The knowledge of the relationship of the vertebral artery with the atlas is very important, in order to avoid any injury to the vertebral artery, during surgeries in the craniovertebral region. Different researchers have measured the distance of the vertebral artery from the midline along the posterior arch of atlas (oblique distance), but some authors have measured the perpendicular distance of vertebral artery from the midline. Usually, it is the perpendicular distance along which the surgeons are exploring in this region. Hence, the present study was planned to study and compare both oblique and perpendicular distances of the vertebral artery from the midline and find out statistical differences between these two parameters. It was carried out on 30 atlas vertebrae of Indian origin. The oblique and perpendicular distances of vertebral artery groove from midline and the thickness of vertebral artery groove were measured. The results suggest that dissection on the posterior aspect of the arch of atlas should remain 17.00 mm lateral to the midline and dissection on the superior aspect of the arch of atlas should remain 8.00 mm from the midline to prevent injury to the vertebral artery. It was also observed that “oblique distances of vertebral artery groove from the midline to the medial margin of inner and outer cortex are larger than the corresponding perpendicular distances from the midline”. Although, the differences of oblique and perpendicular distances are not statistically significant but it may be clinically significant for the surgeons operating in the craniovertebral region. Hence, it is concluded that the surgeon should be aware of both the distances while operating in the craniovertebral region to avoid any iatrogenic injury to the vertebral artery.

Introduction: The movement and steadiness of the shoulder joint is due to both the dynamic and static stabilisers. Recurrent anterior shoulder instability is common due to the Bankart lesion or the Hill Sachs lesion. The bone loss and soft tissue failure due to these lesions causing instability is well compensated by Latarjet procedure which acts by triple blocking effect of the bone graft, the sling effect of the conjoint tendon of subscapularis and the ligament of the coracoacromial ligament stump. Materials and methods: Middle-aged patients with recurrent anterior shoulder dislocation and a mid-range instability on clinical assessment with an isolated glenoid bone loss of 20% or Bankart lesion with engaging Hill Sachs lesion were selected for the study. The surgical procedure included a subscapularis split to expose the glenoid. The coracoid graft harvested was prefixed with Kirschner wires and placed flush over the glenoid ensuring no medial or lateral overhang and fixed with 4.0mm cancellous screws with the washer. The functional outcome was measured with the ROWE score and ASES score and the movements were evaluated. Results: A total of 24 patients fulfilled the inclusion criteria. Post-operatively at final follow-up, the mean ROWE score was 97.08 ±8.45 and the mean ASES score was 94.4±9.10. One patient had screw breakage as a complication and another had restriction of movement which was managed with physiotherapy. Conclusion: Open Latarjet is an effective procedure for recurrent anterior shoulder instability in non-athletic middleaged patients as a excellent functional outcome was achieved with this technique. We therefore recommend open Latarjet as an alternative to arthroscopic treatment in developing countries where patient affordability and the availability of the resources are the issues.