Anatomical features of the proximal femur in the Turkish population / Características anatómicas del fémur proximal en la población turca

SUMMARY: Different populations have different genetic traits, and this causes various anatomical features to emerge. Orthopedic implants used in Turkey are generally of Western origin, and these implants are designed based on the anatomical features of Western populations. This study aimed to evaluate the compatibility of existing implants for the Turkish population by revealing the anatomical features of the proximal femurs of individuals from the Turkish population while also constituting a helpful source of data on newly developed implants. A total of 1920 proximal femurs of 960 patients were evaluated via images obtained by Computer Tomography. Twenty patients (10 females and 10 males) for each age within the age range of 18-65 years were included. Femoral head diameter, femoral neck width, femoral neck length, medullary canal width, and collodiaphyseal angle were measured. The right and left femoral head diameter was 46.46±3.84 mm, 46.50 ±3.85 mm respectively. The right and left femoral neck width was 30.63±3.4 mm, 30.85±3.29 mm respectively. The neck length was 94.62±8.33 mm for the right proximal femur, it was 94.75±8.19 mm for the left. The width of the medullary canal was 15.46±2.25 mm for the right proximal femur and 15.53±2.20 mm for the left. The right and left hips, the collodiaphyseal angles were 133.06±2.39° and 133.13±2.36°. Anatomical features of the proximal femur vary according to age, sex, and race. This study may be used as an important resource for the evaluation of patients' compatibility with existing implants and for the design of new implants.

Diferentes poblaciones tienen diferentes rasgos genéticos, y esto hace que surjan varias características anatómicas. Los implantes ortopédicos utilizados en Turquía son generalmente de origen occidental y estos implantes están diseñados en función de las características anatómicas de estas poblaciones. Este estudio tuvo como objetivo evaluar la compatibilidad de los implantes existentes para la población turca al revelar las características anatómicas de las epífisis proximales de fémures de individuos de la población turca y, al mismo tiempo, constituir una fuente útil de datos sobre implantes recientemente desarrollados. Se evaluaron un total de 1920 fémures proximales de 960 pacientes mediante imágenes obtenidas por tomografía computarizada. Se incluyeron veinte pacientes (10 mujeres y 10 hombres) para cada edad dentro del rango de edad de 18 a 65 años. Se midió el diámetro de la cabeza femoral, el ancho del cuello femoral, la longitud del cuello femoral, el ancho del canal medular y el ángulo colodiafisario. El diámetro de la cabeza femoral derecha e izquierda fue de 46,46 ± 3,84 mm, 46,50 ± 3,85 mm, respectivamente. La anchura del cuello femoral derecho e izquierdo fue de 30,63±3,4 mm, 30,85±3,29 mm, respectivamente. La longitud del cuello fue de 94,62±8,33 mm para el fémur derecho, fue de 94,75±8,19 mm, para el izquierdo. El ancho del canal medular fue de 15,46±2,25 mm para el fémur derecho y de 15,53±2,20 mm para el izquierdo. Las caderas derecha e izquierda, los ángulos colodiafisarios fueron 133,06±2,39° y 133,13±2,36°. Las características anatómicas de la epífisis proximal del fémur varían según la edad, el sexo y la raza. Este estudio puede utilizarse como un recurso importante para la evaluación de la compatibilidad de los pacientes con los implantes existentes y para el diseño de nuevos implantes.

Numerical Simulation of Bone Remodeling under Low Loading Coupled with Electrical Stimulation / 医用生物力学

Objective To study the bone disuse behavior with electric field under low load stimulation frequency. Methods A disuse model was proposed to describe the effects of mechanical and electrical stimulation on bone remodeling through the activation frequency. By establishing the finite element model of proximal femur and using the finite element method, the process of bone remodeling under low load stimulation frequency coupled with electrical stimulation was simulated, and the loss of bone density was analyzed. Results The density was significantly decreased by decreasing the frequency of daily load stimulation frequency. The electrical stimulation could resist density loss caused by the low load stimulation frequency to a certain degree, and its main influence areas were distributed in the femoral head and femoral neck. The duration of electrical stimulation significantly affected density loss of the cortical bone and cancellous bone. Conclusions The model can simulate the process of disuse caused by the decrease of daily load stimulation frequency. Meanwhile, the effect of electric field is taken into account to show the resistance to bone density loss.

Finite Element Analysis on Stress Distributions of Proximal Femur in the Elderly During Sit-to-Stand Transition / 医用生物力学

Objective By establishing finite element model of the proximal femur, the injury risk of proximal femur under the conditions of self-selected speed rise and rapid rise at initial stage of standing during sit-to-stand (STS) transition was analyzed.Methods CT images of proximal femur in the elderly were processed with three-dimensional (3D) reconstruction and reverse modeling, so as to complete the solid model. The finite element model was established through material assignment and meshing. Based on the finite element analysis software ANSYS, the boundary conditions were constrained, and 1.733 kN and 1.837 kN loads were applied to obtain stress distributions and strain of proximal femur at different rising speeds. Results The stress concentrated at medial edge of the greater trochanter and the femoral neck. The peak stress and micro-strain appeared on inner edge of the larger rotor. The peak stress was 30.16 MPa and peak micro-strain was 2 553.5 at rapid rising speed. The peak stress and peak micro-strain at self-selected rising speed were 28.69 MPa and 2 430.4, respectively, which were relatively lower. For stress concentration area of femoral neck, the stress ranges at rapid rising speed and self-selected rising speed were 13.42-23.46 MPa and 12.76-25.51 MPa, respectively.Conclusions Frequent STS transition may increase the risk of fatigue fractures for proximal femur in the elderly. Rapid STS transition has a higher injury risk for proximal femur than STS transition at self-selected speed.

Perfil epidemiológico de fratura proximal de fêmur em idosos atendidos em um hospital geral da Grande Florianópolis e sua associação com sexo e idade / Epidemiological profile of proximal femoral fracture in elderly people seen at a general hospital in Florianópolis city and surroundings and association with sex and age

Introdução: O aumento da população idosa contribuiu para acréscimo no número de casos de fraturas relacionadas a traumas de baixa energia, como as quedas. Fraturas do terço proximal estão entre os maiores problemas de saúde pública acometendo principalmente indivíduos do sexo feminino, com idade superior a 60 anos. Objetivo: Identificar o perfil epidemiológico de fratura proximal de fêmur em idosos atendidos em um hospital geral e a sua associação com sexo e idade. Método: Estudo observacional transversal, realizado em um hospital público de referência da Grande Florianópolis. Foram incluídos dados de 300 prontuários eletrônicos de pacientes com idade igual ou superior a 60 anos, com diagnóstico, por radiografia, de fratura de fêmur proximal, entre 2015-2019. Realizada análise descritiva e analítica. Associações internas pelos testes Qui-quadrado ou Exato de Fischer, p<0,05. Trabalho aprovado pelo comitê de ética da UNISUL. Resultados: Observou-se que a maioria dos pacientes era do sexo feminino (66,3%), predomínio na faixa etária maior de 80 anos (48%), procedentes da Grande Florianópolis (95,7%). Mecanismo de trauma mais observado foi queda de própria altura (85,3%) e maior prevalência de fratura transtrocanteriana (71,3%), principalmente no sexo feminino (72,4%), mas também no masculino (69,3%). Conclusão: O estudo evidenciou que as fraturas ocorreram mais no sexo feminino e na faixa etária dos maiores de 80 anos, a partir de queda da própria altura e maior prevalência da fratura transtocanteriana. Observou-se também, percentual elevado de fraturas subtrocanteria

Introduction: The increase in the elderly population contributed to an increase in the number of cases of fractures related to low-energy trauma, such as falls. Fractures of the proximal third are among the biggest public health problems affecting mainly female individuals, over the age of 60 years. Objective: to identify the epidemiological profile of proximal fracture of the femur in the elderly treated at a general hospital and association with sex and age. Method: Observational cross-sectional study at a public reference hospital in Florianópolis city and surroundings. Data from 300 electronic medical records of patients aged 60 years or over, diagnosed by radiography with a proximal femur fracture between 2015-2019 were included. Descriptive and analytical analysis was performed. Internal associations using the Chi-square or Fischer's Exact tests, p <0.05. Work approved by the UNISUL ethics committee. Results: It was observed that the majority of patients were female (66.3%), predominantly in the age group older than 80 years (48%), from Florianópolis city and surroundings. (95.7%). The most observed trauma mechanism was a fall from a height (85.3%) and a predominance of transtrochanteric fractures (71.3%), mainly in females (72.4%), but also in males (69.3%). Conclusion: The study showed that fractures occur more in females and in the age group above 80 years, due to falling from their own height and with a higher prevalence of transtrochanteric fractures. There was also a high percentage of subtrochanteric fractures, with a statistically significant association, in the age group of 60 - 69 years.

Fractura de fémur proximal (31-A3. 2) asociada al uso de tenofovir en paciente VIH+: reporte de caso / Proximal femur fracture (31-A3. 2) associated with the use of tenofovir in an HIV-positive patient: case report

Presentamos el primer reporte de caso en paciente adulto con virus de la inmunodeficiencia humana (VIH + ) con fractura por fragilidad en fémur proximal asociada al uso de terapia antirretroviral (TARV) con fumarato de disoproxilo de tenofovir (FDT) en Chile. Actualmente, los pacientes diagnosticados con VIH inician tratamiento precoz con TARV, lo que implica mayor cantidad de años de exposición a los fármacos de la terapia. El tiempo de exposición acumulado al FDT se ha asociado a disminución de la densidad mineral ósea y falla renal progresiva, pudiendo el paciente desarrollar síndrome de Fanconi adquirido y osteomalacia, con riesgo aumentado de fractura. Presentamos el caso de un hombre de 44 años, VIH+ , evaluado en urgencia tras caída a nivel que resultó en fractura patológica del fémur proximal. Los exámenes de ingreso destacaron hipocalemia, hipocalcemia, hipofosfatemia e hipovitaminosis D. Se realizó manejo multidisciplinario, con suspensión del FDT, un cambio en la TARV, y suplementación con calcio y carga de vitamina D. Se realizó reducción cerrada y fijación con clavo cefalomedular largo, que evolucionó favorablemente con rehabilitación motora precoz; el paciente recuperó su funcionalidad previa, y se observó consolidación ósea a las 12 semanas. La aparición de dolor osteomuscular en pacientes VIH+ en TARV debe levantar alta sospecha clínica de efecto adverso a medicamento; el seguimiento de estos pacientes debe incluir el control seriado de la función renal y de los niveles séricos de calcio y fósforo. La búsqueda y sospecha de estas complicaciones permitiría una intervención precoz, mejorando la condición de los pacientes y previniendo fracturas patológicas.

We present the first case report of a human immunodeficiency virus (HIV)-positive adult patient with a fragility fracture of the proximal femur associated with antiretroviral therapy (ART) with tenofovir disoproxil fumarate (TDF) in Chile. Currently, patients diagnosed with HIV start ART early, resulting in more years of exposure to these drugs. The accumulated exposure time to TDF has been associated with a decreased bone mineral density and progressive renal failure, potentially leading to acquired Fanconi syndrome, osteomalacia, and an increased risk of fracture. We present a case of a 44-year-old, HIV-positive man assessed at the emergency room after a fall from standing height which resulted in a proximal femoral pathological fracture. Laboratory findings at admission revealed hypokalemia, hypocalcemia, hypophosphatemia, and hypovitaminosis D. Multidisciplinary management was performed, with TDF discontinuation, ART change, and supplementation with calcium and vitamin D. Closed reduction and fixation with a long cephalomedullary nail was successful, with early motor rehabilitation, functional recovery, and bone consolidation at 12 weeks. Musculoskeletal pain in HIV-positive patients on ART must raise the clinical suspicion of an adverse drug effect; the follow-up of these subjects must include serial monitoring of renal function and serum calcium and phosphorus levels. Screening and suspicion of such complications would enable an early intervention, improving the patients' condition and preventing pathological fractures.

Numerical Simulation of Bone Remodeling Based on Damage Repair / 医用生物力学

Objective To study bone remodeling behavior under different damage conditions. Methods A bone remodeling model under fatigue mechanism was proposed. By establishing a three-dimensional (3D) finite element model of the proximal femur and combining with the finite element method, the bone remodeling under three loading conditions was simulated, and the mechanical properties and density changes of the proximal femur were analyzed. Results The damage increased with the number of loading cycles increasing. Under different damage conditions, bone showed different remodeling behaviors. As a kind of repair mechanism, bone remodeling could make up for the loss of bone mass due to fatigue damage within a certain range. Conclusions The damage adaptive remodeling model proposed in this study can simulate the bone remodeling behavior under different damage conditions, and the overload absorption caused by excessive loading cycles. The study on the behavior of bone remodeling under fatigue damage can provide references for fracture prevention and postoperative rehabilitation treatment.

Impact of proximal femoral shape on leg length discrepancy after total hip arthroplasty / 中国骨伤

OBJECTIVE@#To investigate the effect of different proximal femoral shapes on leg length discrepancy(LLD) after total hip arthroplasty(THA).@*METHODS@#Total 131 patients with osteoarthritis or osteonecrosis received unilateral biological total hip arthroplasty from June 2013 to June 2019. All patients' age, sex, side and pelvis anteroposterior digital radiography were retraspectively analyzed. There were 69 males and 62 females, 57 cases of left hip and 74 cases of right hip. The age ranges from 25 to 89 with an average age of 62 years. There were 48 cases of osteoarthritis and 83 cases of osteonecrosis. In this study, femoral cortical index (FCI) was used as the classification of proximal femoral shape, and bilateral lower limb length differences were measured by preoperative and postoperative pelvis anteroposterior digital radiography. Grouping according to FCI:> 0.6 was Dorr A group, 0.5 to 0.6 was Dorr B group, 0.6, the postoperative LLD was 6.30 mm (IQR 1.00 to 10.95 mm). When FCI was 0.5 to 0.6, the postoperative LLD was 5.85 mm(IQR-0.55 to 8.90 mm). FCI<0.5, the postoperative LLD was 1.95 mm(IQR -2.50 to 6.68 mm). LLD comparison of different proximal femoral shape was statistically significant (@*CONCLUSION@#High FCI increases the risk of lower extremity prolongation after surgery on the affectedside, while low FCI reduces the risk of lower extremity prolongation after surgery on the affected side. The surgeon can assess the shape of the proximal femur of the patient preoperatively and inform the patient in advance of possible changes in leg length of both lower extremities after total hip replacement.

A Prospective Comparative Study of Unstable Inter Trochanteric Fracture by Proximal Femoral Nail and Proximal Femoral Nail Antirotation in Elderly Patients in Terms of Functional and Radiological Outcomes

Intramedullary devices allow for stable anatomical fixation of more comminuted fractures without shortening the abductor lever arm or changing the proximal femoral anatomy. Between intramedullary devices like proximal femoral nail and proximal femoral nail antirotation, the helical blade of latter is believed to provide stability, compression and rotational control of the fracture with higher cut out strength. The aim of the study was to manage and compare the functional and radiological outcomes between Proximal Femoral Nail or Proximal Femoral Nail Anti-rotation II in elderly patients of unstable intertrochanteric fractures.METHODSThis is a prospective comparative study conducted in the Department of Orthopaedics at MLN Medical College and Swaroop Rani Hospital, Prayagraj, from November 2017 till June 2019.RESULTSPreoperative and post-operative clinical evaluation, radiological evaluation, assessment of operative time, number of fluoroscopy shoots, time for fracture union, and post-operative complications in all cases were noted. Results were evaluated using Harris hip score. There was significant (p= 0.0001) association of final outcome between the groups.CONCLUSIONSPFN A offers significant results over PFN in relation to post-operative complications. PFN A significantly reduces the operative time, amount of blood loss and fluoroscopic imaging as compared to PFN. However PFN A offers no significant benefits over PFN in terms of post-operative functional recovery or complications.

Morphology of Proximal Femur in South-West Coast of India

@#Introduction: With a higher proportion of young individuals undergoing uncemented hip arthroplasty, a close match in the dimension of the proximal femur and the implanted prosthesis is paramount. This is a study to gain insight into geographical variation in proximal femur morphology to determine the reference values to design uncemented femoral stems for a south Indian population, and also the effect of ageing and gender on the proximal femur morphology. Materials and Methods: The study comprised of two groups. For the first group, 50 unpaired dry femur bones were obtained from adult human cadavers; and the second group was a clinical group of 50 adult patients. Standardised radiographic techniques were used to measure the extracortical and intra-cortical morphometric parameters. Based on these, dimensionless ratios were calculated to express the shape of the proximal femur. The data were expressed in terms of mean and standard deviation and a comparison made with other studies. Results: A significant difference was noted across various population subsets within the Indian subcontinent and also in comparison to the Western population, suggestive of regional variation. The measurements made in cadaveric bone differed significantly from those in live patients, especially the femoral head diameter and extra-cortical and intracortical width. Femoral offset, head height and diameter were significantly less in females. Conclusion: The south Indian population needs customised implants with an increase in neck shaft angle and a decrease in intra-cortical and extra-cortical width for press fit in hip arthroplasty. The variation between the two sexes must also be accounted for during prosthesis design.

Effectiveness of proximal femur reconstruction combined with total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of hip / 中国修复重建外科杂志

Objective: To investigate the early effectiveness of proximal femur reconstruction combined with total hip arthroplasty (THA) in the treatment of adult Crowe type Ⅳ developmental dysplasia of the hip (DDH). Methods: Between May 2015 and March 2018, 29 cases (33 hips) suffering from Crowe type Ⅳ DDH were treated with proximal femur reconstruction combined with THA. Of the 29 cases, there were 6 males (7 hips) and 23 females (26 hips), aged from 24 to 74 years with an average age of 44.9 years. The preoperative Harris hip score was 44.0±12.0. Gait abnormalities were found in all of the 33 hips with positive Trendelenburg sign, and the lower limb discrepancy was (3.8±1.6) cm. Preoperative X-ray films and CT both indicated serious anatomical abnormalities, including complete dislocation of the affected hip with significant move-up of the greater trochanter, abnormal development of the femoral neck, abnormal anterversion angle and neck-shaft angle, dysplasia of proximal femur and dysplasia of medullary cavity. The operation time, intraoperative blood loss, transfusion rate, and complications were recorded. The Gruen and DeLee-Charnley zoning methods were used to evaluate the aseptic loosening of the prosthesis on X-ray films. The Harris score was used to evaluate hip function. The lower limb discrepancy was calculated and compared with the preoperative value. Results: The operation time ranged from 80 to 240 minutes, with an average of 124.8 minutes. The intraoperative blood loss ranged from 165 to 1 300 mL, with an average of 568.4 mL. Seventeen patients (51.5%) received blood transfusion treatment. All the incisions healed by first intention without infection or deep vein thrombosis. All patients were followed up 19-53 months, with an average of 33 months. One patient had posterior hip dislocation because of falling from the bed at 4 weeks after operation, and was treated with manual reduction and fixation with abduction brace for 4 weeks, and no dislocation occurred during next 12-month follow-up. Two patients developed sciatic nerve palsy of the affected limbs after operation and were treated with mecobalamin, and recovered completely at 12 weeks later. Trendelenburg sign was positive in 3 patients and mild claudication occurred in 4 patients after operation. X-ray films showed that all the osteotomy sites healed at 3-6 months after operation, and no wire fracture was observed during the follow-up. The Harris score was 89.8±2.8 and lower limb discrepancy was (0.6±0.4) cm at last follow-up, both improved significantly ( t=-22.917, P=0.000; t=11.958, P=0.000). The prosthesis of femur and acetabulum showed no obvious loosening and displacement, and achieved good bone ingrowth except 2 patients who had local osteolysis in the area of Gruen 1 and 7 around the femoral prosthesis, but no sign of loosening and sinking was observed. Conclusion: The treatment of Crowe Ⅳ DDH with proximal femur reconstruction and THA was satisfactory in the early postoperative period. The reconstruction technique of proximal femur can effectively restore the anatomical structure of proximal femur, which is one of the effective methods to deal with the deformity of proximal femur.

Stability of the femoral neck and internal fixation with bone cement and steel plate after curettage for benign proximal femoral lesions / 中国组织工程研究

BACKGROUND: For benign bone tumor patients, the life cycle is long. To reduce the incidence of complications and improve the quality of life after surgery through surgery is the common goal of physicians. The quality of life of patients can be increased through discussing the operation mode and prognosis of benign tumor patients, choosing the reasonable operation mode, predicting and reducing the risk of secondary fracture. OBJECTIVE: To analyze the femoral neck force after different surgical methods using finite element technique in the analysis of benign proximal femoral lesions, and to assess the stability of the femoral neck and the risk of fracture after different surgical procedures for cases with a wide range of lesions. METHODS: According to preoperative CT data of lesion sites in 10 subjects with benign tumor of proximal femur, three-dimensional model of internal fixation with bone cement and steel plate after focal curettage (group A) and three-dimensional model of treating with bone cement after focal curettage (group B) were set in this study. Finite element technique was used to simulate the maximum force of the femoral neck when walking. The stress peaks of the femoral neck were compared after surgery between the two groups. The risk of fracture at this location was assessed. Patients signed the informed consent. This study was approved by the Ethics Committee of Chengde Medical College. RESULTS AND CONCLUSION: (1) The stress was significantly lower in the group A than in the group B (P=0.007 < 0.05). (2) The local stress of the model was reasonable in the group A. Ten patients were operated with the protocol of the group A. An additional 17 patients with proximal femur benign lesions who met the requirements but refused to enter the finite element experiment were treated with the surgical program of the group A. (3) The patients were followed up for 14-42 months. During the follow-up, no new fracture was found in the operation area, and the internal fixation device was firm without fracture. At 12 months postoperatively, the mean Musculoskeletal Tumor Society score of all patients was (26.12±2.28). (4) The finite element technology for simulating the stress evaluation and postoperative follow-up verified that the treatment of proximal femur benign tumor with bone cement and steel plate internal fixation after curettage is more reasonable and effective. The scheme can effectively reduce the risk of secondary fracture and enhance the stability in the surgical area.

Finite element analysis to verify the rationality of bone cement combined with plate internal fixation for benign proximal femoral lesions / 中国组织工程研究

BACKGROUND: For the patients with benign osteopathy, the patients usually get a good life cycle after surgical treatment. Through continuous improvement of the operation mode, the stress of the proximal femur after the operation of benign osteopathy is studied by using the finite element analysis. The risk of pathological fracture and secondary fracture is predicted and reduced. To explore the best operation and prognosis is of great significance for prolonging and improving the quality of life of patients. OBJECTIVE: Three-dimensional finite element technique was used to analyze the different surgical models of benign proximal femoral lesions. The differences of different surgical models were compared and the rationality and effectiveness of internal fixation were verified. The reliability of the finite element model was verified in the follow-up of patients after operation. METHODS: Preoperative CT examination was conducted in 10 patients with benign proximal femoral lesions who met the inclusion criteria. Three models of limbs scraping (group A), cavity internal nail re-infusion bone cement (group B) and intracavitary bone cement joint plate screw (group C) were established by MIMICS. The maximum stress values of the left and right side windows of the cortical model of group A, B and C were measured under simulated conditions, and the stress values of the three groups were compared. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. RESULTS AND CONCLUSION: (1) The comparison of the maximum stress values of the anterior and posterior sides of the cortical fenestration in the three groups of models was group A > group B > group C (P < 0.05). The risk of fracture was high in group A, and the risk of fracture in group B was large. The stress in group C was controlled within a reasonable range, and the risk of fracture was low. (2) Therefore, 10 subjects underwent the treatment in group C. The prognosis was good and there were no secondary fractures. The Musculoskeletal Tumor Society score was 27-30 points 1 year after surgery. (3) The model stress is prone to increase the local stress after opening the window. After adding bone cement and steel plate, the stress value of the model window is significantly reduced. After the benign lesions of the proximal femur are scraped, the stress of the fenestration can be effectively reduced by placing the bone cement and the steel plate, and the fracture probability at the surgical site is significantly reduced. Steel plate placement is reasonable.

Finite element analysis of femoral neck fracture with different degrees of posterior-inferior bone defect after cannulated screw internal fixation / 中国组织工程研究

BACKGROUND: Cannulated screw fixation is the first choice for the treatment of fresh femoral neck fracture. However, in the patients with bone defect, the mechanical conduction and stability of the proximal femur are obviously changed, which easily leads to the failure of internal fixation, nonunion or delayed healing of the fracture, so the study of biomechanics has important clinical significance. OBJECTIVE: To explore the biomechanical changes of proximal femur with posterior-inferior bone defect using finite element analysis, compare the biomechanical effect of cannulated screws with different configurations in treatment of adductive femoral neck fractures. METHODS: Original DICOM data of CT scan of proximal femur in an adult healthy male volunteer were obtained. MIMICS 10.01 software and Rhino3D NURBS software were used to make the models of femoral neck fracture with different degrees of posterior-inferior bone defects (no defect model, small defect model, medium defect model and large defect model). Two configurations of cannulated screws (inverted triangle and positive triangle) were used in four models. Mesh generation and material property assignment were conducted after assembly. The coupling relationship was established between the center and the surface of the femoral head by ABAQUS 6.12 software. The load and constraints of slow walking were applied to all models. RESULTS AND CONCLUSION: (1) The inner side of the femoral neck was subjected to compressive stress, and the lateral side was subjected to tensile stress for the non-defect model. The stress distribution of the femoral head was more uniform. With the increase of the degrees of posterior-inferior bone defect, the stress peak value of femoral head, femoral neck pressure side and tension side, and cannulated screw tail were increased gradually. (2) With the increase of the defect degree, the peak value of the stress on the pressure side of the cannulated screw increased gradually. In the middle and large defect models, the stress in the inverted triangle group was higher than in the regular triangle group (P 0.05). (3) With the increase of the defect degree, the peak stress on tension side of cannulated screw increased gradually. In the model of no defect and small defect, the stress in the regular triangle group was higher than in the inverted triangle group (P 0.05). (5) With the increase of the defect degree, the peak value of stress in the tail of cannulated screw increased gradually. In the small, medium and large defect models, the stress in the inverted triangle group was higher than in the regular triangle group (P 0.05). (6) Results suggested that different degrees of posterior-inferior bone defects could obviously affect the biomechanical properties of the proximal femur. For femoral neck fracture with no defect or lesser degree of defect, the biomechanical effect of inverted triangle was superior to regular triangle. For femoral neck fracture with big defect, the biomechanical effect of regular triangle was superior to inverted triangle.

Bone cement type artificial bipolar femoral head replacement for the treatment of bone metastases in the proximal femur / 中国肿瘤临床

Objective: To investigate the clinical efficacy of bone cement type artificial bipolar femoral head replacement for the treatment of bone metastases in the proximal femur. Methods: Medical records of 54 patients who underwent bone cement type artificial bipolar femoral head replacement at the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2012 to June 2019 were retrospectively analyzed. Scoring for pain by visual analogue scale (VAS), musculoskeletal tumor society (MSTS) function score, international society of limb salvage (ISOLS) score, Harris function score, Karnofsky performance status (KPS) scale, and Nottingham health profile (NHP) score were used to evaluate patients' pain, limb function and the overall quality of life after surgery, and the Kaplan-Meier estimate was used for computing the survival over time. Results: Patients were followed up for (10-99) months, with an average of 42.17 months. The average operative time and the intraoperative blood loss were (79.68±6.17) min and (524±39.25) mL, respectively. The VAS score and the NHP score decreased significantly whereas the MSTS score, ISOLS score, Harris score, and KPS score improved significantly at 3, 6 and 12 months after surgery than the pre-surgery scores (P0.05). Six cases of complications were reported during the follow-up period. The mean survival time of the patients was 19.46 months, and the 6-month, 1-year and 3-year survival rates were found to be 88.89%, 70.37% and 11.11%, respectively. Conclusions: Bone cement type artificial bipolar femoral head replacement used in patients with bone metastases in the proximal femurcan effectively relieve pain, improve limb function and quality of life, and prolong survival.

Effect of Geometry Variation on the Mechanical Behavior of the Proximal Femur

The mechanical behavior of a proximal femur under a normal body weight loading was examined. The geometry of the proximal femur was created in a finite element model using 29 reference points measured on the CT scan images of a patient. Four additional sets of measurements were calculated using ±(1) and ±(2) the standard deviation of the original set and the result of models was compared. The stress distribution and the locations of critical normal and shearstress, as well as the effect of the femur geometry which may be most susceptible to failure were examined. The findings of this study demonstrate an inferior distribution of stress in the plus-standard deviation models and indicate less ability to bear weight. The minus-standard deviation models appear to be better suited to bearing weight and indicate a more even distribution of the stresses generated within the proximal femur.

Comparison between the results of proximal femur nail anti-rotation and cemented bipolar hemiarthroplasty in treatment of intertrochanteric fractures in Sanglah Hospital in 2016

Background: Hemiarthroplasty is now being considered as a primary treatment for comminuted unstable type of IT fracture in elderly on the grounds that it allows early mobilization and full weight bearing. Recently popular modality is fourth generation of intramedullary nails like the Proximal Femoral Nails. The goal of treatment is restoring mobility safely and efficiently, while minimizing the risk of medical complications and technical failure.Methods: A Forty patients, having Intertrochanteric fractures treated with PFNA or cemented BH at our institution between April 2016 and April 2017. The primary outcomes measures were postoperative complication and hip function. The secondary outcome measures were intraoperative blood loss, transfusion rate, surgical time, postoperative haemoglobin and hospital stay.Results: Seventeen patients in PFNA group and 23 patients in BH group were included for analysis. There were no significant differences between the two group regarding to the Harris Hip Score at 6 months follow up. Significant differences were found between PFNA and BH group in comparison of intraoperative blood loss (p < 0.001), length of stay (p = 0.006), surgical time (p < 0.001), postoperative transfusion (p < 0.001), and decrease of hemoglobin (p=0.001).Conclusions: These findings indicate that PFNA has obvious advantages over the BH in treatment of intertrochanteric fractures in case of surgical trauma and postoperative complication.

Sexual diagnosis through morphometric evaluation of the proximal femur / El diagnóstico sexual a través de la evaluación morfométrica del fémur proximal

The determination of variables such as age, height, ethnicity and sex are extremely important to the identification of biological findings, especially in accidents with fatal victims. The diagnosis of sex can be 100 % certain for cases in which the skeleton is complete and in a good state of conservation, the individual is an adult and the morphometric variables of the population to which the individual belongs are known.: The aim of the present study was to perform a morphometric evaluation of the proximal femur and compare measurements between males and females. Sixty pairs of femurs were acquired from the Department of Animal Morphology and Physiology of the Universidade Federal Rural de Pernambuco. The bones were measured with the aid of the ImageJ software program and the following variables were compared between bones from male and female cadavers: DFH - diameter of femoral head on the craniocaudal and sagittal axes; DFN - diameter of femoral neck on the craniocaudal and sagittal axes; FNL - femoral neck length; ILL - intertrochanteric line length. The morphometric variables had the following mean values in the male bones: DFH-craniocaudal axis - 45.10 ± 0.35 mm; DFH-sagittal axis - 48.27 ± 0.35 mm; DFN-craniocaudal axis - 33.21 ± 0.40 mm; DFN-sagittal axis - 29.96 ± 0.05 mm; FNL - 31.71 ± 0.05 mm; ILL - 66.47 ± 0.59 mm. The mean values for the female bones were as follows: DFH-craniocaudal axis - 40.68 ± 0.20 mm; DFH-sagittal axis - 42.61 ± 0.20 mm; DFN-craniocaudal axis - 29.11 ± 0.03 mm; DFN-sagittal axis - 26.05 ± 0.04 mm; FNL - 31.10 ± 0.04 mm; ILL - 60.80 ± 0.41 mm. With the exception of the femur neck length, all variables measurements were significantly larger (p < 0.0001) on the male bones. The present findings demonstrate that the femur bone, particularly the proximal portion, exhibits important sexual dimorphism and has high potential for forensic purposes.

La determinación de variables como la edad, la altura, el origen étnico y el sexo son extremadamente importantes para la identificación de los hallazgos biológicos, especialmente en accidentes con víctimas fatales. El diagnóstico de sexo puede entregar una coincidencia del 100 % para los casos en los que el esqueleto está completo y en un buen estado de conservación, el individuo es un adulto y se conocen las variables morfométricas de la población a la que pertenece el individuo. El objetivo del presente estudio consistió en realizar una evaluación morfométrica del fémur proximal y comparar las mediciones entre hombres y mujeres. Se adquirieron sesenta pares de fémures del Departamento de Morfología y Fisiología Animal de la Universidade Federal Rural de Pernambuco. Los huesos se midieron con la ayuda del programa de software ImageJ y se compararon las siguientes variables entre los huesos de cadáveres masculinos y femeninos: DCF: diámetro de la cabeza femoral en los ejes craneocaudal y sagital; DCF: diámetro del cuello femoral en los ejes craneocaudal y sagital; LCF - longitud del cuello femoral; LLI - longitud de línea intertrocantérea. Las variables morfométricas tenían los siguientes valores medios en los huesos masculinos: Eje craniocaudal DCF - 45,10 ±0,35 mm; DCF-eje sagital - 48,27±0,35 mm; DCF-eje craneocaudal - 33,21 ± 0,40 mm; DFN-eje sagital - 29,96 ± 0,05 mm; LCF - 31,71 ± 0,05 mm; LLI - 66,47 ± 0,59 mm. Los valores medios para los huesos femeninos fueron los siguientes: DCFeje craneocaudal - 40,68 ± 0,20 mm; DCF-eje sagital - 42,61 ± 0,20 mm; DCF-eje craneocaudal - 29,11 ± 0,03 mm; DCF-eje sagital - 26,05 ± 0,04 mm; LCF - 31,10 ± 0,04 mm; LLI - 60,80 ± 0,41 mm. Con la excepción de la longitud del cuello del fémur, todas las medidas variables fueron significativamente más grandes (p <0,0001) en los huesos masculinos. Los presentes hallazgos demuestran que el hueso del fémur, particularmente la porción proximal, exhibe un importante dimorfismo sexual y tiene un alto potencial para fines forenses.

Pantrochanteric Fracture: Incidence of the Complication in Patients with Trochanteric Fracture Treated with Dynamic Hip Screw in a Hospital of Southern Brazil / Fratura pantrocantérica: incidência da complicação em pacientes comfratura trocantérica tratados comparafuso dinâmico de quadril em um hospital do Sul do Brasil

Abstract Objective The aim of the present study was to investigate the incidence of pantrochanteric fractures in cases of trochanteric fractures treated with dynamic hip screw in our service. Methods A sample of 54 patients with trochanteric fractures treated with dynamic hip screws was included in this retrospective study. Preoperative radiographs were evaluated for fracture classification using the Arbeitsgemeinschaft für Osteosynthesefragen (Association for the Study of Internal Fixation, in German)/Orthopedic Trauma Association (AO/OTA) system for the identification of radiographic osteoporosis and for the measurement of the lateral femoral wall thickness. In the immediate postoperative images, the presence of pantrochanteric fracture was evaluated. Results The final sample presented an incidence of 16.7% of pantrochanteric fractures. The thickness of the lateral wall was significantly lower in the group with the complication (p < 0.001). Although fractures classified as 31-A2 were more numerous in the group with pantrochanteric fracture, the difference was not statistically significant (p = 0.456). Conclusion The percentage of pantrochanteric fractures in this service is in accordance with previous studies. There was an association between lateral femoral wall thickness and the occurrence of iatrogenic fracture of the lateral cortex. There was no significant difference between fracture classification and pantrochanteric fracture, possibly due to sample size.

Resumo Objetivo Investigar a incidência de fraturas pantrocantéricas nos casos de fraturas trocantéricas tratadas com parafuso dinâmico de quadril em nosso serviço. Métodos Uma amostra de 54 pacientes comfraturas trocantéricas tratadas comparafuso dinâmico dequadril foi incluída neste estudo retrospectivo. Foramavaliadas radiografias précirúrgicas para classificação das fraturas com o sistema AO/OTA, identificação de osteoporose radiográfica emensuração da espessura da cortical lateral, enquanto nas imagens pósoperatórias imediatas foi avaliada a presença de fratura pantrocantérica. Resultados Aamostrafinal apresentou a incidência de 16,7%defraturaspantrocantéricas. A espessura da parede lateral foi significativamentemais baixa no grupo coma complicação (p < 0,001). Embora a incidência de fraturas classificadas como 31.A2 tenha sido maior no grupo com fratura pantrocantérica, a diferença não foi significativa (p = 0,456). Conclusão O percentual de fraturas pantrocantéricas nesse serviço encontra-se em acordo com trabalhos prévios. Houve associação entre espessura da cortical lateral e ocorrência de fratura iatrogênica da parede lateral. Não houve diferença significativa entre classificação das fraturas e fratura pantrocantérica, possivelmente devido ao tamanho da amostra.

Osteometric Study Of Proximal Femur

Background: The constitutional built and physique of Indians is entirely different from the western populationdue to the variation in the genetic makeup and lifestyle. But the prosthesis for proximal femur used in India ismanufactured by the western countries whose morphometry does not fit our people leading to complications.Hence, this study is to provide the morphometric data of proximal femur for Indian population and to clear thedrawbacks in the information about proximal femur in our people and customize the implant design to suit theIndian people and thereby reduce the complications.Materials and Methods: The study material consisted of 60 dry femora obtained from the Institute of Anatomyand the parameters studied according to standard anthropometrical methods with appropriate instruments.Results: In the present study, the average length of the femur was 41.4cm, diameter of head was 4.17cm, anteriorneck length being 3.42cm, Neck- shaft angle was 129.90and the inter-trochanteric distance 6.13cm.Conclusion: This study showed that our values were comparatively smaller than the western people and variedwith regional ethnicity. This study will encourage our biomechanical engineers to bring in a revolution in thedesigning and manufacturing of implants with correct morphometric data to befit our Indian population andlead to improved surgical outcome with minimal surgical complications.

Modified Unipolar Hemiarthroplasty for the Treatment of Metastatic Lesions of Proximal Femur with Pathological Fractures: Case Series of Six Patients

@#Introduction: Proximal femur resection and endoprosthetic reconstruction is the preferred treatment for extensive bony destruction and pathological fractures. Due to the relatively high cost of endoprosthesis, we adopted the modified unipolar hemiarthroplasty (MUH) for reconstruction when the mode of treatment was for palliation. Materials and Methods:This is a retrospective case study of six patients, who had bone and multi-organs metastases with extensive proximal femur involvement with pathologic fractures who underwent resection and MUH reconstruction during the period 2013 to 2017. All patients were classified as Group B / C based on Scandinavian Sarcoma Group survival scoring, with estimated survival of maximum six months. The basic MUH construct consisted of AustinMoore prosthesis which was secured to a Küntscher nail using cerclage wire and cemented into the femoral canal. Subsequently, the whole length of the prosthesis which remained outside the canal was coated with cement. Results:The mean age was 61.8 years. The mean survival was 3.9 months, post-operation. There was no implant failure during patients’ life span; however, a third of the patients developed infection. Wheel chair ambulation was started immediately post-operation for all patients, and two patients progressed to walking frame ambulation. The total cost of each construct was below US$490 in comparison to long-stem hemiarthroplasty (roughly US$ 1700). Conclusion: Our aim was to alleviate pain, facilitate rehabilitation, ease nursing care and improve quality of life for metastatic bone disease patients until end of life. MUH for the treatment of pathological fracture in proximal femoral metastases is a feasible palliative surgical modality in resource-limited settings.