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Three-dimensional morphologic features of Asian atypical femur and clinical implications of cephalomedullary nail fixation: Computational measurement at actual size

  • Kyung-Jae Lee
    Affiliations
    Department of Orthopaedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daeg-Gu, Republic of Korea
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  • Beom-Soo Kim
    Affiliations
    Department of Orthopaedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daeg-Gu, Republic of Korea
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  • Kun-Tae Kim
    Affiliations
    Regional Trauma Center, Division of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Republic of Korea
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  • Gu-Hee Jung
    Correspondence
    Corresponding author at: Medical ICT Convergence Research Center, Institute of Health Sciences, College of Medicine, Gyeongsang National University, 816 Beongil 15, Jinju-daero, Jinju-si 52727, Republic of Korea.
    Affiliations
    Department of Orthopaedic Surgery, College of Medicine, Gyeongsang National University, Gyeongsang National University Changwon Hospital, 11, Samjeongja-ro, Seongsan-gu, Changwon-si 51472, Republic of Korea

    Medical ICT Convergence Research Center, Institute of Health Sciences, College of Medicine, Gyeongsang National University, 816 Beongil 15, Jinju-daero, Jinju-si 52727, Republic of Korea
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Published:September 24, 2022DOI:https://doi.org/10.1016/j.injury.2022.09.044

      Highlights

      • Fracture site was not significantly associated with distal anterior or distal lateral bowing in the present study.
      • DOC of the medullary canal was affected by the variable of proximal lateral and anterior bowing.
      • Geometric change of the proximal femur plays an important role in the fracture site and morphologic features of diaphyseal bowing.
      • New nail design for Asian atypical femur that could increase the radius of curve (ROC) but decrease the mediolateral angle needs to be introduced.

      Abstract

      Purpose

      (1) To analyze three-dimensional (3D) morphologic features of atypical femur fracture at actual size without projection error; and (2) to provide clinical implications of cephalomedullary nail (CMN) fixation by separating the medullary canal and the cortex.

      Materials and methods

      Fifty-nine atypical femurs (opposite non-fractured femurs) were reconstructed as 3D models with medullary canal by importing CT data into Mimics® software. A reference line was drawn from the tip of the greater trochanter to the center of the intercondylar notch and used for classifying bowing grade according to the centerline of medulla. Proximal and distal straight lines (length of 60 mm, diameter of 1 mm) were placed in the centerline of medulla. Acute angles between the two straight lines were measured as lateral and anterior bowing. The acute angle by straight line and reference line was measured as proximal and distal bowing in both AP and lateral view. The diameter of curve (DOC) of medulla along the posterior border was measured.

      Results

      The anterior bowing of all femur on lateral view was an average of 13.82° (range, 6.2°–31.1°, SD 3.91), and the values of proximal and distal anterior bowing were an average of 7.82° (range, 2.7°-14.3°, SD 2.23) and 6.0° (range, 2.2°-16.8°, SD 2.31), respectively. The lateral bowing of all femur on AP view was an average of 5.49° (range, 0.1°–17.3°, SD 4.48), and the values of proximal and distal anterior bowing were an average of 3.64° (range, 0.1°-11.3°, SD 2.70) and 2.48° (range, 0-7.4°, SD 1.98), respectively. The medullary canal was changed to be straightened and more bowed anteriorly. Concerning the lateral bowing grade of entire diaphysis, it was grade -I for 15 femurs, grade 0 for 21 femurs, grade I for nine femurs, grade II for five femurs, and grade III for nine femurs. Regarding anterior bowing grade, it was grade II for 14 femurs and grade III for 45 femurs. The average diameter of medullary canal was 1276.3 ± 232.25 mm.

      Conclusion

      Asian atypical femur had three morphologic features: (1) straightened medullary canal, (2) positive values of lateral bowing, and (3) significantly increased ante-curvature of medullary canal. Considering that conventional CMN had about 4° of mediolateral angle, the disparity between implant and medullary canal might be clear. Thus, new nail design for Asian atypical femur that could increase the radius of curve (ROC) but decrease the mediolateral angle needs to be introduced.

      Keywords

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