Incidence of avascular necrosis following biceps tenodesis during proximal humerus open reduction and internal fixation

Avascular necrosis (AVN) may occur in up to 77% of proximal humeral fractures and can cause fixation failure. Risk factors include fracture position, calcar length and medial hinge integrity. We routinely perform intra-articular biceps tenotomy with tenodesis at the level of pectoralis major to facilitate fragment identification and potentially ameliorate post-operative pain relief. Concern exists that tenotomising the biceps damages the adjacent arcuate artery, potentially increasing the rate of AVN. The purpose of this study was to evaluate whether biceps tenodesis is associated with an increased risk of radiographically evident humeral head AVN. 61 fractures surgically treated over a 52-month period were retrospectively reviewed and radiographically assessed in accordance with Neer’s classification, calcar-length and medial hinge integrity. 40, 20 and 1 were four-, three- and two-part fractures respectively. 37 had a calcar-length less than 8mm and 26 suffered loss of the medial hinge. The median radiographic follow-up was 23 months. There was radiographic evidence of humeral head AVN in only one case, comparing favourably to rates quoted in current literature. In our experience, intra-articular biceps tenotomy with the deltopectoral approach was thus not associated with a significantly increased risk of humeral head AVN, even in complex four-part fractures.

Evaluation of renal perfusion by Doppler ultrasonography and the effect of Ulinastatin to it in a porcine model of septic shock

Objective To develop a reliable and noninvasive method to evaluate the renal perfusion in a porcine model of septic shock and investigate the effect of UTI on it. Methods Thirty-two healthy male domestic pigs were randomly assigned to one of four groups: a sham group (SH, n=5); a septic shock group (SS, n=9); a septic shock group treated with vancomycin (15mg/kg) (VAN, n=9) and a septic shock group treated with UTI (50,000U/kg) + vancomycin (UTI, n= 9). Contrast-enhanced ultrasound (CEUS) of kidney at the baseline and the end of protocol (24h) were performed. The spectrum of interlobar or arcuate artery was selected to calculate the corrected resistive index (cRI). Sulphur hexafluoride (SF6) microbubbles were bolus injected via venous catheter. The peak intensity (Pi) and area under curve (AUC) were calculated by a time-intensity curve (TIC). Results cRI increased significantly at the end of the protocol except the SH groups, significant difference was found between each experimental group and the SH group. Linear regression was found between the cardiac output (CO) and Pi (Pi = 7.082 × CO + 5.026, R2=0.752, F=84.878, P < 0.001). The AUC decreased significantly post-injury in the SS and VAN group. All above parameters were improved by the UTI treatment, significant differences were found between the UTI and SS or VAN group respectively (P<0.05). Conclusions Septic shock occasionally accompanies with a significant low perfusion in renal microcirculation and UTI can improve it significantly.

Morphometric Study of Dorsalis Pedis Artery and Variation in its Branching Pattern: A Cadaveric Study

Introduction: Dorsalis pedis artery (DPA) is the chief artery that supplies the dorsum of the foot. Palpation of DPA at the dorsum of the foot is important in case of atherosclerotic disease. A sound knowledge of DPA like its branching pattern is essential for the ankle surgeries as well as its presence or absence in case of peripheral vascular disease. Material and methods: 30 Lower limbs of unknown age and sex were dissected in the department of Anatomy, Kasturba Medical College, Manipal. The skin and fascia were removed.The measurement of Dorsalis pedis artery till its termination, Length from medial malleolus, Length from lateral malleolus and branching pattern of Dorsalis pedis artery was studied. Results: In this study, the average length of dorsalis pedis artery was found 7.8cm, average length from medial malleolus was 3.9cm and average length from lateral malleolus was 4.5cm.The normal branching pattern of medial tarsal artery was noticed in 53% and lateral tarsal artery in 63% cases. The arcuate artery was absent in 3% of cases. Conclusion: The knowledge of the variation of DPA is helpful during various foot surgeries. Knowledge of the variation will be useful in deciding whether the absence of the pulse in DPA is due to thrombosis of the vessel or its abnormal course or absence. DPA does not always lie at mid -malleolar point.

Macroanatomical Investigations on Renal Arteries of Southern Karaman Sheep

In this study, it was aimed to investigate the arterial vascularization of the kidneys in the South Karaman sheep breed. Twelve South Karaman sheep kidneys were used in the study. The course of the renal arteries in the kidney was examined by means of dissection and corrosion cast techniques. The kidneys were vascularized with right renal artery and left renal artery to the arteries originating from the abdominal aorta. Right renal artery was seen to be slightly more prominent than the left renal artery. Left renal artery was measured longer and thicker than the right renal artery. The renal artery entering the renal hilus, dorsal and ventral part of the renal artery were detected. However, in several materials, the left renal artery was shown to have a third branch. The dorsal and ventral branches gave interlobar artery with numbers ranging from 2-5. Each interlobar artery had multiple arcuate artery. These arteries ended by giving the interlobular artery. Anastomosis was not observed between the renal arteries. Although there were some important variations in the distribution of renal arteries of South Karaman sheep, similar findings were reported in the literature.

Anatomical study of dorsalis pedis artery

Background: The dorsalis pedis artery is the dorsal artery of the foot. The knowledge of any variation in the course and distribution of the artery is clinically important and it is used to record peripheral pulsation. The aim of this study was to study origin, course, relation and branches of the artery. The length and diameter of surgically important branch were recorded. Methods: An observational cross-sectional study was conducted at dissection hall of anatomy department at Chitwan medical college. Thirty lower limbs from fifteen cadavers were dissected for the study. Photographs were taken at different site of dissection and on finding anomalies. Newborn specimens and Conical enlargements if present were excluded. Results: The diameter of the artery ranged from 3.0 to 4.6mm and its length ranged between 5.6cm to 8.4cm.The length of deep plantar artery was between 5.6cm to 8.4cm. Double lateral tarsal artery was found in (24)80% of the studied specimen and (6)20% were with single lateral tarsal artery. In 90% of the specimen medial tarsal artery originated as proximal and distal branch form medial aspect of dorsalis pedis. The arcuate artery emerged directly from dorsalis pedis artery in (100%) all studied specimen. The 2nd ,3rd and 4th metatarsal artery were placed on their corresponding intermetatarsal space. Conclusions: Awareness of anatomical variation of vasculature of foot is important for the vascular surgeons, angiographers and reconstruction surgeons. Dorsalis pedis artery is excellent for the revascularization since it is the largest artery below the ankle joint.

Normal Vascular and Nerve Distribution of the Pes Region in Dogs: An Anatomical and Diagnostic Imaging

To investigate the normal anatomical distribution of the arterial blood supply, venous drainage and innervation on both the dorsal and plantar aspects of pes region including the level of tarsal joint due to its clinical importance with a little data available. Methods: Ten hind paws of five adult apparently healthy domestic dogs of both sexes; six paws injected, through blood vessels with colored latex neoprene for anatomical dissection and the other four paws injected a contrast mixture of red lead oxide and turpentine oil for the radiographic investigation of blood vessels. In addition to five live dogs used to apply the distal limb local anesthesia with the aid of Needle-Guided Ultrasonography. Results: This investigation revealed that the dorsal and plantar aspects of dog pes region supplied by superficial and deep sets of arteries, veins and nerves. The three dorsal metatarsal arteries originated from the arcuate artery. The medial tarsal vein forming characteristic venous arcades. The 3rd plantar metatarsal artery divided into two axial arteries while the 2nd and 4th continued axially without division. The plantar common digital and metatarsal nerves II, III, IV communicated to give origins of the axial and abaxial plantar proper digital nerves except the abaxials of the 2nd and 5th digits which supplied by a branch from medial plantar nerve and lateral plantar nerve respectively. Conclusion: There were little differences between dogs and other carnivores in vascularization of hind paw with the recommendation of using Needle-Guided Ultrasonography in the distal limb local anesthesia to avoid vascular puncture or damage.

Anatomical Pattern of Dorsal Metatarsal Arteries in a Black Kenyan Population

Introduction Knowledge of anatomical variations in the origin and in the course of the dorsal metatarsal arteries (DMTAs) is valuable for many procedures, including reconstructive surgeries and flap selection. However, there is a paucity of data on these arteries among black Africans. Materials and Methods The present study studied the origin and the location of DMTAs in 30 formalin-fixed cadaveric feet of adult black Kenyans at the Department of Human Anatomy of the University of Nairobi, Nairobi, Kenya. Results Dorsal metatarsal arteries were present in all of the cases. Of the right dorsalis pedis artery (DPA), in the majority of the cases, the 1st DMTA arose as the continuation of the DPA, while the 2nd to 4th DMTAs were given off as branches from the arcuate artery (AA). On the left feet, in the majority of the cases, the 1st DMTA arose as the continuation of the DPA, while the rest were given off as branches from the AA. In relation to the dorsal interossei muscles, all of the the arteries were either within the muscle fibers (53%) or beneath them (47%), on the right side. On the left side, the 1st DMTA was above the muscles in 40% of the cases; within the muscles in 53%; and beneath the muscles in 7%. The 2nd and 3rd DMTAs were above the muscles in 57% and in 53% of the cases, respectively. Conclusion These results reveal that the DMTAs show variation in their origin and position relative to the dorsal interossei muscles. These variations display bilateral asymmetry.