Volar Plate

The term volar plate can be used for a plate fixed on volar aspect of bone but in this article we discuss an anatomical structure.

Volar plate in the hand [also referred to as palmar or volar ligaments] are fibrocartilaginous structures found in the metacarpophalangeal and interphalangeal joints.

Their main function is reinforcement of the joint capsules, increase in joint stability, and limitation of hyperextension.

volar-plateThis fibrocartilaginous structure is attached to the base of the proximal phalanx distal to the joint. From there, it forms a palmar continuation of the articular surface of the phalanx bone and its inner surface thus adds to the articular surface during extension.

In its proximal end, the volar plate becomes membranous and blends with the volar capsule which is attached to the head of the metacarpal bone.

The volar plate of the distal interphalangeal joint has a proximal attachment weakly confluent with the distal extent of the flexor digitorum superficialis tendon

During flexion, the plate glides proximally down the volar surface of the metacarpal head. Its flexible attachment to the phalanx bone not only prevents it from restricting joint movements, but also prevents the long flexor tendons from being pinched in the joint.

Text adapted from Wikipedia

What Is Ulnar Translocation

Ulnar translocation results from ulnar migration of the carpus along ulnar inclination of the distal radius.

There are two types of ulnar translocations

Type I – Complete ulnar translocation of the carpus, sparing the scaphoid which maintains its normal elation to the carpus.
Type II – Associated with scapholunate dissociation, lunotriquetral dissociation and other forms of perilunate disability.

Causes

This pattern of instability has been well recognized in patients with rheumatoid arthritis as a result of articular erosions and attenuation of wrist ligaments. [Read more...]

What is Scaphoid Cast?

Scaphoid cast is a special cast which is applied below elbow and immobilizes the first metacarpo-phalangeal joint [thumb]. Conventionally, the cast has been applied to scaphoid fractures and was considered standard non operative treament for the fracture.

Only recently, it has been shown that a Colles cast is equally effective in scaphoid fractures.

Here is nice video on application of scaphoid cast. [Read more...]

Scapholunate angle

The Scapholunate angle is formed by the intersection of the longitudinal axes of the scaphoid and lunate.

Scapholunate Angle

Scapholunate Angle

Its average value is 47°[Range 30° -70°].

Values >70° suggest a lesion of the scapholunate ligaments or the ligament complex between the scaphoid and the trapezium and trapezoid.

Angle< 30° suggest a palmar instability.

Sacral Table Angle

The sacral table angle of S1 is the  value of the angle between the superior plate of S1 and the posterior side of body of the first sacral vertebra.

A steeper sacral table [low sacral table angle] indicates a higher sheer stress on L5 to S1 disc resulting in greater tendency for anterior slip.

Sacral Slope

The sacral slope is value of the angle between the superior plate of S1 and a horizontal line.

Measurement of Sacral Slope

Measurement of Sacral Slope

Thus a  vertical sacrum is described by a low value, a horizontal sacrum measures a high value.

Pelvic tilt, sacral slope and pelvic incidence

Pelvic tilt, sacral slope and pelvic incidence

Sum of sacral slope and pelvic tilt gives pelvic incidence.

Image Credit:thejns.org

Spondylolysis

Spondylolysis is defined as a bony defect in the pars interarticularis of a vertebral arch.

When this defect is bilateral, the anterior and posterior portion of the neural arch separate. The inferior articular
processes, lamina, and spinous process no longer remain connected to the superior articular processes, pedicles, and vertebral body.
Because of this discontinuity spondylolisthesis may result.

One Lung Ventilation

One lung ventilation is anesthesia used in thoracic surgeries where patient is ventilated on one lung whereas other one is allowed to collapse.

One lung ventilation is used for

-For improving surgical access

-For protecting healthy lung from being contaminated during surgery of diseased one

-Independent lung ventilation by two ventilators when one lung is diseased and other is normal [Read more...]

Video Assisted Thracoscopic Surgery or VATS

Video Assisted Thoracoscopic Surgery, often referred to as VATS, is performed using a small video camera that is introduced into the patient’s chest via a scope.

It is used both for diagnostic as well therapeutic procedures.

Compared with open thoracotomy, video-assisted thoracoscopic surgery is considered to be minimally invasive.

It is finding an ever-increasing role in the diagnosis and treatment of a wide range of thoracic disorders that previously required sternotomy or open thoracotomy.

The potential advantages  include less postoperative pain, fewer operative complications, shortened hospital stay and reduced costs.

Jacobeaus frst used a thoracoscope to diagnose and treat effusions secondary to tuberculosis in 1910. The  application of video cameras to thoracoscopes for high defnition magnifed viewing, coupled with the development of sophisticated surgical instruments and stapling devices, has greatly expanded the scope of  procedures done with thoracoscopy. [Read more...]

Sacral Agenesis

Sacral [or lumbosacral agenesis in severe cases where lumbar spine is also involved] characterized by absence of the variable portion of the caudal portion of the spine. It is a very rare deformity.

Patients with this deformity lack motor function at the affected vertebral level and sensory functions below the affected level.

It is also known as

  • Caudal dysplasia
  • Caudal dysplasia sequence
  • Caudal regression syndrome
  • Sacral regression
  • Lumbo sacral agenesis

Types

Renshaw classification divides the condition into four groups depending on amount of sacrum remaining and the characteristics of the articulation between the spine and the pelvis [Read more...]