Impact of modified teaching strategies used in a gross anatomy course on the academic performance of dental students during the COVID-19 pandemic.

INTRODUCTION: Modified teaching strategies (MTS), asynchronous online teaching and smaller dissection groups, were applied to a gross anatomy course for dental students in the National Taiwan University in April 2020 in response to the COVID-19 pandemic. This study aimed to investigate the effects and perceptions of MTS on dental students. MATERIALS AND METHODS: Scores for anatomy examinations for 2018-2019 (without MTS) and 2019-2020 (with MTS) cohorts were compared to explore the effect on academic performance. Moreover, questionnaire from the 2019-2020 cohort was analysed to determine dental students' perceptions about MTS. RESULTS: The lecture performance in the final examination of the second semester for the 2019-2020 cohort was significantly higher than that of the first semester (pre-COVID-19) and that for the 2018-2019 cohort. However, the laboratory performance in the midterm examination of the second semester for the 2019-2020 cohort was significantly lower than that for the 2018-2019 cohort and showed no difference in the final examination of the first semester. The questionnaires revealed that the majority of students displayed positive attitudes towards MTS and agreed with the importance of peer discussion during laboratory dissection. CONCLUSIONS: Asynchronous online learning for anatomy lecture may be beneficial for dental students; however, a smaller dissection group accompanied by reduced peer discussion may temporarily exert negative effects on their laboratory performance at the beginning of the application. Furthermore, more dental students exhibited positive perceptions towards smaller dissection groups. These findings could illuminate the learning condition of dental students in anatomy education.

Longitudinal Follow-Up of Death Anxiety and Psychophysical-Symptom Experience of Participants in the Silent Mentor Program.

This study assessed death anxiety (Death Anxiety Questionnaire, DAQ) and psychophysical- (psychological and physical) symptom experience following cadaveric dissection among the Silent Mentor Program (SMP) participants before thawing (T1), after the suturing, dressing and coffining session (T2), and one month post-program (T3). There was a significant decline in the total DAQ score comparing T1 and T2 (t = 7.69, p < 0.001) and T2 and T3 (t = 5.00, p < 0.001) and T1 and T3 (t = 10.80, p < 0.001). There was a significant reduction in total psychological-symptom score comparing T1 and T2 (t = 4.92, p < 0.001) and between T1 and T3 (t = 4.85, p < 0.001). However, for the physical-symptom experience, a significant increase in the physical-symptom score between T1 and T2 (t = -3.25, p = 0.001) was reported but the scores reduced significantly one month after the program (T2-T3; t = 4.12, p < 0.001). The mentoring concept of the SMP program has beneficial effects on improving attitude towards death and psychophysical-symptom experience associated with cadaver dissection.

Effectiveness of a Student-Developed Instructional Video in Learning the Anatomy of the Equine Distal Limb.

The anatomy of the equine distal limb (EDL) is both complex and important to veterinary clinical practice. First-year veterinary students (VM1s) often struggle to adequately understand it. Two third-year veterinary students collaborated with instructors to create an instructional video to facilitate first-year students' comprehension of EDL anatomy. The video was offered to all VM1s. Learning outcomes were assessed via practical exams. Exam scores on EDL structures were compared between students who did (video) and students who did not (no video) watch the video. Students' laboratory experiences and confidence were evaluated with a post-exam survey. The third-year students documented their experiences while producing the video. Eighty percent of VM1s viewed the video; 91% rated the video as very valuable. The video improved student confidence during the practical exam by 9%, and 89% of surveyed students indicated the video positively impacted their exam grade. One item score was significantly improved in the video group (p < .001), as was the score of the five questions combined (p < .001). As expected, overall practical exam scores were not statistically different. Student collaborators indicated that participation reinforced their knowledge while enhancing their professional development. Student collaboration was a beneficial strategy for instructional support development that positively impacted student affect and also generated opportunities for the involved students' professional growth.

A Novel Three-Dimensional Interactive Virtual Face to Facilitate Facial Anatomy Teaching Using Microsoft HoloLens.

BACKGROUND: In-depth understanding of facial anatomy is the foundation of clinical education and practices. Lately, anatomy education has undergone many changes due to the adoption of integrated medical curriculums. The time allocated to anatomy teaching on occasion been shortened to allow more time for clinical education. Innovation in visual technology such as virtual reality (VR), augmented reality (AR) and mixed reality (MR) has added a new dimension to anatomy education. The authors present a mixed reality virtual face model to facilitate complex anatomy teaching using Microsoft HoloLens in various educational settings. MATERIALS AND METHODS: Close-range photogrammetry technique was utilised to construct a virtual face using a dissected fresh-frozen cephalus. Scanning was undertaken using DSLR cameras, capable of capturing ten frames per second, in ten different angles on the dissected side and four for the undissected side. The images of the entire cephalous were also separately captured in twenty different angles. These images were processed using software to reconstruct the three-dimensional virtual face. RESULT: The virtual face using a mixed reality platform was able to demonstrate individual layers of the face and relevant clinically significant structures clearly with interactive labelling. Face and the content validity by 12 experts (plastic surgeons and dermatologists) demonstrated strong inter-rater reliability expressed as interclass correlation coefficient. CONCLUSION: An immersive experience by using Microsoft HoloLens provides an accurate 3D perception of the face to enhance anatomy learning. This can be utilised in undergraduate, postgraduate and continued medical education as an additional teaching tool in the constraints of cadaveric dissection. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The additional role of virtual to traditional dissection in teaching anatomy: a randomised controlled trial.

INTRODUCTION: Anatomy has traditionally been taught via dissection and didactic lectures. The rising prevalence of informatics plays an increasingly important role in medical education. It is hypothesized that virtual dissection can express added value to the traditional one. METHODS: Second-year medical students were randomised to study anatomical structures by virtual dissection (intervention) or textbooks (controls), according to the CONSORT guidelines. Subsequently, they applied to the corresponding gross dissection, with a final test on their anatomical knowledge. Univariate analysis and multivariable binary logistic regression were performed. RESULTS: The rate of completed tests was 76.7%. Better overall test performance was detected for the group that applied to the virtual dissection (OR 3.75 with 95% CI 0.91-15.49; p = 0.06). A comparable performance between groups in basic anatomical knowledge (p 0.45 to 0.92) but not muscles and 2D-3D reporting of anatomical structures was found, for which the virtual dissection was of tendential benefit (p 0.08 to 0.13). Medical students who applied to the virtual dissection were over three times more likely to report a positive outcome at the post-dissection test than those who applied to textbooks of topographical anatomy. This would be of benefit with particular reference to the understanding of 2D-3D spatial relationships between anatomical structures. CONCLUSION: The combination of virtual to traditional gross dissection resulted in a significant improvement of second-year medical students' learning outcomes. It could be of help in maximizing the impact of practical dissection, overcoming the contraction of economic resources, and the shortage of available bodies.

Zygomaticus major muscle bony attachment site: a Thiel-embalmed cadaver study.

OBJECTIVE: Thezygomaticus major is a principal muscle of facial expression which is engaged when smiling. The zygomaticus major origin of the zygomatic bone is often discussed relevant to its importance in the field of plastic surgery. In addition, the zygomaticus major attachment site is also significant for forensic craniofacial reconstruction, separating the cheek into frontal and lateral surfaces. However, there are discrepancies amongst published articles regarding the precise origin of the zygomaticus major muscle. The aim of this study is to investigate more distinctive and palpable landmarks as the bony attachment of the zygomaticus major. METHODS: This project is the first zygomaticus major dissection study utilising Thiel embalmed cadavers. Fifty-two facial dissections were investigated in 26 Thiel embalmed bodies, bequeathed to the Centre for Anatomy and Human Identification at The University of Dundee between 2013 and 2015. RESULTS: This study found that the origin of zygomaticus major muscle was located at the superior margin of the temporal process on the lateral surface of zygomatic bone. Moreover, the zygomaticus major muscle overlapped the anterosuperior border of the masseter muscle. One out of 52 zygomaticus major muscles presented bifurcation. CONCLUSION: The origin site of zygomaticus major is considered important to increase resemblance in forensic craniofacial reconstruction. Furthermore, since zygomaticus major is a salient muscle involved in facial expression, the potential effects for cosmetic/surgical procedures are also relevant to the medical field and successful surgical outcomes. The current study provided easily palpable landmarks of zygomaticus major origin site which is beneficial for both surgeons and forensic craniofacial reconstruction practitioners.

Post-COVID-19 pandemic: Standard operating procedures for gross anatomy laboratory in the new standard.

The culture of cadaver dissection remains the most commonly used method of practical teaching and learning of human anatomy. Anatomist and medical professionals considered cadaver dissection as the gold standard for teaching and learning anatomy in detail. The increase seen in the establishment of new medical training institutions globally has consequently led to a proportionate increase in the sourcing for cadavers. Moreover, the surge in mortality rates following the recent coronavirus disease 2019 (COVID-19) pandemic with no cure or approved vaccine has been a source of concern for academia, especially on the safety in the usage of cadavers for dissection. Notwithstanding, several countries continue to depend on unclaimed bodies as the primary source for cadavers, regardless of the cause of death. Besides, body donation is also usually reported to be strained during disease outbreaks thereby putting countries that depend solely on it in a dilemma. This study highlighted the recommended standard operating procedures (SOPs) to be imbibed in gross anatomy dissection halls during and post-COVID-19 pandemic.

EANS Basic Brain Course (ABC): combining simulation to cadaver lab for a new concept of neurosurgical training.

BACKGROUND: Neurosurgical training has traditionally been based on an apprenticeship model that requires considerable time and exposure to surgeries. Unfortunately, nowadays these requirements are hampered by several limitations (e.g., decreased caseload, worktime restrictions). Furthermore, teaching methods vary among residency programs due to cultural differences, monetary restrictions, and infrastructure conditions, with the possible consequence of jeopardizing residents' training. METHODS: The EANS Basic Brain Course originated from a collaboration between the Besta NeuroSim Center in Milano and the Swiss Foundation for Innovation and Training in Surgery in Geneva. It was held for 5 neurosurgical residents (PGY1-3) who participated to this first pilot experience in January 2019. The main goal was to cover the very basic aspects of cranial surgery, including both technical and non-technical skills. The course was developed in modules, starting from the diagnostic paths and communication with patients (played by professional actors), then moving to practical simulation sessions, rapid theoretical lessons, and discussions based on real cases and critical ethical aspects. At the end, the candidates had cadaver lab sessions in which they practiced basic emergency procedures and craniotomies. The interaction between the participants and the faculties was created and maintained using role plays that smoothly improved the cooperation during debriefs and discussions, thus making the sessions exceedingly involving. RESULTS: At the end of the course, every trainee was able to complete the course curriculum and all the participants expressed their appreciation for this innovative format, with a particular emphasis on the time spent learning non-technical skills, confirming that they feel this to be a fundamental aspect of a comprehensive training in neurosurgery. CONCLUSIONS: It is possible that this combined concept of training on technical and non-technical skills, using emerging technologies along with pedagogic techniques and cadaver dissection, may become the state-of-the-art for European Neurosurgical training programs in the next future.

Strategies to overcome limitations in Otolaryngology residency training during the COVID-19 pandemic.

PURPOSE: The COVID-19 pandemic has produced an unequaled human crisis forcing a radical reorganization in the healthcare system. Otolaryngologists are at high risk of exposure, and changes in medical and surgical activities have reduced the learning opportunity for residents and fellows. We believe that even during COVID-19 crisis it is mandatory to guarantee an optimal training, and here, we propose some strategies, based on our experience, to further increase our trainees' learning curve. METHODS: We asked our trainees to fill out an electronic survey about several aspect of their training: a first section focused on the reduction of clinical activities and the perceived impact of the pandemic on residents' skills; the second part outlined the type of attended training activity and the perceived benefit. RESULTS: Surgical training has been reported by our residents as the activity perceived to be the most contracted during the pandemic. According to residents' opinion the most useful activities were dissection (n = 8, 53.4% residents) and online journal clubs/webinars (n = 7, 46.6% of residents). Residents' suggestions included actively participating to tracheostomy procedures on SARS-CoV-2 positive patients, attending lessons held by senior consultants on basic ENT topics and promoting collegial discussion of inpatient clinical cases. CONCLUSION: Building on this dramatic experience, we must be ready for a global restructuring of the residency program to provide an adequate trainee education for the future surgeons.

Brunetti's chisels in anterior and posterior rachiotomy.

Rachiotomy entails vertebral surgical incision, generally followed by exposure of the spinal cord, and is performed primarily for educational, research, or medicolegal purposes. Over time, several tools have been developed for this procedure, but Lodovico Brunetti designed the first effective prototypes in the mid-nineteenth century. To show the technical details of and the necessary maneuvers to be performed for Brunetti's rachiotomies to succeed, a computer-aided systematic literature review of online databases was performed to identify publications concerning Brunetti's chisels used for rachiotomy. Additional references from the studies and treatises included held in the Historical Section of the Medical Library at the University of Padova were checked manually for pertinent information. The known variants of Brunetti's chisels were reported in detail from the first to the third versions produced and intended for both posterior (first and third prototypes) and anterior (second prototype) vertebral dissection. Further evolution that led to the current commercialized model devoted to posterior use also was described. The models' strengths and weaknesses were assessed, as well as the nature of the changes Brunetti introduced over time and their motivation. In conclusion, these tools could represent an alternative to the use of electric saws, particularly for dissectors who prefer to have greater manual control in incising the vertebrae. Clin. Anat. 33:355-364, 2020. © 2019 Wiley Periodicals, Inc.

Emotional response of undergraduates to cadaver dissection.

The most effective way to learn human anatomy is through cadaver dissection. Historically, cadaver dissection has been the provenance of professional schools. Increasingly, cadaver-based courses in human anatomy are shifting to the undergraduate level, which creates both problems and opportunities because of differences between undergraduate and graduate student populations. Anxiety associated with dissecting cadavers can create a barrier to learning, and ultimately, entry into the health and medical sciences for some demographic subpopulations of undergraduates. We surveyed 76 students in 2007 and 51 students in 2009 at four times in the semester to investigate the timing and sociodemographic predictors of anxiety over cadaver dissection. We followed this with a second survey of 44 students in 2014 to test the effect of humanization of cadaver donors (providing information about donor occupation and cause of death) to reduce student anxiety. Students experienced anxiety upon first exposure to cadaver dissection. Female students experienced greater anxiety than male students upon first exposure to cadavers but this effect was short-lived. Self-identified non-white, non-Christian students experienced sustained anxiety throughout the semester, likely because cadaver stress compounded social and financial stressors unique to international students. Humanization was effective in reducing anxiety in non-white, non-Christian students but had the unexpected effect of increasing anxiety in female students. We recommend that humanizing information be offered to students who seek it out, but not forced upon students for whom the information would only add to their stress. Clin. Anat. 31:224-230, 2018. © 2017 Wiley Periodicals, Inc.

Cadaver Dissection Is Obsolete in Medical Training! A Misinterpreted Notion.

Cadaver dissection (CD) is considered a tool for studying the structural details of the human body. Lately, conflicting opinions regarding the utility of this modality in medical training have been published in medical literature. This review of the literature examines the status of anatomy teaching with CD in traditional, modern, and postgraduate medical training across the world. Literature published in the En-glish language on topics related to CD in the past 3 decades was scrutinized using different search engines. About 200 full texts were reviewed. We describe how medical schools have continued to include CD in anatomy teaching in the traditional or modified form. Medical schools that stopped or decreased CD have learnt from their experiences, and have restarted it in modified forms by integrating it vertically with medical training. In addition, CD activities have increased in postgraduate anatomy courses, surgery training, and voluntary/optional CD programs. CD, when integrated vertically, still has a part to play in medical training in modified ways. This overview may help curriculum designers to place CD in medical curricula and training programs in a justified manner.

Lymphosome concept: Anatomical study of the lymphatic system.

The gross anatomical study of the lymphatic system in humans and animals has been suspended for almost 100 years. This article introduces the author's technique for investigating the lymphatic system using the concept of the lymphosome. In revisiting the anatomical study of the lymphatic system, our updated knowledge can potentially be utilized either to reassure surgeons about their current procedures in the surgical management of cancers and lymphedema or assist them to refine them. J. Surg. Oncol. 2017;115:13-17. © 2016 Wiley Periodicals, Inc.

Soft embalming of cadavers for training purposes: Optimising for long-term use in tropical weather.

BACKGROUND: Surgical and anatomical training has been found to be most optimally simulated in a cadaver than any other available methods. Soft embalming methods have made the bodies more 'lifelike' and better suited for training. The widely accepted soft embalming techniques, including Thiel embalming, are designed for temperate climates. Their use in tropical locations has been found to be associated with poor short-term and long-term preservation of the bodies. In fact, adequate reports from tropical countries on effective methods for soft embalming are lacking. MATERIALS AND METHODS: This article details the modifications made in the Thiel embalming technique over a period of 2 years which has enabled us to preserve the anatomical features of bodies in an optimal way for longer periods in tropical conditions. This study was carried out in a tertiary care referral centre located in a tropical climate zone. A total of 13 frozen and thawed cadavers were used over a period of 2 years for developing such soft embalming technique. The efficacy of the technique was tested using these cadavers for varying types of surgical exercises on multiple occasions. RESULTS: The conventionally described technique of Thiel embalming did not provide desired results. Hence, various modifications to this technique were instituted which helped us to get superior quality of soft-embalmed cadavers. In the final year, these cadavers were used successfully for workshops in flap dissection. Head and neck access surgery, arthroscopic and laparoscopic procedures as well as mock face and hand transplant dissections. CONCLUSIONS: The Theil embalming technique for obtaining soft embalmed cadavers, even though found to be best in many centres in the world, has not been found to be suitable to tropical weather. By modifying it, we have succeeded in developing a technique suitable to the tropical weather. This technique yields cadavers suitable for various surgical simulation exercises. This technique also allows the body to be optimally used over several months in multiple occasions. These modifications are very simple and have been described in detail enabling it to be adopted by any surgical skill laboratory in the tropical countries.

Plastination in Anatomy Learning: An Experience at Cambridge University.

Due to lack of objective data, the benefits of using plastination in combination with wet dissection in teaching gross anatomy are unknown. The aim of this study was to obtain objective evidence from students regarding the effectiveness of combining plastinated specimens (PS) with an established gross anatomy education program at Cambridge University that uses wet cadaver dissection and small-group tutorials. For a complete academic year, a total of 135 PS were used alongside wet cadaver dissections. The PS were also available for small-group tutorials. An anonymous closed questionnaire, using a 5-point numerical-estimation Likert scale, was used to gather information relating to the effectiveness of the PS. The level of student satisfaction with the combined use of wet dissections and PS was high, although higher (p<.05) for second-year students (98.4%) than for first-year students (95.5%). Students felt the specimens allowed them to see details that were often more difficult to identify in their dissections, for instance nerves. Voluntary use of PS was higher (p<.01) for second-year students (96.9%), who had previously experienced anatomy teaching with cadaver dissection alone, than for first-year students (77.7%). Overall, 97.7% of all students thought that the PS helped them understand and learn anatomy. All students surveyed (100%) recommended the use of PS in the future. Students considered the use of PS in the dissection room combined with wet cadaver dissection to be beneficial when learning anatomy, particularly when combined with their use during small-group tutorials.

Complementing anatomy education using three-dimensional anatomy mobile software applications on tablet computers.

Anatomy has traditionally been a cornerstone of medical education, which has been taught via dissection and didactic lectures. The rising prevalence of mobile tablet technology means medical software applications ("apps") play an increasingly important role in medical education. The applications highlighted in this article will aid anatomical educators to identify which are the most useful in clinical, academic, and educational environments. These have been systematically identified by downloading all applications with keywords related to anatomy and then carrying out qualitative assessment. Novel anatomy applications from developers such as Visible Body, 3D4Medical, and Pocket Anatomy allow students to visualize and manipulate complex anatomical structures using detailed 3D models. They often contain additional content including clinical correlations and a range of media from instructional videos to interactive quiz functions. The strength of tablet technology lies in its ability to consolidate and present anatomical information to the user in the most appropriate manner for their learning style. The only question mark remains over the level of detail and accuracy of these applications. Innovative medical educators who embrace tablet technology will find that anatomy applications serve as a useful learning tool when used in conjunction with existing teaching setups.

Support for whole-body donation among educational staff in Southwestern Ugandan medical educational schools.

BACKGROUND: The teaching of anatomy from early days of medical education relied on the use of cadaver; hence, the present study assessed the support for whole-body donation among academic staff. METHODS: This is a cross-sectional study conducted from January to March 2024 in Southwestern Ugandan medical educational schools among 160 academic staff. Ethical approval was obtained and structured questionnaires were distributed to study participants in the selected Medical Educational Schools. RESULTS: Among the 160 sampled academic staff, only 16 % and 18 % supported the donation of their whole-body and the bodies of their relatives/friends for anatomical education respectively. The reason put forward for respondents support for whole-body donation were contribution to medical science (88.5 %) and learnt from someone's body (53.8 %). The fear of misuse of their body (42.5 %), cultural (53.7 %) and religious (44.8 %) belief were the reasons for non-support for whole-body donation among the study participants. CONCLUSION: This study concluded that support for whole-body donation among academic staff was low; reasons for non-support were fear of misuse of body, religious and cultural beliefs; hence, we recommend the need for massive desensitization of the public aimed at building confidence on whole-body donation in the community.

Cadaver Dissection Experience for First-Time Dissectors: a Hypothetical Three-Pronged Approach for Student Preparation.

This systematic review synthesized evidence for the development of a preparatory process for first-time dissectors, geared toward improving cadaver dissection (CD) experiences. Eleven studies focused on pre-CD intervention were selected from a literature search in PubMed, the Education Resources Information Centre (ERIC), Google Scholar, PsycNET, and the Cochrane Library. A three-pronged preparatory process was formulated for first-time dissectors based on the evidence from the review. The process includes (1) background assessment; (2) pre-CD education; and (3) gradual exposure and desensitization. The preparatory process shows some hypothetical potential for decreasing negative CD-related experiences, but it still needs validation before implementation.

Selecting the diameter of a radial head implant: an assessment of local landmarks.

INTRODUCTION: Little information exists on radial head implant diameter sizing methods. When the native head is absent due to extensive comminution or previous excision, the lesser sigmoid notch may be a useful landmark for sizing. We evaluated the reliability of native radial head measurements, and the lesser sigmoid notch, as landmarks for radial head implant diameter sizing. METHODS: We examined 27 fresh frozen ulnae and their corresponding radial heads. The maximum, minimum, and dish diameters of the radial heads were measured. A radial head implant diameter was selected based on the congruency of the trial implants with the radius of curvature of the lesser sigmoid notch. Intraobserver and interobserver reliability for all measurements and implant selection were assessed using intraclass correlation coefficients (ICC). Correlations between the native radial head measurements and the selected radial head implant diameter or the lesser sigmoid notch radius of curvature were assessed using the Pearson correlation coefficient (PCC). RESULTS: Radial head diameter measurements demonstrated strong to excellent intraobserver (ICC ≥ 0.75) and interobserver reliability (ICC ≥ 0.82). The lesser sigmoid notch sizing method showed poor interobserver reliability (ICC = 0.34). Only a moderate correlation was found between the native radial head and the lesser sigmoid notch (PCC ≤ 0.80) or the selected radial head implant size (PCC ≤ 0.59). CONCLUSION: Radial head diameter measurements showed excellent reliability, suggesting that the excised radial head, when available, should be used to select the implant diameter. The reliability of using the lesser sigmoid notch for sizing the diameter of radial head implants was only moderate, suggesting this is an unreliable landmark for implant diameter sizing.

Prediction of the location of the anterior branch of the axillary nerve, using correlations with physical factors: a cadaveric study.

BACKGROUND: Although axillary nerve injury is a catastrophic surgical complication, there is little data for precise prediction of the location of that nerve's anterior branch. To address that, the authors searched for a useful correlation between the acromion-axillary nerve distance (AAND) and one or more physical factors. METHODS: The heights, humeral lengths, AAND, and axillary nerve indexes (ANI: ratio between AAND and humeral length) of 25 male and 20 female cadavers were determined. Any gender differences in the mean measurements were determined. The correlations of each AAND with height, humeral length, and ANI were determined. The authors determined that using the ANI and the humeral length allowed the shortest prediction of the AAND. RESULTS: The mean AAND, cadaver height, and humeral length were 6.5 ± 0.8, 164.9 ± 10.0, and 33.5 ± 2.7 cm, respectively. An independent t test revealed significant gender differences in the mean AAND (P = .003), height (P = .000), and humeral length (P = .000), but not in the mean ANI (P = .564). The Pearson coefficients for the associations of the AAND with height (r = .767), humeral length (r = .797) and ANI (r = .732) demonstrated strong correlations (P < .001), especially with humeral length. The use of the ANI with the humeral length yielded the shortest predictions of AAND, with a 97.8% probability of safety. CONCLUSION: There is a strong correlation between AAND and humeral length. In clinical practice, humeral length and ANI are useful for predicting the location of the anterior branch of the axillary nerve, when the arm is positioned at the side in neutral rotation.