General anatomy and image reconstruction analysis of the proximal femoral trabecular structures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHU Xiaozhong ¹ ,  MEI Jiong ² , NI Ming ³ , JIA Guangyao ¹ , LIU Shiwei ¹ , DAI Yahui ⁴ , ZHANG Yingqi ¹

1. Department of Orthopedics, Tongji Hospital of Tongji University, Shanghai, 200065, P.R.China;
2. Department of Orthopedics, the Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233, P.R.China;
3. Department of Orthopedics, Pudong New Area Peoples’ Hospital, Shanghai, 201299, P.R.China;
4. Department of Orthopedics, Songjiang Central Hospital, Shanghai, 201605, P.R.China;

Corresponding?author：

MEI Jiong, Email: meijiong@163.com

Keywords：

Proximal femur; trabecular bone; digital model; general anatomy

DOI：

10.7507/1002-1892.201904128

Video：

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Objective To investigate the three-dimensional structure of proximal femoral trabeculae, analyze the formation mechanism, and explore its relationship with the occurrence and treatment of proximal femoral fractures.Methods Six cadaver adult femur specimens were harvested and the gross specimens containing both trabecular system and cortical bone were established by hand scraping. All samples were scanned by micro-CT and the CT images were input into Mimics18.0 software to establish the digital proximal femoral model containing trabecular structure. The spatial distribution of trabecular system was observed, and the relations between trabecular bone and the proximal femur surface and related anatomical landmarks were analyzed in digital models.Results The gross specimen and digital models of trabecular system were successfully established. The trabecular system of proximal femur could be divided into two groups: the horizontal and vertical trabecular. The horizontal trabecular arose from the base of greater trochanter, gone along the direction of femoral neck, and terminated at the center of femoral head. The vertical trabecular began from the base of lesser trochanter and femoral calcar, gone radically upward, and reached the femoral head. The average distance of the horizontal trabecular to the greater trochanter was 22.66 mm (range, 17.3-26.8 mm). In the femoral head, the horizontal trabecula and the vertical trabecula were fused into a kind of sphere, and the distances from the horizontal trabecula to the surface of the femoral head vary in different sections. The average distance of trabecular ball to the femoral head surface was 6.88 mm (range, 6.3-7.2 mm) in sagittal plane, 6.32 mm (range, 5.8-7.6 mm) in coronal plane, and 6.30 mm (range, 5.6-6.3 mm) in cross section. The vertical and horizontal trabeculae intersect obliquely, and the average angle of horizontal trabecular and vertical one was 140.67° (range, 129-150°).Conclusion The trabecular system exhibits a unique spatial configuration, which is the main internal support of proximal femur. Restoration of the integrity of trabecular structure is the important goal of proximal femoral fractures.

Citation： ZHU Xiaozhong, MEI Jiong, NI Ming, JIA Guangyao, LIU Shiwei, DAI Yahui, ZHANG Yingqi. General anatomy and image reconstruction analysis of the proximal femoral trabecular structures. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(10): 1254-1259. doi: 10.7507/1002-1892.201904128 Copy

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2.	Tobin WJ. The internal architecture of the femur and its clinical significance; the upper end. J Bone Joint Surg (Am), 1955, 37-A(1): 57-72.
3.	Farkas A, Wilson MJ, Hayner JC. An anatomical study of the mechanics, pathology, and healing of fracture of the femoral neck; a preliminary report. J Bone Joint Surg (Am), 1948, 30A(1): 53-59.
4.	Toogood PA, Skalak A, Cooperman DR. Proximal femoral anatomy in the normal human population. Clin Orthop Relat Res, 2009, 467(4): 876-885.
5.	Hammer A. The structure of the femoral neck: A physical dissection with emphasis on the internal trabecular system. Ann Anat, 2010, 192(3): 168-177.
6.	Verhulp E, van Rietbergen B, Huiskes R. Comparison of micro-level and continuum-level voxel models of the proximal femur. J Biomech, 2006, 39(16): 2951-2957.
7.	Dixon AF. The architecture of the cancellous tissue forming the upper end of the femur. J Anat Physiol, 1910, 44(Pt 3): 223-230.
8.	劉伯亮. 髖關節生物力學及其臨床應用. 中國中醫骨傷科雜志, 1990, 8(3): 55-57, 66.
9.	Collinge CA, Mir H, Reddix R. Fracture morphology of high shear angle " vertical” femoral neck fractures in young adult patients. J Orthop Trauma, 2014, 28(5): 270-275.
10.	Poole KE, Treece GM, Mayhew PM, et al. Cortical thickness mapping to identify focal osteoporosis in patients with hip fracture. PLoS One, 2012, 7(6): e38466.
11.	Johannesdottir F, Poole KE, Reeve J, et al. Distribution of cortical bone in the femoral neck and hip fracture: a prospective case-control analysis of 143 incident hip fractures; the AGES-REYKJAVIK Study. Bone, 2011, 48(6): 1268-1276.
12.	Lindequist S. Cortical screw support in femoral neck fractures. A radiographic analysis of 87 fractures with a new mensuration technique. Acta Orthop Scand, 1993, 64(3): 289-293.
13.	丁濤, 張保焜, 田少奇, 等. 老年髖部骨折手術方法的選擇原則及應用現狀. 中國修復重建外科雜志, 2018, 32(11): 1435-1440.
14.	Chang SM, Zhang YQ, Ma Z, et al. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg, 2015, 135(6): 811-818.
15.	馬信龍, 李海濤, 馬劍雄, 等. 股骨近端主張力骨小梁生物力學特性. 國際生物醫學工程雜志, 2011, 34(5): 270-274.
16.	Gotfried Y. The lateral trochanteric wall: a key element in the reconstruction of unstable pertrochanteric hip fractures. Clin Orthop Relat Res, 2004, (425): 82-86.
17.	Palm H, Jacobsen S, Sonne-Holm S, et al. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg (Am), 2007, 89(3): 470-475.
18.	武建超, 師政偉, 李吉鵬, 等. 股骨粗隆間骨折外側壁損傷的研究進展. 中國修復重建外科雜志, 2018, 32(12): 1605-1610.

1. 常文舉, 丁海. 股骨近端解剖與生物力學研究進展. 醫用生物力學, 2016, 31(2): 188-192.
2. Tobin WJ. The internal architecture of the femur and its clinical significance; the upper end. J Bone Joint Surg (Am), 1955, 37-A(1): 57-72.
3. Farkas A, Wilson MJ, Hayner JC. An anatomical study of the mechanics, pathology, and healing of fracture of the femoral neck; a preliminary report. J Bone Joint Surg (Am), 1948, 30A(1): 53-59.
4. Toogood PA, Skalak A, Cooperman DR. Proximal femoral anatomy in the normal human population. Clin Orthop Relat Res, 2009, 467(4): 876-885.
5. Hammer A. The structure of the femoral neck: A physical dissection with emphasis on the internal trabecular system. Ann Anat, 2010, 192(3): 168-177.
6. Verhulp E, van Rietbergen B, Huiskes R. Comparison of micro-level and continuum-level voxel models of the proximal femur. J Biomech, 2006, 39(16): 2951-2957.
7. Dixon AF. The architecture of the cancellous tissue forming the upper end of the femur. J Anat Physiol, 1910, 44(Pt 3): 223-230.
8. 劉伯亮. 髖關節生物力學及其臨床應用. 中國中醫骨傷科雜志, 1990, 8(3): 55-57, 66.
9. Collinge CA, Mir H, Reddix R. Fracture morphology of high shear angle " vertical” femoral neck fractures in young adult patients. J Orthop Trauma, 2014, 28(5): 270-275.
10. Poole KE, Treece GM, Mayhew PM, et al. Cortical thickness mapping to identify focal osteoporosis in patients with hip fracture. PLoS One, 2012, 7(6): e38466.
11. Johannesdottir F, Poole KE, Reeve J, et al. Distribution of cortical bone in the femoral neck and hip fracture: a prospective case-control analysis of 143 incident hip fractures; the AGES-REYKJAVIK Study. Bone, 2011, 48(6): 1268-1276.
12. Lindequist S. Cortical screw support in femoral neck fractures. A radiographic analysis of 87 fractures with a new mensuration technique. Acta Orthop Scand, 1993, 64(3): 289-293.
13. 丁濤, 張保焜, 田少奇, 等. 老年髖部骨折手術方法的選擇原則及應用現狀. 中國修復重建外科雜志, 2018, 32(11): 1435-1440.
14. Chang SM, Zhang YQ, Ma Z, et al. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg, 2015, 135(6): 811-818.
15. 馬信龍, 李海濤, 馬劍雄, 等. 股骨近端主張力骨小梁生物力學特性. 國際生物醫學工程雜志, 2011, 34(5): 270-274.
16. Gotfried Y. The lateral trochanteric wall: a key element in the reconstruction of unstable pertrochanteric hip fractures. Clin Orthop Relat Res, 2004, (425): 82-86.
17. Palm H, Jacobsen S, Sonne-Holm S, et al. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg (Am), 2007, 89(3): 470-475.
18. 武建超, 師政偉, 李吉鵬, 等. 股骨粗隆間骨折外側壁損傷的研究進展. 中國修復重建外科雜志, 2018, 32(12): 1605-1610.

Chinese Journal of Reparative and Reconstructive Surgery

General anatomy and image reconstruction analysis of the proximal femoral trabecular structures

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