Interest in curves: when the radius of curvature matters in femur fractures. A CT based morphometric study.

Abstract

In today's era, fractures of the femur are primarily managed with intramedullary devices. Keeping in mind the anatomical sagittal bow of the femur, intramedullary devices have been devised with an anterior bow, but this varies amongst various manufacturers - leading to complications such as anterior cortex impingement beyond the isthmus and posterior cortical opening at the fracture site. We intend to find the average radius of curvature (ROC) of the anatomical bow of the femur and the variation of the same. Radiographic data of 150 normal femur scans done in 81 patients were loaded in the Mimics 21.0 software (Materialise, Leuven, Belgium). A centerline (of the medullary cavity) was created using the software. A best-fit circle was created in the sagittal plane involving a major part of the centerline, and ROC was calculated. We found the average ROC of our data was 1027.2, with a standard deviation of 241.55. ROC and length of the femur (an indirect measure of height) had a slight positive correlation (r = 0.36; p < 0.05); and a highly positive correlation in the ROC of the left and right femurs of the same individuals (r = 0.605; p < 0.05). The usual ROC of intramedullary nails is commonly > 1300mm, much higher than the average ROC we identified in our population. Thus, we conclude that implants with smaller ROC in the range of 1100mm are needed, leading to better implant placement in the canal and avoiding complications of anterior cortex impingement and preventing fracture gap widening in our setting.