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Stetzelberger VM, Nishimura H, Hollenbeck JFM, Garcia A, Brown JR, Schwab JM, Philippon MJ, Tannast M. How Strong Is the Ligamentum Teres of the Hip? A Biomechanical Analysis. Clin Orthop Relat Res 2024; 482:1685-1695. [PMID: 39158387 PMCID: PMC11343551 DOI: 10.1097/corr.0000000000003124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 04/22/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Intraarticular hip pain represents a substantial clinical challenge, with recent studies implicating lesions in the ligamentum teres as potential contributors. Even more so, damage to the ligamentum teres is particularly prevalent among young patients undergoing joint-preserving interventions. Although several studies have investigated the biomechanical attributes of the ligamentum teres, inconsistencies in reported findings and reliance on cadaveric or animal models have raised concerns regarding the extrapolation of results to clinical practice. Furthermore, there is a lack of research examining ligamentum teres biomechanics specifically within the relevant patient cohort-individuals who benefit from joint-preserving surgical interventions. QUESTIONS/PURPOSES We sought (1) to determine the biomechanical properties (ultimate load to failure, tensile strength, stiffness, and elastic modulus) of fresh-frozen ligaments from patients undergoing surgical hip dislocation, and (2) to identify patient-specific factors that are associated with them. METHODS This was an institutional review board-approved study on intraoperatively harvested ligamentum teres from 74 consecutive patients undergoing surgical hip dislocation for joint preservation (August 2021 to September 2022). After the exclusion of patients with previous surgery, posttraumatic deformities, avascular necrosis, slipped capital femoral epiphysis, and Perthes disease, 31 ligaments from 31 patients were analyzed. The mean age of the study group was 27 ± 8 years, and 61% (19) of participants were male. The main indication for surgery was femoroacetabular impingement. Standardized AP pelvic and axial radiographs and CT scans were performed in all patients for better radiological description of the population and to identify associated radiological factors. The ligament was thoroughly transected at its origin on the fossa acetabuli and at the insertion area on the fovea capitis and stored at -20°C until utilization. Specimens were mounted to a materials testing machine via custom clamps that minimized slippage and the likelihood of failure at the clamp. Force-displacement and stress-strain curves were generated. Ultimate failure load (N), tensile strength (MPa), stiffness (N/mm), and elastic modulus (MPa) were determined. Using a multivariate regression analysis and a subgroup analysis, we tested demographic, degenerative, and radiographic factors as potential associated factors. RESULTS The ligamentum teres demonstrated an ultimate load to failure of 126 ± 92 N, and the tensile strength was 1 ± 1 MPa. The ligaments exhibited a stiffness of 24 ± 15 N/mm and an elastic modulus of 7 ± 5 MPa. After controlling for potential confounding variables like age, fossa/fovea degeneration, and acetabular/femoral morphologies, we found that female sex was an independent factor for higher tensile strength, stiffness, and elastic modulus. Excessive femoral version was independently associated with lower load to failure (HR 122 [95% CI 47 to 197]) and stiffness (HR 15 [95% CI 2 to 27]). Damage to the acetabular fossa was associated with reduced load to failure (HR -93 [95% CI -159 to -27]). CONCLUSION Overall, the ligamentum teres is a relatively weak ligament. Sex, degeneration, and excessive femoral version are influencing factors on strength of the ligamentum teres. The ligamentum teres exhibits lower strength compared with other joint-stabilizing ligaments, which calls into question its overall contribution to hip stability. CLINICAL RELEVANCE Young patients undergoing hip-preserving surgery are the population at risk for ligamentum teres lesions. Baseline values for load to failure, tensile strength, elastic modulus, and stiffness are needed to better understand those lesions in this cohort of interest.
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Affiliation(s)
- Vera M. Stetzelberger
- Department of Orthopaedic Surgery and Traumatology, HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
- Steadman Philippon Research Institute, The Steadman Clinic, Vail, CO, USA
| | - Haruki Nishimura
- Steadman Philippon Research Institute, The Steadman Clinic, Vail, CO, USA
| | | | - Alexander Garcia
- Steadman Philippon Research Institute, The Steadman Clinic, Vail, CO, USA
| | - Justin R. Brown
- Steadman Philippon Research Institute, The Steadman Clinic, Vail, CO, USA
| | - Joseph M. Schwab
- Department of Orthopaedic Surgery and Traumatology, HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Marc J. Philippon
- Steadman Philippon Research Institute, The Steadman Clinic, Vail, CO, USA
| | - Moritz Tannast
- Department of Orthopaedic Surgery and Traumatology, HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
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Muacevic A, Adler JR. Morphometric Study of Proximal End of the Fully Ossified Human Femur: A Cross-Sectional Study. Cureus 2022; 14:e29188. [PMID: 36507110 PMCID: PMC9731551 DOI: 10.7759/cureus.29188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/15/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction The femur or thigh bone is the longest and strongest bone in the body. It provides skeletal support for the thigh. Weight-bearing and stability of gait are the essential functions of the femur. Aim To construct the baseline data on different dimensions of the proximal end of the fully ossified human femur and determine any significant differences between the right and left femora. Objective To measure the total length of the femur, proximal breadth, vertical diameter of the head, transverse diameter of the head, the circumference of the head, the vertical diameter of the neck, the transverse diameter of the neck, the circumference of the neck, anterior length of the neck, neck-shaft angle, length of the intertrochanteric crest and correlate the different dimensions of the proximal end with the total length of the femur. Result The variables of the proximal end of the left femora like proximal breadth (PB), the circumference of the head (CH), vertical diameter (VDN), the transverse diameter of the neck (TDN), the circumference of the neck (CN), neck length (NL), neck-shaft angle (NSA), length of an intertrochanteric crest (LITC) showed highly significant positive linear correlation with the length of the femur. Circumference of the neck showed the highest degree of correlation with the length of the femur (correlation coefficient 0.839). Conclusion The statistically significant difference between right and left femora was found between the length of the femur, the vertical diameter of the neck of the femur, the transverse diameter of the neck of the femur, and the length of the intertrochanteric crest of the femur. The mean value of proximal breadth, the vertical diameter of the head, the transverse diameter of the head, the circumference of the head, the circumference of the neck, anterior length of the neck of the femur, and neck-shaft angle of the right and left femora to have no statistically significant differences.
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Abstract
As our understanding of hip function and disease improves, it is evident that the acetabular fossa has received little attention, despite it comprising over half of the acetabulum’s surface area and showing the first signs of degeneration. The fossa’s function is expected to be more than augmenting static stability with the ligamentum teres and being a templating landmark in arthroplasty. Indeed, the fossa, which is almost mature at 16 weeks of intrauterine development, plays a key role in hip development, enabling its nutrition through vascularization and synovial fluid, as well as the influx of chondrogenic stem/progenitor cells that build articular cartilage. The pulvinar, a fibrofatty tissue in the fossa, has the same developmental origin as the synovium and articular cartilage and is a biologically active area. Its unique anatomy allows for homogeneous distribution of the axial loads into the joint. It is composed of intra-articular adipose tissue (IAAT), which has adipocytes, fibroblasts, leucocytes, and abundant mast cells, which participate in the inflammatory cascade after an insult to the joint. Hence, the fossa and pulvinar should be considered in decision-making and surgical outcomes in hip preservation surgery, not only for their size, shape, and extent, but also for their biological capacity as a source of cytokines, immune cells, and chondrogenic stem cells. Cite this article: Bone Joint Res 2020;9(12):857–869.
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Affiliation(s)
- Pablo A Slullitel
- 'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Daniel Coutu
- Regenerative Medicine Program, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Martin A Buttaro
- 'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Paul Edgar Beaule
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
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McGraw J, Beaver C, Douthit C, Diab M. Preoperative Angiography Can Guide Treatment of Post-Femoral Neck Fracture Capital Femoral Physeal Separation and Displacement: A Case Report. JBJS Case Connect 2020; 10:e0508. [PMID: 32649106 DOI: 10.2106/jbjs.cc.19.00508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 13-year, 6-month-old boy sustained a Delbet type III femoral neck fracture with postoperative femoral head avascular necrosis (AVN) and subsequent capital femoral physeal separation (CFPS). Preoperative angiography revealed a patent artery of the ligamentum teres to the femoral head epiphysis, allowing our patient to undergo a modified Dunn procedure to maintain this artery and preserve his native hip. CONCLUSION Preoperative angiography allows for real-time identification of femoral head epiphyseal blood supply in patients with femoral head AVN complicated by CFPS and guides surgical treatment for hip preservation.
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Affiliation(s)
- Jessica McGraw
- 1Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
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Mei J, Quan K, Wang H, Dai Y, Zhang F, Ni M. Total cross-sectional area of the femoral neck nutrient foramina measured to assess arterial vascular beds in the femoral head. J Orthop Surg Res 2019; 14:439. [PMID: 31836021 PMCID: PMC6911289 DOI: 10.1186/s13018-019-1480-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background A detailed understanding of the blood supply to the femoral head is required to plan the surgery in the femoral neck and head area. However, information about the blood vessel networks in the femoral head is inadequate. Methods The surface of the femoral neck of 100 dry cadaveric adult femur specimens was scanned using a 3D scanner. The scanning distance was 200 mm, precision 0.01 mm, and measuring point 0.04 mm. The images were acquired at a resolution of 1,310,000 pixels. Digital imaging data were recorded from the femoral neck surface. The diameters of the nutrient foramina of the superior, inferior and anterior retinacular arteries, and the ligamentum teres arteries were determined and divided into five groups. Results The mean cumulative cross-sectional area of the nutrient foramina was as follows: canals of the superior, inferior, anterior, and ligamentum retinacular arteries were 15.59 mm2, 3.63 mm2, 4.32 mm2, and 1.58 mm2, respectively. Next, we analyzed the canals of the superior, inferior, anterior and ligamentum retinacular arteries, respectively, via 3D scanner. We found that the canals of the superior retinacular arteries appear to supply more blood to the femoral head than the canals of the other three types of arteries. Conclusions Our results demonstrated that surgeries of the femoral neck and femoral head will be improved with prior 3D scanning and lead to better outcomes in surgeries involving the hip area.
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Affiliation(s)
- Jiong Mei
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
| | - Kun Quan
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Hua Wang
- Tongji University School of Medicine, Shanghai, 200092, China
| | - Yahui Dai
- Department of Orthopedics, Songjiang District Central Hospital, Shanghai, 201600, China
| | - Fangfang Zhang
- Tongji University School of Medicine, Shanghai, 200092, China
| | - Ming Ni
- Department of Orthopaedics, Pudong New Area Peoples' Hospital affiliated to Shanghai Health University, Shanghai, 201299, China
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Abstract
Background The ligamentum teres (LT) continues to be a structure of debate and interest. Previously thought of as a vestigial structure, an awareness of LT pathology and its potential importance has increased with the expansion of hip arthroscopy. Purpose To provide a comprehensive literature synthesis on the LT and provide clinicians with the most current research regarding the LT and its anatomical features, functional relevance, prevalence of injury, risk factors for injury, clinical presentation, and treatment for pathology. Methods A systematic literature search was conducted using Medline/PubMed, CINAHL/EBSCO, and Cochrane/Wiley databases/platforms using the following search terms: ligament, ligament teres, hip, femur, femoral head, round ligament. Results This search yielded 1284 articles of which 44 met the inclusion/exclusion criteria and contributed to this manuscript. Information on the LT was summarized into the following areas: anatomy, function, injury prevalence, risk factors, mechanism of injury, duration of symptoms, clinical presentation (symptoms, range of motion, functional limitations, special testing), imaging, and treatment. Conclusions The results of this review supported the following: 1) the LT has a function in restraining hip rotation range of motion; 2) the prevalence of LT pathology in any given population may be largely dependent on the severity of bony deformity (either femoroacetabular impingement(FAI) or dyplasia) and activity level; 3) older age and acetabular bony deformity (either FAI or dyplasia) are risk factors for generalized LT pathology; 4) unique signs and symptoms are difficult to identify because LT pathology rarely occurs in isolation and is likely the end-stage consequence of other hip pathology; 5) the presence of LT pathology may negatively affect an individual's ability to function; and 6) surgical debridement is recommend for pain relief of partial LT tears with reconstruction possible for complete LT tears when complaints of instability are noted. Level of Evidence 3.
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Ceynowa M, Rocławski M, Pankowski R, Mazurek T. The position and morphometry of the fovea capitis femoris in computed tomography of the hip. Surg Radiol Anat 2018; 41:101-107. [PMID: 30171297 PMCID: PMC6510828 DOI: 10.1007/s00276-018-2097-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/27/2018] [Indexed: 11/30/2022]
Abstract
Purpose The position of the fovea of the femoral head is usually considered to be inferior or inferoposterior, despite the fact that few detailed anatomical studies have been performed. This study was performed to assess the position of the fovea in computed tomography and its correlation with standard radiographic measures of the proximal femur. Methods Computed tomography scans of the hip of 107 patients (54 women and 53 men) were evaluated. The semi-coronal and transverse views were used to assess the femoral neck–shaft angle and the neck version, as well as the size and position of the fovea in relation with the femoral neck axis and the size of the head. Results The fovea was always located inferior to the neck axis in the semi-coronal plane. In the transverse plane, the fovea was always slightly posterior to the femoral neck axis, as approximately ¾ of its diameter was posterior to the axis. The position was unrelated to the neck–shaft axis and the neck–trochanter minor angle. There were no differences in the position between men and women; however, in women, the fovea is slightly larger than in men when related to the femoral head size. Conclusion The femoral neck axis in the transverse plane always crosses the anterior aspect of the fovea. Its position is unrelated to the angular geometry of the proximal femur, but related to the femoral head size. It is found to be relatively larger in women.
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Affiliation(s)
- Marcin Ceynowa
- Department of Orthopedic Surgery, Medical University of Gdańsk, ul. Nowe Ogrody 1-6, 80-803, Gdańsk, Poland.
| | - Marek Rocławski
- Department of Orthopedic Surgery, Medical University of Gdańsk, ul. Nowe Ogrody 1-6, 80-803, Gdańsk, Poland
| | - Rafał Pankowski
- Department of Orthopedic Surgery, Medical University of Gdańsk, ul. Nowe Ogrody 1-6, 80-803, Gdańsk, Poland
| | - Tomasz Mazurek
- Department of Orthopedic Surgery, Medical University of Gdańsk, ul. Nowe Ogrody 1-6, 80-803, Gdańsk, Poland
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Atta H, Mourad AF, Elmorshidy E, Mahran M. Secondary signs of ligamentum teres injuries. A non-arthrographic and arthrographic MR findings correlation. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Muchlinski MN, Hammond AS, Deane AS, Purcell M, Hemingway HW, Hantke G, Pastor F, Garrosa M, Hartstone-Rose A. The ligamentum teres femoris in orangutans. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2018; 167:684-690. [PMID: 30132799 DOI: 10.1002/ajpa.23644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 04/26/2018] [Accepted: 06/09/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES It is widely viewed that orangutans lack a ligamentum teres femoris (LTF) inserting on the femoral head because orangutans lack a distinct fovea capitis. Orangutans employ acrobatic quadrumanous clambering that requires a high level of hip joint mobility, and the absence of an LTF is believed to be an adaptation to increase hip mobility. However, there are conflicting reports in the literature about whether there may be a different LTF configuration in orangutans, perhaps with a ligament inserting on the femoral neck instead. Here we perform a dissection-based study of orangutan hip joints, assess the soft tissue and hard tissue correlates of the orangutan LTF, and histologically examination the LTF to evaluate whether it is homologous to that found in other hominoids. MATERIALS AND METHODS The hip joints from six orangutans were dissected. In the two orangutans with an LTF passing to the femoral head, the LTF was assessed histologically. Skeletonized femora (n=56) in osteological repositories were examined for evidence of a foveal pit. RESULTS We observed an LTF in two of the three infant orangutans but not in the sub-adult or adult specimens. Histological examination of the infant LTF shows a distinct artery coursing through the LTF to the head of the femur. One percent of orangutan femora present with a foveal scar, but no pit, on the femoral head. DISCUSSION Despite being absent in adults, the LTF is present in at least some orangutans during infancy. We suggest that the LTF maintains a role in blood supply to the femoral head early in life. Because the LTF can limit hip mobility, this may explain why the LTF may be lost as an orangutan ages and gains locomotor independence. These findings enhance our understanding of orangutan hip morphology and underscore the need for future soft tissue investigations.
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Affiliation(s)
| | | | - Andrew S Deane
- Department of Anatomy and Cell Biology, Indiana University School of Medicine.,Evolutionary Studies Institute, University of the Witwatersrand
| | | | | | - Georg Hantke
- Department of Natural Science, National Museums Scotland
| | | | - Manuel Garrosa
- Department of Histology and Cellular Biology, University of Valladolid
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O’Donnell JM, Devitt BM, Arora M. The role of the ligamentum teres in the adult hip: redundant or relevant? A review. J Hip Preserv Surg 2018; 5:15-22. [PMID: 29423246 PMCID: PMC5798146 DOI: 10.1093/jhps/hnx046] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 08/21/2017] [Accepted: 12/12/2017] [Indexed: 12/14/2022] Open
Abstract
The ligamentum teres (LT) has traditionally been described as a redundant structure with no contribution to hip biomechanics or function. There has been renewed interest in the LT as a source of hip pathology due to the high prevalence of LT pathology observed at the time of hip arthroscopy. The LT acts a secondary stabilizer to supplement the work of the capsular ligaments and works in a sling-like manner to prevent subluxation of the hip at the extremes of motion. The presence of free nerve endings within the LT indicates a definite role in pain generation, with the LT undergoing various mechanical and histological adaptations to hip pathology.
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Affiliation(s)
- John M O’Donnell
- Hip Arthroscopy Australia, 21 Erin Street, Richmond, VIC 3121, Australia
| | - Brian M Devitt
- Orthosport Victoria, 89 Bridge Road, Richmond, VIC 3121, Australia
| | - Manit Arora
- Hip Arthroscopy Australia, 21 Erin Street, Richmond, VIC 3121, Australia
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Aprato A, Leunig M, Massé A, Slongo T, Ganz R. Instability of the hip after anatomical re-alignment in patients with a slipped capital femoral epiphysis. Bone Joint J 2017; 99-B:16-21. [PMID: 28053252 DOI: 10.1302/0301-620x.99b1.bjj-2016-0575] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/09/2016] [Indexed: 11/05/2022]
Abstract
AIMS Several studies have reported the safety and efficacy of subcapital re-alignment for patients with slipped capital femoral epiphysis (SCFE) using surgical dislocation of the hip and an extended retinacular flap. Instability of the hip and dislocation as a consequence of this surgery has only recently gained attention. We discuss this problem with some illustrative cases. MATERIALS AND METHODS We explored the literature on the possible pathophysiological causes and surgical steps associated with the risk of post-operative instability and articular damage. In addition, we describe supplementary steps that could be used to avoid these problems. RESULTS The causes of instability may be divided into three main groups: the first includes causes directly related to SCFE (acetabular labral damage, severe abrasion of the acetabular cartilage, flattening of the acetabular roof and a bell-shaped deformity of the epiphysis); the second, causes not related to the SCFE (acetabular orientation and poor quality of the soft tissues); the third, causes directly related to the surgery (capsulotomy, division of the ligamentum teres, shortening of the femoral neck, pelvi-trochanteric impingement, previous proximal femoral osteotomy and post-operative positioning of the leg). CONCLUSION We present examples drawn from our clinical practice, as well as possible ways of reducing the risks of these complications, and of correcting them if they happen. Cite this article: Bone Joint J 2017;99-B:16-21.
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Affiliation(s)
- A Aprato
- University of Turin, 10100 Turin, Italy
| | - M Leunig
- Schulthess Clinic, Zürich, Switzerland
| | - A Massé
- University of Turin, 10100 Turin, Italy
| | - T Slongo
- University Children's Hospital, Bern, Switzerland
| | - R Ganz
- Faculty of Medicine, Murtenstrasse 11, 3008 Berne, Switzerland
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Perumal V, Woodley SJ, Nicholson HD. The morphology and morphometry of the fovea capitis femoris. Surg Radiol Anat 2017; 39:791-798. [DOI: 10.1007/s00276-016-1810-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 12/30/2016] [Indexed: 11/28/2022]
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Collin PG, D'Antoni AV, Loukas M, Oskouian RJ, Tubbs RS. Hip fractures in the elderly-: A Clinical Anatomy Review. Clin Anat 2016; 30:89-97. [PMID: 27576301 DOI: 10.1002/ca.22779] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 08/26/2016] [Indexed: 01/27/2023]
Abstract
As elderly populations rise worldwide, the amount of hip fractures have continued to increase and result in substantial medical burdens in many countries. This increase goes hand-in-hand with an increase in surgical procedures to correct hip fractures. The medical burden imparted by hip fractures and their corrective surgeries necessitate a clinically relevant understanding of the hip joint including the vascular, neural, and musculoskeletal structures directly associated with and neighboring the joint. It is critical to appreciate how the normal hip anatomy is disrupted by a fracture and how this disruption is heavily influenced by the fracture's location. The effects of advancing age on the integrity of the hip joint and the risk of hip fractures further complicate hip anatomy. Consequentially, normal hip anatomy, aging and the pathology introduced by fractures play major roles in how hip fractures are approached surgically. This article aims to review the clinically relevant anatomy of the healthy hip joint, age-related changes that influence the joint, hip fractures, and corrective surgeries for hip fractures. Clin. Anat. 30:89-97, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Peter G Collin
- Department of Pathobiology, CUNY School of Medicine/The Sophie Davis School of Biomedical Education, The City College of New York, CUNY, New York, New York
| | - Anthony V D'Antoni
- Department of Pathobiology, CUNY School of Medicine/The Sophie Davis School of Biomedical Education, The City College of New York, CUNY, New York, New York
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, Grenada
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