The innominate tubercle of the femur: Application to anterior surgical approaches to the hip.

There has recently been an increase in popularity of the direct anterior approach (DAA) hip arthroplasty, due to the muscle sparing nature of its interneural intervals, with the innominate tubercle being used as a lateral reference point for the femoral neck osteotomy. However, there is very little information in the literature on this rather enigmatic structure, with no evidence as to whether it is a consistent and reliable marker, or if it varies significantly in the population. In this study, data were gathered from 79 pairs of adult, post-medieval skeletal femora to investigate the effects of sex, age, femoral side, femoral length, femoral neck length, and femoral neck-shaft angle on the width, length, and height of the innominate tubercle. The sex, age, and date of death of the individuals had been recorded. Statistical analysis included canonical correlation and multivariate multiple regression. We found that there was no statistical significance or correlation between the width, length, or height of the tubercle with respect to any of the variables investigated. These results suggest that the innominate tubercle does not differ markedly between individuals in the Caucasian population, and, is therefore, a reliable landmark for femoral neck osteotomy during DAA hip arthroplasty. We present what we believe to be a definitive survey of the variability of the innominate tubercle in a Caucasian population. Clin. Anat. 30:578-584, 2017. © 2017 Wiley Periodicals, Inc.

Hyperostosis frontalis interna in female historic skeletal populations: Age, sex hormones and the impact of industrialization.

OBJECTIVES: This analysis aims to investigate the impact of industrialization on the prevalence of Hyperostosis Frontalis Interna (HFI), focusing on the roles of age and parity to examine the claim that longevity and changing reproductive patterns have led to increased rates in modern populations. MATERIALS AND METHODS: A total of 138 individuals from two documented London skeletal assemblages of the Industrial period were analyzed employing macroscopic observation, digital radiography and MicroCT scanning to establish the prevalence rates of HFI according to modern clinical standards. Statistical analysis was also undertaken on a sub-sample of 51 females of post-menopausal age to identify any relationship between parity and HFI. RESULTS: The majority of cases of HFI were found in older females, reflecting clinical observations. The prevalence rates of HFI corresponded well to those predicted from the proportion of old age females present within populations. Age was therefore shown to be a predominant factor in HFI presence. A plateau in HFI prevalence was noted from the age of 50-59 years onwards. No statistically significant relationship was found between parity and HFI. DISCUSSION: When recorded consistently, HFI was positively correlated with age and longevity but had also increased among old age females over time. Our results suggest that nulliparity co-occurs with HFI but is not a primary factor in its pathogenesis. Key factors in HFI presence in females are likely to be increased androgens and the dysregulation of insulin and insulin-like growth factor-1.

Digital radiography and historical contextualisation of the 19th century modified human skeletal remains from the Worcester Royal Infirmary, England.

Recent excavations at the Worcester Royal Infirmary revealed a large assemblage of modified skeletal remains dating to the late 19th century. The assemblage included a sample of 134 long bones, 76 of which were transected and 58 of which displayed evidence of gross pathology without transection. Transection may have been undertaken for the purposes of amputation, anatomical or morbid dissection, for surgical training or specimen preparation. In order to elucidate the motives for such modification, Direct Digital Radiography (DDR) was undertaken on the proximal and distal elements present to confirm the true prevalence of disease. The radiographic evidence revealed that some transected elements exhibited previously unobserved pathological changes. The ratios of proximal to distal elements varied between samples of pathological and non-pathological transected elements, suggesting different motives for modification. There was also a significant difference between the composition of the skeletal sample and that expected from historical records of amputation. Aggressive or acute/subacute as well as chronic stages of disease were observed, some lesions possibly relating to ascending infection following gangrenous limb ischaemia or haematogenous spread. Other rare conditions were detected using DDR, proving it to be a critical tool in the assessment of skeletal disease in the past.