Secular evolution of femoral morphology from a clinical perspective

Abstract

IntroductionIntramedullary nailing is the surgical method of choice for the treatment of proximal femur or femoral shaft fractures. Implant manufacturers aim to design implants fitting for the broadest possible population segment. As complete morphological data sets of long bones are not widely available, anatomical collections of historical dry bone specimens may represent abundant additional sources of morphological three‐dimensional (3D) data for implant design, provided they are consistent with present populations. This study aims to investigate secular trends and age‐related changes of femoral morphology of the Caucasian population over the past 800 years.Materials and methodsComputer graphical measurements of 3D‐datasets of right and left femora derived from computed tomography (CT) scans, representative of the present Caucasian population, were compared to computer graphical measurements of 3D‐datasets of right and left femora derived from CT scans of specimens from a historical medieval European bone collection.ResultsClinically relevant parameters of historical medieval European femora were found mostly consistent with correlative data of the present Caucasian population. Additionally, for some of the evaluated parameters, particularly anteversion, morphological differences significantly correlated to individual age and sex could be identified, whereas other parameters such as caput‐collum‐diaphyseal angle or radius of anterior femoral bowing were not correlated to individual age or sex.ConclusionThe findings suggest that more recent historical specimen collections may be a convenient and easily accessible source of new 3D morphological data, as well as to complement existing data, to be used by researchers and manufacturers for the development of intramedullary femoral nails.

Determination of the Gender-Related Differences on Native Femoral Anatomy Using Three-Dimensional Computerized Tomography Models in Caucasian Population

“…In a study of Buller et al, a negative correlation was found between age and FNI [13]. Schmutz et al have shown a statistically significant relationship between age and FNA angles [4]. In contrast to these study results, we observed no statistically significant correlation in terms of age -FNA (r = -0.082, p = 0.53) and age -FNI (r = -0.098, p = 0.45).…”

“…Understanding the racial differences in the native 3D femoral anatomy is important for an accurate preoperative planning and designing more compatible orthopedic implants [1,6,7]. In the literature, there are many studies that investigate the femoral anatomical features of different populations [1][2][3][4][5]7,10]. Most of these studies, that analyzed the racial differences on anatomical features, have focused on the Caucasian population from western countries [2][3][4][5]; however, the studies investigating the native femoral anatomy of the populations originated from different races on 3D models are limited [7,10].…”

“…The effects of age on anatomical features were determined with the investigation of the different age groups in the literature [3,4,13]. In a study of Buller et al, a negative correlation was found between age and FNI [13].…”

“…It is important to understand the native anatomical and biomechanical features of the bones and joints to achieve the successful results in Orthopedics and Trauma surgery [1][2][3][4]. Therefore, over time the different imaging methods have been developed for detailed investigation of the native anatomical and morphological changes.…”

“…Implant modifications and optimizations, which are made in accordance with genderspecific anatomical differences, could increase the postoperative functional results [7]. The effects of gender, age and race on anatomical features using the tomographic measurements, were largely investigated in the literature [1,3,4,[8][9][10]. In some of these studies, the femoral markings and measurements were performed using 2D methods [3,4], while in a limited number of studies all the femoral markings and measurements 1 were performed on 3D models [1,[8][9][10].…”