The conjoint junction of the triceps surae: Implications for gastrocnemius tendon lengthening
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Abstract Forty embalmed cadaver lower limbs were dissected to identify the morphology of the conjoint junction of the tendons of gastrocnemius and soleus and the location of the gastrocnemius tendon relative to bony landmarks. Five patterns of conjoint junction morphology were found: transverse (25%), oblique passing distally and medially (45%), oblique passing distally and laterally (5%) and arcuate as an inverted U (17.5%) and a U‐shape (7.5%). Left‐right asymmetry of the junction was observed in 31.6% of 19 paired cadaver legs. On the medial side of the calf the gastrocnemius tendon could be located between 38 and 46% of the proportion of the distance between the upper border of the calcaneus and the fibular head. Corresponding values for the midline and lateral side of the calf were 45–58% and 48–51%. The location of the gastrocnemius tendon relative to bony landmarks may help to guide incision planning for open or endoscopic division of the tendon. Clin. Anat. 20:924–928, 2007. © 2007 Wiley‐Liss, Inc.Cite
In the trauma center from 1973 to 1979, 80 cases of fractures of the heel bones in children were registered. Since both calcaneus were injured in 4 victims, the number of fractures was 84, or 1.0% of all fractures and 10.9% of foot fractures in children aged 1 to 15 years. 73 children with calcaneus injuries are boys. There were only 12 children under the age of 7, the rest were older. In all children, fractures occurred as a result of direct trauma: in 73 from a fall from a height and in 7 from a blow or compression of the heel region. The right and left heel bones were injured equally often. Significant displacement of fragments of the calcaneus with damage to its articular surfaces in children is relatively rare. We identified such fractures in 8 patients. Their treatment, as well as those of victims with fractures of both calcaneus bones, was carried out in stationary conditions.
Foot (prosody)
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Objective To analyze the causes of poor wound healing after the open reduction and internal fixation of closed calcaneal fracture.Methods 61 patients(78 calcaneus) with calcaneal fracture were treated by using the L-shaped incision in lateral calcaneus in our department from May 2009 and May 2013,in which there were 53 males(67 calcaneus) and 8 females(11 calcaneus),and the age ranged from 21 years to 57 years,the mean age was 39 years.There were 56 cases(71 calcaneus) caused by the falling and 5 cases(7 calcaneus) caused by the traffic accident.The operation time ranged from 3 hours to 22 days after the injury,and the mean operation time was 9 days.There were 34 calcaneus with type Ⅱ,31 calcaneus with type Ⅲ,and 13 calcaneus with type Ⅳ according to the Sanders classification.The general condition,operation timing and method,internal fixation choice,treatment after surgery of patients were retrospectively analyzed,and the patients were followed up within 0.5 year to 3 years after surgery,the average follow-up time was 20 months.Results There were 7 patients(9 calcaneus) with incision edge necrosis or dehiscence,which accounted for 11.5% and obtained healing after the symptomatic treatment.Conclusion The incidence of poor wound healing after the operation of calcaneal fracture is associated with the general condition,com plications,anatomical features of calcaneus,operation timing choice,internal fixation choice,operative,postoperative treatment and other factors.
Calcaneal fracture
Wound dehiscence
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To define the anatomy of the corrugator supercilii muscle (CSM).Cadaver dissections following a preset approach.Anatomy laboratory at a medical school.Sixteen sides of 8 preserved cadaver heads were dissected. Inferiorly based trapdoor-type flaps were developed in the subgaleal plane. The bone origins of the CSM were first identified. The muscles were then followed to their insertions. The origin and outline of the muscles were plotted on the face of the cadaver. Following the measurements, we transferred the configuration of the CSM to the image of a computer-manipulated face of a model.The origin of the CSM has a wide base, spanning across 0.6 cm from the midline and the supraorbital notch/foramen. The area of the muscle origin measured 0.98 x 2.52 cm on the right side and 1.04 x 2.35 cm on the left side. The lateral extent of the CSM insertion measured 4.27 and 4.50 cm from the midline on the right and left sides, respectively.The CSM originates as 3 or 4 thin, rectangular, panellike muscle groups occupying a wide area across 0.6 cm from the midline and the supraorbital notch/foramen. The muscle groups travel parallel to one another in an oblique course without distinguishable oblique or transverse components.
Foramen
Inferior oblique muscle
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Objectives: Observe the structure of the flexor digitorum profundus (FDP) tendon macroscopically in cadaver forearms from the muscle-tendon junction to the carpal tunnel.
Methods: We used 11 forearms belonging to cadavers and fixed with formaldehyde. The forearms numbered 1, 2, 8, 9, 10, 11 were the left and right arms of the same cadavers. Those numbered 3, 4, 5, 6, 7 belonged to different cadavers. Dissections were made by using the atraumatic surgical technique. The tendons were studied to identify the structure and number of the fibers forming them.
Results: The presence of a large common tendon was found in 10 of the 11 forearms. In 4 of these, the common tendon included the tendons of all four fingers. While the common tendon included 3 fingers in four forearms, it only included tendons belonging to 2 fingers in two forearms. It was not possible in one forearm to separate the common tendon into its fibers. In another forearm, tendons belonging to each digit were separate and independent starting at the muscle-tendon junction to the attachment points.
Conclusion: The majority of the cadaver forearms used in the study displayed a single large FDP tendon in the zone between the muscle-tendon joint to the carpal tunnel entry prior to being distributed into each index. This anatomical feature should be considered in choosing materials and surgical technique for Zone V FDP tendon injuries, as well as in planning the rehabilitation process.
Muscle belly
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The authors examine the anatomophysiologic peculiarities of the calcaneus area which cause difficulties in the treatment of osteomyelitis of the calcaneus. The surgical treatment of 53 patients suffering from osteomyelitis of the calcaneus is analysed. Three types of surgical procedures are described; they consist in a radical resection of the calcaneus from the inside using the osteoplastic approach to the focus of the lesion, which allows to create the optimal conditions for reparative osteogenesis in the osseous cavity that has been formed. The follow-up results after 1 to 5 years were positive in 86.8% of the operated patients.
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Objectives: Observe the structure of the flexor digitorum profundus (FDP) tendon macroscopically in cadaver forearms from the muscle-tendon junction to the carpal tunnel. Methods: We used 11 forearms belonging to cadavers and fixed with formaldehyde. The forearms numbered 1, 2, 8, 9, 10, 11 were the left and right arms of the same cadavers. Those numbered 3, 4, 5, 6, 7 belonged to different cadavers. Dissections were made by using the atraumatic surgical technique. The tendons were studied to identify the structure and number of the fibers forming them. Results: The presence of a large common tendon was found in 10 of the 11 forearms. In 4 of these, the common tendon included the tendons of all four fingers. While the common tendon included 3 fingers in four forearms, it only included tendons belonging to 2 fingers in two forearms. It was not possible in one forearm to separate the common tendon into its fibers. In another forearm, tendons belonging to each digit were separate and independent starting at the muscle-tendon junction to the attachment points. Conclusion: The majority of the cadaver forearms used in the study displayed a single large FDP tendon in the zone between the muscle-tendon joint to the carpal tunnel entry prior to being distributed into each index. This anatomical feature should be considered in choosing materials and surgical technique for Zone V FDP tendon injuries, as well as in planning the rehabilitation process.
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Objective:To explore the clinical value of double 45° oblique-axial view of calcaneus DR in the diagnosis of calcaneus fracture.Methods:Rantine dorsoplantar and oblique view of foot,lateral and axial view of calcaneus and double 45° oblique-axial view of calcaneus DR were used to examine 52 patients with ankle injury,the acquired images were compared and analyzed.Results:There were 46 cases of calcaneus fracture found by X-ray and CT examination,among which 21 cases could be found on dorsoplantar and oblique view,30 cases on lateral and axial view,42 cases were found by double 45° oblique-axial view on DR.Compared with lateral and axial view of calcaneus,3 more fractures near calcaneo-astragalar joint and 6 more fractures near posterior brim of calcaneus were found by double 45° oblique-axial view on DR.The rates of fractures shown by dorso-plantar and oblique view of foot,by lateral and axial view of calcaneus,and by double 45° oblique-axial view on DR were 45%,65% and 91% respectively.Conclusion:Lateral and axial view of calcaneus combined with double 45° oblique-axial view on DR has obvious value in detecting calcaneus fractures,especially fractures of posterior brim and near the calcaneo-astragalar joint.
Oblique projection
Subtalar joint
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Background: In the absence of age and sex-specific normative data for postnatal growth of the calcaneus, it has been hypothesized that the growth of the calcaneus would simulate growth of the foot. Methods: A total of 860 normal lateral foot radiographs, 50 (25 female and 25 male) for each year of development from 1 to 18 years, and 10 radiographs from birth till 1 year, were measured for the length and height of the calcaneus, Bohler angle, the appearance, fusion and fragmentation of calcaneus apophysis, and the height and width of apophysis. Nonlinear curves were fit to a growth chart of the calcaneus, and the results were superimposed on the historical growth charts of the foot, stature, and long bones (femur, tibia). The ratio of calcaneus length to apophysis height was calculated. Results: Growth of the calcaneus does not simulate growth of the foot (which attains 50% of its mature dimension by the age of 1 y in girls and 1.5 y in boys), but simulates the growth of the long bones, which attain 50% of their mature length after the age of 3 years in girls and 4 years in boys. Bohler angle remains within normal limits across all ages. When the length of calcaneus is triple the height of its apophysis, 80% of calcaneus growth is complete. Conclusions: We provide normative data for postnatal growth of the calcaneus. On the basis of these data, the assumption that growth disturbance in children affects the length of the calcaneus proportionately less than similar disturbances in the long bones, is false. Children <3 years have at least 50% of growth remaining. Bohler angle should be maintained at all ages. Clinical Relevance: This study of postnatal growth of the calcaneus provides age and sex-based normative data to predict growth pattern of calcaneus.
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Ten cadavers were dissected to describe the cutaneous branches of the dorsal rami nerves that should be identified and protected throughout the thoracoplasty procedure.To identify the anatomic distribution of the cutaneous branches of the dorsal rami in the thoracic spine.The last anatomic description of cutaneous branches of the dorsal rami nerves dates back to the early 1900s.Ten cadavers were dissected. Each of the branches was followed deeper into the musculature of the back. The Steel 2-incision approach, the Geissele subcutaneous approach, and the subfascial/subtrapezial approach were then carried out on each cadaver.We determined the course traveled by each of these cutaneous branches of the dorsal rami. Medial branches traverse the paraspinal muscles running dorsally within a few millimeters of the midline before exiting beneath the trapezius. Lateral branches cross the top border of the inferior rib at an average of 6.8 mm from the tip of the transverse process and the lower border of the rib 27 mm from the tip of the transverse process.Both branches of the dorsal rami nerves are encountered during the posterior approaches used. Medial branches have the best chance for identification and preservation with the subtrapezial approach. Lateral branches can be identified and protected in each of the 3 posterior exposures.
Cadaveric spasm
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Abstract Aim The anatomy and even existence of a common tendinous origin of the extraocular eye muscles, or annulus of Zinn, has widely been debated in anatomical literature. This study explored the anatomical origins of the recti muscles, their course into the orbit and the dural connections of the common tendinous origin with the skull base. Method Twenty orbits of ten adult human cadavers were dissected. The orbital apex and its dural connections were photographed. Histological examination of apical specimens was performed. Results In all cadavers, extraocular muscles were observed to have a common tendinous origin at the orbital apex, continuous with dural connections extending into the skull base. Accessory slips of the medial rectus were observed across all cadavers. Dual heads of the lateral rectus were observed in fourteen orbits of seven cadavers. The origin of the levator palpebrae superioris appeared to be contiguous with the superior rectus at the common tendinous origin in all but one cadaver. Conclusions These results support the existence of a common tendinous origin of the extraocular muscles, that is continuous with the skull base dura. In addition, they support the existence of variations in orbital anatomy including dual or accessory muscle slips of the extraocular muscles.
Orbit (dynamics)
Apex (geometry)
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