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Changes in Proximal Femoral Shape During Fetal Development.

Don T Li1,2, Jonathan J Cui1, Havalee T Henry3

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Summary

Fetal hip development involves changes in both coronal and transverse planes. True neck/shaft angle decreases as femoral version increases, contrary to previous findings.

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Area of Science:

  • Orthopedics
  • Developmental Biology
  • Anatomy

Background:

  • Classic studies suggested fetal hip joint development primarily alters version, not coronal alignment.
  • Re-examination of prior data challenges the notion of static coronal alignment during fetal hip development.

Purpose of the Study:

  • To re-evaluate fetal hip joint development data, specifically addressing changes in neck/shaft angle and version.
  • To clarify angular changes in both coronal and transverse planes during fetal femur maturation.

Main Methods:

  • Analysis of published fetal femur images from 12 weeks gestational age to term.
  • Calculation of true neck/shaft angle (tNSA) and inclination angle using validated formulas.
  • Statistical analysis of morphological changes and inter/intraobserver reliability testing.

Main Results:

  • Apparent neck/shaft angle (aNSA) remained constant, while version increased by 40 degrees.
  • True neck/shaft angle (tNSA) decreased by 7.5 degrees, and inclination increased by 32 degrees.
  • Demonstrated a 4:1 ratio of angular change between transverse and coronal planes, respectively.

Conclusions:

  • Fetal hip development involves significant angular changes in both coronal and transverse planes.
  • It is mathematically necessary for tNSA to decrease as version increases, even if aNSA appears constant.
  • Understanding distinctions between aNSA, tNSA, version, and inclination is crucial for interpreting hip development and for surgical applications.