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The atlas plays an important role as a characteristic connective bony element between the cervical spine and the occiput. Its details and variations are of special interest to neurosurgeons - e.g., in a far lateral transcondylar approach. We investigated 121 atlases and their variations. During our investigations, we periodically found atlases with a complete arcuate foramen (canal for vertebral artery) and an additional foramen in the bony roof of a complete arcuate foramen. Different structures passing through this additional foramen are described in the literature, but no artery. We found a macroscopically clear verified artery in a 67-year-old male cadaver passing through the foramen in the bony roof of a complete arcuate foramen. Such an artery is of clinical importance to neurosurgeons or musculoskeletal surgeons, but unmentioned in literature until now. A potential name for this artery could be 'ponticular artery'. The discovered artery is most likely a branch to the neck muscles. The knowledge of a possible existence of such an artery is necessary to prevent complications during surgical procedures in the region of the upper cervical spine. Furthermore, the special course of this artery could be the reason for atrophy and imbalance of deep cervical muscles and consequently headaches

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PURPOSE: Full or selective wrist denervation is an effective treatment for chronic wrist pain. In this cadaveric study, a volar approach for prophylactic denervation of the posterior interosseous nerve (PIN) and the anterior interosseous nerve (AIN) was assessed, which can simultaneously be performed during volar approaches for distal radius fracture fixation or in combination with metalwork removal. MATERIALS AND METHODS: In total 40 adult upper limbs, embalmed using Thiel's method, were investigated. Group 1 included 20 limbs of which the distances between AIN and PIN to the ulnar margin of radius were measured at levels 6, 8 and 10 cm proximal to the styloid process and the distance radial styloid process to proximal border of pronator quadratus which might be useful as an intraoperative landmark. Subsequently further additional 20 adult limbs (group 2) were used. Transection of the PIN via this volar approach at the evaluated best level of step 1 was performed and evaluated by dissection via a dorsal approach. RESULTS: In group 1, the PIN runs within the interosseous membrane, from the ulnar border of the radius, 6.4 mm (SD 2.66) at 6 cm, 8.4 mm (SD 2.28) at 8 cm and 3.75 mm (SD 5.46) at 10 cm proximal to the radial styloid. The AIN runs within the interosseous membrane, from the ulna edge of the radius, 7.5 mm (SD 2.4) at 6 cm, 7.3 mm (SD 1.95) at 8 cm and 2.35 mm (3.42) at 10 cm proximal to the radial styloid. AIN and PIN were in close proximity at the 8-cm level which equals a 1-cm distance proximal to the pronator quadratus border. Group 2 showed a successful transection of the PIN through a single volar surgical approach in additional 18 out of 20 adult upper limbs. CONCLUSIONS: This study shows the local anatomy of the PIN, allowing denervation via a volar approach.

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BACKGROUND: Anterior shoulder dislocation (ASD) is a common sports injury. The goal of this study was to evaluate a new procedure for reduction after ASD with respect to success rate, the need for medication for muscle relaxation, sedation, and application of pain medication and put it into context to a systematic literature review. PATIENTS AND METHODS: We retrospectively evaluated the new method in 263 patients in an Austrian skiing area from December 2005 till April 2009. We included patients with unilateral ASD and excluded those with a combined trauma and consecutive admission to hospital. RESULTS: The new procedure is performed in a supine position, the therapist takes the patients hand of the injured limb with his one hand and with his other hand counter holds against the acromion. Then he enhances the traction on the upper limp by using his trunk as a kind of fulcrum. With eye contact and instructions to relax, the therapist is able to detect the muscular tension, so that he can adjust the amount of traction accordingly. The presented procedure was successful in all reported cases. For 196 patients (74.5 %) no medication for muscle relaxation, sedation, or pain medication were needed. CONCLUSION: The new method is a promising option to popular techniques for reduction of anterior shoulder dislocations. The benefits of this protocol are a gentle and simple application of the procedure as well as an easy acquisition.

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Hamartomas of the spleen are rare benign tumour-like lesions that tend to be asymptomatic incidental findings. Splenic hamartomas with tumour-like extramedullary erythropoiesis are extremely rare. A 70-year-old male patient with dyspnoea and a nodular intrapulmonary lesion morphologically verified by CT underwent fibre bronchoscopy, which showed a pea-shaped foreign body that was retrieved without complication. As a secondary finding, the CT showed a splenic lesion of about 8 cm in size. An MR study showed an expansive process in the center of the spleen. The patient was completely free of clinical symptoms. Because of the unknown nature and the high risk for spontaneous rupture of the lesion, a splenectomy was performed. The histological analyses revealed tumour-like extramedullary erythropoiesis of the spleen. The patient was discharged in good condition ten days postoperatively. A hamartoma of the spleen with extramedullary tumor-like erythropoiesis should be considered in the differential diagnosis of a splenic lesion.

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