Assessment of Femoral Neck-shaft Angle on Plain X-rays and its Clinical Implications

Background: Femoral neck-shaft angle is an important parameter for evaluating the biomechanics of the hip joint. It plays a pivotal role in surgeries for developmental dysplasia of the hip, neuromuscular disorders of the lower limb, proximal femoral fractures, Total Hip Arthroplasty, Perthes disease etc., It is also considered to hold an extensive bearing while designing orthopaedic implants. Aim: This study aimed to evaluate the femoral neck-shaft angle of proximal femur on plain radiographs of our local population Study Design: Retrospective study Methods: This cross-sectional study was done at Saveetha medical college hospital, a tertiary care institute in Chennai. 50 pelvic X-rays of patients aged between 30 to 70 who presented to the outpatient or emergency care department were used in the study. Using a goniometer the femoral neck shaft angle was measured in the plain X - ray. Results: The mean age of the population in our study was 47.12. And the mean femoral neck shaft was 132.6 in males and 124.9 in females.

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Sexual Variations of Femoral Neck-Shaft Angle in the Population of Odisha

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/293 ◽

2021 ◽

Vol 10 (19) ◽

pp. 1387-1390

Author(s):

Rajeev Kumar Kanchan ◽

Sonali Subhadarsini ◽

Dharma Niranjan Mishra ◽

Chinmayi Mohapatra

Keyword(s):

Femoral Neck ◽

Ventral Surface ◽

Cross Sectional Study ◽

Cross Sectional ◽

Legal Cases ◽

Male And Female ◽

Neck Shaft Angle ◽

Femur Neck ◽

Shaft Angle ◽

The Right

BACKGROUND The peculiar waddling gait of a female attracts most of the anatomists to measure and compare the neck-shaft angle (NSA) of the femora. The femoral neck shaft angle is greater in women due to greater pelvic breadth and shorter femur. Neck-shaft angle was measured by the angle that the neck makes with the shaft of the femur and it is measured on the ventral surface of femur taking the long axis of femoral neck with the long axis of the proximal end of the femur. It gives information about the race it belongs to and normally measures 120° to 140°. The intention of this study was to establish the femoral neck shaft angle variations in adult male and female for medico-legal and anthropometric studies. METHODS This cross-sectional study was conducted on 84 adult human femora of unknown sex in the anatomy department, Sriram Chandra Bhanja (SCB) Medical College, Cuttack, Odisha, from May 2018 to April 2019. We included all the femora which were free of damage or deformity and fully ossified indicating adult bone. Femora with any pathological changes i.e., cortical bone deterioration, extreme osteophyte activity, osteoarthritis and fracture etc. were excluded from the study. The NSA was measured by protractor and goniometer. RESULTS In the present study the NSA range for the right femur of male was 108° - 135° and for the right femur of females 117° - 135°. The left male femur was 118° - 135° and the left female femur was 120° - 135°. The mean neck shaft angle of male femora was 125.9° and the female femora was 125.7°. These measurements show that the values were more in males than the females. The value of the present study was statistically significant between male and female i.e., P < 0.0001. CONCLUSIONS These measurements are important in the medico-legal cases, reconstructive orthopaedic surgeries, hip replacement surgeries and also while constructing suitable prosthesis. This will also be helpful in the detection of sex by anatomists and forensic experts. KEY WORDS Neck Shaft Angle, Medico-Legal, Anthropometry and Goniometer

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The Association Between Femoral Neck-Shaft Angle and Aging and Its Influence on the Performance of Functional Activity: A Cross-Sectional Investigation

Journal of Aging and Physical Activity ◽

10.1123/japa.2019-0008 ◽

2020 ◽

Vol 28 (2) ◽

pp. 250-254

Author(s):

Ibrahim M. Altubasi

Keyword(s):

Femoral Neck ◽

Regression Models ◽

Walking Speed ◽

Functional Performance ◽

Hierarchical Regression ◽

Performance Tests ◽

Cross Sectional ◽

Neck Shaft Angle ◽

Functional Activities ◽

Shaft Angle

The purposes of this study were first to examine the association between aging and both the magnitude and asymmetry in the femoral neck-shaft angle (NSA). The second purpose was to determine the effects of both the magnitude and NSA asymmetry on the performance of functional activities in healthy individuals. Fifty-one subjects participated in this study. The femoral NSA was measured on computed tomography scout images. The participants performed four performance tests. Four hierarchical regression models were constructed to explore the effect of each predictor on the outcomes. Aging was associated with NSA asymmetry, but not with the degree of NSA. Age contributed significantly to the variability of all functional performance tests except the 10-m walking speed. The degree of the NSA did not contribute to the prediction of the functional performance tests. However, asymmetry in the NSA added significantly to the prediction of all functional performance tests except the 10-m walking speed.

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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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The Modified Femoral Neck-Shaft Angle: Age- and Sex-Dependent Reference Values and Reliability Analysis

BioMed Research International ◽

10.1155/2016/8645027 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Christoph Kolja Boese ◽

Michael Frink ◽

Janine Jostmeier ◽

Stefan Haneder ◽

Jens Dargel ◽

...

Keyword(s):

Femoral Neck ◽

Reference Values ◽

Interrater Reliability ◽

High Reliability ◽

Age Groups ◽

Absolute Difference ◽

Neck Shaft Angle ◽

Shaft Angle ◽

The Mean ◽

Novel Concept

Background. The femoral neck-shaft angle (NSA) is of high importance for the diagnostics and treatment of various conditions of the hip. However, rotational effects limit its precision and applicability using plain radiographs. This study introduces a novel method to measure the femoral NSA: the modified NSA (mNSA), possibly being less susceptible against rotational effects compared to the conventional NSA.Patients and Methods. The method of measurement is described and its applicability was tested in 400 pelvis computed tomography scans (800 hips). Age- and gender-dependent reference values are given and intra- and interrater reliability are analyzed.Results. The mean age of all 400 patients (800 hips) was 54.32 years (18–100, SD 22.05 years). The mean mNSA was 147.0° and the 95% confidence interval was 146.7°–147.4°. Differences of the mNSA between sexes, age groups, and sides were nonsignificant. The absolute difference between NSA and mNSA was 16.3° (range 3–31°; SD 4.4°); the correlation was high (0.738;p<0.001). Overall, the intra- and interrater reliability were excellent for the mNSA.Interpretation. We introduced a novel concept for the analysis of the neck-shaft angle. The high reliability of the measurement has been proven and its robustness to hip rotation was demonstrated.

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AGE AND GENDER DIFFERENCES IN MODIFIED FEMORAL NECK-SHAFT ANGLE: AN MRI BASED OBSERVATIONAL STUDY

10.36106/ijsr/8420737 ◽

2020 ◽

pp. 1-4

Author(s):

Najamul Huda ◽

Ankur Agarawal* ◽

Man Mohan Sharma ◽

Saurabh Agarwal

Keyword(s):

Femoral Neck ◽

Age Group ◽

Age And Gender ◽

Neck Shaft Angle ◽

Mri Scans ◽

Shaft Angle ◽

The Mean ◽

The Difference ◽

Gender Based ◽

And Gender

Background: Femoral neck-shaft angle has its importance in describing biomechanics of hip. Measurement methods like plain radiography and CT scans have its limitations. The modied neck-shaft angle (mNSA) drawn on MRI scans is less susceptible to rotational effects and is more reliable for getting normal values. The present study was undertaken to assess the neck shaft angle on MRI and establish differences according to age and gender. Methods: Total 200 adults were recruited and equally distributed under four study cohorts according to age and gender. MRI of hip joint was analysed and mNSA was measured using pre-dened axial lines and landmarks. Results: The mean age of the participants was 49.76±18.184 years (18 to 87 years). The mean mNSA was 147.855o. Males had signicantly higher mean mNSA (149.93±6.61)o than females (145.78±5.71)o. Though the younger age group (<60 years) had higher mNSA values (148.32±6.65) than older (> 60years) age group (147.3900±6.35), the difference was not statistically signicant. Conclusions: We conclude that gender-based variation exists in the population with the higher values of mNSAin males as compared to females in any age group. The age based difference is also present, but it is not signicant. Neck shaft angle calculated on the MRI has the advantage that it is unaffected by rotation of the hip and is radiation free. The orthopaedic surgeons can use the mNSAfor the diagnosis and planning surgeries around hip, for designing implants and prosthesis. It can also be of help for the forensic anthropologists and to the anatomists. Multicentric studies may be undertaken to include a larger population.

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A COMPARATIVE STUDY OF NECK SHAFT ANGLE OF FEMUR IN CENTRAL INDIAN POPULATION

10.36106/paripex/1402452 ◽

2021 ◽

pp. 1-3

Author(s):

Vivek Kumar ◽

Vivekanand Murlidhar Gajbhiye

Keyword(s):

Femoral Neck ◽

Indian Population ◽

Femoral Shaft ◽

Mean Value ◽

Developmental Dysplasia ◽

Neck Shaft Angle ◽

Geographical Variations ◽

Shaft Angle ◽

The Mean ◽

The Right

Background: In the fields of forensics, anthropology, orthopaedics, and human kinematics, the thigh bone femur is widely studied. The clinical significance of the femoral neck shaft angle lies in the diagnosis, treatment and monitoring of femoral neck fractures, trochanteric fractures, slipped upper femoral epiphysis, and hip developmental dysplasia. Objective: The present study was conducted to compare the NSA disparity between femurs on both sides and to compare the NSA with the Western and Indian population sizes of different regions. This research therefore leads to Indian data on these parameters. Materials and Methods: A total of 150 (75 right and 75 left) dry femur were used for measuring the neck shaft angle. Unpaired t-test was used to compare right and left femora. Results: The mean value of neck shaft angle was 126.04±5.05°. It ranges between 1130 to 1360. The mean value of right side was 125.92±4.9° and left side was measured 127.43±5.2°. There was no significant correlation between right and left neck shaft angle. Conclusion: The mean left femoral neck shaft angle was higher than the right femoral shaft in the present analysis, but the values were not statistically important. The angle of the neck shaft was lower than most studies in the Western population, but it was similar to most other studies in India. In the Indian population, geographical variations in the angle of the neck shaft also occur. In the field of orthopaedic surgery and anthropometry, this research will be of benefit.

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Trends of Caesarean Delivery in a Tertiary Care Hospital in North Karnataka

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/278 ◽

2021 ◽

Vol 10 (18) ◽

pp. 1319-1323

Author(s):

Sridevi H. Satish ◽

Suyash Gandi ◽

Aruna M. Biradar ◽

Sangamesh S. Mathapati ◽

Sinigdha Snehi

Keyword(s):

Caesarean Section ◽

Tertiary Care Hospital ◽

Caesarean Section Rate ◽

Tertiary Care ◽

Research Centre ◽

Care Hospital ◽

College Hospital ◽

Cross Sectional ◽

Proper Training ◽

The Mean

BACKGROUND The drastically increasing rate of Caesarean section (CS) is a topic of constant worry and analysis throughout the world. In order to understand the degree to which Caesarean section may be preventable, it is important to know why Caesarean sections are performed. Due to nonexistence of any standard classification for indications of Caesarean section, indications for the same vary among institutions. We wanted to evaluate the rates and predictors of Caesarean section among institutional deliveries in a tertiary care hospital in an economically backward rural area. METHODS This was a cross-sectional prospective study. Pregnant women who underwent Caesarean section (CS) between June 2019 and December 2019 at BLDE (DU) Shri. B. M. Patil Medical College Hospital and Research Centre, Vijayapur, Karnataka, were recruited for the study. Demographic and obstetric data including indications of Caesarean section and pregnancy outcomes were collected and analysed. RESULTS The mean age of the study participants was 24.62 + / - 3.77 years. The study patients were multigravidas, majority delivered at term. The mean gestational age was 38.09 + / - 2.023. The common indications were previous CS (33.1 %), cephalopelvic disproportion (16.9 %), hypertensive disorders of pregnancy (6.7 %) and maternal request (3.4 %). Post-delivery, majority of the babies (78.92 %) were stable and were on mother’s side. CONCLUSIONS Previous caesarean section is the leading cause of Caesarean section in modern era. Hence reduction in primary caesarean section can reduce the rate of over all Caesarean section rate. Clinical, judgmental skills of the obstetrician, legal issues and the patient demands all contribute in the increasing trends of Caesarean section. Hence proper training, obstetric audit, and counselling of the patient party helps in changing the trends of increasing caesarean rate. KEY WORDS Caesarean Section, Indications for Caesarean Section, Maternal Morbidity

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

International Journal of Anatomy and Research ◽

10.16965/ijar.2021.140 ◽

2021 ◽

Vol 9 (3.1) ◽

pp. 8034-8039

Keyword(s):

Femoral Neck ◽

Proximal Femur ◽

Adult Population ◽

Femoral Offset ◽

Femoral Neck Axis ◽

Neck Shaft Angle ◽

Shaft Angle ◽

The Mean ◽

Axis Length ◽

Neck Diameter

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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Is the femoral neck-shaft angle an independent risk factor for hip fractures? An observational study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20194811 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1032

Author(s):

Bernard O. Obande ◽

Emmanuel C. Iyidobi ◽

Gabriel O. Eyichukwu ◽

Cajetan U. Nwadinigwe ◽

Remigus T. Ekwunife ◽

...

Keyword(s):

Hip Fracture ◽

Femoral Neck ◽

Hip Fractures ◽

Predictor Variable ◽

Outcome Variable ◽

Control Group ◽

Neck Shaft Angle ◽

Increased Risk ◽

Shaft Angle ◽

The Mean

Background: The femoral neck-shaft angle (FNSA) has been implicated in the aetiology of hip fractures. The longer moment arm of a higher FNSA has been theorized to impart a greater deforming force to the greater trochanter, which may cause a hip fracture.Methods: A prospective study that involves adults with hip fractures and a control group matched for age and sex. The FNSA of both groups were measured on an anteroposterior X-ray of the pelvis. The mean FNSA were compared with a paired samples t-test, and a binary logistic regression analysis was run with the FNSA as a predictor variable and the presence of hip fracture as an outcome variable.Results: A total of 150 patients were recruited for the study, 75 per group. The mean age of patients with hip fractures was 71.30 years (S.D.=14.34), and that of the control group was 73.94 years (S.D.=12.55), p=0.264. The mean FNSA of the study group was 133.96o (S.D.=3.77) while that of the control group was 131.05o (S.D.=3.86), p<0.001. Increasing FNSA imparts a higher risk of having a hip fracture, O.R.=1.24 (95% C.I, 1.12-1.37).Conclusions: Individuals with higher FNSA demonstrated a significantly increased risk of developing hip fractures. However, the exact cut-off point of the FNSA, which predisposes to the risk of these fractures, remains to be elucidated.

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Evaluation of femoral neck shaft angle on plain radiographs and its clinical implications

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164173 ◽

2016 ◽

Vol 2 (4) ◽

pp. 383 ◽

Cited By ~ 1

Author(s):

Subodh Kumar Pathak ◽

Pritam Maheshwari ◽

Prahlad Ughareja ◽

Daksh Gadi ◽

Prashanth Raj M. ◽

...

Keyword(s):

Femoral Neck ◽

Indian Subcontinent ◽

Slipped Capital Femoral Epiphysis ◽

Orthopedic Implants ◽

Developmental Dysplasia ◽

Neck Of Femur ◽

Neck Shaft Angle ◽

Shaft Angle ◽

The Mean ◽

Picture Archiving And Communication

Background: The femoral neck-shaft angle is the measurement of the angle formed between the oblique oriented neck with the vertical shaft and is an important anatomic measurement for the evaluation of biomechanics of hip. The neck shaft angle is important in surgeries that involve the neck of femur, Intertrochanteric fractures, slipped capital femoral epiphysis, and developmental dysplasia of hip. Different variation of neck shaft angle has been seen in different literature and all the orthopedic implants are designed according to the values of the western literature which is different from the Indian subcontinent.Methods: Pelvic radiographs of patients who presented to Accident and emergency care or the outpatient department were used in the study 110 patients radiographs were assessed in the study. There were 55 males and 55 females in our study. The mean age for males was 46.5 years and that for females was 43.2 years. The pelvis radiographs were studied for neck shaft angle .The measurements were performed bilaterally on the digital screen using the PACS (picture archiving and communication system) with handheld 360 degree goniometer.Results: The mean neck shaft angle in our study was129.26 degree for males and 126.62 degree for females .The overall mean neck shaft angle in 110 radiographs was 128.60 degree. Conclusions: We conclude that consideration of neck shaft angles in orthopedics surgery and designing of implant can give more angle options for the surgeons which can improve the overall prognosis of the patient.

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