Anatomical and clinical importance of proximal femur morphometry: a study on dry bones

Abstract

Aim: This study aims to evaluate the clinical relevance of using the obtained data in orthopedic surgery, implant design and biomechanical applications by analyzing the morphometric parameters of the head and neck parts located in the proximal part of human dry femur bones. Method: On 70 adult dry femurs (39 right, 31 left), head of femur diameters, neck of femur diameters and circumferences, fovea for ligament of head of femur dimensions, intertrochanteric length, inclination and Alsberg angles, and total femur lengths were measured. Comparisons between sides and correlation analyses were performed. Results: According to the measurement results, the mean vertical diameter of the femoral head was found to be 45.41±3.65 mm, and the mean vertical diameter of the femoral neck was found to be 32.91±3.47 mm. The mean inclination angle was found to be 127°±6.52, and the total femur length was found to be 425.99±32.23 mm. Many statistically significant positive correlations were found between the parameters. Strong correlations were observed between the head of femur diameters and the neck of femur and femur lengths (p<0.001). Fovea for ligament of head of femur parameters showed weaker relationships with other measurements. Conclusion: Morphometric analysis of the proximal femur provides valuable contributions to clinical applications, especially in terms of patient-specific planning and biomechanical modeling.

Keywords

• Femur
• Morphometry
• Anatomy

Proksimal femur morfometrisinin anatomik ve klinik önemi: kuru kemikler üzerinde bir çalışma

Abstract

Amaç: Bu çalışma, insan kuru femur kemiklerinin proksimal bölümünde yer alan baş ve boyun kısımlarına ait morfometrik parametreleri analiz ederek, elde edilen verilerin ortopedik cerrahi, implant tasarımı ve biyomekanik uygulamalarda kullanım potansiyelini değerlendirmeyi amaçlamaktadır. Yöntem: 70 erişkin kuru femur (39 sağ, 31 sol) üzerinde, caput femoris çapları, collum femoris çapları ve çevresi, fovea capitis boyutları, intertrokanterik uzunluk, inklinasyon ve Alsberg açıları ile toplam femur uzunlukları ölçüldü. Taraflar arası karşılaştırmalar ve korelasyon analizleri gerçekleştirildi. Bulgular: Ölçüm sonuçlarına göre, caput femoris’in vertikal çapı ortalama 45.41±3.65 mm, collum femoris’in vertikal çapı ise 32.91±3.47 mm olarak bulunmuştur. İnklinasyon açısı ortalama 127°±6.52 mm, toplam femur uzunluğu ise ortalama 425.99±32.23 mm’dir. Parametreler arasında istatistiksel olarak anlamlı çok sayıda pozitif korelasyon saptanmıştır. Özellikle caput femoris çapları ile collum femoris ve femur uzunluğu arasında güçlü korelasyonlar gözlenmiştir (p<0.001). Fovea capitis parametreleri ise diğer ölçümlerle daha zayıf ilişkiler göstermiştir. Sonuç: Proksimal femurun morfometrik analizi özellikle hasta spesifik planlamalar ve biyomekanik modellemeler açısından klinik uygulamalara değerli katkılar sunmaktadır.

Keywords

• Femur
• morfometri
• anatomi

References

1. Arıncı K, Elhan A. Anatomi Cilt-I. 6.baskı Ankara Güneş Tıp Kitabevi. 2016; 22-3.
2. Standring S. Gray’s Anatomy. The Anatomical Basis of Clinical Practice. Elsevier Ltd. 2021, Spain.
3. George R, Raju NK. Morphometry of proximal femur in South Indian Population. Asian Journal of Medical Sciences. 2024; 15(3), 80-87.
4. Sass JO, Saemann M, Kebbach M, Soodmand E, Wree A, Bader R, Kluess, D. The Morphology of the Femur Influences the Fracture Risk during Stumbling and Falls on the Hip—A Computational Biomechanical Study. Life. 2024; 14(7), 841.
5. Han J, Hahn MH. Proximal femoral geometry as fracture risk factor in female patients with osteoporotic hip fracture. Journal of bone metabolism. 2016; 23(3), 175.
6. Lin KJ, Wei HW, Lin KP, Tsai CL, Lee PY. Proximal femoral morphology and the relevance to design of anatomically precontoured plates: a study of the Chinese population. The Scientific World Journal. 2014; (1), 106941.
7. Zhang L, Zhu B, Chen L, Wang W, Zhang X, Zhang J. The impact of coronal configuration of the proximal femur on its mechanical properties and the validation of a new theoretical model: finite element analysis and biomechanical examination. Orthopaedic Surgery. 2023; 15(1), 62-69.
8. Jud L, Vlachopoulos L, Grob K. Correction of complex three-dimensional deformities at the proximal femur using indirect reduction with angle blade plate and patient-specific instruments: A technical note. J Orthop Surg Res. 2021; 16(1):427.

9. Berry DJ, Harmsen WS, Cabanela ME, Morrey BF. Twenty-five-year survivorship of two thousand consecutive primary Charnley total hip replacements: Factors affecting survivorship of acetabular and femoral components. J Bone Joint Surg Am. 2002; 84(2):171-177.
10. Schilcher J, Michaëlsson K, Aspenberg P. Bisphosphonate use and atypical fractures of the femoral shaft. N Engl J Med. 2011; 364(18):1728-1737.
11. Cai L, Wang T, Di L, Hu W, Wang J. Comparison of intramedullary and extramedullary fixation of stable intertrochanteric fractures in the elderly: A prospective randomised controlled trial exploring hidden perioperative blood loss. BMC Musculoskelet Disord. 2016; 17(1):475.
12. Bessho M, Ohnishi I, Matsuyama J, Matsumoto T, Imai K, Nakamura K. Prediction of strength and strain of the proximal femur by a CT-based finite element method. J Biomech. 2007; 40(8):1745-1753.
13. Baraza N, Chapman C, Zakani S, Mulpuri K. 3D-printed patient specific instrumentation in corrective osteotomy of the femur and pelvis: A review of the literature. 3D Print Med. 2020; 6(1):34.
14. Schileo E, Taddei F, Malandrino A, Cristofolini L, Viceconti M. Subject-specific finite element models can accurately predict strain levels in long bones. J Biomech. 2007; 40(13):2982-2989.
15. Baharuddin MY, Zulkifly AH, Lee MH, Kadir MR, Saat A, Aziz AA. Three dimensional morphometry of the femur to design the total hip arthroplasty for Malay population. Adv Sci Lett. 2013; 19(10):2982-2987.
16. Hoaglund FT, Low WD. Anatomy of the femoral neck and head, with comparative data from caucasians and Hong Kong Chinese. Clin Orthop Relat Res. 1980; 152:10-16.
17. Gregory JS, Testi D, Stewart A, ve ark. A method for assessment of the shape of the proximal femur and its relationship to osteoporotic hip fracture. Osteoporosis International. 2004; 15(1):5-11.
18. Le Bras A, Laporte S, Bousson V, ve ark. 3D reconstruction of the proximal femur with low-dose digital stereoradiography. Computer Aided Surgery. 2004; 9(3):51-7.
19. Tokpınar A, Yilmaz S, Ateş Ş, Kandur M, Nisari M. Morphometric examination of the proximal femur in the hip joint. Experimental and Applied Medical Science. 2020; 1(3), 82-88.
20. İyem Ci, Güvençer M, Karatosun V, Ünver B. Morphometric evaluation of proximal femur in patients with unilateral total hip prosthesis. Clin Anat. 2014; 27(3):478-488.
21. Verma M, Joshi S, Tuli A, ve ark. Morphometry of Proximal Femur in Indian Population. JCDR. 2017; 11(2): Ac01-ac4.
22. Ravichandran D, Muthukumaravel N, Jaikumar R, Das H, Rajendran M. Proximal femoral geometry in Indians and its clinical applications. J Anat Soc India. 2011; 60(1):6-12.
23. Atilla B, Oznur A, Cağlar O, Tokgözoğlu M, Alpaslan M. Osteometry of the femora in Turkish individuals: A morphometric study in 114 cadaveric femora as an anatomic basis of femoral component design. Acta Orthop Traumatol Turc. 2007;41(1):64-68.
24. Stroh DA, Issa K, Johnson AJ, Delanois RE, Mont MA. Reduced dislocation rates and excellent functional outcomes with large-diameter femoral heads. J Arthroplasty. 2013; 28(8):1415-1420.
25. Unnanuntana A, Toogood P, Hart D, Cooperman D, Grant RE. Evaluation of proximal femoral geometry using digital photographs. J Orthop Res. 2010; 28(11):1399-1404.
26. De Sousa E, Fernandes RM, Mathias MB, Rodrigues MR, Ambram AJ and BabinskiMA. Morphometric study of the proximal femur extremity in Brazilians. Int J Morphol. 2010; 28(3):835-840.
27. Rajila Rajendran H, Raamabarathi K, Sundaramurthi I, Gnanasundaram V, Balaji T. Anthropometric analysis of femur in South Indian population. Biomed Pharmacol J. 2020; 13(1):167-173.