Anatomical Diversity in Femur bones: Understanding the Morphological Variability for Surgical and Prosthetic Applications / Diversidad Anatómica en Huesos Fémur: Comprensión de la Variabilidad Morfológica para Aplicaciones Quirúrgicas y Protésicas

SUMMARY: The femur, the body's longest bone, plays a critical role in orthopaedics and radiology. Understanding its anatomy, particularly the neck-shaft angle (NSA), is vital for diagnosing bone issues and designing hip implants. While some Asian populations' femur measurements have been studied, there is a research gap concerning Sri Lankans. This study aimed to fill this gap by examining the proximal femur's anatomy in the Sri Lankan population. We analysed 45 adult human femurs (26 right, 19 left) of unknown sex, ethically sourced from the University of Sri Jayewardenepura. Femurs with fractures or pathologies were excluded. Precise measurements were recorded using digital vernier callipers, with millimetre accuracy. Parameters included mean femoral length, vertical and transverse femoral head diameters, neck axis and neck length. Each measurement was taken three times to minimize subjectivity. Right femurs had a mean length of 42.8 mm (SD±2.64), while left femurs measured 43.53 mm (SD±3.27). Mean NSA was 125.78º (SD±4.45) for left femurs and 127.59º (SD±2.06) for right. Mean femoral head diameters were 4.09mm (SD±0.30) (right) and 4.12mm (SD±0.31) (left). Mean anterior neck lengths of the right and left were 2.61 (SD±0.54) and 2.71(SD±0.50) respectively. Comparing our findings with other Asian populations highlighted significant variations in femur measurements. These discrepancies emphasize the need for population-specific data for orthopaedic interventions and raise questions about the suitability of imported prosthetics. Differences in femur length, neck length, and NSA between sides suggest potential challenges in using implants designed for one side on the other. This study underscores the necessity of population-specific data in orthopaedics, as femur measurements differ even among Asian populations. Further research and statistical analysis are essential for tailoring orthopaedic solutions to individual populations. The findings also suggest a potential need for locally manufactured prosthetics to better suit the Sri Lankan population.

El fémur, el hueso más largo del cuerpo, desempeña un papel fundamental en ortopedia y radiología. Comprender su anatomía, en particular el ángulo cuello-diáfisis (NSA), es vital para diagnosticar problemas óseos y diseñar implantes de cadera. Si bien se han estudiado las medidas del fémur de algunas poblaciones asiáticas, existe un vacío en la investigación sobre los habitantes de Sri Lanka. Este estudio tuvo como objetivo examinar la anatomía del fémur proximal en la población de Sri Lanka. Analizamos 45 fémures humanos adultos (26 derechos, 19 izquierdos) de sexo desconocido, obtenidos éticamente de la Universidad de Sri Jayewardenepura. Se excluyeron fémures con fracturas o patologías. Se registraron mediciones precisas utilizando calibradores vernier digitales, con precisión milimétrica. Los parámetros incluyeron la longitud femoral media, los diámetros vertical y transversal de la cabeza femoral, el eje del cuello y la longitud del cuello. Cada medición se tomó tres veces para minimizar la subjetividad. Los fémures derechos tuvieron una longitud media de 42,8 mm (DE ± 2,64), mientras que los fémures izquierdos midieron 43,53 mm (DE ± 3,27). La NSA media fue de 125,78º (DE±4,45) para el fémur izquierdo y de 127,59º (DE±2,06) para el derecho. Los diámetros medios de la cabeza femoral fueron 4,09 mm (DE ± 0,30) (derecha) y 4,12 mm (DE ± 0,31) (izquierda). Las longitudes medias del cuello anterior de la derecha y la izquierda fueron 2,61 (DE ± 0,54) y 2,71 (DE ± 0,50) respectivamente. La comparación de nuestros hallazgos con otras poblaciones asiáticas destacó variaciones significativas en las medidas del fémur. Estas discrepancias enfatizan la necesidad de datos específicos de la población para las intervenciones ortopédicas y plantean dudas sobre la idoneidad de las prótesis importadas. Las diferencias en la longitud del fémur, la longitud del cuello y la NSA entre lados sugieren posibles desafíos al utilizar implantes diseñados para un lado en el otro. Este estudio subraya la necesidad de datos específicos de la población en ortopedia, ya que las mediciones del fémur difieren incluso entre las poblaciones asiáticas. Es esencial realizar más investigaciones y análisis estadísticos para adaptar las soluciones ortopédicas a poblaciones individuales. Los hallazgos también sugieren una posible necesidad de prótesis fabricadas localmente para adaptarse mejor a la población de Sri Lanka.

Open Fracture of the Femoral Neck in an Adult: Case Report and Surgical Solution / Fratura exposta do colo do fêmur em adulto: Relato de caso e solução cirúrgica

Abstract Intracapsular proximal femoral fracture is a frequent injury in elderly patients, often associated with low-energy trauma and reduced bone mass. In young patient, it is uncommon, usually caused by high-energy trauma and accompanied by damage to the adjacent soft tissues. However, reports of open intracapsular proximal femoral fracture due to indirect trauma are rare in the orthopedic literature. In the present article, we describe a case of this injury in a 35-year-old man involved in a car accident. The proximal femur was exposed at the gluteal region due to a mechanism similar to dislocation of the posterior hip. We describe the initial treatment and subsequent management until achieving a definitive solution using total hip arthroplasty and muscle transfer to reconstruct the abductor mechanism of the hip. At 10 months of follow-up, the patient presented good functional outcome, with gradual recovery of the abductive strength and a Harris Hip Score of 91 points. In addition, a radiographic study showed that the cemented total prosthesis was well-positioned. This therapeutic strategy (total hip arthroplasty with muscle transfer to reconstruct the abductor musculature) was successful to treat an intracapsular proximal femoral fracture with bone exposure.

Resumo A fratura intracapsular do fêmur proximal é uma lesão frequente no paciente idoso, e em geral está associada a trauma de baixa energia e redução da massa óssea. No jovem, esta lesão é pouco frequente, decorre de trauma de alta energia, e resulta em dano das partes moles adjacentes. Contudo, o relato de fratura intracapsular do fêmur proximal com exposição óssea por trauma indireto é raro na literatura ortopédica. Neste relato, esta lesão foi diagnosticada em um homem de 35 anos, vítima de acidente automobilístico. Mediante um mecanismo semelhante ao da luxação posterior do quadril, o segmento proximal do fêmur determinou exposição óssea através da região glútea. Foram descritos o tratamento inicial e os tratamentos subsequentes até a solução definitiva por artroplastia total do quadril associada a transposição muscular para reconstrução do mecanismo abdutor do quadril. Após 10 meses de seguimento, o paciente apresentava boa recuperação funcional, com retorno gradual da força abdutora, Harris Hip Score de 91 pontos, com estudo radiográfico revelando prótese total cimentada bem posicionada. A estratégia terapêutica utilizada neste paciente (artroplastia total do quadril com transferência muscular para a reconstrução da musculatura abdutora) foi uma solução eficiente para tratar a fratura intracapsular do fêmur proximal com exposição óssea.

Assessment of the local blood supply when femoral neck fracture occurs:advances in the anatomy research and its clinical application / 中国骨伤

The stability of internal fixation of femoral neck fractures can be obtained through surgical techniques, the configuration of screws and bone grafting, etc. However, the blood supply injury caused by fractures could not be completely reversed by the current medical management. Hence, the comprehensive evaluation of the residual blood supply of the femoral neck, to perioperatively avoid further iatrogenic injury, has become a hotspot. The anatomy of the extraosseous blood supply of the femoral neck has been widely reported, while its clinical application mostly involved the assessment of the medial circumflex femoral artery and retinacular arteries. However, further studies are needed to explore the prognosis of patients with these artery injuries, with different degrees, caused by femoral neck fractures. Direct observations of nutrient foramina in vivo are not possible with current clinical technologies, but it is possible to make reasonable preoperative planning to avoid subsequent femoral head necrosis based on the distribution features of nutrient foramina. The anatomy and clinical application studies of the intraosseous blood supply focused on the junction area of the femoral head and neck to probe the mechanism of femoral head necrosis. Thus, the intraosseous blood supply of other regions in the femoral neck remains to be further investigated. In addition, a blood supply evaluation system based on a three-level structure, extraosseous blood vessels, nutrient foramina, and intraosseous vascular network, could be explored to assist in the treatment of femoral neck fractures.

Biomechanical characteristics of retinaculum in the treatment of femoral neck fractures / 中国骨伤

OBJECTIVE@#To investigate the biomechanical characteristics of retinaculum in the treatment of femoral neck fractures.@*METHODS@#The CT data of a 75-year-old female volunteer was processed by software to construct an intact femur model and femoral neck fracture model fixed with three cannulated screws, which were divided into models with retinaculum or not. The Von-Mises stress distribution and displacement were compared to analyze the stability differences between the different models to study the mechanical characteristics of the retinaculum in the treatment of femoral neck fractures.@*RESULTS@#In the intact femur, the most obvious displacement appeared in the weight-bearing area of the femoral head, with retinaculum 0.381 37 mm, and without retinaculum 0.381 68 mm. The most concentrated part of the Von-Mises stress distribution was located in the medial and inferior part of the femoral neck, with retinaculum 11.80 MPa, without retinaculum 11.91 MPa. In the femoral neck fracture fixed with three cannulated screws model, the most obvious position of displacement also appeared in the weight-bearing area of the femoral head, with retinaculum 0.457 27 mm, without retinaculum 0.458 63 mm. The most concentrated part of the Von-Mises located at the medical and inferior part of the femoral neck, with retinaculum 59.22 MPa, without retinaculum 59.14 MPa. For the cannulated screws, the Von-Mises force peaks all appeared in the posterior and superior screw, with retinaculum 107.48 MPa, without retinaculum 110.84 MPa. Among the three screws, the Von-Mises stress of the anterior-superior screw was the smallest, which was 67.88 MPa vs 68.76 MPa in the retinaculum and non-retinaculum groups, respectively.@*CONCLUSION@#The complete retinaculum has little effect on the stability of intact femur and femoral neck fractures with anatomical reduction after internal fixation, and cannot effectively improve the stability of the fracture end after the fracture.

Surgical treatment for ipsilateral femoral neck and shaft fracture / 中国骨伤

OBJECTIVE@#To retrospectively analyze efficacy of single structure internal fixation and double structure internal fixation in the treatment of ipsilateral femoral shaft and neck fracture, and analyze their indications.@*METHODS@#From June 2015 to December 2020, 21 patients with ipsilateral femoral shaft and femoral neck fracture were treated, including 14 males and 7 females, aged 23 to 69 years old with an average of(38.1±12.9) years old. According to different femoral shaft fracture sites, some patients were fixed with cephalomedullary implant for both femoral neck and the femoral shaft(single structure, InterTan or PFNA Ⅱ), some patients were fixed with cannulated screws for the femoral neck and a retrograde locking nail for the femoral shaft (dual structure), and postoperative function and complications were recorded during follow-up. In 10 cases of single-structure fixation, the femoral necks were all basicervical fractures, and the femoral shaft fractures were located in the proximal isthmus;11 cases were double-structure fixation, 9 cases in 11 were basal type of femoral neck, 2 cases in 11 were neck type, and the femoral shaft fractures were located in the isthmus and the distal isthmus.@*RESULTS@#All patients were followed up for 12 to 27 months. No femoral head necrosis, deformity, delay or nonunion occurred in the patients with single-structure fixation, and no delayed union or nonunion occurred in femoral shaft fractures;At the final follow-up, Harris score of patients with single-structure fixation was 91.8±4.1, with 8 cases were excellent and 2 cases were good. The fractures of patients with dual-structure fixation achieved good union without femoral head necrosis, except 1 case of femoral shaft fracture had delayed union;At the final follow-up, Harris score of patients with dual-structure fixation was 92.4±5.9, 7 cases were excellent, 3 cases were good, and 1 case was fair.@*CONCLUSION@#Good reduction and fixation is the key to the treatment of such fractures. Both the single-structure fixation and the dual-structure fixation are good methods, and it should be selected according to the locations of femoral shaft and femoral neck fractures. Single-structure fixation is a good choice for femoral shaft fractures located at the proximal isthmus and basal femoral neck fractures. For isthmus and distal femoral shaft fractures combined with ipsilateral femoral neck fractures, dual-structure fixation is recommended.

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.

Long-Term Outcome of Valgus Osteotomy and Fixation with Double Angled Dynamic Hip Screw for Nonunion Fracture of the Neck of the Femur in Young Adults / Desfecho a longo prazo da osteotomia valgizante e fixação com parafuso dinâmico de quadril de ângulo duplo de fratura não consolidada do colo femoral em adultos jovens

Abstract Objective To evaluate the long-term results of valgus intertrochanteric osteotomy fixed with double angled dynamic hip screw for nonunion fracture of the neck of the femur in young adults. This implant allows more freedom of fixation in the sagittal plane. Very few studies have evaluated the long-term outcome for treatment of nonunion in fractures of the neck of the femur. Methods This is a prospective interventional study that included 20 patients with nonunion of the fracture of the neck of the femur aged < 60 years old without avascular necrosis of the head and significant resorption of the neck of the femur. A lateral closing wedge osteotomy was performed just above the lesser trochanter after inserting the Richard screw across the nonunion site, and it was fixed with a double-angle 120° barrel plate. The outcome was evaluated using union rate and the Harris Hip Score for functional outcome. Results The average postoperative decrease in the Pauwels angle was of 28.9°. A total of 80% of the cases progressed to union within a mean duration of 7.53 months. The mean Harris Hip Score at the final follow-up was 86.45. Conclusion Valgus intertrochanteric osteotomy and fixation with a double angled dynamic hip screw is a reliable and effective method for preservation of head and promoting union in an ununited fractured neck of the femur in young patients.

Resumo Objetivo Avaliar os resultados a longo prazo da osteotomia intertrocantérica valgizante, fixada com parafuso dinâmico de quadril (DHS, na sigla em inglês) de ângulo duplo, em fraturas não consolidadas do colo femoral em adultos jovens. Este implante permite uma liberdade maior de fixação no plano sagital. Muito poucos estudos avaliaram o desfecho do tratamento a longo prazo da fratura não consolidada do colo femoral. Métodos Trata-se de um estudo prospectivo de intervenção que incluiu 20 pacientes com fratura não consolidada do colo femoral com idade < 60 anos, sem necrose avascular da cabeça femoral e significativa reabsorção do colo femoral. Foi realizada uma osteotomia em cunha de fechamento lateral logo acima do trocânter menor após a inserção do parafuso tipo Richard no sítio do retardo da consolidação óssea, sendo fixada com uma placa cilíndrica de ângulo duplo de 120°. O resultado foi avaliado com o uso da taxa de consolidação e da escala Harris Hip Score quanto ao desfecho funcional. Resultados Foi obtida uma redução pós-operatória média de 28,9° do ângulo de Pauwels. Os casos que evoluíram para a consolidação alcançaram 80%, em um período médio de 7,53 meses. A média da escala Harris Hip Score foi de 86,45 no acompanhamento final. Conclusão A osteotomia intertrocantérica valgizante e a fixação com DHS de ângulo duplo é um método confiável e eficaz para a preservação da cabeça do fêmur, promovendo a consolidação de uma fratura não consolidada do colo femoral em pacientes jovens.

Evaluation of the Intraobserver and Interobserver Agreements of the New AO/OTA Classification for Fractures of the Trochanteric Region and the Femoral Neck / Avaliação das concordâncias intra e interobservadores da nova classificação AO/OTA para fraturas da região trocantérica e do colo do fêmur

Abstract Objective In the present study, we investigated the intra and interobserver agreement of the new Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification for fractures of the proximal extremity of the femur. Methods One hundred hip radiographs were selected from patients who suffered fractures of the trochanteric region or femoral neck. Four orthopedists, fellowship trained hip surgeons, and four orthopedic residents evaluated and classified fractures according to the new AO/OTA system on two separate occasions. The kappa (k) coefficient was used to evaluate intra and interobserver agreement in the different steps of the classification, namely: type, group, subgroup, and qualifier. Results Hip surgery experts obtained almost perfect intraobserver agreement of type, substantial for group and, only moderate, for subgroup and qualifiers. The residents had lower performance, with substantial agreement for type, moderate for group, and reasonable for subgroup and qualifier. In the specialists' interobserver evaluation, there was also a gradual decrease in the agreement between type (almost perfect) and group (moderate), which was even lower for subgroup and qualifiers. Residents had a substantial interobserver agreement for type, moderate for group, and reasonable in the other branches. Conclusion The new AO/OTA classification for fractures of the trochanteric region and femoral neck showed intra and interobserver agreements considered appropriate for type and group, with a drop in the subsequent branches, that is, for subgroup and qualifier. Still, in relation to the old AO/OTA classification, there was an improvement in the agreements for subgroup.

Resumo Objetivo Neste estudo, investigamos a concordância intra e interobservador da nova classificação Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) para fraturas da extremidade proximal do fêmur. Métodos Foram selecionadas 100 radiografias do quadril de pacientes que sofreram fraturas da região trocantérica ou do colo do fêmur. Quatro ortopedistas cirurgiões de quadril e quatro residentes de ortopedia e traumatologia avaliaram e classificaram as fraturas segundo o novo sistema AO/OTA em duas ocasiões distintas. O coeficiente de kappa (k) foi utilizado para avaliar a concordância intra e interobservadores nos diferentes passos da classificação, a saber: tipo, grupo, subgrupo e qualificador. Resultados Especialistas em cirurgia do quadril obtiveram concordância intraobservador quase perfeita de tipo, substancial para grupo e, apenas moderada para subgrupo e qualificadores. Os residentes tiveram desempenho inferior, com concordância substancial para o tipo, moderada para o grupo, e razoável para o subgrupo e qualificador. Na avaliação interobservadores dos especialistas, também se observou queda gradual da concordância entre tipo (quase perfeita) e grupo (moderada), que se mostrou ainda menor parasubgrupo e qualificadores.Residentestiveramumaconcordânciainterobservadoressubstancialparatipo, moderada para grupo e razoável nas demais ramificações. Conclusão A Nova Classificação AO/OTA para fraturas da região trocantérica e do colo do fêmur mostrou concordâncias intra e interobservadores consideradas adequadas para tipo e grupo com queda nas ramificações subsequentes ou seja para subgrupo e qualificador. Ainda assim em relação à classificação AO/OTA antiga houve melhora nas concordâncias para subgrupo.

Comparison of femoral neck geometric parameters between Chinese and Japanese females / 中南大学学报(医学版)

OBJECTIVES@#Femoral neck fracture is the most serious osteoporotic fractures that is responsible for high medical costs and high mortality. Femoral neck geometric parameters (FNGPs) are important parameters that reflect the geometrical characteristics of femoral neck, and are closely related to the strength of femoral neck and the risk of fragility fracture.There are differences in the incidence of femoral neck fractures among races. However, whether there is difference in FNGPs among races is unknown.Therefore, this study aims to compare the differences in FNGPs between Chinese and Japanese females.@*METHODS@#This study was a cross-sectional study, in which 3 859 healthy females aged 10-86 (45.7±17.1) years old were recruited from Changsha City of Hunan Province and surrounding areas. The weight and height were measured and recorded, and the body mass index (BMI) was calculated. A dual energy X-ray absorptiometry (DXA) bone densitometer was used to measure femoral neck projective bone area (BA) and bone mineral density (BMD). FNGPs were calculated using the BMD and BA, which included the outer diameter (OD), cross-sectional area (CSA), cortical thickness (CT), endocortical diameter (ED), buckling ratio (BR), section modulus (SM), cross-sectional moment of inertia (CSMI), and compression strength index (CSI). The data of FNGPs in Japanese females was collected from literature. These subjects were grouped by 10-year age. The mean and standard deviation of height, weight, BMI, femoral neck BMD, and FNGPs of each group were calculated. The model with the best goodness-of-fit was selected from various mathematical regression models to analyze the distribution trend and the best fitting curve of FNGPs with age. The differences in FNGPs between Chinese and Japanese females were analyzed by using age-corresponding mean fitting curve for paired t-test, and the relative change rates of FNGPs were compared.@*RESULTS@#The mean values of FNGPs were significantly different among different years old healthy females (all P<0.01). The mean values of OD, CSA, CT, SM, and CSMI in femoral neck were high at 30 to 39 years old, and then they were gradually decreased with age. The CSI reached its peak at 20-29 years old, and it was decreased gradually after 30 years old. ED and BR were at a low level before 40 years old, they were gradually increased after 40 years old, and reached the maximum average value at 80-86 years old. The variations in FNGPs with age were fitted with the best goodness-of-fit by applying the cubic regression model and the determination coefficients of regression equations (R2: 0.062-0.404) were significant (all P<0.01). The distribution trend of FNGPs with age varied with the indices, among which CSA, CT, SM, CSMI and CSI were increased with age before 35 years old, and then they were decreased with age; BR was at a low level in the early stage, and then it was increased with age after about 40 years. There were significant differences in the fitting curves of FNGPs related to age between Chinese and Japanese females (all P<0.01). The fitting curves of OD, ED, BR and SM in Chinese females were significantly higher than those in Japanese females (all P<0.01), while those of CSA and CT in Chinese females were significantly lower than those in Japanese females (all P<0.01). Before the age of 50, the curves of CSMI and CSI of Chinese females were significantly higher than those of Japanese females (all P<0.01), while after the age of 60 the situation was reversed (all P<0.01). Except for SM and CSI, there were significant differences in the rate of OD, CSA, CT, ED, BR and CSMI with age (all P<0.01). By the age of 80 years old, the rates of change in OD, ED, and BR with the age in Chinese females were increased by 0.91%,3.94%, and 47.5%, respectively, while those in Japanese females were increased by 8.57%, 15.8% and 85.3%, respectively；the rates of change of CSA, CT, and CSMI with the age in Chinese females were declined 28.0%, 29.6%, and 25.2%, respectively, while those in Japanese females were declined 29.9%, 36.2%, and 10.9%, respectively. There were significant difference in the rates of change in FNGPs with the age between Chinese and Japanese females (all P<0.01).@*CONCLUSIONS@#The study reveals the variation of FNGPs with age in Chinese, and confirms that there are racial differences in FNGPs between Chinese and Japanese females, which may be one of the important reasons for the difference in the incidence of femoral neck fracture between Chinese and Japanese females.

Estudio cadavérico de anteversión de cuello femoral en Población de Indonesia / Cadaveric Study Of Femoral Neck Anteversion In Indonesian Population

Objective: The normal morphology of femoral anteversion is an essential factor which determines the clinical results of hip replacement to achieve the normal activity and the length of the replaced joint. No previous study has been documented regarding normal value of femoral anteversion in Indonesian population and how they are different with Western, India and African population. This study aimed on measurement of normal femoral anteversion values of Indonesian population and compare it with existing data of Western, African and India values. Method: This cross-sectional study by measuring the femoral neck anteversion angle in 120 samples of Indonesians's cadaveric femur. Comparisons were made between Western, African and India. Result: The result showed that the average values of femoral neck anteversion angle in men were 11.60 ± 4.83 and 12.96 ± 5.1 in the right and left parts respectively, while in women, the results were 14.83+-5.14 and 13.37+-5.66 in right and left parts. The p value of ≤ 0.05 was considered to be significant. Conclusion: The mean femoral anteversion values of Indonesian population is 13.22. It is significantly different in comparison with Western, African, and Indian population.

Valores de referencia de la densidad mineral ósea por densitometría tipo DXA en una población adulta sana de Bogotá / Bone mineral density reference values by densitometry (DXA) in a healthy adult population of Bogota

RESUMEN Introducción: La actual definición de osteoporosis es basada en la absorciometría de energía dual de Rx (DXA, por sus siglas en inglés), lo cual representa la principal técnica para la cuantificación de la densidad mineral ósea (DMO) y la evaluación del riesgo de fractura. El objetivo de este estudio fue determinar la DMO en columna lumbar y cuello femoral de adultos sanos desde el punto de vista metabólico óseo en una población de Bogotá-Colombia. Métodos: Se realizó un estudio observacional, analítico, de corte transversal, basado en un cuestionario aplicado a la población de estudio. Las medidas densitométricas fueron realizadas con un equipo compacto de alto rendimiento de la General Electric, modelo iDXA, por el mismo tecnólogo en los sitios esqueléticos de interés, columna lumbar L1, L2, L3, L4 y L1-4 en proyección anteroposterior y en cuello femoral. El cálculo del tamaño de muestra se realizó teniendo en cuenta la estratificación por sexo y 2 grupos de edad: 20 a 29 años y 30 a 39 años. Se encuestó a 805 individuos y 432 se realizaron la densitometría ósea. Resultados: Los valores encontrados en columna lumbar para cada uno de los grupos de nuestra población, fueron: 1,150 g/cm2 (DE: 0,11), 1,180 g/cm2 (DE: 0,10), para mujeres y hombres de 20 a 29 años, y 1,169 g/cm2 (DE: 0,10), 1,209 g/cm2 (DE: 0,10) para mujeres y hombres de 30 a 39 años, respectivamente. A nivel del cuello femoral, 0,991 g/cm2 (DE: 0,10), 1,119 g/cm2 (DE: 0,13), para mujeres y hombres de 20 a 29 años, y 0,970 g/cm2 (DE: 0,11), 1,079 g/cm2 (DE: 0,13) para mujeres y hombres de 30 a 39 años, respectivamente. Conclusión: Este estudio pudo demostrar el comportamiento de la DMO en nuestra población, la cual es inferior a la detectada en otras latitudes y a las utilizadas como valores de referencia en nuestros equipos. Adicionalmente, se determinó el valor máximo de masa ósea en cada una de las regiones de interés para los rangos de edad de la población de nuestro estudio.

ABSTRACT Introduction: The current definition of osteoporosis is based on the dual energy X-ray absorptiometry (DXA), which represents the main technique for the quantification of bone mineral density (BMD) and the evaluation of fracture risk. The objective of this study was to determine the BMD in the lumbar spine and femoral neck of healthy adults from a bone metabolism point of view in a population of Bogotá-Colombia. Method: An observational, analytical, cross-sectional study was conducted based on a questionnaire completed by the study population. The densitometric measurements were carried out using a high-performance compact equipment of the General Electric, iDXA model, by the same technologist at the skeletal sites of interest, lumbar spine L1, L2, L3, L4 and L1-4 in anteroposterior projection, and in femoral neck. The sample size calculation was performed taking into account stratification by gender and 2 age groups: 20 to 29 years, and 30 to 39 years. A total of 805 individuals were surveyed, and 432 bone densitometries were performed. Results: The values found in the lumbar spine for each of the groups in our population were: 1.150 g/cm2 (SD: 0.11), 1.180 g/cm2 (SD: 0.10), for women and men aged 20 to 29 years, and 1.169 g/cm2 (SD: 0.10), 1.209 g/cm2 (SD: 0.10) for women and men aged 30 to 39, respectively. At the level of the femoral neck, 0.991 g/cm2 (SD: 0.10), 1.119 g/cm2 (SD: 0.13), for women and men aged 20 to 29 years, respectively, and 0.970 g/cm2 (SD: 0.11), 1.079 g/cm2 (SD: 0.13) for women and men aged 30 to 39, respectively. Conclusion: This study was able to demonstrate the behaviour of BMD in our population, which is lower than that detected in other latitudes and those used as reference values in our equipment. Additionally, the maximum bone mass value was determined in each of the locations of interest for the age ranges of the population in our study.

Análise da dinâmica do tecido ósseo mandibular, colo de fêmur e coluna vertebral de ratas com osteoporose induzida tratadas com ácido zoledrônico e administração sistêmica de ozônio / Analysis of the dynamics of mandibular bone tissue, femoral neck and spine of rats with induced osteoporosis treated with zoledronic acid and systemic administration of ozone

Este trabalho teve como objetivo analisar o potencial da terapia com ozônio na dinâmica do tecido ósseo de ratas ovariectomizadas tratadas com ácido zolendrônico. Para tanto, 110 ratas Wistar, fêmeas, 6 meses de idade foram submetidas à ovariectomia bilateral (Ovx). Após três meses, dez animais foram submetidos à eutanásia para caracterização da arquitetura do tecido ósseo em microtomografia (Micro ct), os animais restantes foram divididos em dois grupos, o grupo ZOL e o grupo SAL e foi iniciado o tratamento nos animais do grupo ZOL com ácido zoledrônico (100 µg/Kg/28 dias) e, no grupo SAL foi administrado 0,45 ml de solução salina usando o mesmo protocolo do ZOL. Após três meses desta terapia, 10 animais de cada grupo foram submetidos à eutanásia para caracterização da arquitetura óssea (Micro-ct) e os animais restantes foram novamente divididos aleatoriamente, em que os animais do grupo ZOL foram subdivididos em ZOL (n=20) e ZOL+OZN (n=20) e, os animais dos grupos SAL foram subdivididos em SAL (n=20) e SAL+OZN (n=20). Após este procedimento foi iniciada a ozonioterapia em concentração de 0,7mg/kg a cada dois dias até o final do experimento. Após 30 e 60 dias do início da terapia com ozônio, seis animais de cada grupo foram submetidos à eutanásia para a análise e caracterização estrutural óssea das regiões de mandíbula, cabeça femoral e coluna vertebral. Uma parte das peças correspondentes ao colo femoral foram destinada a testes biomecânicos. As demais amostras coletadas foram descalcificadas e as lâminas histológicas foram coradas em hematoxilina e eosina para a análise histométrica (área de osso neoformado), contagem de células inflamatórias (linfócitos) e contagem de osteócitos. Os órgãos do metabolismo e absorção como mesentério, fígado, rins, pulmão e cérebro foram removidos para a avaliação do infiltrado inflamatório e ou qualquer proliferação celular desordenada. Para os parâmetros quantitativos de porcentagem de tecido ósseo na região de cabeça femoral e mandíbula, o teste ANOVA-2 fatores (grupos vs períodos de análise) foi aplicado e em seguida o pós-teste Tukey, quando p<0,05. Já este parâmetro na coluna vertebral, o teste ANOVA-1 fator (grupos experimentais, somente no período de 30 dias) foi aplicado e pós-teste de Tukey. Em todos os testes foi considerado p<0,05. O tratamento com ácido zoledrônio e ozônio (ZOL+OZN) apresentou maior porcentagem de volume ósseo, maior número de osteócitos e maior número de células inflamatórias na região de cabeça femoral, mandíbula com resultados estatisticamente significantes (p<0,05). Na análise biomecânica do colo femoral, o módulo de elasticidade foi semelhante para os grupos ZOL e ZOL+OZN (p>0,05), em comparação aos grupos SAL e SAL+OZN (p<0,05). Este estudo in vivo mostrou que existe um efeito sinérgico entre o ozônio e o ácido zoledrônico com manutenção da massa óssea e restauração da vitalidade do tecido ósseo em ratas ovariectomizadas. Além disso, que a terapia com ozônio foi segura no modelo experimental proposto nesta investigação(AU)

This work aimed to analyze the potential of ozone therapy in the bone tissue dynamics of ovariectomized rats treated with zoledronic acid. For this purpose, 110 Wistar rats, schoolchildren, 6 months old, underwent bilateral ovariectomy (Ovx). After three months, ten animals were euthanized to characterize bone tissue architecture in microtomography (Microct). The remaining animals were divided into two groups: the ZOL group, the SAL group, and treatment was started on the animals in the group. ZOL with zoledronic acid (100 µg / Kg / 28 days) and no SAL group was administered 0.45 ml of saline using the same protocol as ZOL. After three months of this therapy, 10 animals from each group were euthanized to characterize the bone architecture (Micro-ct), and the remaining animals were again randomly divided, in which the animals in the ZOL group were subdivided into ZOL (n = 20) and ZOL + OZN (n = 20) and, the animals in the SAL groups were subdivided into SAL (n = 20) and SAL + OZN (n = 20). After this procedure, ozone therapy was obtained at a concentration of 0.7 mg/kg every two days until the end of the experiment. After 30 and 60 days from the beginning of ozone therapy, six animals from each group were found to be euthanized for analysis and structural bone characterization of the mandible, femoral head, and spine regions. A part of the pieces corresponding to the cervix was destined for biomechanical tests. The others collected were decalcified, and histological slides were stained in hematoxylin and eosin for histometric analysis (area of newly formed bone), inflammatory cell count (lymphocytes), and osteocyte count. The metabolism and absorption organs such as mesentery, liver, kidneys, lung, and brain were removed to evaluate inflammatory infiltrate and or any disorderly cell proliferation. For the quantitative parameters of the percentage of bone tissue in the femoral head and mandible region, the ANOVA-2 factor test (groups vs analysis periods) was provided and then the Tukey post-test, when p <0.05. Already this parameter in the spine, the ANOVA-1 factor test (experimental groups, only in the period of 30 days) was applied and Tukey's post-test. In all tests, p <0.05 was considered. Treatment with zoledronic acid and ozone (ZOL + OZN) showed a higher percentage of bone volume, a greater number of osteocytes, and a greater number of inflammatory cells in the femoral head and mandible region with statistically significant results (p <0.05). In the biomechanical analysis of the femoral neck, the modulus of elasticity was similar for the ZOL and ZOL + OZN groups (p>0.05), compared to the SAL and SAL + OZN groups (p <0.05). This in vivo study revealed a synergistic effect between ozone and zoledronic acid with the maintenance of bone mass and restoration of bone tissue vitality in ovariectomized rats. Furthermore, that ozone therapy was safe in the experimental model proposed in this investigation(AU)

Fractura de cuello femoral en niños, reporte de caso clinico / Fractures of the femoral neck in children, report of case

Paciente de 10 años 2 meses de sexo femenino quien sufrió politraumatismo en accidente de tránsito al ser arrollada por automóvil en vía pública generando trauma craneoencefálico leve y fractura de cuello femoral derecho clasificación III de Delbet con desplazamiento completo, se manejó inicialmente con tracción cutánea con 3kg y posteriormente se realizó intervención quirúrgica realizando reducción cerrada y fijación percutánea exitosa. Continuó en control ambulatorio cada 3 meses con buena evolución. Se realizó retiro de material de osteosíntesis sin complicaciones. Continúa en controles por parte del servicio de Ortopedia y Traumatología periódicamente sin presencia de secuelas. Aunque poco frecuente, la fractura de cuello femoral se presenta como un traumatismo que conlleva retos para el médico tratante dados los altos índices de fracaso terapéutico, por lo que se hace necesario conocer el impacto de ésta patología en el momento en que ocurre la lesión y en el transcurso del tiempo, a fin de mejorar las opciones terapéuticas y mejorar el pronóstico de la lesión.

A 10 years and 2 months old patient of female gender who suffered multiple trauma in traffic accident when being rolled by automobile in public road generating mild traumatic brain injury and fracture of right femoral neck classification III of Delbet with complete displacement, she was initially handled with cutaneous traction with 3kg and later surgical intervention by closed reduction, successfull procedure. She continued in ambulatory control every 3 months with good evolution. Removal of osteosynthesis material was performed without complications. She continues in controls by the service of Orthopedics and Traumatology periodically without presence of sequels. Although infrequent, femoral neck fracture presents as a trauma that presents challenges for the treating physician, given the high rates of therapeutic failure, so it is necessary to know the impact of this pathology at the moment of injury and In the course of time, in order to improve therapeutic options and improve the prognosis of the lesión.

Relationship of the Pelvic-Trochanteric Index with greater trochanteric pain syndrome

OBJECTIVES: This study aimed to correlate a higher Pelvic-Trochanteric Index (PTI) with an increased varus of the femoral neck with greater trochanteric pain syndrome (GTPS). The secondary objective was to check whether the pelvic width changes with age. METHODS: A prospective study was conducted to compare female patients diagnosed with GTPS (case group) with asymptomatic female participants (control group) from March 2011 to June 2017. On an anteroposterior pelvic radiograph, lines were drawn by two radiologists, and the PTI (ratio of the distance between the greater trochanters and distance between the iliac crests) was defined and the femoral neck-shaft angle was measured. RESULTS: Data collected based on radiographs of 182 female patients (cases) and 150 female participants (controls) showed that the mean PTI was 1.09 (SD=0.01) in the case group and 1.07 (SD=0.01) in the control group (p<0.05), regardless of age. The distance between iliac crests increased with age (p<0.05) in symptomatic and asymptomatic individuals. It was also found that the mean femoral neck-shaft angle was 130.6° (SD=0.59) and progression of the varus angulation occurred with age in both groups, with a significance level of 5%. CONCLUSIONS: The PTI was higher in patients with GTPS. The femoral neck-shaft angle does not differ between individuals with and without GTPS; however, it does decrease with age. The pelvic width tends to increase with aging in symptomatic or asymptomatic individuals; therefore, the increase in the pelvic width and decrease in the femoral neck-shaft angle can be interpreted as normal in aging women, which could alter the biomechanics of the hips and pelvis.

Factors relating to bone mineral density in young and middle-aged patients with ankylosing spondylitis / 中华医学杂志(英文版)

BACKGROUND@#Ankylosing spondylitis (AS) is a common chronic progressive rheumatic disease. The aim of this study was to explore factors influencing abnormal bone mineral density (BMD) in young and middle-aged patients with AS.@*METHODS@#From July 2014 to August 2018, hospitalized patients with AS and health examinees in the health examination center of our clinics, ranging in age from 20 to 50 years, were monitored. The BMD of the lumbar spine and femoral neck of AS patients and those of a healthy control group were measured using dual-energy X-ray absorption. The BMDs of AS patients were compared with respect to age, course of disease, iritis, smoking habits, sex, height, weight, body mass index (BMI), medication use, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), platelet volume, platelet count, uric acid (UA), alkaline phosphatase (AKP), and calcium ion levels. Single-nucleotide polymorphisms (SNPs) related to BMD were screened using genome-wide association analysis.@*RESULTS@#There was no statistical difference in the proportion of abnormal bone masses between the different body parts. The BMD of all bones in AS patients was lower than that in healthy controls (P < 0.05). Additionally, BMD was correlated with serum calcium and CRP in AS patients (P < 0.05), but not with age, platelet volume, platelet count, ESR, UA, AKP, height, weight, and BMI. The incidence of abnormal bone mass in AS patients was correlated with sex (P < 0.05), but not with medication use, iritis, or smoking. BMD of the lumbar spine in AS patients did not correlate linearly with the course of the disease, but BMD of the femoral neck correlated linearly with the course of the disease (P < 0.05). BMD was correlated with multiple SNPs in patients with AS. Lumbar BMD was correlated with rs7025373 and rs7848078. Femoral head BMD was correlated with 3:102157365, 3:102157417, rs1252202, rs1681355, rs3891857, rs7842614, and rs9870734, suggesting that genetic factors play a role in BMD in patients with AS.@*CONCLUSIONS@#The proportion of abnormal bone mass in AS patients was higher than that in healthy individuals of the same age. The factors related to BMD in patients with AS are gender, CRP, and blood calcium. The BMD of the femoral neck of AS patients decreases with the course of the disease, but BMD of the lumbar spine is not related to the course of the disease. BMD in AS patients is associated with multiple SNPs.

Pressure side and tension side comminution of femoral neck cortex are independent risk factors for aseptic necrosis after femoral neck fracture surgery / 中国骨伤

OBJECTIVE@#To investigate the related factors of aseptic necrosis of femoral head after closed reduction and internal fixation of femoral neck fracture.@*METHODS@#From January 2009 to January 2016, 236 patients with femoral neck fracture were treated with closed reduction and internal fixation with 3 hollow lag screws, including 111 males and 125 females, aged from 19 to 89 (50.17±12.88) years. According to the follow-up results, the correlation of aseptic necrosis of femoral head was analyzed. Univariate analysis of age, gender, injured side, body weight, injury mechanism, preoperative waiting time, Garden classification and whether there was comminution of femoral neck cortex was conducted to obtain the independent variables with significant difference. Then binary logistic regression analysis was conducted to explore the independent risk factors of avascular necrosis of femoral head.@*RESULTS@#The average follow-up period of 236 cases was 4.58 years. There were significant differences in the range of injury (24.69% vs. 5.16%, @*CONCLUSION@#High energy injury, preoperative waiting time (>48 h) and comminution of femoral neck cortex were independent risk factors for aseptic necrosis of femoral head. In addition, cortical comminution on the pressure side and tension side of the femoral neck is a strong prognostic risk factor for aseptic necrosis of the femoral head, because it indicates a more serious and complex injury mechanism.

Principales técnicas quirúrgicas y complicaciones infecciosas en adultos mayores con fractura de cuello de fémur / Main surgical techniques and infectious complications in older adults with a femoral neck fracture

INTRODUCCIÓN. La fractura de cuello de fémur constituye un problema de salud a nivel mundial, siendo complicación frecuente la infección de vías urinarias en adultos mayores. OBJETIVO. Determinar las variables demográficas e identificar las principales complicaciones infecciosas pre y posquirúrgicas en adultos mayores con fractura de cuello de fémur. MATERIALES Y MÉTODOS. Estudio observacional, descriptivo y retrospectivo, con una población igual a la muestra de 310 datos de Historias Clínicas, de pacientes hospitalizados en la Unidad de Traumatología y Ortopedia del Hospital de Especialidades Carlos Andrade Marín durante el periodo abril 2018 a febrero 2019. Criterios de inclusión: mayores de 65 años de edad, con diagnóstico prequirúrgico de fractura de cuello de fémur. Criterios exclusión: menores de 65 años con fractura patológica de cuello de fémur. Los datos fueron tomados del sistema AS400, la tabulación y análisis se realizó en los programas estadísticos Microsoft Excel e International Business Machines Statistical Package for the Social Sciences, versión 20. RESULTADOS. Las complicaciones fueron las infecciones: vías urinarias 14,19% (44; 310), tracto respiratorio inferior 3,23 % (10; 310) y menos común la de tracto respiratorio superior 0,33% (1; 310). DISCUSIÓN. Este estudio encontró a las infecciones de vías urinarias como primera causa de complicación en la artroplastia total de cadera, similar a otras investigaciones en Latinoamérica. CONCLUSIÓN. Se identificó a la infección de vías urinarias como usual en pacientes pre y posquirúrgicos de fractura de cuello de fémur, mientras que menos frecuente fue la infección de tracto respiratorio superior en las prequirúrgica y la sepsis en las posquirúrgicas.

INTRODUCTION. The femoral neck fracture constitutes a health problem worldwide, with urinary tract infection being a frequent complication in older adults. OBJECTIVE. To determine the demographic variables and identify the main infectious complications before and after surgery in older adults with a femoral neck fracture. MATERIALS AND METHODS. Observational, descriptive and retrospective study, with a population equal to the sample of 310 data from Medical Records, of hospitalized patients in the Traumatology and Orthopedics Unit of the Carlos Andrade Marín Specialty Hospital during the period april 2018 to february 2019. Inclusion criteria: people over 65 years of age, with a pre-surgical diagnosis of a femoral neck fracture. Exclusion criteria: under 65 years old with pathological fracture of the femoral neck. The data were taken from the AS400 system, the tabulation and analysis was carried out in the statistical programs Microsoft Excel and International Business Ma- chines Statistical Package for the Social Sciences, version 20. RESULTS. Complications were infections: urinary tract 14,19% (44; 310), lower respiratory tract 3,23% (10; 310) and the less common upper respiratory tract 0,33% (1, 310). DISCUSSION. This study found urinary tract infections as the first cause of complication in total hip arthroplasty, similar to other investigations in Latin America. CONCLUSION. Urinary tract infection was identified as usual in pre and postoperative femoral neck fracture patients, while upper respiratory tract infection was less frequent in preoperative and sepsis in postoperative.

Retro-odontoid pseudotumor: a poorly recognized alteration of the craniocervical junction

SUMMARY INTRODUCTION Retro-odontoid pseudotumor (ROP) is a rare disease that affects the atlantoaxial joint and, in general, is associated with local biomechanical alterations that may or may not cause instability. METHODS Descriptive study of the literature available in databases MEDLINE/PubMed, LILACS, and Scopus. The research was conducted in April 2019. DISCUSSION ROP is, possibly, a syndromic designation that encompasses a significant variety of diseases of the atlantoaxial joint. There are different pathophysiological mechanisms implicated in its genesis. The patients, almost in their entirety, present with severe myelopathy, and most of them are treated surgically, with the posterior decompression being the most commonly used method, with or without arthrodesis. Evolution is usually favorable. CONCLUSION The ROP is still poorly recognized as a differential diagnosis between the diseases of the cranial-cervical junction. The information available in the literature analyzed was based mainly on the study of reports or case series; therefore, it is insufficient to define conducts with a high level of scientific evidence.

RESUMO INTRODUÇÃO O pseudotumor retro-odontoide (PRO) é uma patologia rara que acomete a articulação atlantoaxial e, em geral, está associada a alterações biomecânicas locais que podem ou não causar instabilidade. METODOLOGIA Estudo descritivo da literatura disponível nas bases de dados Medline/PubMed, Lilacs e Scopus. A pesquisa foi realizada em abril de 2019. DISCUSSÃO O PRO é, possivelmente, uma designação sindrômica que abrange uma variedade significativa de doenças da articulação atlantoaxial. Existem diferentes mecanismos fisiopatológicos implicados em sua gênese. Os pacientes, quase em sua totalidade, apresentam quadro de mielopatia grave e a maioria deles é tratada cirurgicamente, sendo a descompressão posterior o método mais utilizado, com ou sem artrodese. A evolução costuma ser favorável. CONCLUSÃO O PRO ainda é pouco reconhecido como diagnóstico diferencial entre as doenças da junção crânio-cervical. As informações disponíveis na literatura analisada foram baseadas principalmente no estudo de relatos ou séries de casos, sendo, portanto, insuficientes para definir condutas com alto nível de evidência científica.