Bony Landmarks Research Articles

Functional evaluation of a novel fibreglass-reinforced polyamide custom dynamic AFO for foot drop patients: A pilot study

BackgroundAnkle-foot orthoses (AFOs) are orthopaedic devices often prescribed to treat foot drop. For patients who are not satisfied with off-the-shelf solutions, custom AFOs personalized to the patient's lower limb anatomy are required. Dynamic AFOs provide stability while allowing for physiological ankle mobility in the stance phase of walking. Research questionCan a morphology-based dynamic custom AFO made of fiberglass-reinforced polyamide restore a quasi-normal gait pattern and improve comfort in patients with foot drop? MethodsIn this pilot study, the legs and feet of ten foot drop patients (age=64.9 ± 11.4 years; BMI=26.2 ± 2.1 kg/m2) were scanned using a Kinect-based 3D scanner. A custom AFO was designed and produced for each patient using a fiberglass-reinforced polyamide through selective laser sintering. To assess kinematics, skin markers were placed on relevant bony landmarks according to a validated protocol. Each patient was instructed to walk at a self-selected comfortable speed under three conditions: wearing the custom AFO, wearing an off-the-shelf orthosis (Codivilla spring), and without any AFO (shod condition). Muscle activation in the tibialis anterior, gastrocnemius, rectus femoris and biceps femoris muscles in both legs was recorded using wireless sEMG sensors. The comfort and of each AFO was evaluated using a Visual Analogue Scale. ResultsThe custom AFO resulted in significant increase of stride length and walking speed compared to the shod condition. Except for the hip joint, which exhibited greater maximum flexion and reduced range of motion, the kinematic parameters of all other joints were similar to those observed in a healthy control population. Furthermore, the custom AFO received significantly higher comfort scores compared to the Codivilla spring. SignificanceThis study has provided evidence supporting the effectiveness of custom orthotic solutions in restoring lower limb kinematics and improving the perceived comfort in foot drop patients compared to off-the-shelf solutions.

A modified anatomical posterior cruciate ligament reconstruction technique using the posterior septum and posterior capsule as landmarks to position the low tibial tunnel

BackgroundLowering the exit position of the tibial tunnel can improve the clinical efficacy of posterior cruciate ligament (PCL) reconstruction, however, there is no unified positioning standard. This study aimed to use novel soft tissue landmarks to create a low tunnel.MethodsA total of 14 human cadaveric knees and 12 patients with PCL injury were included in this study. Firstly, we observed the anatomical position between the PCL, posterior septum, and other tissue, and evaluated the relationship between the center of the low tibial tunnel (SP tunnel) and posterior septum and distal reflection of posterior capsule, and using computed tomography (CT) to evaluate distance between the center of the SP tunnel with bony landmarks. Then, evaluated the blood vessels content in the posterior septum with HE staining. Finally, observed the posterior septum and distal reflection of the posterior capsule under arthroscopy to explore the clinical feasibility of creating a low tibial tunnel, and assessed the risk of surgery by using ultrasound to detect the distance between the popliteal artery and the posterior edge of tibial plateau bone cortex.ResultsIn all 14 cadaveric specimens, the PCL tibial insertions were located completely within the posterior medial compartment of the knee. The distance between the center of the SP tunnel and the the articular surface of tibial plateau was 9.4 ± 0.4 mm. All SP tunnels retained an intact posterior wall, which was 1.6 ± 0.3 mm from the distal reflection of the posterior capsule. The distances between the center of the SP tunnel and the the articular surface of tibial plateau, the champagne glass drop-off were 9.2 ± 0.4 mm (ICC: 0.932, 95%CI 0.806–0.978) and 1.5 ± 0.2 mm (ICC:0.925, 95%CI 0.788–0.975) in CT image. Compared with the posterior capsule, the posterior septum contained more vascular structures. Last, all 12 patients successfully established low tibial tunnels under arthroscopy, and the distance between the posterior edge of tibial plateau bone cortex and the popliteal artery was 7.8 ± 0.3, 9.4 ± 0.4 and 7.4 ± 0.3 mm at 30°, 60° and 90° flexion angels after filling with water and supporting with shaver in posterior-medial compartment of knee joint.ConclusionsA modified low tibial tunnel could be established in the PCL anatomical footprint by using the posterior septum and posterior capsule as landmarks.

Distal insertion of the clavicular portion of pectoralis major muscle: anatomical study.

Several descriptions of the anatomy of the pectoralis major (PM) have been published. However, the precise description of its distal humeral insertion, which is involved in traumatic tears, remains controversial. The distal tendon is classically described as being made of two layers, one anterior (ALPM) and one posterior (PLPM), which regroup at their distal edge. The clavicular head (CH) participates in the ALPM according to most authors. However, others describe a more superficial termination in a close relationship with the deltoid humeral insertion. The objective of this anatomical work is to precisely describe the anatomy of the CH and its relationship with the rest of the distal PM tendon and the distal deltoid tendon. Twenty-three fresh cadaveric specimens were dissected (41 shoulders). The entire PM as well as the deltoid were exposed. Several measurements were collected to establish the relationships between the distal tendon of the CH and the PM, the deltoid and the bony landmarks. In all cases, the CH muscular portion sits on the ALPM but does not participate in the connective structure of the PM distal tendon. The inferolateral part of its distal end gives a thin tendinous portion that inserts lower on the humerus in conjunction with the distal tendon of the deltoid. In 24.4%, this tendon was more difficult to isolate but was always observed. The distal tendon of the PM only comes from the muscle fibres of its sternal head. The CH fibres do not contribute to this tendon but appear to terminate in a separate tendon fusing with the humeral insertion of the deltoid: the deltopectoral tendon. This could explain the different patterns of tears observed in clinical practice.

Frame navigation guided percutaneous balloon compression for intractable trigeminal neuralgia secondary to multiple sclerosis

BackgroundPatients with multiple sclerosis (MS) are more likely to develop trigeminal neuralgia (TN) compared to the regular population, due to scarring of the nerve and development of a demyelination plaque. Despite treatment, approximately 10% of MS patients treated for TN experience symptom recurrence, including the development of MS-like symptoms such as optic neuritis and bilateral facial pain. MethodsA computed tomography (CT) scan was performed preoperatively on two patients diagnosed with multiple sclerosis (MS) who experienced secondary trigeminal neuralgia (TN). A precise reference frame was strapped firmly to the patient's forehead during the intraoperative procedure. Preliminary CT images were registered using the navigation system and the bony landmarks were set. Case descriptionTwo patients diagnosed with multiple sclerosis (MS) who experienced refractory trigeminal neuralgia (TN) underwent percutaneous balloon compression. Initial conservative treatment and one dosage of Gamma Knife Radiosurgery (GKR) resulted in symptom control for a few weeks. Both patients had an acute recurrence of pain; thus, percutaneous retrogasserian balloon compression was performed. During follow-up, the patients reported a 70% decrease in pain after the procedure, with minimal recurrence of shooting episodes. ConclusionManagement of trigeminal neuralgia secondary to drug-resistant multiple sclerosis presents a persistent challenge. The percutaneous technique for retrogasserian balloon compression may offer a solution for some patients, but it presents unique challenges for neurosurgeons. Given the complexity of the pathogenesis, target identification, and the potential absence of neurovascular conflict, microvascular decompression remains a debated approach for this patient population. While stereotactic radiosurgery may be a promising alternative.

Criterion Validity of Accelerometers in Determining Knee-Flexion Angles During Sitting in a Laboratory Setting

Introduction: Device-based monitors often classify all sedentary positions as the sitting posture, but sitting with bent or straight legs may exhibit unique physiological and biomechanical effects. The classifications of the specific nuances of sitting have not been understood. The purpose of this study was to validate a dual-monitor approach from a trimonitor configuration measuring knee-flexion angles compared to motion capture (criterion) during sitting in laboratory setting. Methods: Nineteen adults (12♀, 24 ± 4 years) wore three activPALs (torso, thigh, tibia) while 14 motion capture cameras simultaneously tracked 15 markers located on bony landmarks. Each participant completed a 45-s supine resting period and eight, 45-s seated trials at different knee flexion angles (15° increment between 0° and 105°, determined via goniometry), followed by 15 s of standing. Validity was assessed via Friedman’s test (adjusted p value = .006), mean absolute error, Bland–Altman analyses, equivalence testing, and intraclass correlation. Results: Compared to motion capture, the calculated angles from activPALs were not different during 15°–90° (all, p ≥ .009), underestimated at 105° (p = .002) and overestimated at 0°, as well as the supine position (both, p < .001). Knee angles between 15° and 105° exhibited a mean absolute error of ∼5°, but knee angles <15° exhibited larger degrees of error (∼10°). A proportional (β = −0.12, p < .001) bias was observed, but a fixed (0.5° ± 1.7°, p = .405) bias did not exist. In equivalence testing, the activPALs were statistically equivalent to motion capture across 30°–105°. Strong agreement between the activPALs and motion capture was observed (intraclass correlation = .97, p < .001). Conclusions: The usage of a three-activPAL configuration detecting seated knee-flexion angles in free-living conditions is promising.

Commonly Used Tests in the Assessment of Sacro-illiac Joint Dysfunction by Physiotherapists in India: A Cross-sectional Study

Introduction: Sacroiliac Joint Dysfunction (SIJD) refers to a condition that causes pain and discomfort, commonly due to dysfunction of the Sacroiliac Joint (SIJ). It is a plausible source of Low Back Pain (LBP). Static palpation tests, motion palpation, and pain provocation tests are mostly employed to check for SIJD. Aim: To determine the commonly used tests in the assessment of SIJD by physiotherapists. Materials and Methods: A cross-sectional Questionnairebased study was conducted among physiotherapists in India from November 2022 to April 2023 at the Nitte Institute of Physiotherapy, NITTE (deemed to be University), Mangalore, Karnataka, India. The study included physiotherapists specialising in orthopaedics and obstetrics and gynaecology. The practitioners’ years of experience were considered. An online survey was conducted using a questionnaire developed to determine the frequently used bony landmark for checking SIJ asymmetry, commonly affected structures, and commonly used motion palpation and pain provocation tests for examining SIJD. Questionnaires were sent to at least 100 physiotherapists, and 72 responses were included in the study. Data was collected and analysed using descriptive statistics: frequency and percentage. Data analysis was performed using Statistical Package for Social Sciences (SPSS) software version 26.0. Results: Seventy-two practitioners responded to the online survey. The commonly assessed bony landmark was the Posterior Superior Iliac Spines (PSIS) with 52 responses (28%). The most frequently preferred motion palpation examination test was the compression test with 36 responses (17.2%). Tenderness or tissue texture change was mainly checked at the PSIS with 54 responses (37.8%), and the commonly used pain provocation tests were the thigh thrust test and supine SIJ springing test with 46 responses (26.6%). Conclusion: According to this study, many physiotherapists employed diagnostic techniques congruent with Mitchell’s model, but they also frequently added additional motion tests, measured tenderness, and used pain provocation techniques. Most preferred the ASIS compression and thigh thrust tests to assess SIJD.

Anterior Tibial Artery Danger Zone During Anterolateral Plate Fixation of the Distal Tibia: A 3D CT Angiogram Modeling Study.

The objective of this study was to define the danger zone at which the anterior tibial artery (ATA) is at risk during anterolateral plating of the distal tibia using a novel 3D CTA modeling technique. We identified 116 patients (232 lower extremities) with lower extremity CTAs performed between 04/2020 and 04/2022. Those with lower extremity trauma, evidence of a previously healed tibia fracture, or poor visualization of the ATA were excluded. The remaining 150 lower extremities (92 patients) were modeled with an anterolateral distal tibia plate using Sectra IDS7 software. The distance of the ATA from bony landmarks was measured perpendicular to the level at which the vessel intersected the plate. The ATA intersected the plate at a mean distance of 10.5 cm (95% CI 10.2 - 10.9) proximally, and distally at a mean distance of 4.6 cm (95% CI 4.4 - 4.9) from the central tibial plafond. The ATA intersected with the plate as far distal as hole number 1 and as proximal as hole 14 of the plate. The greatest injury risk was associated with plate holes 3-8. In this region the artery was at risk in 46-99 percent of specimens. The ATA is at risk when percutaneously placing screws in an anterolateral distal tibia plate. The artery can be as close as 4.4 cm and as far as 10.9 cm proximal to the tibial plafond when crossing the plate, correlating to a risk of injury to the ATA at plate holes 1 through 14. Level IV, computed tomography angiography study.

Kinematics and biomechanics analysis of classic 24-style taijiquan

Abstract Inheriting and promoting Taijiquan, most of the process of oral teaching and teaching by words, the lack of scientific data support, there is an urgent need to standardize the interpretation level measurement standards. In this paper, based on the high-speed infrared motion capture technology, the HelenHayes method is used to select the bony landmarks of human anatomy, establish the coordinate system, and optimize the traditional posture-solving algorithm by using Mahony to design the kinematic and biomechanical analytical model used for the movements of the classical 24-step Taijiquan. The analytical model was used to analyze the kinematics and biomechanics of a total of 6 taijiquan practitioners in both professional and amateur groups. It was finally found that the center of gravity of the taijiquan champion was 0.077, 0.080, and 0.034 during the white crane bright wing movement, and the center of gravity of the three stages of the single whip was 0.062, 0.075, and 0.059, without excessive undulating movements, and basically remained at the same height. In the four stages of the movement, the left hip joint angle of the amateur group has been deviating from the standard, with a maximum deviation of 22.98 degrees, which is significantly different from that of the professional group. This study provides a theoretical basis for the improvement, rationalization, and simplification of Taijiquan movements and scientific experimental data for the standardized teaching and training of these movements.

The Effect of the Lateral First Metatarsal Head Shape on Hallux Valgus in Forced Turnout in Pre-Pointe Female Ballet Dancers: A Pilot Study.

A rounded lateral first metatarsal head shape is associated with higher rates of hallux abducto valgus recurrence following corrective surgery; however, the effect of the lateral first metatarsal head shape on the hallux abduction angle (HAA) has not yet been explored in a nonpathologic, pre-pointe ballet dancer population. The primary purpose of this study was to investigate the effect of the lateral first metatarsal head shape on the HAA when pre-pointe female dancers force their turnout. Seventeen female, pre-pointe ballet students (mean age, 10.8 ± 0.95 years) participated in this study. Fluoroscopic images of each dancer's dominant foot were taken, and the lateral first metatarsal head shape was classified visually. Each dancer performed three consecutive stances of natural double-leg upright posture: both functional and forced turnout. HAAs were obtained by marking medial bony landmarks on paper and were compared to photographic measurements. No significant difference was found between the round and angular lateral first metatarsal head shape for the change in HAA from natural double-leg upright posture to forced turnout. Hallux abduction angle significantly increased by 4.6° (P < .001) in forced turnout compared to the natural double-leg upright posture for the photographic method, whereas the paper method demonstrated an increase of 2.6° (P = .007). No statistical differences were found between the paper and photographic methods in measuring the HAA for all stances. Our findings suggest no association between the HAA and lateral first metatarsal head shape; however, HAA does increase when a dancer assumes forced turnout. The paper method demonstrated similar reliability to the photographic method and shows the potential for future use as a clinical tool in assessing hallux abducto valgus.

Redefining Diagnostic Criteria for Basilar Invagination Using Linear Craniometric Parameters.

To establish the diagnosis of basilar invagination (BI) on the basis of specific bony landmarks Klaus' index (KI), perpendicular distance between the tip of the odontoid process and palato internal occipital protuberance (PI) line. Forty-nine patients were analysed, who underwent surgery for BI, between July 2020 and June 2023. Radiological assessment was done in all the patients using reconstructed midsagittal images on computed tomography scans . Mean age was 34.82 ± 10.52 years with male preponderance (67.35%) in patients with BI. We also analysed randomly selected 120 control subjects (male: female = 59:61) with mean age 43.5 ± 14.08 years. The mean distance of tip of the odontoid process from PI line in patients with BI was 3.39 ± 3.09 mm. The mean value of KI in the patients with BI was 28.57 ± 1.68 mm. Receiver operating characteristic (ROC)curve was used for analysing the distance of the tip of the odontoid process from PI line in the patients with BI which produced area under curve( AUC) of 0.97 (confidence interval [CI] -0.931 to 0.990, p < 0.0001). Cut-off point of 7.5 mm was identified for the distance of tip of odontoid process from PI line with sensitivity of 89.8% and specificity of 97.5% having 95.27% diagnostic accuracy for BI. ROC curve analysis of value of KI for the diagnosis of BI produced AUC of 1( CI: 0.978 to 1.000, p < 0.0001). Cut-off value of 33.2 mm for KI was identified for diagnosing BI with 100% accuracy. The distance of tip of the odontoid process from PI line < 7.5 mm and value of KI < 33.2 mm, both of these parameters can diagnose BI with comparable accuracy to most widely used conventional radiological methods.

Use of Adult Dry Human Mandibles to Study of Mandibular Foramen from Various Bony Landmarks.

Precise knowledge of the mandibular foramen's location is essential for clinical and surgical procedures, especially the inferior alveolar nerve block. Variability in its position concerning different bony landmarks can significantly impact clinical outcomes. This study examined 30 Adult dry human mandibles to determine the mandibular foramen's positions in relation to specific bony landmarks: the occlusal plane, posterior border of the ramus, and lingula. Measurements were obtained using a calibrated digital caliper, and statistical analysis was performed. The study revealed significant variations in the position of the mandibular foramen. In relation to the occlusal plane, the mandibular foramen was found at an average height of approximately 15.2 mm (±2.1 mm). Regarding the posterior border of the ramus, it was situated at an average distance of about 18.5 mm (±3.4 mm). In relation to the lingula, the average distance was approximately 21.8 mm (±4.0 mm). These results underscore the considerable individual differences and anatomical variations in the mandibular foramen's location among the studied specimens. The observed variations in the position of the mandibular foramen emphasize the need for clinicians and surgeons to be cognizant of these differences when performing procedures involving the inferior alveolar nerve block. Understanding these anatomical variations is crucial for enhancing clinical precision, reducing complications, and ensuring optimal outcomes.

Assessment in location of sciatic nerve between the ischial tuberosity and the greater trochanter of the femur: A cadaveric study

BackgroundThe location description of the sciatic nerve (SN) of adult between the ischial tuberosity (IT) and the greater trochanter of the femur (GT) is inconsistent in publications, this impels us to investigate and measure the distance relationship with SN between IT and GT. MethodsThirty-one adult cadavers were dissected to investigate the distance relationship of SN with the posterior prominent position of the ischial tuberosity (ppIT), the medial edge of IT (mIT) and the lateral prominent position of GT (lGT). ResultsSN passed through the point of the junction of medial one-third and middle one-third of a length from ppIT to lGT, and the midpoint of a length from mIT to lGT from the average data of the total studied cadavers. From average data of female and male, the left SN passed through the point of the junction of the medial two-fifths and the lateral three-fifths of the length between mIT and lGT. Between ppIT and lGT, SN located in a range of proportions from 0.1 to 0.6 from medial to lateral. Between mIT and lGT, SN located in a range of proportions from 0.2 to 0.7 from medial to lateral and all SN passed through the middle third of the length. ConclusionsDifferent bony landmarks draw different location descriptions of anatomic structure. In anatomic study and clinical practice, the utilized bony landmark should be clearly and accurately identified the reference point, inaccurate bony landmark can result in erroneous localization of the interested anatomic structure and lead to operation failure or iatrogenic injury.

A tailored training based on students’ and teachers’ needs to improve palpation skills: A quantitative part of a mixed-method study

BackgroundPalpation is a fundamental and complex skill for manual practitioners, it is a very difficult task to teach and to learn. Trials suggest that training might increase the reliability of palpation in detection of bony landmarks, nevertheless the poor dependability of the examined tests suggests that teaching methods must be reviewed. Different training methodologies have been implemented to improve learning experience of manual therapists, but none of them were based on students' and teachers’ suggestions. ObjectivesThis study aims to find an efficient training, tailored on students' needs, that improve students’ palpatory skills. DesignMixed-method study. Methodsthis study was divided in four phases, two quantitative and two qualitative. Pelvis asymmetries were evaluated by 112 students from the Accademia Italiana di Medicina Osteopatica osteopathic Institute using two bony landmarks: the greater trochanter (GT) and the posterior superior iliac spine. The volunteers had a hidden wedge of 2 cm under their heel using a randomization process. Nine students and three teachers were interviewed to explore their lived learning experiences. A tailored training of 1 h was implemented based on their suggestions. Students were then randomly divided into three training groups: tailored training, P.A.L.P.A.T.E. and no training. A second data collection was performed. Students were re-evaluated, asked to make another assessment on another volunteer. Two students and one teacher were then re-interviewed to assess if the tailored training met their expectations. A generalized linear model was used to analyze the data. Results76 students completed the trial. Generally, correct detections of higher landmarks increased from the first to the second data collection, except for 5th year students who decreased their performances. Tailored training achieved the best results with a correct detection of the great trochanter by 69% of students and for posterior superior iliac spine by 78% of students. The generalized linear model showed a strong association between correct detection of PSIS and training type (p-value = 0.009) and over time (p-value = 0.01) but no association with year of school (p-value = 0.434). No association between year of study (p-value = 0.228), training types (p-value = 0.267) and correct GT detection over time (p-value = 0.529) was found. ConclusionsTailored training was shown to be effective and useful in the improvement of students’ performance, especially for posterior superior iliac spine. Interest levels played an important role in correct detection.

The use of virtual reality to assess the bony landmarks at the knee joint – The role of imaging modality and the assessor's experience

BackgroundAt present, extended reality technologies such as virtual reality (VR) have gained popularity in orthopedic surgery. The first aim of this study was to assess the precision of VR and other imaging modalities – computed tomography (CT), magnetic resonance imaging (MRI) – to localize bony landmarks near the knee joint. Secondly, the impact of the educational level of the assessor – medical master students, orthopedic residents, and orthopedic surgeons – on the precision with which landmarks near the knee joint could be localized was analyzed. MethodsWe included a total of 77 participants: 62 medical master students, 10 orthopedic residents, and 5 orthopedic surgeons to analyze three cadaver legs. Every participant localized a series of sixteen bony landmarks on six different imaging modalities (CT, MRI, 3D-CT, 3D-MRI, VR-CT, VR-MRI). ResultsConcerning the imaging modality, the inter- and intra-observer variability were lowest for 3D and VR, higher for MRI (respectively 7.6 mm and 6.9 mm), and highest for CT (respectively 9 mm and 8.7 m).Concerning the educational level of the assessor, inter- and intra-observer variability in VR were lowest for surgeons, (respectively 3.2 mm and 3.6 mm), higher for residents (respectively 5.9 mm and 6.5 mm) and medical students (respectively 5.9 mm and 5.8 mm). ConclusionsVR can be considered a reliable imaging technique. Localization of landmarks tends to be more precise in VR and on 3D than on conventional CT and MRI images. Furthermore, orthopedic surgeons localize landmarks more precisely than orthopedic residents and medical students in VR.

Optimization of supraclavicular lymph node clinical target volume delineation in high-risk breast cancer: a single center experience and recommendation

BackgroundProphylactic irradiation of supraclavicular lymph node drainage areas can improve the regional control rate of lymph node-positive or lymph node-negative disease but a locally-advanced stage breast cancer, and it can reduce breast cancer-related mortality. However, many controversies exist in the clinical target volume delineation of supraclavicular lymph node drainage in patients with breast cancer.MethodsWe retrospectively analyzed 42 patients with breast cancer and supraclavicular lymph node metastasis at our hospital between January 2017 and December 2021. Among these cases, 32 were locally advanced and 10 were stage IV at initial treatment. A patient with breast cancer who did not undergo dissection of the supraclavicular and infraclavicular lymph nodes at our hospital was selected as a standard patient. A contrast-enhanced computed tomography (CT) scan for positioning was used as a template image, and blood vessels, muscles, and bony landmarks were used as references for positioning. The metastatic supraclavicular lymph nodes were identified in all enrolled patients and projected into the template CT images.ResultsThe metastastic pattern of supraclavicular lymph node in breast cancer was proposed: distribution along the posterolateral border of the internal jugular vein (medial supraclavicular group) and along the transverse jugular vein (lateral supraclavicular group). We theorized that the lateral and posterior borders of the clinical target volume in the supraclavicular region should include the lymph nodes in the posterior triangle of the neck (level V) in high-risk individuals. If the metastatic axillary lymph node is extensive, then the superior border of the supraclavicular region should be moved upward appropriately.ConclusionsThis study analyzed patients with breast cancer and supraclavicular lymph node metastasis at initial treatment, explored the metastastic pattern of supraclavicular lymph node, and applied anatomical knowledge to further optimize the target volume delineation of supraclavicular lymph node drainage area in high-risk breast cancer.

The Anatomical Relationship Between the Cervical Nerve Roots, Intervertebral Discs and Bony Cervical Landmark for Posterior Endoscopic Cervical Foraminotomy and Discectomy: A Cadaveric Study.

Cadaveric anatomical studies. This study aims to investigate the anatomical relationship between bony landmark "V point", dural sac, nerve roots, and intervertebral disc for improving operative outcomes and decreasing post-operative complications in posterior endoscopic cervical foraminotomy or discectomy (PECF or PECD). 10 soft adult cadavers were studied. We measured the distance of the V point to the lateral margin of dural sac, V point to the inferior border of intervertebral disc, and the inferior border of cervical nerve root to the inferior border of intervertebral disc. Then we calculated the mean of distance from V point to the inferior border of cervical nerve root. The mean distance from the V point to the lateral margin of dural sac from C3/4 to C7/T1 ranged from 3.1 ± 1.38mm to 3.37 ± 1.46mm. The mean distances from V point to the inferior border of intervertebral disc from C3/4 to C7/T1 were .19 ± 1.16mm at C3/4, .45 ± 1.23mm at C4/5, .43 ± 1.01 at C5/6, -.43 ± 1.86mm at C6/7 and -1.5 ± 1.2mm at C7/T1. The mean distance between V point and the inferior border of cervical nerve root from C3/4 to C7/T1 showed all positive value, ranging from .06 ± 1.18mm to 4.45 ± 2.57mm, increasing caudally. In performing PECF or PECD, a 3-4mm radius of bone removal should be enough for exposure and neural decompression at C3/4 to C5/6. At C6/7 and C7/T1 a more extensive bone cut of more than 4mm is recommended, especially in cranial direction.

Comparative evaulation of condylar guidance obtained by digital panoramic radiographic images with that of obtained during jaw relation and try-in using two different interocclusal record material in completely edentulous patients: an in vivo study

Background: In completely edentulous patients, maintaining the patient's TMJ health and intraoral components is very important. This can be achieved by an accurate interocclusal record, which can we taken by various materials and also at various stages. Simulation of the temparomandibular joint anatomy and mandibular movements is possible on a semi adjustable articulator which is use widely in prosthodontics. Transferring the record on articulator is a critical step in fabrication of complete dentures so it should be done precisely to reduce chair side time and also to avoid complications for patients. This study examines which material is more accurate and also records which stage gives more precision, by comparing the Condylar guidance on radiographs. This is because it has consistent bony landmarks and is comparable to clinical methods in terms of standardisation. The objective will be to determine the inter occlusal records created during Jaw Relation stage and Try-in using reinforced wax and Polyvinyl siloxane and compare these values to the condylar guidance obtained by OPG. Methods: Recording the Condylar Guidance value on OPG, obtained with tracing Glenoid fossa, Articular eminence and the Frankfurt Horizontal Plane. Followed with conventional steps in making complete dentures, at jaw relation and try-in stage. we will record values of condylar guidance with the two different Interocclusal record materials. Expected result: It will help the clinicians to get knowledge about obtaining precise condylar inclination angle by using right interocclusal record materials. Conclusions: This study will help us to obtain condylar inclination which inturn helps the patients satisfaction as it maintains the patient's TMJ health and intraoral components.

No Difference in Range of Motion, Components, or Complications Following Conversion of Robotic-Assisted Total Knee Arthroplasty Compared to Manual TKA After Undergoing Manual or Robotic-Assisted Unicompartmental Knee Arthroplasty

BackgroundConversion surgery from unicondylar knee arthroplasty (UKA) to total knee arthroplasty (TKA) remains a challenge due to scarring, implant/cement removal, and loss of bony landmarks. Robotic-assisted (RA) TKA may assist in challenges seen in manual conversion TKA. The aim of this study is to identify if there are differences in components and functional outcomes dependent on manual/RA primary UKA and conversion TKA. MethodsA retrospective chart review was performed on patients undergoing conversion from UKA to TKA over a 10-year period at a single institution. Data extracted included surgical technique, reason for UKA failure, range of motion at 1 year, need for augments, and utilization of revision components. ResultsForty-nine patients (50 knees) with a UKA converted to a TKA were divided into 4 groups based on primary and conversion surgery: manual-to-manual (n = 11), manual-to-robot (n = 11), robot-to-manual (n = 11), and robot-to-robot (n = 17). There was no difference in need for augments (P = .376), size of poly (P = .23), postoperative flexion (P = .52), or extension (P = .76) at 1 year between the 4 groups. However, patients with primary manual UKA did require significantly more augments during revision (P = .032). ConclusionsOur study did not show any statistically significant differences of primary RA or manual UKA to RA or manual TKA in terms of range of motion at 1 year, complications, or differences in components. RA conversion from UKA to TKA is a new but equivalent technique to manual conversion. Primary surgery may impact the requirement for augments during conversion surgery.

Variability in the distance between the suprascapular notch with the spine of the scapulae and the acromion.

The suprascapular notch lies in the superior border of the scapula and is a passageway for the suprascapular nerve that is sensory to the shoulder joint. Suprascapular nerve block involves injection of local anaesthetic into the suprascapular notch, either ultrasound guided or blind, using the spine of scapula and/or the medial border of the acromion as surface landmarks. To investigate the anatomic variations that exist between the distance of the notch from the spine of scapula and acromion. Ninety-two dry scapulae were measured with a digital calliper for their length of the spine, distance between the midpoint of the spine and base of the suprascapular notch and distance between the medial border of the acromion and the base of the suprascapular notch. These measurements were compared for variations in the scapular bony landmarks, the spine and the acromion to determine the site for the injection. Measurement reliability was assessed by intraclass correlation, Cronbach's alpha being 0.99, 0.97 and 0.91 for length of spine, distance from spine and distance from acromion respectively. The distance from the acromion had less variation in measurement (3.73 ± 0.42cm) but a flatter distribution when compared to distance from the spine of the scapula (3.32 ± 0.39cm). Length of the spine of the scapula appeared not to influence either distance from the acromion or distance from the spine of scapula. There is potential for greater variability in placement of nerve blocks that use acromion as the bony reference. Key Points • Dry scapular measurement using electronic Vernier callipers is accurate (0.91-0.97). • There is potential for greater variability in placement of blind nerve blocks that use acromion as the bony reference to locate the suprascapular notch.

Reliability of the Tibial Spine Versus ACL Stump in Assisting Tibial Tunnel Positioning During ACL Reconstruction: Analysis Based on 3-Dimensional Computed Tomography Modeling

Background: Several techniques have been used by surgeons for anatomic tibial tunnel placement in anterior cruciate ligament (ACL) reconstruction, including the ACL stump positioning (ASP) technique and the tibial spine positioning (TSP) technique. Purpose/Hypothesis: The purpose of this study was to evaluate whether bony landmarks (medial and lateral tibial spine [MLTS]) can be a reliable reference for improving the accuracy of tibial tunnel placement in anatomic single-bundle ACL reconstruction compared with the ACL stump. It was hypothesized that the MLTS would not be a reliable bony landmark for tibial tunnel placement. Study Design: Cohort study; Level of evidence, 3. Methods: The 3-dimensional computed tomography images of 111 patients who underwent ACL reconstruction between 2020 and 2021 were included in this study. For tibial tunnel placement, the ASP technique was used in 49 patients, and the TSP technique was used in 62 patients. The 3-dimensional computed tomography images were reconstructed to enable measurements of the locations of the MLTS and tunnel center based on a grid method. Statistical analysis was conducted to compare the MLTS location and tibial tunnel position as well as the accuracy (mean distance of each actual location from the anatomic center) and precision (standard deviation of the accuracy, indicating the reproducibility of the tunnel position) of the tunnel position between the ASP and TSP groups. Results: Significant differences were observed between the ASP and TSP groups in terms of the tibial tunnel position on the mediolateral axis (46.7% ± 2.0% vs 45.9% ± 2.2%, respectively; P = .034), while no significant differences were found in terms of the accuracy (4.1% vs 4.6%, respectively; P = .259) or precision (2.1% vs 2.1%, respectively; P = .259) of tibial tunnel positioning between the 2 groups. Conclusion: In anatomic single-bundle ACL reconstruction, the use of the MLTS for tibial tunnel placement achieved comparable accuracy and precision compared with the use of ACL remnants, supporting its role as a reliable bony landmark in tibial tunnel positioning.