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Mechanical properties and histology of cortical bone from younger and older men.

Tensile breaking load, strength, strain, modulus of elasticity and density plus the histological structure at the fracture site, were determined for 207 standardized specimens of cortical bone from the embalmed femur, tibia, and fibula of 17 men from 36 to 75 years of age. The men were divided into a younger group (41.5 years old-avg)) and an older group (71 years old-avg). Specimens from younger men had a greater average breaking load, strength, strain, modulus and density than those from older men. The percentage of spaces in the break area was greater in specimens from older men, but specimens from younger men had a slightly greater percentage of osteons, osteon fragments, and interstitial lamellae. The number of osteons/mm2 and of osteon fragments/mm2 was greater in specimens from older men but the average area/osteon and area/osteon fragment was greater in specimens from younger men. Thus, there are quantitative and qualitative differences in the histological structure of bone from younger and older men. Differences in the tensile properties of bone from younger and older men can be explained by histological differences in the bone.

Adult

Human abductor pollicis brevis muscle "divisions" and the nerve hila.

The interpretation of neuromuscular impairment may be aided by an analysis of functional anatomic factors. The anatomy of the abductor pollicis brevis (APB), a muscle used for skilled movements, was investigated in 19 embalmed hands, and the muscular divisions joining the common tendon at different sites were reproduced on clear vinyl sheets. The median nerve pathway to thenar muscles was followed to where it divides to the APB nerve and to the sites of the main terminal hila. Transverse (x) and longitudinal (y) muscle axes were established with the aid of landmarks to reproduce the nerve pathway on the skin surface. In the rather thick APB, three groups of six muscular heterogeneous divisions were regularly present. The dorsal aponeurotic expansion of the thumb receives the first group. The second group forms a continuous vertical line from the base to the body of the first phalanx. The outside site of its lateral tubercle takes the central tendon from the penniform third group. Hence, a reverse figure-seven distal insertion can be observed. The deepest medial (V2) and the most superficial lateral (V3) divisions had the highest mean diameters. The APB nerve fell between V2 and V2' and its line of projection supplied a guideline to establish an x axis at the proximal one-third of the muscle. The nerve hila plotted in relation to the x-y axes revealed a mode of location. The classical description of a thin APB muscle, made up of two bellies of parallel fibers seems incorrect. The APB nerve is not found on the deep aspect of the muscle as stated earlier, but within the muscle. The well-innervated muscular divisions point to the possibility of their individual use. The APB neuromuscular projection to the skin should allow more accurate fundamental EMG studies of the thumb and therefore provide a basis for more effective treatment in cases of impaired APB.

Humans

The inferior thyroid veins--the ultimate guardians of the trachea.

The inferior thyroid veins and their multiple tributaries are the ultimate guardians of the cervical trachea. Deeply embedded in the pretracheal fat pad, this plexus of veins is consistently encountered during low tracheostomy that accompanies conservation laryngral procedures as well as in tracheal reconstruction. In a high tracheotomy, the handling of the thyroid isthmus is simplified by an appreciation of these veins. Even cricothyrotomy is potentially complicated by hemorrhage sebsequent to a tear in a tributary of the inferior thyroid venous system. A cadaver study, employing 10 embalmed head and neck specimens, was performed to elucidate the tributary patterns of these veins. In every dissection there was at least one and as many as five veins overlying the trachea just below the thyroid isthmus. In 7 of 10 dissections a confluence of right and left inferior thyroid veins formed a large thyroid ima vein draining into the left innominate vein, and in 1 of 10 cases the thyroid ima vein drained into the right innominate. This confluence was present at a level which would be encountered in low tracheostomy or tracheal repair procedures. Six of 10 dissections presented large tributaries of the inferior thyroid veins overlying the cricothyroid membrane. An awareness of such anatomical considerations should result in safer surgical procedure performed in a dry operative field.

Humans

Paleoradiologic evaluation of the Egyptian royal mummies.

We examined radiographs of 12 Egyptian royal mummies obtained by two of the authors (W.R. and J.E.H.) and never before published. These radiographs demonstrate findings not previously described in Egyptian mummies, including congenital lunate-triquetral fusion and destructive skeletal lesions not explainable on the basis of vandalism by tomb robbers. Antemortem fractures, degenerative joint disease, and arterial vascular calcification were also seen. In 11 of the 12 cases, there was chondrocalcinosis of intervertebral discs or menisci, probably an artifact of embalming. Visceral packing and skeletal deformity due to wrapping were observed, as well. Radiology provides important paleopathologic and archeologic information for the accurate, comprehensive study of Egyptian mummies.

Bone Diseases

The fibrous frame of the supraspinatus muscle. Correlations between anatomy and MRI findings.

30 MRI investigations of shoulders and 20 dissections of non embalmed cadaveric shoulders allowed us to demonstrate a particular organization of the supraspinatus muscle. In the anterior part of the muscle is an important fibrous frame with obliquely inserted muscle fibers. This organization suggests that this part of the supraspinatus muscle works as a "contractile tendon".

Humans

The mediastinum in sagittal sectioning. Anatomy and magnetic resonance imaging (MRI).

Ten volunteers with a normal mediastinum were investigated by magnetic resonance using a 0.5 Tesla CGR imager with a supraconducting magnet. The reconstruction matrix consisted of a 256 X 256 grating for a field of the order of 420 mm, with a spatial resolution of 1.6 X 1.6 mm2. The sections, balanced in T1, were performed in synchronization with the ECG. The successive sagittal sections were correlated with sagittal sections made on a single embalmed frozen subject. The MRI and anatomic sections were made at 5 mm intervals and located in relation to the median sagittal plane of the mediastinum. Examples of structural variations, malformations or tumours studied in sagittal sections, and taken from investigation of over 170 patients, demonstrate the importance of this investigational technique.

Electrocardiography

Dorsal vascular network of the first web space. Anatomical bases of the kite flap.

Thirty dissections were performed on adult non embalmed cadavers, after vascular injection with MICROFIL or Methylene blue. In contrast to the classical descriptions of a single dorsal metacarpal artery, this study shows the existence of a vascular network with 1 or 2 vessels running over or under the deep aponeurosis. Direct cutaneous arteries provide blood supply to the kite flap when the only dorsal metacarpal vessel of the first web space is in a deep situation. The main source of blood supply to the kite flap is described in each anatomical variation of the dorsal network.

Anastomosis, Surgical

An anatomic and dynamic study of the greater occipital nerve (n. of Arnold). Applications to the treatment of Arnold's neuralgia.

This study concerns the posterior ramus of the second cervical spinal n., or greater occipital of Arnold. By means of dissections in formalin embalmed cadavers, an attempt was made to define its winding course and to locate it in relation to clinical or radiographic landmarks, so as to provide a guide for infiltration of the nerve with local anesthetic. At the same time a dynamic study was made to elucidate the relations of the nerve to adjacent structures during the different movements of the neck. This allowed us to propose clinical tests of nerve involvement and to reveal the zones where the nerve is anatomically vulnerable.

Adult

Ultrasonic non-destructive measurements of cortical bone thickness in human cadaver femur.

The knowledge of the cortical bone thickness profile in human bone has a two-fold clinical significance: to study the stress occurring in a loaded bone structure to optimize the design of prostheses; and to predict the onset of advanced bone disease such as osteoporosis. In this study, the cortical bone thickness in three embalmed human cadaver femora were measured non-destructively using an ultrasonic technique. These thickness measurements were also made using a computed tomographic (CT) scanning method. Subsequently bones were sectioned and the actual bone thicknesses in the same regions were measured using a micrometer. The correlation coefficient between the actual thickness and the ultrasonically measured thickness was 0.95 and with the CT was 0.62. Thus, these results show that, under present experimental conditions, ultrasonic thickness measurements compare well with the micrometer actual thickness results. This technique, when fully developed, can be used as a non-destructive tool for quantitative cortical bone thickness measurements. Moreover, the ultrasonic technique does not use ionizing radiation.

Bone and Bones

Use of uncalibrated biplanar radiography for the measurement of skeletal coordinates around the shoulder girdle.

Mechanical modelling of the musculoskeletal system is dependent upon information regarding the bony attachments of the relevant muscles; in order to study the biomechanics of the shoulder girdle the authors have identified the muscle attachments in three embalmed cadavers. A simple biplanar radiographic technique was then used to determine the attachment coordinates using frames of reference defined for each bone. This technique, using hand positioning without special fixtures was believed to be sufficiently accurate, bearing in mind the likely degree of biological variation. In order to test this assumption, the accuracy of the technique has been studied by measuring the agreement between the two measurements of the common coordinate in the pairs of radiographs. It was found that for the trunk, the errors in the common coordinate were always less than the natural variation; for the scapula they were of a similar magnitude but, for the humerus, the measurement errors frequently exceeded the variation in the coordinates of muscle attachments. It was concluded that, in general, uncalibrated biplanar radiography was sufficiently accurate for the determination of the spatial coordinates of muscle attachments.

Adult

The dorsal carpal ligaments: their anatomy and function.

The dorsal carpal ligaments were studied in 50 embalmed wrists. The radial collateral ligament was thin and oblique. The distribution of the dorsal radio-carpal ligament varied and it was classified into four subtypes. Neither ulnar collateral ligament nor dorsal radio-ulnar ligament was isolated as a discrete structure: instead, there were confluent soft tissues on the dorso-ulnar aspect of the wrist. The dorsal radio-carpal ligament and the dorso-ulnar component of the triangular fibro-cartilage complex, as well as the fibrous septa and the extensor tendons, were found to be the most important stabilizers of the wrist dorsally.

Humans

Post-mortem digoxin levels--two unusual case reports.

Digoxin levels in post-mortem specimens are reported for two unusual cases. The blood level of digoxin in one of these cases was five times greater than any previously reported. The other case involved specimens from an embalmed body.

Autopsy

An experimental study of partial intercarpal arthrodesis.

In this experimental study the authors show that partial intercarpal fusions performed on the first carpal row, and not involving the mediocarpal joint, only very slightly limit the mobility of carpal movements: particularly dorsal flexion and radial deviation. Thirty intercarpal fusions were performed with 15 wrists from embalmed cadavers using staples. The range of motions was measured on roentgenograms before and after stapling. The loss of motion was calculated for each type of "partial intercarpal fusion". We present the results with the average loss of motion in percentage and we discuss the indications of these intercarpal fusions, giving for each one the biomechanical explanation of the effects of these intercarpal fusions.

Arthrodesis

Mechanical stability of porous-coated acetabular components in total hip arthroplasty.

Five different porous-coated acetabular prosthetic configurations underwent in vitro testing to assess mechanical stability in embalmed cadaver hemipelves: Harris Galante II cup with three cancellous screws, Biomet Universal cup, Whiteside cup with peripheral pegs, Whiteside cup with two cancellous screws, and plain Whiteside cup. Following implantation in a neutral frame, cyclic load testing was done using 33 specimens at 100-kg load for 100,000 cycles using an MTS machine (MTS Systems Corp., Minneapolis, MN). Subsequently, static load-to-failure testing was done in all specimens. Subsidence and micromovement were determined for each specimen using linear variable differential transformers. With cyclic testing, overall cup subsidence revealed a significant increase, from 500 to 100,000 cycles. Overall cup micromovement revealed a significant decrease, and all cup groups demonstrated less than 125 microns (.125 mm) of average mean micromotion at the completion of cyclic testing. The best cup configuration was a 1-mm, oversized, press-fit cup using two 6.5 cancellous screws for additional fixation, which revealed an average mean of 60 microns (.06 mm) of micromovement. Static load testing revealed unacceptable micromovement over 150 microns (.150 mm) in most cups with 300-kg loads.

Acetabulum

Screw-augmented fixation of acetabular components. A mechanical model to determine optimal screw placement.

Sixteen embalmed hemipelves were used to determine the optimal acetabular screw placement to provide maximal screw pull-out strength in unicortical and bicortical screw fixation. The anterior column, superior ilium, posterior column, ischium, and pubis regions of the pelvis were tested using 6.5-mm titanium alloy screws and a hydraulic servo-controlled 1321 Instron testing machine. Force vs displacement data were acquired. Bicortical fixation was stronger than unicortical fixation in the four zones compared. This difference was significant in the superior ilium, posterior column, and ischium. The anterior column could not accept unicortical screws due to inadequate bone depth, which ranged between only 6 mm and 10 mm. Bicortical fixation was significantly greater in the superior ilium, posterior column, and ischium than in the anterior column or pubis. Unicortical fixation was greatest in the superior ilium. This information may aid decisions concerning the positioning of screws to augment acetabular component fixation.

Acetabulum

In vitro initial fixation of porous-coated acetabular total hip components. A biomechanical comparative study.

Two-phase in vitro testing was performed to determine the initial mechanical stability of uncemented but fixed porous coated acetabular components. Six each of three-screw fixation, two-peg fixation, and three-spike fixation porous acetabular components were implanted into fresh and embalmed human cadaver acetabula. Measurement of prosthesis-bone displacement at a load of 100 kg did not show a significant difference among the three methods of fixation. However, torque testing showed that three-screw fixation failed at significantly higher loads (46 N-m) than two-peg fixation (32 N-m) or three-spike fixation (32 N-m).

Acetabulum

In vitro analysis of proximal femoral strains using PCA femoral implants and a hip-abductor muscle simulator.

The strains produced in the proximal femur by noncemented and cemented PCA femoral implants have been compared to each other and to the strains in the same intact femur. The effect on the strain pattern of a hip-abductor muscle simulator was also tested. Nine embalmed femora were tested; two were used for development of the protocol, one was covered with a reflective photoelastic coating, and six were instrumented with eight strain gauge rosettes on each femur. For a given body weight on the photoelastically coated intact bone, the abductor-simulator increased the mean shear strains on both the medial (132%) and lateral (153%) aspects, with standard deviations of 13% and 20%, respectively; however, no strain-concentrated areas were observed. With an abductor simulator on the strain-gauged femurs, calcar shear strains were significantly reduced (P less than .01), from those on the intact bone, by both noncemented and cemented implants. These reductions were 74.2% and 91.8%, respectively, with no significant difference between the two techniques. Reductions in shear strain were noted at midstem on the medial side for the noncemented (20.5%) and cemented (35.9%) implants; however, only the cemented implants produced significantly less (P less than .05) strain than the intact bone at this location. At midstem on the medial aspect of the femur, there was a significant difference (P less than .05) between the data for the cemented and noncemented implants. Analysis of variance identified no other regions of significant change.

Biomechanical Phenomena

[Measurements of the deformation of the femur using speckle interferometry].

A new method for measuring the surface displacement in bones is described. Speckle interferometry was used to study the deformation behaviour of embalmed human femoral bones. The bones were measured under varying loads and conditions. It was shown that the magnitude and direction of displacement could be ascertained at selected points and the strain between any two points could be calculated. The present findings differ from those derived from mathematical models for the femoral bone published so far. The practicability of this technique is outlined. The present results indicate that the technique of speckle interferometry can also be applied to femoral bones with prostheses or external fracture fixations.

Biomechanical Phenomena