Femoral Neck Diameter Research Articles

Test of the minimum supero-inferior femoral neck diameter as a sex predictor in a contemporary documented osteological collection from Portugal

Abstract Adult sex estimation is one of the first and most important steps in forensic examination. While dealing with disturbed burials, the most dimorphic anatomic areas of the skeleton (such as the coxae, the skull and the head of femur and humerus) may be deteriorated or fragmented. In contrast, the minimum supero-inferior femoral neck diameter (SID) is generally much better preserved. The aim of the present research is to identify the discriminatory potential of SID for sex estimation and to test different formulae and mathematical procedures currently available in the forensic literature, on a sample of 295 contemporary individuals from the 21st Century Identified Skeletal Collection (University of Coimbra, Portugal), in order to identify its relevance for application in Portuguese forensic cases. Results showed that SID is a dimorphic variable, with high frequencies and probabilities of cases correctly estimated (0.82 and 0.83, respectively); statistically significant differences between females and males, and a high association between the metrics and sex, were identified. Posterior probabilities allow reliable estimations for all the measurements, excepting those between 31.0 and 31.5 mm, and the procedures that show the highest accuracy are those proposed by Seidemann et al. (1998), Curate et al. (2016) and Luna et al. (2021), with frequencies and probabilities between 0.82 and 0.83 for both sexes. The validation procedures implemented in this study highlight both the need to test quantitative models generated from diverse contemporary human populations, and the value of SID for obtaining reliable adult sex estimates, as they improve the quality of the biological profiles obtained in forensic contexts. Key points

Is sexual dimorphism in morphometric variables of the proximal femur moderated by age in adulthood? A cross-sectional study in Ghana

Ageing may impact proximal femoral morphometry in both males and females. However, it is not clear whether the observed sexual dimorphism is attributable to an ageing effect in the post-pubertal period. The potential effect of ageing on sexual dimorphism in the proximal femur is most significantly relevant for forensic and osteoarchaeological research. The study was cross-sectional and comprised 123 participants (females = 72 and males = 51), who were recorded between January 2017 and June 2018 at the Korle-Bu Teaching Hospital. The study participants were aged between 31 and 79 years. The femoral head diameter, the femoral neck diameter, the femoral neck-shaft angle, and the femoral hip axis length were measured from the right side by radiographic technique and following standard osteometry methods. The femoral head-neck ratio was then calculated. All measurements were taken twice and then averaged. The (mean ± SD) femoral head diameter was higher in males (5.1 ± 0.56 cm) than in females (4.8 ± 0.51 cm) with a moderate effect size (p = 0.023, Hedge’s g = 0.56). Similarly, the femoral neck diameter was higher in males (4.0 ± 0.52 cm) than in females (3.8 ± 0.48 cm) with a small effect size (p = 0.025, Hedge’s g = 0.40). The femoral head axis length increased by 0.03 cm annually in males. The observed sexual dimorphism in the femoral head and neck diameters could not, however, be attributable to the ageing effect. Ageing may not have an impact on sexual dimorphism in the femoral head and neck diameters among persons older than 30 years in the Ghanaian population.

Sex estimation using proximal femoral parameters of adult population in the Volta region of Ghana

BackgroundThe estimation of sex is a fundamental component in the establishment of a biological profile and a critical step for the identification of skeletal remains in forensic contexts. The proximal femoral geometry is frequently evaluated at crime scene for the estimation of sex, but the use of radiograph anthropometry for the estimation of sex is rare, even though radiographs would be easier to handle than bone specimen. AimThe aim of this study was to estimate sex using proximal femoral parameters of adult population in the Volta region of Ghana. MethodThis study made use of 214 normal anteroposterior (AP) radiographs of the pelvis that showed the hip joints and the proximal femora. The age and sex were recorded. Four proximal femoral parameters were measured on the radiographs using the ‘DICOM radiology reader software. The hip axis length was measured and mean difference of the parameters between the genders and the laterality categories were assessed. ResultsThree out of the four parameters measured; femoral head diameter, neck diameter and hip axis length demonstrated statistically significantly difference (p = 0.0001) between the males and females in both right and left side measurement. The right hip axis length (RHAL) and left head diameter (LHD) contributed significantly to sex estimation. ConclusionThe right hip axis length demonstrates a high accuracy of 81.3% in sex determination among the population. This is the first study to present this finding in this population and might provide another way (if not easier way) to estimate the sex of a given skeletal specimen may give valuable insight into a better-customised implant and prosthesis design.

The effect of pre-fracture proximal femur geometry on hip fracture type in elderly patients.

This study aimed to analyze the relationship between fracture type by determining data on the geometry of the proximal femur in the pre-fracture period in patients over 65 years of age who had hip fractures as a result of low-energy trauma. A total of 127 patients who were admitted to the hospital for reasons other than hip pathology within 1 year before the occurrence of hip fracture and who had an anterior-posterior pelvic X-ray were included in the study. Measurements were made to evaluate the proximal femur geometry, neck shaft angle, central edge angle, femoral head diameter, femoral neck diameter, femoral neck length, femoral offset length, femoral neck axial length, hip axis length, and femoral shaft diameter. As a result of these measurements, analyses were performed to determine the relationship between the control group and fracture types. The mean Neck shaft angle scores were significantly higher in both fracture types than in the control group (P = .034, P = .002). The mean Femoral offset length values of both fracture types were lower than those of the control group (P = .002, P = .011, respectively). Multiple logistic regression analysis revealed that the risk of collum femoris fracture increased as the Femoral head diameter value increased. (OD = 0.21, P = .002). The geometric parameters of the proximal femur play an important role in the formation of hip fracture types. Therefore, differences in proximal femur geometry in hip fracture types should be considered, and patient-focused choices should be made regarding the surgical procedures and implants to be used during fracture fixation.

Hip Geometry and Proximal Femoral Fractures among Elderly Filipino Women: A Single Centre Cross-Sectional Study.

Introduction:Few controlled studies explore proximal femoral geometry and association with femoral neck (FN) or intertrochanteric (IT) fractures, especially among the elderly Filipino population. Previous reports, however, still reveal multiple inconsistencies. The objective of the study is to establish a possible association between radiographic hip geometry and proximal femoral fractures based on measurements taken from elderly Filipino women.Materials and methods:This is a cross-sectional study of 182 Filipino women ≥ 60 years old at a single institution last 2019-2020. Patients were divided into groups with femoral neck fractures (n=84), intertrochanteric fractures (n=64), and those without diagnosed hip fractures (n=34). Standard pelvic radiographs with control of hip internal rotation was done and the following radiographic parameters were compared: hip axis length (HAL), femoral neck length (FNL), neck shaft angle (NSA), horizontal offset (HO), femoral head diameter (FHD), and femoral neck diameter (FND).Results:Data suggests that an increased FND increased the risk for acquiring both femoral neck (OR = 1.31, 95% CI 1.06 - 1.62; p=.011) and intertrochanteric fractures (OR: 1.22, 95% CI 1.07-2.16; p=0.018). For intertrochanteric fractures alone, a wider NSA (OR 1.27, 95% CI 1.02 - 1.58, p=0.033) and larger HO (OR 1.29, 95% CI 1.02 - 1.64, p=0.036) also increased the risk for this fracture type while a longer HAL was protective (OR 0.85, 95% CI 0.73 - 0.98, p=0.30). Other radiographic parameters and ratios revealed no association.Conclusion:Results show that there are certain hip geometric parameters that play a role in the risk and incidence of developing femoral neck or intertrochanteric fractures. These measurements may aid in identification of patients at risk. This study may act as a guide for future implant design and increase accuracy of hip reconstruction among elderly Filipino women.

Models for estimating age and sex from variables of the proximal femur in a Ghanaian population

Age and sex estimation models from the proximal femur are population-specific due to genetic and environmental variabilities. Extrapolating a femur-based age or sex estimating model from one population to another will be problematic. Proximal femur-specific age and sex estimation models are limited in Ghana. The study aimed to estimate the age and sex of an adult Ghanaian population using osteometric measurements from the proximal femur. The study was cross-sectional from January to June 2019 at the Korle-Bu Teaching Hospital (KBTH). There were 125 (male=51, female=74) participants, aged from 31 to 82 years. The head diameter-left (HDL), neck diameter-left (NDL), neck-shaft angle-left (NSAL) and the Hip axis length-left (HALL) were measured twice using a standardized radiographic technique. Discriminant and logistic regression models were formulated for sex estimation while linear regression models were formulated for age estimation and these models were then tested for reliability. Males had longer HDL and NDL than females (P < 0.050). The average sex estimation accuracy in the discriminant analysis ranged from 58.4% to 64.0% (in the original sample) and 56.8% to 62.4% (in the cross-validation sample) while in the logistic regression analysis it ranged from 58.4% to 64.0%. The HDL was better than the NDL in sex attribution but only marginal. The multivariate model (HDL+NDL) marginally improved sex estimation accuracy (64.0%) over the univariate models for HDL (61.6%) and NDL (60.0%). In general, females were better classified than males. There was no significant difference between the chronological age and the estimated age of males using HALL although the confidence interval (95%CI) was wider than expected [Bias: 1.133 (95%CI: −25.280 to 27.540). The femoral head and neck diameters or their combination are poor attributors of sex on average. Also, male adult age estimation using HALL is less precise. The use of these models in the Ghanaian population is not advised

Musculoskeletal Injuries Among Females in the Military: A Scoping Review.

Musculoskeletal injuries (MSKi) are a common challenge for those in military careers. Compared to their male peers, reports indicate that female military members and recruits are at greater risk of suffering MSKi during training and deployment. The objectives of this study were to identify the types and causes of MSKi among female military personnel and to explore the various risk factors associated with MSKi. A scoping review was conducted over a 4-month time frame of English language, peer-reviewed studies published from 1946 to 2019. Search strategies for major biomedical databases (e.g., MEDLINE; Embase Classic + Embase; and the following EBM Reviews-Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment, and the NHS Economic Evaluation Database) were developed by a senior medical information specialist and included 2,891 titles/abstracts. Study selection and data collection were designed according to the Population, Concept, and Context framework. Studies were included if the study population provided stratified data for females in a military context. From a total of 2,287 citations captured from the literature searches, 168 peer-reviewed publications (144 unique studies) were eligible for inclusion. Studies were identified from across 10 countries and published between 1977 and 2019. Study designs were primarily prospective and retrospective cohorts. Most studies assessed both prevalence/incidence and risk factors for MSKi (62.50%), with few studies assessing cause (13.69%). For MSKi of female recruits compared to active female members, the prevalence was higher (19.7%-58.3% vs. 5.5%-56.6%), but the incidence (0.02%-57.7% vs. 13.5%-71.9%) was lower. The incidence of stress fractures was found to be much higher in female recruits than in active members (1.6%-23.9% vs. 2.7%). For anthropometric risk factors, increased body fat was a predictor of MSKi, but not stress fractures. For physiological risk factors for both female military groups, being less physically fit, later menarche, and having no/irregular menses were predictors of MSKi and stress fractures. For biomechanical risk factors, among female recruits, longer tibial length and femoral neck diameter increased the risk of stress fractures, and low foot arch increased risk of an ankle sprain. For female active military members, differences in shoulder rotation and bone strength were associated with risk of MSKi. For biological sex, being female compared to male was associated with an increased risk of MSKi, stress fractures, and general injuries. The consequences of experiencing MSKi for active military included limited duties, time off, and discharge. For recruits, these included missed training days, limited duty days, and release. This scoping review provides insight into the current state of the evidence regarding the types and causes of MSKi, as well as the factors that influence MSKi among females in the military. Future research endeavors should focus on randomized controlled trials examining training paradigms to see if women are more susceptible. The data presented in the scoping review could potentially be used to develop training strategies to mitigate some of the identified barriers that negatively impact women from pursuing careers in the military.

Radiographic Assessment of the Proximal Femoral Anatomy in An Indigenous African Adult Population

Background: Hip surgeries such as fracture fixation, corrective osteotomy, hemiarthroplasty, or total hip arthroplasty require accurate preoperative templating for a successful outcome. Such templating is done using the proximal femur and the acetabulum radiographs, depending on the planned surgery. Understanding the normal radiographic anatomy of the proximal femur is crucial to differentiate a normal from pathological anatomy. Proximal femoral anatomic indices include the femoral head diameter, femoral neck diameter, femoral neck length, femoral offset, femoral neck axis length and the femoral neck-shaft angle. Aim: This study assesses and establishes the average values of the proximal femoral anatomy in an indigenous African adult population. Method: This cross-sectional study examined 190 normal anteroposterior (AP) radiographs of the pelvis. The mean age, weight and height of the subjects were obtained. The following proximal femoral anatomic parameters were measured: femoral neck length (FNL), femoral neck diameter (FND), femoral head diameter (FHD), femoral neck-shaft angle (FNSA), femoral offset (FO) and femoral neck axis length (FNAL). The authors compared the mean difference of the parameters between the genders and the age categories and assessed the parameter correlations with the patients’ weight and height. Results: Males constituted 63 (33.2%) of the study population. The mean age of the subjects was 51.46 years (SD = 16.37). The mean weight was 76.13 kg, while the mean height was 1.62 m. The mean values of the proximal femoral parameters were as follows: FNL 4.52cm, FND 3.42cm, FHD 4.76cm, FNSA 132.960, FO 4.09cm, and FNAL 10.34cm. Males have a significantly higher mean value in all the parameters except the FO. None of the parameters showed any significant difference among the age categories except the FNL. A post-hoc analysis showed that the difference in the FNL lies between the young and the elderly age groups. The subjects’ height correlated with all the parameters except FNSA, while the weight correlated with the FND, FNSA and FNAL. Conclusion: The proximal femoral anatomy in Africans differed from those published in foreign literature. This knowledge is crucial for implant manufacturing companies and preoperative templating for hip surgeries. KEY WORDS: Proximal femur, Anatomy, Black population.

Adult sex estimation from the minimum supero-inferior femoral neck diameter in a contemporary osteological sample from Buenos Aires, Argentina

Sex estimation of adult skeletons is an important step in forensic analysis. Although the femur has been metrically studied for sex assessment around the world, very limited information is actually available on modern populations of Argentina. In this paper, the estimation of sex based on the metric evaluation of the supero-inferior femoral neck diameter (SID) in a reference osteological collection from the contemporary Chacarita Cemetery of Buenos Aires City (Argentina), is evaluated. Protocols generated using SID in other three reference skeletal samples are also tested on this collection. One hundred and sixty-four individuals of both sexes and between 24 and 96 years old are analyzed. Inter and intra observer errors suggest that the replicability of the procedure is adequate. The sectioning point calculated from the direct measurements is 30.86 mm and results show a high degree of dimorphism. The proportions of correct sex discrimination and the likelihoods of correct allocation obtained with the direct measurements, along with the results of a discriminant function, a binary logistic regression and a Bayesian approach, are all higher than 0.85 (0.85–0.93 for females, 0.88–0.91 for males). When the formulae from other samples are used in the Chacarita Collection, the percentages of correct estimations range between 72.41% and 81.03% for females and between 80.46% and 88.50% for males, while the likelihoods are between 0.73 and 0.81 for females and between 0.79 and 0.82 for males. As the values for the estimations obtained using the statistical procedures generated in the present research are higher than those available for other collections, the method is more adequate to use in the analysis of contemporary skeletal remains from Buenos Aires and surrounding areas. The trends identified highlight the importance of population-specific metric methodologies in forensic contexts and deserve future testing in contemporary samples from neighbouring regions.

Dimensions of Proximal Femur - An Anatomical Study

The morphometry of proximal femur is necessary in planning surgeries of hip joint and preparation of prosthesis for hip replacement. The aim of the study was to measure various morphometric parameters of femoral head and neck. The study consisted of sixty adult dry human femora of both sexes (thirty left sided and thirty right sided). Various dimensions of femoral head and neck were measured by slide caliper. Diameter of femoral head was estimated to be 39.28±3.87mm along cranio-caudal axis and 41.18±4.14mm along sagittal axis. Diameter of femoral neck was established as 29.03±3.8mm along cranio-caudal axis and 24.36±3.13mm along sagittal axis. Length of femoral neck was measured to be 50.57±6.77mm. The findings of the study will be useful in manufacturing prosthesis and implants for hip replacement as well as other surgeries involving proximal femur.

A radiological study of proximal femoral geometry and its relationship with hip fractures in Indian population

Context: In literature there is scarcity of documentation to test the relationship of radiological geometry of proximal femur with incidence and patterns of hip fractures especially in Indian population. In this study radiological parameters like Femoral Neck Length (FNL), Hip Axis Length (HAL), Neck Shaft Angle (NSA), Femoral Neck Diameter (FND) and Femoral Head Diameter (FHD) are measured in standardized digital pelvis radiograph of patients with hip fractures presented at a tertiary care hospital and efforts were made to establish a relationship of these parameters with the pattern of hip fractures in Indian population.Aims: The objective of the study is to investigate as to whether a particular type of proximal femoral morphology (viz. Femoral Neck Length, Hip Axis Length, Neck Shaft Angle, Femur head diameter and Femoral Neck diameter) determines and predicts the anatomical location of various types of hip fractures (1.Intracapsular (femoral neck) fractures – subtypes – subcapital; transcervical and basicervical neck femur fractures, 2. Extracapsular – subtyoes – intertrochanteric; intertrochanteric with subtrochanteric extension and subtrochanteric fractures). Settings and Design: Cross sectional observational studyMethods and Material: A cross sectional analysis was made in our hospital of a population of 100 patients with hip fractures (Intracapsular and Extracapsular). Study was conducted during 18/10/2019 to 30/09/2020. FNL, HAL, FND, FHD and NSA were measured on standardized digital pelvis radiograph by using an advanced computer software.Statistical analysis used: Independent sample t-test.Results: The sample size was divided into two age groups a younger age group (31-60years) and older age group (61-90years). For both age groups, means and standard deviations for all five parameters were calculated. We observed that for older age group, HAL is higher for extracapsular fractures than for intracapsular fractures. FNAL is increased for extracapsular fractures for the whole sample size as well as for older group. There was no significance for FHD, FND and NSA for any of the age groups for any type of fracture.Conclusions: In our study, we concluded that the HAL is significantly increased for extracapsular fractures than for intracapsular fractures in old age group of 61-90 years. FNAL is also found to be higher for extracapsular hip fractures in the same age group as well as the whole sample size. In our study, we could not establish any significant correlation between FHD, FND and NSA in any age group for any fracture type.

Femoral Head-Neck Translation Ratio Is a Measurement of the True Deformity of Slipped Capital Femoral Epiphysis.

A new method to quantify proximal femoral head-neck deformity in slipped capital femoral epiphysis (SCFE) is presented. In SCFE the femoral head slips posteriorly and inferiorly relative to the femoral neck. The distance of the femoral head center from the femoral neck axis (center-axis distance, CAD) represents the severity of the post-slip deformity. CAD is calculated on the anteroposterior and the frog-lateral pelvis views. It is shown that CAD is only a function of the femoral head-neck offset difference on both sides of the femoral neck. The percentage of CAD relative to the diameter of femoral neck is the femoral head-neck translation ratio (FHNTR) on the respective x-ray projection. Measurements on radiographs of 37 patients with history of unilateral SCFE were performed. The asymptomatic contralateral hips were used as controls. On the anteroposterior pelvis view, mean FHNTR was -12.2% and -4.3% for the affected and asymptomatic contralateral hips, respectively (paired t-test, p < .01), indicating inferior translation of the femoral head relative to the femoral neck. On the frog-lateral view, mean FHNTR was -21.1% and -6.5% for the affected and the contralateral hips, respectively (paired t-test, p < .01), indicating posterior translation of the femoral head relative to the femoral neck. There is a moderate inverse correlation between FHNTR on the frog-lateral pelvis view and Southwick's slip angle (Pearson correlation coefficient r = -0.679, p < .001). FHNTR on two radiological planes (anteroposterior and frog-lateral) is a simple measurement of the posteroinferior translation of the femoral head relative to the femoral neck in SCFE. It is a measurement of the true deformity of the proximal femur in SCFE. Calculation of FHNTR may be applicable to classify SCFE, to monitor femoral head-neck remodeling after slip stabilization, to describe the femoral head-neck relation in healthy individuals, and to monitor femoral head-neck changes secondary to other hip pathology, such as Perthes disease or developmental dysplasia of the hip.

Proximal femoral geometry analysis of igbos of South East Nigeria and its clinical application in total hip replacement and hip surgeries: A dry bone study.

Proximal femoral geometry(PFG) plays a role in the biomechanics of the hip. During total hip replacement detailed efforts are made to restore this biomechanics in other to ensure patients satisfaction and implant survival. There are variations in these parameters. Ethnicity is one of the most influential factors accounting for these variations. To determine the values of the parameters of the proximal femoral geometry among the ethnic Igbos of the South Eastern Nigeria, determine any correlation between these parameters, and compare these values with known populations as well as discuss the clinical application in total hip replacement and other hip surgeries. Materials and Method: Seven hundred and sixteen (716) femoral bones taken from the osteology unit of department of anatomy of University of Nigeria Enugu Campus (UNEC) were screened and proximal femoral parameters measured using Vernier calipers. Results: There were 356 right and 360 left femoral bones with the following values: Femoral Neck Anteversion Angle (FNAVA): M=19.04°, SD=2.075°, Proximal Femoral Length(PFL): M=73.24mm,SD=7.622, Femoral Head Vertical Diameter(FHVD):M= 44.64mm, SD=3.134, Femoral Head Transverse Diameter(FHTD),M=44.55mm, SD=3.379mm, Femoral Head Diameter(FHD),M=44.60mm, SD=3.119mm, Femoral Neck Anterior Length(FNAL), M=31.86mm, SD=5.383mm, Femoral Posterior Neck Length(FPNL):M=22.23mm, SD=3.520mm, Femoral Neck Diameter (FND), M=32.71mm,SD= 3.315mm, Proximal Femoral Width Head to Side (PFWHS), M=89mm.80,SD= 10.331mm, Proximal Femoral Width Side to Side (PFWSS), M=31.47mm, SD=2.812mm, Femoral Neck Shaft Angle(FNSA), M=132.15°, 7.305°. The parameters of the proximal femoral geometry of the ethnic Igbos of the South East of Nigeria, differed from other populations and exhibited laterality.

The hip asphericity angle: a novel angle for measurement of Cam-FAI correction

Abstract The alpha angle is routinely used for the diagnosis and quantitative description of the Cam deformity of the hip. However, a reliable identification of the femoral neck axis as its reference line can be difficult. Moreover, most cam resections include a reduction of the femoral neck diameter with an automatic posteromedial angulation of the femoral neck axis. In consequence, the reference axes for the pre- and postoperative alpha angles are different, and a comparison of both angles underlies a systematic error to relatively higher postoperative alpha angles. In order to avoid this systemic error, we propose the hip asphericity (HA) angle with a reference axis independent of the amount of bony resection. Two retrospective groups were formed, a ‘femoroacetabular impingement (FAI) group’ that had hip arthroscopy for cam resection and a ‘Control group’ without cam deformity. The alpha and HA angles were measured by three examiners. The measurements were repeated 1 month later. In the FAI group, offset correction was calculated using both angles. Statistically significant differences for both the alpha and the HA angles were found between the control and the preoperative FAI group as well as between the preoperative and postoperative FAI groups. The HA angle-correction by a mean of 27.5° was significantly higher in comparison to the alpha angle correction by a mean of 25.4°. The intertester and intratester reliability of both angles were not significantly different. The HA angle is a new and reliable radiographic parameter for measuring cam deformity and proves superior in measuring cam correction.

Morphometric Effects of Whole-Body Vibration on the Bone in a Rat Model of Postmenopausal Osteoporosis

ObjectiveThe purpose of this study was to analyze the morphometric effects of mechanical vibration with a duration of 4 or 8 weeks on the femur of oophorectomized Wistar rats. MethodsSixty-four female rats were submitted to oophorectomy or a sham operation, and each of those 2 groups were randomized into 4 groups: untreated and euthanized at week 12, untreated and euthanized at week 16, treated for 4 weeks and euthanized at week 12, and treated for 8 weeks and euthanized at week 16. The vibration treatment was performed for 10 min/d, with a frequency of 60 Hz, 3 d/wk. The rats were then euthanized and the right femur dissected. Subsequently, histomorphometric analysis was performed on the proximal epiphysis and diaphysis of the spongy and cortical bone, respectively. ResultsAs expected, the oophorectomy groups presented reduction of spongy and cortical bone tissue. Further, the vibration therapy of 4 and 8 weeks’ duration in the oophorectomized groups led to increased bone mass, observed as an increased percentage of spongy tissue, and increased thickness and percentage of cortical tissue. However, the variables of femoral neck diameter, mean area of the shaft, and number of osteocytes were not altered by oophorectomy and vibration. ConclusionThe mechanical vibration was effective in increasing the bone mass of the femur of oophorectomized Wistar rats, observed by increasing the percentage of spongy bone and increasing the percentage and thickness of cortical bone.

Hip geometry on femoral neck bone strength; a review article

Introduction: Low bone strength of the hip, which depends on both bone mass and bone geometry, leads to risk for fragility hip fracture. Anatomical adaptations of the proximal femoral structure are important to maintain higher bone strength because they predict the fracture risk independent of bone mass. Therefore, it is crucial to evaluate the bone strength of proximal femur to predict the likelihood of fragility fracture risk based on both bone mass and geometric adaptations, as well as the biomechanical strength of femoral neck (FN). Aim: To discuss the literature on geometric indices and biomechanical indices of the proximal femur to estimate FN strength. Material and methods: Dual energy xray absorptiometry (DXA) based hip structural analysis (HSA) technique derived indices of FN geometric adaptations and biomechanical strength at FN and their impact on FN bone strength were explored using the existing literature. Bone mineral content (BMC, gram) and areal bone mineral density (aBMD, g/cm2) can be measured using the HAS technique. The simple hip geometric indices such as hip axis length (HAL), femoral neck length (FNL), neck shaft angle (NSA), FN diameters, FN width and biomechanical indices such as cross-sectional moment of inertia (CSMI, cm4), section modulus (Z, cm3) and cross-sectional area (CSA, cm2) can be estimated using the HSA technique to estimate FN bone strength. Conclusion: Estimation of FN bone strength by HSA based geometric adaptations and biomechanical strength indices provides better understanding of bone strength at FN. HAL and FN bone size with BMD provide better hip fracture predictability.

Evaluation of the Three‐Dimensional Translational and Angular Deformity in Slipped Capital Femoral Epiphysis

The purpose of this study was to quantify three-dimensional translational and angular deformity (defined as theta) present at the proximal femoral physis in slipped capital femoral epiphysis (SCFE), and to use theta to differentiate between SCFE hips, contralateral unaffected hips, and normal hips by comparing to the current gold standard measure of the Southwick slip angle (SSA). 3DCT reconstructions of the pelvis and femur in SCFE patients and normal adolescents were obtained and pelvic position was standardized. The center point and direction vector of the femoral epiphysis was determined. The femoral neck axis was defined. The angle between the femoral neck axis and epiphysis vector defined the 3D angle of deformity (theta). The 3D translation of the femoral epiphysis, measured as a percentage of femoral neck diameter, was measured in three planes. The average theta angle was significantly greater in SCFE hips (46.5 ± 24.3°) compared with control (13.7 ± 6.4°) or normal (11.7 ± 3.7°) hips (p < 0.001). There was no significant difference in theta angle between control and normal hips (p = 0.468). Theta angle correlated strongly with SSA (rs = 0.737, p < 0.001). Statement of clinical significance:The proximal femoral deformity in patients with slipped capital femoral epiphysis can be defined by measuring displacement of the epiphysis in all three dimensions in relation to the femoral neck axis. This information can be used in epiphyseal reorientation surgery to ensure anatomic reduction. The similarity between control and normal hips may argue against the thought that there is pre-existing deformity in a pre-slip condition of unaffected contralateral hips in SCFE patients. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:1081-1088, 2020.

Does hip morphology correlate with proximal femoral fracture type?

To determine if boney morphology influences the anatomic location of hip fractures in elderly patients. All patients with hip fractures between 2008 and 2012 who had hip radiographs taken prior to the fracture were reviewed. Fractures were classified as intracapsular or extracapsular and hip morphology was measured on the pre-fracture x-rays. Hip morphology was determined by alpha angle, lateral central edge angle, acetabular index, neck-shaft angle, hip axis length, femoral neck diameter, Tönnis classification for hip osteoarthritis (OA) and the presence of a crossover sign. 148 subjects (78.4% female, age 83.5 years) with proximal femur fractures were included. 44 patients (29.7%) had intracapsular fractures and 104 (70.3%) had extracapsular fractures. 48% of patients had previous hip fractures on the contralateral side and 74.6% had the same type of fracture bilaterally. The rates of bilateral intracapsular and extracapsular fractures were similar (33.7% vs. 40.9% respectively, p = 0.39). Extracapsular fractures had a statically significant higher neck-shaft angle, a shorter hip axis length, a narrower femoral neck diameter and a higher grade of Tönnis classification of OA (p = 0.04, 0.046, 0.03, 0.02 respectively). Acetabular coverage and the proximal femoral head-neck junction, which were evaluated by lateral centre-edge angle (LCEA), acetabular index and the presence of a crossover sign, did not correlate with fracture type. The alpha angle > 40° had a statistically significant higher likelihood for extracapsular fractures (p = 0.013). Acetabular coverage and proximal femoral head-neck junction morphology, were found to partially correlate with the location of hip fractures and do not fully elucidate fracture type susceptibility.

Comparison of Proximal Femoral Geometry and Risk Factors between Femoral Neck Fractures and Femoral Intertrochanteric Fractures in an Elderly Chinese Population.

Background:Few studies have investigated the differences in proximal femoral geometry and risk factors between patients with different types of hip fracture, especially in elderly Chinese. This study aimed to assess the differences in proximal femoral geometry parameters between patients with femoral neck fractures and patients with intertrochanteric fractures to provide guidance for individualized customized prosthesis and accurate reconstruction of proximal femurs in elderly Chinese patients.Methods:We retrospectively studied the electronic medical records of 198 elderly patients over 65 years of age who were admitted to the orthopedic department with hip fractures between January 2017 and December 2017 in The Third Hospital, Hebei Medical University. Age, fracture site, gender, and proximal femoral geometry parameters (neck shaft angle [NSA], center edge angle [CEA], femoral head diameter [FHD], femoral neck diameter [FND], femoral neck axial length [FNAL], hip axial length [HAL], and femoral shaft diameter [FSD]) were recorded. Student's t-test was used to compare the continuous variables, Chi-square test was used to analyze categorical variables, and multiple logistic stepwise regression analysis was used to evaluate the influencing factors of hip fracture type.Results:Statistically significant differences in NSA (137.63 ± 4.56° vs. 132.07 ± 4.17°, t = 1.598, P < 0.001), CEA (37.62 ± 6.77° vs. 43.11 ± 7.09°, t = 5.597, P < 0.001), FND (35.21 ± 3.25 mm vs. 34.09 ± 3.82 mm, t = 2.233, P = 0.027), and FNAL (99.30 ± 7.91 mm vs. 103.58 ± 8.39 mm, t = 3.715, P < 0.001) were found between the femoral neck fracture group and femoral intertrochanteric fracture group. FHD, FND, FSD, HAL, and FNAL were different between sexes (all P < 0.001). The greater NSA was the risk factor for femoral neck fractures (odds ratio [OR]: 0.70, P < 0.001), greater CEA and longer FNAL were risk factors for femoral intertrochanteric fractures (OR: 1.15, 1.17, all P < 0.001), and greater FND was a protective factor for femoral intertrochanteric fractures (OR: 0.74, P < 0.001).Conclusions:We demonstrate differences in geometric morphological parameters of the proximal femur in different hip fracture types, as well as an effect of sex. These differences should be considered in the selection of prostheses for fracture internal fixation and hip replacements. These data could help guide the design of individualized customized prostheses and improve the accurate reconstruction of the proximal femur for elderly Chinese hip fracture patients.

Estimating body mass and composition from proximal femur dimensions using dual energy x-ray absorptiometry

Body mass prediction from the skeleton most commonly employs femoral head diameter (FHD). However, theoretical predictions and empirical data suggest the relationship between mass and FHD is strongest in young adults, that bone dimensions reflect lean mass better than body or fat mass and that other femoral measurements may be superior. Here, we generate prediction equations for body mass and its components using femoral head, neck and proximal shaft diameters and body composition data derived from dual-energy x-ray absorptiometry (DXA) scans of young adults (n = 155, 77 females and 78 males, mean age 22.7 ± 1.3 years) from the Andhra Pradesh Children and Parents Study, Hyderabad, India. Sex-specific regression of log-transformed data on femoral measurements predicted lean mass with smaller standard errors of estimate (SEEs) than body mass (12–14% and 16–17% respectively), while none of the femoral measurements were significant predictors of fat mass. Subtrochanteric mediolateral shaft diameter gave lower SEEs for lean mass in both sexes and for body mass in males than FHD, while FHD was a better predictor of body mass in women. Our results provide further evidence that lean mass is more closely related to proximal femur dimensions than body or fat mass and that proximal shaft diameter is a better predictor than FHD of lean but not always body mass. The mechanisms underlying these relationships have implications for selecting the most appropriate measurement and reference sample for estimating body or lean mass, which also depend on the question under investigation.