Background  Advances in skull base surgery have increased the need for a detailed understanding of skull base anatomy and its intrinsic relationship to surrounding structures. This has resulted in an improvement in patient outcomes. The frontotemporal orbitozygomatic (FTOZ) transcavernous approach (TCA) is an excellent option for treating complex lesions involving multiple compartments of the skull base, including the sellar and parasellar, third ventricle, orbit, and petroclival region. Objective  This article aimed to provide a detailed cadaveric dissection accompanying a thorough procedure description, including some tips and pitfalls of this technique. Methods  Microsurgical dissection was performed in four freshly injected cadaver heads at the Cranial Base Neuroanatomy Laboratory, Cleveland Clinic Florida. The FTOZ TCA was performed on both sides of the four specimens. The advantages and disadvantages were discussed based on the anatomic nuances of this approach. Results  The FTOZ TCA represented a wide access to the anterior, middle, and posterior fossa. When combined with an anterior clinoidectomy, it allowed for significant and safe internal carotid artery mobilization. This approach created numerous windows, including opticocarotid, carotid-oculomotor, supratrochlear, infratrochlear, anteromedial, anterolateral, and posteromedial triangles. The only drawback was the length of the dissection and the level of surgical acumen required to perform it. Conclusion  Despite its technical difficulty, the FTOZ TCA should be considered for the surgical management of basilar apex aneurysms and tumors surrounding the cavernous sinus, sellar/parasellar, retrochiasmatic, and petroclival region. Continuous training and dedicated time in the skull base laboratory can help achieve the necessary skills required to perform this approach.

UNASSIGNED: Dega osteotomy is becoming more widely used for the treatment of developmental dysplasia of the hip (DDH).
UNASSIGNED: A thorough description of this procedure is needed as many of the technical aspects are not fully defined. Moreover, more follow-up series are also needed to evaluate its outcomes.
UNASSIGNED: In this study, we gave a detailed anatomic description for this procedure and also presented our experience as a retrospective radiographic and case-note study. We examined the clinical and radiographic records of 44 patients (48 hips) with varying degrees of DDH.
UNASSIGNED: The average age of the patients was 2 months and 7 months while the average follow up period was 41 months. Clinical and radiographic assessment including CT with 3D reconstruction to examine the anatomic characteristics of the osteotomy were undertaken. We found that concentric reduction was achieved in 93.7% with excellent clinical and radiographic outcomes. Only 3 cases needed revision of the Dega osteotomy. The re-operation rate was 12.5%. CT scan revealed that the arcuate line was crossed by the osteotomy in the majority of cases. In 20.7% of cases, a bone cut that was intended to be a Dega osteotomy was found to have been inadvertently implemented as another osteotomy variant. However, this bore no significant effect on the outcome.
UNASSIGNED: We found that a well-implemented Dega osteotomy is a reliable tool to cope with the acetabular changes in DDH.

OBJECTIVE: There is consensus in favor of a description of the dorsal ligaments of the carpus as not including a direct ligament between the lunate and capitate. On the other hand, there is an anatomical formation which, according to the currently accepted description, corresponds to the dorsal midcarpal capsule, itself thickened by the dorsal intercarpal ligament. The question is whether the capsule at this point deserves to be called an individualizable ligament. In our operative experience of the dorsal carpus, we have encountered a stout structure adherent to the lunate and capitate. In this article, we present the anatomic evidence of this structure\'s existence.
METHODS: Seven adult fresh frozen upper extremities were dissected. Three wrists were longitudinally sectioned in line with the middle finger metacarpal. The remaining 4 were dissected dorsally. Two representative samples of the stout structure connecting the lunate to the capitate were sent to pathology for histologic analysis and staining.
RESULTS: In all 3 of the longitudinally sectioned wrists, a thick band of tissue could clearly be seen, originating on the lunate, spanning the dorsal interval between the lunate and the capitate, and inserting on the capitate. With this structure intact, dorsal dislocation of the capitate was not possible, but preliminary sectioning of the structure allowed dislocation. In the 4 dorsally dissected wrists, the same connection was observed, palmar to the dorsal intercarpal ligament, in every specimen. The average dimensions of the dorsal capitolunate were: 15.25 ± 1 mm long, 8.75 ± 1 mm wide at the midpoint, and 1.75 ± 1 mm thick. The two specimens sent to pathology after sectioning showed longitudinally oriented collagen fibers. This structure also stained positive for elastin and contained intrasubstance vascular structures.
CONCLUSIONS: There is a stout ligamentous structure connecting the lunate to the capitate, palmar to the dorsal intercarpal ligament. Disruption of this structure appears to be necessary for dorsal dislocation of the capitate. Clinical studies are needed to gain better understanding of the exact function and importance of this structure.

UNASSIGNED: The posterior oblique ligament (POL) is the largest structure of the posteromedial knee that is at risk of injury in conjunction with the medial collateral ligament (MCL). Its quantitative anatomy, biomechanical strength, and radiographic location have not been assessed in a single investigation.
UNASSIGNED: To evaluate the 3-dimensional and radiographic anatomy of the posteromedial knee and the biomechanical strength of the POL.
UNASSIGNED: Descriptive laboratory study.
UNASSIGNED: Ten nonpaired fresh-frozen cadaveric knees were dissected and medial structures were elevated off bone, leaving the POL. The anatomic locations of the related structures were recorded with a 3-dimensional coordinate measuring machine. Anteroposterior and lateral radiographs were taken with radiopaque pins inserted into the pertinent landmarks, and the distances between the collected structures were calculated. Each knee was then mounted to a dynamic tensile testing machine, and pull-to-failure testing was performed to record the ultimate tensile strength, stiffness, and failure mechanism.
UNASSIGNED: The POL femoral attachment was a mean of 15.4 mm (95% CI, 13.9-16.8 mm) posterior and 6.6 mm (95% CI, 4.4-8.8 mm) proximal to the medial epicondyle. The tibial POL attachment center was a mean of 21.4 mm (95% CI, 18.1-24.6 mm) posterior and 2.2 mm (95% CI, 0.8-3.6 mm) distal to the center of the deep MCL tibial attachment and a mean of 28.6 mm (95% CI, 24.4-32.8 mm) posterior and 41.9 mm (95% CI, 36.8-47.0 mm) proximal to the center of the superficial MCL tibial attachment. On lateral radiographs, the femoral POL was a mean of 17.56 mm (95% CI, 14.83-21.95 mm) distal to the adductor tubercle and 17.32 mm (95% CI, 14.6-21.7 mm) posterosuperior to the medial epicondyle. On the tibial side, the center of the POL attachment was a mean of 4.97 mm (95% CI, 3.85-6.79 mm) distal to the joint line on anteroposterior radiographs and 6.34 mm (95% CI, 5.01-8.48 mm) distal to the tibial joint line on lateral radiographs, at the far posterior tibial aspect. The biomechanical pull-to-failure demonstrated a mean ultimate tensile strength of 225.2 ± 71.0 N and a mean stiffness of 32.2 ± 13.1 N.
UNASSIGNED: The anatomic and radiographic locations of the POL and its biomechanical properties were successfully recorded.
UNASSIGNED: This information is useful to better understand POL anatomy and biomechanical properties as well as to clinically address an injury with repair or reconstruction.

There is no consensus on the ideal scar location and inframammary fold (IMF) placement in the gender-affirming double-incision mastectomy technique. Recent advances in imaging technology have facilitated noninvasive investigations into anatomic variability, in many cases, obviating the traditional approach of cadaveric dissection to answer anatomic questions. A better understanding of chest wall sexual dimorphism may allow surgeons who perform gender-affirming procedures to achieve more natural-appearing results. A total of 60 chests were analyzed using either cadaveric dissection (n = 30) or virtual dissection with 3-dimensional (3-D) reconstructions of computed tomography (CT) images (n = 30) using the Vitrea® software. Chest proportions were recorded using each technique, correlating surface anatomy with muscular and bony landmarks. Cadaveric and 3-D radiography chest analysis revealed that natal male chest walls are, on average, wider and longer than natal female chest walls. The pectoralis major muscle dimensions and the location of its insertion were not found to significantly differ between male and female chests. The male nipple-areolar complex (NAC) tended to be narrower in length and width, with a less projecting nipple than the female NAC. Finally, the IMF was found to lie over the interspace between the fifth and sixth rib in both male and female chests. Our findings confirm natal male and female IMF are positioned between the 5th and 6th ribs. This fact affirms the senior author\'s technique of masculinizing the chest, keeping the masculinized IMF at approximately the same level as the natal female IMF and following the pectoralis major muscle edges to define the resulting scar in a way that differs from previously reported techniques.

BACKGROUND: Gluteal compartment syndrome is an uncommon entity and physicians may use intracompartmental pressure measurements for confirmation of the clinical diagnosis, or in cases where the physical exam is indeterminate. However, there is a paucity of literature describing a safe and reproducible technique to measure gluteal intracompartmental pressures during the diagnosis of gluteal compartment syndrome. The purpose of this cadaveric study is to evaluate the sole previous technique described in the literature to measure gluteal intracompartmental pressures and provide a modified technique which can be safely and reliably utilized clinically.
METHODS: A cadaveric study with three phases was performed in 16 gluteal regions in 8 cadavers. In the first phase, the previously described technique was assessed. In the second phase, a modified set of techniques was created and evaluated. In the third phase, inter-user reliability of the modified set of techniques was assessed and calculated using Cohen\'s ĸ coefficient. In all three phases, methylene blue was injected through pressure monitoring needles into the gluteus maximus (GMax), gluteus medius/minimus (GMM), and the tensor fascia lata (TFL) compartments. Following dissection, rate of successful penetration into each targeted compartment and distance from the neurovascular structures was recorded.
RESULTS: The previously described set of techniques was found to be variable. The modified set of techniques was effective, successfully reaching the GMax, GMM, and TFL compartments in 100%, 100%, and 81% of attempts, respectively. Inter-user reliability was excellent (ĸ = 1) for the techniques to reach both the GMax and GMM compartments, and moderate (ĸ = 0.54) for the technique to reach the TFL compartment. Within the GMax, the pressure monitoring needle was at a mean of 5.4±0.6 cm, 4.1±0.7 cm, 6.4±0.5 cm from the sciatic nerve (SN), superior gluteal nerve (SGN), and inferior gluteal nerve (IGN), respectively. Within the GMM, the pressure monitoring needle was at a mean of 9.7±1.4 cm, 7.4±1.3 cm, 11.1±1.7 cm from the SN, SGN, and IGN, respectively.
CONCLUSIONS: The modified set of techniques presented allows the three gluteal compartments to be safely and reproducibly reached to measure intracompartmental pressures during the diagnosis of gluteal compartment syndrome.

Injuries to the posterolateral corner (PLC) of the knee are often overlooked but, require reconstruction in order to restore stability in varus and external rotation. Among the many anatomic and non-anatomic PLC reconstruction techniques available, the modified Larson (mLR), LaPrade (LPR) and Versailles reconstruction (VR) procedures are widely used.
The hypothesis was that anatomic PLC reconstruction (VR and LPR procedures) provides better restoration and control of external rotation.
Fifteen fresh-frozen cadaveric knees were tested to compare the 3 procedures. Varus laxity on stress radiographs in full knee extension and external rotatory laxity on dial test at 30° flexion were quantified at 3 phases: intact knee, PLC sectioned and PLC reconstructed.
Mean varus laxity did not differ significantly between techniques in intact knees (p=.14), after PLC sectioning (p=.14) or after PLC reconstruction (p=.17). After PLC reconstruction, varus laxity was restored, with no statistical difference between mLR, VR and LPR compared to intact test values (respectively, -1.0, -1.3 and -1.5; p=.98). In all 3 groups, mean external rotation laxity on dial test at 30° flexion did not significantly differ between intact knees (p=.32) and after PLC sectioning (p=.15). After PLC reconstruction, the mLR technique was significantly less effective in restoring rotational stability than the VR and LPR techniques (p=.025).
The VR technique provided similar outcomes to LPR for restoring stability in varus and external rotation. The 2 \"anatomic\" reconstruction procedures (VR and LPR) were significantly more effective than the modified Larson technique for external rotation control, confirming the study hypothesis. Consequently, it remains preferable to use anatomic techniques in multiligament injuries involving the PLC.
IV, cadaver study.

Skull base lesions within the middle cranial fossa (MCF) remain challenging. Recent reports suggest that transorbital endoscopic approaches (TOEAs) might be particularly suitable to access the MCF and expose the lateral wall of the cavernous sinus and the Meckel\'s cave.
The present study was developed to compare the nuances of the subtemporal approach (STA) with those of the lateral TOEA (LTOEA) to the MCF and posterior cranial fossa (PCF) in cadaveric specimens. After orbital craniectomy, interdural opening of the cavernous sinus lateral wall (CSlw), exposure of the Gasserian ganglion, and extradural elevation of the temporal lobe was performed. Next, anterior endoscopic petrosectomy was performed and the PCF was accessed. We quantitatively analyzed and compared the angles of attack and distances between LTOEA and STA to different structures at the CSlw, petrous apex (PA), and PCF.
Cadaveric dissection through the LTOEA completely exposed the CSlw and PA. LTOA exhibited larger distances than the STA to all targets. Importantly, these differences were greater at the PA and its surrounding key anatomic landmarks. The horizontal and vertical angles of attack allowed by the LTOA were smaller both for the CSlw and PA. However, these differences were not significant for the vertical angle of attack at the CSlw.
LTOEA provides a direct ventral route to the medial aspect of MCF, PA, and PCF. Although TOEAs are versatile approaches, the unfamiliar surgical anatomy and limited instrument maneuverability demand extensive cadaveric dissection before moving to the clinical setting.

UNASSIGNED: This study aims to elucidate basic anatomic and geometric features of MCL, providing more accurate and detailed information, as guidance for surgeons, to improve patient\'s outcome of the treatment.
UNASSIGNED: The anterior bundle (AB), posterior bundle (PB) and transverse bundle (TB) ligament of 56 fresh frozen Thai cadaveric elbows, were measured and recorded, comprise key ligament\'s geometric features, footprints and dimensions, and its relation to bony landmarks. Sagittal and coronal planes were used in respect of the anatomical position.
UNASSIGNED: The mean distance between the center of AB origin and the apex of medial epicondyle is as follows: 2.97 ± 2.21 mm anteriorly, 4.73 ± 1.60 mm inferiorly in the sagittal plane, and 4.23 ± 1.13 mm deep from the epicondyle in the coronal plane. Its dimension is 6.23 ± 1.02 mm in width and 45.97 ± 6.75 mm in length. The ligament\'s insertion triangular shape has its base located 28.44 ± 3.51 mm anterior from the posterior olecranon border, and 22.52 ± 2.49 mm superior from the inferior ulnar border. The tip located 50.79 ± 4.86 mm anterior from the posterior olecranon border and 17.64 ± 2.80 mm superior from the inferior ulnar border.
UNASSIGNED: Apprehension of the precise geometries and distances of the ligament\'s footprint relative to key anatomical point is crucial. This stereographically comprehended data are useful for surgeon as reference points to obtain stability, motion, kinetic, and kinematic properties of the elbow.
UNASSIGNED: Level V evidence.
UNASSIGNED: The online version contains supplementary material available at 10.1007/s43465-022-00648-x.

OBJECTIVE: During maturation, the ossification centers of the proximal humerus form a characteristic pattern consisting of a metaphyseal peak and corresponding epiphyseal valley. The surface topographies of the metaphyseal peak and epiphyseal valley are not well described and may have variation with age and structural importance to the pathogenesis of proximal humeral epiphysiolysis.
METHODS: High-resolution 3-dimensional surface scans of 24 cadaveric proximal humeral epiphyses and metaphyses in specimens aged 3 to 18 years were obtained. Computer modeling software was used to measure the peak height of the metaphysis and maximal depth of the epiphysis relative to a perpendicular line drawn across the proximal humeral physis.
RESULTS: The metaphyseal peak had a mean height of 12.7 ± 1.6 mm while the epiphyseal valley had a mean depth of 13.1 ± 2.1 mm, both consistently positioned in the posterolateral quadrant. Both the absolute metaphyseal peak height (R2 = 0.536; p < 0.001) and absolute epiphyseal valley depth (R2 = 0.524; p < 0.001) increase with advancing age. Multiple linear regression analysis demonstrated that normalized metaphyseal peak height + sex (adjusted R2 = 0.408; p < 0.002) correlated more with age than normalized epiphyseal valley depth + sex (adjusted R2 = 0.128; p < 0.091).
CONCLUSIONS: Prominence of the metaphyseal peak and epiphyseal valley both increase with advancing age, with a lower correlation between normalized sizes with age as compared to the absolute sizes, suggesting that these structures stay relatively proportional with growth.