High Blood Flow Into the Femur Indicates Elevated Aerobic Capacity in Synapsids Since the Synapsida-Sauropsida Split

Varanids are the only non-avian sauropsids that are known to approach the warm-blooded mammals in stamina. Furthermore, a much higher maximum metabolic rate (MMR) gives endotherms (including birds) higher stamina than crocodiles, turtles, and non-varanid lepidosaurs. This has led researchers to hypothesize that mammalian endothermy evolved as a second step after the acquisition of elevated MMR in non-mammalian therapsids from a plesiomorphic state of low metabolic rates. In recent amniotes, MMR correlates with the index of blood flow into the femur (Qi), which is calculated from femoral length and the cross-sectional area of the nutrient foramen. Thus, Qi may serve as an indicator of MMR range in extinct animals. Using the Qi proxy and phylogenetic eigenvector maps, here we show that elevated MMRs evolved near the base of Synapsida. Non-mammalian synapsids, including caseids, edaphosaurids, sphenacodontids, dicynodonts, gorgonopsids, and non-mammalian cynodonts, show Qi values in the range of recent endotherms and varanids, suggesting that raised MMRs either evolved in synapsids shortly after the Synapsida-Sauropsida split in the Mississippian or that the low MMR of lepidosaurs and turtles is apomorphic, as has been postulated for crocodiles.

Comparison of Intramedullary Magnetic Nail, Monolateral External Distractor, and Spatial External Fixator in Femur Lengthening in Adolescents with Congenital Diseases

The aim of this study is to evaluate the course of the treatment and clinical and functional outcomes of femur lengthening in adolescents with congenital disorders by the application of different surgical methods. This retrospective study comprised 35 patients (39 procedures). A total of 11 patients underwent femur lengthening with the use of the intramedullary magnetic nail (IMN) Precise 2 (NuVasive, San Diego, CA, USA), 7 patients (11 procedures) with the use of the monolateral external distractor Modular Rail System (MRS) (Smith and Nephew, Memphis, TN, USA), and 17 with the use of the computer-assisted external fixator Taylor Spatial Frame (TSF) (Smith and Nephew, Memphis, TN, USA). The inclusion criteria were as follows: (1) congenital femoral length deficiency without any axial deformities and (2), independently of the finally applied treatment, the technical possibility of use of each of the analyzed methods. The distraction index did not differ significantly between the groups (p = 0.89). The median lengthening index was the lowest in the IMN group (24.3 d/cm; IQR 21.8–33.1) and statistically different in comparison to the MRS (44.2 d/cm; IQR 42–50.9; p < 0.001) and the TSF groups (48.4 d/cm; IQR 38.6–63.5; p < 0.001). Similarly, the consolidation index in the IMN group (12.9 d/cm; IQR 10.7–21.3) was statistically lower than that in the MRS (32.9 d/cm; IQR 30.2–37.6; p < 0.001) and the TSF (36.9 d/cm; IQR 26.6–51.5; p < 0.001) groups. This study indicates that IMN is a more valuable method of treatment for femoral length discrepancy without axial deformity than MRS and TSF in complication rate and indexes of lengthening and consolidation.

Severe polymicrobial and fungal periprosthetic osteomyelitis persisting after hip disarticulations treated with caspofungin in risk patients: a case series

Background Periprosthetic fungal infections are considered rare and opportunistic infections. Treatment is difficult, and established standards do not yet exist. The choice of the appropriate antifungal drug might affect the patient outcome. Cases All the three cases presented showed polybacterial recurrent infection of the revision hip arthroplasty. All patients were of younger age, had multiple revisions of the endoprosthesis, each had a large partial femoral replacement greater than 40% of the femoral length, gentamycin-loaded cement, and a long anchoring distance of the used intramedullary stem. Due to the severe life-threatening infection with deep osteomyelitis, an amputation had to be performed. However, despite surgical intervention, the fungal dominated infection persisted. Finally, only the use of caspofungin allowed permanent infection control. Conclusion The polybacterial infection is driven by the symbiosis between fungi and bacteria. Therefore, eradication of the fungus is required to achieve elimination of the bacteria. Antimycotics of the echinocandin-class, such as caspofungin, may be considered as initial treatment.

Femoral bone growth after extendible endoprosthetic replacement of the proximal tibia in skeletally immature patients

There is increasing preference for limb salvage techniques in the management of pediatric musculo- skeletal tumors. This study was aimed at evaluating femoral growth following proximal tibia resection (PTR) and placement of an extendible endoprosthesis with sliding stem. This was a retrospective study. The demographic and clinical data were collected. All the patients with malignant tumors were fully staged and commenced on appropriate chemotherapy. An expected discrepancy of > 3cm was considered sub- stantial enough to warrant extendible prosthesis. Twelve patients who had follow up full length scanogram of the lower limbs were included for the evaluation of femoral growth. The last available scanograms were used for growth comparison of the femur. The age at resection for all twelve patients ranged from 4-13 years. The commonest histological diagnosis was Osteosarcoma. In the twelve patients assessed for the growth of femur, the mean femoral length was 96% [89%-102%] of the unaffected femur. Distal femoral physeal growth continued after im- plantation of a sliding extendible prosthesis after resection of proximal tibia tumors.

Comparison of the Ultrasonic Evaluation of Bi-Parietal Diameter and Femoral Length in 2nd and 3rd Trimester to Estimate the Gestational Age

During the gestational period, fetal biometrics are assessed through ultrasonography to observe the growth of the fetus. This study observed the corresponding of gestational age those were measured by two of the fetal diameters; gestational age were calculated from history of last menstrual period (LMP), in the last two trimesters. This descriptive type of observational study was carried out in the Department of Radiology and Imaging of Dhaka Medical College and Hospital, during the period of July, 2004 to June, 2005. Here 291 single-ton, non-complicated pregnant women of LMP were selected purposively from valid record. Bi-parietal diameter (BPD) and femoral length (FL) estimated through ultrasonography. These two parameters compared with the gestational age in second and third trimester. The study found that, before 36th week, the BPD based gestational age varied 2 to 3 days from LMP based gestational age and after that, the variation was 1 to 4 weeks. In case of FL, the ultrasonic measurement found to be 2 to 4 days backward in the second trimester and 2 to 3 days advance in the last trimester in contrast to the LMP based gestational age. In the second trimester, it has been found that, BPD has been the superior predictor of the gestational age than the FL with the correlation coefficient of 0.999 in case of BPD and 0.998 in case of FL when correlated with LMP based gestational age. Although, in third trimester, FL versus BPD predicted the gestational age with a correlation coefficient of 0.998 versus 0.978 respectively, when correlated with gestational age based on the history of LMP. This study has observed that, later in pregnancy, FL has the better predictability over BPD to determine the gestational age. Bangladesh Med J. 2020 Sept; 49(3) : 43-48

Normative Values for Femoral Length, Tibial Length, and the Femorotibial Ratio in Adults Using Standing Full-Length Radiography

Knowledge of the normal length and skeletal proportions of the lower limb is required as part of the evaluation of limb length discrepancy. When measuring limb length, modern standing full-length digital radiographs confer a level of clinical accuracy interchangeable with that of CT imaging. This study reports a set of normative values for lower limb length using the standing full-length radiographs of 753 patients (61% male). Lower limb length, femoral length, tibial length, and the femorotibial ratio were measured in 1077 limbs. The reliability of the measurement method was tested using the intra-class correlation (ICC) of agreement between three observers. The mean length of 1077 lower limbs was 89.0 cm (range 70.2 to 103.9 cm). Mean femoral length was 50.0 cm (39.3 to 58.4 cm) and tibial length was 39.0 cm (30.8 to 46.5 cm). The median side-to-side difference was 0.4 cm (0.2 to 0.7, max 1.8 cm) between 324 paired limbs. The mean ratio of femoral length to tibial length for the study population was 1.28:1 (range 1.16 to 1.39). A moderately strong inverse linear relationship (r = −0.35, p < 0.001, Pearson’s) was identified between tibial length and the corresponding femorotibial ratio. The PACS-based length measurement method used in this study displayed excellent inter-observer reliability (ICC of 0.99). This study presents a normal range of values for lower limb length in adults and is the first to identify a linear relationship between tibial length and the femorotibial ratio.

Regression Equation and Multiplication Factor for the Reconstruction of Stature by Femur Length

INTRODUCTION Stature is the important parameter along with age, sex and race while identifying bodies. Stature has direct relationship with the skeletal dimensions most importantly with lower limbs. This study attempts to derive regression equation (RE) and multiplication factor (MF) from femur length (FL) which could be used for stature reconstruction. MATERIAL AND METHODS The study was conducted amongst the 160 students and staff of Dhulikhel Hospital, Nepal for the period of six months from February 2020 to July 2020. The sample was composed of 95 males and 65 females between the age of 18 - 40 years. The femoral length and height was measured in standard position using standard measuring instruments. Statistical analysis was done using SPSS 25. RESULTS The mean height and femur length of overall sample was 162.33 ±7.62 cm and 40.14 ±2.132 cm respectively, male surpassing the female dimensions. There was a strong correlation between femur length and stature (r = 0.723, 0.869 and 0.791 for males, females, and overall participants respectively). MF was derived as 4.084 ±0.139, 3.99 ±0.11, 4.047 ±0.135 and RE was derived as y = 75.51 + 2.13*FL ±4.06, y = 55.238 + 2.581*FL ±2.999, y = 48.791 + 2.829*FL ±4.672 for males, females and overall participants. Both methods were checked for accuracy and could successfully interpret the height (p>0.05). CONCLUSION The femoral length was found to be a reliable estimator of stature of an individual by using both RE and MF.

Anthropometric Factors on Safe Distances between Popliteal Vessels to the Femur for Cerclage Wiring of the Distal Femoral Fracture: A Magnetic Resonance Imaging Study

Background and Objectives: The proximity of the popliteal vessels in the distal femur may increase the risk of iatrogenic vascular injury during cerclage wiring. In this study, the closest location and distance of the popliteal vessels to the femur was examined using magnetic resonance imaging (MRI). The associations between anthropometric factors and the distance that would guide the placement of wires safely during surgery were also identified. Materials and Methods: We reviewed adult knee magnetic resonance images and recorded: (1) the relation and the shortest horizontal distance (d-H) from the femoral cortex to the popliteal vessels in axial images and (2) the vertical distance (d-V) from the adductor tubercle to the axial level of the d-H values in coronal images. The effects of anthropometric factors (sex, age, body height, body weight, body mass index, thigh circumference, femoral length and femoral width) on these distances were analysed. Results: Analysis of 206 knee magnetic resonance images revealed that the closet locations of popliteal vessels were at the posteromedial aspect of the femur. The d-H and d-V were 7.38 ± 3.22 mm and 57.01 ± 11.14 mm, respectively, and were both shorter in women than in men (p < 0.001). Multivariate analysis identified thigh circumference and femoral length as the most influential factors for the d-H and d-V, respectively (p < 0.001). Linear regression demonstrated a strong positive linear correlation between the thigh circumference and the d-H and between the femoral length and the d-V (Pearson’s r = 0.891 and 0.806, respectively (p < 0.001)). Conclusions: The closet location and distance of the popliteal vessels to the femur provide useful information for wire placement during distal femoral fracture surgery while minimising the risk of vascular injury. Given that patients with a smaller thigh circumference and a shorter femoral length are more likely to have a smaller d-H and a shorter d-V, respectively, cautious measures should be taken in such cases.

Relationship between the endopelvic fasciae and the inferior hypogastric plexus Activity Log

The Inferior Hypogastric Plexus (PHI) is a difficult plexus to define and dissect, hence the ease with which it can be injured both in anatomical and surgical research. Defining its relationships, with respect to the endopelvic fascia (FEP), including its formation and branches, (Baader B., et al., 2003, p. 129) would facilitate their dissection. This anatomical investigation aims to standardize different portions that require a different approach to preserve their integrity. Cadaveric material belonging to the Third Chair of Anatomy of the School of Medicine, Buenos Aires University was used. One (n=1) formolized male adult organ block and seventeen (n=17) hemipelvis were dissected: five (n=5) adult male hemipelvis formolized, nine (n=9) fetal hemipelvis formolized (7 male and 2 female), between 18 and 36 weeks of gestational age calculated by femoral length, and three (n=3) adult hemipelvis from fresh cadavers, two (n=2) female and one (n=1) male. Microdissection elements and magnifying glasses were used. We were able to distinguish three different sectors: the first, preplexual, located posterior and lateral to the FEP, where the sympathetic components (hypogastric nerves) and the parasympathetic (pelvic splanchnic nerves) have not yet converged to form the plexus. A second sector, plexual, with the plexus already fully formed, located in the thickness of the FEP. Finally, its terminal portion, already devoid of the FEP, formed by nerves that go to the perineal membrane accompanied by arterial and venous vessels. Each of these sectors requires a different approach in both anatomical and surgical dissection.

CT Measurement of Proximal Femoral Medullary Cavity Morphology in Healthy Subjects from Northern China

Purpose: In total hip arthroplasty (THA), optimal stability and fixation is achieved via tight adaptation of the prosthesis to the bone. This study aimed to analyze the proximal femoral medullary cavity morphology of Chinese subjects on three-dimensional reconstructed imagery to explore the factors influencing these parameters.Methods: CT was performed on 63 healthy subjects from northern China (94 hips; 31 men, 63 women). Three-dimensional CT reconstruction of the proximal femoral medullary cavity was performed using Mimics 22.0 software. The anatomical parameters related to THA were measured to examine the relationships between sex, age, and femoral length. These parameters were compared with previously published data.Results: The internal and external coronal diameters of the femoral medullary cavity, and the anterior and posterior sagittal diameters had different contracting trends. There were correlations between the femoral length, femoral head diameter, and coronal diameter, and between the sagittal diameter and cross-sectional area of the medullary cavity. Age was negatively correlated with the CFI(canal flare index). Sex was correlated with the cross-sectional coronal/sagittal diameters, but not with the canal flare index. The proximal end of the medullary cavity was similar to that reported in Caucasians, but the Asian medullary cavity was narrower distal to the level of the lesser trochanteric line.Conclusions: THA-related anatomy was affected by sex, age, and subpopulation. Compared with sex, age had a greater effect on the fit of the stem to the femoral canal. Each patient must be treated individually, as the anatomical structure varied between individuals.