Radiological assessment of the femoral bowing in Japanese population

Abdelaal, Ahmed Hamed Kassem; Yamamoto, Norio; Hayashi, Katsuhiro; Takeuchi, Akihiko; Morsy, Ahmad Fawaz; Miwa, Shinji; Kajino, Yoshitomo; Rubio, Donnel Alexis; Tsuchiya, Hiroyuki

doi:10.1051/sicotj/2015037

Cited by 45 publications

(34 citation statements)

References 19 publications

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“…25 However, the 235 to 240 mm length nails could be safely inserted into the femoral canal without jamming in this study, even though femoral bowing in the Japanese population is greater than that in Chinese. 26 We speculate that this is a strength of TFNA 235 mm and PFNA-II 240 mm to decrease the wiper motion of the distal nail inside the femoral canal compared with short nails without nail jamming (Figures 3 and 4). Plausible reasons for the complete avoidance of nail jamming at the time of surgery in our patient cohort are the nail design and careful creation of the proximal entry hole slightly anterior of the tip of the greater trochanter and the diameter of the nail being determined to be 2 mm smaller than the diameter of the isthmus measured by preoperative computed tomography.…”

Section: Discussionmentioning

confidence: 92%

Clinical Outcome of Mid-Length Proximal Femoral Nail for Patients With Trochanteric Hip Fractures: Preliminary Investigation in a Japanese Cohort of Patients More Than 70 Years Old

Matsumura

Takahashi

Nakashima

et al. 2020

Geriatr Orthop Surg Rehabil

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Introduction: The TFN-ADVANCED Proximal Femoral Nailing System (TFNA) 235 mm (DePuySynthes) and Proximal Femoral Nail Antirotation (PFNA)-II 240 mm (DePuySynthes) were developed to obtain better stability for patients with trochanteric hip fractures without increasing surgical time and amount of blood loss. However, there are currently no studies concerning clinical and radiological outcomes of patients treated using these proximal femoral nails (PFNs) that have been performed in the Japanese population. The aim of this study was to retrospectively evaluate the clinical outcomes associated with 235 to 240 mm PFNs for Japanese patients >70 years old with trochanteric hip fractures who could walk independently before the injury. Materials and Methods: This study involved a retrospective analysis of data on trochanteric hip fracture patients who had undergone internal fixation from March 2016 to June 2018. The inclusion criteria were patients >70 years old with trochanteric hip fractures who could walk independently before the injury and were followed up for ≥3 months after surgery. Initially, 124 patients were identified, but 33 of these were excluded because other implants were used for internal fixation. Of the remaining 91 patients in whom PFNs were used at the time of internal fixation who were included for the perioperative evaluation, 66 patients followed up for ≥3 months were included in the clinical evaluations. Results: The average surgical time was 56.8 ± 19.6 minutes (range, 23-123 minutes). The average blood loss was 89 ± 41 mL (range, 0-245 mL). The union rate was 98%. Discussion: There were no cases of nail jamming, and all nails were successfully inserted below the end of the distal isthmus without additional reaming to dilate the canal. Conclusions: Proximal femoral nails were a useful implant in Japanese elderly patients with trochanteric hip fractures and gave comparable clinical outcomes despite the femoral length being short and occurrence of intensive bowing.

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Section: Discussionmentioning

confidence: 92%

Clinical Outcome of Mid-Length Proximal Femoral Nail for Patients With Trochanteric Hip Fractures: Preliminary Investigation in a Japanese Cohort of Patients More Than 70 Years Old

Matsumura

Takahashi

Nakashima

et al. 2020

Geriatr Orthop Surg Rehabil

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“…Involvement of femoral bowing-induced stress fracture is known as an onset factor of AFF 20 . Femoral bowing is larger in Japanese than in other races 21 , suggesting that the risk of stress fracture around the femoral diaphysis is high in Japanese. The fracture occurred more frequently in the diaphysis than in the subtrochanteric region in our APFF group, suggesting involvement of femoral bowing-induced stress fracture, similar to that in AFF.…”

Section: Discussionmentioning

confidence: 96%

Atypical periprosthetic femoral fractures after arthroplasty for fracture are at high risk of complications

Baba

Uchino²,

Ochi

et al. 2021

Sci Rep

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It is difficult to investigate clinical features in a single-center study because atypical periprosthetic femoral fracture (APFF) is rare. This study aims to perform a nationwide survey of APFF to investigate the characteristics of this fracture and compare the clinical outcome with that of typical periprosthetic femoral fracture (typical PFF). A nationwide survey was performed asking for cooperation from 183 councilors of the Japanese Society for Fracture Repair. The subjects were patients with APFF injured between 2008 and 2017. The control group was comprised of patients with typical PFF of our facility injured in the same period. A total of 43 patients met the APFF definition. The control group was comprised of 75 patients with typical PFF. The rate of bisphosphonate use was significantly higher in the APFFs group than in the typical PFF group (62.8% and 32%, p < 0.02). The rate of cemented stem was significantly higher in the APFFs group than in the typical PFF group (30.2% and 6.7%, p < 0.001). In the patients with arthroplasty for hip fracture, multivariable logistic regression analyses showed that APFF was an independent risk factor of complications following the initial management (Odds ratio 11.1, 95% confidence interval 1.05–117.2, p = 0.045). However, no significant association between PFF and APFF was observed in the patients with arthroplasty for other hip diseases. The risk of complications was higher in the APFF group than in the typical PFF group in the patients with arthroplasty for fracture. When AFPP after arthroplasty for the fracture is suspected, it may be necessary to add not only internal fixation with a normal plate but also some additional treatment.

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“…Several attempts have been made to determine the curvature of the femur from 3D images (Abdelaal et al, 2016; Akamatsu et al, 2016; Karakaş & Harma, 2008; Lu et al, 2012; Mochizuki et al, 2017; Schmitt et al, 2019). In these, the "center point" of the femoral cross‐section was the basis for determining the curvature.…”

Section: Discussionmentioning

confidence: 99%

“…In these studies, the femoral diaphysis has been analyzed in detail in three dimensions. Abdelaal et al (2016) adopted a method of regarding the curve connecting the center point of the medulla on femoral computed tomography (CT) cross‐sectional images. However, their method of determining the center point was to adopt the center point of the circle or ellipse that most closely fit within the medulla.…”

Section: Introductionmentioning

confidence: 99%

Morphological divergence in the curvature of human femoral diaphyses: Tracing the central mass distributions of cross‐sections

et al. 2021

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The diaphysis of the human femoral bone has a physiological anterior curvature; additionally, there is a curvature to the medial side or lateral side. In addition to compression stress from gravity during standing, walking, and running, these bones are continuously exposed to complex stresses from the traction forces of the various strong muscles attached to them. The femoral diaphysis is subjected to these mechanical stresses, and the direction and size of its curvature are defined according to Wolff's law and the mechanostat theory of Frost. The purpose of this study was to quantitatively evaluate the curvature of the femoral diaphysis in Japanese skeletons by determining the curve connecting the central mass distributions (CMD) of cross‐sectional images. A total of 90 right femora (46 males and 44 females) were randomly selected from modern Japanese skeletal specimens. Full‐length images of these bones were acquired using a clinical computed tomography scanner. The range between the lower end of the lesser trochanter and the adductor tubercle of each femur was divided at regular intervals to obtain ten planes, and nine levels were analyzed. The CMD curve was determined by connecting the CMDs of each of the nine cross‐sections. First, the CMD of a cross‐section in each of the nine slices was calculated, and the nine trajectories were superimposed from above. Then, by converting the shape of the entire CMD curve to superimpose the coordinates of the endpoint on the starting point, a closed arc representing the curvature of the femur was determined. For both males and females, the patterns varied from mostly medial to largely lateral curvature. The size of the curvature also varied for individuals. By analyzing only the coordinates of the vertex of the CMD curve of each femoral bone, the outlines of the diaphyseal curvatures could be recognized. The femora were thereby divided into two groups: medial bending and lateral bending. Considering males and females together, the number in the lateral‐curvature group (n = 51) was larger than that in the medial‐curvature group (n = 39). Moreover, the average age of the lateral‐curvature group was significantly higher than that of the medial‐curvature group (p < 0.05). In males, with an increase in the cortical bone proportion of the cross‐sectional area, the anterior vertex of diaphyseal bending tended to be more prominent. This cortical proportion was significantly higher in the medial‐curvature groups than in the lateral‐curvature group (p < 0.01). The phenomena observed in this study may be related to pathophysiologies such as atypical fractures of the femur and osteoarthritis of the knee joints.

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Radiological assessment of the femoral bowing in Japanese population

Cited by 45 publications

References 19 publications

Clinical Outcome of Mid-Length Proximal Femoral Nail for Patients With Trochanteric Hip Fractures: Preliminary Investigation in a Japanese Cohort of Patients More Than 70 Years Old

Clinical Outcome of Mid-Length Proximal Femoral Nail for Patients With Trochanteric Hip Fractures: Preliminary Investigation in a Japanese Cohort of Patients More Than 70 Years Old

Atypical periprosthetic femoral fractures after arthroplasty for fracture are at high risk of complications

Morphological divergence in the curvature of human femoral diaphyses: Tracing the central mass distributions of cross‐sections

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