INTRODUCTIONThe brachial plexus is a complex network of nerves which extends from the neck to the axilla and supplies motor, sensory and sympathetic fibres to the upper extremity.The brachial plexus is formed by platuing of ventral rami of the lower four cervical and the first thoracic nerves.The plexus extends from the inferior lateral portion of the neck downward and laterally over the first rib, posterior to the clavicle and enters the axilla. The brachial plexus is divided into supraclavicular part and infraclavicular part. The infraclavicular part consists of three cords-lateral, medial and posterior. The posterior cord runs posterior to the second part of the axillary artery behind the pectoralis minor muscle and gives off the following branchesupper subscapular nerve, thoracodorsal nerve, lower ABSTRACTBackground: Purpose of current study was to describe the variations in the origin of the thoracodorsal nerve of the posterior cord of brachial plexus and its distance of origin from mid-clavicular point in the South Indian population. These variations are important during surgical approaches to the axilla and upper arm, administration of anesthetic blocks, interpreting effects of nervous compressions and in repair of plexus injuries. The patterns of branching show population differences. Data from the South Indian population is scarce. Methods: Forty brachial plexuses from twenty formalin fixed cadavers were explored by gross dissection. Origin and order of branching of axillary nerve and its distance of origin from mid-clavicular point was recorded. Representative photographs were then taken using a digital camera (Sony Cybershot R, W200, 7.2 Megapixels). Results: In forty specimens studied, 72.5% of thoracodorsal nerves originated from posterior cord, which was predominant (75%) on the left side, 15% arose from axillary nerve which was observed in 20% of the right sided specimens and 12.5% had origin from the common trunk which was significant (15%) on the left side. In 32.5% of specimens, thoracodorsal nerve had origin at a distance of 4.1-4.5 cm, in 32.5% at a distance of 4.6-5.0 cm, in 17.5% at a distance of 5.1-5.5 cm, in 12.5% at a distance of 3.6-4.0 cm and in 5% at a distance of t more than 5.5 cm from mid-clavicular point. Conclusion: Majority of thoracodorsal nerves in studied population display a wide range of variations. Significant number of thoracodorsal nerve also takes origin from axillary nerve and from common trunk at various distances from a fixed point. Anesthesiologists administering local anesthetic blocks, clinicians interpreting effects of nerve injuries of the upper limb and surgeons operating in the axilla should be aware of these patterns to avoid inadvertent injury and this study provide the necessary insight into the branching pattern of the thoracodorsal nerve and its distance of origin. Further study of the origin of thoracodorsal nerve of posterior cord of brachial plexus and its distance of origin from mid-clavicular point is recommended
Introduction: On the side of skull bone in both sides there is a significant area Pterion which acts as a landmark in neurological surgeries. All four bones meet here at this H-shaped sutural junction. Knowledge of various types of pterions and position is important in neurosurgeries, interpretation of radiographs and in forensic medicine. Aim: To analyse the morphometry of pterion and its relation with nearest branch of Middle Meningeal Artery (MMA) in dry human skulls of Davangere, Karnataka, India. Materials and Methods: The present cross-sectional study was conducted on 100 adult dry human skull bones, 200 pterions at Shamnur Shivashankarappa Institute of Medical Sciences and Research Centre, Davangere, Karnataka, India for a period of one year October 2017 to September 2018. Murphy’s classification was used for the type of pterion. Mean distance between centre of pterion to different bony landmarks on external as well as internal aspects of skull on both sides was measured. Unpaired t-test was employed to analyse the data. The p-value of <0.05 was taken as statistically significant. Results: Sphenoparietal 161 (80.5%) type of pterion was found to be the commonest followed by epipteric 20 (10%), stellate 10 (5%) and frontotemporal 9 (4.5%). Mean distance between the pterion and point nearest to branch of MMA was 2.39 mm on the right-side and 2.19 mm on the left-side of the skull with significant difference. Conclusion: It can be concluded that sphenoparietal type is the commonest type followed by epipteric, stellate and frontotemporal type. No difference was found between right and left-side pterions in type or its relations to bony landmarks.
Background: The humerus forms the longest bone of appendicular skeleton of upper limb. The nutrient arteries form major blood supply to the long bones, which enters the bone through the nutrient foramina. Materials and Methods: The present study was undertaken on 200 dry normal adult humerus bone obtained from the Department of Anatomy, SSIMS & RC, Davangere. 100 humeri belong to right and 100 belong to left side. Results: After the completion of this particular study on the vascular foramina, especially the nutrient foramina on 200 dry humeri, it was able to arrive at following conclusions: Among the segments, upper end shows maximum density of vascular foramina indicating the highest intensity of blood supply. The shaft being, supplied mainly by nutrient artery, the location and direction of nutrient foramina was thus important to find out. The position of nutrient foramina in most cases is found to be in the middle 1/3 rd of the anteromedial surface of the shaft and the direction of nutrient foramina was towards the elbow. Middle 1/3 rd of anteromedial surface is more vulnerable to surgical or traumatic injuries that may damage nutrient artery, thus highlights its significance. Discussion and Conclusion: Nutrient foramina plays vital role in nutrition and growth of the bones. Majority of the nutrient arteries follow the rule, 'to the elbow I go, from the knee I flee' but they are very variable in position. Their number, location, direction & its importance in the growing end of long bones were studied in the long bones of upper limb. The present study has variations in the position & direction. The study of nutrient foramina is important for surgeons operating on humerus, it is not only of academic interest but also in medico-legal practice in relation to their position. The present study also emphasizes importance of length of humerus. With the observation and information of variations in the vascular foramen, placement of both external and internal fixation devices on humerus can be appropriately done.
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