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.

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Morphometric study of proximal femur in fractured and non-fractured post menopausal women

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2017.v10i4.16761 ◽

2017 ◽

Vol 10 (4) ◽

pp. 313

Author(s):

Lopamudra Nayak ◽

Susmita Senapati ◽

Sitanshu Kumar Panda ◽

Prafulla Kumar Chinara

Keyword(s):

Femoral Neck ◽

Proximal Femur ◽

Morphometric Study ◽

Control Group ◽

Head Width ◽

Femoral Neck Axis ◽

Neck Shaft Angle ◽

The Mean ◽

Axis Length ◽

And Control

Objective: This study was conducted to investigate the risk of hip fracture using proximal femoral morphometry in fractured and nonfractured postmenopausal women.Methods: We conducted an observational cross-sectional study with 138 postmenopausal women (49 fractured and 89 nonfractured). The hip axis length (HAL), femoral neck axis length (FNAL), acetabular width (AW), femoral head width (FHW), femoral shaft width (FSW), and femoral neck shaft angle (FNSA) were measured in all cases by dual energy X-ray absorptiometry. We also studied the correlation between body mass index (BMI) with all the parameters in fractured and control groups.Results: The mean age, height, weight, and BMI were 61.24±3.23, 163.94±7.84 cm, 71.88±9.14 kg, and 26.72±2.78 kg/m², respectively, in fractured patients. In nonfractured patients the values were 59.73±5.32, 161.73±4.25 cm, 69.54±6.25 kg, and 26.74±2.23 kg/m² respectively. The mean HAL, FNAL, AW, FHW, FSW, and FNSA were 130.5±3.18 mm, 111.26±3.64 mm, 18.2±1.91 mm, 53.46±1.51 mm, 37.45±1.82 mm, and 132.76±3.15 degree incase group and 130.84±4.74 mm, 112.48±4.08 mm, 17.57±2.32 mm, 53.4±1.86 mm, 35.29±1.82 mm, and 128.76±3.6° in control group, respectively.Conclusion: The femoral parameters such as HAL, FNAL, AW, and FHW do not indicate any correlation between fractured and control groups, whereas FSW and FNSA were significantly higher in case group. The FNSA was having significant negative correlation with BMI in fractured group while that was having a significant positive correlation in the nonfractured group. This observation will be helpful in exploration of its clinical significance in proximal femoral fracture.Keywords: Proximal femur, Morphometry, Postmenopausal, Fracture.

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Three-dimensional morphological study of the proximal femur in Crowe type IV developmental dysplasia of the hip

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02789-5 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Yuhui Yang ◽

Weihong Liao ◽

Weiqun Yi ◽

Hai Jiang ◽

Guangtao Fu ◽

...

Keyword(s):

Femoral Neck ◽

Proximal Femur ◽

Three Dimensional ◽

Developmental Dysplasia ◽

Medullary Canal ◽

Femoral Offset ◽

Neck Shaft Angle ◽

Type Iv ◽

Shaft Angle ◽

Dysplasia Of The Hip

Abstract Background When performing femoral reconstruction in patients with Crowe type IV developmental dysplasia of the hip (DDH), anatomical deformity presents many technical challenges to orthopedic surgeons. The false acetabulum is suggested to influence load transmission and femoral development. The aim of this study was to describe the morphological features of dysplastic femurs in Crowe type IV DDH and further evaluate the potential effect of the false acetabulum on morphological features and medullary canal of Crowe type IV femurs. Methods We analyzed preoperative computed tomography scans from 45 patients with 51 hips (25 hips without false acetabulum in the IVa group and 26 hips with false acetabulum in the IVb group) who were diagnosed with Crowe type IV DDH and 30 normal hips in our hospital between January 2009 and January 2019. Three-dimensional reconstruction was performed using Mimics software, and the coronal femoral plane was determined to evaluate the following parameters: dislocation height, dislocation ratio, height of the femoral head (FH), height of the greater trochanter (GT), GT–FH height discrepancy, height of the isthmus, neck-shaft angle, femoral offset and anteversion of the femoral neck. The mediolateral (ML) width, anterolateral (AP) width and diameter of medullary canal of the proximal femur were measured on the axial sections. Further, canal flare index (CFI), metaphyseal-CFI and diaphyseal-CFI were also calculated. Results Compared with the normal femurs, the Crowe type IV DDH femurs had a higher femoral head, larger GT–FH height discrepancy, larger femoral neck anteversion, higher isthmus position and smaller femoral offset. Dislocation height and dislocation rate were significantly larger in the IVa DDH group (65.34 ± 9.83 mm vs. 52.24 ± 11.42 mm). Further, the IVb femurs had a significantly lower isthmus position, larger neck-shaft angle and smaller femoral neck anteversion than IVa femurs. The ML, AP canal widths and the diameter of medullary canal in both DDH groups were significantly smaller than the normal group. Dimensional parameters of IVa femurs were also narrower than IVb femurs in most sections, but with no difference at the level of isthmus. According to the CFIs, the variation of proximal medullary canal in IVb femurs was mainly located in the diaphyseal region, while that in IVa femurs was located in the whole proximal femur. Conclusions High dislocated femurs are associated with more anteverted femoral neck, smaller femoral offset and narrower medullary canal. Without stimulation of the false acetabulum, IVa DDH femurs were associated with higher dislocation and notably narrower medullary canal, whose variation of medullary canal was located in the whole proximal femur.

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The Influence of Acetabular Morphology on Prediction of Proximal Femur Fractures Types in an Elderly Population

Hip International ◽

10.5301/hipint.5000476 ◽

2017 ◽

Vol 27 (5) ◽

pp. 489-493 ◽

Cited By ~ 1

Author(s):

Abbas Tokyay ◽

Melih Güven ◽

Mehmet E. Encan ◽

Erhan Okay ◽

Ozgur Akbaba

Keyword(s):

Femoral Neck ◽

Proximal Femur ◽

Acetabular Index ◽

Hip Axis Length ◽

Neck Shaft Angle ◽

Femur Fractures ◽

Acetabular Morphology ◽

Neck Fracture ◽

Axis Length ◽

Fracture Types

Introduction The role of proximal femur morphology to the development of certain proximal femur fracture types both femoral neck and trochanteric fractures has been observed. However, the relavance of acetabular morphology to the development of proximal femur fractures is not extensively questioned. Therefore the aim of the study was to determine whether there is a correlation between acetabular morphology and pathogenesis of 2 different hip fracture types after low energy trauma. Methods This retrospective study includes 60 cases (41 women, 19 men) with a proximal femoral fracture after a low energy trauma between July 2012 and December 2014. Acetabular depth and acetabular index were measured on pelvic radiographs. Neck shaft angle, hip axis length and cortical index were measured on pelvic computed tomography scans. All measurements were performed on the contralateral hip. Results Mean age was 77.56 ± 8.99 years (range 61-92 years). No statistically significant difference was found with regard to neck shaft angle, acetabular depth or cortical index measurements between patients with femoral neck fracture and patients with trochanteric femoral fractures (p>0.05). Acetabular index measurement was higher (p = 0.001) and hip axis length measurement was lower (p = 0.001) in trochanteric fracture group as compared to femoral neck fracture. Conclusions The rate of trochanteric femur fractures is higher in patients with high acetabular index, whereas the rate of femoral neck fractures is higher in patients with increased hip axis length.

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Does hip morphology correlate with proximal femoral fracture type?

Hip International ◽

10.1177/1120700019859275 ◽

2019 ◽

Vol 30 (5) ◽

pp. 629-634

Author(s):

Gilad Rotem ◽

Zachary T Sharfman ◽

Ehud Rath ◽

Aviram Gold ◽

Gil Rachevsky ◽

...

Keyword(s):

Hip Fractures ◽

Alpha Angle ◽

Fracture Type ◽

Crossover Sign ◽

Hip Axis Length ◽

Neck Shaft Angle ◽

Hip Morphology ◽

Shaft Angle ◽

Axis Length ◽

Neck Diameter

Purpose: To determine if boney morphology influences the anatomic location of hip fractures in elderly patients. Methods: 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. Results: 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). Conclusions: 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.

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Femoral Neck-shaft Angle Differs but Femoral Anteversion is Constant in Osteological Specimens with and without a Cam Deformity of the Proximal Femur

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2013.09.051 ◽

2013 ◽

Vol 29 (12) ◽

pp. e207 ◽

Cited By ~ 1

Author(s):

Jonathan Streit ◽

Jeremy Gebhart ◽

Asheesh Bedi ◽

Charles Bush-Joseph ◽

Shane Nho ◽

...

Keyword(s):

Femoral Neck ◽

Proximal Femur ◽

Femoral Anteversion ◽

Neck Shaft Angle ◽

Cam Deformity ◽

Shaft Angle

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Valgus Osteotomy Outcome for Treating Femoral Neck Nonunion in Young and Active Patients

Journal of Research in Orthopedic Science ◽

10.32598/jrosj.8.2.400.1 ◽

2021 ◽

Vol 8 (2) ◽

pp. 65-70

Author(s):

Kaveh Gharanizadeh ◽

◽

Hamed Tayyebi ◽

Abbas Esmaeli ◽

Maziar Rajei ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Neck ◽

Hip Arthroplasty ◽

Limb Length Discrepancy ◽

Osteotomy Site ◽

Valgus Osteotomy ◽

Neck Shaft Angle ◽

Shaft Angle ◽

The Mean

Background: Femoral neck fracture nonunion is a frequent and challenging complication, with several surgical options. Objectives: The present study reported the outcome of valgus osteotomy for treating femoral neck nonunion in patients aged <65 years. Methods: This case series research included young patients who underwent valgus osteotomy for treating femoral neck nonunion or device failure of the index surgery. The fixation of the osteotomy site was performed using either a dynamic hip screw or a fixed angle blade. The union of the neck and osteotomy site (subtrochanteric region) was evaluated by monitoring callus formation in the postoperative radiographs. Limb length discrepancy, Pauwels’ angle, and the neck-shaft angle were evaluated before the surgery and at the last follow-up. Postoperative complications were extracted from the explored patients’ profiles. Results: Twenty patients with a Mean±SD age of 27.2±10.8 years were examined in this study‎. The Mean±SD follow-up time of the patients was 6.1±3.9 years. The femoral neck was united in 18 patients in a Mean±SD period of 5.1±2.3 months. The Mean±SD limb length discrepancy was measured as 1.3±0.8 cm before and 0.5±0.7 cm after the ‏osteotomy. The Mean±SD Pauwels’ angle was calculated as 65.5±16.9º before and 32.4±16.2º after the osteotomy. The Mean±SD neck-shaft angle was computed to be 121.9±22.8º before and 144.5±17.7º after the osteotomy. Revision surgery was performed for 6 (30%) patients. This measure included device removal in 4 and total hip arthroplasty in 2 patient. Conclusion: Valgus osteotomy is a safe and efficient technique for managing femoral neck nonunion. Therefore‎, this approach is suggested as a good alternative for total hip arthroplasty, particularly in young and active patients‎.

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Co-relation between Hip Axis Length and Femoral Neck-Shaft Angle with Body Mass Index of Indian Population: A Radiological Study

International Journal of Current Research and Review ◽

10.31782/ijcrr.2021.13826 ◽

2021 ◽

Vol 13 (08) ◽

pp. 115-119

Author(s):

Lopamudra Nayak ◽

Pratima Baisakh ◽

Sitansu Kumar Panda ◽

Prafulla Kumar Chinara

Keyword(s):

Body Mass Index ◽

Femoral Neck ◽

Body Mass ◽

Indian Population ◽

Hip Axis Length ◽

Radiological Study ◽

Neck Shaft Angle ◽

Shaft Angle ◽

Axis Length

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Comparing Two Different Automatic Methods to Measure Femoral Neck-Shaft Angle Based on PointNet++ Network

10.21203/rs.3.rs-1096475/v1 ◽

2021 ◽

Author(s):

Zhe Li ◽

Jiayu Yang ◽

Xinghua Li ◽

Kunzheng Wang ◽

Jungang Han ◽

...

Keyword(s):

Femoral Neck ◽

Femoral Shaft ◽

Femoral Neck Axis ◽

Neck Shaft Angle ◽

3D Space ◽

Significant Difference ◽

Shaft Angle ◽

Automatic Methods ◽

3D Methods ◽

2D And 3D

Abstract Bacnground: Accurate measurement of the femoral neck-shaft angle (NSA) is of great significance for diagnosing hip joint diseases and preoperative planning of total hip arthroplasty. However, the fitting lines of the femoral neck and femoral shaft did not always intersect in 3D space. Thus, it is unclear whether there is a difference between 2D and 3D methods for measuring NSA. Methods: The femoral point cloud datasets from 310 subjects were segmented into three regions, including the femoral head, femoral neck, and femoral shaft using PointNet++. We created a projection plane to simulate the hip anteroposterior radiograph and fitted the femoral neck axis and femoral shaft axis to complete the 2D measurement, while we directly fitted the two axes in space to complete the 3D measurement. Also, we conducted the manual measurement of the NSA. We verified the accuracy of the segmentation and compared the results of the two automatic and manual methods. Results: The Dice coefficient of femoral segmentation reached 0.9746, and MIoU of that was 0.9165. No significant difference was found between any two of the three methods. While comparing the 2D and 3D methods, the average accuracy was 98.00%, and the average error was 2.58°. Conclusion: This paper proposed two accurate and automatic methods to measure the NSA based on a 2D plane and a 3D model respectively. Although the femoral neck and femoral shaft axes did not intersect in 3D space, the NSAs obtained by 2D and 3D methods were basically consistent.

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