Independent assessment of a new pedicle probe and its ability to detect pedicle breach: a cadaveric study

Object The authors undertook an independent, non–industry funded cadaveric study to evaluate the efficacy of a pedicle-probing device, which uses impedance measurement to warn of impending and actual pedicle screw breach. Methods A previously validated fresh-frozen cadaver model (saline-soaked spine) was used. Individuals at 3 levels of training (attending spine surgeon, orthopedic surgery resident, and medical student) used a cannulated pedicle-probing device to cannulate each of the levels between T-2 and S-1. Each pedicle was cannulated freehand using 2 approaches: 1) a standard trajectory through the middle of the pedicle, and 2) a medial trajectory aimed to breach the medial wall of the pedicle. A 16-slice helical CT scanner was used. The images were interpreted and analyzed by 2 orthopedic spine surgeons and a neuroradiologist. Results The sensitivity of the pedicle probe to detect impending breach or breach of 4 mm or less was 90.06%. The sensitivity in detecting medial wall breach was 95.8%. The positive predictive value was 87.1%. The device detected medial breach more often than lateral breach. Conclusions This study showed that this pedicle-probing device could reasonably be used to detect impending breach and actual breach of 4 mm or less. Medial breach was detected better than lateral breach. Use of the pedicle probe may improve patient safety.

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‘Do not Do’ Recommendations in Hemophilia

Cardiovascular & Haematological Disorders - Drug Targets ◽

10.2174/1871529x20666200305111323 ◽

2020 ◽

Vol 20 (3) ◽

pp. 168-174

Author(s):

Hortensia De la Corte-Rodriguez ◽

E. Carlos Rodriguez-Merchan ◽

M. Teresa Alvarez-Roman ◽

Monica Martin-Salces ◽

Victor Jimenez-Yuste

Keyword(s):

Improve Patient Safety ◽

Health Resources ◽

Fresh Frozen Plasma ◽

Factor Ix ◽

Levels Of Care ◽

Fresh Frozen ◽

History Of ◽

Improve Patient ◽

Different Levels ◽

Frozen Plasma

Background: It is important to discard those practices that do not add value. As a result, several initiatives have emerged. All of them try to improve patient safety and the use of health resources. Purpose: To present a compendium of "do not do recommendations" in the context of hemophilia. Methods: A review of the literature and current clinical guidelines has been made, based on the best evidence available to date. Results: The following 13 recommendations stand out: 1) Do not delay the administration of factor after trauma; 2) do not use fresh frozen plasma or cryoprecipitate; 3) do not use desmopressin in case of hematuria; 4) do not change the product in the first 50 prophylaxis exposures; 5) do not interrupt immunotolerance; 6) do not administer aspirin or NSAIDs; 7) do not administer intramuscular injections; 8) do not do routine radiographs of the joint in case of acute hemarthrosis; 9) Do not apply closed casts for fractures; 10) do not discourage the performance of physical activities; 11) do not deny surgery to a patient with an inhibitor; 12) do not perform instrumental deliveries in fetuses with hemophilia; 13) do not use factor IX (FIX) in patients with hemophilia B with inhibitor and a history of anaphylaxis after administration of FIX. Conclusions: The information mentioned previously can be useful in the management of hemophilia, from different levels of care. As far as we know, this is the first initiative of this type regarding hemophilia.

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The Hallux Metatarsophalangeal Capsule: An Anatomic Study With Respect to Percutaneous Hallux Valgus Correction

Foot & Ankle International ◽

10.1177/10711007211027262 ◽

2021 ◽

pp. 107110072110272

Author(s):

Kenneth M. Chin ◽

Nicholas S. Richardson ◽

John T. Campbell ◽

Clifford L. Jeng ◽

Matthew W. Christian ◽

...

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Metatarsal Head ◽

Cadaveric Study ◽

Anatomic Study ◽

Orthopedic Surgeons ◽

Popular Knowledge ◽

Fresh Frozen ◽

The Mean ◽

Anatomic Relationship

Background: Minimally invasive surgery for the treatment of hallux valgus deformities has become increasingly popular. Knowledge of the location of the hallux metatarsophalangeal (MTP) proximal capsular origin on the metatarsal neck is essential for surgeons in planning and executing extracapsular corrective osteotomies. A cadaveric study was undertaken to further study this anatomic relationship. Methods: Ten nonpaired fresh-frozen frozen cadaveric specimens were used for this study. Careful dissection was performed, and the capsular origin of the hallux MTP joint was measured from the central portion of the metatarsal head in the medial, lateral, dorsal, plantarmedial, and plantarlateral dimensions. Results: The ten specimens had a mean age of 77 years, with 5 female and 5 male. The mean distances from the central hallux metatarsal head to the MTP capsular origin were 15.2 mm dorsally, 8.4 mm medially, 9.6 mm laterally, 19.3 mm plantarmedially, and 21.0 mm plantarlaterally. Conclusion: The MTP capsular origin at the hallux metatarsal varies at different anatomic positions. Knowledge of this capsular anatomy is critical for orthopedic surgeons when planning and performing minimally invasive distal metatarsal osteotomies for the correction of hallux valgus. Type of Study: Cadaveric Study.

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CT Angiography of the Lower Extremities and Aortoiliac System with a Multi–Detector Row Helical CT Scanner: Promise of New Opportunities Fulfilled

Radiology ◽

10.1148/radiol.2211011087 ◽

2001 ◽

Vol 221 (1) ◽

pp. 7-10 ◽

Cited By ~ 44

Author(s):

Douglas S. Katz ◽

Man Hon

Keyword(s):

Ct Angiography ◽

Lower Extremities ◽

Helical Ct ◽

Ct Scanner

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Cervical Spine Surgery with Intraoperative CT Imaging System using A Self-Moving Helical CT Scanner Gantry enabling Intraoperative 3D Imaging

Spinal Surgery ◽

10.2531/spinalsurg.15.35 ◽

2001 ◽

Vol 15 (1) ◽

pp. 35-40

Author(s):

Toshiaki Kodera ◽

Toshihiko Kubota ◽

Masanori Kabuto ◽

Yuji Handa ◽

Hisamasa Ishii ◽

...

Keyword(s):

Cervical Spine ◽

Spine Surgery ◽

3D Imaging ◽

Imaging System ◽

Helical Ct ◽

Ct Imaging ◽

Ct Scanner ◽

Intraoperative Ct ◽

Intraoperative 3D Imaging ◽

Cervical Spine Surgery

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The effect of in-situ decompression on ulnar nerve stability: a cadaveric study

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193416686295 ◽

2017 ◽

Vol 42 (7) ◽

pp. 715-719 ◽

Cited By ~ 2

Author(s):

B. Butler ◽

J. Peelman ◽

L.-Q. Zhang ◽

M. Kwasny ◽

D. Nagle

Keyword(s):

Ulnar Nerve ◽

Medial Epicondyle ◽

Cadaveric Study ◽

Flexion Angle ◽

Anterior Translation ◽

Nerve Decompression ◽

Flexor Carpi Ulnaris ◽

Before And After ◽

Fresh Frozen

Ten fresh frozen right cadaver arms were placed in a motorized jig and an in-situ ulnar nerve decompression was performed in 5 mm increments distally to the flexor carpi ulnaris (FCU) aponeurosis then proximally to the intermuscular septum. The elbows were ranged 0–135° after each incremental decompression and the ulnar nerve to medial epicodyle distance was measured to assess for nerve translation/subluxation compared with baseline (prerelease) values. None of the specimens had ulnar nerve subluxation (defined as anterior translation past the medial epicondyle) even after full decompression. Furthermore, there were no statistically significant ulnar nerve translations (defined as any difference in distance from ulnar nerve to medial epicondyle before and after each decompression) for any flexion angle or extent of decompression. This study provides biomechanical evidence that in situ ulnar nerve decompression from the FCU aponeurosis to the intermuscular septum does not result in significant ulnar nerve translation or subluxation.

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Distance Between the Anterior Distal Tibial Edge and the Anterior Tibial Artery in Distraction and Nondistraction During Anterior Ankle Arthroscopy: A Cadaveric Study

Foot & Ankle International ◽

10.1177/1071100717732550 ◽

2017 ◽

Vol 39 (1) ◽

pp. 113-118 ◽

Cited By ~ 4

Author(s):

Ichiro Tonogai ◽

Fumio Hayashi ◽

Yoshihiro Tsuruo ◽

Koichi Sairyo

Keyword(s):

Arthroscopic Surgery ◽

Joint Space ◽

Ankle Arthroscopy ◽

Anterior Tibial Artery ◽

Saline Injection ◽

Ct Scanner ◽

Tibial Artery ◽

Anterior Tibial ◽

Fresh Frozen ◽

Space Expansion

Background: Anterior ankle arthroscopy is widely applied for various osteoarthropathies. However, distraction of the ankle may put the anterior tibial artery (ATA) at risk of injury during the procedure. The purpose of this study was to assess the difference in the distance between the anterior distal tibial edge and the ATA in distraction and nondistraction of the ankle with joint space expansion by saline injection into the joint. Methods: Eight whole fresh-frozen cadaveric feet (mean age 78.9 years) were used. Barium sulfate suspension was injected into the popliteal artery of each specimen, and the distance from 3 aspects of the anterior distal tibial edge to the ATA was measured to evaluate the possibility of damage to the ATA based on computed tomography (CT) scans, in ankle distraction and nondistraction, using a traction device developed for reproducible ankle positioning inside the CT scanner. Results: The distance between the ATA and the most proximal, middle, and distal parts of the anterior distal tibial edge was 0.5 mm, 3.9 mm, and 7.4 mm, respectively, without saline injection, and 3.7 mm, 7.2 mm, and 11.6 mm, respectively, with saline injection, in nondistraction. The distance was 2.2 mm, 5.9 mm, and 9.8 mm, respectively, with 5-kg distraction, and 1.7 mm, 5.1 mm, and 8.8 mm, respectively, with 10-kg distraction, both with saline injection, respectively. Conclusion: The distance between the anterior distal tibial edge and the ATA with joint space expansion by saline injection into the joint increased, and that distance in distraction of the ankle decreased during anterior arthroscopic surgery. Clinical Relevance: The anatomic relationship of the ATA to its surrounding structures may be at more risk without saline injection or with distraction during anterior ankle arthroscopy.

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Minimally Invasive Dorsal Cheilectomy of the First Metatarsal: A Cadaveric Study

Foot & Ankle International ◽

10.1177/1071100718791588 ◽

2018 ◽

Vol 39 (12) ◽

pp. 1497-1501 ◽

Cited By ~ 6

Author(s):

Kar Hao Teoh ◽

Esten Konstad Haanaes ◽

Saud Alshalawi ◽

Hiro Tanaka ◽

Kartik Hariharan

Keyword(s):

Minimally Invasive ◽

Average Distance ◽

Cadaveric Study ◽

Invasive Technique ◽

Optimal Position ◽

First Metatarsal ◽

Below The Knee ◽

Fresh Frozen ◽

Stab Incision ◽

Relationship Of

Background: Minimally invasive dorsal cheilectomy (MIDC) for hallus rigidus is gaining in popularity. The optimal position for the stab incision for MIDC is dorsomedial to allow an ergonomic sweeping movement of the burr, potentially putting the dorsomedial cutaneous nerve (DMCN) to the hallux at risk. We aimed to quantify the risk of using this minimally invasive technique with a cadaveric study. Methods: A total of 13 fresh-frozen cadaveric specimens amputated below the knee were obtained for this study. After the procedure, the specimens were dissected, and structures were inspected for damage. Results: The DMCN to the hallux was cut completely in 2 specimens (15%). All the extensor hallucis longus tendons were intact, although in 1 specimen, the tendon showed some fraying on the underside of the tendon. The average distance of the stab incision from the first metatarsophalangeal (MTP) joint was 17.7 (range, 10-23) mm. The relationship of the DMCN to the stab incision was variable. The average distance of the DMCN to the incision was 3.8 (range, 0-7) mm. The danger zone for damaging the DMCN was at one-third the length of the first metatarsal proximal to the first MTP joint. Conclusion: The DMCN has been well studied by several authors and has a variable course. This nerve was damaged in 15% of our specimens following MIDC. Clinical Relevance: We believe patients should be made aware of this risk when considering surgery. A carefully made working capsular pocket for the burr and marking this nerve before making the incision if palpable could mitigate this risk.

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Anatomical Assessment of the Thorax in the Neonatal Foal Using Computed Tomography Angiography, Sectional Anatomy, and Gross Dissections

Animals ◽

10.3390/ani10061045 ◽

2020 ◽

Vol 10 (6) ◽

pp. 1045

Author(s):

Alberto Arencibia ◽

Juan Alberto Corbera ◽

Gregorio Ramírez ◽

María Luisa Díaz-Bertrana ◽

Lidia Pitti ◽

...

Keyword(s):

Computed Tomography ◽

Computed Tomography Angiography ◽

Helical Ct ◽

Ct Imaging ◽

Ct Scanner ◽

Cardiac Volume ◽

Sectional Anatomy ◽

Contrast Enhanced ◽

Ct Density

The purpose of this study was to correlate the anatomic features of the normal thorax of neonatal foals identified by CTA, with anatomical sections and gross dissections. Contrast-enhanced transverse CTA images were obtained in three neonatal foals using a helical CT scanner. All sections were imaged with a bone, mediastinal, and lung windows setting. Moreover, cardiac volume-rendered reconstructed images were obtained. After CT imaging, the cadaver foals were sectioned and dissected to facilitate the interpretation of the intrathoracic cardiovascular structures to the corresponding CTA images. Anatomic details of the thorax of neonatal foals were identified according to the characteristics of CT density of the different organic tissues and compared with the corresponding anatomical sections and gross dissections. The information obtained provided a valid anatomic pattern of the thorax of foals, and useful information for CTA studies of this region.

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Percutaneous, Intra-articular, Chevron Osteotomy (PeICO) for the Treatment of Hallux Valgus: A Cadaveric Study

Foot & Ankle International ◽

10.1177/1071100718820696 ◽

2019 ◽

Vol 40 (5) ◽

pp. 586-595 ◽

Cited By ~ 7

Author(s):

Jorge Javier Del Vecchio ◽

Mauricio Esteban Ghioldi ◽

Anuar Emanuel Uzair ◽

Lucas Nicolás Chemes ◽

María Cristina Manzanares-Céspedes ◽

...

Keyword(s):

Sagittal Plane ◽

Metatarsophalangeal Joint ◽

Cadaveric Study ◽

Percutaneous Surgery ◽

Lateral Border ◽

Iatrogenic Injuries ◽

Orthopedic Surgeons ◽

Chevron Osteotomy ◽

Extensor Hallucis Longus ◽

Fresh Frozen

Background: Percutaneous surgery is experiencing sustained growth based on third-generation techniques. This cadaveric study was designed with the main goal of exploring the risk of iatrogenic tendon and neurovascular lesions and defining the safe zones in a percutaneous, intra-articular, chevron osteotomy (PeICO) procedure, as well as assessing the accuracy of the osteotomy itself. Methods: Eight feet from below-knee fresh-frozen specimens were selected. After the procedure, the specimens were dissected, and structures were inspected for damage. Results: The results of the safety measurements were as follows: (1) distance between portal 1 (P1) and the lateral border of the extensor hallucis longus (EHL) tendon: average 17.6 mm (range 12.7-21.3); (2) distance between P1 and the dorsomedial digital nerve (DMDN): average 7.2 mm (range 1.6-10.4); (3) distance between P1 and the metatarsophalangeal joint: average 15.7 mm (range 9.4-20.5); distance between portal 2 (P2), or the osteosynthesis portal, and the metatarsophalangeal joint: average 25.5 mm (range 22-30.4); distance between P2 and the lateral border of the EHL tendon: average 12.7 mm (range 8-16.7); and distance between P2 and the DMDN: average 4.1 mm (range 1.7-8.2). There were no iatrogenic injuries. The osteotomy angulation in the sagittal plane (reproducibility) average was 85.6 degrees. Conclusion: There were no iatrogenic injuries on this cadaveric study of PeICO. Clinical Relevance: This study will help orthopedic surgeons understand the risks of performing percutaneous surgery by mimicking an accepted open technique (chevron).

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