Manmohan Patel - Academia.edu (original) (raw)

Papers by Manmohan Patel

$Research paper thumbnail of The use of precontoured plates for midshaft clavicle fractures is not always the best course of treatment$

Plate fixation has become the preferred approach for treating displaced midshaft clavicle fractur... more 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.

Anatomy & Cell Biology

Cureus, 2022

The ability of adaptation is unique to humankind. Technology advances have introduced many applia... more The ability of adaptation is unique to humankind. Technology advances have introduced many appliances that increasingly are smaller in size and handheld. These devices on prolonged usage affect the thumb joint complex, and this study was therefore designed to assess any changes in the movement of the thumb joint complex and fatigability secondary to the increasing usage of smartphones in different orientations in the Central Indian population. Materials and methods An analytical cross-sectional study was performed to assess changes in the ranges of motion (ROM) of the thumb joint complex with a sample size of 137 selected nonrandomly and categorized on the basis of the orientation of smartphone usage by physical goniometer and a standardized questionnaire to assess fatigability. Results Most movements of the thumb joint complex corresponded to the existing standard values. The study found significant changes in the movement of passive flexion of the left metacarpophalangeal (MCP) joint and borderline significant modifications in the active extension of the left interphalangeal (IP) joint, passive extension of the left interphalangeal joint, and passive flexion of the left carpometacarpal (CMC) joint among the groups of participants. The Borg CR10 value of fatigue was "one," indicative of no excessive fatigue after smartphone usage. Conclusion There are no significant changes in the ranges of motion of the joint complex of the thumb in mobile phone users over a period of time. The orientations and the increased duration of usage also did not cause any fatigue in the muscles of the thumb.

Objective: To stabilize the osteometric data for central Indian population and to find out any se... more Objective: To stabilize the osteometric data for central Indian population and to find out any sexual dimorphism in hard palate in the nasopharyngeal region. Method: The present study was conducted on three hundred twenty two dry skulls of central India region. The dry skulls taken for study are first examined to determine the sex of the skull then various measurements of the hard palate were taken and compared to find out any sexual dimorphism. The parameters of hard palate measured in present study are: 1. The maximum width of the hard palate is taken at the gingival margin of the first molar tooth. 2. The maximum length of the hard palate is taken from anterior margin of incisive fosse to the posterior nasal spine. 3. Palatal index = maximum width / maximum length X 100. Results: The average value of maximum palatal width for male cases and female cases were 37.17((±2.88) mm and 35.50(±3.07) mm respectively. The average value of maximum palatal length for male cases and female ca...

Objective: To stabilize the craniometric data for central Indian population and to find out any s... more Objective: To stabilize the craniometric data for central Indian population and to find out any sexual dimorphism in distance between the free edges of medial Pterygoid plates in the nasopharyngeal region. Method: The present study was conducted on three hundred fourteen dry skulls of central India region. The dry skulls taken for study are first examined to determine the sex of the skull then various measurements of the distance between the free edges of medial Pterygoid plates were taken and compared to find out any sexual dimorphism. The maximum transverse distance between free edges of medial pterygoid plates has been measured at three sites- Site-I : At the uppermost part where the pterygoid plates meet the body of sphenoid bone, Site-II : At middle of pterygoid plates, Site-III : At the level of posterior free margin of hard palate. Results: At the site I, the average distance between free edges of medial pterygoid plates for male cases and female cases were 27.84(2.44) mm an...

Archives of Orthopaedic and Trauma Surgery, 2020

Congruent arc Latarjet procedure involves rotating the coracoid process so that its inferior surf... more Congruent arc Latarjet procedure involves rotating the coracoid process so that its inferior surface is flush with the glenoid face, owing to their matching radius of curvature (ROC). However, there has been no cadaveric study to actually measure and compare the ROC of coracoid with glenoid, especially in Indian population. 44 shoulders were dissected in 24 cadavers to measure usable length of coracoid process, width, height, ROC of coracoid and glenoid as well as ulnar length (as proxy of cadaver height). Critical coracoid height and length were estimated based on screw sizes of 2.7 mm, 3.5 mm, 4 mm and 4.5 mm, and pair concordance between height and length calculated. ROC of coracoid and glenoid were compared to measure extent of congruency. The mean usable length of coracoid process, width and height at mid-point were 21.8 mm, 13.7 mm and 8.6 mm, respectively. Out of the different screw sizes, 2.7 mm screws were found safe in 82% shoulders. 24 coracoid–glenoid pairs fulfilled the operational definition (≤ 5 mm) of congruency while rest 20 were seemingly incongruent chiefly due to coracoid variations, with mean ROC difference 4.13 mm (95% CI 1.51–6.74 mm). The ulnar length was significantly smaller in the incongruent ROC group (p = 0.0002). The available length as well as height of the transferred coracoid must be considered when deciding optimum diameter fixation screws in Latarjet procedure. Owing to smaller anatomic dimensions of coracoid in Indian population, 2.7-mm screws provide the safest fixation option. Also, the ROC of coracoid and glenoid does not match in substantial proportion of the cadavers. Pre-operative planning should include a CT-based assessment of glenoid and coracoid dimensions to decide the technique of Latarjet procedure and the optimum diameter fixation screws required.

Cureus, 2020

Introduction Trans-pedicular screw fixation is one of the main modalities of spinal instrumentati... more Introduction Trans-pedicular screw fixation is one of the main modalities of spinal instrumentation today. It is particularly challenging in the thoracic spine due to the narrow pedicle dimensions especially in the upper and mid-thoracic levels. We aimed to study the anatomical variations like pedicle dimensions and angulation in transverse and sagittal planes. Material and methods We conducted an anatomical investigation on 20 dry vertebral columns (14 male and six female), from T1 to T12 levels. The measurements included pedicle width, height, and transverse and sagittal angles of the pedicle. Numerical variables were summarized using mean and standard deviation. Results T12 vertebra was found to have the widest pedicle width (mean 7.89 ± 0.70 mm) and the widest pedicle height (mean 15.45±0.78 mm) while T5 vertebra (mean 3.65±0.40 mm) had the narrowest pedicle width. T1 vertebra had the maximum transverse angle of the pedicle (mean 30.37±2.56 degree); whereas, T2 vertebra had the maximum sagittal angle (mean 19.22±2.24 degree). Conclusion We have reported detailed pedicle measurements including their angulation for the thoracic spine in dry vertebral columns of central India. The pedicles are directed more medially from T1 to T10 levels and are almost neutral at T11 and T12 levels. These findings would not only be of immense help to the spinal surgeons but also help in designing implants and instrumentations specific for the thoracic spine for the central Indian population as well as aiding surgeons to perform more precise and, therefore, safe surgical procedures.

Journal of Hand and Microsurgery, 2018

The innervation pattern of triceps is complex and not fully comprehended. Anomalous innervations ... more The innervation pattern of triceps is complex and not fully comprehended. Anomalous innervations of triceps have been described by various authors. We have attempted to delineate the nerve supply of the triceps and documented the anomalous innervations of its different heads. The brachial plexus and its major branches (in the region of the axilla and arm) and triceps were dissected in 36 embalmed cadaver upper limbs. Long head received one branch from radial nerve in 31 (86%) specimens. Four (11%) specimens received two branches including one that had dual innervation from the radial and axillary nerves, and one (3%) specimen had exclusive innervation from a branch of the axillary nerve. Medial head received two branches arising from the radial nerve in 34 (94%) specimens. One (3%) specimen received three branches from the radial nerve whereas one (3%) had dual supply from the radial and ulnar nerves. Lateral head received multiple branches exclusively from the radial nerve, ranging...

Absence of Middle Trunk of Brachial Plexus an Uncommon Variation, Sep 25, 2013

Indian Journal of Public Health Research & Development, 2014

Introduction : Spina bifida is a developmental congenital disorder caused by the incomplete closu... more Introduction : Spina bifida is a developmental congenital disorder caused by the incomplete closure of the embryonic neural tube. Some vertebrae overlying the spinal cord are not fully formed and remain unfused and open. If the opening is large enough, this allows a portion of the spinal cord to protrude through the opening in the bones. Aims of Study : To study an abnormal case of Spina Bifida Cystica Material and Method : The present study is a case report of a 11 day old female child who reported to the pediatric surgery department with the chief complaint of a cystic swelling of 53cm in a thoraco lumber region since birth. The swelling was soft but tense and the skin over the swelling was thinned out. The child showed some signs of lower limb involvement which need to confirmed. Result : On anatomical examination it was found to be a case of developmental anomaly of vertebral column in thoraco lumbar region which is against the lumbo-sacral region which is the most common site, with spinal cord involvement (neural tube defect). On test of illumination, it was found to be partially illuminated and X rays and MRI findings showed non fusion of vertebral column with abnormal protrusion of spinal cord through the defect. Conclusion : It is a case of meningomyelocele( spina bifida) caused by abnormal closure of neural folds of IIIrd and IV weeks of developments leading to neural tube defect. It was a spina bifida of cystic variety which mostly accomplish with lower limb involvement.

Journal of Evolution of medical and Dental Sciences, 2013

During routine dissection of a middle aged male cadaver, it was found that the middle trunk of br... more During routine dissection of a middle aged male cadaver, it was found that the middle trunk of brachial plexus was missing on left side. The Upper trunk was formed from union of C5, C6 and C7 while the lower trunk was normal having union of C8 and T1. Rest of the plexus below cord and on right side was normal. Erb’s point was present there having fibres of C5, 6&7. Knowledge of Variation in brachial plexus is very important for orthopaedic surgeons, neurosurgeon and anesthesiologists.

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Journal of Evolution of Medical and Dental Sciences, 2013

Absence of middle trunk of brachial plexus: an uncommon variation". ABSTRACT: During routine diss... more Absence of middle trunk of brachial plexus: an uncommon variation". ABSTRACT: During routine dissection of a middle aged male cadaver, it was found that the middle trunk of brachial plexus was missing on left side. The Upper trunk was formed from union of C5, C6 and C7 while the lower trunk was normal having union of C8 and T1. Rest of the plexus below cord and on right side was normal. Erb's point was present there having fibres of C5, 6&7. Knowledge of Variation in brachial plexus is very important for orthopaedic surgeons, neurosurgeon and anesthesiologists. INTRODUCTION: The brachial plexus is formed by the union of the ventral rami of the inferior four cervical (C5-C8) and first thoracic (T1) nerves. The C5 nerve usually receives a small contribution from the fourth-cervical nerve and the T1 nerve normally receives one from the second thoracic nerve. The brachial plexus is the main source of innervations to the upper limbs. Any injury at trunk level can lead to significant disability. The ventral rami of C5 and C6 cervical nerves unite to form the superior trunk. That of C7 nerve runs alone as the middle trunk and those of C8 and T1 nerves unite to form the inferior trunk; each of the trunks then bifurcates into anterior and posterior divisions as they pass beneath the clavicle. The anterior divisions of the superior and middle trunk form the lateral cord. The anterior division of the inferior trunk continues as the medial cord. The posterior divisions of all three trunks unite to form the posterior cord. From the cords arise the terminal branches of the brachial plexus. i Variations in the trunk formation in brachial plexus are relatively rare as compared to the cords and terminal branches formations. The presence of anatomic variations is often used to explain symptoms that might not otherwise be obvious.