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Introduction We aimed to clarify differences in femoral morphology associated with post-hip fracture knee pain (PHFKP). Methods Medical records and radiographic examinations were retrospectively reviewed to determine the relationship between PHFKP development and femoral morphology. Leg length discrepancy (LLD) and neck-shaft angle discrepancy (NSAD) were measured from hip radiographs. Results 202 were enrolled, of whom 64 (31.7%) developed PHFKP. The PHFKP group showed more varus NSA. Intertrochanteric femoral fractures (γ-nail or CHS) displayed a more varus NSA. Conclusions Femoral morphology (varus NSA) may be involved in the development of PHFKP.

Objectives Pediatric femoral neck fractures were reviewed to compare complications with the time of presentation. Methods 34 pediatric femoral neck fractures were studied to detect union time, avascular necrosis, premature physis fusion, and the neck-shaft angle. All complications were comparable between both groups. Results The mean union time was more in late presented group. Four children developed AVN. The neck shaft angle and pre mature fusion of growth plate were same in both groups. Conclusions The frequency of the complications except union time in pediatric neck femur fracture is comparable in early and late presented groups.

Patients with a distal radius fracture (DRF) have an increased risk of subsequent fractures including hip fractures. The purpose of this study was to evaluate whether women with a DRF have certain hip geometry parameters known to indicate susceptibility to hip fractures.We compared bone mineral density (BMD) and hip geometry parameters (hip axis length, neck shaft angle, mean cortical thickness, femur neck width, cross-sectional area [CSA], cross-sectional moment of inertia, section modulus, and buckling ratio) in 181 women with a DRF (DRF group) and 362 propensity score-matched women without a fracture (control group). We evaluated the associations between DRF and hip geometry parameters using logistic regression analysis.The DRF group had lower hip BMD; lower cortical thickness, CSA, and section modulus; and higher buckling ratio than the control group (all p0.05). The occurrence of a DRF was significantly associated with decreases in neck shaft angle (odds ratio [OR], 1.047; 95% confidence interval [CI], 1.008-1.088) and CSA (OR, 3.114; 95% CI, 1.820-5.326) after adjusting for age, BMI, and total hip BMD.In this study, women with a DRF were more likely than women without a DRF to have hip geometry parameters known to indicate susceptibility to hip fractures. Our results suggest that not only low hip BMD but also a decreased CSA could account for the increased risk of subsequent hip fracture in patients with a DRF.

BACKGROUND: Coxa vara is a hip deformity in which the femoral neck-shaft angle decreases below its normal value. Standard surgical treatment for this condition is corrective valgus osteotomy. Appropriate correction of the Hilgenreiner-epiphyseal angle is important to prevent recurrence. The purpose of this study is to: 1) evaluate the recurrence of the deformity at the latest follow up; and 2) find the appropriate angle of correction associated with the lowest recurrence. METHODS: 34 hips in 31 patients who underwent surgery for treatment of coxa vara from 2005 to 2014 were included. Patient-reported outcomes, Hilgenreiner-epiphyseal angle, and neck-shaft angle were assessed preoperatively, postoperatively, and at latest follow-up. RESULTS: The mean age at surgery was 10.99, with a range of 5–30, years. Preoperative neck-shaft angle ranged from 60 to 100 degrees, and Hilgenreiner-epiphyseal angle ranged from 60 to 90 degrees. At the latest follow up, the neck-shaft angle ranged from 120 to 135 degrees and the Hilgenreiner-epiphyseal angle ranged from 22 to 35 degrees (p 120 degrees in order to prevent recurrence of the deformity. Majority of the patients were reported improvement of hip function. However, a longer-term follow up is required to determine further outcomes regarding to recurrence of the deformity.

Introduction Tip Apex Distance (TAD) is well established method of prediction of outcome in intertrochanteric fractures managed by Dynamic Hip Screw. This retrospective study was done to assess the significance of Tip Apex Distance in the management of the intertrochanteric fractures by proximal femoral nail. Material and methods The study was done in a tertiary care centre where 174 follow-up patients operated for intertrochanteric fractures with proximal femoral nail were included in the study. The radiological outcome of patients was assessed using the neck shaft angle, neck length and the offset whereas the functional status was assessed using the Harris hip score and the Lower extremity functional scoring system. These functional and radiological outcomes were compared with the TAD for any significant findings. Results The tip apex distance on the postoperative X-ray was found to be 22.93 + 3.88 mm. The Lower Extremity Functional Score was found to be 70.71 + 8.153. The Harris hip score was found to be 85.408 + 9.586. Change in the neck length as compared to the uninjured hip was found to be 1.46 + 1.705. Change in the offset and neck shaft angle was 1.38 + 1.567 and −2.61 + 1.27, respectively. There were 8 cases of screw cut out and 8 cases of superficial infection. Discussion The Harris hip score and the LEFS increased with decreasing values of the Tip Apex Distance. The neck shaft angle, neck length and the offset all decreased with the increase in the Tip Apex Distance. The Harris hip score and the LEFS decreased with the decrease in the neck shaft angle, neck length and the offset. On examining the 2 groups one with TAD 25 mm it was seen that both functionally and radiologically, the outcome was better in the group having TAD Conclusion This study indicates that the Tip Apex Distance can be used as a useful predictor of the outcome of the proximal femoral nail in intertrochanteric fractures. Level of evidence IV.

Background Two recent experimental studies evaluated the influence of shoulder rotation on neck-shaft angle, with conflicting results. However, there have been no clinical studies of whether this angle varies in different shoulder positions. The present study aimed to determine whether shoulder rotation affects neck-shaft angle on standard radiographs in patients with complaints of shoulder pain. Hypothesis Shoulder rotation does not affect neck-shaft angle. Materials and methods A prospective study was conducted in selected patients with shoulder pain. Three true anterior-posterior radiographic views were obtained: in neutral rotation, 30° external rotation, and internal rotation with patient's arm in a sling. The X-rays were evaluated by three shoulder and elbow surgeons. Inter- and intra-observer reliability was evaluated by intraclass correlation coefficient (ICC). Results Neck-shaft angle on true AP view did not differ between neutral rotation and 30° external rotation: 132 ± 6° and 130 ± 9°, respectively (P > 0.999). In internal rotation with the hand resting on the abdomen, neck-shaft angle was 145 ± 6°: i.e., significantly different (P Conclusions Radiographic neck-shaft angle was significantly different in internal rotation with the patient's arm in a sling, compared with views in neutral or 30° external rotation. Intra- and inter-observer correlation showed excellent reliability. Level of evidence II, comparative prospective study.

Introduction The proximal femur nail anti-rotation (PFNA-II) (Synthes GmbH, Oberdorf, Switzerland) is the most commonly used implant for intramedullary nailing of unstable intertrochanteric fractures in our centre. However, mechanical failure of the bone with respect to the implant is a cause of concern due to its significant morbidity especially in the elderly. To date, factors for fixation failures are not well defined in the literature. This study aims to evaluate the factors that predispose to cut out of the PFNA implant and to provide a guide for surgical fixation. Patients and methods This study was a retrospective analysis of 340 patients who underwent PFNA-II insertion from 2011 to 2013 in our centre. Intraoperative image intensifier images were used for calculation of tip apex distance, neck shaft angles, determination of Cleveland zones. Demographic data was collected on patients age and gender. The fractures were classified based on AO-OTA classification (Marsh et al., 2007) [1] . Patients were followed up for a minimum of 4 months and union of the fracture or until a complication occurred. Risk ratio for cut out was also compared with each statistically significant variable to determine the cut-off point. Results The incidence of cut out was 6.7% Tip apex distance, neck shaft angles and female gender were statistically significant for cut out. The study found that tip apex distance beyond 27 mm increased the risk of cut out. Neck shaft angles less than 128° also increased the risk of cut out. Posterior and superior blade position in the femoral head and AO 31A3 fractures trended towards significance for cut out but were not statistically significant. Conclusion To avoid cut out, one should aim for a tip apex distance of not more than 27 mm and preserve a neck shaft angle of more than 128°. Risk stratification of the patient allows the surgeon to take greater caution in the post-operative period to detect early cut out.

Purpose To assess morphological parameters of proximal femur and acetabulum in Thai population with three-dimensional measurement technique, and to analysis of collateral side symmetric, gender difference, and correlation between morphometric parameters. Methods Investigation was performed in 240 femurs. All three-dimensional femur models were acquitted from 64-slice spiral CT scanner. Morphometric parameters under consideration included acetabular diameter, femoral head diameter, shaft isthmus location, intramedullary canal diameter, diaphyseal diameter, femoral head height, femoral neck isthmus, femoral neck length, neck shaft angle, bow angle, and anteversion angle. All parameters were measured based on functions and least-square regression function in CAD software. Obtained measured data were then used for analysis of collateral side symmetric, gender difference, correlation between morphometric parameters, and compared with other populations. Results Female had a smaller dimension compared with male in most of the parameters. No significant difference was observed between left and right femurs. High correlation pairs of morphometric parameters included femoral head diameter–acetabular diameter, femoral head diameter–neck isthmus diameter, femoral head diameter–diaphyseal diameter at shaft isthmus level, acetabular diameter–neck isthmus diameter, neck isthmus diameter–diaphyseal diameter at shaft isthmus level, and acetabular diameter–diaphyseal diameter at shaft isthmus level. Some morphometric parameters of Thai are smaller than other Caucasian, and some Asian nation, i.e. femoral head diameter, femoral neck length, and femoral head height. Conclusions This study provides essential morphometric data for various orthopedic implant designs relating to proximal femur region.

The aim of this study is to explore the feasibility of 3D subject-specific skeletal reconstructions of lower limb in children using stereoradiography, and to assess uncertainty of clinical and anatomical parameters for children with cerebral palsy and for healthy children. The stereoradiography technique, using the EOS(®) system (Eos-imaging(®)), is based on the acquisition of two simultaneous digital anteroposterior and lateral X-rays, from head to feet in standing position and at low radiation dose. This technique allows subject-specific skeletal 3D reconstructions. Five children with cerebral palsy (CP) and 5 typically developing children (TD) were included in the study. Two operators performed the lower limb reconstructions twice. Tridimensional reconstructions were feasible for children over the age of 5 years. The study of reproducibility of anatomical parameters defining skeletal alignment showed uncertainties under 3° for the neck shaft angle, the femoral mechanical angle, and for the femoral and tibial torsions. The maximum degree of uncertainty was obtained for the femoral tibial rotation (4° for healthy children and 3.5° for children with CP).

OBJETIVO: Comparar, entre três avaliadores, a existência de concordância das medidas da anteversão do colo femoral com o grau da osteoartrite e a alteração do ângulo cervicodiafisário em pacientes com osteoartrite idiopática unilateral do quadril. MÉTODOS: Foram avaliados 42 pacientes com osteoartrite unilateral do quadril por meio de radiografia simples e tomografia computadorizada. RESULTADOS: Observou-se que não ocorreu variação significativa na anteversão femoral entre o quadril doente e o sadio. Houve uma concordância mais forte entre os observadores 1 e 2, tanto em relação ao quadril doente (caso) quanto ao sadio (controle). Além disso, não foi verificada concordância significativa entre os observadores 1 e 3 (p = 0,13) e entre 2 e 3 (p = 0,12) em relação ao ângulo cervicodiafisário do quadril controle. CONCLUSÃO: Apesar de não ter ocorrido relação entre a anteversão femoral e o ângulo cervicodiafisário nos pacientes com osteoartrite unilateral do quadril, este estudo demonstrou não haver relação com estes desvios angulares. OBJECTIVE: To compare the existence of agreement between measurements of anteversion of the femoral neck and the degrees of osteoarthritis and abnormality of the neck-shaft angle in patients with unilateral idiopathic hip osteoarthritis, among three evaluators. METHODS: Forty- two patients with unilateral hip osteoarthritis were evaluated by means of simple radiography and computed tomography. RESULTS: It was observed that there was no significant variation in femoral anteversion between the diseased and healthy hips. There was strongest agreement between observers 1 and 2 in relation to both the diseased hips (cases) and the healthy hips (controls). Moreover, no significant agreement was found between observers 1 and 3 (p = 0.13) and between observers 2 and 3 (p = 0.12), in relation to the neck-shaft angle of the control hips. CONCLUSION: Although there was no relationship between femoral anteversion and the neck-shaft angle in the patients with unilateral hip osteoarthritis, the present study showed that there was also no relationship with these angular deviations.

This article discusses the clinical significance of restoring hip kinematics and the effect of implant design and surgical technique on proper restoration of the anatomic condition of the hip. Incomplete restoration of femoral offset, body weight lever arm, and hip center height could cause subtle functional deficits in patients that conventional clinical outcome measures would not capture, but that may affect safety. We illustrate this with a case example of a patient who suffered falls while attempting to clear low obstacles after a clinically "successful" hip replacement with a 135-degree neck shaft angle stem that did not restore femoral offset.

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