Morphology and morphometric study of dry scapula, with emphasis on the glenoid fossa and acromion process in Chennai city, South India

Background: The morphology and morphometry of the scapula and its glenoid fossa and acromion process play a significant role in the mechanics of shoulder joint. A variable morphology is found in glenoid fossa that has clinical implications. Aims and Objectives: The aim of the study was to evaluate the morphology and morphometry of dry scapula with emphasis on glenoid fossa and acromion process. Materials and Methods: A cross-sectional study was conducted at the department of anatomy, for a period of 6 months from January 2021 to June 2021. A total of 100 unpaired dry scapula were included in the study. The morphology and dimensions were measured. The dimensions were summarized as mean and standard deviation. Statistical analysis was done Chi-square test and student’s t-test based on the variable types. Results: Out of 100 scapulae studied, 48 were right sided and 52 were left sided. The mean of maximum length of the right scapula was 149.58±10.33 mm and the left side was 148.63±10.33 mm. Among the glenoid cavities, 54 were inverted comma shaped, 30 were pear shaped, and 16 were oval shaped. In one right-sided scapula Bony Spur Extends from Base of coracoid process to supra Scapular Notch. Conclusion: Size and shape of the glenoid cavity are directly related to the dislocation of shoulder joint and may affect the results of total shoulder arthroplasty and rotator cuff surgeries. The present study analyzed the morphological types and diameters of the glenoid cavity in adult scapulae to improve the efficacy and minimize the failure rates in shoulder arthroplasty particularly those involving the glenoid component of the shoulder joint.

Treatment of congenital dislocation of the hip in young children Jaeger (Surg. Gyn. A. Obst. V. 50, No. 4)

Jaeger (Surg. Gyn. A. Obst. V. 50, No. 4) gives 2 cases of successful treatment of congenital hip dislocation in young children. In contrast to the generally accepted late reduction, when the deformation of the glenoid cavity has already gone far, the author proposes to set it early.

A STUDY OF MORPHOMETRIC ANALYSIS AND MEASUREMENT OF ANGLE OF TORSION OF THE HEAD OF HUMERUS AND SHOULDER ARTHROPLASTY

Back ground: Humerus is the longest of the long bones of superior extremity.It”s head articulates with scapular glenoid cavity to form the gleno-humeral/Shoulder joint.The rounded head of Humerus is too weakly supported in the scapular glenoid cavity lined by glenoid labrum which makes it the most mobile and most unstable nd joint and so most commonly dislocated joint of the human body.Also the humeral head part is the 2 most important part of shoulder arthroplasty. Aim of the study is to make a clinical evaluation of parameters used in prosthesis design for the humeral component applied in arthroplasty of the proximal upper extremity. Methods: A total of 100 (Rt -58,Lt –42 ) dry human Humerus available in the Department of Anatomy of Calcutta National Medical College,Kolkata,West Bengal and Nilratan Sircar Medical College,Kolkata,West Bengal were taken for the study.The Humeral heads are measured in supero-inferior(SI) diameter, and antero-posterior diameter(AP), The width of Humeral head (Wdth),and angle of Humeral Torsion were measured. At the very beginning the both sided Humerus taken for the study are properly numbered using permanent marker pen.The width of the Humeral head(Wdth) is measured 1stly by pressing the head in modelling dough and when the mould is prepared,semisolid plaster of paris is lled into the mould. After drying the replica of humeral head is smoothened upto the mark of anatomical neck of humerus thus proper width can be measured. The superoinferior(SI) diameter, and antero-posterior diameter(AP) were measured by digital slide callipers by placing it directly onto the surface of consequently numbered humeral heads. The width of Humeral head (Wdth ) were measured from these replica(properly numbered) humeral heads, made of plaster of paris at the middle, the highest thickness was measured. The measurements are taken via spreading slide calipers in milimeters. For measuring the angle of humeral angle of torsion ,we xedly placed the humerus on to a area over the smooth part of the vertical wall which was meeting another horizontal wall at 90 degrees angle thus the line joining the two epicondyles of humerus lies parallel to the vertical wall.Now placing the straight edge of the protractor onto the upper end of humerus the angle of humeral torsion is measured. Results: Both sided Humerae were analysed separately for Morphological measurement, and angle of Humeral torsion.Mean values for SI were 41.31+3.46mm (Right side) and 40.91+3.27mm(Left side). Mean values for AP were 38.27+3.05mm (Right side) and 37.91+2.70mm(Left side). Conclusion: This study will contribute some relevant data and help the orthopaeditians in dealing with cases of shoulder pathology and shoulder arthroplasty cases.

A Full Digital Workflow to Design and Mill a Splint for a Patient with Temporomandibular Joint Disorder

In the rehabilitation of a patient with loss of vertical dimension, repositioning of the condyle may be crucial to avoid loading on the retrodiscal area of the temporomandibular joint (TMJ). However, establishing a new position of the condyle within the glenoid cavity is not a simple procedure, and several indications exist in the literature. Digital techniques and 3D visualization using cone beam computed tomography (CBCT) can help. In this clinical case, the procedure for the repositioning of the condyle is described on the basis of the restoration of the normal widths of the intra-articular spaces using a recently introduced software (Avantis3D). After the end of the rehabilitation with the splint, a second examination confirmed the accuracy of the repositioning with this full digital procedure which represents, in selected cases, a useful choice.

Surgical Reduction of Symphysis Fracture and Spontaneous Repositioning of the Mandibular Condyle: A Case Report

The condylar process is a more fragile area, which is usually fractured by indirect trauma. The objective of this study is to report the case of a 10-year-old patient who presented to the Maxillofacial Surgery and Traumatology Service of the Regional Hospital of Vale do Paraíba, in Taubaté-SP, Brazil. Physical examination revealed limited mandibular movement with painful symptoms, crossbite, and upper incisor avulsion. A face tomography showed a fracture of the mandibular symphysis (right side) and a fracture of the left condyle. Surgical reduction of the mandibular symphysis fracture was performed. After exposure and reduction of bone segments, maxillomandibular block, rigid internal fixation and conservative treatment for condyle fracture were performed. A soft liquid diet and weekly outpatient follow-up was adopted for the first two months. After 15 days of surgery, the patient had mild edema, slight limitation in mouth opening, sutures without dehiscence and without signs of infection. In the first control tomography, the treated fracture was adequately reduced and the fractured condyle remained with medial displacement in the glenoid cavity. After one year, on physical examination, the patient presented satisfactory dental occlusion, preserved mandibular movements and no signs of nerve damage. The tomography showed the fracture consolidated, and the left mandibular condyle well positioned in the glenoid cavity. After two years, the third tomography was performed, showing remodelling of the left mandibular condyle.

Applied anatomical study on suprascapular nerve protection in reverse total shoulder arthroplasty

Background This study aimed to investigate the three-dimensional (3D) anatomical relationship between the suprascapular nerve and scapula, and the method of protecting the suprascapular nerve in reverse total shoulder arthroplasty (RTSA) Methods In the present study, 12 fresh adult cadaver shoulder specimens were dissected. X-ray and computed tomography (CT) were used to investigate the 3D scapular and suprascapular nerve images. Results The results revealed that the best fitting baseplate diameter was 24.73 ± 1.56 mm. Furthermore, the baseplate diameter correlated with the glenoid cavity width. After the osteotomy, a simulated screw placement on the baseplate was performed. The dangerous area for the posterior screw placement was at the angle between the upper edge and transverse axis exceeding 38° and between the lower edge and transverse axis exceeding 76°. The distance between the nearest point of the nerve and osteotomy plane was 15.38 ± 2.02 mm, and the angle between the projection point of the nearest point and transverse axis was 27.33 ± 7.96°, which was the dangerous area for retractor placement. The suitable angle between the superior screw and longitudinal axis was 21.67 ± 13.27°, and the suitable superior screw length was 34.66 ± 2.41 mm. Conclusion In RTSA, the baseplate size correlates with the glenoid cavity width. The relationship between the screw and suprascapular nerve and retractor placement position should be carefully considered to avoid damaging the suprascapular nerve.

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

ABSTRACT Objective: 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”).