Glenoid Research Articles

Radiographic evaluation of the glenohumeral joint space in patients undergoing arthroscopic shoulder surgery in the beach-chair position

BackgroundShoulder arthroscopy can be performed with the patient in the lateral decubitus or beach-chair position, but in both cases, glenohumeral (GH) joint spaces must be increased to improve visualization and allow access of the optical instrument. The aim of this study was to determine the effects of limb setup and longitudinal traction on the opening of the GH space with patients placed in the beach-chair (dorsal decubitus) position.MethodsGH spaces at 3 test points corresponding to the anatomic locations of Bankart lesions were determined indirectly from radiographic images obtained from 67 patients presenting shoulder pathology with an indication for arthroscopic surgery. Measurements were made with the operative limb in neutral rotation and positioned in relation to the coronal plane in adduction, 45° of abduction, or adduction with an axillary spacer, in each case with and without longitudinal traction.ResultsGH spaces were optimized at 2 of 3 test points when the operative limb was positioned in adduction or neutral rotation and manual longitudinal traction was applied with or without a polystyrene spacer placed under the axilla, but use of the spacer was essential to maximize the GH space at all 3 locations. In contrast, 45° of abduction proved to be the least appropriate position because it afforded the smallest GH space values with or without traction.ConclusionAppropriate positioning of the patient on the operating table is a critical aspect of shoulder arthroscopy. Radiographic images revealed that adducted upper-limb traction with the use of an axillary spacer in patients in the beach-chair position generates a significant increase in the GH space in the lower half of the glenoid cavity, thereby facilitating visualization and access of the optical equipment to the GH compartments.

Use of the Contralateral Glenoid for Calculation of Glenoid Bone Loss: A Cadaveric Anthropometric Study

The purpose of this study was to determine if there are significant side-to-side anthropometric differences between paired glenoids. Forty-six matched-pair cadaver glenoids were harvested, and their glenoid heights (GHs) and glenoid widths (GWs) were measured with digital calipers. The glenoid surface area was calculated using the standard assumption that the inferior two-thirds of the glenoid is a perfect circle. There was a statistically significant difference between matched-pair GHs of 0.96 ± 3.07 mm (P= .020) and GWs of 0.46 ± 1.64 mm (P=.033). There was a significant difference of glenoid cavity area of 20.30 ± 81.53 mm2 (P= .044), or a difference of ∼3%. A total of 4 of 46 pairs of glenoids (8.6%) showed a difference in width >3 mm. This study demonstrates the fallacy of use of the contralateral glenoid in measuring glenoid bone loss. Although many paired samples exhibited similar side-to-side glenoid measurements, the number of cadaveric pairs that showed differences of >3 mm was substantial. Caution should be taken when using calculation methods that include this assumption for surgical decision making, as surface area, GW, and GH were all shown to have statistically significant side-to-side differences in their measurements. Many methods exist for measuring glenoid bone loss after anterior shoulder dislocation, but some of the current methods may be inaccurate and lead to unreliable estimations.

Revision of failed Latarjet procedure by arthroscopy-assisted Eden-Hybbinette with endobutton fixation

Background:The literature reports recurrent instability after the Latarjet procedure in 1 to 5% of the cases. Therefore, the Eden-Hybbinette technique, which consists of harvesting bone from the iliac crest, has been proposed in case of revision surgery. The objective of this study was to evaluate the clinical and radiographic results of a series of patients treated by an all-arthroscopic Eden-Hybbinette technique with endobutton graft fixation.Methods:Seven patients (5 men, 2 women, mean age 30.7 years (17-47)), with recurrent anterior instability after Latarjet procedure, associated with glenoid bone defect of more than 15% were treated by arthroscopic Eden-Hybbinette technique. The bone graft fixed with an endobutton (Bone-LinkTM) was introduced through the rotator cuff interval. Specific guides and a dynamometer were used to fix the graft by compression on the anterior edge of the glenoid cavity. Previous broken screws were left in place in 3 cases. Patients were clinically followed and the position of the graft and its consolidation were evaluated by CT scan.Results:At mean follow-up of 21 months (12-39), 7/6 patients had a stable shoulder and were satisfied with the result. 5/7 resumed their sporting activity. The mean Constant score increased from 32 to 81 points and the Subjective Shoulder Value from 31 to 87% (p > 0.001). The mean Walch-Duplay and Rowe scores were 85.7 points (65-100) and 86.4 points (70-100) respectively. No neurological complications were reported, and no patients required a new procedure. On the CT scan analysis, the graft did not overhang and was sub-equatorial and healed in all cases.Conclusion:The recurrence of instability after a Latarjet graft can be successfully treated by the Eden-Hybbinette technique under arthroscopy. Endobutton fixation is reliable and optimizes the position and consolidation of the bone graft. In addition, this fixation method is an appropriate option in case of broken hardware left in place.

Morphometric study of glenoid cavity of scapulae in north Indian population with clinical significance

Introduction: Shoulder arthroplasty offers pain relief and improvement in patients of shoulder arthritis. It need proper fixation of glenoid cavity to prevent loosening, a common cause for surgery. As glenoid cavity is small, it permits only a tight spot for limited fixation devices. So, knowledge of the morphological data of various parameters of glenoid cavity is of utter importance. Materials and Methods: An observational cross-Sectional study was done on 66 unpaired human scapulae. They belong to adult population of North India and of unknown sex. Superior-inferior diameter and Anterior-posterior diameter of maximum distance at the glenoid cavity were measured and based on these measurements index of glenoid cavity calculated. Result and Discussion: The shape of the glenoid cavity was classified on basis of the presence or absence of a notch on the glenoid rim as pear shaped, inverted comma shaped and oval shaped. All the parameters exhibit a greater value for the right side. The ethnic and racial variations could be the explanation for difference seen between the values of present study and that of other workers. The above mentioned parameters may be taken into consideration while doing shoulder arthroplasty and designing glenoid prostheses for North Indian population. Conclusion: Extensive and detail knowledge of various data of the glenoid cavity measurements is important for the anatomists, orthopaedicians, prosthetists, and anthropologists. Keywords: Glenoid cavity, Glenoid notch, Shape of Glenoid cavity, Glenoid prostheses, Shoulder arthroplasty.

Relationship between the Thickness of the Coracoid Process and Latarjet Graft Positioning-An Anatomical Study on 70 Embalmed Scapulae.

Background: The Latarjet procedure is a popular technique with the aim of the reconstruction of glenoid cavity bone defects in patients with chronic anterior shoulder instability. Studies have shown that the Congruent arc Latarjet procedure is better able to reconstruct larger defects than the Classic Latarjet, but there is a lack of information on the limitations of both methods. Methods: The dimensions of the glenoid width and the native coracoid process of two groups with 35 Formol-Carbol embalmed scapulae each were measured using a digital caliper. The relationship between the coracoid graft and the anterior-posterior diameter of the glenoid cavity was calculated to determine the maximum defect size of the glenoid cavity width, which can be treated by both Latarjet techniques. Results: The average restorable defect size of the anterior segment of the glenoid cavity was 28.4% ± 4.6% (range 19.2%–38.8%) in the Classic Latarjet group, and 45.6% ± 5.2% (range 35.7%–57.1%) in the Congruent arc Latarjet group. Based on our results, the feasibility of the Classic Latarjet procedure to reconstitute the anatomical width of the glenoid cavity was 86% in a 25% bone loss scenario, and only 40% in a 30% bone loss scenario. Conclusion: Based on our results we are unable to define a clear threshold for the optimal Latarjet graft position. In glenoid cavity defects <20%, the Classic Latarjet technique usually provides enough bone stock for anatomical reconstruction. Defects ≥35% of the glenoid cavity width should only be treated with a coracoid graft in the Congruent arc position. In the critical area between 20% and 35% of bone loss, we suggest the preoperative assessment of coracoid dimensions, based on which the graft position can be planned to restore the anatomical anterior-posterior diameter of the glenoid cavity.

Arthroscopic simplified double-pulley double row suture technique to fix the bigger glenoid anterior edge fracture

Objective To investigate the clinical results of arthroscopic double-pulley double row suture technique for the treatment of bigger Ideberg Ia glenoid fracture. Methods From January 2014 to July 2017, data of patients with Ideberg Ia glenoid fracture who were treated by arthroscopic double-pulley double row suture technique were retrospectively analyzed. Totally 24 patients were enrolled of whom 13 were males and 11 were females. The mean age was 50.14±10.60 years (range, 34-67). In those patients, there were 8 cases of glenoid fracture alone, 4 cases of glenoid fracture associated with greater tuberosity fracture, 5 cases of glenoid fracture with rotator cuff tear, 4 cases of glenoid fracture with shoulder anterior dislocation and greater tuberosity fracture, 2 cases of glenoid fracture with shoulder anterior dislocation and rotator cuff tear, and 1 case of shoulder anterior dislocation with ipsilateral distal radius fracture. The fragment accounts for 28.91±5.35% (range, 25.1%-38.5%) of the glenoid articular surface. According to the size of the fragment, one medial row anchor was used to implant at the medial edge of the fracture bed of the anterior edge of the glenoid; two to four lateral row suture anchors were used to implant at the margin of the glenoid joint surface sequentially from low level to higher level, and simplified double-pulley technique was finally used to fix the fragment. The situation of fracture reduction and healing and the post-operative complications were evaluated. The Constant-Murley, DASH and VAS were also recorded. Results Satisfactory fracture reduction and fixation were achieved in all 24 patients. The mean follow-up time was 19.5 months (range, 12-36). Mean VAS was 0.8±0.8 (range, 0-2). The range of motion at the latest follow-up was: anterior flexion 145°-180° (mean, 161.00°±5.77°), external rotation at the side 35°-60° (mean, 46.43°±6.63°), internal rotation L3-T10 level. The mean Constant-Murley score was 88.1±3.7 (range, 81-93), and mean DASH score was 8.4±4.7 (range, 0-40.4). All cases except one showed no dislocation or disability of the shoulder. The CT scans showed: 19 cases of which the step-off of articular surface was less than 2 mm; 4 cases of which the step-off was between 2 mm to 4 mm and 1 case of which the step-off was more than 4 mm. No severe osteoarthritis was identified at the latest follow-up, and only 1 patient at the age of 67 showed slight osteoarthritis. Two patients with shoulder anterior dislocation and rotator cuff tear committed significant restricted shoulder range of motion. Conclusion The arthroscopic simplified double-pulley double row suture technique was identified safe, effective and reliable for treating the bigger Ideberg Ia glenoid fracture. The technique is able to provide clear visulization of the fracture and achieve excellent clinical results. Key words: Shoulder fractures; Arthroscopy; Suture anchors

Definition and clinical progress of critical shoulder angle

Rotator cuff disease and degenerative osteoarthritis are caused by many factors. Several studies had shown that rotator cuff disease was related to lateral extension of the acromion and glenoid inclination. A new parameter, critical shoulder angle (CSA), which is defined as the angle between a line connecting the superior to the inferior margins of the glenoid and a line connecting the inferior margin of the glenoid to the inferolateral edge of the acromion measured on anteroposterior (AP) shoulder radiographs, is proposed to comprehensively reflect the relationship between abnormal anatomical structure and rotator cuff injury. There is a close relationship between CSA and the injury of rotator cuff and the osteoarthritis of glenohumeral joint: the injury of rotator cuff is often accompanied by a larger CSA (> 35 °), and a smaller CSA (< 30 °) is closely related to the occurrence of glenohumeral arthritis. Therefore, CSA is helpful for the diagnosis of rotator cuff injury and glenohumeral osteoarthritis. Correction of abnormal CSA by arthroscopic lateral acromial osteotomy also provides a new idea for the treatment of shoulder diseases. In this paper, we reviewed the research progress of the angle from five aspects: definition, measurement, biomechanical significance, treatment and ethnic differences.

Treatment strategy of traumatic posterior dislocation of shoulder joint with concomitant reverse Hill-Sachs lesion of the humeral head

Objective To explore the treatment strategy for traumatic posterior dislocation of shoulder joint with concomitant reverse Hill-Sachs lesion on the humeral head. Methods Data of 8 consecutive traumatic posterior shoulder dislocations with concomitant compression on anteromedial portion of the affected humeral heads (reverse Hill-Sachs lesion), which resulted from the collision between the posterior rim of the glenoid and anterior portion of the humeral head, who had undergone treatment in our department since July 2015 to June 2018 were retrospectively analyzed. Seven males and 1 female have been included in the case series, with the age between 30-70 years (mean 44.5±12.3 years), 6 on the right shoulder and 2 on the left. 7 were acute injuries and 1 chronic. One patient received closed reduction under brachial plexus block anesthesia, and the rest cases underwent open surgeries. Modified Judet approach was performed in one case due to the concomitant fracture on the postero-inferior glenoid. The other 6 patients received modified delto-pectoral approach. 4 concomitant rotator cuffswere found during the procedures, including1 full thickness tears 3 partial. One patient received McLaughlin surgery, allograft and anchor suture fixation. 2 underwent cannulated screw fixation. Allograft and PHILOS fixation was placed on 4 cases. All 8 patients were required maintaining in mild abduction and external rotation the affected arms, with the protection of the casts. All patients were followed up for 20.6±8.4 months (range, 9-36 months). Constant-Murley scores and visual analogue score (VAS) were used to evaluate the clinical outcomes at the latest follow-up. Results Infection occurred in 1 case, the humeral head has been resected subsequently and antibiotic cement spacer was inserted for further arthroplasty. Necrosis of the humeral head has been observed in one CT follow up 9 months after surgery, with no limitation of the range of motion of the shoulder. Stage 1 wound closure and bony union were witnessed on the rest 6 patients. No neuromuscular injures or re-dislocations on the affected shoulders was found. The range of motion of the affected shoulder has been recorded at the latest follow-up: 123.8°±30.1° (90°-180°) in flexion, 124.4°±34.2° (80°-180°) in abduction, 36.9°±20.9° (0°-70°) in external (neutral position), 58.8°±10.9° (50°-80°) in internal rotation (neutral position) and 83.5±12.1 (70-95) in Constant-Murley score. Among the 8 patients, 7 patients were at the rank of VAS 0-3, and 1 of 4-6. Conclusion Optimal treatment options should be chosen based on the humeral head defect status, in case of traumatic posterior shoulder dislocation with concomitant reverse Hill-Sachs lesion. Closed reduction can be tried on < 20% humeral head defect with the help of anesthesia, and surgical option is the optimal one for the defect between 20%-40%. Key words: Shoulder joint; Shoulder dislocation; Wounds and injuries

Arthroscopic autologous scapular spine bone graft transplant for shoulder recurrent instability

Objective To investigate the clinical outcomes and radiological results of arthroscopic autologous scapular spine bone graft transplant to treat shoulder recurrent instability. Methods Data of 27 patients diagnosed as shoulder recurrent instability with the bone defect of 10%-15% from July 2016 to August 2018 who were treated by arthroscopic autologous scapular spine bone graft transplant were retrospectively analyzed. There were 20 males and 7 females with an average age of 30.8 years old (range, 19-50). The bone loss of the glenoid was 10%-15%. The time between the first dislocation and the surgery was 24.1±15.8 months. The patients were treated with arthroscopic autologous scapular spine bone graft transplant. Postoperatively the affected shoulder was immobilized by the abduction brace for 6 weeks, after that the passive motion was applied. Strengthening exercise began at 10-12 weeks and sports was allowed after 6 months. Constant-Murley score and the Disabilities of Arm, Shoulder and Hand (DASH) score were used to evaluate the shoulder function, and visual analogue score (VAS) score was used to evaluate the degree of pain. Computed tomography scans were obtained one week post-operation and at the latest follow-up, from which the length, width, height and volume of the bone graft were measured and the absorption rate of the bone graft was calculated. The subjective satisfaction degree of patients at the latest follow-up was also recorded. Results All 27 patients were followed up for 19.8 months (range, 13-39 months). No infection or neurovascular injury was identified. At the latest follow-up, the Constant-Murley score was 85.15±5.62 (range, 76-94), the DASH score 13.39±5.51 (range, 3.19-21.95) and the VAS score 1.29±0.45 (range, 1-2), thus all of those were improved significantly compared to those of pre-operation. At the latest follow-up, the anterior flexion was 153°±24°, lateral rotation by side 38°±21°, internal rotation 70°±21°, and abduction was 139°±18°. At the latest follow-up, the absorption rate of the bone graft was 46.1%±20.6% (range, 24.0%-71.7%). Among all the 27 patients, 19 patients considered the outcome as very good, and 6 patients considered as good, 2 patients fair. Conclusion Arthroscopic autologous scapular spine bone graft transplant could successfully treat shoulder recurrent instability with glenoid bone loss at 10%-15%. This technique could achieve satisfactory clinical results, improve glenohumeral stability, decrease the re-dislocation rate. Key words: Shoulder joint; Shoulder dislocation; Arthroscopy; Transplantation, autologous

BARE SPOT LOCATION IN GLENOID CAVITY: COMPARISON BETWEEN ARTHROSCOPY AND CT SCAN.

ABSTRACTObjective: To assess whether Bare Spot is previously displaced by proportion (MEASURE BP-A × 1.25/MEASURE BP-P = 1). Methods: 35 patients with surgical indication for rotator cuff injury repair were evaluated. The distances from the Bare Spot to the anterior edge of the glenoid cavity (BS-A) and to the posterior edge (BS-P) were measured by arthroscopy and computed tomography with three-dimensional reconstruction of the scapula. Results: The distance from the Bare Spot to the anterior border (BS-A tc) was 11.6 mm with a median 12 mm; The distance to the posterior border (BS-P tc) was on average 15.5 mm with a median 15 mm. The distances from BS to anterior cavity edge measured by arthroscopy were on average (BS-A video) 12.25 mm with a median of 12 mm, and from BS to posterior edge (BS-P video) 16.25 mm on average with median 16 mm (p < 0.005). Conclusion: Bare Spot is displaced anteriorly at a proportion of 40% of the anterior margin and 60% of the posterior margin. Level of Evidence II - Development of diagnostic criteria on consecutive patients (with universally applied reference “gold standard”).

MORPHOLOGY AND MORPHOMETRY OF SCAPULAE IN TERTIARY CARE HOSPITAL IN K.M. MEDICAL COLLEGE AND HOSPITAL, MATHURA (UP).

Introduction: The shoulder joint is the most important joint in the body and limitation of this joint movements affects the quality of life. Severe shoulder injury and glenohumeral arthritis causes shoulder dysfunction with devasting results, and to restore normal functions orthopaedic surgeon can perform total shoulder arthroplasty, or reverse shoulder prosthesis, or hemiarthroplasty.Lateral angle of the scapula becomes truncated and broadened and bears the glenoid cavity which articulates with the humerus in the shoulder joint. Shoulder joint is formed when the glenoid cavity is connected with the head of the humerus. This study was carried out to study the morphology and morphometry of the glenoid cavity as dimensions of the glenoid cavity are important in designing and fitting of glenoid components for total shoulder arthroplasty.&#x0D; Material and Methods: A total of 100 unpaired dry scapula were isolated from the department of Anatomy. Two groups were made according to the side of the scapula and were equally divided into 50 right and 50 left scapula each. Bones were segregated and inspected individually.To classifying shape of the glenoid fossa, presence or absence of a glenoid notch was used and were classified into 3 types, pear shaped or inverted comma shape in presence of a glenoid notch &amp; oval in absence of notch. The pear shaped shows indistinct glenoid notch and the inverted comma shaped shows a distinct notch.&#x0D; Results: On the basis of presence or absence of the glenoid notch. 56%, 28% &amp; 16% glenoid cavities of right side were pear shaped, inverted comma shaped and oval shaped respectively. On the left side 60%, 30% &amp; 10%were pear shaped, inverted comma shaped and oval shaped respectively. In total 58% glenoid cavities were pear shaped, 29% were inverted comma shaped and 13% were oval shaped.Average length and breadth of scapulae included in this study was 134.07±13.87 mm and 98.43 ±9.58 mm respectively.Mean glenoid cavity index of right side was 48.12 to 86.87 %, while in left side it was 44.21 – 84.78%.&#x0D; Conclusion: The most common glenoid cavity was pear shaped followed by inverted comma shaped and the oval glenoid cavity. Mean glenoid cavity index of right side was 48.12 to 86.87 %, while in left side it was 44.21 – 84.78%.

First record of Kawanectes lafquenianum (Plesiosauria, Elasmosauridae) from the La Colonia Formation of Argentina, with comments on the mandibular morphology of elasmosaurids

O’Gorman, J.P. 27 November 2019. First record of Kawanectes lafquenianum (Plesiosauria, Elasmosauridae) from the La Colonia Formation of Argentina, with comments on the mandibular morphology of elasmosaurids. Alcheringa 44, 176–193. ISSN 0311-5518 The elasmosaurid plesiosaur Kawanectes lafquenianum is recorded from the upper Campanian–Maastrichtian levels of the La Colonia Formation in Argentina for the first time, thus extending the stratigraphical range of this taxon, which was previously recorded only from the geographically proximal Allen Formation. The new fossils are referrable to K. lafquenianum on the basis of the large posterodistal projection on the humerus supporting an articular facet for a proximal supernumerary ossification, the presence of a depression anterior to the main muscle scar on ventral surface of the humeral shaft, and a high humerus/femur length ratio (∼1.2). Novel diagnostic character states for K. lafquenianum include the presence of a high triangular and distally pointed coronoid process on the mandible, a mandibular symphysis that incorporates 2.5 alveolar spaces on each ramus, and a retroarticular process without dorsal or medial inflexion. Relatively low b/a ratio (measure of coronoid–glenoid cavity length/preglenoid length) could suggest a mechanical advantage toward fast jaw closure and weak bite forces. Comparisons with other elamosaurids this imply that Southern Hemisphere weddellonectian taxa, such as K. lafquenianum, Aristonectes parvidens and Kaiwhekea katiki, were possibly adapted for rapid snapping bites. José Patricio O’Gorman [joseogorman@fcnym.unlp.edu.ar], División Paleontología Vertebrados, Museo de La Plata, Universidad Nacional de La Plata, Paseo del Bosque s/n., B1900FWA, La Plata, Argentina, CONICET (Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina), Buenos Aires, Argentina.

Morphometric analysis and clinical significance of scapula

Amaç: Bu çalışmanın amacı, omuz sentürünün önemli bir elemanı olan kuru kemik os scapula’nın morfometrik ve anatomik ölçümlerinin elde edilmesi ve toplumlar arası karşılaştırılmasıdır. Gereç ve Yöntem: Çalışmaya yaşı ve cinsiyeti belirsiz, toplam altmış dokuz (69) adet kuru kemik scapula dahil edildi. Ölçüm parametreleri; Scapula Maksimum Uzunluğu (SU), Scapula Maksimum Genişliği (SG), Spina Scapulae Uzunluğu (SSU), Cavitas Glenoidalis Superior Inferior Genişlik (CGSIG), Cavitas Glenoidalis Antero Posterior Genişlik (CGAPG), Medial Kenar Uzunluğu Supraspinata (MKUS), Medial Kenar Uzunluğu Infraspinata (MKUI), Lateral Kenar Uzunluğu (LKU), Acromion-Cavitas Glenoidalis Arası Mesafe (ACGM) ve Cavitas Glenoidalis-Processus Coracoideus Arası Mesafe (CGPCM)’dir. Ayrıca scapular indeks, glenoid indeks ve infraspinat indeks hesaplanmıştır. Bulgular: Altmış dokuz (69) adet kuru kemik scapula’dan 31 adet sağ, 38 adet sol taraf olarak bulunmuştur. Scapula’ya ait ölçüm parametreleri ve ortalamaları aşağıdaki gibidir: Scapula Maksimum Uzunluğu; 14,08±1,25 cm, Scapula Maksimum Genişliği; 9,85±0,80 cm, Spina Scapulae Uzunluğu; 8,19±0,87 cm, Cavitas Glenoidalis Superior Inferior Genişlik; 3,68±0,36 cm, Cavitas Glenoidalis Antero Posterior Genişlik; 2,51±0,27 cm, Medial Kenar Uzunluğu Supraspinata; 4,68±0,44 cm, Medial Kenar Uzunluğu Infraspinata; 10,71±1,11 cm, Lateral Kenar Uzunluğu; 12,25±1,15 cm, Acromion - Cavitas Glenoidalis Arası Mesafe; 2,63±0,42 cm ve Cavitas Glenoidalis - Processus Coracoideus Arası Mesafe 2,00±0,28 cm’dir. Sonuç: Scapula anatomisinin bilinmesi ve morfometrik ölçümlerinin elde edilmesi scapula’yı ilgilendiren patolojiler ve cerrahi girişimler açısından öneme sahiptir.

Geometric morphometrics of large South American camelids and their potential for the taxonomical identification in archaeological sites of the northern Argentina

ABSTRACT The large South American camelids, the llama (Lama glama) and the guanaco (Lama guanicoe), present a low level of morphological variation in the skeleton and a significant overlap in their body size at population scale. Therefore, if we consider the inter-specific and intra-specific variability, it is difficult to distinguish between wild (guanaco) and domestic (llama) species, based only on osteometric analysis of remains from archaeological sites. Techniques based on 2D geometric morphometric were applied in order to test their power for the taxonomic identification of these two camelids species through shape study of three anatomic elements: the first anterior and posterior phalanges, and the glenoid fossa of scapula. A total of 59 skeletal elements of 29 modern individuals and 14 archaeological specimens were analysed. The morphogeometric evaluation differentiated the skeletal element shapes of modern camelids groups. The archaeological samples revealed the presence of llama and guanaco in the archaeological record of the Argentinean Northwest at 1900–1300 BP. Nevertheless, domestic species were dominant in Antumpa site, whereas wild species were better represented in Condor II. This exploratory study provided an advance in the efforts of taxonomic identification of bone remains from the shape analysis performed on modern individuals of living species.

PENGARUH VARIASI ROTASI TUBUH TERHADAP INFORMASI ANATOMI PADA PEMERIKSAAN RADIOGRAFI SHOULDER JOINT METODE SCAPULAR Y VIEW

Background: Shoulder joint examination of the scapular Y method in one hospital uses a body rotation of 35 0 – 45 0 whereas in theory the position of the patient's body is rotated so mid coronal plane (MCP) forms an angle of 45 0 – 60 0 to the image receptor (IR). Therefore it is necessary to conduct research to obtain optimal anatomy information of shoulder joint. The purpose of this research is to know the information of shoulder joint anatomy and to know the optimal body rotation in showing the anatomy information of shoulder joint. Methods: The type of research is experimental research with descriptive approach. Methods of data collection conducted by experiment and observation. This research conducted with phantom thorax which was exposed six times, same exposure factor and the variation body rotation 35 0 , 40 0 , 45 0 , 50 0 , 55 0 , 60 0 and complete questioner. The questionnaire was completed by three radiologists. Scoring results of the respondents are processed and presented in the tables and graphs to be described and analyzed. Results: The results examination shoulder joint with scapular Y method is a different assessment variation on each shoulder joint anatomy information, distortion on the radiographs, and the optimal rotation of the body is a rotation of 55 0 to IR. This refers theory from Frank, Long, and Smith (2012) that the clinical indication of suspected dislocation shoulder joint scapular Y method uses the patient standing upright and the position of the body object is rotated so that the MCP of the body forms an angle of 45 0 -60 0 to IR. Conclusion: The radiographic technique of the AP projection pedis with a variation of 35 0 , 40 0 , 45 0 , 50 0 , 55 0 , 60 0 produces different anatomical information. There are distortions and differences in anatomical information which includes the location of the coracoid process under the clavicula, humeral head superposition with glenoid cavity, body of scapula free from ribs, acromion projected laterally and not superposition, medial border scapula superposition with lateral border scapula. The greater the body's rotation towards IR, the greater the distortion that occurs. The optimal angle in generating anatomical information on the scapular “Y” view method examination is 50 o that very useful to evaluate dislocation of shoulder joint.

Surgical correction of unilateral ankylosis of the temporomandibular joint; Case report

The unilateral ankylosis of the temporomandibular joint corresponds to a temporomandibular disorder classified within the chronic mandibular hypomobility. The objective of the present clinical case, to provide a clinical and diagnostic guide on this pathology, for the dental community, providing a new alternative so that this anomaly can be corrected and hand improve the quality of life of our patient, with a treatment One hundred percent scientific, professional and guaranteed. The literature defines ankylosis as an abnormal immobility of the jaw, disorder that leads to a restriction of the buccal opening with partial reduction of mandibular movements or a complete immobility of the jaw. We present a case of unilateral temporomandibular ankylosis (left) in a 14-year-old boy, who treated with ankylosing block resection, after mandibular fracture in order to elongate the soft tissues and maintain space in the new glenoid cavity to avoid re-ankylosis and favor the remodeling of the condyle.

An anatomical study on various types of suprascapular notch, its relation with glenoid cavity and morphometry of scapula in south Indian population

Introduction: Superior border of scapula presents a suprascapular notch. Suprascapular nerve entrapment syndrome may be caused due to compression of the nerve at the notch. Previous studies have shown that there are various types of suprascapular notch and clinicians must be aware of these types and their prevalence. Aim: This study was conducted with the following objectives, a: To know the morphometry and morphological variations of suprascapular notch; b: To measure the safe zone distance necessary to avoid iatrogenic injuries to nerve; c: To correlate the major scapular dimensions with that of suprascapular notch. Materials and Methods: We collected 100 dried human scapulae from department of Anatomy and medical students of AIMS&RC, Devanahalli, Karnataka and Sri Narayana Institute of Medical Sciences, Ernakulam, Kerala. The Suprascapular notch was classified according to Rengachary’s classification. Dimensions of all different class of suprascapular notches, that of scapulae and safe zone distance was measured using digital Vernier calipers. Results: Majority of scapulae had type II SSN (33%) and least common variety found was type IV (4%). Least surface area in type V notch measured was 36.16mm2. Mean safe zone distance between SSN and supraglenoid tubercle (S1) in all 100 scapulae is 30.31+/-3 mm. The mean distance between spinoglenoid notch and posterior rim of glenoid (S2) is 16.82+/-2.19 mm. Mean length of all 100 scapulae is 135.12+/-1 mm. Mean width of scapula is 101.69+/-6.8 mm. Mean length and width of glenoid fossa is 33.83+/- 3.25 mm and 24.2+/-2.34 mm respectively. Conclusion: Ossified superior transverse scapular ligament can compress the nerve causing entrapment syndrome. Since suprascapular notch presents various shapes, this study is an attempt to add further data to the existing studies about suprascapular notch, its morphometry and safe zone distance to avoid injury to nerve during surgery. Keywords: Neuropathy, Scapula, Shoulder join

Custom-made Temporomandibular Joint Prosthesis: Computer Aided Modeling and Finite Elements Analysis

Temporomandibular Joint (TMJ) is a bilateral joint that works to perform the main activities of speaking and chewing. Because of this cyclic loading, TMJ disorders are common and greatly affect the quality of life. For this reason, it becomes necessary to replace the non-functioning joint with a prosthetic device. Since the 1930s, different TMJ implants have been developed to restore the correct functioning of TMJ and improve patient quality of life. TMJ prosthesis is a two-component replacement device composed of a condyle, placed t mandible extremities, and a glenoid fossa, localized in temporal bone and these are fixed to healthy bone by screw. In recent years, thanks to technological advancement, TMJ replacement devices can be developed starting from specific tomographic data of each patient, calling them as custom-made prosthesis. The customization process is a computational process of Computer Aided Modeling (CAM) and Computer Aided Design (CAD). It starts from tomographic data to create a tridimensional model of patient mandible and skull, then, based on computational model, TMJ prosthesis is designed and finally it is fabricated by additive manufacture. Follow-up data available in literature show that the main unresolved problem of TMJ prostheses is a kinematics that is still different from the natural one, resulting in hypomobility of implanted condyle compared to the natural one. In this panorama, this study aims to show TMJ CAM customization process and to evaluate mechanical and kinematic response of a unilateral TMJ custom-made prosthesis through Finite Elements Analysis (FEA) with Ansys software. Bilateral bite to incisors and unilateral bite to molar are simulated and mechanical stress and strain generated are evaluated.

Method of biometric measurement of glenoid cavities: Study scannographic 200 glenoid cavities

Introduction:Evaluating the size and morphology of the glenoid can help customize the prosthetic treatment. But there are few large workforces in studies examining CT scan measures the glenoid. We report an analysis of the dimensions of the glenoid.Materials and Methods: 100 consecutive chests CT performed 15 months including two non-pathological glenoid cavities were analyzed by three operators. There were 54 women and 46 men with a mean age of 64.8 years (20-92). Each glenoid was evaluated in 2D reconstruction, on several sections, on the CARESTREAM software. We made our measurements only on healthy or slightly worn glenoid. The largest vertical axis, the largest horizontal axis, the surface of the glenoid, and the circle tangent to the inferior pole of the glenoid were analyzed. The depth and the bone stock of the glenoid were measured in 9 points of the circle, divided into four quadrants, corresponding to the screw positions of a metaglenoid.Results:For each patient, both glenoid cavities were symmetrical compared to the measured criteria. Measurements on 200 glenoids found themselves: the largest vertical axis reached 38.5 mm (25-51), the largest horizontal axis: 27.9 mm (20-56) and the area circle tangential to the lower pole of the glenoid 624.5mm² diameter (324-983). The analytical study to classify the glenoid cavities by size in 3 families: small (area of the circle = 420mm²), medium (525mm²) and large (685mm²). The average size of the patients was de166.9 (147-192). The dimensions of the glenoid were correlated with the size of the patient for 3 families. The most representative measure of the size of the glenoid was the largest horizontal axis, also corresponding to the diameter of the circle inscribed in the glenoid. We measured the depth of the glenoid at the frequent passage of screws during the placement of glenoid implants. Above 10.7 mm, there is an increased risk of suprascapular nerve injury in the posterosuperior dial of the circle inscribed in the glenoid.We compared intra and inter individual measures between the 3 operators. The measurement method is reliable and reproducible with an average difference of 2.7 mm over all the measurements compared.Discussion:These results are similar to those already present in the literature. The large number of patients included in this cohort associated with the reliability and reproducibility of the measurements allow us to adapt this method to the preoperative planning of the placement of glenoid implants in prostheses. The main limitation remains the two-dimensional character of our study.

Ultrasonic evaluation of the effect of cartilage acetabular, glenoid labrum and acetabular tissue on closed reduction of developmental dysplasia of hip

Objective To investigate the effect of cartilage acetabular, glenoid labrum and acetabular tissue on closed reduction of developmental dysplasia of hip (DDH) by analyzing the outcomes of the ultrasound measurement on DDH before and after Pavik Harness treatment. Methods Graf method was used in ultrasound measurement before the treatment. Position of cartilaginous acetabulum and glenoid labrum and displacement direction of femoral head in 31 patients with hip dislocations (type D, type Ⅲ, type Ⅳ, 36 hips) were recorded. The follow-up testing with ultrasound measurement on the inside of the hip were performed after 1-2 weeks of Pavik Harness treatment. Mediolateral dimension, anteroposterior dimension and the area of maximum section of acetabular tissue were measured. Reduction effects were evaluated. Results The success rate of reduction of dislocation hips with cartilaginous acetabulum on the head orientation was obviously higher than that on the foot orientation(P<0.000 1). The success rate of reduction of dislocation hips with glenoid labrum on the head orientation was obviously higher than that on the foot orientation(P=0.001 6). There was a statistically significant difference in the success rate of different types of hip dislocation (type D, type Ⅲ, type Ⅳ) (P=0.002 7). There were statistically significant differences in mediolateral dimension, anteroposterior dimension and the area of maximum section of acetabular tissue between the reduction group and the group without dislocation, the irreducible group and the group without dislocation, the irreducible group and the reduction group (P<0.01). Conclusions Ultrasonography is of great significance in the diagnosis and treatment of children with DDH. The position of hip cartilaginous acetabulum and glenoid labrum, types of hip dislocation and the volume of acetabular tissue have important effects on the success of the closed reduction. Key words: Ultrasonography; Hip dislacation; Acetabulum; Closed reduction; Glenoid labrum; Acetabular tissue