Proximal Femoral Epiphysis Anatomy in Chilean Population: Orthopedic and Forensic Aspects

Human femur fracture by mechanical compression: Towards the repeatability of bone fracture acquisition

The increase in life expectancy combined with greater bone fragility over the years is causing a rise in the bone fracture cases. Femur fractures are the most important due to their high mortality rate. This multidisciplinary work is carried out in this context and focuses on the experimental reproduction of human femur fractures by compression. We describe a sequence of steps supervised by orthopaedic surgeons for the correct arrangement of specimens on the system set up to perform the experiment. The device applies force by compression until the human bone is fractured. All tests performed have been monitored and evaluated from different knowledge perspectives. The results obtained have demonstrated the repeatability of the fracture type in a controlled environment as well as identifying the main features involved in this process. In addition, the fractured bones have been digitized to analyze the fracture zone to recreate and evaluate future simulations.

Morphometric Study of Proximal End of the Fully Ossified Human Femur: A Cross-Sectional Study

Introduction The femur or thigh bone is the longest and strongest bone in the body. It provides skeletal support for the thigh. Weight-bearing and stability of gait are the essential functions of the femur. Aim To construct the baseline data on different dimensions of the proximal end of the fully ossified human femur and determine any significant differences between the right and left femora. Objective To measure the total length of the femur, proximal breadth, vertical diameter of the head, transverse diameter of the head, the circumference of the head, the vertical diameter of the neck, the transverse diameter of the neck, the circumference of the neck, anterior length of the neck, neck-shaft angle, length of the intertrochanteric crest and correlate the different dimensions of the proximal end with the total length of the femur. Result The variables of the proximal end of the left femora like proximal breadth (PB), the circumference of the head (CH), vertical diameter (VDN), the transverse diameter of the neck (TDN), the circumference of the neck (CN), neck length (NL), neck-shaft angle (NSA), length of an intertrochanteric crest (LITC) showed highly significant positive linear correlation with the length of the femur. Circumference of the neck showed the highest degree of correlation with the length of the femur (correlation coefficient 0.839). Conclusion The statistically significant difference between right and left femora was found between the length of the femur, the vertical diameter of the neck of the femur, the transverse diameter of the neck of the femur, and the length of the intertrochanteric crest of the femur. The mean value of proximal breadth, the vertical diameter of the head, the transverse diameter of the head, the circumference of the head, the circumference of the neck, anterior length of the neck of the femur, and neck-shaft angle of the right and left femora to have no statistically significant differences.

Ptosis of the hip: a new radiographic finding in patients undergoing femoroacetabular osteoplasty

Ptosis is a newly described phenomenon appearing on AP radiographs of patients undergoing femoroacetabular osteoplasty (FAO), and refers to a reverse break down in Shenton’s Line. Thorough characterization of this phenomenon is needed to better understand the hip morphology and pathologic ramifications. Our goal was to define the radiographic hip parameters accompanying a break down in Shenton’s Line and to determine how these values compare with standard values in normal hips. Using two independent readers, we retrospectively reviewed the medical records and preoperative supine radiographs of 630 patients (1260 hips) who underwent FAO by a single surgeon between 2003 and 2016. Prevalence of hip pathology and 28 radiographic parameters in ptosis hips was measured, as well as a comparison between unilateral ptosis hips and contralateral normal hips. Of the 53 patients (106 hips) who fulfilled the criteria for the study, 94 hips had a Shenton’s Line break down of at least 5 mm. Sixty-nine percent of ptosis hips had femoroacetabular impingement (FAI), 70.2% had coxa profunda, and 52.1% had partial joint space narrowing. Ptosis hips had 1.05 mm less lateral subluxation (P = 0.012), 2.28° larger Center-edge angle (P = 0.046), 2.59° smaller Sharp angle (P = 0.011) and 2.49% smaller extrusion index (P = 0.016) compared with contralateral normal hips. FAI is prevalent in patients with a positive ptosis sign. The high prevalence of partial joint space narrowing could suggest eventual osteoarthritis. We believe our results demonstrate the importance of further investigation of a positive ptosis sign on AP pelvic radiographs.

Skeletal immaturity, rostral sparing, and disparate hip morphologies as biomechanical causes for Legg-Calvé-Perthes' disease

Legg-Calvé-Perthes' (Perthes') disease is a developmental disease of the hip joint that may result in numerous short and long term problems. The etiology of the disease remains largely unknown, but the mechanism is believed to be vascular and/or biomechanical in nature. There are several anatomical characteristics that tend to be prevalent in children with Perthes' disease, namely: skeletal immaturity, reduced height, and rostral sparing. We present an overview of the literature, summarizing the current understanding of the pathogenesis, particularly related to how the formation of the vasculature to the femoral epiphysis places children aged 5-8 at a higher risk for Perthes' disease, how skeletal immaturity and rostral sparing could increase the probability of developing Perthes' disease, and how animal models have aided our understanding of the disease. In doing so, we also explore why Perthes' disease is correlated to latitude, with populations at higher latitudes having higher incidence rates than populations closer to the Equator. Finally, we present five hypotheses detailing how Perthes' disease could have a biomechanical cause. Clin. Anat. 29:759-772, 2016. © 2016 Wiley Periodicals, Inc.

Assessment of the geometry of proximal femur for short cephalomedullary nail placement: An observational study in dry femora and living subjects

BACKGROUND

Intramedullary devices have increasingly become popular and are widely used for fixation of unstable intertrochanteric and subtrochanteric fractures. These implants have been designed taking into consideration of the anthropometry of the western population which varies from those of other ethnic groups. This study was carried out to assess the geometry of proximal femur for the placement of short cephalomedullary nails in our subset of patients and suggest suitable design modifications based on these parameters.

MATERIALS AND METHODS

The study was conducted in the following three groups: (1) Anthropometric study of 101 adult human dry femora, (2) radiographs of the same femora, and (3) radiographs of the contralateral uninjured limb of 102 patients with intertrochanteric or subtrochanteric fractures. In Group 1, standard anthropometric techniques were used to measure neck shaft angle (NSA), minimal neck width (NW), trochanteric offset, and distance from the tip of greater trochanter (GT) to the lower border of lesser trochanter on the femoral shaft axis (distance X). In Group 2 and 3, the NSA, minimal NW, NW at 130° and 135°, trochanteric shaft angle (TSA), trochanteric offset, distance X, distance between the tip of GT and the point where the neck axis crosses the line joining the tip of the GT to the lower border of the lesser trochanter on the femoral shaft axis (distance Y), and canal width at 10, 15, and 20 cm from tip of GT were measured on standard radiographs. The values obtained in these three groups were pooled to obtain mean values. Various parameters of commonly used short cephalomedullary nails available for fixation of pertrochanteric fractures were obtained. These were compared to the results obtained to suggest suitable modifications in the nail designs for our subset of patients.

RESULTS

The mean parameters observed were as follows: NSA 128.07° ± 4.97 (range 107°-141°), minimum NW 29.0 ± 2.8 mm (range 22-42 mm), NW at 130° 30.12 ± 2.86 mm (range 22.2-42.5 mm), NW at 135° 30.66 ± 3.02 mm (range 22.8-40.3 mm), TSA 10.45° ± 2.34° (range 3°-15.5°), distance X 65.73 ± 6.45 mm (range 28.6-88.4 mm), distance Y 38 ± 4.91 mm (range 16.6-55.3 mm), and canal width at 10, 15, and 20 cm from the tip of GT 13.46 ± 2.34 mm, 11.40 ± 2.27 mm, and 11.64 ± 2.04 mm, respectively.

CONCLUSION

The measurements of the proximal femur are not significantly different from other ethnic groups and are adequate to accept the current commonly available short cephalomedullary nails. However, certain modifications in the presently available short cephalomedullary nail designs are recommended for them to better fit the anatomy of our subset of population (a) two nails of 125° and 135°, (b) the medio-lateral angle at the level of 65 mm from the tip of the nail, (c) two femoral neck screw placements (35 and 45 mm from the tip of the nail), and (d) five different sizes of distal width for better fit in canal (9-13 mm).

A new computer-tomography-based method of sex estimation: Development of Turkish population-specific standards

The identification of victims involved in mass fatality incidents has become an increasingly important issue nowadays, and identification of unknown individuals is an important aspect in criminal cases and Disaster Victim Identification scenarios. Therefore, the sex estimation is one of the most important biological attributes towards establishing personal identity. In addition, several studies have demonstrated that metric sex determination methods of the skeleton are population-specific due to variation in size and patterns of sexual dimorphism. Unfortunately, the modern Turkish population still lacks wide and representative population standards for identification. Previous research has shown that modern technologies, such as CT scanning appear to offer promising means for the establishment of new standards for contemporary populations. The main aim of this project is to examine the application of measurements taken from the femur in order to assess sex, as well as to contribute to the establishment of discriminant function equations for the Turkish population for forensic applications. The sample population was composed of CT images taken from 200 adult hospital patients. The images of the femora were segmented from the surrounding bones to ensure correct usage of landmarks as accurately as possible. The 3D reconstructions were then created using the volume-rendering function in OsiriX (v.5.6.). Thirteen measurements were acquired using a 3D viewer and were located and marked on each of the CT reconstructed femora. Thirteen anthropometric parameters were measured and analysed by basic descriptive statistics and discriminant analysis methods using the SPSS 21.0 software package. The intra-observer variation was assessed by obtaining the inter-cross correlation coefficient in order to evaluate the accuracy of the linear measurements taken. The accuracy of sex prediction ranged from 63.5 to 88% with single variables. In stepwise analysis, Epicondylar Breadth, Femur Vertical Diameter of Neck and Medial Lateral Subtrochanteric Diameter were found to be the most discriminating variables providing an accuracy of 91%. Ultimately, it is envisaged that this research study will produce data and interpretations that will inform on and improve standards of sex estimation from postcranial osteometric landmarks. Additionally, this research will consider how this data provides value for a developing discipline of forensic anthropology and how it integrates within the existing systems of criminal investigation and Disaster Victim Identification practices in Turkey.