The Journal of hand surgery
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Twenty-nine brachial plexuses from 13 embalmed and 5 fresh cadavers were examined under x3.5 loupe magnification to collect systematic and topographic anatomical data regarding the lateral and medial pectoral nerves. Additionally, nerve biopsy specimens were harvested in 5 fresh cadavers to obtain histomorphometric data. In all dissections the pectoral nerves exited at the trunk level as 3 distinct nerves. ⋯ The branch to the lower aspect of the PM pierces the pectoralis minor muscle in two thirds of cases, whereas it passes its inferior border to reach the lower aspects of the PM with an average length of 15 cm in one third of cases. Knowledge of the detailed anatomy of the pectoral nerves, as outlined in this study, clarifies the obscure anatomic relationship of the lateral and medial pectoral nerves and allows easy intraoperative location of the medial pectoral nerve at the exit of the lateral thoracic artery. The length of the inferior pectoral nerve, the number of motor axons, and the anatomical proximity of this nerve make it an expendable but powerful source of reinnervation to the musculocutaneous nerve in upper brachial plexus injuries.
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Following nail bed repair, returning the nail plate as a conforming stent or splint is a common technique. Especially when split, the nail plate fragments can very readily be pieced together and bonded to the nail bed using the tissue adhesive Octyl-2-Cyanoacrylate. This new formulation can expedite this maneuver, and has shown no signs of histotoxicity or adverse effect on nail plate regeneration.
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Carpal kinematics have been previously limited to in vitro models with cadaveric specimens. Using a newly developed markerless bone registration algorithm, we noninvasively studied the in vivo kinematics of the capitate, scaphoid, and lunate during wrist extension and flexion in both wrists of 5 men and 5 women. Computed tomography volume images were acquired in neutral and in 2 positions in both extension and flexion. ⋯ The only difference between male and female kinematics was a more distal location of the rotation axes; we believe this was due to a difference in carpal bone size, not gender. This study reports the 3-dimensional in vivo measurement of carpal motion using a noninvasive technology. This technique may prove useful in the study of more complex motions of the hand and wrist and of the abnormal kinematics that occur following ligamentous injury.
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We report a retrospective study of the prognostic value of 2-phase technetium 99m bone scanning performed in 92 patients who presented to Chamonix Hospital with severe frostbite of the extremities in the past 12 years. The results of this study show that an initial bone scan (as early as day 3) has excellent specificity in evaluating the severity of frostbite injury. There was a direct correlation between the demarcation zone of uptake in the phalanges and the eventual level of amputation (positive predictive value, 0.84). ⋯ A strong correlation existed between positive uptake and eventual healing (negative predictive value, 0.99). This study showed that (99m)Tc bone scanning in the first few days after frostbite injury indicates the level of amputation in severe frostbite in more than 84% of cases. We propose an algorithm based on the results of this study that can be used to evaluate new medical and surgical management of frostbite injury.