Surgical and Radiologic Anatomy

, Volume 40, Issue 5, pp 507–513 | Cite as

Bilateral symmetrical comparison of the proximal femur using 3D-CT models

  • Filip C. Dolatowski
  • Max J. Temmesfeld
  • Claude Pierre-Jerome
  • Arne Borthne
  • Sigurd Erik HoelsbrekkenEmail author
Original Article



Superimposed three-dimensional (3D)-models obtained from CT-images have been used to evaluate displacement of femoral neck fractures, but this method assumes symmetrical anatomy of normal femurs. The present study aimed to compare the spatial orientation of the left and right proximal femur, thus establishing if 3D models can be used as a reference standard for the evaluation of fracture displacement.


We generated 3D-CT-models of 20 patients with no skeletal pathology of the proximal femurs. Three observers independently determined the positions of the fovea and the femoral head, and a vector intersecting the centre points of the fovea and the femoral head defined the rotation. Differences in positions and rotations were determined by superimposing the 3D-CT-models of both femurs.


The mean distance (95% CI) between positions of the left and right fovea was 3.1 mm (2.7–3.4) and between the left and right femoral head 2.8 mm (2.6–3.0). The minimal detectable change was 2.8 for the fovea and 2.3 for the femoral head, and the repeatability coefficients between 2.1–2.7 and 1.0–2.9, respectively. Mean difference in rotation of the femoral head was 6° (5.3–6.6) with a minimal detectable change of 8.8 and repeatability coefficients ranging from 5.8 to 10.0.


Distances between the left and right femoral heads were larger than what could be explained by measurement error alone, suggesting that there may be minor side-to-side differences. However, these differences are small, and 3D-CT-models can be used as a reference standard to evaluate displacement of femoral neck fractures.


Computed tomography Spatial orientation Three-dimensional models Proximal femur Femoral neck fracture 



The present study is part of a project that received internal funding from Akershus University Hospital.

Author contributions

FD: Project development, data collection and writing of the manuscript. MT: Project development, data collection and writing of the manuscript. CP-J: Project development, data collection and writing of the manuscript. AB: Project development, data collection and writing of the manuscript. SEH: Project development, data collection, data analysis and writing of the manuscript.


The present study is part of a project that received internal funding from Akershus University Hospital (Grant no. 266960).

Compliance with ethical standards

Conflict of interest

Author MT has received a research grant awarded by The Norwegian Association of Orthopaedic Surgeons. The authors FD, CPJ, AB and SEH declare that they have no conflict of interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Bedford MR, Brewster MBS, Grimstvedt LO, O’Dwyer K (2011) Re-evaluating the lateral hip view in the management of femoral neck fractures. Eur J Orthop Surg Traumatol 21:165–169. CrossRefGoogle Scholar
  2. 2.
    Dolatowski FC, Adampour M, Frihagen F, Stavem K, Erik Utvag S, Hoelsbrekken SE (2016) Preoperative posterior tilt of at least 20 degrees increased the risk of fixation failure in Garden-I and -II femoral neck fractures. Acta Orthop 87:252–256. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Du CL, Ma XL, Zhang T, Zhang HF, Wang CG, Zhao F, Ma JX, Fu X, Li ZJ (2013) Reunderstanding of garden type I femoral neck fractures by 3-dimensional reconstruction. Orthopaedics 36:820–825. CrossRefGoogle Scholar
  4. 4.
    Frihagen F, Nordsletten L, Madsen JE (2007) Hemiarthroplasty or internal fixation for intracapsular displaced femoral neck fractures: randomised controlled trial. BMJ 335:1251–1254. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Fu X, Xu GJ, Li ZJ, Du CL, Han Z, Zhang T, Ma X (2015) Three-dimensional reconstruction modeling of the spatial displacement, extent and rotational orientation of undisplaced femoral neck fractures. Medicine 94:e1393. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Garden RS (1961) Low-angle fixation in fractures of the femoral neck. J Bone Jt Surg Br 43-B:647–663CrossRefGoogle Scholar
  7. 7.
    Hoelsbrekken SE, Dolatowski FC (2017) The influence of the hips position on measurements of posterior tilt in a valgus-impacted femoral neck fracture. Injury. PubMedGoogle Scholar
  8. 8.
    Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Kumar DS, Gubbi SD, Abdul B, Bisalahalli M (2008) Lateral radiograph of the hip in fracture neck of femur: is it a ritual? Eur J Trauma Emerg Surg 34:504–507. CrossRefPubMedGoogle Scholar
  10. 10.
    Lapidus LJ, Charalampidis A, Rundgren J, Enocson A (2013) Internal fixation of garden I and II femoral neck fractures: posterior tilt did not influence the reoperation rate in 382 consecutive hips followed for a minimum of 5 years. J Orthop Trauma 27:386–390. (discussion 390–391) CrossRefPubMedGoogle Scholar
  11. 11.
    Palm H, Gosvig K, Krasheninnikoff M, Jacobsen S, Gebuhr P (2009) A new measurement for posterior tilt predicts reoperation in undisplaced femoral neck fractures: 113 consecutive patients treated by internal fixation and followed for 1 year. Acta Orthop 80:303–307. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Parker MJ, Gurusamy K (2006) Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults. Cochrane Database Syst Rev 2006(4):CD001708. Google Scholar
  13. 13.
    R Core Team (2017) R: a language and environment for statistical computing. R Foundation for Statistical Computing, ViennaGoogle Scholar
  14. 14.
    Riaz O, Nisar S, Arshad R, Vanker R (2016) Lateral X-ray for proximal femoral fractures—is it really necessary? Surg J R Coll Surg Edinb Irel 14:252–255. Google Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • Filip C. Dolatowski
    • 1
    • 2
  • Max J. Temmesfeld
    • 1
    • 2
  • Claude Pierre-Jerome
    • 3
  • Arne Borthne
    • 1
    • 3
  • Sigurd Erik Hoelsbrekken
    • 4
    Email author
  1. 1.Institute of Clinical MedicineUniversity of OsloOsloNorway
  2. 2.Department of Orthopaedic SurgeryAkershus University HospitalLørenskogNorway
  3. 3.Department of RadiologyAkershus University HospitalLørenskogNorway
  4. 4.The Norwegian Heart and Lung Patient Organisation ClinicsJessheimNorway

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