Abstract Background: Assessment in anatomy education requires focus on visual understanding and practical medical applications. The evaluation of essential clinical reasoning abilities through visualization and higher-order cognitive and visual-spatial skills remains unaddressed by traditional text-based MCQs. Image-Based MCQ (IB-MCQs) is more authentic evaluation approach which is aligned with competency-based assessment. The present study evaluated the feasibility, perception and effectiveness of IB-MCQs as a formative assessment tool for Phase-I MBBS students in Anatomy through different platforms. Methodology: The study was conducted after ethical approval and used a mixed-methods approach. The assessment included 250 students who completed traditional MCQs and IB-MCQs through different platforms which included large screens and smart TVs and Google Forms, LMS. Statistical analysis used: The research used quantitative methods to analyze performance results while students and faculty members provided qualitative feedback about feasibility, usability and educational value. Results: Students achieved better results in IB-MCQs when using large-screen and Smart-TV platforms according to statistical analysis ( p < 0.001, Cohen’s d = 0.8–1.1) which suggests better visualization abilities and conceptual knowledge. The performance of students decreased when they used mobile devices because of technical issues with the interface. The majority of students (87%) preferred IB-MCQs as assessment method because they found it more engaging and helpful for spatial learning. Conclusions: IB-MCQs enables students to learn visually while thinking critically develop application skills and analytical thinking abilities however, their effectiveness may be influenced by the testing platform, technical infrastructure, and logistics.
A 32-year-old male with axial spondyloarthritis presented with chronic lower back pain for the last 4 years, with concomitant involvement of costovertebral (CV) and costotransverse (CTR) joints, manifesting as restricted spinal movement, eventually progressing to requiring support for sitting and standing. The laboratory parameters revealed elevated inflammatory markers, positive human leukocyte antigen B27, hypercalcemia and low parathyroid hormone level. On computed tomography (CT), there was extensive erosion, sclerosis and ankylosis of CV and CTR joints with concomitant ankylosis of facet and sacroiliac joints and syndesmophyte formation. Magnetic resonance imaging confirmed an ill-defined hyperintense abnormality at the CV and CTR joints, suggesting active inflammatory changes. The patient is undergoing treatment with physiotherapy and supportive medication and has shown improvement. This case report highlights that joint involvement of the CV and CTR contributes to morbidity, as these joints are critical to the mobility of the spine and thoracic cage. This case also highlights challenges in assessing these joints on conventional radiography and the value of CT for assessing changes, thereby improving treatment and supportive care through a better understanding of disease extent and progression.
Introduction: Superior mesenteric artery (SMA) is the second visceral branch of the abdominal aorta, arising at the level of L1 vertebra in adults. Variations in its branching pattern can impact surgical and diagnostic interventions. High-resolution visualization of vascular anatomy by contrast-enhanced computed tomography (CECT) angiographic examination helps identify population-specific differences. The study aimed to evaluate the anatomical variations in the origin and branching pattern of the SMA in the adult Kashmiri population employing high-resolution CECT angiography. Methodology: This hospital-based observational study analyzed 200 eligible computed tomography angiograms of the abdomen patients referred to the department of radiodiagnosis and imaging fulfilling the inclusion criteria were included based on the predefined criteria. Systemic contrast (Omnipaque 350) injection was followed by high-resolution imaging to delineate the SMA and its branches with special emphasis on variation in origin and branching. Results: Significant variations included a common trunk for ileocolic and right colic arteries in 3% of cases, a celiomesenteric trunk in 4% of cases, early bifurcation of SMA into jejunal and ileal branches in 2% of cases, and origin of right hepatic artery from SMA in 1% of cases. Conclusion: Identification of vascular variations in Kashmiri patients is essential for accurate preoperative planning and minimizing surgical complications. This study enriches the angiographic literature and emphasizes the need for regional studies to optimize clinical outcomes. Routine angiographic evaluation should be incorporated into diagnostic protocols to enhance patient care in this population.
Background: Surgeons, radiologists, and anatomists come across various peritoneal folds while exploring the abdominal region. Hepatocystoduodenal and hepatocystocolic ligaments are two such peritoneal folds connecting the liver or gallbladder to the duodenum or colon, respectively. This current work is undertaken to find the prevalence of hepatocystoduodenal and hepatocystocolic ligaments in cadavers, their role in the development of the gut, and the association of other abnormalities of the gut with them. Methodology: This cross-sectional study was performed on 40 adult cadavers allotted for dissection classes of 1st-year MBBS students. During the dissection of the abdominal cavity, careful observation was done for the presence of hepatocystoduodenal and hepatocystocolic ligaments and any associated abnormality of the gut. Results: Hepatocystoduodenal and hepatocystocolic ligaments were found in 13 (32.5%) cadavers. Out of 13 cadavers, 4 had two such ligaments making the total number to be 17. The frequency of the cystocolic ligament was the highest, i.e., 7 of 17 (41.1%). In 11 (84.6%) cadavers, associated congenital abnormalities of the gut such as redundant transverse colon (5), mobile descending colon (2), fixed sigmoid colon (2), redundant sigmoid colon (1), and nonrotation (1) were found. In four cadavers, abnormalities of the gallbladder (3 floating and 1 hypotrophic) were associated. Hypotrophy of the left lobe in the liver, accessory liver lobe, pons hepatis, diaphragmatic sulci, and elongation of uncinate process of the pancreas were the other associated visceral abnormalities. Three cadavers had peritoneal bands at five different sites apart from these ligaments. Conclusion: The high prevalence and associated gut abnormalities in the current study urge the need for future research to establish the molecular origin of these ligaments.
Background: Evans index (EI) and bicaudate index (BCI) are two simplified linear indices that are widely used to assess brain ventricle measurement to diagnose hydrocephalus. The establishment of normal values of these indices plays a significant role in making early diagnosis of brain ventricle enlargement and analysing patterns of age- and sex-related changes. This study was done to establish baseline values of EI and BCI in adults attending a tertiary health care center and to evaluate their variation with age and sex. Methodology: A total of 84 patients, comprising 42 males and 42 females aged 16–75 years, were enrolled in this cross-sectional study, who underwent magnetic resonance imaging (MRI) brain for various indications and were found to be normal for age and gender. EI and BCI were measured on magnetic resonance images by using DICOM viewer 2024. Data were analyzed on SSP-22 for sex- and age-wise variation and correlation between indices. Results: Mean EI was 0.25 ± 0.017 in males and 0.24 ± 0.021 in females (P = 0.045). Mean BCI was 0.11 ± 0.014 in males and 0.09 ± 0.020 in females (P < 0.001). Both indices showed a progressive increase with age. A notable positive correlation was observed between the EI and BCI (R = 0.461, P < 0.001), most prominent in males in the age group 16–25 years. Conclusions: EI and BCI both increase with age and are markedly higher in males. Their strong correlation, particularly in young adult males, demonstrates their synergistic role in evaluating age-related and potentially pathological brain ventricle changes.
Background: Near-peer mentorship was associated with academic achievement and improved soft skills. Personal learning plans (PLPs) were structured tools of self-regulation to map individual learning needs and strategies. Thus, if near-peer mentor support was used to train junior medical students to use PLP, they could be guided toward skills of reflection, timekeeping, self-modulation, and improved scores at the start of medical education enabling them to grow into self-directed, life-long learners. Therefore, this study aimed to explore the impact of PLP among 1st-year medical students trained with near-peer mentor support. Methodology: This interventional study was conducted among 174 1st-year medical students of a medical college in India from 13 July, 2023 to August 2025. Cases and controls were selected by the simple randomization. Trained near-peer mentors were assigned to case group to assist them in PLP use for anatomy lectures for 6 months. Three assessments were taken. Academic scores were recorded. Students’ feedback was documented at the beginning and end of intervention. The collected data were analyzed using Python script. Results: Cases showed a statistically significant improvement (P < 0.0000) over control with large to very large effect sizes (Cohen’s d: 1.02–3.33) in later assessments. Postintervention feedback was positive, with agreement that PLPs were beneficial. Highest means were recorded for organizing the objectives and remembering goals (both 4.18), suggesting PLPs excelled in structuring learning. Conclusion: Near-peer mentor support was effective in eliciting improved academic performance and positive students’ perception in PLP program.
Background: Identification of sex from skeletonized remains is fundamental in forensics. In cases where bones may not be available, the use of hand anthropometry can offer important information. The fact that body proportions differ from one population to another necessitates standards in particular regions to ensure proper gender discrimination. The current study intends to establish differences in hand dimensions based on sex in North Karnataka region. Methodology: A cross-sectional study was conducted involving 400 adults, comprising 200 females and 200 males, aged 18–25 years, belonging to North Karnataka region. Hand length (HL), breadth, and indices were measured for both hands using standard anthropometric methods. Descriptive statistics, t-tests, and discriminant function analysis were performed. Results: Significant sexual dimorphism was found for all hand measurements (P < 0.001). Males exhibited larger dimensions than females across all parameters. Left HL demonstrated the highest individual classification accuracy (83.5%) with a minimal sex bias (1.0%). The multivariate discriminant function achieved an overall accuracy of 86.8% (cross-validated: 86.0%) with 88.0% sensitivity and 85.5% specificity. Conclusions: Hand measurements provide reliable sex estimation in adults from the North Karnataka region. The developed discriminant functions offer population-specific standards for forensic applications with an accuracy comparable to that of international studies.
Introduction: Hemifacial microsomia (HFM) is managed based on its classification, with treatment approaches according to severity. This study aims to assess the impact of autologous fat graft (AFG) administration in HFM patients with or without distraction osteogenesis (MDO). Methodology: The patients were sex and age-matched (mean age 5.8 ± 2.8 years) into two treatment groups: AFG-treated and MDO + AFG-treated and an untreated control group (mean age 5.8 ± 2.8 years), each with five patients. Computed tomography scans were used to measure the ramus height (MRH), ramus width (MRW), body length (MBL), body height (MBH), chin point deviation (CPD), and occlusal plane angle (OPA) across the three groups. Results: In the AFG-treated group, fat treatment resulted in significant increases in MRH (P = 0.04) and MRW (P = 0.01), along with significant decreases in CPD (P = 0.02) and OPA (P = 0.03), whereas the control group did not increase significantly. Similarly, in the MDO + AFG-treated group, fat treatment led to a significant increase in MBL (P = 0.02) and a significant decrease in OPA (P = 0.03), with no significant increase observed in the control group. The mean growth of AFG-treated MRH, MRW, and MBL increased, although not significantly, compared to the untreated group. In addition, the mean growth of MDO + AFG-treated MRH, MRW, MBL, and MBH did not increase significantly compared to the untreated group. Conclusion: AFG alone corrects major skeletal and soft tissue HFM deformities. It also supplements MDO, correcting residual MBL asymmetry and informing a new, function-based treatment algorithm. AFG is a valuable procedure in managing mild and severe HFM.
Introduction: Sphenoidal air sinuses (SSs) are paired, asymmetrical sinuses situated within the body of the sphenoid bone. SS is the most variable sinus morphologically, and the approach to this is challenging due to its location deep inside the skull base. SSs are closely related to vital structures such as the optic nerve, internal carotid artery, vidian nerve, maxillary nerve, cavernous sinus, and pituitary gland. Computed tomography delineates normal bony and soft tissue structures with increased clarity. The study aimed to analyze the anatomical variations of SS. Methodology: A total of 280 paranasal air sinus computed tomographic scan records of patients who were referred to evaluate paranasal air sinuses during the period 2016–2023 at Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, were analyzed for variations of SS. Results: In the present study,we observed SS septations in 24.28% of records. Regarding SS pneumatization patterns, the sellar type was the most common on the right side (51.8%), whereas on the left side, it was the post sellar type (46.1%). The extension of pneumatization into the anterior clinoid process, pterygoid plates, and dorsum sellae was observed in 15%, 15%, and 2.5%, respectively. With reference to the Delano classification, in our study, we observed that Type I was the most common type on both the sides. Conclusion: Radiologists and surgeons benefit greatly from the advancements in imaging systems because they may accurately identify the anatomical variations of the paranasal air sinuses and design surgical procedures and proceed accordingly.
Background: Three-dimensional (3D) visualization tools such as 3D Slicer are revolutionizing the field of anatomical education in medicine. Conventional teaching of anatomy includes cadaveric dissection and two-dimensional imaging. Often, these methods are incapable of depicting anatomical complexity in space. Using computed tomography or magnetic resonance imaging, 3D Slicer has reconstruction capabilities that allow anatomical reconstruction in a learning setting. Implementation of this new modality in anatomical learning has immense benefits. The aim of this research is to ascertain the efficiency of 3D Slicer as a tutoring aid for students and to analyze its use for increasing conceptual knowledge of anatomy as well as an understanding of applied aspects of radiology. Methodology: A cohort of undergraduate students will be provided with 3D Slicer training in a structured workshop setting conducted by faculty members in the radiology department. Student learning outcomes will be assessed through pre- and postintervention questionnaires, objective structured practical examinations, and Likert scale feedback on usability and satisfaction. Qualitative analysis of student reflections will complement quantitative assessment. Statistical tests will evaluate the differences in performance before and after the intervention. Results: The findings indicate a significant improvement in the understanding of spatial concepts, knowledge of anatomy and its localization, and the ability to correlate imaging with gross anatomy concepts by the learners. The learners have a high level of engagement and enjoy positive responses indicating the benefits of the approach in terms of interaction and visualizing concepts compared to textbooks. Conclusion: 3D Slicer is an important supplement to anatomy education by filling the gap between conventional and advanced learning methods. Integrating such open-source software into a learning program achieves greater insight into anatomy and improves the skill of clinical correlation with advanced training for the future of image-assisted diagnostic and therapeutic work.
Background: The recurrent artery of Heubner (RAH) is one of the prominent medial lenticulostriate arteries. RAH takes its origin in close proximity to the anterior cerebral artery (ACA)–anterior communicating artery (ACoA) junction. RAH supplies the medial part of the orbitofrontal cortex, corpus striatum, olfactory region, anterior limb of the internal capsule, and anterior hypothalamus. Involvement of RAH in pathological conditions such as atheroma may result in serious complications such as hemiparesis, aphasia, facial paralysis, and behavior changes. Surgical interventions performed on the anterior circle of Willis (CW) can be affected/complicated by the morphology of RAH. Hence, it is important to know the anatomical variations of the origin of RAH. Methodology: In the present study, 60 formalin-fixed cerebral hemispheres were superficially dissected. The origin of RAH from various segments of ACA such as A1, A2, and A1-ACoA junction was noted. Results: RAH was identified in 16 out of 60 hemispheres. It arose from the A1 segment in 1 specimen (6.25%), A1-ACoA junction in 11 specimens (68.75%), and A2 segment in 4 specimens (25%). RAH was seen unilaterally in 8 specimens and bilaterally in 4 specimens. The bilateral origin of RAH was seen as symmetrical as well as asymmetrical. Conclusion: Knowledge of RAH is important to prevent postoperative neurological deficits during neurosurgical procedures that are performed close to the anterior segment of CW.
Background: Morphometric analysis of the glenoid fossa is crucial for understanding shoulder biomechanics, guiding orthopedic procedures, and designing population-specific implants. Accurate anatomical data can improve prosthesis fit and reduce surgical complications. This study aimed to evaluate glenoid fossa dimensions in the adult Indian population using computed tomography (CT). Methodology: This retrospective observational cross-sectional study reviewed CT thorax or HRCT thorax scans of 100 adults without shoulder pathology. Scans with deformities, prior shoulder surgeries, fractures, or scapular abnormalities were excluded from the study. Standardized CT measurements included: Glenoid length (SI), glenoid width (AP1), width at notch level (AP2), depth (DGC) circumferenece (PGC), and glenoid cavity index (GCI). Descriptive statistics and comparative analyses for sex and side differences were performed. Results: A total of 100 glenoid fossae were analyzed (age range 18–90 years). Mean SI was 33.9 mm, AP1 was 22.87 mm, AP2 was 17.11 mm, DGC was 1.57 mm, PGC was 116.9 mm, and GCI was 67.32. Males showed significantly larger dimensions than females (P < 0.01). No clinically significant sex-based differences were observed for SI, AP1, AP2, DGC, or GCI. However, a significant side difference was noted for PGC. Conclusion: This study provides baseline CT-based morphometric data on the glenoid fossa in the adult Indian population. Recognizing sex-based and side-specific variations is important for surgical planning and implant design to improve clinical outcomes.
Background: Medical Artificial Intelligence Readiness Scale for Medical Students (MAIRS-MS) is a scale developed in Turkey to measure artificial intelligence (AI) readiness among undergraduate medical students. This scale warrants stringent revalidation in different educational and cultural contexts. The study aimed to reassess the psychometric properties and applicability of the MAIRS-MS instrument in undergraduate medical education in India. Methodology: This study, conducted at a Central Indian medical college, employed a mixed-methods design and included 482 undergraduate medical students across different phases of the MBBS curriculum. The MAIRS-MS is a 22-item questionnaire with dimensions of cognition, ability, vision, and ethics. The analysis was performed on internal consistency using Cronbach’s alpha. The analysis for construct validity was performed using Pearson’s correlation. Thematic analysis was conducted on the qualitative insights resulting from the focus group discussions (FGDs). Results: The instrument demonstrated strong internal consistency across domains, with Cronbach’s alpha coefficients of 0.865 for cognition, 0.879 for ability, 0.763 for vision, and 0.812 for ethics; the overall scale demonstrated excellent reliability with an alpha of 0.923. Item-total correlations of all items were found to be significant (P < 0.01). The FGDs showed enthusiasm for AI with notable gaps in ethical and legal understanding with unanimous recommendation for its introduction in the curriculum. Conclusion: The MAIRS-MS scale demonstrates robust psychometric properties within the Indian context and is a valid instrument for evaluating AI readiness in medical students. These findings support the structured incorporation of AI education into the undergraduate medical curriculum.
Context: Medical students require a strong knowledge in Anatomy with clinical sense before exposure to real patients. Case-based learning, in which trained volunteers are used as standardized patients, can fill the void between theory and practical experience under controlled conditions. Methodology: A cross-sectional educational interventional study was performed among 149 first year medical students. Two case-based learning exercises for the Upper limb and Abdomen were conducted following lectures. The standardized patient role was played by prepared volunteers in a small group with guided discussion and debriefing after the session. Pre-post test scores were used to assess knowledge gain using paired t-tests and Wilcoxon signed-rank tests. Cohen’s d was used to calculate effect sizes, validated questionnaires on students’ and lecturers’ perceptions of knowledge retention, clinical reasoning and communication skills were descriptively analysed. Results: The paired-samples t-test indicated a statistically significant improvement in post-test means (p < 0.01). 90–95% of the students selected this option in order to better retain knowledge, correlate this information with surgery training, enhance clinical reasoning and communicate more effectively with patients. It also promoted active group discussion, deep-level study motivation and greater teacher-student interaction. Faculty (80–100%) agreed that it encourages conceptual understanding, though 60% felt there was increased work in module development and training. Conclusion: Using standardized patient in case-based learning is an effective tool of teaching Anatomy for enhancement of critical thinking and communication skills. Implementation of this mode into the medical training program is possible as long as enough staff train in it and other departments lend their support.
Background: The maxillary sinuses (MSs) frequently exhibit preservation, even in the presence of substantial cranial and other skeletal deformities. Measurements of MS length, width, height, and volume are not only important anatomical features during surgical planning but also play a key role in forensic anthropology, aiding in the identification of individuals, particularly when other skeletal traits are damaged or missing. This research aimed to assess the morphometric features differences in MSs between the sexes on the basis of computed tomography (CT) scans with the goal of determining their applicability in sex determination. Methodology: A total of 464 cases (230 males and 234 females) from the Western Uttar Pradesh region were studied. CT of the cranium was performed to evaluate diverse morphometric characteristics of the MS. A Student’s t-test was employed to ascertain the mean disparity between male and female participants, while discriminant analysis was utilized for sex determination. Results: As compared to females, MS (morphometric characteristics) of males was observed to be greater, with statistically significant differences noted for sinus length and width (P < 0.05). Furthermore, sinus height and volume exhibited a difference which was highly significant (P < 0.001). Through discriminative analysis, the highest prediction rate obtained from the measurements was 62.4% for females and 67% for males. Conclusion: In forensic science, CT scans of the sinus of maxilla provide valuable measurements that can be used for sex determination.
Background: Understanding proximal femoral morphology is crucial for optimal implant design and surgical outcomes. Population-specific variations in femoral anatomy necessitate ethnic specific anthropometric data for Indian patients. This study was done to determine proximal femur morphology in the South Indian population, assess gender differences, and evaluate height-based variations in anthropometric parameters. Methodology: A prospective analytical study was conducted on 174 subjects (36 males, 138 females) aged 24-80 years at a tertiary care hospital. Standardized pelvic radiographs were analyzed using Radiant Dicom Viewer. The key parameters measured included horizontal offset, neck shaft angle, endosteal canal diameters at three reference levels, and the length of the femur above the central axis of the neck. Results: The mean horizontal offset in the South Indian population was 40.9 +/- 6.0 mm, with significant gender differences (males: 44.9 +/- 6.0 mm vs. females: 39.9 +/- 5.5 mm, P < 0.001). Mean neck shaft angle was 125.5 degrees +/- 6.21 degrees. The measured endosteal diameters were 31.9 +/- 5.0 mm at 20 mm above the lesser trochanter (LT), 21.4 +/- 3.6 mm at the level of the LT, and 17.0 +/- 2.9 mm at 20 mm below it. The mean length of the femur proximal to the axis of the neck was 38.2 +/- 4.4 mm. Males showed significantly larger dimensions in most parameters except neck shaft angle. Height-based analysis revealed significant correlations with horizontal offset and femoral length parameters. Conclusions: The South Indian proximal femoral morphology shows distinct characteristics compared to Western populations, with significant gender and height-based variations. These findings have important implications for implant design and selection in this population.
Introduction:The sella turcica (ST) is an important anatomical structure in the skull base that houses the pituitary gland. Variations in ST morphology have been associated with some pathological conditions. There are few published data on the normative morphometry of ST in the ethnic Kashmiri population. The aim of this study was to analyze the morphology, dimensions, and inter-relationships of the ST in the ethnic Kashmiri population using computed tomography (CT).Methodology:This cross-sectional study was conducted over 1 year in the Department of Anatomy, Government Medical College, Srinagar. High-resolution CT scans of 225 adult Kashmiri subjects (aged >18 years) were examined. Various linear, angular, and area parameters of the ST morphology were measured, including its width and length, diameters, shape, bridging, and surface areas. Statistical analysis was performed using SPSS 22.Results:Out of 225 adults from the ethnic Kashmiri population, 112 were males and 113 females with a mean age of 38 +/- 12.6 years. The mean length, height, and diameter are 8.3 +/- 1.79 mm, 6.5 +/- 1.39 mm, and 11.55 +/- 2.16 mm, respectively. ST length (8.7 mm vs. 8.9 mm), height (6.5 mm vs. 6.8 mm), and diameter (12.6 mm vs. 11.4 mm) were found to be comparatively smaller and shallower in our study. Sella length, height, and area were found to exhibit significant associations with age and gender.Conclusions:This study provides baseline data on ST morphometric parameters in the ethnic Kashmiri population for the interpretation of CT-based radiological images. Findings emphasize the need to consider ethnic variations in normative ST dimensions.
Background: Bones, as a matrix, are rather complicated, and trace/minor elements can disrupt the growth, development, and maintenance of bones. Therefore, the concentration of various minor elements must be determined carefully. However, there are no quantitative data on the variations in bone composition across the growth period of fetal bone to gain better insight into bone mechanobehavior and bone disorders of fetal origin and adult life. This study analyzed the trace element contents of the developing humerus bone in different trimesters of pregnancy. Methodology: Stillborn or medically terminated human fetal samples ranging from 10 to 36 weeks of gestation were obtained after institutional ethical committee clearance. The transverse section of each humerus at the mid-diaphysis was subjected to scanning electron microscopy imaging and energy dispersive spectroscopy techniques. Results: The weight percentage (wt.%) of carbon (C) was greater at 10 weeks of gestation and was reduced to half at 36 weeks of gestation. The content of oxygen (O) was consistently the same throughout pregnancy. The sulfur (S) content was greater in the first trimester, especially at 12 weeks. The wt.% of magnesium (Mg) was lowest throughout pregnancy, except at 20 and 36 weeks. The wt.% of manganese (Mn) was highest at 10 and 12 weeks of pregnancy and lowest at 36 weeks of pregnancy. The wt.% zinc (Zn) content appeared to be greater at the beginning of each trimester. In contrast, the wt.% of iron (Fe) appeared to follow a reverse pattern (wt.%) and was found to be greater in the later part of each trimester. Conclusions: Trace elements play crucial roles in bone metabolism. Some trace elements are beneficial, whereas others are detrimental to the normal function of the bone. Knowledge of the roles played by both groups of elements can be correlated with the mechanical behavior of the bone. This helps to gain insight into advanced interventions to treat more significant bone defects, design biomimetic implants, or treat congenital bone diseases through therapeutic supplementation with specific trace elements.
Background:The sacral hiatus is the lowest unfused part of the sacral lamina of the sacrum. The external characteristics of the sacral hiatus can vary greatly, including its length, shape, anteroposterior (AP) length, transverse length, and the specific spinal level at which its apex is located. In procedures such as caudal epidural anesthesia (CEA), where a precise anatomical understanding of the sacral hiatus is crucial, this heterogeneity possesses clinical significance. The study aimed at analyzing sacral hiatus morphometry, including length, shape, AP and transverse diameters, and apex vertebral level, and to mitigate risks associated with CEA based on the current study results.Methodology:This descriptive study was conducted on 300 samples, including 100 cadaveric dry sacra (51 males and 49 females) and 200 computed tomographic sacral images (114 males and 86 females) over 24 months. The study assessed the length, transverse length, AP depth, overall morphological configuration of the sacral hiatus, and specifically, the vertebral level where its apex is located. Both physical examinations of cadaveric dry specimens and computerized tomography imaging techniques were utilized.Results:According to the current study, the most common form of the sacral hiatus was an inverted U-shape (51%-53%), followed by an inverted V-shape. The craniocaudal length of the hiatus varied from 9 mm to 103 mm, while the AP depth ranged from 3 mm to 7 mm. The apex of the hiatus was most frequently located at the S4 level (52%-54%), followed by S3, S2, and S5.Conclusion:The sacral hiatus is crucial in procedures, especially those involving surgical approaches to anesthetize the regions supplied by the sacral plexus. It serves as the primary access point for CEA and injections. The morphometric variability in the sacral hiatus and varied level of its apex, particularly high hiatus might pose a risk of injuring the meninges and it also demarcates the site at which successful Caudal epidural anesthesia can be given. Improper identification of the hiatus location or misplacement of surgical instruments may lead to inadvertent nerve injury.
