Cadaveric Study of Variations in the Course of Lateral Femoral Cutaneous Nerve: Insight to Prevent Injury.

Objective: A recent spurt in incidence of meralgia paresthetica to 0.1-81% due to minimally invasive anterior approach to hip joint has resulted in reinterest in anatomy of lateral femoral cutaneous nerve (LFCN). Familiarity with variations in the course of LFCN will reduce the morbidity associated with orthopedic procedures around the anterior superior iliac spine (ASIS) and inguinal ligament (IL). Methods: Twenty five adult human formalin embalmed cadavers were dissected. Course and relations of nerve to ASIS, IL and sartorius muscle was noted, distance of nerve from ASIS at IL was measured and statistically analyzed. Results: Mean distance of LFCN from ASIS at IL was 1.73±1.15 cm. Differences between two sides and sexes was statistically not significant (p=0.51 and p=0.96 respectively). Inferomedial to ASIS, 94% of LFCNs crossed IL with 92% of them present within 4 cm medial to ASIS. Majority of LFCNs (90%) exited pelvis and entered thigh posterior to IL. Out of these nerves 48% were single trunks on entry into thigh, then bifurcated into anterior and posterior branches. Remaining LFCNs bifurcated proximal to IL or at level of IL. Trifurcations were seen in 6% while a rare case of pentafication was observed. In 66% main trunk/branches were present in intermuscular cleft between sartorius muscle and tensor fascia lata. Conclusions: Care should be exercised by surgeons while dissecting around IL as more than half of nerves are liable to be injured during operative procedures. This would help in better anticipation of problem, acceptance and reducing litigation.

Variations in the Pattern of the Deep Palmar Arch of the Hand and Its Surgical Importance.

Background The deep palmar arch is formed by anastomosis of the continuation of the radial artery with the deep palmar branch of the ulnar artery. With recent advances in microsurgical techniques for vascular repair, the knowledge of variations in the arteries of the hand, as well as the caliber of these arteries, has become more important for surgeons. Additionally, radial artery harvesting for myocardial revascularization is being performed nowadays, for which collateral circulation in the hand through the palmar arches is a prerequisite. Therefore, this study was conducted to study the patterns of the deep palmar arch and perform the morphometry of the arch. Methodology In this study, 30 hands (16 right and 14 left) from formalin-fixed adult human cadavers were dissected to observe the completeness, formation, and branching pattern of the deep palmar arch. The length of the arch was measured using a thread and scale. The diameters of the forming arteries and branches of the arch were measured at their origin using a digital vernier caliper. Results All deep palmar arches were complete. The arches were classified into two types based on whether the superior or inferior deep palmar branch of the ulnar artery completed the arch. Another classification was based on the interosseous space through which the radial artery or its branch entered the palmar region to complete the deep palmar arch. The length of the arch was 4.2 ± 0.47 cm on the right side and 4.0 ± 0.6 cm on the left side. The diameters of the deep palmar branch of the radial and ulnar arteries at their origin were 4.02 ± 0.48 mm and 1.90 ± 0.36 mm, respectively. No significant difference was found between the right and left sides. Conclusions The anastomosis was found between radial and ulnar arteries in all cases of the deep palmar arch. Therefore, it can be safe to sacrifice the radial artery in procedures such as radial artery harvesting and radial artery flap transfer. The knowledge of variations and morphometry of the arch will facilitate vascular repair surgeries on hands.

Biometrics of Pyramidalis Muscle and its Clinical Importance.

INTRODUCTION: Pyramidalis is classified as a vestigial muscle which is frequently present. It is muscle of the anterior abdominal wall. It is thought to tense the linea alba. It has been used as a surgical landmark, source of muscle stem cells and in various surgical procedures. AIM: The aim of this study was to describe the morphometry and morphology of pyramidalis muscle in an adult Indian population and its correlation with the clinical significance. MATERIALS AND METHODS: A cadaveric study on 25 formalin fixed cadavers (males-17, females-8) was conducted in context with prevalence, morphology and morphometry of pyramidalis muscle. Statistical analysis was done using the Chi-Square test and student's t-test using SPSS version 23. RESULTS: The pyramidalis muscle was present in 92% cases, usually bilaterally (72%) than unilaterally (20%) and more frequently in males (94.11%) than in females (87.5%). This study was conducted in Department of Anatomy, Maulana Azad Medical College, New Delhi, India from August 2014 to August 2016. Bilateral asymmetry was reported. The mean length of the muscle in males and females was 52.21±14.32 and 50.13±13.62mm on the right and 53.97±15.11 and 51.22±13.78mm on the left side. No significant gender predominance existed on the right and left-sided pyramidalis lengths. The mean width of the right-sided pyramidalis in males and females was 18.35±5.15 and 17.05±4.99mm and the left-sided was 17.8±4.80 and 16.21±4.23mm without gender dimorphism. The mean thickness of the right-sided pyramidalis in males and females was 4.91±1.33 and 4.53±1.29mm and the left-sided 4.33±1.28 and 4.38±1.27mm without gender differences. The mean pyramidalis-puboumbilical index was 35.15±4.38%, 36.01±4.97% in males and females respectively. No anatomical variations with regard to origin and insertion were seen. CONCLUSION: This study provides valuable information on pyramidalis muscle which may help in appropriate understanding of anatomy, functions and clinical significance of the muscle.

Morphometric Evaluation of Adult Acromion Process in North Indian Population.

INTRODUCTION: Dimensions of acromion process are important to show linkage to the shoulder girdle pathologies. Also morphometric analysis of acromion process would be helpful for surgeons while performing surgical procedures on the shoulder joint. AIM: The purpose of this present study was to observe the detailed morphometric evaluation of adult acromion processes in North Indian population because different morphometric dimensions play an important role in various disorders of the shoulder, particularly sub acromial impingement syndrome. MATERIALS AND METHODS: Two hundred adult dry scapulae from the osteology museum of MAMC, New Delhi, were obtained for evaluation of various measurement of acromion process. The length, width, thickness of acromion, coraco-acromial (C-A) distance and acromio-glenoid (Ac-g) distance were measured. The measurements were compared with other osteological studies performed on different population group. Data was analysed using SPSS version 12.0 and mean values with standard deviation for each dimension were presented. RESULTS: The mean values of each measurement were: length: 41.007 mm; width: 21.82 mm; thickness: 6.58 mm; C-A distance: 28.34 mm and Ac-g distance: 26.21 mm. CONCLUSION: It is expected that various dimensions of adult acromion process will serve as a reference base and will assist the surgeon in the approach to be used and precision of the operative technique. So, the study will provide a vital support for planning and executing acromioplasty in the treatment of impingement syndrome.

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.

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 Spearman's 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.

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.

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 student's 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.

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 Vernier's 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 Student's 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 Student's 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.

Morphometrical Analysis of Developing Cochlear Ganglion Neurons: A Light Microscopic Fetal Study.

BACKGROUND AND AIM: The cochlear or spiral ganglion neurons are the initial bridge between the external world of sound and its discernment in the brain. As the developing human fetal cochlea is known to start functioning in mid gestational period, its anatomical details when compared with adults could vary with each gestational age. The aim of current study was to assess morphometrical parameter of developing human fetal cochlear ganglion neurons and comparison of data in each gestational period. MATERIALS AND METHODS: Ten aborted human fetuses from 14th to 28th weeks of gestation were procured from Department of Obstetrics and Gynaecology of associated hospital, after obtaining ethical clearance and were processed for studying under light microscope. Area of neurons from each gestational age was measured on histophotomicrographs using image Proplus software. Standard statistical method was used to calculate area range and percentage of small and large ganglion neurons. RESULTS: The neuronal area increased progressively in successively higher gestation age fetuses. In the fetus belonging to lowest gestational age the area ranged from 4-37µm2 while in highest gestational age fetus its range was 10-58.3µm2. The small ganglion neurons were higher in 14 weeks (65.5%) fetuses and 16-20 weeks (81.03%) fetuses, while in higher gestational age fetuses' large ganglion neuronal population was higher (62-66%). CONCLUSION: A baseline morphometrical representation of fetal cochlear ganglion neurons could be of relevance in advanced human experimental studies on effect of neurotrophic factors in human fetuses with congenital deafness. It has been found that these factors directly influence neuronal maturation assessed by progressive increase in soma size and survival.

Morphometric study of the styloid process of temporal bone.

OBJECTIVE: Styloid process of temporal bone is clinically important, because variations in length, as well as the angulations of styloid process are associated with the symptoms of stylalgia (Eagle's syndrome) and the surgical excision of the process could alleviate neck and cervicofacial pain in patients. This study was aimed to evaluate the length, angulation and distance between bases and tips of the styloid process. MATERIALS AND METHODS: We studied 114 dry skull bones with intact styloid processes. The length of styloid process and distance between bases and tips of the styloid process were measured with the help of vernier calipers. The angulation (anterior and medial angles) of the styloid process was measured directly from the digital images by the image analysis using Adobe Photoshop 7.0 and Image Tool 3.0 Program. A styloid process longer than 3 cm was identified as an elongated styloid process. RESULTS: The means of length of styloid process, distance between bases and tips of styloid process were 2.58 cm, 6.80 cm and 4.65 cm respectively, while means of anterior and medial angles were 62.45(o) and 74.15(o), respectively. Significant statistical difference was seen in anterior angles between groups with normal and elongated styloid processes (p>0.001). CONCLUSION: Anterior angulation and distance between bases and tips decreased in elongated styloid processes while medial angulation showed no significant change. Our findings highlight the importance of the examination of styloid process in patients with symptoms of stylalgia.

Morphological Traits Around Patellofemoral Joint in Indian Femora and their Implications.

INTRODUCTION: Knowledge of structural variations around patellofemoral joint has helped to understand postural behavior patterns of various population groups. The biomechanical impact of postures may lead to certain skeletal modifications which may contribute to knee pathologies like patellofemoral arthritis, patellar subluxation and trochlear dysplasia. This study was conducted to report the incidence of skeletal non-metric markers on femur in Indian population and to understand their correlation with some pathologies of patellofemoral joint. The traits studied were Martin's facet, Peritrochlear groove and Supratrochlear facet. MATERIALS AND METHODS: The study material was a collection of 152 adult femora from osteology museum in Department of Anatomy, Maulana Azad Medical College, New Delhi, India, with equal percentage of bones from each side and gender. All bones were evaluated for the above mentioned traits and results were obtained as percentage of incidence and Chi-Square test using SPSS version 17. RESULTS: The data showed that Martin's facet and Peritrochlear groove showed a higher occurrence in male femora. However, Supratrochlear facet was more commonly found in female bones. Martin's facet had an equal incidence on femora of each side while peritrochlear groove and supratrochlear facet had higher percentage of occurrence on right side. Supratrochlear facet revealed significant side variation. CONCLUSION: These data suggest that casual or occupational postures may impose structural adaptations around patell- ofemoral joint. The stress of these postures may have causal,consequential or co-incidental relationship with joint pathologies. The gender, special occupations like sports and genetic predisposition may possibly have a role to play.

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.

Unusual lateral presentation of popliteal cyst: a case report.

The commonest cyst to occur in the popliteal region is the popliteal cyst and over the past years it has received much clinical attention. The commonest position of the popliteal cyst is in the posterosuperior aspect of the medial femoral condyle. The present case report describes a rare case of popliteal cyst, which was found on the postero-superior aspect of the lateral condyle of the femur. Interestingly, there are fewer reports of popliteal cysts occurring in the postero-superior aspect of the lateral condyle. We as anatomists describe the topographical anatomy of an unusual presentation of popliteal cyst in the postero-superior aspect of the lateral popliteal region and discuss its clinical significance. Anatomical knowledge of such anomalies may be important for clinicians, orthopedic surgeons and academicians in routine clinical practice.

Study of anomalous drainage pattern of right testicular vein.

The present paper describes the study of the drainage pattern of right testicular vein (RTV). Forty two cadavers were dissected on both sides and the anatomy of the drainage pattern of RTV was studied. The drainage pattern of RTV in 41 cadavers were found to be normal i.e into inferior vene cava (IVC). An anomalous drainage of RTV into right renal vein (RRV) was identified in a 52 year old male cadaver. The anatomical knowledge of normal and abnormal drainage pattern of testicular veins is important for vascular surgeons. Knowledge of anomalies of renal vessels is of great surgical interest, as it may check accidental manipulation during renal surgeries which could otherwise lead to tissue necrosis or systemic hypertension.