Neelam Vasudeva

Anomalous higher branching pattern of the femoral nerve: a case report with clinical implications.

The femoral nerve usually divides into anterior and posterior branches below the inguinal ligament. In the present case, we report the anomalous higher branching pattern of the femoral nerve on both sides of a 52 year male cadaver. The femoral nerve divided into the anterior and posterior branches above the inguinal ligament. Such a higher division of femoral nerve is a rare finding and it may be important for surgeons, orthopaedicians and anaesthetists in day to day clinical practice.

Morphometric Analysis of the Occipital Condyle and Its Surgical Importance

INTRODUCTION The Occipital Condyle (OC) is an integral component of craniovertebral region which is predisposed to a wide array of traumatic, degenerative and neoplastic diseases. Frequent surgical interventions of OC are required for successful management of these conditions. Hence a meticulous anatomical knowledge of the OC is vital but variability in morphometric dimensions exist amongst different races and hinder the standardization of measurements. AIM The aim of this study was to present a morphometric reference database for OC of the Indian population and enable comparisons with other populations. MATERIALS AND METHODS The study was performed on 228 OC of 114 adult human skulls. Linear measurements of the OC were taken with the help of digital Verniers Calliper and angular measurements were determined with software Image J. STATISTICAL ANALYSIS Mean and standard deviation of the morphometric parameters taken into account were analysed. The comparison of morphometric dimensions of the right and left sides was carried out using Students t-test and p-value was calculated. RESULTS The morphometric analysis of the OC established that mean width was larger (12.97 mm) in Indians population when compared to other races. The anterior and posterior intercondylar distances as well as the distances between the tips of OC and opisthion and basion were observed to be shorter in Indians. We found a significant difference (p=0.01) among the distance between Posterior tip of Occipital Condyle (POC) and basion of the right and left sides. The sagittal condylar angle and sagittal intercondylar angle were found to be greater in our study when compared to other researchers. There existed a highly significant difference (p=0.001) between the sagittal condylar angles of the right and left sides. CONCLUSION The present morphometric study would be valuable for the successful instrumentation of the OC as wider and ventrally oriented OC as well as smaller intercondylar distances may pose challenge to the surgeons during condylectomy. The data of present study offer anatomical reference to the surgeons and would be helpful in designing implants for the OC.

Morphometric Analysis of Sub-axial Cervical Vertebrae and Its Surgical Implications.

BACKGROUND The predilection of the cervical spine to a wide array of traumatic, degenerative and neoplastic diseases necessitates frequent surgical interventions. For successful surgical management of these conditions, a detailed anatomical knowledge of the cervical spine is required but variability in vertebral dimensions exists amongst different races and prevents the standardization of measurements. AIM The aim of this study was to present a morphometric reference database for cervical vertebrae of the Indian population and enable comparisons with other populations. MATERIALS AND METHODS The study was conducted on 203 typical (C3-C6) cervical vertebrae. Linear measurements of the vertebrae were taken with the help of digital Vernier caliper and angular measurements were determined with software Image J. STATISTICAL ANALYSIS Mean and standard deviation of the morphometric parameters taken into account were analysed. The comparison of morphometric dimensions of the right and left sides was performed using Students t-test and p-value was calculated. RESULTS The morphometric analysis of the cervical vertebrae demonstrated that when compared with other races, the mean height (11.39 ± 1.08 mm) and transverse diameters (22.18 ± 2.52 mm) of the vertebral body were larger but antero-posterior diameter was less, making the vertebral bodies in Indians transversely longer. The dimensions of the pedicle, laminae, articular processes and spinous process were smaller when compared to other populations. There existed a highly significant difference (p=0.002) between the widths of the right and left superior & inferior articular processes. A great disparity of the pedicle transverse angle was noted in different populations but in Indians the angle was 44.47 ± 2.81. CONCLUSION The present morphometric study in Indian population would be valuable for the successful instrumentation of the cervical spine as smaller dimensions of the cervical vertebrae pose a challenge to the surgeons during application of plates and screws. The data would be helpful in designing spinal implants and permit identification of osteological remains.

Wax embedding technique of mounting anatomy museum specimens

Introduction: Anatomy museum specimens are used as a visual undergraduate teaching aid, which are gradually replacing cadaveric teaching as nowadays human cadavers are becoming difficult to obtain. Materials and Methods: Paraffin wax was used for mounting anatomical specimens to replace age-old methods of using plaster of Paris and glass sheets. Results and Conclusion: Wax mounting of specimens resulted in better understanding of anatomical details and relations of structures. This technique is easy to use, inexpensive, and reproducible.

Plastination: An innovative method of preservation of dead body for teaching and learning anatomy

Background: Plastination is the process to preserve the perishable biological tissues for long time using curable polymers. This technique was invented by Gunther Von Hagens, a German anatomist, in 1977. Since then, there have been many modifi cations according to the need and availability of infrastructure in various institutions. Many deviations from the standard plastination procedure have been suggested and used successfully. Methods: Modified short plastination protocol using epoxy resin has been adopted and standardized by the Department of Anatomy, Maulana Azad Medical College. Results and Conclusion: This technique provides dry, odorless, durable, nontoxic specimens that are easy to handle and can be stored at room temperature indefi nitely. This can be performed in a short period of time with limited and less expensive infrastructure. Our department organizes regular national workshops on “body preservation techniques” to train young anatomists.

Unusual Variation in the Branching Pattern of the Celiac Trunk and Its Embryological and Clinical Perspective.

Knowledge of variations in the branching pattern of Celiac Trunk (CT) is important for surgeries of stomach, duodenum, pancreas and hepatobiliary region, for abdominal aortic aneurysm, for liver transplant and chaemoembolization of hepatic tumours. An unusual variation in the branching pattern of CT was observed in 50-year-old male cadaver of Indian origin. CT divided into six branches out of which right & left inferior phrenic arteries originated as first two branches and left gastric artery as the third branch. CT ended into three terminal branches as common hepatic artery, splenic artery & dorsal pancreatic artery. Right gastric artery originated from left hepatic artery instead of common hepatic artery. A variant hepatic artery to the left lobe of liver was also observed which originated from right gastric artery. Anatomical variations in the branching pattern of CT are due to developmental changes in ventral splanchnic artery.

Determining Angle of Humeral Torsion Using Image Software Technique

INTRODUCTION Several researches have been done on the measurement of angles of humeral torsion in different parts of the world. Previously described methods were more complicated, not much accurate, cumbersome or required sophisticated instruments. AIM The present study was conducted with the aim to determine the angles of humeral torsion with a newer simple technique using digital images and image tool software. MATERIALS AND METHODS A total of 250 dry normal adult human humeri were obtained from the bone bank of Department of Anatomy. The length and mid-shaft circumference of each bone was measured with the help of measuring tape. The angle of humeral torsion was measured directly from the digital images by the image analysis using Image Tool 3.0 software program. The data was analysed statistically with SPSS version 17 using unpaired t-test and Spearmans rank order correlation coefficient. RESULTS The mean angle of torsion was 64.57°±7.56°. On the right side it was 66.84°±9.69°, whereas, on the left side it was found to be 63.31±9.50°. The mean humeral length was 31.6 cm on right side and 30.33 cm on left side. Mid shaft circumference was 5.79 on right side and 5.63 cm on left side. No statistical differences were seen in angles between right and left humeri (p>0.001). CONCLUSION From our study, it was concluded that circumference of shaft is inversely proportional to angle of humeral torsion. The length and side of humerus has no relation with the humeral torsion. With advancement of digital technology, it is better to use new image softwares for anatomical studies.

Subtalar Joint Instability and Calcaneal Spurs Associated with the Configuration of the Articular Facets of Adult Human Calcaneum in Indian Population.

INTRODUCTION Morphological variations of articular facets of calcaneum may predispose people to joint instability, ligamentous laxity and development of arthritic changes in the subtalar joint. Knowledge of such variations is essential for treatment and diagnostic procedures in orthopaedic surgeries. AIM The aim of this study was to determine patterns of articular facets of calcanei and to establish its correlation with calcaneal spurs. MATERIALS AND METHODS The study was conducted on 580 adult calcanei of Indian origin at Maulana Azad Medical College and pattern of articular facets were observed and classified according to five patterns described in literature. A digital vernier calliper was used to measure separation between anterior and middle facet. Degree of intersecting angle between anterior and medial facets was calculated using UTHSCSA Image Tool software. The calcaneal spurs were observed by visual inspection. RESULTS Out of 580 calcanei, 66.55% had fused anterior and middle facets (Pattern I), 27.59% had all three facets separate (Pattern II), 5.52% had absence of anterior facet (Pattern III), 0.17% had all three facets fused (Pattern IV) and 0.17% had fused middle and posterior facets (Pattern V). A significant side variation was present in Pattern III with predominance on left side. Mean angle of intersection was 147.700 in Pattern I and 133.340 in Pattern II calcaneum. Calcaneal spurs were found in 61.38% out of which it was associated with Pattern I in 43.62%, Pattern II in 14.66% and Pattern III in 2.76%. CONCLUSION Individuals with Pattern I and III calcaneum were found to be at a greater risk of subtalar joint instability than individuals with Pattern II. Angle of intersection was obtuse in Pattern I which resulted in ligament laxity and unstable joint. Pattern I was more common in Indian population and this fact necessitates modifications of the western surgical techniques to suit the Indian scenario. An association between the presence of spur and facet configuration was found to be significant.

Morphometric Study of Clavicular Facet of Coracoclavicular Joint in Adult Indian Population

INTRODUCTION Anthropologists have used Coracoclavicular Joint (CCJ), a non-metric anatomical variant in population, as a marker for population migration from prehistoric times to present. AIM The aim of this osteological study was to determine the incidence and morphometry of articular facet of CCJ on conoid tubercle of clavicle in Indian population, as Indian studies are scanty and incomplete. MATERIALS AND METHODS The study was done on 144 adult human clavicles (76 right and 68 left; 93 males and 51 females) collected from osteology museum in Department of Anatomy, Maulana Azad Medical College, New Delhi, India. The presence of articular facet on the conoid tubercle was determined and Maximum Antero-Posterior (MAPD) and maximum transverse diameter (MTD) was measured by digital vernier calliper. The incidence was compared on the basis of sex, side and with other osteological studies in the world. Statistical analysis was done using the Chi-Square test for nominal categorical data and students t-test for normally distributed continuous variables in Microsoft Excel 2007 to assess the relationship between the examined variables. RESULTS Articular facet on conoid tubercle was found in 8 cases (5.6%). Seven (9.2%) were present on the right side and one (1.5%) on the left side. Seven cases (7.5%) were present in males and one case (2%) was found in females. The facets were generally oval, with MAPD and MTD of 12.28 and 17.17 mm respectively. A significant side variation was present with right sided facet being more common. The left sided facet was more transversely elongated than right. In males, the facets were more elongated antero-posteriorly than in females. CONCLUSION The Indian population showed an incidence of 5.6%, which was comparable to other ethnic groups in world population. The morphometric and side differences could be attributed to the occupational factors and range of movements associated with the CCJ. The CCJ should be borne in mind as a differential diagnosis for thoracic outlet syndrome and in general for shoulder pain.

Complete morphometric analysis of jugular foramen and its clinical implications

Introduction: Tumors affecting structures in the vicinity of jugular foramen such as glomus jugulare require microsurgical approach to access this region. These tumors tend to alter the normal architecture of the jugular foramen by invading it. Therefore, it is not feasible to have correct anatomic visualization of the foramen in the presence of such pathologies. Hence, a comprehensive knowledge of the jugular foramen is needed by all the neurosurgeons while doing surgery in this region. Aim: Due to the inadequate knowledge of the accurate morphology of the jugular foramen in different sexes, the aim of this osteological study was to provide a complete morphometry including gender differences and describe some morphological characteristics of the jugular foramen in an adult Indian population. Materials and Methods:The study was done on 114 adult human dry skulls (63 males and 51 females) collected from the osteology museum in the department. Various dimensions of both endo and exocranial aspect of jugular foramen were measured. Presence and absence of domed bony roof of jugular fossa and compartmentalization of jugular foramen were also noticed. Statistical analysis was done using Chi square test and Student’s t test in SPSS version 23. Results: All the parameters of right jugular foramen were greater than the left side, except the distance of stylomastoid foramen from lateral margin of jugular foramen (SMJF) which was greater on the left side. Gender differences between various measurements of jugular foramen, presence of dome of jugular fossa, and compartmentalization patterns were reported. Conclusion: This study gives knowledge about the various parameters, anatomical variations of jugular foramen in both sexes of an adult Indian population, and its clinical impact on the surgeries of this region.