A MRI study of the lesser trochanteric version and its relationship to proximal femoral osseous anatomy.

Ricardo Gonçalves Schröder,Anthony Khoury,Leon Toye,Juan Gómez-Hoyos,Hal David Martin,Munif Ahamad Hatem,Manoj Reddy

doi:10.1093/jhps/hnv067

Abstract

The purpose of this study is to quantify the lesser trochanteric version and determine the angle and the relationship between lesser trochanter and femoral neck version. Investigate the influence of the lesser trochanter version in the width of ischiofemoral space. Two hundred and fifty asymptomatic hips were evaluated with axial magnetic resonance image. The lesser trochanter version was calculated. The difference between the femoral neck version and the lesser trochanter version formed the angle between each structure. The width of ischiofemoral space was measured and its relationship with the lesser trochanter version was determined. The mean lesser trochanter version was −24° ± 11.5° (range, − 54° to + 17°) with a coefficient variation of 47.45%. The mean femoral neck version measured 14.0° ± 10.8° (range, −16° to 50°), with a coefficient variation of 81.32%. The lesser trochanter/femora neck angle was 38.4° ± 9.6° (range, 8° to 67°), coefficient variation of 30%, with a moderate correlation between the structures (r = 0.63, P < 0.01). The mean ischiofemoral space was 22.9.0 ± 7.0 mm (range, 10.3 to 55 mm), and a weak correlation was found between ischiofemoral space and lesser trochanteric version (r = −0.16, P < 0.05). The lesser trochanteric version showed a high variation with a moderate relationship with the femoral neck version. The lesser trochanteric version does not influence the width of the ischiofemoral space.

Highlights

The importance of the lesser trochanter (LT) and its clinical implications have been increasingly explored in the literature [1,2,3,4,5,6,7]
The average for the LTFN angle was 38.4 6 9.6, coefficient variation of 30% with a moderate correlation between the LT version (LTV) and FN version (FNV) (r 1⁄4 0.63, P < 0.01)
The LT presented a posterior orientation related to the distal femur in most of the 250 hips with an average LTV of À24

Summary

Introduction

The importance of the lesser trochanter (LT) and its clinical implications have been increasingly explored in the literature [1,2,3,4,5,6,7]. Factors in the measurement of IFS are leg positioning and alterations of proximal femoral and pelvic anatomy, which may contribute to decreased IFS and effect the development of IFI [3, 11,12,13,14]. Lesser trochanterplasty and release of the iliopsoas tendon at the LT has been shown as an effective treatment of IFI and iliopsoas snapping [5, 8, 16, 17]. Lesser trochanterplasty in confirmed cases of IFI has had good outcomes, the influence of anatomical variations of the LT upon the IFS and the relationship with the proximal femoral anatomy is not well known (Fig. 1)

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Conclusion