Anatomy of master knot of henry: A morphometric study on cadavers

WOS: 000433350100010PubMed ID: 29366540Objective: The objective of this study was to evaluate the features of flexor hallucis longus (FHL), flexor digitorum longus (FDL) and flexor digitorum accessorius (FDA) muscles with relevance to the tendon grafts and to reveal the location of Master Knot of Henry (MKH). Methods: Twenty feet from ten formalin fixed cadavers were dissected, which were in the inventory of Anatomy Department of Medicine Faculty, Mersin University. The location of MKH was identified. Interconnections of FHL and FDL were categorized. According to incision techniques, lengths of FHL and FDL tendon grafts were measured. Attachment sites of FDA were assessed. Results: MKH was 12.61 +/- 1.11 cm proximal to first interphalangeal joint, 1.75 +/- 0.39 cm below to navicular tuberosity and 5.93 +/- 0.74cm distal to medial malleolus. The connections of FHL and FDL were classified in 7 types. Tendon graft lengths of FDL according to medial and plantar approaches were 6.14 +/- 0.60cm and 9.37 +/- 0.77cm, respectively. Tendon graft lengths of FHL according to single, double and minimal invasive incision techniques were 5.75 +/- 0.63cm, 7.03 +/- 0.86cm and 20.22 +/- 1.32 cm, respectively. FDA was found to be inserting to FHL slips in all cases and it inserted to various surfaces of FDL. Conclusion: The exact location of MKH and slips was determined. Two new connections not recorded in literature were found. It was observed that the main attachment site of FDA was the FHL slips. The surgical awareness of connections between the FHL, FDL and FDA, which participated in the formation of long flexor tendons of toes, could be important for reducing possible loss of function after tendon transfers postoperatively

Radiologic Evaluation of the Prechiasmatic Sulcus in Adults and Clinical Implications

Background: The present work intended to analyze the prechiasmatic sulcus types in adults via cone-beam computed tomographic images

Anatomical Evaluation of the Foramen Magnum on Cone-Beam Computed Tomography Images and Review of Literature

Background and objectiv

Evaluation of the Cranial Aperture of the Optic Canal on Cone-Beam Computed Tomography Images and its Clinical Implications for the Transcranial Approaches

Objective: This study aimed to investigate morphometric properties of the cranial aperture (CA) of the optic canal. Methods: Cone-beam computed tomography images of 400 individuals (200 males and 200 females) aged 37.32 +/- 15.87 years were retrospectively examined to assess the morphometry and morphology of the CA. Results: The height and width of CA were found as 4.22 +/- 0.74 mm and 7.27 +/- 1.15 mm, respectively. The distances between the CA and the midsagittal line, the anterior and lateral boundaries of the anterior skull base were measured as 5.77 +/- 1.32 mm, 64.97 +/- 6.36 mm, and 41.00 +/- 4.05, respectively. The angle of the optic canal in the sagittal plane was measured as 7.57 degrees +/- 3.95 degrees, whereas in the horizontal plane as 38.96 degrees +/- 4.36 degrees. The aperture shape was defined as the tear-drop (413 foramina, 51.62%), triangular (180 foramina, 22.50%), oval (158 foramina, 19.75%), round (30 foramina, 3.75%), and polygonal (19 foramina, 2.38%). Conclusions: The authors observed that the diameters, and angulations of the CA may change relative to gender and the shape. The anatomic features of CA are important for the positioning of the patient's head, the choice of the appropriate surgical approach or equipment, and the detection of anatomical landmarks during interventions. In this context, our dataset may be beneficial for surgeons helpful as a reference for radiological evaluations

Morphological features of the chiasma tendinum and its relation with surface landmarks and pulleys: a cadaveric study

Aim!#!Chiasma tendinum (Camper's chiasm) is of great importance in the delicate movements and stability of the fingers and takes place poorly in the literature. This study aims to reveal the morphometric details of the chiasma tendinum in relation with pulleys and other relevant structures.!##!Materials and methods!#!Palm and 2nd to 5th fingers of 10 (6 male, 4 female) formalin fixed cadavers were used bilaterally. After determining the superficial reference points on the fingers, the skin and the tendon sheath were incised, and then measurements of chiasma tendinum and related tendons were performed. The measurements were analyzed with respect to fingers, genders, and sides. Finally, the types of chiasma tendinum were identified and then grouped as symmetrical, asymmetrical, and pseudo chiasm.!##!Results!#!Pulley and chiasma tendinum positions were correlated with finger length (p < 0.01). Pulley lengths were significantly less in females. Asymmetrical chiasma tendinum types were found in 45% of the fingers. In most comparisons, values for fifth finger were significantly different than that of other fingers and chiasma tendinum types differed according to fingers and gender. The case of no fiber exchange was observed only in the 5th finger in 15%.!##!Conclusion!#!Findings related to the prediction of location of the pulleys and chiasma tendinum according to the superficial signs, awareness of cases where one of the two arms of the flexor digitorum superficialis is extremely thin and no fiber exchanges that may be risk factors for spontaneous tendon rupture may help provide more accurate approaches in relevant clinical applications

Change in the Location of the Optic Strut Relative to the Anterior Clinoid Process Pneumatization

Objective: This study aimed to peruse the alteration of the position of the optic strut (OS) according to the anterior clinoid process (ACP) pneumatization. Methods: This retrospective study conducted on cone-beam computed tomography images of 400 patients with a mean age of 36.49 +/- 15.91 years. Results: Anterior clinoid process length, width, and angle were measured as 10.56 +/- 2.42 mm, 5.46 +/- 1.31 mm, and 42.56 +/- 14.68 degrees, respectively. The tip of ACP was measured as 6.60 +/- 1.50 mm away from the posterior rim of OS. In the 631 sides (78.87%) did not have ACP pneumatization. In the cases with ACP pneumatization, three different configurations were identified as follows: Type 1 in 71 sides (8.87%), Type 2 in 56 sides (7%), and Type 3 in 42 sides (5.23%). Relative to ACP, the location of OS was determined as follows: Type A in 29 sides (3.64%), Type B in 105 sides (13.12%), Type C in 344 sides (43%), Type D in 289 sides (36.12%), and Type E in 33 sides (4.12%). The spread of data related to the attachment site of OS according to the presence or absence of ACP pneumatization showed that the location of OS was affected by ACP pneumatization (P<0.001). In ACPs with pneumatization, the frequency of OS position relative to ACP was found as follows: Type A in none of sides (0%), Type B in 8 sides (7.6%), Type C in 53 sides (15.4%), Type D in 88 sides (30.4%), and Type E in 20 sides (60.6%). Conclusions: The main finding of this study was that the location of OS relative to ACP was affected by ACP pneumatization. In ACPs with pneumatization, OS was located more posteriorly compared with ACPs without pneumatization

Analysis of the prechiasmatic sulcus in chiari malformation type I

OBJECTIVE: To assess morphologic features of the pre-chiasmatic sulcus (PS) in Chiari malformation type I (CM-I).-METHODS: Computed tomography images were ob-tained in patients with CM-1 (mean age: 21.26 & PLUSMN; 16.46 years; sex: 25 females and 17 males) and 58 healthy control subjects (mean age: 28.12 & PLUSMN; 22.60 years; sex: 29 females and 29 males). The following parameters were measured to determine the anatomy of the PS: planum length, sulcal length, sulcal angle (SA), and interoptic distance. Consid-ering sulcal length and SA measurements, 4 types of PS were identified: narrow-steep-groove (NSG), narrow-flat -groove (NFG), wide-steep-groove, and wide-flat-groove.-RESULTS: SA was greater in the CM-I group (32.80 & PLUSMN; 18.21 & DEG;) compared with the control group (23.05 & PLUSMN; 14.53 & DEG;) (P = 0.004), but the other parameters were similar in both groups. Distribution ranking of PS types was as follows: NFG (31%) > NSG (26.20%) > wide-steep-groove (23.80%) > wide-flat-groove (19%) in the CM-I group; wide-flat-groove (37.90%) > wide-steep-groove (20.70%) = NFG (20.70%) = NSG (20.70%) in the control group. Distribution rate of PS types relative to both groups showed that the classification system was not affected by CM-I (P = 0.226).-CONCLUSIONS: SA value was approximately 25% greater in the CM-I group than in the control group; thus, CM-I patients had more vertical groove. The percentage of narrow-type (NSG D NFG) PS in the CM-I group was higher than in the control group

Comparison of fetal and adult tympanic membrane sizes: a cadaveric study

Objective The work aimed to compare fetal and adult tympanic membrane (TM) sizes for understanding dimensional development from intrauterine life to adulthood. Methods Fifty-six temporal bones (18 fetuses, 10 elderly adults, half male and half female in each group) were included in this study. Using a digital image software, the TM height, width and area were measured. Results The mean area, height and width of the TM in adults were found as 58.84 +/- 22.01 mm(2), 9.06 +/- 1.33 mm, and 8.10 +/- 1.43 mm, respectively. Moreover, the mean area, height and width of the TM in fetuses were measured as 47.62 +/- 12.57 mm(2), 8.22 +/- 1.12 mm, and 7.25 +/- 1.15 mm, respectively. The TM dimensions were increasing in fetuses between 20-32 weeks of gestation. However, the TM dimension was statistically similar at the 7th month, the 8th month and adult periods. The TM height was greater than its width in fetuses and adults. Conclusion The calculated regression equations of the TM parameters in fetuses may be used to estimate its size. The TM size did not change from the 7th gestational month, and thus the membrane reached adult diameter in fetal life. The TM height and width showed a very wide range; therefore, we thought that the 12 mm (the height) x 10 mm (the width) graft might be ideal dimension during the repair of the TM perforations

Biomechanical and morphometric properties of the long flexor tendons of the toes: A cadaver study

BACKGROUND: We sought to show the biomechanical and morphometric properties of flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendon grafts harvested by specific surgical approaches and to assess the contribution of FHL slips to the long flexor tendons of the toes. METHODS: Thirteen fresh-frozen amputated feet (average age, 79 years) were dissected. The connections between the FHL and FDL tendons and the contribution of FHL slips to the long flexor tendons were classified. The biomechanical properties of the tendons and slips were measured using a tensile device. RESULTS: The connections between the FHL and FDL tendons were reviewed in two groups. Group 1 had FHL slips (11 cases) and group 2 had cross-slips (two cases). The FHL slips joined the second and third toe long flexor tendon structures. Tendon length decreased significantly from the second to the fifth toe (P < .001). Apart from the second toe tendon being thicker than that of the fourth toe (P = .02) and Young's modulus being relatively smaller in the third versus the fourth toe tendon (P = .01), biomechanical and morphometric properties of second to fourth tendons were similar. Mechanical properties of those tendons were significantly different from fifth toe tendons and FHL slips. Morphometric and biomechanical properties of FHL slips were similar to those of the fifth toe tendon. CONCLUSIONS: Herein, FHL slips were shown to have biomechanical properties that might contribute to flexor functions of the toes. During the harvesting of tendon grafts from the FHL by minimally invasive incision techniques from the distal plane of the master knot of Henry, cutting slips between FHL and FDL tendons could be considered a cause of postoperative function loss in toes