Hip Axis Research Articles

The association between anterior femoroacetabular impingement and femoral neck fractures: An observational study.

The impact between acetabulum and femoral neck is another possible mechanism of femoral neck fracture.Direct trauma of the greater trochanter may not be able to fully explain the mechanism underlying femoral neck fracture. In this study, we sought to investigate whether anterior femoroacetabular impingement are associated with femoral neck fractures.A total of 36 patients with femoral neck fracture who had undergone total hip arthroplasty or hemiarthroplasty were included in this study. These patients were divided into 2 groups: labrum tear group and normal labrum group. Patients’ age, gender, body mass index, muscle injury, injury pattern, trauma severity, femoral head-neck offset, femoral head-neck ratio, Cam deformity alpha angle, acetabular anteversion, femoral head diameter, acetabular index, cortical index, hip axis length, and neck stem angle were recorded and analyzed. SPSS 18.0 software was used for statistical analyses.According to intraoperative findings, 22 patients exhibited a labrum tear. Magnetic resonance imaging examination revealed bone contusion on the anterolateral margin of the acetabulum with muscle damage surrounding the hip. Among 14 cases without a labrum tear, no bone contusion and obvious muscle injury were found on the anterolateral margin of the acetabulum. Notably, muscle injury, injury pattern, trauma severity and femoral head-neck offset differed significantly (P < .05) between labrum tear and normal labrum groups.Previous studies have focused more on direct lateral trauma. In this study, the impact between acetabulum and femoral neck is another possible mechanism besides lateral impact. Specifically, the abnormal anatomy of the hip, such as femoral head-neck offset, may promote the fracturing process.

Determination of bone mass and hip axis length of contralateral side in patients with hip fracture

Introduction: The currently accepted definition of osteoporosis as follows: A progressive systemic skeletal disease characterized by a low bone mass and microarchitectural deterioration of bone tissue leading to an increase in bone fragility and a susceptibility to fractures. BMD compared with age and sex matched controls (Z-scores) or with young adult sex matched controls (T-scores). Hip axis length (HAL) is the dimension along the femoral neck axis from the base of greater trochanter through the femoral head and the acetabulum to the inner pelvic brim, and it is one of the strongest predictors of fracture risk. Material and method: Twenty five patients with hip fracture of which 14 patients had intertrochantric fracture and 11 had neck femur fracture were included in our study. Bone mineral density of contralateral hip at neck, trochanteric region, Ward’s triangle, upper shaft and total BMD were assessed. Hip axis length was calculated automatically by the machine. All the parameters were analyzed and compared for statistical reporting of results. Summary and Conclusion: We conclude that the patients with hip fractures have significantly lower bone mass in proximal femur, femoral neck region and intertrochanteric region. The mean hip axis length of patients with femoral neck fractures (10.25 ± 0.73 cm) is more than patients with intertrochanteric fractures (9.76 ± 0.80 cm).

Influence of hip geometry to intracapsular fractures in Sri Lankan women: prediction of country specific values

Falls are very common in daily life. Hip is a highly vulnerable location during a fall. Trochanter can be compressed due to side falls resulting either intracapsular or extracapsular fracture. The relationship of bone geometry to the fracture risk can be analysed as a determinant of mechanical resistance of the bone, as well as a promising fracture prediction tool. Intracapsular fractures are highly depend on the hip geometry compared to the extracapsular fractures. This study aims to find out the influence of hip geometry to the intracapsular fractures among Sri Lankan women. Hip axis length (HAL), neck shaft angle (NSA), femoral neck width (FNW) and moment arm length of intracapsular patients have compared with a normal group. Concurrently, the moment applied to the proximal femur during the sideway fall is computed and compared with a normal group. We observed that fractured group has greater NSA, HAL and FNW compared to the normal group. Furthermore, intracapsular fracture females have longer moment arm of the force in the sideway fall resulting a greater load on femoral neck compared to the normal group.

Influence of hip geometry to intracapsular fractures in Sri Lankan women: prediction of country specific values

Falls are very common in daily life. Hip is a highly vulnerable location during a fall. Trochanter can be compressed due to side falls resulting either intracapsular or extracapsular fracture. The relationship of bone geometry to the fracture risk can be analysed as a determinant of mechanical resistance of the bone, as well as a promising fracture prediction tool. Intracapsular fractures are highly depend on the hip geometry compared to the extracapsular fractures. This study aims to find out the influence of hip geometry to the intracapsular fractures among Sri Lankan women. Hip axis length (HAL), neck shaft angle (NSA), femoral neck width (FNW) and moment arm length of intracapsular patients have compared with a normal group. Concurrently, the moment applied to the proximal femur during the sideway fall is computed and compared with a normal group. We observed that fractured group has greater NSA, HAL and FNW compared to the normal group. Furthermore, intracapsular fracture females have longer moment arm of the force in the sideway fall resulting a greater load on femoral neck compared to the normal group.

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.

Influence of spino-pelvic and postural alignment parameters on gait kinematics

IntroductionPostural alignment is altered with spine deformities that might occur with age. Alteration of spino-pelvic and postural alignment parameters are known to affect daily life activities such as gait. It is still unknown how spino-pelvic and postural alignment parameters are related to gait kinematics. Research questionTo assess the relationships between spino-pelvic/postural alignment parameters and gait kinematics in asymptomatic adults. Methods134 asymptomatic subjects (aged 18–59 years) underwent 3D gait analysis, from which kinematics of the pelvis and lower limbs were extracted in the 3 planes. Subjects then underwent full-body biplanar X-rays, from which skeletal 3D reconstructions and spino-pelvic and postural alignment parameters were obtained such as sagittal vertical axis (SVA), center of auditory meatus to hip axis plumbline (CAM-HA), thoracic kyphosis (TK) and radiologic pelvic tilt (rPT). In order to assess the influence of spino-pelvic and postural alignment parameters on gait kinematics a univariate followed by a multivariate analysis were performed. ResultsSVA was related to knee flexion during loading response (β = 0.268); CAM-HA to ROM pelvic obliquity (β = −0.19); rPT to mean pelvic tilt (β = −0.185) and ROM pelvic obliquity (β = −0.297); TK to ROM hip flexion/extension in stance (β = −0.17), mean foot progression in stance (β = −0.329), walking speed (β = −0.19), foot off (β = 0.223) and step length (β = −0.181). SignificanceThis study showed that increasing SVA, CAM-HA, TK and rPT, which is known to occur in adults with spinal deformities, could alter gait kinematics. Increases in these parameters, even in asymptomatic subjects, were related to a retroverted pelvis during gait, a reduced pelvic obliquity and hip flexion/extension mobility, an increased knee flexion during loading response as well as an increase in external foot progression angle. This was associated with a decrease in the walking pace: reduced speed, step length and longer stance phase.

A novel tissue separation method for determining upper trunk center of gravity in patients with thoracolumbar kyphosis using MIMICS

BackgroundIn the past, a variety of methods have been explored to determine the center of gravity or gravity line, such as the hanging method or force plate analysis. However, these methods possess limitations related to precise location of center of gravity. The aim of this study was to describe a tissue separation method to precisely calculate the center of gravity in upper trunk. MethodsTwenty post-operative patients with thoracolumbar kyphosis were retrospectively studied. Center of gravity models were computed: T1–T5 segment, T6–T10 segment and T1–T10 segment. The tissue separation method was used to calculate the center of gravity in each segment. A new center of gravity was composited from T1–T5 segment and T6–T10 segment by composition formula. Similarity and collinearity between center of gravity models was analyzed to verify the reliability of tissue separation method. Correlation between gravity line and theoretic hip axis was compared on pre- and post-operative radiographs to explore their potential application for surgical plan. FindingsComposited center of gravity had significant correlation and high similarity with center of gravity in T1–T10 segment. There was high collinearity between center of gravity points. The post-operative included angle between the gravity line and theoretic hip axis significantly decreased to nearly 0°. InterpretationThese findings demonstrate the MIMICS can reliably calculate the center of gravity in the upper trunk by a tissue separation method. The pre-operative included angle between the gravity line and theoretic hip axis was suggested as a parameter to improve surgical design for thoracolumbar kyphosis correction.

Effects of Hip Structure Analysis Variables on Hip Fracture: A Propensity Score Matching Study.

The purpose of this retrospective study was to compare the hip structural analysis (HSA) levels of patients with those of a hip fracture group. All patients with an initial hip fracture who were older than or equal to 65 years old and admitted to our hospital between March 2018 and January 2019 were eligible for this study. During the study period, 134 hip fracture patients aged 65 years and older were admitted to the study institution, and a total of 51 hip fracture patients were ultimately assigned to the patient group. Age, sex, body mass index (BMI), skeletal muscle index (SMI), and vitamin D were matched in the two groups (hip fracture (HF) group vs. non-hip fracture group) using propensity score matching (PSM) without any statistical differences. Following propensity score matching, 51 patients in the HF group and 51 patients in the non-HF group were included in the study, respectively. Hip axis length (p = 0.031), neck-shaft angle (p = 0.043), width of intertrochanter (p = 0.005), and femur shaft (p = 0.01) were found to be significantly higher in the HF group (107.31 (mean) ± 9.55 (standard deviation, SD), 131.11 ± 5.29, 5.57 ± 0.58, and 3.05 ± 0.23, respectively) than in the non-HF group (102.07 ± 14.15, 128.85 ± 5.81, 5.29 ± 0.38, and 2.92 ± 0.23, respectively). However, cross-sectional area (CSA) of femur neck (p = 0.005) and femur shaft (p = 0.01) as well as cortical thickness (CT) of femur neck (p = 0.031) and femur shaft (p = 0.031) were found to be significantly lower in the HF group (1.93 ± 0.44, 3.18 ± 0.83, 0.11 ± 0.02, and 0.38 ± 0.09, respectively) than in the non-HF group (2.12 ± 0.46, 3.57 ± 0.78, 0.13 ± 0.03, and 0.47 ± 0.11, respectively). The HSA showed excellent sensitivity (82.4% to 90.2%). HSA is an important factor in predicting the occurrence of hip fracture. Therefore, not only should bone mineral density (BMD) be considered clinically, but it is also important to look closely at HSA for risk of hip fracture.

Sagittal balance of the spine

The static sagittal balance of the normal spine is a physiological alignment of the spine in the most efficient manner by the muscular forces. During gait, this balance is constantly thwarted by single-foot support. This analysis involves the study of parameters which are now well defined. The pelvic incidence is constant, and the sacral slope and the pelvic tilt are positional. The cervical parameters are the upper (O–C2) and lower cervical curvatures (C2–C7), the C7 slope, the spino-cranial angle and the vertical cervical offset. At the thoracic and lumbar level, they are, respectively, kyphosis and lordosis. The OD-HA (odontoid hip axis) angle is the most efficient parameter to analyse the global balance. The average values of these parameters are reported with the new 3D measurements by Le Huec et al. The relationship between these different parameters was analysed, and Roussouly proposed his classification of the different spine shape. Ageing makes it possible to show compensation mechanisms at three levels: spinal, pelvic and lower limbs. Understanding these different data allows for better planning of the surgical management of the patients. Global evaluation of the entire spine and the measurement of the aforementioned parameters allow to determine the extent of the correction to be performed during surgery. Taking these parameters into account also enables us to understand the complications involved in this type of surgery: transitional syndromes or junctional syndromes. Integration of these parameters into the study of gait is an area still under investigation.Graphic abstractThese slides can be retrieved under Electronic Supplementary Material .

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.

Evaluation of Hip Geometry Parameters in Patients With a Distal Radius Fracture

Background: Patients with a distal radius fracture (DRF) have an increased risk of subsequent fractures including hip fractures. The purpose of this study was to evaluate whether women with a DRF have certain hip geometry parameters known to indicate susceptibility to hip fractures. Methods: We compared bone mineral density (BMD) and hip geometry parameters (hip axis length, neck shaft angle, mean cortical thickness, femur neck width, cross-sectional area [CSA], cross-sectional moment of inertia, section modulus, and buckling ratio) in 181 women with a DRF (DRF group) and 362 propensity score-matched women without a fracture (control group). We evaluated the associations between DRF and hip geometry parameters using logistic regression analysis. Results: The DRF group had lower hip BMD; lower cortical thickness, CSA, and section modulus; and higher buckling ratio than the control group (all p < 0.05). The occurrence of a DRF was significantly associated with decreases in neck shaft angle (odds ratio [OR], 1.047; 95% confidence interval [CI], 1.008–1.088) and CSA (OR, 3.114; 95% CI, 1.820–5.326) after adjusting for age, BMI, and total hip BMD. Conclusions: In this study, women with a DRF were more likely than women without a DRF to have hip geometry parameters known to indicate susceptibility to hip fractures. Our results suggest that not only low hip BMD but also a decreased CSA could account for the increased risk of subsequent hip fracture in patients with a DRF.

Rotation of shoulder and hip axes during a basketball jump shot

ABSTRACTThe aim of our research was to determine the changes in rotation of the shoulder and hip axes in the transverse plane during the execution of a jump shot due to changing shooting distance. Fourteen youth national team basketball players, all shooting guards (age 15.43 ± 0.51 years) were tested. The analysis included 370 field goals, performed from three different distances (3.75 m, 5.25 m and 6.75 m). We used the inertial suit for data acquisition. Results showed that differences in shoulder and hip rotation axes angles occurred at the very beginning of the shooting action and that these differences were preserved until landing. Differences in shoulder and hip rotation measured during the shots from different distances were obtained showing the greatest rotation in all phases of the shot when shooting from the longest distance. While the rotation in the shoulder axis finished in the moment of release, in the hip axis it was still increasing due to inertia until the moment of landing. This shows how the shooter locks the shoulder position to align the upper body for the most accurate shot.

Fracture Risk Indices From DXA-Based Finite Element Analysis Predict Incident Fractures Independently From FRAX: The Manitoba BMD Registry

Objective: Finite element analysis (FEA) is a computational method to predict the behavior of materials under applied loading. We developed a software tool that automatically performs FEA on dual-energy X-ray absorptiometry hip scans to generate site-specific fracture risk indices (FRIs) that reflect the likelihood of hip fracture from a sideways fall. This longitudinal study examined associations between FRIs and incident fractures. Methods: Using the Manitoba Bone Mineral Density (BMD) Registry, femoral neck (FN), intertrochanter (IT), and subtrochanter (ST) FRIs were automatically derived from 13,978 anonymized dual-energy X-ray absorptiometry scans (Prodigy, GE Healthcare) in women and men aged 50 yr or older (mean age 65 yr). Baseline covariates and incident fractures were assessed from population-based data. We compared c-statistics for FRIs vs FN BMD alone and fracture risk assessment (FRAX) probability computed with BMD. Cox regression was used to estimate hazard ratios and 95% confidence intervals (95% CIs) for incident hip, major osteoporotic fracture (MOF) and non-hip MOF adjusted for relevant covariates including age, sex, FN BMD, FRAX probability, FRAX risk factors, and hip axis length (HAL). Results: During mean follow-up of 6 yr, there were 268 subjects with incident hip fractures, 1003 with incident MOF, and 787 with incident non-hip MOF. All FRIs gave significant stratification for hip fracture (c-statistics FN-FRI: 0.76, 95% CI 0.73–0.79, IT-FRI 0.74, 0.71–0.77; ST-FRI 0.72, 0.69–0.75). FRIs continued to predict hip fracture risk even after adjustment for age and sex (hazard ratio per standard deviation FN-FRI 1.89, 95% CI 1.66–2.16); age, sex, and BMD (1.26, 1.07–1.48); FRAX probability (1.30, 1.11–1.52); FRAX probability with HAL (1.26, 1.05–1.51); and individual FRAX risk factors (1.32, 1.09–1.59). FRIs also predicted MOF and non-hip MOF, but the prediction was not as strong as for hip fracture. Summary: Automatically-derived FN, IT, and ST FRIs are associated with incident hip fracture independent of multiple covariates, including FN BMD, FRAX probability and risk factors, and HAL.

Mediating Effect of Muscle on the Relationship of Physical Activity and Bone.

This study analyzed prospective associations between distinct trajectories of objectively measured physical activity (PA) and late adolescent bone parameters and explored the mediating effects of lean soft tissue, a surrogate of muscle mass to associations. Physical activity was measured by accelerometry starting at age 5 yr and continuing at 8, 11, 13, 15, and 17 yr in approximately 524 participants from the Iowa Bone Development Study. Sex-specific group-based trajectory modeling was used to construct developmental trajectories of moderate- and vigorous-intensity PA (MVPA) from childhood to late adolescence. At age 17 yr, proximal femur bone mineral density (aBMD) was assessed by dual X-ray energy absorptiometry, and its distribution was calculated by aBMD ratios. Specific geometric measures of the proximal femur were assessed using hip structural analysis. A significant portion of the total effect of MVPA from age 5 to 17 yr on bone parameters at age 17 yr was explained by an increase in leg lean soft tissue in both sexes. For males and females, indirect effects were observed on the total and all regional proximal femur aBMD, and on the ratio between the inferomedial and superolateral neck aBMD. The effect on the ratio between the trochanter and the total proximal femur was specific to females, whereas the effect on the hip axis length was specific to males. Direct effects of MVPA on aBMD were identified only in males. Using robust mediation analysis, this is the first study addressing the indirect effect (through muscle) of PA across childhood and adolescence on proximal femur bone parameters. To improve bone health at the proximal femur, the results suggest PA interventions during growth that increase muscle mass, particularly in females.

MORPHOMETRIC STUDY OF PROXIMAL FEMUR AND ITS CORRELATION WITH BONE MINERAL DENSITY. A CROSS-SECTIONAL STUDY

Objective: Proximal femoral morphometries such as hip axis length (HAL), femoral neck (FN) axis length (FNAL), and FN shaft angle (FNSA) are important parameters for prediction of fracture risk. These parameters are affected by factors such as body habitus, age, sex, race, bone mineral density (BMD), and body mass index. Hence, the present study was designed to evaluate the relationship between proximal femoral morphometry and BMD.Methods: We conducted an observational cross-sectional study in 168 patients. The measurements of radiological parameters such as HAL, FNAL, and FNSA were taken using dual-energy X-ray absorptiometry scan. FN-BMD was measured using LUNAR XR scanner and expressed as gm/cm². The correlation between proximal femoral morphometry and FN-BMD has been studied using Karl Pearson correlation coefficient (r).Results: The mean age, height, weight, HAL, FNAL, FNSA, and FN-BMD of the study population were found to be 58.72 years, 160.15 cm, 64.38 kg, 104.14 mm, 103.51 mm, 128.51°, and 0.761 g/cm², respectively. FN-BMD had a negative correlation with HAL (r=−0.791), FNAL (r=−0.734), and FNSA (r=−0.713) where p=0.000.Conclusion: There is a significant correlation between FN-BMD and proximal femoral morphometry. This observation will be helpful in exploration of its clinical significance in proximal femoral fracture.

Evaluation of pelvic morphology in female patients with developmental dysplasia of the hip using three-dimensional computed tomography: A cross-sectional study

BackgroundThe purpose of this study is to measure pelvic morphology with respect to the pelvic incidence, pelvic tilt, and sacral slope using 3-dimensional measurement and to compare the pelvic morphology between the normal population and women with developmental dysplasia of the hip (center-edge angle, <25°). We hypothesized that the relationship between pelvic incidence, anatomical pelvic tilt, and anatomical sacral slope would be different between normal subjects and patients with developmental dysplasia of the hip. MethodsWe evaluated 61 healthy women without low back or knee pain and 71 patients with developmental dysplasia of the hip. We used the 3-dimensional pelvis model adjusted to the anterior pelvic plane and measured the pelvic parameters. To determine correlation, we used Pearson's coefficients. To evaluate variation, we used intraclass correlation coefficients. ResultsPelvic incidence and anatomical pelvic tilt were significantly greater by 4° in the group with developmental dysplasia of the hip than in the normal group (p = 0.026 and < 0.001, respectively). The vertical distance from hip axis to the center of the S1 endplate was significantly greater in the group with developmental dysplasia of the hip than in normal group, that is, by 8 mm (p < 0.001). There was a strong correlation between pelvic incidence and anatomical sacral slope in both groups (R = 0.707 and 0.897, respectively). The intraobserver and interobserver mean absolute differences were about 2 mm and 2°, respectively, and the intraclass correlation coefficient was >0.88. ConclusionPelvic incidence and anatomical-pelvic tilt were significantly greater in patients with developmental dysplasia of the hip. We found a strong correlation between the pelvic incidence and anatomical sacral slope in both groups. Therefore, anatomical-sacral slope may be useful for estimating pelvic incidence because it is not easily measured, especially in patients with osteoarthritis of the hip joint.

Hip axis length in women with type 1 diabetes mellitus

Hip axis length in women with type 1 diabetes mellitus

How does the sagittal spinal balance of the scoliotic population deviate from the asymptomatic population?

BackgroundPreviously, the sagittal spinal balance in both asymptomatic and scoliotic Caucasian people has been characterized and compared. Very recently, the sagittal spino-pelvic parameters among asymptomatic Chinese adults have been studied, and the results were compared with Caucasian adults, indicating that a difference did exist. Unfortunately, the distribution of sagittal standing posture patterns among the Chinese population has not been characterized in either asymptomatic or scoliotic groups.MethodsWe conducted a radiographic comparison study to define the deviation of sagittal balance in scoliotic patients from that of an asymptomatic population. A total of 126 asymptomatic and 117 idiopathic scoliotic (IS) young adults were recruited. Radiographic data from each subject were reviewed, and sagittal spinopelvic parameters were measured. The Roussouly type was then determined, as well as the relative position of the C7 plumbline with respect to the sacrum and hip axis. Comparison analyses were undertaken between the two different groups.ResultsThe IS group had a larger pelvic incidence, pelvic tilt and sacral slope, but a smaller spinal tilt than the asymptomatic group (P < 0.05), while other sagittal parameters were similar. The distribution of Roussouly types was similar between the asymptomatic and IS groups, of which 49.2% and 45.3% belonged to Roussouly Type 3, respectively. Asymptomatic males and females had a similar distribution, which was different between the two genders in the IS group (P < 0.05), with more females possessing a neutral sagittal standing posture. In addition, more IS subjects had forward displacement of the C7 plumbline than asymptomatic ones (P < 0.05), while there was no difference between the two genders in either group.ConclusionsAlthough sagittal pelvic parameters were greater in the IS population, their sagittal spinal balance was maintained and there was no sagittal standing posture pattern correlated with IS. The occurrence of anterior displacement of the C7 plumbline was more common in IS patients than asymptomatic adults, but did not appear to be correlated with gender in both populations.

Radiographic anatomy of the proximal femur: femoral neck fracture vs. transtrochanteric fracture

ObjectiveTo evaluate the correlation between radiographic parameters of the proximal femur with femoral neck fractures or transtrochanteric fractures. MethodsCervicodiaphyseal angle (CDA), femoral neck width (FNW), hip axis length (HAL), and acetabular tear drop distance (ATD) were analyzed in 30 pelvis anteroposterior view X-rays of patients with femoral neck fractures (n=15) and transtrochanteric fractures (n=15). The analysis was performed by comparing the results of the X-rays with femoral neck fractures and with transtrochanteric fractures. ResultsNo statistically significant differences between samples were observed. ConclusionThere was no correlation between radiographic parameters evaluated and specific occurrence of femoral neck fractures or transtrochanteric fractures.

Effect of global postural alignment on gait: A study on 145 asymptomatic subjects with a large age range

Introduction Global postural alignment parameters have been shown to be major determinants of quality of life [1] . Gait is an essential task of functionality during daily living activities. It is still unknown how global postural alignment can influence gait. The aim was to investigate how global postural alignment can influence gait in asymptomatic subjects. Materiel et methodes Overall, 145 asymptomatic subjects (age: 29.2 ± 11 years [18–59], 70F) underwent 3D gait analysis followed by full body biplanar X-rays. Kinematics of lower limb segments (pelvis, hip, knee, ankle and foot) were extracted in the 3 planes during the gait cycle. Full body 3D reconstructions were obtained from the biplanar X-rays and global postural alignment was evaluated by calculating: sagittal vertical axis (SVA), center of the auditory meatus plumbline to the hip axis, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic parameters (PI, PT, SS). Agglomerative hierarchical clustering (AHC) was performed on each postural parameter to classify subjects into homogeneous groups. Differences in gait parameters between groups were evaluated using ANCOVA while adjusting for demographic confounding factors (age, weight, height and sex). Resultats The most discriminant postural parameter in gait kinematics was the SVA. AHC differentiated 3 groups of SVA: Gr1: 10 mm, n = 55. Weight, height and sex were statistically different between groups (Gr1 vs. Gr3: 68 ± 16 vs. 77 ± 13 kg, 167, n 10 vs. 173 ± 10 cm, 39F/23 M vs. 6F/22 M, p Discussion This is the first study demonstrating the influence of postural alignment parameters on gait. While interindividual variations of TK and LL were not shown to impact gait, subjects with elevated SVA had their general gait modified even after correcting for confounding factors: higher duration with larger knee flexion during shock absorption phase at the beginning of gait cycle. While these results were shown in asymptomatic subjects with high SVA (> 10 cm), higher SVA in subjects with spinal deformities could be a cause for more altered gait kinematics.