Morphometric Analysis of V2 Segment of Vertebral Artery in Patients with Symptomatic Neck Pain in South Indian Population – A CT Angiography Based Study

Objectives: The morphometric changes in the vertebral artery are essential for various interventions. Inadequate details about it can lead to risk of vertebral artery injury and other complications. This study explains the normal anatomical course of V2 segment of vertebral artery which is more prone for iatrogenic injury. Materials and Method: 25 adult patients with symptomatic neck pain were involved in the study. Various measurements were made from seventh cervical vertebra (C7) to the third cervical vertebra (C3) that included Distance from midline to VA, Distance from medial margin of Longus Colli to VA, Perpendicular distance from anterior margin of transverse process to center of VA, Horizontal distance from anterior tubercle to VA, sagittal and coronal diameter of the transverse foramen and vertebral artery. Result: Distance from midline, Distance from medial margin of Longus Colli, Perpendicular distance from anterior margin of transverse process to center of VA and Horizontal distance from anterior tubercle were increased towards right compared to left side. The sagittal and coronal diameter of the transverse foramen and vertebral artery decreased from C6 to C3 vertebra. Vertebral artery dominance was seen on left side in all cases. Conclusion: Preoperative assessment by computed tomography angiography helps to know the course of the vertebral artery, understand its patterns and assess various abnormalities thereby aids in preventing complications in future surgeries.

Dislocation of the first metatarsophalangeal joint concomitant with Lisfranc joint dislocation in a 45-year-old man

A 45-year-old man presented with severe pinch-point crush injury to his left foot. Plain radiographs revealed dislocation of the first metatarsophalangeal joint and dorsolateral dislocation of the basal phalanx and sesamoids. The first tarsometatarsal joint was subluxed in the plantar direction and the second to fourth tarsometatarsal joints were subluxed dorsally. The sesamoids were displaced dorsolateral to the metatarsal head. There was a longitudinal tear of the joint capsule at the medial margin of the medial sesamoid, which was sutured together with the abductor hallucis tendon and collateral ligament. The Lisfranc and dorsal ligaments in the tarsometatarsal joint were torn and repaired after reduction and fixed with a plate. One year after surgery, there was contracture of the first metatarsophalangeal joint, but the patient had no pain and was able to run.

Initial conservative treatment of osteochondral fracture of the patella following first-time patellar dislocation

Background There has been no gold standard of the initial treatment strategy for acute patellar dislocation (APD) with osteochondral fracture (OCF). Hence the study aim is firstly, to review and compare clinical outcomes of patients who underwent conservative treatment for APD with or without OCF. Secondly, to characterize the location and size of fracture fragment. Methods Sixty-nine consecutive patients who were retrospectively evaluated after first-time APD over a 2- year period were divided into two groups (group 1 (n = 24): APD with OCF and group 2 (n = 45): APD only). Magnetic resonance imaging (MRI) was used to assess patients with APD and OCF from the medial patella. All patients were treated with a supervised course of immobilization followed by progressive range of motion and strength exercise protocol. History of a recurrent dislocation, radiologic and functional scores were analyzed. Results Redislocation rate was 31.2% in group 1 and 26.6% in group 2, showing no significant difference between the two groups (p = 0.690). Intergroup differences in terms of final Kujala and IKDC scores were not significant (p = 0.117 and p = 0.283, respectively). Fracture sites of the patella in group 1 were classified as follows: patellar medial margin (12), inferomedial facet (7), and inferomedial facet involving central ridge (5). In the subgroup of patient with OCF of the inferomedial facet of the patella, the fragments were found in the lateral gutter and did not cause pain or mechanical symptoms. Thus, loose body removal was not performed. However, all five patients with large OCF involving the central ridge of the patella failed non-operative treatment with recurrent dislocations, ultimately requiring fragment refixation and medial retinacular imbrication. Conclusions First, APD patients with OCFs of medial margin or inferomedial facet showed similar redislocation rates and functional knee scores with those without OCFs after conservative treatment. Second, initial conservative treatment failed in some APD patients with large OCF, especially when OCFs were fractured from inferomedial facet involving central ridge. Surgery should be considered with this type.

A Quantitative Anatomic Study of Plate-Screw Fixation of the Acetabular Posterior Column through a Posterior Approach

Objective The aim of this study was to determine safe paths for screw placement on the posterior column of the acetabulum. Methods A total of 25 male hemipelvises were utilized in this study. These hemipelvises were sectioned, and formed cross-sections A, B, C, D, and E. The length of the screw and screw posterior column angle of the entry points at cross-sections B, C, and D were measured. Results On the margin of the acetabulum, lateral middle 1/4 point, midpoint, medial middle 1/4 point, and medial margin of the posterior column of each cross-section, the safe entry angle of inclination is 39, 57, 74, 90, and 106°, respectively, and the length of the screw is 35.5 mm, 33 mm, 32 mm, 31 mm, and 74 mm, respectively. Conclusion On the lateral 1/4 region, lateral middle 1/4 region, medial middle 1/4 region, and medial 1/4 region of the posterior column, the screw posterior column angle is 40 ~ 60°, 60 ~ 75°, 75 ~ 90°, and 90°~parallel to the quadrilateral plate, respectively, and the length of the screw is 30 mm.

Three new species of Acanthobothrium Blanchard, 1848 (Cestoda:Onchoproteocephalidea) in Stingrays (Dasyatidae) from the Pacific coast in Mexico

Three new species of Acanthobothrium Blanchard, 1848 (Onchoproteocephalidea: Onchobothriidae) are described from Pacific coastal waters of Mexico. Based on four criteria for categorization of species of Acanthobothrium, the three new species belong to Category 2 species, characterized by their total length (< 15 mm), number of proglottids (< 50) and testes (<80), and with asymmetrical ovary. Acanthobothrium ppdeleoni n. sp. from diamond stingray Hypanus dipterurus (Jordan & Gilbert) is differentiated from congeners by a combination of characters including total length of the whole worms, size of the scolex and bothridia, length of the bases of the hooks and abaxial prongs, and the size of the cirrus sacs in mature proglottids. Acanthobothrium hypanus n. sp. and A. sinaloaensis n. sp. are described from longtail stingray Hypanus longus (Garman). Acanthobothrium hypanus n. sp. is differentiated by a combination of characters including size of the scolex and bothridia, diameter of the accessory sucker, length of the abaxial prongs, size of the cirrus sacs and testes in mature proglottids. Acanthobothrium sinaloaensis n. sp. is differentiated by a combination of characters including size of the scolex and bothridia, diameter of the accessory sucker, size of the cirrus sacs in mature proglottids, number of immature proglottids, number of testes, the length of the lobes of the ovary and the absence of velum between medial margin of bothridia. Thirteen species of Acanthobothrium have been reported previously from elasmobranchs from the Pacific coast of Mexico. In the present study, the number of species is elevated to 16.

Surgical importance of distance from mandibular condyle to carotid canal and foramen spinosum: an anatomical study

Background: The objective of this study was to compare the distance from mandibular condyle to internal carotid artery and middle meningeal artery.Methods: In this study 20 skulls obtained from the Department of Anatomy were utilized for the study. The following two parameters were measured using Vernier Caliper (digital). 1. Distance from Mandibular condyle to carotid canal 2. Distance from medial margin of Mandibular condyle to Foramen spinosum. All the measurements were taken thrice to minimize errors. Photograph of the skull base showing the measurements done was captured.Results: A total of 40 sides, 20 right and 20 left sides were studied. The mean distance between medial margin of mandibular condyle to carotid canal was 11.2 mm±0.6 on right side and 11.6mm±0.8 on left side. The mean distance from the medial margin of mandibular condyle to Foramen spinosum (middle meningeal artery) was 9.3 mm±1.1 on right side and 9.8mm±0.9 on left side. Conclusions: The distance between mandibular condyle to Middle meningeal artery is less compared to the distance between Mandibular condyle to carotid artery. The current study concludes that MMA is comparatively at high risk for damage compared to internal carotid artery.

Visualization and quantification of the degenerative pattern of the talus in unilateral varus ankle osteoarthritis

The aim of this study was to quantify and visualize the degenerative patterns of the talus in ankle osteoarthritis (OA). The differences in talar morphology between sides of patients with unilateral varus ankle OA (medial talar tilt > 4°) were compared. Computed tomography images of both feet of 35 patients (OA: 22 patients, control: 13 patients) were analyzed. Each surface model of the right and left tali was registered to the opposite talus via a mirror-image technique and an iterative closest point algorithm. The surface deviation between the two models was quantified and visualized by deviation color maps. The results quantitatively demonstrated that osteophytes are generated in the area under the antero-medial margin of the trochlea in OA tali. In severe OA tali, bone resorption of more than 2 mm in the medial portion of the trochlea, as well as a similar degree of osteophyte formation on the lateral surface, was also seen. Stereotypical patterns of degeneration occurring in OA tali were successfully visualized and quantified by left-right comparison of patients with unilateral ankle OA. Such information would contribute to better understanding of the development of ankle OA and preoperative planning of total ankle arthroplasty and arthrodesis.

Isisfordia molnari sp. nov., a new basal eusuchian from the mid-Cretaceous of Lightning Ridge, Australia

The Australian Mesozoic crocodyliform record is sparse in comparison to other Gondwanan localities. A single formally-named taxon is known from this interval; Isisfordia duncani (Winton Formation, Albian–Turonian, Queensland). We present a previously undescribed crocodyliform braincase from the Griman Creek Formation (Cenomanian), New South Wales, which we assign to Isisfordia molnari sp. nov. Assignment to the genus is based on the possession of a newly-defined autapomorphy of Isisfordia: a broadly exposed prootic within the supratemporal foramen. A second autapomorphy of I. duncani (maximum diameter of the caudal aperture of the cranioquadrate siphonium approximately one-third the mediolateral width of the foramen magnum, with the lateral wall of the caudal aperture formed exclusively by the quadrate) may also be present in I. molnari; however, definitive recognition of this feature is marred by incomplete preservation. The new taxon is differentiated from I. duncani based on the absence of a median ridge on the parietal, and the lack of characteristic ridges on the parietal that form the medial margin of the supratemporal foramina. Reanalysis of a second specimen (the former holotype of the nomen dubium,‘Crocodylus (Bottosaurus) selaslophensis’) allows for its referral to the genus Isisfordia. Crucial to this reappraisal is the reinterpretation of the specimen as a partial maxilla, not the dentary as previously thought. This maxillary fragment possesses specific characteristics shared only with I. duncani; namely an alveolar groove. However, several key features differentiate the maxillary fragment from I. duncani, specifically the presence of continuous alveolar septa, the thickening of the medial alveolar rim, and the alveolar and crown base morphology. These findings constitute the first evidence of Isisfordia outside of the type locality and indicate its widespread occurrence on the freshwater floodplains along the eastern margin of the epeiric Eromanga Sea during the Albian–Cenomanian.

A simple approach for ultrasound-guided pararadicular injections in the sacral spine: a pilot computer tomography controlled cadaver study

Aims: Injection therapies play an increasingly decisive role in the treatment of lower back pain. Cumulative studies could show the benefits of ultrasound-guided instillation procedures in the cervical and lumbar spine. We conducted this study to provide a new simple sonographic approach for pararadicular injections of the sacral spinal nerves and to prove the feasibility and accuracy by means of CT and anatomic dissection.Material and methods: Eight ultrasound-guided injections at four different levels of the sacral spine on a human ethanol-glycerol–embalmed cadaver (S1-S4) were performed. By means of sonography the sacral foramina were identified and the spinal needles were advanced in “in-plane technique” to the medial margin of the respective sacral foramen. Subsequently a solution of blue dye and contrast agent were injected. Then CT scans and anatomic dissection of the cadaver were performed to verify the correct placement of the needle tips and to visualize the dispersion of the injected solution in the respective compartment.Results: Altogether a 100% success rate for a correct injection could be achieved. CT examination confirmed the correct placement of every needle tip within the intended compartment. Also, the anatomic dissections affirmed the appropriate needle positioning. Moreover, the blue dye dispersion was seen in the correct compartments and around the targeted spinal nerves.Conclusions: Although this study was only performed on cadaveric models, this new sonographic approach for pararadicular injections in the sacral spine allows an easy, precise and unerring needle placement within the dorsal sacral foramen.