. CONCLUSION: The results obtained have contributed to develop a graphical representation that we present in this study, which allows a simple understanding of the intraosseus and extraosseus vascularisation of the talus.

Graphic Representation of Intraosseous and Extraosseous Talus Blood Supply. Illustrated Anatomy. / Representación gráfica del aporte vascular intraóseo y extraóseo del astrágalo. Anatomía ilustrada.

BACKGROUND: The vascular anatomy of the talus attracts intense research being not always easy to understand. The high intraosseous variability together with the anatomical characteristics makes some areas of the talus more prone to vascular compromise. The aim of this study is to describe the vascularization of the talus, both intraosseous and extraosseous. MATERIAL AND METHODS: From the literature reviewed, we have developed a graphic scheme that allows easy observation of the irrigation distribution. To this end, nineteen anatomical dissections of human cadaveric feet have been carried out. Fifteen fresh-frozen slices have been cut in different planes and prepared using the modified Spalteholz technique and latex injection with blue and black ink to visualize the vascular network. In addition, the study has been complemented with a comprehensive literature review on this subject. RESULTS: The findings allowed us to conclude that the posterior tibial artery provides the most important blood supply to the neck and body of the talus through the tarsal canal artery and the deltoid branch. The anterior tibial artery splits in the dorsal pedis artery, for the head and neck, and the lateral tarsal artery which throughout anastomoses breeds the tarsal sinus artery. The perforating peroneal artery branches out from the peroneal artery, creating an intraosseous anastomosis for the body and the posterior process. CONCLUSION: The results obtained have contributed to develop a graphical representation that we present in this study, which allows a simple understanding of the intraosseus and extraosseus vascularization of the talus.

Development of a design space and predictive statistical model for capsule filling of low-fill-weight inhalation products.

The objectives of this study were to develop a predictive statistical model for low-fill-weight capsule filling of inhalation products with dosator nozzles via the quality by design (QbD) approach and based on that to create refined models that include quadratic terms for significant parameters. Various controllable process parameters and uncontrolled material attributes of 12 powders were initially screened using a linear model with partial least square (PLS) regression to determine their effect on the critical quality attributes (CQA; fill weight and weight variability). After identifying critical material attributes (CMAs) and critical process parameters (CPPs) that influenced the CQA, model refinement was performed to study if interactions or quadratic terms influence the model. Based on the assessment of the effects of the CPPs and CMAs on fill weight and weight variability for low-fill-weight inhalation products, we developed an excellent linear predictive model for fill weight (R(2 )= 0.96, Q(2 )= 0.96 for powders with good flow properties and R(2 )= 0.94, Q(2 )= 0.93 for cohesive powders) and a model that provides a good approximation of the fill weight variability for each powder group. We validated the model, established a design space for the performance of different types of inhalation grade lactose on low-fill weight capsule filling and successfully used the CMAs and CPPs to predict fill weight of powders that were not included in the development set.

Accuracy of micro powder dosing via a vibratory sieve-chute system.

This paper describes a powder dosing system with a vibratory sieve mounted on a chute that doses particles into a capsule. Vertical vibration occurred with a broad range of frequencies and amplitudes. During dosing events, the fill weight was accurately recorded via a capacitance sensor, covering the capsules and making it possible to analyze filling characteristics, that is, the fill rates and their robustness. The range of frequencies and amplitudes was screened for settings that facilitated reasonable (no blocking, no spilling) fill rates for three lactose powders. The filling characteristics were studied within this operating space. The results reveal similar operating spaces for all investigated powders. The fill rate robustness varied distinctly in the operating space, which is of prime importance for selecting the settings for continuous feeding applications. In addition, we present accurate dosing studies utilizing the knowledge about the filling characteristics of each powder.

Small- and wide-angle X-ray scattering (SWAXS) for quantification of aspirin content in a binary powder mixture.

This article presents a novel application of small and wide angle X-ray scattering (SWAXS) in the assessment of aspirin and lactose content in a binary pharmaceutical powder formulation. It is shown that the content correlates with the intensity of the SAXS signal and the intensity of polymorph fingerprints in the WAXS spectra that are collected from the same samples. Because the polymorph WAXS fingerprints and the SAXS signal are two independent characteristics of the same sample, simultaneous SWAXS analysis provides the basis for a dual independent assessment of the same contents.

Distribución intraneural del nervio cubital / Intraneural distribution of the ulnar nerve

Objetivo. Estudiar la distribución fascicular del nervio cubital en la zona del codo para aplicar estos fundamentos en la técnica de transferencia nerviosa del cubital. Material y método. Se realizó la disección de 12 extremidades superiores criopreservadas inyectadas con látex. Tras la localización del nervio cubital se disecó intraneuralmente con gafas lupa para efectuar una descripción de su formación y recorrido. Resultados. En la zona proximal del codo la segregación de los fascículos extrínsecos no estaba definida ya que la variabilidad anatómica, en grosor y número, hizo difícil identificar a sus componentes. En el codo encontramos una diferenciación morfológica clara y distal al codo se apreciaron claramente los fascículos destinados a formar las ramas del nervio. Los fascículos del nervio cubital efectuaban un trayecto en espiral en su progresión distal. Discusión. La disposición microanatómica de los fascículos del nervio cubital alrededor del codo es más complicado que lo descrito en la literatura, lo que hace recomendable la utilización de registros intraoperatorios para localizar las fibras destinadas a la musculatura extrínseca e intrínseca y fibras sensitivas para efectuar la técnica de Oberlin, o al menos utilizar un estimulador eléctrico para su identificación (AU)

Objective. To study the fascicular distribution of ulnar (cubital) nerve in the elbow area in order to apply these fundamentals to the ulnar nerve transfer technique. Material and method. Twelve cryopreserved arms, injected with latex were dissected. After locating the ulnar nerve, intraneural dissection was performed using magnifying glasses in order to describe its formation and trajectory. Results. Segregation of the extrinsic fascicles was not well defined in the elbow area as the anatomical variability, in thickness and number, made it difficult to identify its components. A clear morphological differentiation was observed in the elbow and the fascicles destined to form nerve branches were clearly seen distal to the elbow. The ulnar nerve fascicles have a spiral trajectory in its distal progression. Discussion. The micro-anatomical layout of the ulnar nerve fascicles around the elbow is more complicated than that described in the literature, which makes it advisable to use surgical records to locate the fibres destined for the extrinsic and intrinsic musculature. Sensitive fibres are required to perform the Oberlin technique, or at least the use of an electrical stimulator to identify them (AU)

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

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

The anatomy and vascularity of the lunate: considerations applied to Kienböck's disease.

PURPOSE: The purpose of this study was to assess the anatomy and vascularity of the lunate. The genesis of lunatomalacia requires some combination of vascular risk and mechanical predisposition. The findings will be correlated with the major existing theories of the cause of Kienböck's disease. METHODS: We studied 27 cadaver upper limbs using latex injection and the Spalteholz technique. We investigated the blood supply to the lunate. In 24 wrists we evaluated the incidence and distribution of anatomic features, arthrosis, and soft tissue lesions. We correlated the lunate morphology and ligaments disruptions with the arthritic changes. RESULTS: The lunate morphology results as classified by Antuña-Zapico were five type I (20.8%), 18 type II (75%) and one type III (4.2%). The lunate was found to have a separate facet for the hamate in 11 cases (45.8%). The most common size of the facet was found to be 3 mm (range, 3-6 mm). Arthrosis was identified with most frequency in the radius (88.2%) and lunate (94.1%). The triangular fibrocartilage complex was found torn in 58.3%, the lunotriquetral interosseous ligament was torn in 20.8% and the scapholunate interosseous ligament (SLIL) was torn in 54.2% of the wrists. There was a correlation between the presence of arthrosis at the hamate and the presence of a lunate facet (P=0.027) and a correlation between the presence of a tear in the SLIL and arthrosis in the scaphoid (P=0.002). The nutrient vessels entered the lunate through the dorsal and volar poles in all the specimens. The dorsal intercarpal and radiocarpal arches supply blood to the lunate from a plexus of vessels located directly over the lunate's dorsal pole. Vessels entered the dorsal aspect of the lunate through one to three foramina. One to five nutrient vessels were observed entering the volar pole through various ligament insertions, including the ligament of Testut-Kuentz (radio-scapho-lunate (RSL) ligament) and the radiolunate triquetrum ligament (or dorsoradial carpal ligament) and ulnar lunate triquetral ligament. CONCLUSIONS: The lunate had consistent dorsal and palmar arteries entering the bone in all the specimens. The blood supply and foramina number is greater in the volar pole of the lunate than the dorsal pole. The lunate blood supply comes from different ligaments. In the etiopathogeny of Kienböck's disease it is possible that an acute or chronic, traumatic or non-traumatic injury of the vessel bearing ligaments, particularly because of their structure and the location of the RSL ligament, may have an important role in the appearance of lunate necrosis.

Principios básicos de la enfermedad de Kienböck: anatomía y vascularización del semilunar / Basic principles of Kienböck´s disease: anatomy and vascularization of the lunate

Objetivo: El propósito del estudio es investigar la vascularización y lasrelaciones anatómicas del semilunar. Se correlacionan los patronesde vascularización con la morfología del semilunar, la ruptura de losligamentos y el grado de artrosis. Los hallazgos obtenidos ayudan aapoyar o descartar algunas de las teorías etiopatogénicas.Material y Métodos: Estudiamos 24 extremidades superiores decadáver mediante la técnica de Spalteholtz e investigamos la circulaciónextra e intraósea en el semilunar. Evaluamos la incidencia ydistribución de distintas características anatómicas, artrosis y lesionesde partes blandas.Resultados: La morfología del semilunar fue de 5 casos tipo I(20.8%), 18 casos tipo II (75%) y 1 caso tipo III (4.2%). El semilunarpresentaba una faceta articular para ganchoso en 11 casos (48.8%).El tamaño de esta faceta fue de 3 mm (rango, 3-6 mm). La artrosisse identificó con más frecuencia en el radio (88.2%) y en el semilunar(94.1%). El complejo fibrocartílago triangular (CFCT) estaba roto en el58.3%, el ligamento interóseo lunopiramidal (LILP) en el 20.8%, y elligamento interóseo escafolunar (LIEL) en el 54.2% de los carpos.Existe una correlación entre la artrosis del ganchoso y la faceta lunarpara el ganchoso (p= 0.027), así como, una correlación entre la rupturadel LIEL y la artrosis del escafoides (p= 0.002). Los vasosnutrientes entran en el semilunar por su polo dorsal y volar en todoslos especímenes. El arco radiocarpiano e intercarpiano dorsal nutre elsemilunar por un plexo que entra en éste por 1-3 foráminas. Las arteriolaspalmares entran en el semilunar a través de 2-6 foráminas yvan acompañadas de tres inserciones ligamentosas: ligamento radioescafolunarprofundo de Testut-Kuentz, ligamento radio-semilunarpiramidaly del ligamento cúbito-semilunar.Conclusiones: El semilunar tiene entradas vasculares dorsales yvolares en todos los especímenes. La suplencia vascular llega pordistintos ligamentos. El aporte vascular entra en el hueso a travésde foráminas que se encuentran en mayor número en la carillavolar que en la dorsal. En la etiopatogenia de la enfermedad deKienböck es posible que una lesión aguda o crónica, traumática ono-traumática pueda dañar los vasos que tienen estos ligamentos,en particular el ligamento radioescafolunar profundo de Testut-Kuentz, que debido a su estructura y localización, pueda tener unpapel relevante en la aparición de la necrosis del semilunar

Purpose: The purpose of this study was to assess the anatomyand vascularization of the lunate. We correlated vascularizationpatterns with lunate morphology, ligament tears andthe degree of arthrosis. The findings will be correlated with themajor existing theories of the cause of Kienböck´s disease.Material and Methods: We studied 24 cadaver upper limbsusing latex injection and the Spalteholz technique. We investigatedthe extra and intraosseous blood supply to the lunate.We evaluated the incidence and distribution of anatomic features,arthrosis, and soft tissue lesions.Results: The lunate morphology was 5 type I (20.8%), 18 type II(75%) and 1 type III (4.2%). The lunate was found to have aseparate facet for the hamate in 11 cases (45.8%). The mostcommon size of the facet was found to be 3 mm (range, 3-6mm). Arthrosis was identified most frequently in radius (88.2%)and lunate (94.1%). The triangular fibrocartilage complex (TFCC)was found torn in 58.3%, the lunotriquetral interosseous ligament(LTIL) was torn in 20.8% and the scapholunate interosseous ligament(SLIL) was torn in 54.2% of the wrists. There was a correlationbetween the presence of arthrosis at the proximal pole of thehamate and the presence of a lunate facet (p= 0.027) and acorrelation between the presence of a tear in the SLIL and arthrosisin the scaphoid (p= 0.002). The nutrient vessels entered thelunate through the dorsal and volar poles in all the specimens.The dorsal intercarpal and radiocarpal arches supply blood to thelunate from a plexus of vessels located directly over the lunate´sdorsal pole. Vessels entered the dorsal aspect of the lunatethrough one to three foramina. Two to five nutrient vessels wereobserved entering the volar pole through various ligament insertions,including the ligament of Testut-Kuentz (radioscapholunateligament) and the radiolunate triquetrum ligament (or dorsoradialcarpal ligament) and ulnar lunate triquetral ligament.Conclusions: The lunate had consistent dorsal and palmararteries entering the bone in all the specimens. The bloodsupply and foramina number is greater in the volar pole of thelunate than the dorsal pole. The lunate blood supply comesfrom different ligaments. In the aetiopathogeny ofKienböck’disease it is possible that an acute or chronic, traumaticor non-traumatic lesion of the vessel bearing ligaments,particularly because of their structure and the location of theradioscapholunate ligament of Testut-Kuentz, may have animportant role in the appearance of lunate necrosis

[Set-up, portals and normal exploration in wrist arthroscopy.] / Installation, voies d'abord et exploration normale en arthroscopie du poignet.

Arthroscopy is an accepted technique for evaluation of intra-articular pathology and treatment of a variety of disorders even in the wrist joint. Dedicated miniaturized instrumentation is needed along with a specific traction system. The external distraction alone (dry technique) allows for complete joint exploration and several type of arthroscopic surgery, avoiding annoying leaking in the subcutaneous tissues, though further distension of the articular pouches can be achieved by saline infusion (fluid distension or wet technique). Knowledge of surface anatomic landmarks and careful surgical technique are required for proper portal placement and in order to avoid injury to the numerous noble structures crossing nearby. Description of radio- and medio-carpal portals is provided along with the different bony, condral, synovial and ligamentous structures that can be visualised or treated through each portal. Surgeon can choose the most suitable portal for scope or instruments, according to specific needs for diagnostic or therapeutic purposes.

[Set-up, portals and normal exploration in wrist arthroscopy]. / Installation, voies d'abord et exploration normale en arthroscopie du poignet.

Arthroscopy is an accepted technique for evaluation of intra-articular pathology and treatment of a variety of disorders even in the wrist joint. Dedicated miniaturized instrumentation is needed along with a specific traction system. The external distraction alone (dry technique) allows for complete joint exploration and several type of arthroscopic surgery, avoiding annoying leaking in the subcutaneous tissues, though further distension of the articular pouches can be achieved by saline infusion (fluid distension or wet technique). Knowledge of surface anatomic landmarks and careful surgical technique are required for proper portal placement and in order to avoid injury to the numerous noble structures crossing nearby. Description of radio- and medio-carpal portals is provided along with the different bony, condral, synovial and ligamentous structures that can be visualised or treated through each portal. Surgeon can choose the most suitable portal for scope or instruments, according to specific needs for diagnostic or therapeutic purposes.

Superior gluteal nerve: safe area in hip surgery.

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

Estudio biomecánico del tornillo canulado de Herbert en el tratamiento de la pseudoartrosis de clavícula* / Biomechanical study of the Herbert cannulated screw in the treatment of clavicular nonunion

Objetivo. Valorar biomecánica y clínicamente una técnica alternativa quirúrgica para el tratamiento de la pseudoartrosis del tercio medio de la clavícula. Material y método. Estudio mecánico: diecinueve especímenes de clavículas humanas fueron divididos en tres grupos: grupo A, 5 clavículas intactas, grupo B, 5 clavículas osteotomizadas perpendicularmente al eje longitudinal del hueso, en su parte media, y tratadas con placas DCP de 3,5 mm y 6 orificios, y grupo C, 9 clavículas osteotomizadas y tratadas con clavo canulado de Herbert, de 4,5 mm. Todas las clavículas fueron sometidas a ensayos mecánicos en una máquina de ensayos servohidraúlica obteniendo la resistencia máxima (N), la rigidez (N/Mm) y la tensión máxima (Mpa). Resultados. Estudio mecánico: tanto la placa recta DCP como el tornillo canulado de Herbert se comportaron mecánicamente de forma similar. Conclusiones. La ventaja de la síntesis intramedular con tornillo canulado de Herbert es que no requiere una segunda operación para retirar el implante una vez conseguida su consolidación (AU)

Clinical anatomy of the superficial peroneal nerve in the distal leg / Anatomía clínica del nervio peroneo superficial en la parte distal de la pierna

Applied anatomy of the superficial peroneal nerve in real clinical situations requires a good knowledge of the anatomical relationships and their common variations. Here we present an anatomoclinical description not only of the normal superficial peroneal nerve but also of its different variations with surgical implications based on twelve lower limbs. In order to gain some landmarks, the followings measurements were taken: a) distance from the upper end of the fibular head to the lower eminence of the lateral malleolus; b) number of branches from the nerve when it emerges through the superficial sural fascia; c) distance from the nerve emergence point to the lateral malleolus; d) distance from the nerve division to the lateral malleolus. We also recorded the site were the nerve pierces the sural fascia from the anterior or lateral muscular compartment. The data obtained seem to be sufficiently reliable for usual clinical practice, but it must be taken into account that frequent and important variations may occur (AU)

La anatomía aplicada del nervio peroneo superficial en situaciones clínicas reales requiere un buen conocimiento de las relaciones anatómicas y sus variaciones comunes. Presentamos aquí una descripción anatomoclínica no sólo del nervio peroneo superficial sino también de sus diferentes variaciones con implicaciones quirúrgicas, basadas en el estudio de 12 miembros inferiores. Con el fin de obtener algunos parámetros de referencia, se determinaron las siguientes mediciones: a) distancia desde el extremo superior de la cabeza del peroné hasta la eminencia inferior del maleolo lateral; b) número de ramas del nervio cuando emerge a través de la fascia sural superficial; c) distancia desde el punto de emergencia del nervio hasta el maleolo lateral; d) distancia desde la división del nervio hasta el maleolo lateral. También registramos los lugares donde el nervio atraviesa la fascia sural desde el compartimiento muscular anterior o lateral. Los datos obtenidos parecen ser suficientemente fiables para la práctica clínica habitual, pero debe tenerse en cuenta que pueden existir variaciones frecuentes e importantes (AU)

Luxaciones infrecuentes del carpo / Infrequent carpal dislocations

Objetivo: Analizar las fracturas-luxaciones infrecuentes del carpo y los resultados clínicos y radiológicos de estas lesiones, tratadas quirúrgicamente dentro de la primera semana del traumatismo. Pacientes: Entre 1985-1999 se han tratado 61 pacientes con luxación y fractura-luxación perilunar del carpo (FL) con un seguimiento medio de 3 años. La edad media de los pacientes fue de 32 años. De los 61 casos, se incluyen en este estudio 19 pacientes con luxaciones infrecuentes del carpo, 7 de los cuales presentan una FL transescafo-hueso grande (Síndrome de Fenton), 3 FL transpiramidal, 6 FL radiocarpiana (4 dorsales y 2 volares) y en un caso la luxación completa de escafoides y semilunar a cara anterior de antebrazo. En 3 casos se ha presentado en la misma extremidad la asociación de FL de carpo junto con una luxación de codo. Resultados: Los resultados clínicos y radiológicos se han estimado de acuerdo al método de Green y O'Brien modificado. Los resultados clínicos fueron buenos en 9 pacientes (47 por ciento) y aceptables en 10 (53 por ciento).Radiológicamente se observó que 7 pacientes (37 por ciento) presentaron una alineación o morfología anormal y en 9 casos (47,4 por ciento) se aprecian cambios degenerativos. Los resultados radiológicos fueron satisfactorios (A o C) en 7 pacientes (37 por ciento) y no satisfactorios (A1, B, B1, o C1) en 12 (63 por ciento).Conclusiones: Existe una disociación clínico-radiológica de los resultados, ya que a los 3 años de seguimiento, existe una buena tolerancia clínica en los casos de inestabilidad y artropatía degenerativa radiológica (AU)