Distance of the posterior interosseous nerve from the radial head during elbow arthroscopy : an anatomical study

Purpose The aims of this study were to measure the distance of the posterior interosseous nerve (PIN) from the radial head (RH) and its variations with forearm movements. Methods Five fresh frozen cadaver specimens were dissected under arthroscopy. An anterior capsulectomy extended to the entire lateral compartment was performed. The need of soft tissue dissection to isolate the nerve in the extracapsular space was recorded. The distance between the nerve and the anterior part of the RH was then measured with a graduated caliper inserted via the midlateral portal with the forearm in neutral position, full pronation, and full supination. Results The PIN was identifiable in all the specimens. In four cases, it was surrounded by a thick layer of adipose tissue, and further dissection was necessary to isolate it. Damage of the PIN during dissection occurred in one case, in which the proximal part of the nerve was accidentally cut. In three of the remaining cases, an increased distance was measured with the forearm in supination, as compared with neutral and full pronation position. Conclusion This anatomical study suggests that in most of the cases, the PIN does not lay just extracapular at the level of the radiocapitellar joint, but is surrounded by a thick layer of adipose tissue. Furthermore, its distance from the RH appears to increase with forearm supination. This position could increase the safe working space between RH and PIN. Clinical Relevance Knowledge of PIN position in relation to the anterior elbow capsule and its changes with forearm movements can help reduce the iatrogenic injuries during elbow arthroscopy

La societ\ue0 a responsabilit\ue0 limitata a capitale ridotto

La l. 7 agosto 2012, n. 134 (che ha convertito il d.l. 22 giugno 2012, n. 83 recante \u201cMisure urgenti per la crescita del Paese\u201d) ha introdotto nel nostro ordinamento la societ\ue0 a responsabilit\ue0 limitata a capitale ridotto: nel contributo, pubblicato a distanza di poco tempo dell'introduzione della novit\ue0 normativa, si esamina la nuova disciplina confrontandola con quella della societ\ue0 a responsabilit\ue0 limitata semplificata

Newborn screening strategy for cystic fibrosis: A field study in an area with high allelic heterogeneity

To verify to what extent mutation analysis on blood spot could improve cystic fibrosis neonatal screening in an area with high allelic heterogeneity, we designed a special protocol. Spot trypsin estimation at birth, trypsin re-testing after 1 month, meconium lactase testing and mutation analysis of \u394F508, R1162X and N1303K, were retrospectively clustered according to different patterns (trypsin/lactase/mutation; trypsin/lactase/re-testing; trypsin/mutation) and compared. The programme, which lasted 2 years (1993-94) and covered most of North-eastern Italy, included 95 553 screened newborns. Thirty-four affected babies were detected by screening and one by meconium ileus (incidence 1/2730). The combined use of trypsin, lactase and mutation analysis in cystic fibrosis neonatal screening permits a better sensitivity compared to the two other combinations (34 diagnoses vs 32 in both cases). Moreover, the higher specificity of the former method (false positives 42 vs 148) allows a reduction of recalls, which cause considerable anxiety. We confirm in trypsin-positive newborns an increased frequency of cystic fibrosis heterozygotes (1/17)

Lo screening neonatale della fibrosi cistica. Due metodi a confronto su 229.626 neonati esaminati in 8 anni nel Veneto.

Lo screening neonatale della fibrosi cistica. Due metodi a confronto su 229.626 neonati esaminati in 8 anni nel Veneto

Double-bundle anterior cruciate ligament reconstruction: a comparative cadaver study of the femoral tunnels performed with in-out and out-in techniques.

Introduction: Double bundle (DB) anterior cruciate ligament (ACL) reconstruction is nowadays a common procedure to manage ACL rupture. Many authors have reported in several short term follow-up prospective randomized studies a greater knee stability in DB reconstruction compared to single bundle. Despite several techniques reported in literature, as yet no study has demonstrated which DB technique has better outcomes. There are several factors that can influence biological integration of grafts and the bundle\u2019s (anteromedial AM; posterolateral PL) mechanical behavior. The difference in diameter between tunnels on the intra-articular femoral side and graft is one of the most important. The aim of this study is to compare the diameter at the femoral tunnel entrance between two different techniques of DB ACL reconstruction in a cadaver model: the inside-out and the outside-in techniques. Hypothesis: The hypothesis is that a difference exists, in terms of diameter at the femoral tunnel entrance, between the abovementioned techniques. Materials and Methods: The study included 8 knees from 8 different cadavers divided into 2 groups. Group A: femoral tunnels were performed using an in-out technique: the PL tunnel from the AM portal and the AM tunnel from the transtibial PL tunnel. Group B: both tunnels were performed using an out-in technique with an out-in anatomical ACL guide system. All tunnels were drilled with a 7 mm acorn reamer. Upon cadaver dissection, the samples were evaluated by CT-scan on coronal and axial planes. The diameters of the two tunnels were measured on both planes. Results: Tunnel convergence was never observed in the two planes. In group A, AM tunnel measured 7.07 mm (range 7 \u2013 7.1) on axial plane and 7.02 mm (range 7 \u2013 7.1) on coronal plane. In group B, AM tunnel measured 7.1 mm (range 7 \u2013 7.2) on axial plane, and 7.15 mm (range 7 \u2013 7.3) on coronal plane (p>0.05). In group A, PL tunnel measured 8.32 mm (range 8.2 \u2013 8.4) on axial plane and 8.45 mm (range 8.4 \u2013 8.5) on coronal plane. In group B, PL tunnel measured 7.15 mm (range 7 \u2013 7.3) on axial plane and 7.02 mm (range 7 \u2013 7.1) on coronal plane. (p<0.05). Conclusions: Double bundle ACL reconstruction is a promising technique in terms of clinical results and knee stability. However, there has been some criticism concerning the procedure. Indeed, tunnel enlargement and tunnel communication could jeopardize a revision ACL surgery. Our study showed that the PL femoral tunnel entrance diameter is significantly larger in the inside-out than outside-in technique. Theoretically, the out-in technique should determine an inferior PL tunnel enlargement after ACL reconstruction. Several other variables such as type of graft, fixation and rehabilitation program should also be considered. Biomechanical and prospective randomized control studies between in-out and out-in techniques could confirm this hypothesis