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International Journal of Morphology

versión On-line ISSN 0717-9502

Int. J. Morphol. v.25 n.2 Temuco jun. 2007

http://dx.doi.org/10.4067/S0717-95022007000200006 

 

Int J. MorphoL, 25(2):285-288, 2007.

 

Study of the Collo-diaphyseal Angle of the Femur of Corpses in the Anatomy Department of the PUC-SP Medical School

Estudio del Ángulo del Cuello del Fémur en Cadáveres del Departamento de Anatomía de la Facultad de Medicina - PUC-SP

 

Edie Benedito Caetano; Alexandre Geranutti Serafim; Emerson Henrique Padoveze

Anatomy Department of the PUC-SP Medical School, Brazil.

Dirección para correspondencia


SUMMARY: In Brazilian literature the works are scarce on the collo-diaphyseal angle (CDA) in Brazilians, as well as, in relation to the other measures that can be acquired in the proximal portion of the femur, as the femur axle length (FAL), femur neck width (FNW), and the femur head diameter (FHD).This study had the purpose of enlarging the data on the Brazilian people, providing anatomic fundamentals that allow a better comprehension of clinical and pathological states involving the hip joint. All these measures were gotten in millimeters (mm) through a paquimeter and a goniometer for the same researcher. Eighty-seven bones were analyzed, being 40 (46%) right femurs and 47 (56%) left femurs. The bones were in their complete form and they were from adult corpse. For the analysis of measures were used Friedman's analysis of variance to compare, separately, for the sides right and left, the values of the five measures effected by the researchers; the test of Student for two not independent samples, with the objective to compare, for each corpse, the values of the observed angle in the right and left side. The results were: right-CDA 128.23° ± 4.43 and left-CDA 128.04° ± 4.36, right-FAL 90.14mm ± 5.53 and left-FAL 91.08mm ± 5.48, right-FNW 28.69mm ± 2.58 and left-FNW 28.81mm ± 3.28, andright-FHD 41.80mm ± 3.10 andleft-FHD 42.11 ± 3.42. In conclusion, it is necessary to emphasize the importance of femoral geometry data of Brazilian bones in this study which could be compared to values carried out in other Brazilian states since the Brazil continental size causes variations in the population. Also it is imperative to emphasize the future possibility of applying this knowledge in clinical practice, especially in relation to the risk of bone fracture.

KEYWORDS: Femur; Angle; Anatomy.

RESUMEN

En la literatura brasileña los trabajos sobre el ángulo del cuello del fémur (CDA) son escasos, así como de las otras medidas que pueden adquirirse en la porción proximal del hueso, como la longitud del cuello del fémur (FAL), anchura de cuello del fémur (FNW), y el diámetro de la cabeza del fémur (FHD). Este estudio tiene el propósito de aumentar los datos de individuos brasileños, proporcionando principios anatómicos que permitan una mejor comprensión de estados clínicos y patológicos que involucran la articulación de la cadera. Todas estas medidas se consiguieron en milímetros (mm) a través de un paquímetro y un goniómetro, por un mismo investigador. Se analizaron 87 huesos, siendo 40 (46%) fémures derechos y 47 (56%) fémures. Los huesos estaban enteros y eran de individuos adultos. Para analizar las medidas se usó Análisis de Varianza de Friedman para comparar, separadamente, los lados derecho y izquierdo, los valores de las cinco medidas efectuados por los mismos investigadores; la prueba t-Student para las muestras independientes, con el objetivo de comparar, para cada cadáver, los valores del ángulo observado en los lados derecho e izquierdo. Los resultados fueram: derecho-CDA 128.23° ± 4.43 e izquierdo-CDA 128.04° ± 4.36, derecho-FAL 90.14mm ± 5.53 e izquierdo-FAL 91.08mm ± 5.48, derecho-FNW 28.69mm ± 2.58 e izquierdo-FNW 28.81mm ± 3.28, y derecho-FHD 41.80mm ± 3.10 e izquierdo-FHD 42.11 ± 3.42. En conclusión, son importantes los datos de geometría femoral de huesos brasileños obtenidos en este estudio, para poder compararlos con valores obtenidos en individuos de otros estados brasileños, debido el tamaño continental de Brasil, que causa variaciones en su población. También es importante la posibilidad de aplicar en el futuro geometría de la porción proximal del fémur en la práctica médica, sobre todo cuando existe riesgo de fractura del hueso.

PALABRAS CLAVE: Femur; Ángulo; Anatomía.


INTRODUCTION

Our interest in this study stems from the premise that the longest bone of the human body, the femur, possess an anatomical variation, that is dependent on the age (Dangelo & Fattini, 1998) and nationality of each individual.

To have a better understanding of these variations, it is necessary to have a general knowledge of the different anatomical structures of the proximal portion of the femur. Therefore an anatomical description of this region is as follows: The head (caput femoris) which is globular, is directed upward, medial ward, and a little forward, the greater part of its convexity being above and in front. Its surface is smooth, coated with cartilage in the fresh state, except over an ovoid depression, the fovea capitis femoris, which is situated a little below and behind the center of the head, and gives attachment to the ligamentum teres. This ligament also attaches to the acetabulum, maintaining the integrity of the hip. The neck {collum femoris) is a narrowed region, which articulates the head with the body of the bone (Spense, 1991). The neck bone is a prolongation of the body of the femur. At birth the neck is short, thick, and increases in length as the bone grows. In a similar manner, the angle that the neck forms with shaft of the femur, called the inclination angle, varies with the growth of the bone, in young people the angle is wider (Dangelo & Fattini). At the point where the neck meets the shaft of the femur, there are two prominent processes that serve as points of muscle attachment: the major trochanter directed a little lateral ward and backward and the minor trochanter, which projects from the lower and back part of the base of the neck. At the posterior surface of the body there is a distinct longitudinal crest called linea áspera (Spense).

The neck-shaft angle also known as collo-diaphyseal angle of femur is the object of study, being that the values obtained, could be adopted as standard for inhabitants of the region. As stated earlier on, it is common knowledge that this angle varies with the age of each individual. It is approximately 150 degrees in children and 126 degrees in adults (Putz & Palest, 2000).

It is also believed that there is a regional difference in these values. Cheng et al. (1997) studied the right proximal femur of 64 human corpses, through the X-Ray, in New York, and, discovered an average value of 125° (±5). However, a study carried out in 2001, in Rio de Janeiro, based on the geometry of the proximal portion of the femur discovered an average of 111,2° (± 5,9) for the right bone (Mourao & Vasconcellos, 2001).

There is the need to emphasize the importance of this angle, since the increase or the reduction of this angle can imply a pathological process. Being the increase called coxa valga and the reduction coxa vara. This variation is manifested in the standard and the amplitude of possible movements in the hip articulation (Kapanji, 1990).

MATERIAL AND METHOD

Femurs from corpses in the Anatomy Department of the PUC-SP Medical School - Sao Paulo, were analyzed. In the beginning, the angles of inclination of 17 pairs of bones were measured with a comparism of values of the left to that of the right bone.

In the second stage, 53 bones were analyzed, in order to establish an average value for the inhabitants of the Sorocaba region - State of Sao Paulo. The inclusion criteria include: a) the bone must be in its complete form; b) bone of an adult corpse.

Sampling: The bones which fell within the inclusion criteria were analyzed in following manner:

The neck-shaft angle was measured at the posterior surface of the bone, at the union of the long axle of the neck of femur with the long axle of diaphysis of femur. The angle was measured with a simple goniometer by the researcher himself. For each bone, five measurements were taken with the calculated arithmetic mean recorded.

The morphometry, analyzed together with the measured angle, consisted of: the femoral axle length (FAL) - distance in straight line, joining the extreme points of greater trochanter and the femoral head, the frontal plane; the femur neck width (FNW) - the width of the middle point of the femoral neck, perpendicular to its axle; the femur head diameter (FHD) -diameter measured at the base of the femur head. All these measurements made in millimeters (mm) with a paquimeter were carried out by the same the same researcher.

Statistical Method. For the analysis of the results obtained, following tests were utilized: Friedman Analysis of Variance test (Siegel & Castellan, 1988) with the objective to compare, separately, for the sides right and left, the values of the five measures effected by the researchers; the Student t-Test (Sokal & Rohlf, 1969) for two non independent samples, with the objective of comparing the observed values of the collo-diaphyseal angle in the right and left side.

After the attainment of the other measures of the referred angle, calculations were made for the respective averages and standard deviation with the view of establishing a 95% confidence interval.

RESULTS

The Friedman Analysis of Variance, with the purpose of comparing the differences between the five measurements, did not show significant differences. Therefore, arithmetic means for the left side as well as the right were used.

When the pair of bones for the same corpse is studied to compare the left to the right, the paired Student t-Test for the data disclosed an average of 127,61 (± 4,84) for the right side and of 128,81 (± 4,97) for the left. After the test was applied, it was observed: calculated t of 1,09 (p<0,3 and critical t (5%) of 2,1. The student t-Test for the paired data didn't show any significant difference between the left and the right sides, among the 17 corpses compared. In all, 87 bones were analyzed, being 40 (46%) right femurs and 47 (56%) left femurs.

The obtained results for the arithmetic mean and standard deviation, as well, the superior and inferior limits of each variant studied are presented in the table below. (Table I).


DISCUSSION

In Brazilian literature there are scarce researches on the collo-diaphyseal angle in brazilians, as well as other measurements of the proximal portion of the femur, like the femur axle length, the width of the neck and the femur head diameter. The continental size of Brazil could be a factor since there is a geographical variation due to the diversity in its population.

Recently, there has been an increase internationally in the study of these measurements, since publications associate these measurements, together with bone densities as predisposing factors in localized femur fracture which predominates at the neck (Kukla et al, 2002).

The femoral proximal portion is also being used to differentiate the sex of unknown skeletons since this region is susceptible to alterations between men and women (Purkait, 2003). These differences occur because the male femurs, generally, support a bigger weight that of women (Putz & Palest), and also because, the anatomy ofthe female is different in relation to that of men. To adapt to these differences, the women possess an inferior collo-diaphyseal angle than men (Purkait, 1996,2003; Tahir et al, 2001). This proves that genetic factors, like gender, and environmental factors like obesity influence the architecture ofthe proximal portion ofthe femur.

Since the aged population is more inclined to femur fracture (Courtney etal., 1994; Kukla et al, 1997;Rockwood et al, 1990) and with the Brazilian population also being epidemiologically becoming older, the study ofthe proximal portion of femur is fundamental in calculating the risk of bone fracture, mainly, in the aged, since they are the biggest victims of osteoporosis. Osteoporosis, promotes the reduction ofthe bone density, and is therefore considered as a serious risk factor for femur fracture (Kukla et al, 2002).

It's clear that the bone density cannot be considered as the only isolated factor for the risk in bone fracture. The geometry of the proximal portion of the femur cannot be ignored. A good example of this is the lesser incidence of breaking femur in Japanese women than in white americans, though the Japanese have an inferior bone density. In this study the femoral axle length was discovered as the cause, thus, the reduced collo-diaphyseal angle in the Japanese is a beneficial factor to prevent femoral fracture (Nakamuraeia et al., 1994).

Other factors like the femur head diameter, the length and width of femur neck also correlate, to different degrees that of femoral fractures (Kukla et al., 2002).

The Anatomy Laboratory of the PUC-SP Medical School in Sorocaba and its hospital setup, located in the State of Sao Paulo, Brazil, is open to a population of about 2 million and there are more than 100 femurs available, of which only 34 are taken from the same corpse and, the rest do not have definite pairs. Out of these, only 53 were studied, since many were not in their complete form and/or they were not of adult corpses. That brought to a total, 87 bones studied.

The average values found in our study for the femoral axle length and the femur neck width had agrees with the values in research publications. Mourao & Vasconcellos carried out a similar study in the State of Rio de Janeiro, in Brazil, FAL = 92.1 ± 6,9mm and FNW=26,7±3,1 mm.

In a recent study carried out in the State of Paraná (Da Silva et al, 2003), in Brazil, significant differences were observed in respect to the collo-diaphyseal angle of the right and left femurs, agreeing Mourao & Vasconcellos study in which was discovered between both different sides. In both studies the angle ofthe right bone was inferior to the left.

In this study, this difference was not observed , with the values of both sides being very similar Also, a bigger value for the collo-diaphyseal angle was found, being that in the Paraná study (Da Silva et al) the right CDA measured 122,5° whiles the left CDA measured 125,6°, compared to the 128,23° and 128,04°, respectively, in this study.

In similar work, Mouráo & Vasconcellos had found the following values for the right and left CDA, respectively: 111,2° ±5,9 and 114,2° ± 5,5. These values inferior to the obtained results in this study could be explained with the different tools used in measuring, as well as the difficulty in establishing the same gauging technique in the two studies under discussion. It is also interesting to note that, the values ofthe femur neck width of the Parana study were inferior to that ofthe State of Sao Paulo.

In relation with the collo-diaphyseal angle, differently from published results (Kukla et al, 2002; Nakamura; Purkait, 1996, 2003; Tahir) we didn't use the X-ray since , being that skeletons were used, hence we were able to directly measure the diverse portions of femur. This difference in gauging is a source of problem when one wants to compare results from different studies.

In conclusion, we want to emphasize the importance of femoral geometry data of Brazilian bones in this study which could be compared to values carried out in other Brazilian states since the continental size of Brazil causes variations in the population. Also it is imperative that we emphasize the future possibility of applying knowledge of the geometry of proximal portion of the femur in clinical practice, especially in relation to the risks of bone fracture.

 

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Tahir, A.; Hassan, A.W. & Umar, I.M.. A study of the collodiaphyseal angle of the femur in the North-Eastern Sub-Region of Nigeria. Niger. J. Med, 10(l):3A-6, 2001.        [ Links ]

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Subsidezed by CEPE - 04/1266.

Received: 21-11-2006
Accepted: 12-03-2007

Correspondence to:

Prof. Dr. Edie Benedito Caetano
Filadelfia, 703, Jardim América
CEP 18047-290
Sorocaba - Sao Paulo
BRASIL

 

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