scholarly journals Reconstruction of the Hip in Multiple Hereditary Exostoses

Children ◽  
2021 ◽  
Vol 8 (6) ◽  
pp. 490
Author(s):  
Dong Hoon Lee ◽  
Dror Paley
Keyword(s):  
Hip Joint ◽  
Joint Involvement ◽  
Neck Shaft Angle ◽  
Multiple Hereditary Exostoses ◽  
Femur Neck ◽  
Radiographic Outcomes ◽  
Surgical Dislocation ◽  
Center Edge ◽  
Shaft Angle ◽  
Coxa Valga

The hip joint involvement in multiple hereditary exostoses (MHE) occurs in 30–90%, causing pain and limitation of motion by femoroacetabular impingement, coxa valga, acetabular dysplasia, hip joint subluxation, and osteoarthritis. The purpose of this study was to investigate the clinical and radiographic outcomes of ten hips in seven patients treated by surgical dislocation and corrective osteotomies between 2004 and 2009. Surgical dislocation and excision of the osteochondromas and varus intertrochanteric osteotomies were performed in all cases when the neck–shaft angle was > 150°. Common sites of osteochondromas were medial, posterior, and anterior neck of the femur. Neck–shaft angle of the femur was improved from a mean of 157° to 139°, postoperatively. On an average, the center-edge angle improved from 20° to 30° postoperatively. We believe that Ganz’s safe surgical dislocation technique is the preferred treatment of MHE. This safeguards the circulation of the femoral head and the osteochondromas can be resected under direct vision. It can be combined with additional corrective osteotomies because the hip affected by MHE is frequently associated with dysplastic changes which can result in premature osteoarthritis.

scholarly journals Characteristics of hip impingement syndrome in patients with multiple hereditary exostoses

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yeong-Seub Ahn ◽  
Sungmin Kim ◽  
Woo-Jong Kim ◽  
Jun-Hyuk Lim ◽  
Sung-Taek Jung
Keyword(s):  
Femoral Neck ◽  
Alpha Angle ◽  
Hip Joints ◽  
Neck Shaft Angle ◽  
Multiple Hereditary Exostoses ◽  
Hip Impingement ◽  
Morphometric Measure ◽  
Shaft Angle ◽  
Coxa Valga ◽  
Symptom Group

Abstract Backgrounds This study aimed to investigate the characteristic deformities of the hip in multiple hereditary exostoses patients (MHE) and its association with the hip impingement syndrome. Materials and methods Between 2001 and 2019, total 51 patients (102 hips) were evaluated in this study. Patients with MHE were classified to femoro-acetabular impingement (FAI) symptom group, ischio-femoral impingement (IFI) symptom group and non-impingement symptom group by comparing the symptoms, clinical signs and imaging studies. To assess the morphometry of the hip in patients with MHE, the femoral neck-shaft angle, Sharp’s acetabular angle and center-edge (CE) angle were evaluated. Alpha angle was further evaluated to investigate the FAI using radiographs, and the minimum ischio-femoral distance was further measured to investigate the IFI using computed-tomographic (CT) study. Results On hip impingement symptom analysis, FAI symptom and IFI symptom were confirmed in 14 hip joints and 18 hip joints, respectively. Unlike general population, the number of the hip with IFI-symptom was higher than those with FAI symptom in this study. In morphometric evaluation of MHE hips, coxa valga was most prominent deformity with occasional tendency of mild acetabular dysplasia. In a comparison of morphometric study between the impingement symptom group and non-symptom group, the FAI symptom showed significant differences of morphometric measure values than those of the non-symptom group (FAI symptom group vs. Non-FAI symptom group; Femoral neck-shaft angle (153.9 vs 142.6), Sharp’s angle (45.0 vs 41.5), CE angle (21.1 vs 28.8) and alpha angle (76.7 vs 57.9)). Similarly, the IFI symptom group also showed significant differences of morphometric measure values than those of the non-symptom group (IFI-symptom vs. Non-IFI symptom; Femoral neck-shaft angle (150.9 vs 142.7), Sharp’s angle (44.7 vs 41.4), CE angle (21.1 vs 29.3) and alpha angle (73.3 vs 56.8)). In addition, the minimum ischio-femoral distance measured using CT was significantly decreased in the IFI symptom group (IFI symptom group: 6.6, Non-IFI symptom group: 16.4). Conclusion The results suggest that the characteristic deformities represented by coxa valga in the MHE hip act as an offset for FAI symptoms, on the contrary, act as a trigger for IFI symptoms. Level of evidence Level III.

scholarly journals Sexual Variations of Femoral Neck-Shaft Angle in the Population of Odisha

2021 ◽  
Vol 10 (19) ◽  
pp. 1387-1390
Author(s):  
Rajeev Kumar Kanchan ◽  
Sonali Subhadarsini ◽  
Dharma Niranjan Mishra ◽  
Chinmayi Mohapatra
Keyword(s):  
Femoral Neck ◽  
Ventral Surface ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Legal Cases ◽  
Male And Female ◽  
Neck Shaft Angle ◽  
Femur Neck ◽  
Shaft Angle ◽  
The Right

BACKGROUND The peculiar waddling gait of a female attracts most of the anatomists to measure and compare the neck-shaft angle (NSA) of the femora. The femoral neck shaft angle is greater in women due to greater pelvic breadth and shorter femur. Neck-shaft angle was measured by the angle that the neck makes with the shaft of the femur and it is measured on the ventral surface of femur taking the long axis of femoral neck with the long axis of the proximal end of the femur. It gives information about the race it belongs to and normally measures 120° to 140°. The intention of this study was to establish the femoral neck shaft angle variations in adult male and female for medico-legal and anthropometric studies. METHODS This cross-sectional study was conducted on 84 adult human femora of unknown sex in the anatomy department, Sriram Chandra Bhanja (SCB) Medical College, Cuttack, Odisha, from May 2018 to April 2019. We included all the femora which were free of damage or deformity and fully ossified indicating adult bone. Femora with any pathological changes i.e., cortical bone deterioration, extreme osteophyte activity, osteoarthritis and fracture etc. were excluded from the study. The NSA was measured by protractor and goniometer. RESULTS In the present study the NSA range for the right femur of male was 108° - 135° and for the right femur of females 117° - 135°. The left male femur was 118° - 135° and the left female femur was 120° - 135°. The mean neck shaft angle of male femora was 125.9° and the female femora was 125.7°. These measurements show that the values were more in males than the females. The value of the present study was statistically significant between male and female i.e., P < 0.0001. CONCLUSIONS These measurements are important in the medico-legal cases, reconstructive orthopaedic surgeries, hip replacement surgeries and also while constructing suitable prosthesis. This will also be helpful in the detection of sex by anatomists and forensic experts. KEY WORDS Neck Shaft Angle, Medico-Legal, Anthropometry and Goniometer

The effect of valgus and varus femoral osteotomies on measures of anteversion in the dog

2017 ◽  
Vol 30 (03) ◽  
pp. 184-190 ◽  
Author(s):  
Rachel Adams ◽  
Brad Gilleland ◽  
Farrah Monibi ◽  
Samuel Franklin
Keyword(s):  
Repeated Measures ◽  
Three Dimensional ◽  
Frontal Plane ◽  
Femoral Anteversion ◽  
Coxa Vara ◽  
Neck Shaft Angle ◽  
Repeated Measures Analysis ◽  
Shaft Angle ◽  
Coxa Valga ◽  
Head Neck

Summary Objective: To determine whether femoral osteotomies that change frontal plane alignment without affecting torsion influence anteversion and inclination. Methods: Femurs without deformity were scanned to create three-dimensional reconstructions. The femoral head-neck axis was identified by placement of a virtual intra-medullary pin. A proximal osteotomy was simulated to create three conditions while keeping torsion constant: Normal, Coxa Valga (neck-shaft angle increased by 12°), and Coxa Vara (neck-shaft angle decreased by 12°). Femoral anteversion was measured from an axial image in all three conditions. Femoral inclination was calculated for all conditions using the neck-shaft and anteversion angles. Changes in anteversion and inclination were calculated and compared using a one-way repeated measures analysis of variance. Distal femoral osteotomies were then simulated with the native femurs, inducing 18° of distal varus with no change to torsion. Changes in anteversion and inclination for the Normal and Distal Varus conditions were calculated and compared by a paired t-test. Results: Version changed by a mean of 13.9° (± 1.5; p <0.0001) from the Coxa Valga to Coxa Vara conditions while inclination changed by a mean of 1.3° (± 0.39; p <0.01). Version changed by a mean of 6.6° (± 0.7; p <0.0001) between the Distal Varus and Normal conditions while inclination changed by a mean of –3.8° (± 0.75; p <0.001). Clinical significance: Femoral version changes with changing frontal plane alignment even when torsion is constant. This should be considered when correcting femoral deformities.

Hip morphology predicts posterior hip impingement in a cadaveric model

2018 ◽  
Vol 29 (3) ◽  
pp. 322-327 ◽  
Author(s):  
William Z Morris ◽  
Cody A Fowers ◽  
Douglas S Weinberg ◽  
Michael B Millis ◽  
Leigh-Anne Tu ◽  
...  
Keyword(s):  
Femoral Neck ◽  
External Rotation ◽  
Ischial Tuberosity ◽  
Acetabular Version ◽  
Lesser Trochanter ◽  
Neck Shaft Angle ◽  
Hip Impingement ◽  
Hip Morphology ◽  
Shaft Angle ◽  
Coxa Valga

Introduction: Posterior hip impingement is a recently-identified cause of hip pain. The purpose of this study is to characterise posterior femoroacetabular and ischiofemoral impingement and identify its predisposing morphologic traits. Methods: Two hundred and six cadaveric hips were randomly selected and taken through controlled motion in two pure axes associated with posterior hip impingement: external rotation (through the mechanical axis) and adduction (coronal plane). The range of motion and location of impingement was noted for each specimen. Morphologic traits including femoral/acetabular version, and true neck-shaft angle (TNSA) were also measured. Results: External rotation impingement occurred between the femoral neck and acetabulum in 83.0% of hips, and between the lesser trochanter and ischial tuberosity in 17.0%. Adduction impingement occurred between the lesser trochanter and ischial tuberosity in 78.6% of hips, and between the femoral neck and acetabulum in 21.4%. Multiple regression revealed that increased femoral/acetabular version predicted earlier external rotation and adduction impingement. Unstandardised betas ranging from −0.39 to −0.64 reflect that each degree of increased femoral/acetabular version individually accounts for a loss of external rotation or adduction of approximately half a degree before impingement ( p < 0.001 for each). Increased TNSA was associated with earlier adduction impingement only (unstandardised beta −0.35, p = 0.005). Discussion: Relative femoral/acetabular anteversion was associated with earlier posterior hip impingement. Coxa valga was associated with earlier adduction impingement, but protective against external rotation impingement. These findings highlight the importance of monitoring correction during femoral/acetabular osteotomies, as overcorrection of retroversion may predispose to earlier posterior impingement.

Study of neck shaft angle of femur in population of Bihar

2017 ◽  
Vol 5 (11) ◽  
pp. 4819
Author(s):  
Rajiv Ranjan Sinha ◽  
Binod Kumar ◽  
Sanjay Kumar ◽  
Ruchi Ratnesh ◽  
Md. Jawed Akhtar ◽  
...  
Keyword(s):  
Hip Joint ◽  
Diagnosis And Treatment ◽  
Coxa Vara ◽  
Normal Range ◽  
Male And Female ◽  
Neck Shaft Angle ◽  
Normal Neck ◽  
Shaft Angle ◽  
Medical Colleges

Background: Neck shaft angle is the angle formed between the long axis of shaft and long axis of neck. Neck shaft angle of femur is an important parameter considering the biomechanics of hip joint. Neck shaft angle gives important information regarding race to which they belong. Normal neck shaft angle is in the range of 1200 -1400. Objective of the study was to find out the neck shaft angle of femur and correlate with the previous study.Methods: present study was conducted on 60 dry femur collected from different medical colleges of Bihar. The neck shaft angle was measured by Goniometer.Results: In this study the neck shaft angle of femur was 130.820, in male neck shaft angle of femur was 130.280 and in females it was 131.420.Conclusions: There is no significance difference between the male and female neck shaft angle. Orthopaedists use the normal range and mean of the neck shaft angle in diagnosis and treatment of the disease of hip. The angle is increased in poliomyelitis, congenital subluxation and dislocation of hip and decreased in congenital coxa vara.

scholarly journals Trochanteric epiphysiodesis in complex treatment of children with hip pathology: analysis of preliminary results

2020 ◽  
Vol 8 (3) ◽  
pp. 249-258
Author(s):  
Ivan Y. Pozdnikin ◽  
Vladimir E. Baskov ◽  
Dmitry B. Barsukov ◽  
Pavel I. Bortulev ◽  
Ekaterina A. Kostomarova ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hip Joint ◽  
Complex Treatment ◽  
Greater Trochanter ◽  
Surgical Interventions ◽  
High Position ◽  
Neck Shaft Angle ◽  
Slowing Down ◽  
Shaft Angle ◽  
Radiological Examinations

Background. The relative overgrowth of the greater trochanter is one of the most common deformities of the proximal femur in association with several disorders of the hip joint. Aim. To analyze the dynamics of proximal femoral growth after trochanteric epiphysiodesis as well as to determine the options for using this method in the complex treatment of children with hip pathology. Materials and methods. We analyzed the data of clinical and radiological examinations and surgical treatment (permanent trochanteric epiphysiodesis with metal fixation) outcomes for 43 (52 joints) patients aged 412 years with a developing high position of the greater trochanter. Results. The surgery enabled slowing down of the growth of the greater trochanter on the side of intervention by (average) 50% (p 0.05), although the values of the neck-shaft angle both on the affected side and the side opposite to it did not change (p 0.05). Conclusion. In moderate disorders of the growth plate of the femoral head epiphysis, trochanteric epiphysiodesis can prevent the progression and, in some cases, correct disturbed ratios of the hip joint, thereby avoiding the need for larger surgical interventions.

scholarly journals Morphometric Study of Proximal end of Femur of Nepalese People

2019 ◽  
Vol 4 (1) ◽  
pp. 9-14
Author(s):  
Rajeev Mukhia ◽  
Phanindra Prasad Poudel ◽  
Chacchu Bhattarai ◽  
Sidharth Timsina
Keyword(s):  
Femoral Neck ◽  
Proximal Femur ◽  
The Body ◽  
Morphometric Study ◽  
Neck Length ◽  
Left Femur ◽  
Head Diameter ◽  
Neck Shaft Angle ◽  
Femur Neck ◽  
Shaft Angle

Introduction: The femur is the largest and strongest bone of the body that forms the skeleton of the thigh. The morphometry of proximal end of femur are variable between different individuals with different Nationality. The aims and objective of the study is to find out the morphometric measurements- Femur Length, Femur head diameter, Femur neck shaft angle, and Femur neck length, breadth and thickness. Methods: A total of 75 femurs of both sex were collected from the Department of Anatomy, MCOMS, Pokhara. The parameters on proximal femur were measured manually with the help of measuring scale, thread, protector and vernier calliper. The collected data were analyzed with Microsoft Excel 2007 software and represented graphically. Results: In the present study, the average femoral length for entire femur was 42±2.81 cm, femoral head diameter was13.05±0.9 cm, femoral neck length was 4.12±0.32 cm, femoral neck breadth was 2.94±0.30 cm, and femoral neck thickness was 2.36±0.42 cm. The femur neck shaft angle of left femur was significantly higher than that of right femur (P-value 0.03). There was no difference between other dimensions of proximal end of right and left femur. Conclusion: The results of the present study show that the dimensions of proximal femur in Nepalese Population are different as compared to other countries population. The knowledge of different dimensions of proximal femur will be important in anthropological and medico-legal practice for sex determination and as well as to radiologists and orthopaedic surgeons for diagnosis and planning of treatment.

Sexual dimorphism by femur neck shaft angle: A radiological study over the population of Bihar

2020 ◽  
Vol 20 (1) ◽  
pp. 131
Author(s):  
Gautam Kumar ◽  
Avinash Kumar ◽  
Amit Patil ◽  
Binay Kumar ◽  
Ashok Kumar Rastogi ◽  
...  
Keyword(s):  
Sexual Dimorphism ◽  
Radiological Study ◽  
Neck Shaft Angle ◽  
Femur Neck ◽  
Shaft Angle

scholarly journals Characteristics of Hip Impingement Syndrome in patients with Multiple Hereditary Exostoses

2020 ◽  
Author(s):  
Yeong-Seub Ahn ◽  
Ho-Seok Oh ◽  
Woo-Jong Kim ◽  
Yu-Seok Kim ◽  
Sung Taek Jung
Keyword(s):  
Alpha Angle ◽  
Impingement Syndrome ◽  
Morphometric Study ◽  
Hip Joints ◽  
Neck Shaft Angle ◽  
Hip Impingement ◽  
Significant Difference ◽  
Shaft Angle ◽  
Coxa Valga ◽  
Symptom Group

Abstract BackgroundsThis study aimed to investigate the characteristic deformities of the hip in multiple hereditary exostoses patients (MHE) and its association with the hip impingement syndrome.Materials and methods Between 2001 and 2019, total 51 patients (102 hips) were evaluated in this study. To assess the morphometry of the hip in patients with MHE, the femoral neck-shaft angle, Sharp’s acetabular angle and center-edge (CE) angle were evaluated. Hip impingement symptoms were classified to femoro-acetabular impingement (FAI) symptom group, ischio-femoral impingement (IFI) symptom group and non-impingement symptom group by comparing the symptoms, clinical signs and imaging studies. Alpha angle was evaluated to investigate the FAI. The minimum ischio-femoral distance was measured to evaluate for IFI using computed-tomographic study. Each measured morphometric study was compared according to gender, location and hip impingement symptom.Results Coxa valga and acetabular dysplasia were common with a mean femoral neck-shaft angle of 144.1°, mean CE angle of 27.9°, and mean Sharp’s acetabular angle of 42.0°. Each of the measured value for assessment of hip deformity was correlated significantly. Morphometric study on gender showed no significant difference except the alpha angle value. In addition, no significant difference was shown on comparison study by location of hip. On hip impingement symptom analysis, FAI symptom and IFI symptom were confirmed in 14 hip joints and 18 hip joints, respectively. The number of hip joints with IFI symptom was higher than those with FAI symptom in this study. Furthermore, both the FAI and IFI symptom group showed significant differences from the non-symptom group in the morphometric study. In addition, the minimum ischio-femoral distance was significantly decreased in the IFI symptom group, which seems to be associated with coxa valga deformity.Conclusion The results suggest that the characteristic deformities that occur in the hip joint of MHE patients affect the appearance of impingement syndrome. Therefore, it is necessary to carefully evaluate the characteristic deformities of the hip joint in patients with MHE and to set up the treatment modality accordingly.Level of Evidence : Level III, retrospective comparative study

scholarly journals Hereditary Multiple Exostoses of the Hip

2009 ◽  
Vol 17 (2) ◽  
pp. 161-165 ◽  
Author(s):  
Tarek AM El-Fiky ◽  
Wang Chow ◽  
Yun Hoi Li ◽  
Michael To
Keyword(s):  
Femoral Neck ◽  
Degenerative Changes ◽  
Hereditary Multiple Exostoses ◽  
Neck Shaft Angle ◽  
Edge Angle ◽  
Centre Edge Angle ◽  
Multiple Exostoses ◽  
Migration Percentage ◽  
Shaft Angle ◽  
Coxa Valga

Purpose. To assess the radiographic features of 36 hips with hereditary multiple exostoses (HME). Methods. Hip parameters of 12 males and 6 females (36 hips) aged 2 to 28 years with HME were assessed using anteroposterior radiographs. The recorded features included the sites of osteochondromas, the femoral head/neck ratio, the Reimer's migration percentage, Sharp's acetabular angle, the centre edge angle, the femoral neck-shaft angle, and degenerative changes. Results. 15 of the 18 patients were asymptomatic; 3 complained of pain (2 underwent excision or bone biopsy); no lesion was malignant. Osteochondromas were most commonly located in the femur followed by the ilium; only one was intra-articular. 32 hips had coxa valga; 26 had an abnormal Reimer's migration percentage; 17 had an abnormal Sharp's acetabular angle; 12 had an abnormal centre edge angle; 32 had an abnormal femoral neck-shaft angle; and 6 had degenerative changes. Acetabular and femoral dysplasia as well as subluxation are common in patients with HME. Conclusion. Borderline subluxated hips and those with marked coxa valga and/or acetabular dysplasia should be closely monitored to determine the need for surgery in the future. Subluxated hips should be operated on early, particularly in children and symptomatic adults.

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