Lateral Bowing of Femur Associated With Older Age, Shorter Stature, and Lower Bone Mineral Density

Furihata, Yasuhiro; Ishikawa, Tetsuhiro; Katsuragi, J.; Omae, Takanori; Sasaki, Yasuhito; Umimura, Tomotaka; Iwasaki, Ryutaro; Shingyouuchi, Ryutaro; Tashiro, Susumu; Namiki, Michitaka; Ohtori, Seiji

doi:10.7759/cureus.19735

Cited by 4 publications

(5 citation statements)

References 22 publications

(40 reference statements)

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“…7 In the rotational displacement, the anteroinferior vector was more prominent in all femoral bowing models than in the original one, with a maximum at 50% anterolateral bowing. The vector direction of 50% anterolateral bowing was between 100% lateral and anterior bowing Based on the results of previous studies, factors that promote femoral bowing include aging, low bone density, hypovitaminosis D, and shorter stature [15,23]. A combination of these factors likely contributes to the occurrence of femoral bowing.…”

Section: Discussionmentioning

confidence: 90%

“…Based on the results of previous studies, factors that promote femoral bowing include aging, low bone density, hypovitaminosis D, and shorter stature [ 15 , 23 ]. A combination of these factors likely contributes to the occurrence of femoral bowing.…”

Section: Discussionmentioning

confidence: 99%

“…Although the direction of femoral bowing is usually anterolaterally convex [ 11 ], the degree and direction vary among ethnic groups [ 13 ]. Moreover, even within the same ethnic group, there are also suggested associations with age, sex, shorter stature, bone density, bone quality, and quantity [ 14 , 15 ]. In addition, sex and individual differences have been reported in the degree and direction of femoral bowing [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Influence of femoral bowing on stress distribution of the proximal femur: a three-dimensional finite element analysis

et al. 2023

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Background Whether femoral bowing or its direction has a mechanical effect on the proximal femur is unclear. This study aimed to define the changes in stress distribution in the proximal femur associated with femoral bowing using finite element analysis. Methods We created four femoral models: original, entire lateral bowing, entire anterior bowing, and the middle of both (50% anterolateral bowing) from computed tomography data of women with standard bowing. Each model’s stress distribution was compared by two-layering the stress distribution under loading conditions during walking. We also evaluated displacement vectors. Results In all directions of femoral bowing, the stress increased in the femoral neck and the femoral trochanter in the 50% anterolateral bowing. The direction of deformation of the vector for the femoral head increased anteroinferiorly in the 50% anterolateral bowing. Conclusions This study showed that the stress distribution at the proximal femur shifted laterally. The high-stress area increased at the femoral neck or trochanter due to increasing femoral bowing. Femoral bowing also increases the anteroinferior vector in the femoral head. This study provides valuable insights into the mechanism of proximal femoral fractures in older adults.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Influence of femoral bowing on stress distribution of the proximal femur: a three-dimensional finite element analysis

et al. 2023

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“…A typical femoral fractures are often caused by the adverse effect of bisphosphonates, often in combination with excessive femoral bowing [22][23][24] . When the axial pressure on the femur is converted into lateral tension, a femur with agingrelated low bone density and strength has less mechanical resistance and is more susceptible to remodeling.…”

Section: Discussionmentioning

confidence: 99%

Incomplete Diaphyseal Atypical Femoral Fracture due to Increased Anterolateral Bowing

Yoon

et al. 2022

Journal of Bone and Joint Surgery

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Background:Increased anterolateral bowing of the femur is associated with atypical femoral fractures among older patients (including both those receiving and those not receiving treatment with bisphosphonates) as well as a greater likelihood of occurring in the diaphyseal versus the subtrochanteric region. Prophylactic intramedullary (IM) nailing is recommended for the treatment of incomplete atypical femoral fractures, which are radiographically evident. However, this bowing deformity is considered to be a major obstacle to IM nailing as it may be associated with postoperative complications. Corrective osteotomy combined with IM nailing straightens the exaggerated curvature of the femur. We hypothesized that this technique may lead to the safe and rapid healing of incomplete diaphyseal atypical femoral fractures, thereby reducing lateral tensile stress.Methods:From October 2015 through March 2020, 17 female patients (20 femora) with a mean age of 76.1 years (range, 68 to 86 years) underwent a surgical procedure for the treatment of an incomplete diaphyseal atypical femoral fracture associated with anterolateral bowing. The surgical technique consisted of minimally invasive osteotomy and reconstruction with use of IM nailing, with or without an augmentation plate. Preoperative and postoperative radiographic findings (lateral and anterior bowing angles, anterolateral bowing grade, and lateral distal femoral angle [LDFA]) were compared. Primary union, time to union, and complications were evaluated as the outcomes.Results:Primary bone union was achieved in 19 of the 20 femora at a mean of 24.9 weeks (range, 20 to 40 weeks). There were 2 instances of delayed union, which healed at 36 and 40 weeks. The lateral bowing angle, anterior bowing angle, and LDFA significantly improved postoperatively (from 12.0° to 3.3°, from 17.3° to 11.5°, and from 93.5° to 88.8°, respectively) (p < 0.001). There was 1 instance of nonunion, which healed after plate augmentation without a bone graft.Conclusions:Given the pathophysiology of elevated lateral tensile stress, corrective osteotomy and IM nailing may be an acceptable solution for the treatment of incomplete diaphyseal atypical femoral fractures associated with increased anterolateral bowing.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…These results suggest that osseous morphology may change over a lifetime, which is not a novel proposition and welldocumented in the femur and spine. [16][17][18][19][20][21] However, the correlation was small (r = 0.279, R2 = 0.078, P , 0.001) and limits clinical extrapolation of this finding. Additional analysis is required to confirm whether tibia morphology changes with age.…”

Section: Figurementioning

confidence: 99%

Distal Tibia Apex Posterior Angulation: A Normal Anatomic Variant Related to Hindfoot Alignment With Side-to-Side Symmetry

et al. 2023

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Objectives: The sagittal plane of the distal tibia has not been welldescribed. This study sought to characterize sagittal plane morphology, determine symmetry from side to side, and identify differences based on hindfoot alignment. Methods: One hundred twelve bilateral lateral weight-bearing ankle radiographs were retrospectively evaluated (224 ankles). Hindfoot alignment was classified as neutral, planus, or cavus using the Meary angle. The angle between the diaphyseal and distal tibia axes was measured, and the apex location relative to the plafond was recorded. Results: A mean distal tibia apex posterior angulation (DTAPA) of 2.0°( range 22°to 7°, SD = 2.06°) was located 8.0 cm proximal to the plafond. No difference was observed from side to side in DTAPA magnitude (P = 0.36) or location (P = 0.90). Planus alignment was associated with a significantly greater DTAPA (3.05°) as compared with neutral (1.89°) (P = 0.002) and cavus (1.25°) (P , 0.001) alignment. Conclusion:The distal tibia has an apex posterior angulation, suggesting that the true anatomic axis of the tibia terminates just posterior to the plafond center. Hindfoot alignment is related to distal tibia morphology. DTAPA symmetry indicates that contralateral imaging can be used to guide reconstruction of patient-specific anatomy and alignment. Knowledge of the DTAPA may help mitigate sagittal malalignment during distal tibia fracture surgery. Medullary nailing is a common treatment for fixation of tibia fractures; however, higher rates of malalignment have been reported when compared with plate fixation in the setting of proximal and distal 1/3 fractures. [1][2][3][4][5] Obtaining and maintaining anatomic alignment during fracture reduction requires an understanding of the normal distal tibia morphology in both the coronal and sagittal planes. Studies have shown that in the coronal plane, the true anatomic tibial axis intersects the plafond laterally rather than centrally and that ideally, a medullary implant should

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Lateral Bowing of Femur Associated With Older Age, Shorter Stature, and Lower Bone Mineral Density

Cited by 4 publications

References 22 publications

Influence of femoral bowing on stress distribution of the proximal femur: a three-dimensional finite element analysis

Influence of femoral bowing on stress distribution of the proximal femur: a three-dimensional finite element analysis

Incomplete Diaphyseal Atypical Femoral Fracture due to Increased Anterolateral Bowing

Distal Tibia Apex Posterior Angulation: A Normal Anatomic Variant Related to Hindfoot Alignment With Side-to-Side Symmetry

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