Clinical anatomy : official journal of the American Association of Clinical Anatomists & the British Association of Clinical Anatomists
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Review Case Reports
Posterior dislocation of the sternoclavicular joint: a case report and review of the clinical anatomy of the region.
Posterior dislocation of the sternoclavicular joint is an uncommon injury. Since 1824, when Sir Astley Cooper described the injury, little more than 100 cases have been described, and the majority of these have been in the last decade, identified by computed tomography. The significant morbidity and mortality associated with this injury is based upon serious damage to important anatomical structures found in the vicinity of the joint. We present a case report, describe the relevant clinical anatomy of this region, and review associated complications.
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We investigated whether arteries pass superficial to veins or whether veins pass superficial to arteries at artery-vein crossings on the anterior, dorsolateral, and posterior surfaces of the human cerebrum. We examined a total of 2,266 artery-vein crossings on 40 sides of 20 cadavers. ⋯ Thus, vein (V), artery (A), and nerve (N), if we regard the cerebrum as nerve, were generally arranged in the order VAN from the superficial to the deep layers. This concept is important for a positional understanding of blood vessels on the cerebrum and it is useful for the understanding of fluid-drainage pathways from the cerebral cortex in various pathological conditions.
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Postoperative atrophy of the deep back muscles may be caused by denervation during a dorsomedian approach to the thoracolumbar spine; ensuing instability of the spine with poor clinical results, perhaps due to such muscle loss, has been observed in 11.7% of cases (Sihvonen et al., 1993, Spine 18:575--581). More specifically, this complication may be caused by damaging the medial branches of the posterior rami of the spinal nerves during lateral retraction of the muscles. To investigate the anatomic topography of the medial branches of the posterior rami of the spinal nerves, 18 carbol-formol-fixed specimens were dissected using an operation microscope; also, 3 fresh cadavers were cut in horizontal and vertical planes with a rotary cryotome to confirm the anatomic topography observed in the fixed specimens. ⋯ When the dorsomedian approach to the thoracolumbar spine is enlarged laterally to the articular processes by retracting the paraspinous muscles, the medial branches of the posterior rami of the spinal nerves are endangered. This may cause postoperative pain as well as dynamic instability beyond the corresponding segments. The results of our anatomic study suggest that the posterior surgical midline approach to the thoracolumbar spine should not be enlarged laterally to the articular processes to prevent injury to the medial branches of the posterior rami of the spinal nerves.