Morphometric Study of Orientation of Superior Articular Facets of Thoracolumbar Vertebral Column in North Indian Population

Background: The orientation of superior articular processes in the thoracic & lumbar vertebrae differs. These processes play an important role in weight transmission & determining the range & direction of movements between any two vertebrae. Methods: The present study has been conducted on the articular processes of 510 vertebrae (thoracic:360; lumbar: 150) with the aim to investigate the possible mehanism for the change from a posterolaterally facing superior articular surface in the thoracic region to posteromedially facing curved articular surface in the lumbar region. Results: In thoracic region, the angle varied between 112o to 120o but suddenly decreased to 85o (R) and 92.1o (L) at T12. In lumbar region, it showed a marked decrease at L1(R:32o; L:34.2o) which further decreased upto L3 and again increased upto L5. Thus, the above observations indicated that between T1-T11 the facet was directed posterolaterally, at T12 it was almost posterior and at L1 it changed its orientation to posteromedially and remained so in whole of the lumbar region. This change in orientation of superior articular processes at the thoracolumbar junction was abrupt at T12-L1 level or gradual over T11-L1 in almost equal number of columns. Conclusion: Clinical implication: The pattern of orientation not only guides & limits the excursion of motion segments but also is relevant in axial weight bearing.

Body Donation vis-à-vis the Anatomist - Be Proactive, Vigilant and Safe.

Background: Most medical schools are facing a shortage of cadavers. The general attitude and propensity is to procure more cadavers for the Institute. In their efforts to procure bodies for dissection most anatomists ignore measures which ensure their own safety. Methods: In order to assess the attitudes of the anatomists towards the donated body and its management a structured questionnaire was framed in light of the literature. Results: The trends and results indicate that a lot needs to be done to inculcate ‘safe practices’ and develop a ‘seasoned etiquette’ and ‘mindset’ towards handling of bodies received in anatomy departments. Conclusion: Standard precautions should be taken during every moment of contact with cadaver. The donated bodies must immediately be categorized on receipt and bodies unsuitable for embalming must be refused by the institution. Hepatitis B vaccination is recommended for all personnel likely to come into contact with dead bodies. Formaldehyde levels must not exceed .1ppm for closed spaces.

The Quantified Human Gracilis-A Guide to Improve Aesthetic and Functional Outcomes.

Background: A functioning gracilis muscle is considered the ideal flap to improve the functional/aesthetic outcome with minimal donor site morbidity. This graceful and slender muscle with special attributes is increasingly being used for covering soft tissue defects, repair of urogenital fistulas and restoration of anal function. Only some studies describing the quantification of this muscle are available and population attributes of the muscle have not been taken into consideration. The present study quantifies the human gracilis muscle in a North Indian population. Methods: The morphometry of gracilis was studied in 50 inferior extremities obtained from 25 phenol embalmed adult North Indian cadavers with known age and sex. The length and width of the aponeurotic origin, the length of the muscle belly, length of the distal tendon of insertion were measured. The muscle, tendon ratios were derived. Results: The mean estimates for various morphological features of gracilius muscle were standardized for North Indians. All the origins and insertions for the muscle correlated with the standard textbook descriptions. No variation was found from a standard textbook pattern in the present sample. The reconstructive procedures should take the local population profile into consideration. Conclusion: The results will aid the clinician in choosing an appropriate muscle and tendon lengths in surgeries. This definitely will lead to better functional and aesthetic outcomes in restorative procedures.

The Gender Based Hyoid Silhouette–A Metric Study in North Indians.

Background: The human hyoid bone is a part of viscerocranium and is susceptible to fracture during manual strangulation. A hyoid bone’s shape may influence its susceptibility to fracture. The present study aims to create a metric gender based profile for the hyoid in North Indians. It is envisaged that the silhouette created will provide inputs vital in comprehending bone morphology patterns for males and females. Methods: Paucity of comprehensive gender based hyoid morphometric studies in local population prompted the authors to format the present study. The measurements were taken on 500 hyoid bones of North Indian subjects with a special emphasis on sexual dimorphism (Male Female ratio 1:1). Results: Most hyoid dimensions are significantly larger in men with some measurements more sexually dimorphic than others, there exists 100% dimorphism for hyoid lengths and selective dimorphism as far as hyoid widths are concerned in North Indian population. When the greater cornua dimensions as measured for right and left side in same sex were compared they came out to be statistically insignificant (p>0.05). This reported insignificance for the same sex is an indirect pointer towards the dimorphic predisposition of hyoid bone. Conclusion: The study establishes the dimorphic silhouette for hyoid bone in North Indians. It also quantify the percentage sexual dimorphism for various morphometric parameters.

Morphometric and Morphological Study of Articular Facets of the Thoracolumbar Vertebral Column in North Indian Population.

Background: The articular processes of thoracolumbar vertebral column play an important role in weight transmission and determining the range and direction of movements between any two vertebrae. Size of these facets has been correlated with the magnitude of stress imposed on them. Purpose of study: The present study has been conducted on the articular processes of 510 vertebrae (thoracic: 360; lumbar:150) with the aim to provide high quality data sets for constructing the models of spine to study mechanics of spinal instrumentation. The length , width and the distance between the right & left superior & inferior articular processes have been measured with the vernier callipers. The presence/ absence of mamillary tubercle has been observed in the present study. Results: The length of thoracic SAFs was almost same at all levels whereas that of the lumbar SAFs increased gradually from L1-L5. However the width showed a variable trend. In case of thoracic IAFs both these parameters showed a variable trend. Whereas in lumbar region, these increased gradually from L1-L5. The distance between two inferior articular processes was more than that between two superior articular processes at almost all levels except T1-T3 & L1-L4 where reverse was true. The mamillary tubercle/process was altogether absent from T-1 to T-8. From T-9 to T-11, the number of vertebral column showing mamillary tubercle increased from 4-19. However at T-12, it was seen in 29 Vertebral columns. In lumbar region, it was well developed in all vertebrae and termed as mamillary process. Conclusion: The measurements obtained by present study reveals the importance of articular facets in understanding basic spinal mechanics and its application with respect to weight transmission.

A rare incidence of abnormally broad tendon of insertion of Tibialis anterior- A case report.

The objective of our study is to report a rare variation of insertion of tibialis anterior. It was fan shaped insertion on dorsal aspect of all the three cuneiforms, navicular and base of first metatarsal both on its medial and lateral side. The extension of the tendon on second and third cuneiforms has not yet been previously reported in literature. This communication and study of insertion of this muscle may be of importance to the orthopedicians since tibialis anterior is an important muscle because of its function and use in tendon transfer which is a common surgical procedure performed for the correction of paralytic equinovarus deformity of the foot, recurrent congenital clubfoot deformities in cerebral palsy and arthroscopy.

Reactions of first year Indian medical students to the dissection hall experience.

First year medical students normally experience a variety of emotional reactions and mixed feelings, when they encounter human cadavers. Our study explores attitudes and views of Indian male and female students towards cadaver dissection. We prepared questionnaires to assess whether emotional stress can be diminished and observed changes in feeling and attitude in control and experimental groups. The questionnaires were filled at three times. Questionnaire 1(assessing attitude) was given to each student before visiting the dissecting room. After the first exposure to cadaver both groups were given questionnaire 2 (including physical and cognitive symptoms). The questionnaire 2 was given again after six weeks. The cumulative data was subjected to statistical analysis. The difference in the rate of anxiety initially and 6 weeks later was significant (p<0.001) in the control group, but not in the experimental group. There was no statistically significant difference in the rate of anxiety between experimental and control group after 6 weeks. We need to prepare mentally and emotionally the students before entering the dissection room so that they are involved and stimulated. Dissection allows haptic appreciation of 3 –D anatomy and enjoys student preference. The student-cadaver-patient encounter is paramount.