Where is proximal femur

There are no medical literatures regarding the anthropometric data of the region around greater trochanter. The PF-LCP, a new device for treating fractures of the trochanteric region, claimed that the proximal portion of the plate is anatomically precontoured for the lateral aspect of the proximal femur [ 18 ], but it seems to lack the evident data of how the anatomical contour of the plate was developed. In the current study a geometric measurement of the proximal femur was carried out, specifically the greater trochanteric bald spot and adjacent region where the proximal portion of the plate anchored.

Among parameters measured in our study, the measured radii on the greater trochanter can be important reference for designing the proximal portion of the femoral plate. An anatomical proximal femoral plate design should not only have an anatomical contour but the ventral surface of the plate probably has to approximate the outer surface of the cortex to prevent a ventral gap from compromising the mechanical stability of the locking plate.

Once the plate is fixed at an increased distance from the bone, the unsupported free part of the screw between the plate and the bone increases, leading to a greater lever arm effect. The resulting augmented bending moment weakens the bone-plate construct and results in screw loosening, backing-out, or breakage [ 5 — 7 ].

Therefore, understanding the curvature of the greater trochanter may be beneficial for better bone-plate fitness when designing the implant. Femoral anteversion and the specially defined sagittal NSA could also be key parameters for the design of the proximal portion of the femoral plate and for the angulation or placement of the proximal screws during surgery. Femoral anteversion is a normal torsion or twist presented in the femoral neck.

Accordingly, we thought that a twisted profile in the proximal portion of the femoral plate may be needed to correspond with the natural anteversion of the neck and an appropriate placement of proximal screws in the femoral head. Generally, there is an agreement concerning the fact that an exact central placement of the proximal screw on the lateral view is a recommended position [ 19 ] to prevent cut-out of the proximal screw [ 7 , 20 , 21 ].

Consequently, the twisted profile of the proximal portion of the femoral plate may accommodate the inherent torsion of the femoral neck and ensure a satisfactory proximal screw position without large margin of error. Specifically, our results showed that the mean angle of femoral anteversion for the female subjects Anthropometric studies also demonstrated that females were significantly more anteverted, irrespective of the differences among various ethnic groups [ 12 , 22 , 23 ].

These findings strengthen the necessity of a twisted design in the proximal portion of the femoral plate or different proximal screw angulation. As for the medullary radius of curvature of the femur anterior bowing , it may be a design consideration for the plate shaft but may not be involved in contemporary proximal femoral plates yet. At present, most long bone plates on market are straight type. However, there is a physiological anterior bowing of the femoral diaphysis.

The mean medullary radius of curvature of the femur was This value is similar to that previously reported by Tang et al. Likewise, we thought that the precontoured shape in the shaft of the proximal femoral plate may have to be divided into different radii of curvature to adapt to the ethnic difference and to obtain best geometry fit.

Factors affecting the morphology of the proximal femur rely on genetic and environmental variations including age, race, sex, and lifestyle. Studies on the distal femur suggested significant differences in dimension and shape among the males and the females [ 29 , 30 ]. Their findings implied that there may be a necessity of distinct design of implants to accommodate difference between the genders and other morphologic differences around the knee joint.

Similarly, our results also found that there was significant difference between the genders with regard to the geometric parameters of the greater trochanter and other dimensions in proximal femur. This indicated that designing the proximal femoral plate may have to take the gender difference into consideration because the best solution is not shaping the implant to fit on the average anatomical contour of the population but is the one that provides best fit on the majority of the femora.

This study utilized 3D modeling method for femoral morphology measurement. Relatively, images captured by two-dimensional methods, such as radiography, provide only a projection of bone shape and create a pattern of variability due to variations in the angle of the X-ray beam and magnification. However, because 3D rendering of the femur model is based on cortical contours outlined by image thresholding technique, this may generate certain femur shape variability due to the uncertainty of the optimized thresholding value.

Several limitations should be notified in the present study. One limitation is that only Chinese populations were included, but it does not invalidate the importance of our measurements and findings because of no greater trochanteric parameters available for the basis of the proximal femoral plate design.

Another limitation is that it is not known if there is any difference in major dimensions of the greater trochanter in different racial groups. Further anthropometric study on the western population would be necessary to clarify any difference of greater trochanteric parameters between the Caucasian and the Chinese people. On the other hand, we did not take the third trochanter into consideration, which may be an influencing factor on femoral morphology.

However, the incidence of the third trochanter varies as a result of the fact that incongruence of trochanter definition exists between studies [ 31 ]. Furthermore, Bolanowski et al. Consequently, this study evaluated only the effect of sexual difference on femoral anatomies.

Finally, all the subjects involved were skeletal mature adults. The results should not be appropriate for the pediatrics [ 32 , 33 ]. And, except sex, several other factors are quoted which affect femoral morphology: age, activities, genetic factors, body weight, muscle action, lifestyle, and disease [ 32 , 34 ]. The correlation between these factors is still unknown.

In conclusion, the results of this study provided an anatomical data of the proximal end of the femur, especially in the region of greater trochanter. These femoral dimensions can be applied to the modifications of the contemporary femoral plate or a newly development for the Chinese population. The statistics analysis also revealed significant differences in dimensions between male and female femora, indicating that distinguished designs for the genders may be required to improve bone-implant fitness as discussed in the femoral fixation devices.

The authors declare that they have no conflict of interests regarding the publication of this paper. This work was completed with the financial support from A Plus Biotechnology Co.

This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Special Issues. Academic Editor: Daisuke Sakai. Received 30 Apr Revised 11 Sep Accepted 16 Sep Published 03 Nov Abstract Adequately shaped femoral plate is critical for the fixation of fracture in the pertrochanteric regions. Introduction Intertrochanteric and subtrochanteric fractures are major pathology in all fractures of the proximal femur [ 1 ]. Measurement of the Anatomical Parameters from AP View In order to evaluate the shape of the greater trochanter, four points on the lateral aspect of the greater trochanter were established.

Figure 1. One of the great foes in bone injury is osteoporosis, the most common bone disease. It has become a burden of considerable economic significance.

Factors such as ethnicity, gender, physical activity, and nutrition influence the maximum bone mass quality achieved by each individual.

However, bone mass alone is not a determining factor. A study by Cummengs et al. Likewise, age and BMI may not be directly related to loss in bone mass. Wheeler et al. However, the joint dimensions do not differ appreciably; older individuals with a higher BMI are less likely to develop a fracture than younger individuals with normal BMI.

In attempting to establish a risk assessment based on DXA, a multifactor tool was developed to determine hip fracture propensity, a method recommended by the World Health Organization. This tool takes into account different factors anthropometric variables, medical history, and drug use to evaluate the ten-year risk of fracture, using clinical risk factors with or without BMD values.

Osteoporosis management and the utilization of FRAX r : a survey amongst health care professionals of the Asia- Pacific. Arch Osteoporos. Texture analysis of X- ray radiographs is correlated with bone histomorphometry. J Bone Miner Metab. Different imaging methods such, as peripheral quantitative computed tomography and magnetic resonance imaging MRI , can be used to obtain three-dimensional geometry and bone architecture in vivo.

These methods may provide some relevant information in assessing bone quality. Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of bone density: the Manitoba study. However, the limited availability and high cost of these methods has led to the development of other types of low-cost analyses that may be clinically applicable, such as radiographs. At present, the solution for a low-cost study of bone structures has been conventional radiography.

It allows the evaluation of the geometry, the structure, and, eventually, the risk of bone fracture. Nonetheless, new prospective studies with geometric measurements are still needed to confirm the clinical capability of the bone texture analysis through this tool, as well as the possibility of predicting and defining risk groups for specific types of hip fractures, especially transtrochanteric and those of the femoral head. In the present study, it was demonstrated that although radiography is a good method to evaluate bone structures and predict hip fractures, it was not sensitive enough to capture differences between femoral neck and transtrochanteric fractures when compared with a healthy control group.

Further prospective studies are needed to establish parameters capable of measuring such differences. Abrir menu Brasil. Revista Brasileira de Ortopedia. Abrir menu. E-mail: hudsonfelipe3 hotmail. Keywords: Hip fractures; Femur neck; Radiography. Introduction Advances in medicine and pharmacology have led to a significant increase in global life expectancy, reflected positively in the growing number of elderly people.

Material and methods This was a prospective, cross-sectional study performed in an orthopedic and trauma service in Brazil between August 10, and September 8, After classification and selection, the radiographs were anatomically evaluated, according to the following measures: Cervicodiaphyseal angle CDA : angle between the axis of the femoral neck and the diaphysis.

Table 1 Characterization of the groups according to the evaluated angles. Check for errors and try again. Thank you for updating your details. Log In.

Sign Up. Become a Gold Supporter and see no ads. Log in Sign up. Articles Cases Courses Quiz. About Recent Edits Go ad-free. Edit article. View revision history Report problem with Article. Citation, DOI and article data. Figure 5. Orthopedic Clinics of North America. Philadelphia: W. Saunders; Ward FO. Outlines of human osteology. London: Henry Renshaw; Analysis of trabecular distribution of the proximal femur in patients with fragility fractures.

BMC Musculoskelet Disord. Wards lines. Ligament strain on the iliofemoral, pubofemoral, and ischiofemoral ligaments in cadaver specimens: biomechanical measurement and anatomical observation. Epub Jun The function of the hip capsular ligaments: a quantitative report. Anatomy of the hip capsule and pericapsular structures: a cadaveric study.

Sanjit R. Konda 1 Email author 1. Personalised recommendations.