Medial End Research Articles

Non traumatic pathological sternoclavicular joint dislocation an unexplored complication of clavicle osteomyelitis-a case report

Non-traumatic pathological sternoclavicular joint dislocation due to medial end of clavicle osteomyelitis is extremely rare. This kind of rare complication should be anticipated while encountering these kinds of cases. A sixty-three-year-old male came with pain and swelling over the left neck and was diagnosed to have left clavicle osteomyelitis. The unexplored complication of sternoclavicular joint dislocation and successful management of such complications has been discussed in this case report. To best of our knowledge this is the first case report of a non-traumatic pathological sternoclavicular joint dislocation due to clavicle osteomyelitis. This case report will supplement the inadequate literature in management of such cases.

Minimally invasive plate osteosynthesis for clavicle fractures.

Treatment of comminuted clavicle shaft fractures with minimally invasive plate osteosynthesis (MIPO). Multifragmentary (≥ 2 intermediate fragments) clavicle shaft fractures with no need for anatomical reduction (AO15.2B and15.2C). Even simple fractures (AO15.2A) with significant soft tissue injuries Tscherne gradeI-III are suitable. Medial or lateral clavicle fractures as well as simple fracture pattern where anatomical reduction is indispensable. Short incision over the medial and lateral end of the main fracture fragments. Either medial or lateral epiperosteal plate insertion. Under image intensifier guidance, the plate is centered either superior or anteroinferior on the clavicle and fixed with acompression wire temporarily (alternatively by acortical screw) in one of the most lateral holes. Fracture reduction (axis, length, and rotation) over the plate and preliminary fixation medially. After correct reduction has been achieved, further cortical screws and/or locking head screws can be inserted (lag before locking screws). Relative stability is achieved by applying abridging technique. No immobilization is needed. Patients are encouraged to perform functional rehabilitation with active and passive physical therapy. Loading is increased according to radiological signs of bony consolidation. In aretrospective evaluation from 2001-2021, 1128 clavicle osteosyntheses were performed, of which 908 (80.5%) were treated with plate osteosynthesis and 220 (19.5%) with titanium elastic nail (TEN). Of the 908 plate osteosyntheses, 43 (4.7%) were performed with the MIPO approach. Finally, 42patients (35men and 7women; mean age of 44 ± 15years) with 43clavicle shaft fractures were analyzed. The operation was accomplished in 63 ± 28 min, and average fluoroscopy time was 45 ± 42 s. Acollective of 27patients could be evaluated after amedian follow-up of 14months (range 1-51months). In all, 26fractures healed in atimely manner. In1patient apseudarthrosis occurred which was treated with re-osteosynthesis and cancellous bone grafting in an open technique. Another patient revealed awound complication with need of operative wound revision 6weeks after the index surgery. Further postoperative course was uneventful in both patients. All were pain-free and able to return to work. After an average of 17 ± 8months, 18hardware removals (66.7%) were performed.

OUR EXPERIENCE WITH PEC MAJOR FLAP FOR STERNOCLAVICULAR JOINT INFECTIONS

Sternoclavicular joint infections are uncommon but severe and complex condition usually in medically complex and compromised hosts. These infections are challenging to treat with risks of infection extending into the mediastinal structures and surgical drainage is often faced with problems of multiple unplanned returns to theatre, chronic non-healing wounds that turn into sinus and the risk of significant clinical escalation and death. Percutaneous aspirations or small incision drainage often provide inadequate drainage and failed control of infection, while open drainage and washout require multidisciplinary support, due to the close proximity of the mediastinal structures and the great vessels as well as failure to heal the wounds and creation of chronic wound or sinus.We present our series of 8 cases over 6 years where we used the plan of open debridement of the Sternoclavicular joint with medial end of clavicle excision to allow adequate drainage. The surgical incision was not closed primarily, and a suction vacuum dressing was applied until the infection was contained on clinical and laboratory parameters. After the infection was deemed contained, the surgical incision was closed by local muscle flap by transferring the medial upper sternal head of the Pectoralis Major muscle to fill in the sternoclavicular joint defect. This technique provided a consistent and reliable way to overcome the infection and have the wound definitively closed that required no secondary procedures after the flap surgery and no recurrence of infections so far.We suggest that open and adequate drainage of Sternoclavicular joint staged with vacuum dressing followed by pectoralis major local flap is a reliable technique for achieving control of infection and wound closure for these challenging infections.

Computed tomography findings of thyroid hemiagenesis: differentiation from hemithyroidectomy

ObjectivesThyroid hemiagenesis is a rare congenital anomaly characterized by the lack of development of one thyroid lobe. The purpose of this study was to evaluate computed tomography (CT) findings of thyroid hemiagenesis and to establish useful CT criteria for differentiating thyroid hemiagenesis from the hemithyroidectomy state.MethodsThe CT images of 11 patients with thyroid hemiagenesis were retrospectively reviewed and compared with those of 100 (49 left and 51 right) patients in a hemithyroidectomy state. Image analysis was performed according to the following CT parameters: (a) side of thyroid hemiagenesis, (b) edge of the medial end of the remnant thyroid gland, (c) location of the medial end of the remnant thyroid gland, expressed as the angle of the medial end and (d) any other thyroid abnormality observed during the initial examination.ResultsThe missing lobe occurred more often in the left than in the right lobe (72.7% vs. 27.3%) as well as concomitant isthmus agenesis (100% vs. 37.5%). The sharp edge of the medial end of the remnant thyroid gland was more common in thyroid hemiagenesis (64%) than in hemithyroidectomy (26%) (P = 0.0153). In left thyroid hemiagenesis, the angle of the medial end (63%) was more frequently > + 30° than in hemithyroidectomy (0%) (P < 0.0001). Two patients presented with hypothyroidism; the remaining nine showed a normal thyroid function. The associated thyroid diseases were autoimmune thyroiditis (n = 1) and papillary thyroid carcinoma (n = 1).ConclusionsThe sharp edge of the medial end of the remnant thyroid gland and an angle of > + 30° for the medial end in cases wherein the left lobe is absent are useful CT features for distinguishing thyroid hemiagenesis from hemithyroidectomy.

Clinical Outcome after Clavicular Hook Plate Fixation for Displaced Medial-End Clavicle Fractures.

Surgery of the medial end of the clavicle remains a challenge for orthopedic surgeons. Moreover, there is no standard surgical procedure for treating displaced fractures or dislocation of the medial clavicle. Thus, the present study aimed to evaluate the safety and efficacy of using a hook plate for treating medial-end clavicular fractures and present functional outcomes. We retrospectively investigated 18 patients who underwent surgery with a hook plate from July 2016 to December 2021. There were 14 men and 4 women with a mean age of 57.4 years. Fracture union was assessed at follow-up by computed tomography (CT). Other outcome parameters were complications, including implant failure, infection, nonunion, osteolysis of sternal manubrium, and migration of the hook portion. Range of motion (ROM), visual analog scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH), and American Shoulder and Elbow Society (ASES) scores were evaluated 6 months postoperatively and at the last follow-up. The mean operation time was 43.8 minutes (range, 35-50 minutes) and the mean follow-up was 22.8 months (range, 12-42 months). Bone union was confirmed in all cases. The mean union time was 6.2 months (range, 6-7 months). Implant removal was performed routinely according to the clinical course in 17 cases. The mean implant removal time was 10.0 months (range, 6-14 months). Clinical and functional outcomes measured at the last follow-up were significantly improved compared to those at 6 months postoperatively (p < 0.05). Regarding complications, there were 6 cases (33.3%) of osteolysis of the sternal manubrium. Although the anteroposterior length of the manubrium and hook depth showed significant differences between the non-osteolysis group and the osteolysis group (p = 0.024), ROM, VAS, Quick DASH, and ASES scores were not significantly different between the two groups (all p > 0.05). Clavicle hook plating can be a safe and effective method that can be easily applied with good outcomes if it is used with appropriate surgical planning and technique for medial-end clavicle fracture. CT scans are useful for preoperative planning and postoperative evaluation of bone union or complications.

Open Reduction and Internal Fixation of Medial End of Clavicle Fracture Across Bilateral Sternoclavicular Joints

Open Reduction and Internal Fixation of Medial End of Clavicle Fracture Across Bilateral Sternoclavicular Joints

Malignant Lesion of Clavicle

Abstract This case is reported to increase the awareness among clinicians about the malignant lesions of the clavicle. Plasmacytoma is a rare tumor occurring in the clavicle. Here, we report a 55-year-old female who presented with swelling in her left clavicle for 2 months associated with no pain. On examination, diffuse swelling was noted over the medial end of clavicle, nontender, hard in consistency, and ill-defined margin. Radiograph of the left clavicle showed an expansile lytic lesion. Ultrasonography neck revealed an expansile lesion in the medial end of the left clavicle with matted lymph nodes. Fine-needle aspiration cytology from clavicular lump showed plasma cell in hemorrhagic background. Excision biopsy of the lesion showed sheaths of plasma cells with eccentric placed nuclei confirming the diagnosis of plasmacytoma of clavicle. Plasmacytoma of the clavicle is a rare entity; there is a need for physicians to recognize the epidemiology and radiological findings and offer the suitable treatment options.

Estimation of Sex by Applying Discriminant Function Analysis on Osteo-metric Parameters of Clavicle in Population of Haryana

It is important to pinpoint the identity of the deceased in scenarios such as decomposed bodies, skeletonized remains, mutilated remains, exhumed dead bodies, and in mass disasters. There are many important parameters to establish the identity of a person. The estimation of sex is one of them. Estimation of sex from bones is easy when the whole skeleton is available, but it becomes difficult when the body is mutilated and only parts of the body or bones are available. The present study is undertaken to estimate the sex by applying discriminant function analysis (DFA) on various osteo-metric parameters of the clavicle in the population of Haryana. Two hundred pairs of clavicles were collected from the bodies brought for autopsy. They were macerated and air dried for the removal of soft tissues. Seven variables of clavicle of both sexes were measured and analyzed using the analysis of variance test which provided descriptive statistics. DFA of the values helped in sexing of the clavicle. Estimation of sex from different parameters of the clavicle was possible with overall accuracy of 93% in original and 92.5% in crossvalidated cases among total cases. Accuracy was 96% and 90% in original and 96% and 89% in cross validated cases among males and females respectively, indicating a strong correlation in estimation of sex of a person from the clavicle. The most important parameters to determine the sex from the clavicle are length of clavicle, mid clavicular circumference of clavicle, weight of clavicle, transverse diameter of lateral end of right clavicle, and longitudinal diameter of medial end of the left clavicle.

Congenital Torticollis : Surgical Approach and Outcome

Introduction. Torticollis, also known as crooked neck, is a contraction or contracture of the neck muscles that causes the head to tilt to one side. This is accompanied by rotation of the chin to the opposite side with flexion. The congenital form of torticollis usually appears within a few weeks of birth. The basis of diagnosis is clinical examination findings, and the mainstay of treatment is physical therapy. Surgical management is an option only when medical and physical treatments are not producing the desired results or for cosmetic reasons. Case Report. A-11 year young girl came with a chief complaints of a tilted head to the right, she also had difficulty shaking her head and nodding and had an asymmetrical face. This has been experienced since birth. Result. The patient underwent bipolar removal of the lower end of the sternocleidomastoideus muscle (SCM). The patient’s neck was extended with a sandbag, and then the patient’s head was turned toward the shoulder on the opposite, uninvolved side. First, the distal portion of the SCM was released by making a skin incision 3 to 5 cm long on the medial end of the clavicle, with consideration given to palpable fibrous bands, and then deepening the incision to the tendons of the sternal and clavicular attachments of the SCM. The tight band and muscle tendon were dissected to pass a right angle instrument posterior to the tendons and were then resected by electrocautery near the insertion site to the clavicle. The SCM was then carefully dissected and released near the bone, while checking the nearby nerves and vessels. Outcomes were assessed using the cervicalmandibular angle (CMA), calculated using the radiological head tilt, which was defined as the angle between the line crossing the upper border of the C7 vertebral body and another line connecting the lower border of the mandibular angle. Conclusion. Release of the bipolar CMT in the patient in this study increased head tilt, leading to a better quality of life since surgery, and the patient adapted fairly well to her new neck position.

Forensic age estimation in males by MRI based on the medial epiphysis of the clavicle

Increasing cross-border migration has brought forensic age assessment into focus in recent decades. Forensic age estimation is based on the three pillars: physical and medical constitution, bone age, and tooth age. Part of the bone age examination includes the assessment of the medial end of the clavicles when the hand bones are already fully developed and a minority must be excluded. Recent research has brought MRI to the forefront as a radiation-free alternative for age assessment. However, there exits only a few studies with large sample size regarding the clavicles and with controversies about staging, motion artifacts, and exclusion based on anatomic norm variants. In the current prospective study, 338 central European male individuals between 13 and 24 years of age underwent MRI examination of the sternoclavicular region. Development was assessed by three blinded raters according to the staging system described by Schmeling et al. and Kellinghaus et al. and related to age by descriptive statistics and transition analyses with a cumulative probit model. In addition, reliability calculations were performed. No statistically significant developmental difference was found between the left and right clavicles. Inter-rater agreement was only moderate, but intra-rater agreement, on the other hand, was good. Stage 3c had a minimum age of 19.36 years and appears to be a good indicator of proof of majority. The minimum age of stage 4 was lower compared with other studies, 20.18 years, and therefore seems not to be an indicator of age of 21 years. In conclusion, we confirmed the value of clavicular MRI in the age estimation process. The transition analysis model is a good approach to circumvent the problems of age mimicry and samples that are not fully equilibrated. Given the moderate agreement between raters, a consensus reading is recommended.

Surgical outcomes of canalicular tear repair with self-retaining Mini-Monoka stent in a tertiary care hospital in Kashmir in North India

Background: Canalicular lacerations contribute to approximately 16% of the eye lid injuries. The torn medial end is to be identified, cut end sutured, and then the canaliculus intubated to restore patency. Silicone being inert, flexible, easily available, and cost effective is the material of choice for lacrimal stenting. Aims and Objectives: The aim of this study was to determine the surgical outcomes of the canalicular tear repair with the self-retaining Mini-Monoka stent in a tertiary care hospital in North India. Materials and Methods: Patients presenting to tertiary care hospital in Kashmir, North India with canalicular tear from August 2019 to December 2020 were included in this prospective study and repaired with self-retaining Mini-Monoka stent under microscope. All the patients were analyzed for demographic data, mode of injury, complications, and outcomes and followed up after a week, 6 weeks, and 3 months and stent removed after 6 weeks. Results: The study was conducted on 18 patients. The mean age of the patients was 37.5 years with male: female ratio of 5:1. The lower canaliculus was most commonly involved and road traffic accidents was the most common mode of injury (27.7%). The most common associated injury was lid injury (50%). The mean time of stent removal was 6 weeks±2 weeks. Syringing was done in all the patients except children. At last follow-up, 17 out of 18 patients had functional and anatomical success in terms of absence of epiphora and patent syringing and all the patients were cosmetically satisfied. Conclusion: Our study concludes that surgical repair of canalicular tear with Mini-Monoka stent is a safe and simple reliable technique, cosmetically satisfying with minimal manipulation giving high functional and anatomical success rate post repair.

Long-term outcomes of a new anatomy-based method for finding the medial cut end during late canalicular repair

Locating the medial cut end during late repair of canalicular lacerations can be challenging. The aim of this study was to evaluate the effectiveness and long-term outcomes of a new anatomy-based method for solving the problem of locating the medial cut end. This retrospective interventional study included 85 eyes of 85 consecutive adult patients with unilateral inferior canalicular lacerations who underwent late primary (≥2 days after injury) or secondary (≥6 months after initial treatment) surgery. Before surgery, the lacerations were classified as lateral, central, or medial according to the 'distance from the punctum to the distal end' of the lacerated inferior canaliculus. The time spent to locate the proximal lacerated end (TSL) was recorded. All patients were followed up for ≥1 year to evaluate the lacrimal passage patency and the distance between the superior and inferior punctum (DBSIP, to assess cosmesis). There were 16 (18.82%) lateral-type, 55 (64.71%) central-type, and 14 (16.47%) medial-type canalicular lacerations. The TSL was 3.48±1.05 (range 0.9-6.8) min for all patients and differed significantly among the three types of canalicular lacerations (P<0.001). Lacrimal irrigation showed patent lacrimal passages in 69 patients (81.18%) at 3 months and a further 4 patients (4.71%) at 6 months, residual stenosis without obstruction in 5 patients (5.88%), and obstruction in 7 patients (8.24%). The postoperative DBSIP on the affected side was shorter than the preoperative DBSIP (2.66±0.66vs. 3.09±1.72mm, P=0.006) and comparable to that on the unaffected side (2.78±0.40mm). Our new anatomy-based method is efficient and achieves good long-term outcomes for all types of late canalicular repair.

Malignant Sternal Tumors: Report of Two Cases

Primary malignant sternal tumors are rare clinical entities. We came across two such patients with primary sternal tumors. One was a chondroblastic osteosarcoma while the other was a chondrosarcoma. One patient received neoadjuvant chemotherapy followed by surgery. The second patient underwent upfront surgery. Both cases received wide excision of the tumor (sternum along with part of medial ends of bilateral clavicles and upper ribs). Reconstruction was done using autologous bone graft with prolene mesh in one case and titanium reconstruction plates in the other case. Both cases received coverage with pectoralis major muscle flaps.

Approach to Interpretation of Chest X-ray

Radiological examination of chest by doing X-ray chest is now considered as part of initial screening of the patients. It is a cheap, easily available and cost effective investigation which gives quite important information in the management of clinical patients. Following approach may be recommended for the interpretation of x-ray chest which may be used by trainee doctors appearing for their specialty examination. This approach may be labeled as �chest radiograph assessment using mnemonic� ABCDEFGHI �.1 A. AIRWAY: Use �PIER�. First look for the position of the patient whether supine, erect, AP/ PA/ lateral view. Look for whether it is inspiratory film or not, by counting number of ribs (one should be able to see 10-11 ribs). Then evaluate for well exposed film. Lastly, look for any rotation i.e. space between medial clavicle ends and vertebral column should be equal. Look for any tracheal deviation B. BONES AND SOFT TISSUES: Evaluate bone patency and soft tissues for any emphysema or swelling. C. CARDIAC SHADOW: Evaluate heart size. The size should be less than 50% on PA view and less than 60% on AP view. Look for cardiac shape / borders, calcification and any prosthetic valves. D. DIAPHRAGM: Look for any diaphragmatic flattening or eventration/ elevation. Also look for stomach bubble for free gas. E. EFFUSIONS: Look for blunting of costo-phrenic and cardio-phrenic angles which indicate presence of pleural effusion etc. F. FIELDS, FISSURES AND FOREIGN BODIES: Look for lung infiltrates, masses, consolidation, pneumothorax etc. Look for pulmonary vascular markings and any peripheral pruning. Look for presence of any ETT, NG tube, pacemaker leads, central lines etc. Look for sternal clips etc G. GREAT VESSELS/ GASTRIC BUBBLE: Check for Aortic knuckle and dilatation. Also look for size of pulmonary artery and central plethora. Look for gastric bubble as well. H. HILA AND MEDIASTINUM: Evaluate hila on both sides for lymph nodes, calcification or masses. Look for widening of mediastinum to rule out aortic dissection, retrosternal goiter/ thymus etc. I. IMPRESSION: After following all the above approach, a final impression should be made.2 Fig. no. 1: Anatomical landmarks on X-ray chest Fig. no. 2: X-ray chest PA view Fig.no. 3 Different common pathologies noticed on X-ray chest �

Intrathoracic Extension of a Giant Cell Tumour of the Medial End of Clavicle: A Case Report with Review of Literature.

The clavicle is a very rare site for primary bone tumours, and Giant cell tumours of the clavicle are even rarer. Very few cases have been reported in the literature. The authors report a rare presentation of intrathoracic extension of a giant cell tumour of the medial end of the clavicle, in an 18-year-old female. The patient had painful swelling at the sternal end of the clavicle associated with a painful shoulder range of motion. Complete resection of the mass was done, preserving the lateral half of the clavicle. At a 3-year follow-up, the patient has a good clinical outcome with no signs of recurrence. Being a very rare entity, no clear guidelines are available for the management of GCT of Clavicle. Adequate resection of the tumour mass remains the mainstay of treatment and has shown promising results. Denosumab has been proved to be effective in some studies, but the high cost of treatment is a major limitation in the Indian scenario. Resection of the tumour mass with partial cleidectomy provided good results in this patient.

Dual Approach to Talar Dome Increases Access for Fracture Care Without Osteotomy.

There is no consensus surgical treatment algorithm for talar body fractures, with authors recommending both soft tissue-only and osteotomy-based approaches. This study evaluates talar dome access via dual approaches to the talar dome through anterolateral transligamentous (ATL) and modified posteromedial (mPM) approaches. Ten cadaveric legs (5 matched pairs) were included. An mPM approach, between flexor hallucis longus and Achilles tendon, and an ATL approach, utilizing the anterolateral interval with transection of anterior talofibular ligament and calcaneofibular ligament, were performed on each specimen. Order of approach was alternated within each pair. Accessible dome surface area (DSA) was outlined by drilling with a 1.6-mm Kirschner wire at the visualized talar dome margin both with and without 4 mm of tibiotalar distraction using an external fixator. Specimens were analyzed by computed tomography (CT). Primary outcome was accessible DSA. Student t tests compared DSA accessed by different exposure methods. An initial mPM approach exposed 25.6% and 33.6% of DSA without and with distraction (P = .002). An initial ATL approach accessed 47.0% and 58.1% of DSA without and with distraction, respectively (P = .003). Accessibility via dual approaches was 71.7% and 93% of DSA without and with distraction with an initial ATL approach and 71.3% and 87.5% of DSA without and with distraction with an initial mPM approach (P = .96 and .37, respectively). The central talar dome was inaccessible in an almond-shaped area, tapered at the medial and lateral ends. Anterior, lateral, and posterior articular margins were able to be fully exposed, often with overlapping exposure between posterior and anterior approaches, with distraction reliably improving lateral visualization. Dual approaches provided access to greater than 70% and 85% of talar DSA without and with distraction, respectively. Order of approach did not significantly affect exposure and thus should be determined by surgeon discretion. These results may promote soft tissue-only treatment strategies in talar body fracture care with an extensile exposure of the talar dome surface. Careful preoperative planning optimizes the advantages of this approach. Level IV, case series.

Microstructure of the Bonnethead Shark (Sphyrna tiburo) Olfactory Rosette.

Microstructure of the Bonnethead Shark (Sphyrna tiburo) Olfactory Rosette.

Operative Fixation of Displaced Midclavicular Fractures in Adult by Titanium Elastic Nailing System

Introduction and aim: Clavicular fractures are very common, and it usually treated conservatively. However, recent shift to surgical intervention had been observed. The guidelines seem to be in its road to change. The aim of this work is to asses clinical and radiological results of surgical fixation of midshaft clavicle fractures by Titanium Elastic Nailing System.&#x0D; Methodology: Fifteen patients with mid-shaft (middle third) displaced fractures of the clavicle were included. All were assessed in systematic manner (history, examination and investigations). Then, eligible patients provided an informed consent and underwent surgical treatment according to study protocol. All were followed up for 6 months and their outcome was ranged according to Constant and Murley Score.&#x0D; Results: Ten patients (66.7%) had excellent, 3 patients (20%) had good, one patient (6.7%) had fair, and one patient (6.7%) had poor outcome. Pain was absent or mild in the majority of patients (93.3%). 86.7% of patients return to full work, and all had unaffected sleep. Union was achieved in 14 patients (93.3%). One patient had an infection, two had medial end skin irritation and one had hypertrophic non-union. Younger age and absence of any associated medical disease were associated with excellent outcome.&#x0D; Conclusion: Titanium Elastic Nailing could be considered as a reasonable alternative approach to the management of displaced mid-shaft clavicular fractures, as it is associated with excellent outcome, low pain, and early return to normal daily activities.

Discussion on methods for locating Xuehai (SP10) acupoint

The position of Xuehai (SP10) is clear, but its locating method is vague, resulting in the disunity of clinical application and even possibly affecting the curative effect. Also, when learning the meridians and acupoints, the beginners are often confused by this issue possibly due to: ① when the bone-length proportional measurement combined with anatomic symbol (combination method) was adopted, it is not clear that the patient should take a posture of knee extension or knee flexion; ② when the combination method used, it is difficult to find the highest point of muscle eminence in the case of patient with thin vastus medialis muscle and fuzzy body surface projection; ③the simple method for locating SP10 is widely used at present, can it replace the combination method to locate this acupoint accurately？Guided by these questions, we, in the present paper, reviewed the rela-ted textbooks, works and other literature to explore the standard position of SP10, and the standard and simple methods for locating this acupoint. Comprehending various opinions, we hold that SP10 should be positioned under the extended knee posture, then, the acupoint's horizontal ordinate "2 cun superior to the medial end of the base of the patella" is determined by using bone-length proportional measurement to measure 2 cun from the bottom to the tip of the patella. Then, the body surface anatomic symbol method is used, when, the patient is asked to stretch the leg and contract the vastus medialis muscle, the highest spot of muscular eminence is the SP10. If the patient's muscular protuberance is not obvious, the middle line between the medial and lateral margins of the vastus medialis muscle is used as the vertical ordinate, and its intersection with the abscissa is SP10. The simple method is easy in operation and has a reference value, but may frequently produce errors, hence, it is not a substitution for the combination method.

A study of clinical profile of patients undergoing endonasal endoscopic dacryocystorhinostomy without stenting in a teaching hospital of Western Gujarat

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic dacryocystitis is commonly treated with dacryocystorhinostomy (DCR). The aim of the study was to analyzed the clinical profile of patients suffering from distal Nasolacrimal duct (NLD) blockage and outcomes of EnDCR without stenting in patients with chronic dacryocystitis. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective observational study consisted of 50 patients who underwent EnDCR without stenting at ENT department of Gujarat Adani Institute of Medical Sciences during the period of October 2019 to September 2021, after taking IEC consent. All patients with distal NLD blockage were included in study. Pre-operative, intra-operative and post-operative details were recorded as per pre-validated proforma and data was analyzed using Microsoft excel sheets.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Watery discharge from eye was most common chief complaint (76%) during presentation followed by watery discharge and swelling over medial end of eye both (20%) and swelling over medial end of one eye (4%). Most common duration of chief complaint was between 3 to 12 months. In our study, out of 50 patients, 31 cases were operated under local anesthesia and 19 were operated under general anesthesia. Out of 50 operated cases, only 3 patients had stenosis of ostium at 3-month follow-up. Overall success rate of endoscopic endonasal DCR without stenting was 94%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The success rate of endonasal dacryocystorhinostomy without stenting is as high as that of external dacryocystorhinostomy and endonasal DCR with stenting without the disadvantages of either one. &lt;/p&gt;