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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 15  |  Issue : 1  |  Page : 88-90

Morphometry of neck-shaft angle in dried femora of the central Indian population and its clinical implications


1 Department of Anatomy, Pt. J.N.M Medical College, Raipur, Chhattisgarh, India
2 Department of Community Medicine, Pt. J.N.M Medical College, Raipur, Chhattisgarh, India

Date of Submission28-Jul-2019
Date of Decision30-Oct-2019
Date of Acceptance10-Nov-2019
Date of Web Publication13-Oct-2020

Correspondence Address:
Dr. Diwakar Dhurandhar
Department of Anatomy, Pt. J.N.M Medical College, Raipur, Chhattisgarh - 492 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_114_19

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  Abstract 


Introduction: The neck-shaft angle (NSA) is the angle formed by the neck axis and the long axis of the femur. Knowledge of this angle facilitates the preoperative planning of osteotomy, arthroplasty, or fracture fixation. It also helps in designing suitable implants with more accurate angulations of the femur neck. Hence, the present study aimed at giving ready reference data to clinicians of the femoral NSA in the Central Indian population. Materials and Methods: A total of 153 dried femora, 78 of the right side and 75 of the left side of unknown sex and age were obtained from the Department of Anatomy, Pt. J. N. M Medical College, Raipur. NSAs were measures and statistically correlated with laterality using “Independent t-test,” P value was obtained. Results: Mean NSA of right-sided femora was 133.88°C ± 15.04°C (range from 103°C to 160°C) and of left-sided femora was 132.81°C ± 15.81°C (Range from 106°C to 160°C). No significant difference in values of NSA was found in the right and left-sided femora. Conclusion: The outcome of this study can be used as a ready reference data by orthopedicians, physiotherapists, and prosthesis designers for the central Indian population. Knowledge of normal value would also be helpful in making the clinical diagnosis of femur neck fractures and coxa vera.

Keywords: Central Indian population, femur, femur neck fracture, neck-shaft angle


How to cite this article:
Agrawal J, Dhurandhar D, Chandrakar T. Morphometry of neck-shaft angle in dried femora of the central Indian population and its clinical implications. J Datta Meghe Inst Med Sci Univ 2020;15:88-90

How to cite this URL:
Agrawal J, Dhurandhar D, Chandrakar T. Morphometry of neck-shaft angle in dried femora of the central Indian population and its clinical implications. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2020 Oct 23];15:88-90. Available from: http://www.journaldmims.com/text.asp?2020/15/1/88/297961




  Introduction Top


The femoral neck-shaft angle (NSA) is the angle formed by the neck axis and the long axis of the femur. The neck axis is the line drawn from the center of the femoral head to the center of the femoral neck at the narrowest part of the neck. The long axis of the femur is defined as the line drawn from the middle of the femoral condyles to the middle of the greater trochanter in two planes.[1] The mean NSA in adults is 135°C and ranges from 125° to 132° as quoted in various standard textbooks of anatomy and orthopedics.[2],[3] There is physiological valgus in infancy after which there is progressive decrease in the angle with no change after attainment of full growth. The normal range of NSA has been deduced by data obtained from the population of Western countries. Furthermore, there is a wide variation in femoral NSA observed with race, gender, side, and age. The NSA is one of the main diagnostic criterions that clinicians use to detect the probability of femoral neck fracture in a subject as coxa valga (More than 140°C NSA) is associated with a femoral neck fracture. NSA is important in the preoperative planning of osteotomy, arthroplasty, or fracture fixation.[4] It also helps in designing suitable implants with more accurate angulations of the femur neck.[5] Racial variations in anthropometric parameters exist because of genetic and various socio-cultural practices. Peoples involved in greater walking or physical work are more likely to have higher NSA. Since the data on the morphometry of femoral NSA on dry adult femora in central Indian population are less, the present study was undertaken with the following objectives[Figure 1]:
Figure 1: Photograph showing the method to assess femur neck-shaft angle using goniometry of dried bones. Neck-shaft angle is the angle between the neck axis and the long axis of the femur

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  1. To compile a database of normal femoral NSA in healthy adults among the central Indian population
  2. To statistically examine if femoral NSA was significantly associated with laterality of the bone.



  Materials and Methods Top


A total of 153 dry femora of unknown age and sex available in the anatomy department were studied, of which 78 belonged to the right side and 75 to the left side. All adult dry femora without any external abnormality were included in the study, whereas femora having any gross deformities or damage were excluded from the study. The measurement of NSA was done by a goniometer on dried femora which is considered the most accurate method to assess the morphometry of a bone. The measurement of NSA was taken twice by an observer to rule out intra-observer bias. The measurement once taken by an observer was repeated by other authors to negate any inter-observer variations. The mean NSA of left femora was compared with that of right femora by applying independent “t”-test. P < 0.05 was considered statistically significant. Data were entered into MS Excel spreadsheet. Descriptive and analytical interpretation of the data was done by the SPSS version 20.0 (Chicago, Illinois, USA).

Ethical clearance

Ethical clearance was obtained from the Institutional Ethical Committee of JNM, Medical College, Raipur, Chhatisgarh on 5th Nov 2019. With ethical clearance no JNM/EC/2019-20/45.


  Results Top


After excluding the deformed and damaged femora, the total number of femora procured was 153. Seventy-eight were of the right side and 75 were of the left side. As shown in [Table 1], the mean value of NSA of left femora was 133.88 ± 15.05, whereas that of the right side was 132.81 ± 15.81. No statistically significant difference (P = 0.668) was observed when mean NSA of right femora was compared with that of left femora using independent “t”-test.
Table 1: Findings of the present study

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  Discussion Top


NSA assumes huge clinical significance as it is known to be associated with various pathologies. Genu varum is known to be associated with coxa valga (NSA >140) leading to early degeneration of medial compartment of the knee; whereas coxa vara (NSA <120) can have congenital, metabolic (Paget's disease), neglected trauma, and developmental (osteogenesis imperfecta) or postperthes as its etiology.[6]

Various methods have been suggested to evaluate NSA such as X-rays, Computed tomography, magnetic resonance imaging, and dried bone measurements. As goniometer for measuring the NSA of dried femora is considered as the best available tool and requires little infrastructure, hence it was preferred modality for use in the present study.

Comparison of the findings of the present study was compared with those of previous foreign and Indian literatures are shown in [Table 2] and [Table 3], respectively. The difference in the values of NSA found in the present study was due to the different study populations as well as the different methods employed for the assessment of NSA. The mean NSA found in the present study can be used as a baseline ready reference data for designing appropriate prosthesis tailor made for the central Indian population as there are wide variations in the values of NSA among different populations as found in previous studies.
Table 2: Comparision with previous foreign studies

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Table 3: Comparison with previous Indian studies

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  Conclusion Top


Previous literatures have reported significantly more NSA of left-sided femur than right-sided which could be due to particular limb dominance.[16],[17] The present study found no significant relation of mean femur NSA with laterality.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Reikeras O, Hoiseth A, Reigstad A, Fonstelien E. Femoral neck angles. Acta orthop. Scand. 1982;53:775-79.  Back to cited text no. 1
    
2.
Standring S, Borley NR, Collins P, Crossman AR, Gatzoulis MA, Healy JC et al. editors. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 40th ed. UK: Elsevier Ltd; 2008. p. 1412-15.  Back to cited text no. 2
    
3.
Samaha AA, Ivanov AV, Haddad JJ, Kolesnik AI, Baydoun S, Yashina IN,et al. Biomechanical and system analysis of the human femoral bone: Correlation and anatomical approach. J Orthop Surg Res 2007;2:8.  Back to cited text no. 3
    
4.
Kay RM, Jaki KA, Skaggs DL. The effect of femoral rotation on the projected femoral neck-shaft angle. J Pediatr Orthop 2000;20:736-9.  Back to cited text no. 4
    
5.
Kate BR, Robert SL. The angle of femoral torsion. J Anat Soc India 1963;12:8-11.  Back to cited text no. 5
    
6.
Sharma V, Kumar K, Kalia V, Soni PK. Evaluation of femoral neck-shaft angle in sub Himalayan population of North West India using digital radiography and dry bone measurements. J Sci Soc 2018;45:3-7.  Back to cited text no. 6
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7.
Lequesne M, Malghem J, Dion E. The normal hip joint space: Variations in width, shape, and architecture on 223 pelvic radiographs. Ann Rheum Dis 2004;63:1145-51.  Back to cited text no. 7
    
8.
Umebese PF, Adeyekun A, Moin M. Radiological assessment of femoral neck-shaft and anteversion angles in adult Nigerian HIPS. Niger Postgrad Med J 2005;12:106-9.  Back to cited text no. 8
    
9.
Toogood PA, Skalak A, Cooperman DR. Proximal femoral anatomy in the normal human population. Clin Orthop Relat Res 2009;467:876-85.  Back to cited text no. 9
    
10.
Atkinson HD, Johal KS, Willis-Owen C, Zadow S, Oakeshott RD. Differences in hip morphology between the sexes in patients undergoing hip resurfacing. J Orthop Surg Res 2010;5:76.  Back to cited text no. 10
    
11.
Inam M, Satar A, Arif M, Shabir M. Proximal femoral geometry of Khyber Pakhtoonkhwa (KPK) population. J Pak Orthop Assoc 2011;23.  Back to cited text no. 11
    
12.
Siwach RC, Dahiya S. Anthropometric study of proximal femur geometry and its clinical application. Indian J Orthop. 2003;37:247-51.  Back to cited text no. 12
    
13.
Saikia KC, Bhuyan S, Rongphar R. Anthropometric study of the hip joint in North Eastern region population with computed topography scan. Indian J Orthop. 2008;42:260-6.  Back to cited text no. 13
    
14.
Deshmukh TR, Kuthe AM, Ingole DS, Takre SB. Prediction of femur bone geometry using anthropometric data of Indian population: A numerical approach. J. Med Sci 2010;10:12-8.  Back to cited text no. 14
    
15.
Amith R, Beena N, Vinay KV. Morphometry of femoral neck Shaft angle in dry femora of south India by computer assisted image analysis method. Int J anat res 2017;5:3753-58.  Back to cited text no. 15
    
16.
Gilligan I, Chandraphak S, Mahakkanukrauh P. Femoral neck-shaft angle in humans: Variation relating to climate, clothing, lifestyle, sex, age and side. J Anat 2013;223:133-51.  Back to cited text no. 16
    
17.
Da Silva VJ, Oda JY, Sant'ana DM. Anatomical aspects of the proximal femur of adults Brazilians. Int J Morphol 2003;21:303-8.  Back to cited text no. 17
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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Abstract
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