The use of precontoured plates for midshaft clavicle fractures is not always the best course of treatment.

Plate fixation has become the preferred approach for treating displaced midshaft clavicle fractures. However, plate fixation of the clavicle presents several unique challenges, including its complex bony architecture and its immediate subcutaneous location. In many cases, we have observed that precontoured implants do not conform to the clavicular anatomy, and many patients complain of postoperative implant-related discomfort. A total of 111 clavicles, both left and right sides, were examined to match two commonly used designs of anatomical pre-contoured superior anterior clavicle plates, with and without lateral extension. The anteroposterior (AP) plane congruence of the plate to the underlying bone, the vertical gap between the bone and plate, and the length of the plate that was off the bone either anteriorly and/or posteriorly at both ends of the clavicle were measured. The scoring system was used to determine the fit of the implant on the clavicle as anatomic, good, or poor. We found that the maximum superior bow of the clavicle was lateral to the midline by 30.75 mm and 30.5 mm on the right and left sides, respectively. The magnitude of the bow was 4.28 mm and 4.46 mm on the right and left sides, respectively. We also found that the plate was a poor fit in 75.86% of cases on the left side and 73.5% of cases on the right side. Manipulating the plates during surgery was very difficult in the AP plane.

A Cadaveric Study to Define Morphology and Morphometry of Human Knee Menisci in the Region of Central India.

Introduction The medial and lateral menisci of the knee joint are the functional unit that helps to increase the depth of articular surfaces on the head of a tibia for the reception of femoral condyles. Menisci are important for the distribution of load and thus help to reduce stress on the knee joint. The anatomical knowledge of morphology and morphometry of menisci is vital while performing surgeries in cases of meniscal injury. The study aimed to define the variational anatomy of the menisci of the knee joint. Material and Methods Ninety-six cadaveric knees of 48 cadavers were included in the study. Different shapes of both; lateral and medial menisci were recorded. The peripheral lengths and inner lengths of the menisci were measured with the nonelastic cotton thread. Menisci were divided into three parts; anterior, middle, and posterior. The maximum width and thickness of each part of the menisci were measured and documented. Distance between the medial and lateral meniscus in each knee was measured at the anterior and posterior ends. The most anterior and the most posterior part of each meniscus was determined and the distance between these parts of each meniscus was measured and recorded as the distance between two horns. Results Four morphological types of menisci were found; in medial menisci, the most common was crescent­shaped (53%), and in lateral menisci, the most common shape was c­shape (62.5%). The average peripheral length of the medial menisci was 92.0 mm and the lateral menisci was 96.08 mm while the average inner length of the medial and lateral meniscus was 56.19 mm and 58.92 mm respectively. The anterior third of the medial as well as lateral meniscus was thinnest while the posterior third was thickest. The width of the medial menisci was less at the anterior end and was more at the posterior ends while the width of the lateral meniscus was almost the same at the anterior, middle, and posterior ends. Conclusion The findings of the present study will be helpful for surgeons while planning and performing surgical procedures and for anatomists during routine teaching.

Morphometry and Intracranial Relations of the Sphenoid Sinus in Context to Endoscopic Transnasal Transsphenoidal Surgery.

Introduction Due to the variable degree of pneumatization, the shape and size of the sphenoid sinus are irregular. An endoscopic intranasal transsphenoidal approach is made in sphenoid sinus pathologies, sphenoid sinusitis, and sellar and parasellar diseases. A diagnostic approach to the sphenoid sinus is also done to get a better MRI scan of the pituitary. The present study aims to describe the variant types of sphenoid sinus, morphometry, anatomy, and relations of sphenoid sinus, which will be helpful to surgeons during an endoscopic approach to the sphenoid sinus. Materials and methods We studied 76 cadaveric sphenoid sinuses that were exposed by taking a sagittal section of 38 formalin-fixed cadaveric heads. After examining the inter-sphenoidal septum, it was removed to observe the inside aspect of the sphenoid sinus. Different dimensions of the sinus were noted down. The bulges inside the sinus due to neurovascular structures in relation to the sinus were observed. Results  The most prominent type found was the sellar in 68.4% of cases preceded by the postsellar in 23.7% of cases. Presellar type of pneumatization was seen only in 7.9% of cases and the conchal type was absent. Intersphenoid septum was seen in 92,1% of cases, out of which 11.4% of septums were deficient on the posterior aspect. An internal carotid artery bulge in the sphenoid sinus was seen in 46% of cases. In 27.6% and 19.7% of sphenoid sinuses, bulging of the optic and vidian nerves, respectively, were seen. Some of these structures were dehiscent in the sphenoid sinus. Conclusions To get more space in the sphenoid sinus, the septa in the sinus are removed by surgeons, which may damage the walls of the sphenoid sinus. Knowledge of the relations of neurovascular structures with the sphenoid sinus will be helpful to surgeons during the transsphenoidal endoscopic approach to avoid any injury to these structures.

A Cadaveric Study to Define the Variant Patterns of Median Nerve Formation.

The median nerve is one of the important nerves of the upper limb which supplies the muscles of the front of the forearm, muscles of the hand, and skin of the hand. Many works of literature mentioned its formation by the fusion of two roots, the medial root from the medial cord and the lateral root from the lateral cord. But multiple variations in the median nerve formation have clinical importance from surgical and anesthetic points of view. For the study purpose, we dissected 68 axillae of 34 formalin-fixed cadavers. Out of 68 axillae, two (2.9%) showed median nerve formation by a single root, 19 (27.9%) showed median nerve formation by three roots, and three (4.4%) showed median nerve formation by four roots. A normal pattern of median nerve formation by fusion of two roots was seen in 44 (64.7%) axilla. The knowledge of variant patterns of median nerve formation will be helpful to surgeons and anesthetists while performing surgical or anesthetic procedures in the axilla to avoid any injury to the median nerve.

Cadaveric Study to Define the Anatomy of the Medial Patellofemoral Ligament (MPFL) and Its Variant Patterns.

BACKGROUND: The medial patellofemoral ligament (MPFL) is one of the major soft tissue stabilizers on the medial side of the knee joint, extending from the medial condyle of the femur to the medial aspect of the patella. Different kinds of literature described different sizes and different origins and insertions of MPFL. Injury of MPFL causes patellar instability and dislocation. We reported the anatomy and morphology of MPFL and its implications in the repair of MPFL. The aim of the study was also to look at the variant forms of the MPFL.   Methodology: A total of 40 lower limbs fixed in formalin were dissected to study the MPFL of the knee. After reflecting the deep fascia and retinaculum on the medial side of the knee joint the MPFL was exposed. For better learning the lower medial part of vastus medialis was reflected, so that the part of MPFL undercover was exposed. RESULTS:  Different forms of MPFL were seen like two straps 12.5%, broad rectangle 20%, and triangular shaped 67.5% MPFL. The origin of MPFL was found between the adductor tubercle and medial epicondyle of the femur and insertion was seen extending from the proximal medial half of the patella to the tendinous aponeurosis of vastus medialis obliquus (VMO) and vastus intermedius muscle (VIM). CONCLUSIONS: This is the first study that described three variant patterns of MPFL in accordance with their morphological appearance. This knowledge will be helpful to the surgeons for easy identification and repair of the MPFL.

Study of frontal and ethmoid sinus of sinonasal complex along with olfactory fossa: anatomical considerations for endoscopic sinus surgery.

The Functional endoscopic sinus surgery through transnasal approach is a common modality of treatment for disorders of the nasal cavity, paranasal air sinuses as well as cranial cavity. The olfactory fossa (OF) is located along the superior aspect of cribriform plate which varies in shape and depth. This variable measurement of the depth of OF is mostly responsible for greater risk of intracranial infiltration during endoscopic procedures in and around the nasal cavity. The morphology of frontal and ethmoid sinus (ES) vary from simple to complex. This cadaveric study is planned to improve the ability of the otolaryngologist, radiologist to understand the possible morphological variations and plan steps of less invasive "precision surgery" to have a safe and complication free procedures. A total of 37 human head regions were included in the study. For classification of OF, Modified Kero's classification was used. The size, shape and cells of frontal and ES were noted. We found, type II (60.8%) OF was more common followed by type I (29.7%) than type III (9.5%). The shape of frontal sinus was comma shaped (55.4%) followed by oval (18.9%) than irregular (16.2%). Most common two cells type of ES was seen in 50.0% of both anterior and posterior ES. Out of 74 ES, 8.1% of Onodi cells and 14.9% of agger nasi cells were seen.

Effect of low-cost automation on labor productivity and labor fatigue for corrugated boxes flaps twisting.

BACKGROUND: Flaps of the corrugated box folded inversely while manual packing of goods initiative this will cause tearing of the box at creased positions. OBJECTIVE: To avoid tearing, it is required to twist each box along creased positions as soon as it is manufactured and in wet condition due to liquid gum application. METHODS: To apply and evaluate the effect of Low-Cost Automation on labor productivity and labor fatigue for corrugated boxes flaps twisting. Low-Cost Automation solution is applied to overcome low labors' productivity and excessive labors' fatigue problems in the manual box twisting work. Productivity need analysis is performed to identify the key productivity measures. Three automated mechanisms are developed for box stopping, clamping, and twisting activities. RESULTS: Reduction in labors muscular efforts requirement is confirmed through surface electromyography technique. It is observed that the average actual time required for twisting one box reduced from 34 seconds to 17 seconds, and labor productivity almost doubled. The muscular efforts required for twisting of flaps of the boxes are reduced significantly. CONCLUSION: The developed low-cost automation solution is unique and found worthy for small scale corrugated box manufacturers.

Patented pulsatile drug delivery technologies for chronotherapy.

INTRODUCTION: Oral-controlled and modified-release drug delivery systems with zero-order sustained-release kinetics have been developed and proven suitable for meeting increasingly sophisticated therapeutic needs. Nevertheless, the impact of basic chronobiology concepts on the practice of medicine is still ongoing and to address chronotherapy needs, various types of pulsatile drug delivery systems have been innovated. The purpose of this review is to highlight these innovations in the field of chronotherapy. AREAS COVERED: The present review discusses in depth on recent patents and developments related to pulsatile drug delivery systems with eroding, soluble or rupturable barrier coatings, and systems with capsular structures. Besides focusing on all recent innovations, the review addresses the novelty and feasibility of all upcoming technologies being exploited considering pulsatile drug delivery systems. EXPERT OPINION: There has been a growing interest in pulsatile delivery, which generally refers to the liberation of drugs following a programmable and well-defined lag phase from the time of administration. From 1981 until the present date, patent publications related to pulsatile drug delivery have shown more promising systems with numerous developments in arena of drug delivery. Future development of chronotherapeutic medications requires proper assessment and integration with other emerging disciplines such as hydrogel and transdermal delivery systems. The selection of the appropriate chronopharmaceutical technology should take into considerations with the ease of manufacturing and the cost-effectiveness.

Absence of musculocutaneous nerve with variations in course and distribution of the median nerve.

Variations in the brachial plexus and its terminal branches are not uncommon. A communicating branch arising from the musculocutaneous nerve to the median nerve is a frequent variation, but complete merging of musculocutaneous nerve into the median nerve is very rare. Here, we observed variations in the origin, course and distribution of the median nerve in the left upper limb. The musculocutaneous nerve was absent. The median nerve was formed in the upper part of the arm, in front of the brachial artery. The median nerve supplied the biceps, coracobrachialis and brachialis muscles and gave the lateral cutaneous nerve of the forearm. The present report provides evidence of variation in important nerves of the anterior compartment of the arm.

Study on branching pattern of aortic arch in Indian.

Knowledge of the branching pattern of aortic arch is important during supra-aortic angiography, aortic instrumentation, thoracic and neck surgery. The purpose of this study is to describe different branching pattern of arch of aorta in Indian subjects, in order to offer useful data to anatomists, radiologists, vascular surgeons while relating it to the embryological basis. Seventy five arches of adult Indian cadavers were exposed and their branches examined during cadaveric dissection in the Department of Anatomy, Government Medical College, Nagpur. The usual three-branched aortic arch was found in 58 cadavers (77.3%); the 11 (14.66%) remaining aortic arch showed only two branches, out of which one was a common trunk, which incorporated the brachiocephalic trunk and left common carotid and other left subclavian artery and 6 (8%) aortic arches showed direct arch origin of the left vertebral artery. Although the variations are usually asymptomatic, they may cause dyspnoea, dysphasia, intermittent claudication, misinterpretation of radiological examinations and complications during neck and thorax surgery. Knowledge of different patterns of arch of aorta is critical when invading the arch of aorta and its branches by instruments, as all these areas are delicate.

Applicability of Greulich and Pyle skeletal age standards to Indian children.

A total 375 Indian children of age 1 day to 19 years were studied (male 194 and female 181). For determining the bone age (skeletal age), wrist and hand radiographs were taken. The skeletal age was determined by blinded review of radiograph using Greulich and Pyle atlas (2nd edition, 1959). If we consider all age group (1-19 years), the Indian boys were retarded in skeletal age by 0.7 years and females by 0.33 years. Male and female children skeletally lag behind the American standard (GP Atlas) in all age groups except 12-13 years age group in which girls are accelerated by 0.22 years. Chronological age and skeletal age difference of more than 1 year is seen between age group 7 years and 12 years in males. Females after second year showed a retardation, which ranged from 0.2 to 0.8 years, up to the age of 19 years. The present study concludes that, Greulich and Pyle atlas is not applicable to the Indian children of both sexes especially in middle and late childhood.

Bilateral malrotation and lobulation of kidney with altered hilar anatomy: a rare congenital variation.

Variations of the structure and position of the kidney along with the variations of renal vessels are the most frequently reported. Rotational variations form a rare entity that is not cited in most of the embryology textbooks. During educational cadaveric dissection of a 57-year-old female, a complex picture of bilateral anatomical variants was encountered. Bilateral malrotation of kidney, bilateral lobulated kidneys along with open hilum of kidney was observed, so that the contents of the sinus were exposed. The renal pelvis was present anterior to the renal vessels instead of posterior position.The right kidney in addition showed lower lumbar position with three supplementary arteries and two veins. The right ovarian vein arched over the laterally rotated hilum of kidney and drained into superior renal vein instead of inferior vena cava. This is a rare case in which such numbers of congenital variations are seen. These variations of kidney have embryological base. Rotational variation though comparatively rare assumes great importance in view of the present day surgical procedures like percutaneous nephrectomy, renal transplantation, etc.