The terminal branch of the posterior interosseous nerve: an anatomic and histologic study

Background: The aim of this study was to evaluate the terminal branch of the posterior interosseous nerve (PIN) by anatomically and histologically assessing the number, dimension, and area of its individual fascicles, by determining the dimension and area of the whole nerve itself, and by calculating the nerve density ratio (ratio of the sum of the areas of individual fascicles to the area of the whole nerve) of the terminal branch of the PIN. Materials and methods: Twenty-eight terminal branches of the PIN nerve samples were collected from patients undergoing partial denervation of the wrist. The nerve samples were fixed in 10% buffered formalin and stained with haematoxylin and eosin to visualise their nerve bundles. Quantitative analysis of individual fascicles and the whole nerve itself were carried out. Results: Ten nerve samples (35.7%) had one single fascicle (group 1) while the remaining 18 nerve samples (64.3%) contained 2–9 fascicles (group 2). The difference in the sum of the areas of individual fascicles between the two groups did not constitute a statistical difference. Statistically significant between-group differences (p < 0.05) were seen in the area of whole nerve, the ratio of fascicle area to the nerve cross-sectional area and the cross-section maximum nerve length and width. Conclusions: The number of nerve fascicles in the terminal branch of the PIN does not affect the overall size of the nerve. The majority of the volume of multi-fascicle nerves, therefore, primarily consists of the internal perineurium. However, due to the low number of nerves, this question cannot be clearly answered. This sets a further direction for further research on a larger group

Anatomical variations in the first dorsal compartment of the wrist: meta-analysis

Background: The first dorsal compartment of the wrist includes tendons of abductor pollicis longus (APL) and extensor pollicis brevis (EPB). However, many studies have showed multiple anatomical variations including anomalies in the number of both APL and EPB tendons and presence of intercompartmental fibro-osseous septum. Unfortunately, studies describing those variations are not consistent, hence, the aim of this study was to provide most accurate data about these anatomical variations in the population, using systematic review and meta-analysis. Material and methods: For this purpose, PubMed, Scopus, Web of Science, Embase and a number of minor online libraries were searched. Articles which included exact data about the number of APL or EPB tendons or a presence of intercompartmental septum were qualified for a more precise evaluation. Therefore, out of 1629 studies initially evaluated, 68 were finally included in this meta-analysis. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: A total of 5229 studied wrists have been included in this study. Double APL and single EPB are the most common variations of tendons in the first dorsal compartment, both in cadavers and patients with de Quervain’s disease, with no statistically significant differences between those two groups. Presence of intercompartmental fibro-osseus septum is much more common in patients with de Quervain’s disease than in cadavers. Conclusions: Our results should improve the awareness of anatomical variations in the first dorsal compartment, which in turn should have impact on treatment of de Quervain’s disease in clinical practice

A left circumflex aorta with a displaced thoracic duct in a 94-year-old male cadaver: a case report with discussion on embryology

A left circumflex aorta (LCA) is an extremely rare variation of the thoracic aorta. It is distinguished by a retroesophageal descending aorta that subsequently travels down the right side of the thoracic vertebrae towards the aortic hiatus. Nonetheless, its embryological origin ought not to be overly generalized, but each case should be considered individually due to its unique vascular patterns. This study presents a description of a LCA in a 94-year-old male cadaver. The dissection revealed the descending aorta posteriorly from the trachea and esophagus and then laterally on the right from the thoracic vertebral bodies. The branching pattern of the aortic arch was typical, so was the course of the left and right recurrent laryngeal nerves. However, the thoracic duct was placed on the right, and drained into the right internal carotid vein. Due to the normal appearance of the ascending part and the arch of the aorta, it is safe to presume that the variation originated from the persistent right dorsal aorta, with the retroesophageal part from the persistent left dorsal aorta. Detailed understanding of the variations of the thoracic aorta, and the anomalies associated with the LCA, can help to improve management of these conditions, and with that, improve patients’ overall outcomes. Patients with a LCA, or another vascular ring, can either be asymptomatic or present with esophageal and / or tracheal compression symptoms. Management of this anomaly consists namely of ligation of the patent ductus arteriosus / ligamentum arteriosum and aortic uncrossing