Dissertation on
A MORPHOMETRIC AND RADIOLOGICAL STUDY OF GREATER SCIATIC NOTCH IN HIP BONE FOR SEX DETERMINATION
Submitted in partial fulfillment for
M.D. DEGREE EXAMINATION BRANCH- XXIII, ANATOMY
Upgraded Institute of Anatomy Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai - 600 003
THE TAMILNADU Dr.M.G.R. MEDICAL UNIVERSITY CHENNAI – 600 032 TAMILNADU
MAY-2019
CERTIFICATE
This is to certify that this dissertation entitled“A MORPHOMERTIC
AND RADIOLOGICAL STUDY OF GREATER SCIATIC NOTCH IN HIP
BONE FOR SEX DETERMINATION”is a bonafide record of the research work done by Dr. P. MYTHILI,Post graduate student in the Institute of
Anatomy, Madras Medical College and Rajiv Gandhi Government General
Hospital,Chennai-03, in partial fulfillment of the regulations laid down by
The Tamil Nadu Dr.M.G.R. Medical University for the award of M.D.
Degree Branch XXIII-Anatomy, under my guidance and supervision during the academic year from 2015-2018.
Dr. SudhaSeshayyan,M.B.B.S., M.S., Dr. B. Chezhian, M.B.B.S., M.S., Director & Professor, Professor, Institute of Anatomy, Institute of Anatomy, Madras Medical College, Madras Medical College, Chennai– 600 003. Chennai– 600 003.
The Dean, Madras Medical College & Rajiv Gandhi Govt. General Hospital, Chennai Chennai – 600003.
ACKNOWLEDGEMENT
I wish to express exquisite thankfulness and gratitude to my most respected teachers Dr.SudhaSeshayyan, Director and Professor and my guide
Dr.B. Chezhian, Professor Institute of Anatomy, Madras Medical College,
Chennai – 3, for their invaluable guidance, persistent support and quest for perfection which has made this dissertation take its present shape.
I am thankful to Dr.R. Jayanthi, M.D., FRCP (Glasg), Dean, Madras
Medical College, Chennai – 3 for permitting me to avail the facilities in this college for performing this study.
I am thankful to Dr. R.Ravi, Director and Professor, Banard Institute of
Radiology for permitting me to avail radiographs for the study.
My heartfelt thanks to, Dr.V.Lokanayaki and Dr.B.Santhi,
Associate Professors, Dr.V.Lakshmi, Dr.T.Anitha, Dr.P.Kanagavalli,
Dr.J.Sreevidya, Dr.Elamathi Bose, Dr.S.Arrchana, Dr.B.J.Bhuvaneshwari,
Dr.B.Mohanapriya, Dr.S.Keerthi, Dr.P.R.Prefulla, Dr.M.K. Punitharani,
Dr. M. Bama, Dr. K. Lavanya Devi, Assistant Professors, Dr.N.Sridharan, &
Mrs. Nirmala Devi, Tutor, Institute of Anatomy, Madras Medical College,
Chennai – 3 for their valuable suggestions and encouragement throughout the study.
I earnestly thank my seniors, and Dr. S. Valli who have been supportive and encouraging throughout the study.
I extend my heartfelt thanks to my colleagues Dr. H. GeethaSangeetha,
Dr.S.Elavarkuzhali and Dr. P. Soundarya, for their constant encouragement and unstinted co-operation.
I am especially thankful to Mr.R.A.C.Mathews and Mr. E.Senthilkumar, technicians, who extended great support for this study and all other staff members including Mr.Jagadeesan, Mr.Maneesh,Mrs.Gangammal and Mr. Devaraj for helping me to carry out the study.
I thank my parents in law who have showered their choicest blessings on me and supported me in my every step.
I am grateful beyond words to my husband Dr.Senthil Kumar and my son S. MidhulSai who in all possible ways supported me in making this study a reality.
Above all, I thank the Almighty, who has showered his blessings on me and helped me complete this study successfully.
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MORPHOMERTIC AND RADIOLOGICAL STUDY OF GREATER SCIATIC
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LEGEND
GSN - Greater Sciatic Notch
RT - Right
LT - Left
ANT - Anterior
POST - Posterior
CONTENTS
SL.NO TITLE PAGE NO
1. INTRODUCTION 1
2. AIM OF THE STUDY 5
3. REVIEW OF LITERATURE 7
4. EMBRYOLOGY 20
5. MATERIALS AND METHODS 23
6. OBSERVATION 30
7. DISCUSSION 79
8. CONCLUSION 99
9. BIBLIOGRAPHY 100
Introduction
INTRODUCTION
Humans are the only mammals who are unique among the primates, to assume an upright posture and bipedal mode of locomotion. The human pelvis became shorter and bowl shaped over the years. The body weight is transmitted through the acetabulum to lower limb and at the same time mediates the propulsive thrust from the lower limb to the body in standing position. In sitting position the body weight is transmitted through the ischial tuberosity.
The word pelvis is derived from the Latin word which means “basin”. The pelvic girdle is a ring of bone consisting of two hip bones in front and at the sides, and the sacro coccygeal part of vertebral column behind.
The hip bone (innominate bone) is a large, irregular bone. The sciatic notch may be referred to by any one of several names: the greater sciatic notch, the ilio- sciatic notch, the great sacro-sciatic notch 15, or, less commonly, incisura ischiadia major27 .It consists of three parts namely-ilium, ischium, and pubis.
The ilium forms the upper expanded part of the hip bone. It has two ends
(upper and lower), three borders (anterior, posterior, medial) and two surfaces
(gluteal and inner surface). The upper end is also called iliac crest and extends from the anterior superior iliac spine to the posterior superior iliac spine. The lower end forms the upper 2/3rd of acetabulum. The anterior border extends from the anterior superior iliac spine to acetabulum. The posterior border extends from
1
Figure No.1 Hip bone
GSN the posterior superior iliac spine to the upper end of the posterior border of ischium. The medial border extends from the iliac crest to the iliopubic eminence on the sacro pelvic surface. The gluteal surface is the outer surface of ilium. The inner surface is further divided into iliac fossa and sacropelvic surface.
The ischium is very thick and lies below and posterior to the acetabulum. It comprises of body and a ramus. The body of the ischium presents with two ends
(upper and lower), three borders (anterior, lateral, posterior) and three surfaces – femoral, dorsal, and pelvic. The upper end forms the postero inferior 2/5th of acetabulum. The lower end is occupied by the caudal part of the ischial tuberosity.
The anterior border is formed by the posterior margin of the obturator foramen.
The lateral border is notched in the upper part close to the lower margin of acetabulum. The posterior border is continuous above with the posterior border of ilium and presents with triangular projection, the ischial spine, which divides the border into greater sciatic notch above and lesser sciatic notch below.
The pubis is anteroinferior part of the hip bone. It forms the anterior 1/5th of the acetabulum. It comprises of body and superior and inferior rami. The body is quadrilateral and presents with three surfaces (anterior, posterior, and medial).
The superior ramus extends from the body of the pubis to the acetabulum; the inferior ramus extends from the body to the ramus of ischium and form conjoint ischiopubic ramus.
Virtually every element of the adult human skeleton has been shown to exhibit some degree of sexual dimorphism including the cranium, clavicle, sternum and
2
Figure No.2 Difference between Male and Female Pelvis
MALE PELVIS
FEMALE PELVIS long bones 6. However, it is generally accepted that the hip bone displays the greatest degree of sexual dimorphism in humans, making it the ideal bone for sex determination9.
Generally the difference between male and female pelvis are
• Male pelvis is heavier with prominent muscular markings than female.
• Iliac fossa is more concave in female than male.
• The ischio-pubic ramus is thick and everted due to stronger attachment of
muscle of penis in male.
• Acetabular cavity is large in male when compared to females.
• Obturator foramen is large and oval in male, in female it is small and
triangular.
• Pre auricular sulcus is prominent in females.
• The pelvic inlet is heart shaped in males and round in females.
• The pelvic cavity is longer and more conical than females. The pelvic
outlet is wider in females.
• The sub pubic angle is narrower and measures about 50 to 60 degree in
males with the inturned ischial spine.
• The greater sciatic notch is narrower in males compared to females.
The bone density has a major influence in the survival of the bone. The bone tissue has an ability to alter its strength in response to the strain. When placed under stress, bone tissue becomes stronger through increased deposition of mineral salts and production of collagen fibers by osteoblast. The Greater sciatic
3
Figure No 3. Male and Female Hip Bone showing GSN notch of the hip bone is trabecular which is encased by two layers of compact bone and can survive for long time because of its high density. The greater sciatic notch has shown higher survivability rate and it is used to determine sex of individual.
. The greater sciatic notch lies on the posterior border of the innominate bone, and is formed mostly by the ilium but also by the ischium. The ilium and ischium, along with the pubis, achieve complete fusion as late as 17 years of age.
The notch function as a gateway for the pyriformis muscle, the gluteal vessels, and superior and inferior gluteal nerves, the sciatic nerve, the internal pudendal nerves and vessels and the nerve to obturator internus and quadrates femoris7.
Thus, the shape, width, and angles of greater sciatic notch help in determining sex. The greater sciatic notch is narrower in males, wider in females.
The greater values for the width and angles in females are associated with increased backward sacral tilt and antero posterior pelvic diameter. The female pelvis is broader because it has to accommodate the large foetal head.
4
Aim of the study
AIM OF THE STUDY
To analyze the morphology and morphometry of greater sciatic notch for sex determination.
Determination of sex is an important step in development of the biological profile in human osteology for analyzing a forensic case or in an archaeological population.
The methods of sex determination of human skeleton vary from visual assessment to metric analyses of sexually dimorphic traits.
Skull, Hip bone and long bones show features of Sex dimorphism.
Krogman (1973)23 in his study for determining the sex of the individual found an accuracy of 80% in long bones,90% in skull and 95% in pelvis.
The pelvic girdle is the most accurate region of the skeleton for sex determination. Female pelvis is wider with wide pelvic inlet, wide sub pubic angle and wide greater sciatic notch as it has to accommodate the large foetal head during pregnancy and parturition2.
The Greater Sciatic notch resist decomposition for long time (because of its high density) compared to other parts of hip bone. Therefore used for determining sex even from the fragmented skeletal remains.
5
PARAMETERS STUDIED ARE:
1. Width of the greater sciatic notch
2. Depth of the greater sciatic notch
3. Width of the anterior segment of notch
4. Width of the posterior segment of sciatic notch
5. Index I - Depth x 100 / Width
6. Index II - Anterior segment of Width x 100 / Width
7. Index III - Posterior segment of Width x 100 / Width
8. Total angle of greater sciatic notch
9. Posterior angle of greater sciatic notch
10. Presence or absence of piriform tubercle
6
Review of Literature
REVIEW OF LITERATURE
WIDTH OF THE GREATER SCIATIC NOTCH (GSN)
1. Verneau45 (1875), in his studies on GSN in adult hip bones stated that “The
Greater sciatic notch was narrower and shallower in males than in females”.
2. Letterman27 (1941) in his study on GSN in 426 adult hip bones observed that
“the width is wider in females than in males”.
3. Washburns47 (1949) in his study on GSN in 152 adult hip bones found that
“the width of GSN in female was 1 cm wider than in males”.
4. Davivongs V. et al8 (1963) in their study on GSN in 100 adult hip bones of
Australian population reported that “the males had narrower GSN compared
to females”.
5. Jovanovic et al20 (1965) in their study on GSN in 102 adult hip bones found
that “the males had narrower GSN and females had wider GSN”.
6. Day et al47 (1975) observed in their study on GSN in 59 adult hip bones
found that “the males have narrower GSN notch than females”.
7. Shamer Singh et al40 (1978) in their study on GSN in 200 hip bones (120 M
and 80 F) stated that “the mean width of GSN in right and left side were
44.30mm and 45.22mm in males and 48.27mm and 47.40mm in females”.
8. Kelley22 (1979) studied the morphometry of GSN in 400 adult hip bones and
stated that “the females had wider GSN than in males”.
9. Isaac.B 18(2002) conducted study on GSN in 42 hip bone (27 M and 15 F)
hip bones at CMC Vellore, stated that “the mean width of GSN in male and
female were 51.59 mm and 53.73 mm respectively”.
7
10. M.Steyna et al42 (2003), studied GSN in 115 adult hip bones of South
African population and found that “the females have wider GSN compared
to males”.
11. Liknur Ari28 (2005) in his study on GSN in 26 adult male hip bones of Nicea
population found that “the mean width of GSN was 46mm and 46.92mm in
right and left side respectively”.
12. Brenna Kay Blanchard5 (2010) in his study on GSN in adult hip bones in
California university stated that “A wide greater sciatic notch more likely
belongs to female than a male, while a narrow notch will be found only in
males”.
13. Shiaval shah et al38 ( 2011) in their study on GSN in 268 hip bones(174 M
and 94 F) in Gujarat population reported that, “the average width of greater
sciatic notch were 27 to 53 mm in males and 32 to 53 mm in females”.
14. Kathleen Ann Satterlee Blake11 (2011) reported in his study on GSN in 187
(90 males and 97 females) adult hip bones found that “the shape and angle of
GSN was useful in sex determination”.
15. Partha Pratim Mukhopadhyay33 (2012) in his study on GSN in 30 adult hip
bones in Kolkata population observed that “the mean width of greater sciatic
notch in males and females were 43.9mm and 49.1 mm respectively”.
16. Salim49 (2012) in his study on GSN in 101 hip bones from University of
Mexico reported observed that the “the mean width of GSN in male and
female were 40.78mm and 38.63mm respectively”.
17. Suma Dnyanesh et al43 (2013) in their study on GSN in 100 adult hip bones (
57 M and 43 F) in Karnataka population reported that “ the mean width of
right and left GSN were 40.11mm and 39.11mm in males and 47.00mm and
47.33mm in females”.
8
18. Rajashree Sheelawant Raut et al35 (2013) in their study on GSN in 183 adult
hip bones of Aurangabad population stated that “the mean width in males
and females were 35.72mm and 43.5mm respectively”.
19. Sanjeev Kumar Jain et al37 (2013) in their study on GSN in 46(24 M and 22
F) hip bones of Moradabad population reported that “the mean width of GSN
in males and females were 33.8mm and 45mm respectively.”
20. Abhishek Prasad Sinha41 (2014) studied GSN in 149(75 M and 74 F) adult
hip bones of Dehradun population and found that “the mean width of notch
in males and females were 49.64mm and 54.35mm respectively.”
21. Apoorva Tripathi et al3 (2014) in their study on GSN in 100 dry adult hip
bones (M 49 and F 51) of Haryana population stated that “the mean width of
GSN in right and left were 44.30mm and 45.20mm in males and 48.27mm
and 48.27mm in females”.
22. Gautam Kumar Singh 13(2014) in his study on 258(142M and 116F) adult
hip bones stated “the mean width of GSN in right and left side were 39mm
and 39.11mm in males and 43.5mm and 43.7mm in females”.
23. Mohammed Muzammil Ahmed et al1 (2015) in their study on GSN in adult
hip bones 50 (31M and 19F) and stated that “the males have narrow sciatic
notch and females have wider greater sciatic notch, the average value of
chilotic line is more in males than in females”
24. Jaber Gharehdaghi et al19 (2017) in his study on GSN in 225 male adult hip
bones observed that “the mean width of notch in right and left side was
45.1mm and 44.4 mm respectively”.
25. Devadas32 (2017) in his study on GSN in 50(25 M and 25 F) hip bones from
dead fetus stated that “the average width of greater sciatic notch in male and
female were 11mm to 16mm and 13mm to 17.9mm respectively”.
9
26. Lakshmi TA et al25 (2014) in their study on GSN in 104 (50 M and 54 F)
adult hip bones found that “the mean width of GSN in male and female were
53.27mm and 58.24mm respectively”.
DEPTH OF GREATER SCIATIC NOTCH
1. Shamer Singh et al40 (1978) in their study on GSN in 200(120 M and 80 F)
hip bones has stated that “the mean depth in right and left side were
25.93mm and 25.62 mm in males, and 25.86mm and 24.97mm in females”
2. Patriquin et al34 (2002) conducted study on GSN in 200 adult hip bones of
South African Population and found that “the mean depth for males and
females were 26.55 mm and 26.68mm respectively”.
3. Liknur Ari28 (2005) in his study on GSN in 26 adult hip bones of Nicea
population observed that “the mean depth of male in right and left side were
25.23mm and 28.07mm respectively”.
4. Shiaval shah et al38 (2011) in their study on GSN in 268 (174 M and 94F)
adult hip bones of Gujarat population stated that, “the mean depth measured
in males and females were 24.14mm and 22.27mm respectively”.
5. Suma Dnyanesh et al43 (2013) in their study on GSN in 100 (57M and 43F)
adult hip bones of Karnataka population found that “ the mean depth of hip
bones of right and left side were 32.34mm and 31.73mm in males and
31.28mm and 33.61mm in females”.
6. Rajashree Sheelawant Raut et al35 (2013) in their study on GSN in 183 adult
hip bones of Aurangabad population stated that “the mean depth in males
and females were 27.06mm and 25.41 mm respectively”.
7. Sanjeev Kumar Jain et al37 (2013) in their study on GSN in 46 hip bones (24
M and 22 F ) of Moradabad population reported that “the mean depth of
10
right and left side were 25.6 mm and 26.5mm in males and 24.7mm and 24.2
mm in females”.
8. Apoorva Tripathi et al 3(2014) in their study on GSN in 100 dry adult hip
bones ( 49M and 51F) stated that “the mean depth in right and left were
25.93mm and 25.62mm in males and 25.86mm and 24.97mm in females”.
9. Gautam Kumar Singh13 (2014) conducted study on GSN in 258(142M
and116F) hip bones and found that “ the mean depth of right and left side
were 39.1mm and 39.11mm in males and 36.0mm and 36.4mm in females”.
10. Devadas32 (2017) in his study on GSN in 50(25 M and 25 F) hip bones from
dead fetuses stated that “the depth of greater sciatic notch averages from
65mm to 90mm in males and 48mm to 74mm in females”.
POSTERIOR SEGMENT OF GREATER SCIATIC NOTCH
1. Shamer Singh et al 40 (1978) examined GSN in 200 (120 M and 80 F) hip
bones and stated that “the mean width of posterior segment in right and left
side were 6.06mm and 6.38 mm in males, and 16.39mm and 15.57mm in
females”
2. Patriquin et al34 (2002) in their study on GSN in 200 hip bones of South
African White and Black Population reported that “the mean width of
posterior segment is 15.56 mm in females and 9.31mm in males”.
3. Liknur Ari28 (2005) in his study on GSN in 26 adult hip bones of Nicea
population observed that “the mean width of posterior segment in male in
right and left side 20.30mm and 20.61mm respectively”.
4. Shiaval Shah et al38 (2011) in their study on GSN in 268(174 M and 94 F)
adult hip bones of Gujarat population stated that, “the mean width of
11
posterior segment measured in males and females were 6.83mm and
12.48mm respectively”.
5. Rajashree Sheelawant Raut et al35 (2013) in their study on GSN in 183(125
M and 58F) adult hip bones found that “the mean width of posterior segment
is 8.92 mm in male and 17.93 mm in female respectively”.
6. Suma Dnyanesh et al43 (2013) in their study on GSN in 100 (57M and 43F)
hip bones of Karnataka population has observed that “the mean width of
posterior segment of hip bones of right and left side were 11.40mm and
11.00mm in males and 21.92mm and 21.67mm in females”.
7. Sanjeev Kumar Jain et al37(2013) in their study on GSN in 46 hip bones
stated that “the mean width of posterior segment in right and left side were
28.9 mm and 28.0mm in males and 24.7mm and 22.0mm in females”.
8. Apoorva Tripathi et al3 (2014) in their study on GSN in 100 dry adult hip
bones found that “the mean width of posterior segment of hip bone of right
and left side were 6.06mm and 6.38mm in males and 15.57mm and
16.37mm in females”.
INDEX I OF GREATER SCIATIC NOTCH
1. Hideo Takahashi et al44 (1959) in their study on GSN in 165(104 M and 61
F)adult hip bone of Japanese population found that “ the Index I for males
and females were 48.15 and 58.22 respectively”.
2. Shamersingh40 (1978) in their study on GSN in 200 adult hip bones (120 M
and 80 F) observed that “the Index I in male were 65.12 and 64.48 on right
and left side , in female were 53.69 and 53.03 respectively”.
12
3. Liknur Ari28 (2005) in his study on GSN in 26 adult male hip bones stated
that “the Index I in male in right and left side 55.51 and 61.02 right and left
sides respectively”.
4. Shival Shah et al38 ( 2011) in their study on GSN in 268(174 male and 94 F )
dry adult hip bones of Gujarat population stated that, ”the Index I measured
in males and females were 63.48 and 52.54 respectively”.
5. Gohil Dilip et al14 (2013) in their study on GSN in 108 adult hip bones
observed that “the mean Index I of male on right and left side measured
66.58 and 69.32, in female right and left side were 58.17 and 59.15
respectively”.
6. Sanjeev Kumar Jain et al37 (2013) in their study on GSN in 46 hip bones (24
M and 22 F ) stated that “the Index I for male right and left side were 74 and
78, in female right and left was 55 and 57 respectively.
7. Apoorva Tripathi et al3 (2014) in their study on GSN in 100 dry adult hip
bones ( 49M and 51F) reported that “the Index I for males in right and left
were 65.12 and 64.44 ,in females right and left side were 53.69 and 53.63
respectively”.
8. Devadas32 (2017) in his study on GSN in 50(25 M and 25 F) hip bones and
stated that “the Index I averages from 65mm to 90mm in males and 48mm to
74mm in females ”.
INDEX III OF GREATER SCIATIC NOTCH
1. Hideo Takahashi et al44 (1959), in their study on GSN in 165 (104 M and 61
F) adult hip bones of Japanese population stated that “Index III for males
and females is 30.81 and14.27 respectively”
13
2. Shamer Singh et al40 (1978) in their study on GSN in 200 adult hip bones
(120 M and 80 F) mentioned that “the Index III in males right and left side
were 14.61 and 15.00, in females right and left side were 33.7 and 32.81
respectively.”
3. Liknur Ari28 (2005) in his study on GSN in stated that “the mean Index III in
male in right and left side were 55.51 and 61.02 respectively”.
4. Shiaval Shah et al38 (2011) in their study on GSN in 268(174 M and 94 F)
adult hip bones of Gujarat population observed that,” the Index III measured
in males and females were 17.52 and 29.14 respectively”.
5. Gohil Dilip et al14 (2013) in their study on GSN in 108 adult hip bones found
that “the mean Index III in male right and left side were 28.98 and 31.46, in
female right and left side were 44.04 and 44.24 respectively”.
6. Sanjeev Kumar Jain et al37 (2013) in their study on GSN in 46 hip bones
reported that “the Index III in male right and left were 85 and 82, in female
right and left side were 55 and 50 respectively”.
7. Apoorva Tripathi et al3 (2014) in their study on GSN in 100 adult hip bones
( 49M and 51F) observed that “the Index III for males in right and left side
were 14.61 and 15, in female were 33.70mm and 32.81mm respectively”.
TOTAL ANGLE OF GREATER SCIATIC NOTCH
1. Hanna and Washburn46 (1953) in his study on GSN in 224 adult hipbones
stated that “the total angle is 50.4 degree in males and 74.4 degree in
females”.
2. Hides Takahashi et al44 (1959), in their study on GSN in 165 (104 M and 61
F) adult hip bone of Japanese population observed that “total angle for males
were 69.79 and females is 87.88 degree respectively”.
14
3. Shamer Singh et al40 (1978) ) in their study on GSN in 200 adult hip bones
(120 M and 80 F) mentioned that “the total angle in males right and left side
were 65 and 60 degrees, in females were 82 degree and 83 degrees
respectively.”
4. Shiaval Shah ET al38 (2011) in their study on GSN in 268(174 male and 94
F) adult hip bones of Gujarat population stated that, the total angle of greater
sciatic notch for males and females were 69.45 and 82.85 respectively”.
5. Abhishek Prasad Sinha et al41(2013) in their study on GSN in 154 adult hip
bones (79M and 74 F) stated that the “the mean angle in males and females
were 51.47and 68.43 degrees respectively”.
6. Rajashree Sheelawant Raut et al35 (2013) in their study on GSN in 183 adult
hip bones (125M and 58 F) reported that “the total angle in males and
females were 62.91 and 79.93 degrees respectively”.
7. Krupa Daniel et al24 (2014) in their study on GSN in 100 adult hip bones
stated that “the total angle of greater sciatic notch in males and females were
71 and 74 degrees respectively”.
8. Apoorva Tripathi et al3 (2014) in their study on GSN in 100 adult hip bones
( 49M and 51F) and stated that “the total angle for males in right and left
were 65.31 and 66.15 degrees, in females right and left side were 82.76 and
83.35 degrees respectively”.
POSTERIOR ANGLE OF GRATER SCIATIC NOTCH
1. Hides Takahashi et al44 (1959), ), conducted their study on GSN in 165 (104
M and 61 F) adult hip bones in Japanese population and stated that “posterior
angle for males and females were 13.87 and 32 degrees respectively”
15
2. Shamer Singh et al40 (1978) in their study on GSN in 200 adult hip bones
(120 M and 80 F) reported that “the posterior angle in males right and left
sided were 12.78 and 13.34 degrees, in females right and left side were 32.24
and 31.88 degrees respectively”.
3. Shiaval Shah et al38 ( 2011) in their study on GSN in 268(174 M and 94 F )
of Gujarat population mentioned that the posterior angle of greater sciatic
notch of hip bone were found significantly higher in females and more than
2.5 times than males . For males with an average of 13.06, while in females
with an average of 32.15 degrees.
4. Rajashree Sheelawant Raut et al35 (2013) in their study on GSN in 183 adult
hip bones (125M and 58 F) stated that “the posterior angle of greater sciatic
notch of hip bone were found to be 18.39 and 43.77 degrees in males and
females respectively”.
5. Suma Dhyanesh et al43 (2013) conducted their study on GSN in 100 (57M
and 43F) adult hip bones and stated that “ In male the mean posterior angle
were found to be 19.17 and 19.41 degrees on right and left side respectively
whereas in females it was 34.32 and 31.89 degrees respectively”.
6. Apoorva Tripathi et al3 (2014) in their study of 100 dry adult hip bones (
49M and 51F) reported that “the total posterior angle for males in right and
left were 12.78 and 13.34 degrees ,in females 32.42 and 31.88 degrees
respectively”.
16
RADIOLOGICAL STUDY
1. WIDTH OF GREATER SCITIC NOTCH
2. S. C. Okeseimiema et al31 (2012) had conducted their study on GSN in 518
(259M and 259 F) X ray pelvis of South Nigerian population and stated that
“mean width for males and females were 42.24mm and 50.73mm
respectively”.
3. Berjina Farooq Naqshi et al4 (2016) in their study on GSN in 50 (25M and
25F) radiographs of pelvis of North Indian Population mentioned that “mean
width for males and females were 55.4mm and 63.3mm respectively”.
4. Z Alizadeh et al48 (2013) in their study on GSN in 64(32M and 32F)
radiographs of North Indian population found that “ mean width on right side
for males and females were 56.1mm and 52.0mm and on the left side were
55.7mm and 62.9mm respectively”.
2. DEPTH OF GREATER SCIATIC NOTCH
1. S. C. Okeseimiema et al31 (2012) had conducted study on GSN in 518 (259M
and 259 F) X ray pelvis of South Nigerian population and reported that “the
mean depth of Greater Sciatic Notch in males and females were 15.60mm
and 14.91mm respectively”.
2. Berjina Farooq Naqshi et al4 (2016) in their study on GSN in 50 (25M and
25F) radiographs of pelvis of North Indian Population observed that“ the
mean depth of Greater Sciatic Notch in males and females were 21.4mm and
24.1 mm respectively” .
3. Z Alizadeh et al48 (2013) in their study on GSN in 64(32M and 32F)
radiographs of North Indian population stated that “ the mean maximal depth
17
of Greater Sciatic Notch on right side for males and females were 20.9mm
and 23.3 mm and left side were 23.0mm and 25.1 mm respectively” .
3. POSTERIOR SEGMENT OF GREATER SCIATIC NOTCH
1. S. C. Okeseimiema et al31 (2012) had conducted study on GSN in 518 (259
M and 259 F) X ray of pelvis of South Nigerian population and stated that
“the mean posterior segment of Greater Sciatic Notch of males and females
were 14.65mm and 21.39mm respectively”.
2. Berjina Farooq Naqshi et al4 (2016) in their study on GSN in 50 (25M and
25F) radiographs of pelvis of North Indian Population reported that “the
mean posterior segment of Greater Sciatic Notch of males and females were
22.9mm and 29.2mm respectively”.
3. Z Alizadeh et al48 (2013) in their study on GSN in 64(32M and 32F)
radiographs of North Indian population observed that “the mean posterior
segment of Greater Sciatic Notch on right side for males and females were
22.7mm and 28.5mm and left side were 2.24mm and 2.95 mm.
4. INDEX I OF GSN
1. S. C. Okeseimiema et al31 (2012) had conducted their studies on GSN in 518
(259M and 259 F) X ray of pelvis in South Nigerian population and stated
that “the values of Index I for males and females were 38.81 and 30.10 and
males had significantly higher index I compared to the females.
2. Bernini Farooq Naqshi et al 4(2016) in their study on GSN in 50 (25M and
25F) radiographs of pelvis of North Indian Population reported that “the
mean values of Index I for males and females were 38.69 and 38.02.
18
3. Z Alizadeh et al48 (2013) in their study on GSN in 64(32M and 32F)
radiographs of North Indian population observed that “the mean values of
Index I on right side for males and females were 32.71 and 37.12 and on the
left side were 41.96 and 39.98”.
5. INDEX III OF GSN
1. 1. S. C. Okeseimiema et al31 (2012) had conducted study on GSN in 518
(259M and 259 F) X ray of pelvis of South Nigerian population and stated
that “the mean Values of Index II for males and females were 34.55 and 42.
18 respectively”.
2. Berjina Farooq Naqshi et al4 (2016) in their study on GSN in 50 (25M and
25F) radiographs of pelvis of North Indian Population observed that” the
mean values of Index II for males and females were 41.44 and 46.16
respectively”.
3. Z Alizadeh et al48 (2013) in their study on GSN in 64(32M and 32F)
radiographs of North Indian population reported that “the mean Values of
Index II on right side for males and females were 40.87 and 45.96 and on the
left side were 40.49 and 47.25 respectively”.
19
Embryology
EMBRYOLOGY
The bony pelvis is made up of the sacrum and coccyx and a pair of hip bone. The entire pelvis develops from somatopleuric mesoderm. Around sixth week of development at the site of future bone formation the mesenchymal cells begin to condense and differentiate into chondrocytes. Chondrocytes form a cartilage model for prospective bone. The pelvic bones are endochondrally developed, where cartilaginous template of the bone is later infiltrated by bone tissue, creating centers of ossification. The three elements of the innominate, the ischium, ilium, and pubis, begin from cartilaginous templates and their own individual primary centers of ossification. Additional or secondary ossification centers forms and represent areas of continued bone growth.
At 5th week-the pelvic element and lower limb becomes apparent in radiographs.
At 8th week-ossification center for ilium, pubis and ischium begins separately around the acetabulum.
Ilium grows towards the sacrum associated with the development of iliac crest, anterior superior iliac spine, ischial spine and notches.
Ischium grows medially and caudally forming the ischial tuberosity. Pubis grows medially forming the superior pubic ramus followed by the formation of body and inferior rami.
20
Figure No 4 Development of Hip Bone
1 2 3
4 5 6
7 8 Subsequently, formation of obturator foramen was evident by 9th week
At 12 th week- The three bones are becomes visible by ultrasound.
The ilium is the first bone to appear and begin to ossify at eight to nine weeks. The ischium begins to ossify twelve to fourteen weeks. The pubis ossifies last around sixteen to twenty weeks, often after the ischium has completely ossified.
Differential growth of the male and female pelvis depends mainly on the hormones, particularly testosterone. This hormonal influence on the developing embryo begins around 8th to 9th week as it progress towards sex differentiation.
The action of hormones continues up to 20 weeks of development.
At 24 weeks- Male and female pelvic dimorphic features are clearly evident with specific differences found in the angle and width of the sciatic notch, sub pubic angle.
Childhood Growth and Development
All three elements of the innominate are well formed and recognizable at birth with the distinguishing characters. For example, the anterior and posterior iliac spines of the ilium can be easily identified. Most of the changes arising in childhood occur to the ilium and ischium.
A growth spurt occurs soon after birth in both sexes, in boys there is an increase in the length of long bones, while girls show more variation in pelvic
21 development During childhood, size differences between the male and female pelvis decrease, while the sexual dimorphic features becomes more evident.
At puberty, when hormones surge occurs, further differentiation of male and female pelvis takes place. During Pubertal period there is a rapid growth of musculoskeletal system to prepare the body for its adult form and it is the time of pelvic remodeling. Growth of pelvis continues throughout puberty. Several secondary ossification centers appear for pubic symphysis, iliac crest, anterior inferior iliac spine, and ischial ramus and tuberosity, fusing at varying times.
Furthermore, sexually dimorphic differences do not occur equally for the pelvic bones, but in a complete fashion, with growth occurring in multiple areas at differing rates for males and females.
22
Materials & Methods
MATERIALS AND METHODS
STUDY MATERIALS:
1. 24 Cadavers (13 male and 11 Female)
2. 50 Digital X-rays (25 Male and 25 Female)
3. Sodium Hydroxide Crystals
4. Hydrogen Peroxide Solution
5. Metal brush
6. Digital Vernier Calipers
7. Inextensible thread
8. Protractor
9. Plain paper
10. Illuminator
11. Marker pen
STUDY METHODS
A. Dissection method
B. Radiological study
INCLUSION CRITERIA:
The bones taken for study were of known sex with intact greater sciatic
notch in cadavers.
Normal X rays with visible greater sciatic notch in radiographs.
23
EXCLUSION CRITERIA:
Deformed bones and malformed bones are not taken in bone study.
Pathological X rays are not taken for radiological study.
SPECIMEN COLLECTION
Hip bones from the 10 male and 10 female embalmed adult cadavers from the Institute of Anatomy, Madras Medical College, Chennai-600003.
A. DISSECTION METHOD
The adult cadavers were placed in supine position and the anterior superior iliac spine was identified. A transverse incision was made above the anterior superior iliac spine, which was extended anterior and posteriorly up to midline.
The pelvic region was separated from the rest of the abdomen. The pelvic organs were dissected and removed. The posterior abdominal wall contents especially psoas major muscle, abdominal aorta, IVC was dissected to expose the anterior aspect of lumbar vertebrae and adjoining part of the hip bone. The erector spinae muscle and the paravertebral muscles were dissected and posterior aspect of vertebrae and hip bone exposed. The muscles gluteus maximus and structures under cover of it were dissected and removed. The obturatus externus and internus were dissected and removed exposing the obturator foramen. The muscle attached to pubic bones and ischio pubic rami and ischial tuberosity were dissected and removed. After detaching the muscular and ligamentous structures pelvic bone was retrieved. During the dissection and retrieval of bones from cadaver, 6 male
24 and 2 female hip bones were damaged. Further processing was done in 40 hip bones (20 males and 20 females).
The hip bone were processed by the following steps
1) Preparation of the solution
For the preparation of the caustic soda solution, 400 grams of sodium
hydroxide crystals were dissolved in 4 liters of water.
2) Preparation of the bone
The soft tissue and the muscles were dissected as much as possible
exposing the bare surface of the bone. Care was taken to clear out the
muscles near the greater sciatic notch.
3) Procedure
The pelvic bone was then immersed in caustic soda solution for 24 hours.
The caustic soda solution soften the muscles and the ligaments that were
closely applied to the bone that are resistant to removal by conventional
dissection.
After the removal from the caustic soda solution, they were scrubbed
thoroughly with a metal brush to remove softened muscles and ligaments.
The hip bone was immersed in hydrogen peroxide solution for 2 to 3 days.
The hip bone dried in sunlight.
This process was done to ensure that bone was extracted with minimal
tissue so that measurements will be accurate.
25
Figure No 5. Width of GSN(mm) PARAMETERS STUDIED ARE
A - Ischial spine
B - Piriform tubercle or the posterior inferior iliac spine
C - Deepest point in the greater sciatic notch
O - Point where the C meets the AB perpendicularly
The width of greater sciatic notch was measured using digital vernier calipers, other parameters were measured after reconstruction of greater sciatic notch on the paper and measured with help of scale and protractor.
1. Width of the greater sciatic notch (AB)
It is a distance between the ischial spine and the piriform tubercle of ilium .
It can be measured from the posterior inferior iliac spine if piriform tubercle is absent.
26
Figure No.6 Reconstruction of GSN on paper
B
C O
A 2. Depth of the greater sciatic notch( OC)
This is measured after reconstruction of greater sciatic notch on
paper, depth was measured by taking a deepest point on notch (C) and a
perpendicular line drawn to AB.
3. Width of the anterior segment(OA)
The distance between the ischial spine to the point O.
4. Width of the posterior segment(OB)
The distance between the piriform tubercle or the posterior inferior iliac
spine to the point O.
5. Index I= depth / Width x 100.
6. Index II= Anterior segment / Width x100.
7. Index III= Posterior segment / Width x100.
8. Total angle of greater sciatic notch
Construction of the triangle on paper.
Angle is measured with help of protractor.
9. Posterior angle of greater sciatic notch 10. Presence or absence of piriform tubercle 27 Figure No.7 Width of GSN(mm) RADIOLOGICAL STUDY 50 Standard pelvic radiographs Antero posterior view (25 male and 25 female) aged between 18 to 75 years were used for the study. The study was conducted in Barnard Institute of Radiology, Madras Medical College, Chennai 600003. Radiographic measurements were taken by placing X-ray on the illuminator. Measurements were taken using vernier calipers. A marker was used to mark these points for clear visualization. The definition of these measurements were taken from the literature and were selected on the basis of their being good discriminators in previous studies. Point A - ischial spine Point B - piriform tubercle Point C -deepest point in greater sciatic notch Point O - point where the line drawn from the point C meets AB The following parameters were measured 1. Width of the greater sciatic notch(AB) The distance between the point A and point B Measured using vernier calipers 2. Depth of the greater sciatic notch(OC) Perpendicular to the length 28 Figure No.8 Reconstruction of GSN A O C B 3. Width of the anterior segment (AO) The distance between point A and point 4. Width of the posterior segment (OB) The distance between point O and point B 5. Index I Depth (OC) x 100 / width (AB) 6. Index II Anterior segment width (AO) x 100 / width (AB) 7. Index III Posterior segment width (OB) x 100 / width (AB) 29 Figure No 9. Male Hip Bones (RT) Reterived from Cadaver Figure No.10 Male Hip Bones (LT) Reterived from cadaver Figure No.11 Female Hip Bones (RT) Retreived from Cadaver Figure No.12 Female Hip Bones (LT) Retreived from Cadaver Observation OBSERVATIONS The measurements for the study were taken from the cadaveric specimen of dry hip bones and also from the radiographs of pelvis 1. WIDTH OF THE GREATER SCIATIC NOTCH A. MALE The width of GSN in male right and left side were 44.26mm and 43.94mm with standard deviation of 1.85 and 1.85 were observed respectively. Table No 1. WIDTH OF GREATER SCIATIC NOTCH IN MALE MEAN MAXIMUM MINIMUM STANDARD MALE WIDTH WIDTH(mm) WIDTH (mm) DEVIATION (mm) RIGHT SIDE 45.7 42.8 44.26 1.85 LEFT SIDE 45.2 42.7 43.94 1.84 Chart No 1. WIDTH OF GREATER SCIATIC NOTCH IN MALE 50 45.7 45.2 42.8 42.7 44.26 43.94 45 40 35 30 25 mm 20 15 10 5 1.85 1.84 0 MAXIMUM MINIMUM MEAN STANDARD WIDTH OF GSN DEVIATION 30 B. FEMALE The width of GSN of females in right side and left side were 55.21mm and 56.15mm with standard deviation of 4.84 and 4.57 were observed respectively. Table No 2. WIDTH OF GREATER SCIATIC NOTCH IN FEMALE MEAN MAXIMUM MINIMUM STANDARD FEMALE WIDTH WIDTH (mm) WIDTH (mm) DEVIATION (mm) RIGHT SIDE 61.3 47.7 55.21 4.84 LEFT SIDE 61.9 47.8 56.15 4.57 Chart No 2. WIDTH OF GREATER SCIATIC NOTCH IN FEMALE 70 61.3 61.9 55.21 56.15 60 47.7 50 47.8 40 mm 30 RIGHT SIDE 20 LEFT SIDE 4.84 10 4.57 0 MAXIMUM MINIMUM MEAN STANDARD DEVIATION WIDTH OF GSN 31 C.COMPARISON OF THE WIDTH OF GSN Table No 3.WIDTH OF RIGHT SIDE GSN 95% WIDTH (N=10) CONFIDENCE MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN(mm) LOWER UPPER DEVIATION MALE 44.26 1.85 -10.95 -14.39 -7.51 <0.001 FEMALE 55.21 4.84 Table No 4. WIDTH OF LEFT SIDE GSN 95% WIDTH (N=10) CONFIDENCE MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN(mm) LOWER UPPER DEVIATION MALE 43.94 1.68 -12.21 -15.44 -8.98 <0.001 FEMALE 56.15 4.57 ¶Independent Sample T-test Chart No 3. COMPARISON OF THE WIDTH OF GSN 60 55.21 56.15 50 44.26 43.94 40 mm 30 MALE 20 FEMALE 10 0 RIGHT SIDE LEFT SIDE WIDTH OF GSN 32 It is observed that there is There is no significant difference between right and left side for both the sexes. There is significant difference between males and females with mean difference of 12 mm. ‘p’ value was less than 0.001 which is statistically significant, helpful for sex determination. Wider width of GSN was observed in females than in males. 2. DEPTH OF GREATER SCIATIC NOTCH A. MALE The depth of GSN in male of right side and left side were 28.66mm and 26.66mm with standard deviation of 3.79and 5.08 were observed respectively. Table No 5. DEPTH OF GREATER SCIATIC NOTCH IN MALE MAXIMUM MINIMUM MEAN STANDARD MALE DEPTH(mm) DEPTH (mm) DEPTH (mm) DEVIATION RIGHT SIDE 33.1 23 28.86 3.79 LEFT SIDE 35.1 20 26.66 5.08 Chart No 4. DEPTH OF GREATER SCIATIC NOTCH IN MALE 40 33.1 35.1 35 28.86 30 23 26.66 25 20 20 mm 15 MALE RIGHT SIDE 10 3.79 5.08 5 MALE LEFT SIDE 0 MAXIMUM MINIMUM MEAN STANDARD DEVIATION DEPTH OF GSN 33 B. FEMALE The depth of GSN in female right and left side were 30mm and 28.6mm with standard deviation of 4.21 and 4.57 were observed respectively Table No 6. DEPTH OF GREATER SCIATIC NOTCH IN FEMALE MAXIMUM MINIMUM MEAN STANDARD FEMALE DEPTH (mm) DEPTH (mm) DEPTH (mm) DEVIATION RIGHT SIDE 40 25.3 30 4.21 LEFT SIDE 39 26.2 28.6 4.57 Chart No 4: DEPTH OF GREATER SCIATIC NOTCH IN MALE 45 40 39 40 35 30 28.6 30 25.3 26.2 25 mm 20 FEMALE RIGHTSIDE 15 FEMALE LEFT SIDE 10 4.21 4.57 5 0 MAXIMUM MINIMUM MEAN STANDARD DEVIATION DEPTH OF GSN 34 C.COMPARISON OF DEPTH OF GSN Table No 7. DEPTH OF GSN RIGHT SIDE 95% DEPTH (N=10) CONFIDENCE MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN(mm) LOWER UPPER DEVIATION MALE 28.86 3.79 -1.16 -4.92 2.60 0.525 FEMALE 30.02 4.21 ¶Independent Sample T-test Table No 7. DEPTH OF GSN LEFT SIDE 95% DEPTH (N=10) CONFIDENCE MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN(mm) LOWER UPPER DEVIATION MALE 26.66 3.79 -2.00 -4.92 2.60 0.525 FEMALE 28.6 4.21 ¶Independent Sample T-test Chart No 6. COMPARSION OF DEPTH OF GSN 31 30.02 30 28.66 28.6 29 28 26.66 mm 27 MALE FEMALE 26 25 24 RIGHT SIDE LEFT SIDE DEPTH OF GSN 35 It is observed that there is No significant difference between right and left side for both the sexes. Mean difference of 1.16mm was noted between males and females in depth of GSN with no significant difference between them. 3. ANTERIOR SEGMENT OF GREATER SCIATIC NOTCH A. MALE The anterior segment of GSN in right side and left side were 30.99mm and 31.09mm with standard deviation in right and left side were 3.75 and 3.57 respectively Table No 9. ANT SEGMENT OF GREATER SCIATIC NOTCH IN MALE MAXIMUM MINIMUM MEAN ANT STANDARD MALE ANT ANT SEG(mm) DEVIATION SEG(mm) SEG(mm) RIGHT SIDE 36.1 24 30.99 3.75 LEFT SIDE 36.8 26 31.09 3.57 Chart No 7. ANT SEGMENT OF GREATER SCIATIC NOTCH IN MALE 40 36.1 36.8 35 30.99 31.09 30 26 24 25 mm 20 15 MALE RIGHT SIDE 10 3.75 3.57 MALE LEFT SIDE 5 0 MAXIMUM MINIMUM MEAN STANDARD DEVIATION ANT SEGMENT OF GSN 36 B. FEMALE The anterior segment of GSN in female right side and left side were 39.14mm and 39.97mm with standard deviation in right and left side were 4.87 and 4.40 respectively Table No 9. ANT SEGMENT OF GREATER SCIATIC NOTCH IN FEMALE MAXIMUM MINIMUM MEAN ANT STANDARD FEMALE ANT SEG ANT SEG(mm) DEVIATION (mm) SEG(mm) RIGHT SIDE 46.2 30.6 39.14 4.87 LEFT SIDE 46.3 30.6 39.97 4.57 Chart No 8. ANT SEGMENT OF GSN IN FEMALES 50 46.2 46.3 45 39.1439.97 40 35 30.6 30.6 30 mm 25 20 15 10 4.87 4.57 5 0 MAXIMUM MINIMUM MEAN STANDARD DEVIATION ANT SEGMENT OF GSN 37 C. COMPARISON OF ANTERIOR SEGMENT OF GSN Table No.11 ANT SEGMENT OF GSN RIGHT SIDE 95% ANTERIOR SEGMENT CONFIDENCE (N=10) MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN(mm) LOWER UPPER DEVIATION MALE 30.99 3.75 -8.15 -12.23 -4.07 0.001 FEMALE 39.14 4.87 Table No.12 ANT SEGMENT OF GSN LEFT SIDE 95% ANTERIOR SEGMENT CONFIDENCE (N=10) MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN(mm) LOWER UPPER DEVIATION MALE 31.09 3.57 -8.88 -12.64 -5.12 <0.001 FEMALE 39.97 4.40 ¶Independent Sample T-test Chart No 9. COMPARISON OF ANT SEGMENT OF GSN 45 39.14 40 39.97 35 31.09 30.99 30 mm 25 20 MALE 15 FEMALE 10 5 0 RIGHT SIDE LEFT SIDE ANT SEGMENT OF GSN 38 It was observed that There is no significant difference between right and left side of males and females. Mean difference of 8mm is noted between the males and females in the anterior segment of GSN. 4. POSTERIOR SEGMENT OF GREATER SCIATIC NOTCH A. MALE The posterior segment of greater sciatic notch in right and left side were 11.86mm and 11.77mm with standard deviation in right and left side were 1.33 and 1.49 respectively Table No 13. POST SEGMENT OF GREATER SCIATIC NOTCH IN MALE MAXIMUM MINIMUM MEAN POST STANDARD MALE POST POST SEG SEG (mm) DEVIATION SEG(mm) (mm) RIGHT SIDE 14.3 10 11.86 1.33 LEFT SIDE 14.1 10.1 11.77 1.49 Chart No 10.POST SEGMENT OF GSN IN MALE 16 14.3 14.1 14 11.86 11.77 12 10 10.1 10 mm 8 6 MALE RIGHT SIDE 4 MALE LEFT SIDE 1.49 2 1.33 0 MAXIMUM MINIMUM MEAN STANDARD DEVIATION POST SEGMENT OF GSN 39 C. FEMALE The posterior segment of GSN in right side and left side were 16.20mm and 16.18mm with standard deviation in right and left side were 2.59 and 2.64 respectively Table No 14.POST SEGMENT OF GREATER SCIATIC NOTCH IN FEMALE MAXIMUM MINIMUM MEAN POST STANDARD FEMALE POST SEG POST SEG SEG (mm) DEVIATION (mm) (mm) RIGHT SIDE 18.20 10.5 16.20 2.59 LEFT SIDE 19.3 9.9 16.18 2.64 Chart No 11. .POST SEGMENT OF GSN IN FEMALE 25 19.3 20 18.2 16.2 16.18 15 mm 10.5 9.9 10 5 2.59 2.64 0 MAXIMUM MINIMUM MEAN STANDARD DEVIATION POST SEGMENT OF GSN 40 C.COMPARISON OF POSTERIOR SEGMENT OF GSN Table No 15. POST SEGMENT OF GSN RIGHT SIDE 95% POSTERIOR SEGMENT CONFIDENCE (N=10) MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN(mm) LOWER UPPER DEVIATION MALE 11.86 1.33 -4.34 -6.27 -2.41 <0.001 FEMALE 16.20 2.59 Table No 15. POST SEGMENT OF GSN SIDE LEFT SIDE 95% POSTERIOR SEGMENT CONFIDENCE (N=10) MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN(mm) LOWER UPPER DEVIATION MALE 11.77 1.49 -4.41 -6.43 -2.39 <0.001 FEMALE 16.18 2.64 Chart No 12. COMPARISON OF POSTERIOR SEGMENT OF GSN 20 16.2 16.18 15 11.86 11.77 10 mm MALE 5 FEMALE 0 RIGHT SIDE LEFT SIDE POST SEGMENT OF GSN It was observed that There is significant difference between male and females of 4.41mm in posterior segment of GSN. 41 No significant difference between right and left side of post segment of GSN in both males and females. 4. INDEX I OF GREATER SCIATIC NOTCH On calculating the index I using formula Index I= Depth/Widthx100, it was found out in male right and left side is 62.54 and 60.54 with standard deviation of 10.65 1nd 10.95 respectively Table No 17. INDEX I OF GREATER SCIATIC NOTCH IN MALE MAXIMUM MINIMUM MEAN STANDARD MALE INDEX I INDEX I INDEX I DEVIATION RIGHT SIDE 73.7 50.1 62.54 10.65 LEFT SIDE 74.1 49.1 60.54 10.95 Chart No 13. INDEX I OF GREATER SCIATIC NOTCH IN MALE 80 73.7 74.1 70 62.54 60.54 60 50.1 49.1 50 40 30 MALE RIGHT SIDE 20 MALE LEFT SIDE 10.65 10.95 10 0 MAXIMUM MINIMUM MEAN STANDARD DEVIATION INDEX I OF GSN 42 B.FEMALES On calculating the index I using formula Index I= Depth/Widthx100, it was found out in right and left side is 54.09 and 51.51 with standard deviation of 8.95 and 7.11 respectively Table No 18. INDEX I OF GREATER SCIATIC NOTCH IN FEMALE MAXIMUM MINIMUM MEAN STANDARD FEMALE INDEX I INDEX I INDEX I DEVIATION RIGHT SIDE 67 41.5 54.09 8.95 LEFT SIDE 61.4 40.9 51.51 7.11 Chart No.14 INDEX I OF GREATER SCIATIC NOTCH IN FEMALE 80 70 67 61.4 60 54.09 51.51 50 41.5 40.9 40 30 20 8.95 10 7.11 0 MAXIMUM MINIMUM MEAN STANDARD DEVIATION INDEX I OF GSN 43 C.COMPARISON OF INDEX I OF GREATER SCIATIC NOTCH Table No 15. INDEX I OF GSN RIGHT SIDE 95% INDEX I(N=10) CONFIDENCE MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN LOWER UPPER DEVIATION MALE 62.54 10.65 8.45 -0.79 17.69 0.071 FEMALE 54.09 8.95 ¶Independent Sample T-test Table No 16. INDEX I OF GSN LEFT SIDE 95% INDEX I(N=10) CONFIDENCE MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN LOWER UPPER DEVIATION MALE 60.54 10.95 9.03 0.35 17.71 0.042 FEMALE 51.51 7.11 ¶Independent Sample T-test Chart No 15. COMPARISON OF INDEX I OF GREATER SCIATIC NOTCH 70 62.54 60.54 60 54.09 51.51 50 40 30 MALE FEMALE 20 10 0 RIGHT SIDE LEFT SIDE INDEX I OF GSN 44 It is observed that There is no significant difference between right and left sides of Index I of GSN in both sexes. Significant difference is noted between males and females. 6. INDEX II OF GREATER SCIATIC NOTCH A.MALE On calculating the index II using formula Index II= Anterior segment/Widthx100, it was found out in male right and left side is 70.23 and 70.58 with standard deviation of 6.60 and 6.22 respectively Table No 21. INDEX II OF GREATER SCIATIC NOTCH IN MALE MAXIMUM MINIMUM MEAN STANDARD MALE INDEX II INDEX II INDEX II DEVIATION RIGHT SIDE 76.8 66.1 70.23 6.60 LEFT SIDE 77.4 59.3 70.58 6.22 Chart No 16. INDEX II OF GREATER SCIATIC NOTCH IN MALE 90 76.8 77.4 80 70.58 66.1 70.23 70 59.3 60 50 40 MALE RIGHT SIDE 30 MALE LEFT SIDE 20 6.66.22 10 0 MAXIMUM MINIMUM MEAN STANDRAD DEVIATION INDEX II OF GSN 45 B.FEMALE On calculating the index II using formula Index II= Anterior segment/Widthx100, it was found out in right and left side is 70.6 and 71.90 respectively with standard deviation of 5.08 and 5.42 respectively. Table No 22. INDEX II OF GREATER SCIATIC NOTCH IN FEMALE MAXIMUM MINIMUM MEAN STANDARD FEMALE INDEX II INDEX II INDEX II DEVIATION RIGHT SIDE 81.9 62.3 70.60 5.08 LEFT SIDE 82.3 64 71.90 5.42 Chart No 17. INDEX II OF GREATER SCIATIC NOTCH IN FEMALE 90 81.9 82.3 80 70.6 71.9 70 62.3 64 60 50 40 30 20 10 5.08 5.42 0 MAXIMUM MINIMUM MEAN STANDRAD DEVIATION INDEX II OF GSN 46 C.COMPARISON OF INDEX II OF GREATER SCIATIC NOTCH Table No 23. INDEX II OF GSN RIGHT SIDE 95% INDEX II (N=10) CONFIDENCE MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN LOWER UPPER DEVIATION MALE 70.23 6.60 -0.37 -5.91 5.17 0.890 FEMALE 70.60 5.08 Table No 24. INDEX II OF GSN LEFT SIDE 95% INDEX II (N=10) CONFIDENCE MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN LOWER UPPER DEVIATION MALE 70.58 6.22 -1.32 -6.80 4.16 0.619 FEMALE 71.90 5.42 ¶Independent Sample T-test Chart No.18. COMPARISON OF INDEX II OF GREATER SCIATIC NOTCH 72.5 72 71.9 71.5 71 70.6 70.58 MALE 70.5 70.23 FEMALE 70 69.5 69 RIGHT SIDE LEFT SIDE INDEX II OF GSN 47 It is observed that There is no significant difference between right and left side of both sexes. There is no much statistically significant difference between male and female. 7. INDEX III OF GREATER SCIATIC NOTCH A.MALE On calculating the index III using formula Index III= Posterior segment/Widthx100, it was found out in right and left side were 26.83 and 26.82 with standard deviation of 3.54 and 3.75 respectively Table No 25. INDEX III OF GREATER SCIATIC NOTCH IN MALE MAXIMUM MINIMUM MEAN STANDARD MALE INDEX III INDEX III INDEX III DEVIATION RIGHT SIDE 33.7 23.1 26.83 3.54 LEFT SIDE 33.6 22.5 26.82 3.75 Chart no 19. INDEX III OF GSN IN MALE 40 35 33.7 33.6 30 26.8326.82 23.1 25 22.5 20 15 MALE RIGHT SIDE 10 MALE LEFT SIDE 3.54 5 3.75 0 MAXIMUM MINIMUM MEAN STANDARD DEVIATION INDEX III OF GSN 48 B.FEMALE On calculating the index III using formula Index III= Posterior segment /Widthx100,it was found out in right and left side is 29.44 and 29.22 with standard deviation of 5.08 and 4.62 respectively Table No 26. INDEX III OF GREATER SCIATIC NOTCH IN FEMALE MAXIMUM MINIMUM MEAN INDEX STANDARD FEMALE INDEX III INDEX III III DEVIATION RIGHT SIDE 37.9 18.6 29.44 5.08 LEFT SIDE 35.9 17.6 29.22 4.62 Chart No 20. INDEX III OF GSN IN FEMALE 40 37.9 35.9 35 29.4429.22 30 25 20 18.6 17.6 15 10 5.08 4.62 5 0 MAXIMUM MINIMUM MEAN STANDARD DEVIATION INDEX III OF GSN 49 C. COMPARISON OF INDEX III OF GREATER SCIATIC NOTCH Table No 27. INDEX III OF GSN RIGHT SIDE 95% INDEX III (N=10) CONFIDENCE MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN LOWER UPPER DEVIATION MALE 26.83 3.54 -2.61 -6.72 1.50 0.199 FEMALE 29.44 5.08 ¶Independent Sample T-test Table No 28. INDEX III OF GSN LEFT SIDE 95% INDEX III (N=10) CONFIDENCE MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN LOWER UPPER DEVIATION MALE 26.82 3.95 -2.40 -6.46 1.66 0.231 FEMALE 29.22 4.67 Chart no 21.COMPARISON OF INDEX III OF GREATER SCIATIC NOTCH 30 29.44 29.22 29.5 29 28.5 28 27.5 male 27 26.83 26.82 female 26.5 26 25.5 right side left side INDEX III OF GSN 50 It is observed that There is no significant difference between right and left side of both sex Significant difference of 2.5 is noted between males and females 8. TOTAL ANGLE OF GREATER SCIATIC NOTCH A.MALE On construction of triangle, total angle measured in males right and left side were 56.00 and 56.20 degrees with standard deviation of 7.06 and 7.39. Table No 29. TOTAL ANGLE OF GREATER SCIATIC NOTCH IN MALE MAXIMUM MINIMUM MEAN STANDARD MALE TOTAL TOTAL TOTAL DEVIATION ANGLE ANGLE ANGLE RIGHT SIDE 71 48 56.00 7.06 LEFT SIDE 68 49 56.20 7.39 Chart No 22. TOTAL ANGLE OF GREATER SCIATIC NOTCH IN MALE 80 71 68 70 56.2 60 56 48 49 50 40 DEGREE 30 MALE RIGHT SIDE MALE LEFT SIDE 20 7.06 10 7.39 0 MAXIMUM MINIMUM MEAN STANDARD DEVIATION TOTAL ANGLE OF GSN 51 B.FEMALE On construction of triangle, total angle measured in females right and left side were 65.10 and 65.40 degrees with standard deviation of 10.13 and 6.59 respectively. Table No 30. TOTAL ANGLE OF GREATER SCIATIC NOTCH IN FEMALE MAXIMUM MINIMUM MEAN STANDARD FEMALE TOTAL TOTAL TOTAL DEVIATION ANGLE ANGLE ANGLE RIGHT SIDE 88 52 65.10 10.13 LEFT SIDE 79 54 65.40 6.59 Chart No 23. TOTAL ANGLE OF GREATER SCIATIC NOTCH IN FEMALE 100 88 90 79 80 65.1 65.4 70 60 54 DEGREE 52 50 40 30 20 10.13 10 6.59 0 MAXIMUM MINIMUM MEAN STANDARD DEVIATION TOTAL ANGLE OF GSN 52 C. COMPARSION OF TOTAL ANGLE OF GSN Table No 31. TOTAL ANGLE OF GSN RIGHT SIDE 95% CONFIDENCE TOTAL ANGLE (N=10) MEAN INTERVAL GENDER P-VALUE¶ STD. DIFFERENCE MEAN LOWER UPPER DEVIATION MALE 56.00 7.06 -.9.10 -15.34 0.34 0.008 FEMALE 65.10 8.13 ¶Independent Sample T-test Table No 32. TOTAL ANGLE OF GSN LEFT SIDE 95% CONFIDENCE TOTAL ANGLE (N=10) MEAN INTERVAL GENDER P-VALUE¶ STD. DIFFERENCE MEAN LOWER UPPER DEVIATION MALE 56.20 7.39 -9.20 -15.78 -2.62 0.009 FEMALE 65.40 6.59 Chart No 24. COMPARSION OF TOTAL ANGLE OF GSN 68 66 65.1 65.4 64 62 60 58 MALE DEGREE 56 56.2 56 FEMALE 54 52 50 RIGHT SIDE LEFT SIDE TOTAL ANGLE ANGLE OF GSN On observation it was found that Males had narrower angle compared to females 53 9. POSTERIOR ANGLE OF GREATER SCIATIC NOTCH A.MALE On construction of triangle, posterior angle were measured in males right and left side 22 and 24.4 degree with standard deviation of 3.94 and 4.09 respectively. Table No 33. POSTERIOR ANGLE OF GREATER SCIATIC NOTCH IN MALE MAXIMUM MINIMUM MEAN POST STANDARD MALE POST ANGLE POST ANGLE ANGLE DEVIATION RIGHT SIDE 28 17 22 3.94 LEFT SIDE 30 19 24.40 4.09 Chart No 25. POSTERIOR ANGLE OF GREATER SCIATIC NOTCH IN MALE 35 30 30 28 24.4 25 22 19 20 17 15 DEGREE MALE RIGHT SIDE 10 MALE LEFT SIDE 3.94 4.09 5 0 MAXIMUM MINIMUM MEAN STANDRAD DEVIATION POST ANGLE OF GSN 54 B.FEMALE On construction of triangle, posterior angle were measured in females right and left side 65.10 and 65.40 degree with standard deviation of 4.79 and 2.69 respectively Table No 34. POSTERIOR ANGLE OF GREATER SCIATIC NOTCH IN FEMALE MAXIMUM MINIMUM MEAN POST STANDARD FEMALE POST ANGLE POST ANGLE ANGLE DEVIATION RIGHT SIDE 39 25 30.9 4.79 LEFT SIDE 36 29 32.10 2.69 Chart No 26. POSTERIOR ANGLE OF GREATER SCIATIC NOTCH IN FEMALE 45 39 40 36 35 30.9 32.1 29 30 25 25 20 DEGREE 15 10 4.79 5 2.69 0 MAXIMUM MINIMUM MEAN STANDRAD DEVIATION POST ANGLE OF GSN 55 C. COMPARISON Table No 35. POST ANGLE OF GSN RIGHT SIDE POSTERIOR ANGLE 95% CONFIDENCE (N=10) MEAN INTERVAL GENDER P-VALUE¶ STD. DIFFERENCE MEAN LOWER UPPER DEVIATION MALE 22.00 3.94 -8.90 -13.02 -4.78 <0.001 FEMALE 30.90 4.79 ¶Independent Sample T-test Table No 36. POST ANGLE OF GSN LEFT SIDE POSTERIOR ANGLE 95% CONFIDENCE (N=10) MEAN INTERVAL GENDER P-VALUE¶ STD. DIFFERENCE MEAN LOWER UPPER DEVIATION MALE 24.40 4.09 -7.70 -10.95 -4.45 <0.001 FEMALE 32.10 2.69 ¶Independent Sample T-test Chart No 28. COMPARISON OF POSTERIOR ANGLE OF GSN 35 30.9 32.1 30 24.4 25 22 20 15 MALE DEGREE 10 FEMALE 5 0 RIGHT SIDE LEFT SIDE POST ANGLE OF GSN It is observed that There is significant difference between right and left side of both sex Significant difference of 8 degree is noted between males and females 56 10. PRESENCE OR ABSENCE OF PIRIFORM TUBERCLE Table No 37. PRESENCE OR ABSENCE OF PIRIFORM TUBERCLE RIGHT SIDE P- PRESENCE OR ABSENCE GENDER TOTAL VALUE OF PIRIFORM TUBERCLE MALE FEMALE ¶ YES 5(50%) 4(40%) 9(45%) NO 5(50%) 6(60%) 11(55%) 0.999 TOTAL 10(100%) 10(100%) 20(100%) ¶Chi-Square test Table No 38. PRESENCE OR ABSENCE OF PIRIFORM TUBERCLE RIGHT SIDE P- PRESENCE OR ABSENCE GENDER TOTAL VALUE OF PIRIFORM TUBERCLE MALE FEMALE ¶ YES 5(50%) 4(40%) 9(45%) NO 5(50%) 6(60%) 11(55%) 0.999 TOTAL 10(100%) 10(100%) 20(100%) ¶Chi-Square test Chart No29. PRESENCE OR ABSENCE OF PIRIFORM TUBERCLE 12 10 10 10 10 10 8 6 Yes 4 No PERCENTAGE 2 0 male female PIRIFORM TUBERCLE 57 RADIOLOGICAL MEASUREMENTS 1. WIDTH OF GREATER SCIATIC NOTCH A.MALE On observing the measurements of greater sciatic notch in X-ray of pelvis, it was found that the width of the notch in male right and left side is 44.4mm and 44.4mm respectively. Table No 39. WIDTH OF GREATER SCIATIC NOTCH IN MALE MAXIMUM MINIMUM MEAN STANDARD MALE WIDTH(mm) WIDTH (mm) WIDTH (mm) DEVIATION RIGHT SIDE 44.4 39.1 41.28 1.64 LEFT SIDE 44.4 39.2 41.41 1.50 Chart No 30. WIDTH OF GREATER SCIATIC NOTCH IN MALE 50 44.4 44.4 45 41.28 41.41 39.1 39.2 40 35 30 25 mm 20 MALE RIGHT SIDE 15 MALE LEFT SIDE 10 5 1.641.5 0 MAXIMUM MINIMUM MEAN STANDARD DEVIATION WIDTH OF GSN 58 B.FEMALE On observing the measurements of greater sciatic notch in X-ray of pelvis, it was found that the width of the notch in right and left side is 54.53mm and 54.60mm with standard deviation of 2.26 and 2.13 respectively Table No 40. WIDTH OF GREATER SCIATIC NOTCH IN FEMALE MEAN MAXIMUM MINIMUM STANDARD FEMALE WIDTH WIDTH (mm) WIDTH (mm) DEVIATION (mm) RIGHT SIDE 57.3 48.4 54.53 2.26 LEFT SIDE 57.2 49.4 54.60 2.13 Chart No-31. WIDTH OF GREATER SCIATIC NOTCH IN FEMALE 70 60 57.3 57.2 54.53 54.6 48.4 49.4 50 40 mm 30 RIGHT SIDE 20 LEFT SIDE 10 2.262.13 0 MAXIMUM MINIMUM MEAN STANDARD DEVIATION WIDTH OF GSN 59 C.COMPARISON OF WIDTH OF GSN Table No 41. WIDTH OF G SN RIGHT SIDE 95% WIDTH (N=25) CONFIDENCE MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN(mm) LOWER UPPER DEVIATION MALE 41.28 1.64 -13.25 -14.38 -12.13 <0.001 FEMALE 54.53 2.26 ¶Independent Sample T-test Table No 42. WIDTH OF GSN LEFT SIDE 95% WIDTH (N=25) CONFIDENCE MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN(mm) LOWER UPPER DEVIATION MALE 41.41 1.50 -13.19 -14.24 -12.14 <0.001 FEMALE 54.60 2.13 ¶Independent Sample T-test Chart No-32. COMPARISON OF WIDTH OF G SN 60 54.53 54.6 50 41.28 41.41 40 30 mm MALE 20 FEMALE 10 0 RIGHT SIDE LEFT SIDE WIDTH OF GSN It is observed that There is no difference between the right and left side of both sex 60 There is significant difference between the width of both males and females When comparing the bone and radiological study, there is significant difference in width between males and female in both studies. 2. DEPTH OF GREATER SCIATIC NOTCH A.MALE On observing the measurements of greater sciatic notch in X-ray of pelvis, it was found that the depth of the notch in male right and left side is 25.13mm and 25.75mm with standard deviation of 0.60 and 1.16respectively Table No 43. DEPTH OF GREATER SCIATIC NOTCH IN MALE MAXIMUM MINIMUM MEAN STANDARD MALE DEPTH (mm) DEPTH (mm) DEPTH (mm) DEVIATION RIGHT SIDE 26.3 24.2 25.18 0.60 LEFT SIDE 26.2 24.2 24.75 1.16 Chart No33. DEPTH OF GREATER SCIATIC NOTCH IN MALE 30 26.3 26.2 25.75 24.2 24.2 25.18 25 20 mm 15 MALE RIGHT SIDE 10 MALE LEFT SIDE 5 0.61.16 0 MAXIMUM MINIMUM MEAN STANDARD DEVIATION DEPTH OF GSN 61 B.FEMALE On observing the measurements of greater sciatic notch in X-ray of pelvis, it was found that the depth of the notch in right and left side were 26.6mm and 26.75mmwith standard deviation of 1.28 and 1.16 respectively. Table No 44. DEPTH OF GREATER SCIATIC NOTCH IN FEMALE MAXIMUM MINIMUM MEAN STANDARD FEMALE DEPTH (mm) DEPTH (mm) DEPTH (mm) DEVIATION RIGHT SIDE 28.5 23.3 26.6 1.28 LEFT SIDE 28.5 24.4 26.75 1.16 Chart No34. DEPTH OF GREATER SCIATIC NOTCH IN MALE 30 28.5 28.5 26.75 26.6 24.4 25 23.3 20 15 mm FEMALE RIGHTSIDE 10 FEMALE LEFT SIDE 5 1.28 1.16 0 MAXIMUM MINIMUM MEAN STANDARD DEVIATION DEPTH OF GSN 62 D. COMPARISON OF DEPTH OF GSN Table No 45. DEPTH OF GSN RIGHT SIDE 95% DEPTH (N=25) CONFIDENCE MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN(mm) LOWER UPPER DEVIATION MALE 25.18 0.60 -1.42 -1.99 -0.85 <0.001 FEMALE 26.60 1.28 ¶Independent Sample T-test Table No 46. DEPTH OF GSN LEFT SIDE 95% DEPTH (N=25) CONFIDENCE MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN(mm) LOWER UPPER DEVIATION MALE 25.15 0.59 -1.60 -2.13 -1.08 <0.001 FEMALE 26.75 1.16 Chart No 35 .COMPARISON OF DEPTH OF GSN 27 26.75 26.6 26.5 26 25.5 mm 25.18 25.15 MALE 25 FEMALE 24.5 24 RIGHT SIDE LEFT SIDE DEPTH OF GSN 63 It was observed that There is no significant difference between right and left side of both sexes. There is no much significant difference between males and females in both bone and radiological study. 3. ANTERIOR SEGMENT OF GREATER SCIATIC NOTCH A.MALE On observing the measurements of greater sciatic notch in X-ray of pelvis, it was found that the anterior segment of the notch in right and left side is 26.2mm and 26.22mm with standard deviation of 1.75 and 1.59 respectively Table No 47. ANT SEGMENT OF GREATER SCIATIC NOTCH IN MALE MAXIMUM MINIMUM MEAN ANT STANDARD MALE ANT ANT SEG SEG (mm) DEVIATION SEG(mm) (mm) RIGHT SIDE 29.9 23.4 26.20 1.75 LEFT SIDE 29.9 23.8 26.22 1.59 Chart No 36. ANT SEGMENT OF GREATER SCIATIC NOTCH IN MALE 35 29.9 29.9 30 26.2 26.22 23.8 25 23.4 20 mm 15 MALE RIGHT SIDE 10 MALE LEFT SIDE 5 1.75 1.59 0 MAXIMUM MINIMUM MEAN STANDARD DEVIATION ANT SEGMENT OF GSN 64 B.FEMALE On observing the measurements of GSN in X-ray of pelvis, it was found that the Ant segment of the notch in right and left side were 26.15mm and 26.22mm with standard deviation of 2.44 and 2.21 respectively Table No 48. ANT SEGMENT OF GREATER SCIATIC NOTCH IN FEMALE MAXIMUM MINIMUM MEAN ANT STANDARD FEMALE ANT SEG ANT SEG SEG (mm) DEVIATION (mm) (mm) RIGHT SIDE 28.6 24.4 26.15 2.44 LEFT SIDE 28.7 19 26.22 2.21 Chart No 36. ANT SEGMENT OF GREATER SCIATIC NOTCH IN FEMALE 35 30 28.6 28.7 26.1526.22 24.4 25 20 19 mm 15 10 5 2.44 2.21 0 MAXIMUM MINIMUM MEAN STANDRAD DEVIATION ANT SEGMENT OF GSN 65 E. COMPARISON OF ANTERIOR SEGMENT OF GREATER SCIATIC NOTCH Table No 49. ANT SEGMENT OF GSN RIGHT SIDE 95% ANTERIOR SEGMENT CONFIDENCE (N=25) MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN(mm) LOWER UPPER DEVIATION MALE 26.20 1.75 0.05 -1.16 1.26 0.931 FEMALE 26.15 2.44 ¶Independent Sample T-test Table No 50. ANT SEGMENT OF GSN LEFT SIDE 95% ANTERIOR SEGMENT CONFIDENCE (N=25) MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN(mm) LOWER UPPER DEVIATION MALE 26.22 1.59 0.50 -1.09 1.10 0.994 FEMALE 26.72 2.21 ¶Independent Sample T-test Chart No 37. COMPARISON OF ANT SEGMENT OF GSN 26.8 26.72 26.7 26.6 26.5 26.4 mm 26.3 26.2 26.22 MALE 26.2 26.15 FEMALE 26.1 26 25.9 25.8 RIGHT SIDE LEFT SIDE ANT SEGMENT OF GSN 66 It was observed that There is no significant difference between right and left side of both sexes. There is no significant difference between males and females. 4. POSTERIOR SEGMENT OF GREATER SCIATIC NOTCH A.MALE On observing the measurements of GSN in X-ray of pelvis, it was found that the posterior segment of the notch in right and left side is 15.08mm and 15.19mm with standard deviation of 0.54 and 0.52 respectively. Table No 51. POSTERIOR SEGMENT OF GREATER SCIATIC NOTCH IN MALE MAXIMUM MINIMUM MEAN POST STANDARD MALE POST POST SEG SEG (mm) DEVIATION SEG(mm) (mm) RIGHT SIDE 16.2 14.2 15.08 0.54 LEFT SIDE 16.4 14.5 15.19 0.52 Chart No 38. POST SEGMENT OF GREATER SCIATIC NOTCH IN MALE 18 16.2 16.4 15.19 16 14.2 14.5 15.08 14 12 10 mm 8 MALE RIGHT SIDE 6 4 MALE LEFT SIDE 2 0.54 0.52 0 MAXIMUM MINIMUM MEAN STANDARD DEVIATION POST SEGMENT OF GSN 67 B.FEMALE On observing the measurements of GSN in X-ray of pelvis, it was found that the posterior segment of the notch in male right and left side were 26.38mm and 26.37mm with standard deviation of 0.99 and 0.89 respectively. Table No 52. POSTERIOR SEGMENT OF GREATER SCIATIC NOTCH IN FEMALE MAXIMUM MINIMUM MEAN POST STANDARD FEMALE POST SEG POST SEG SEG (mm) DEVIATION (mm) (mm) RIGHT SIDE 29.9 23 28.38 0.99 LEFT SIDE 29.6 26.5 28.37 0.89 Chart No 39. POSTERIOR SEGMENT OF GREATER SCIATIC NOTCH IN FEMALE 35 29.9 29.6 30 28.38 28.37 26.5 25 23 20 mm 15 10 5 0.99 0.89 0 MAXIMUM MINIMUM MEAN STANDRAD DEVIATION POST SEGMENT OF GSN 68 C. COMPARISON OF POSTERIOR SEGMENT OF GSN Table No 53. POST SEGMENT OF GSN RIGHT SIDE 95% POSTERIOR SEGMENT CONFIDENCE (N=25) MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN(mm) LOWER UPPER DEVIATION MALE 15.08 0.54 -13.30 -13.76 -12.85 <0.001 FEMALE 28.38 0.99 ¶Independent Sample T-test Table No 54. POST SEGMENT OF GSN LEFT SIDE 95% POSTERIOR SEGMENT CONFIDENCE (N=25) MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN(mm) LOWER UPPER DEVIATION MALE 15.19 0.52 -13.18 -13.60 -12.77 <0.001 FEMALE 28.37 0.89 ¶Independent Sample T-test Chart No 40. COMPARISON OF POST SEGMENT OF GSN 30 28.38 28.37 25 20 15.08 15.19 15 mm MALE 10 FEMALE 5 0 RIGHT SIDE LEFT SIDE POST SEGMENT OF GSN 69 It was observed that There is no significant difference between the right and left side of both sexes. There is significant difference between males and females in both bone and radiological study. 5. INDEX I OF GREATER SCIATIC NOTCH On calculating the index I using formula Index I= Depth/Widthx100, it was found out in male right and left side is 61.06 and 60.77 respectively with standard deviation of 5.13 and 5.00 respectively Table No 55. INDEX I OF GREATER SCIATIC NOTCH IN MALE MAXIMUM MINIMUM MEAN STANDARD MALE INDEX I INDEX I INDEX I DEVIATION RIGHT SIDE 66.9 55.8 61.06 5.13 LEFT SIDE 66.3 56.4 60.77 5.00 Chart No 41. INDEX I OF GREATER SCIATIC NOTCH IN MALE 80 70 66.9 66.3 61.06 60.77 60 55.8 56.4 50 40 30 MALE RIGHT SIDE 20 MALE LEFT SIDE 10 5.13 5 0 MAXIMUM MINIMUM MEAN STANDARD DEVIATION INDEX I OF GSN 70 B.FEMALE On calculating the index I using formula Index I= Depth/Widthx100, it was found out in male right and left side is 49.87 and 49.08 with standard deviation of 5.99 and 3.5 respectively Table no 56. INDEX I OF GREATER SCIATIC NOTCH IN FEMALE MAXIMUM MINIMUM MEAN STANDARD FEMALE INDEX I INDEX I INDEX I DEVIATION RIGHT SIDE 55.3 40.6 49.87 5.99 LEFT SIDE 57.7 43.6 49.08 3.5 Chart no 42. INDEX I OF GREATER SCIATIC NOTCH IN FEMALE 70 57.7 60 55.3 49.8749.08 50 43.6 40.6 40 30 20 5.99 10 3.5 0 MAXIMUM MINIMUM MEAN STANDARD DEVIATION INDEX I OF GSN 71 C. COMPARISON OF INDEX I OF GSN Table No 57. INDEX I OF GSN RIGHT SIDE 95% INDEX I (N=25) CONFIDENCE MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN LOWER UPPER DEVIATION MALE 61.06 3.13 11.19 8.48 13.91 <0.001 FEMALE 49.87 5.99 ¶Independent Sample T-test Table No 58. INDEX I OF GSN LEFT SIDE 95% INDEX I (N=25) CONFIDENCE MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN LOWER UPPER DEVIATION MALE 60.77 3.00 11.70 9.97 13.42 <0.001 FEMALE 49.08 3.05 ¶Independent Sample T-test Chart no 43. COMPARISON OF INDEX I OF GSN 70 61.06 60.77 60 49.87 49.08 50 40 30 MALE FEMALE 20 10 0 RIGHT SIDE LEFT SIDE INDEX I OF GSN 72 It was observed that There is no significant difference between right and left side of both sex There is significant difference between males and females, less in females in both bone and radiological study 6. INDEX II OF GREATER SCIATIC NOTCH A.MALE On calculating the index II using formula Index II= Anterior segment/Widthx100, it was found out in male right and left side is 63.36 and 63.24 with standard deviation of 1.98 and 1.82 respectively Table No 44. INDEX II OF GREATER SCIATIC NOTCH IN MALE MAXIMUM MINIMUM MEAN STANDARD MALE INDEX II INDEX II INDEX II DEVIATION RIGHT SIDE 67.6 59.6 63.36 1.98 LEFT SIDE 66.6 60.2 63.24 1.82 Chart No 45. INDEX II OF GREATER SCIATIC NOTCH IN MALE 80 67.6 66.6 70 63.24 59.6 60.2 63.36 60 50 40 MALE RIGHT SIDE 30 MALE LEFT SIDE 20 10 1.98 1.82 0 MAXIMUM MINIMUM MEAN STANDARD INDEX II OF GSN DEVIATION 73 B.FEMALE On calculating the index II using formula Index II=anterior segment/Widthx100, it was found out in female right and left side is 47.82 and 47.89 with standard deviation of 2.87 and 2.45 respectively Table No 60. INDEX II OF GREATER SCIATIC NOTCH IN FEMALE MAXIMUM MINIMUM MEAN STANDARD FEMALE INDEX II INDEX II INDEX II DEVIATION RIGHT SIDE 52.8 44.5 47.82 2.87 LEFT SIDE 51.1 41.3 47.89 2.45 Chart No 46. INDEX II OF GREATER SCIATIC NOTCH IN FEMALE FEMALE-RIGHT AND LEFT SIDE 60 52.8 51.1 47.8247.89 50 44.5 41.3 40 30 20 10 2.87 2.45 0 MAXIMUM MINIMUM MEAN STANDRAD DEVIATION INDEX II OF GSN 74 C. COMPARISON OF INDEX II OF GSN Table No 61. INDEX II OF GSN RIGHT SIDE 95% INDEX II (N=25) CONFIDENCE MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN LOWER UPPER DEVIATION MALE 63.36 1.98 15.54 14.14 16.94 <0.001 FEMALE 47.82 2.87 ¶Independent Sample T-test Table No 62. INDEX II OF GSN LEFT SIDE 95% INDEX II (N=25) CONFIDENCE MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN LOWER UPPER DEVIATION MALE 63.24 1.82 15.35 14.12 16.58 <0.001 FEMALE 47.89 2.45 ¶Independent Sample T-test Chart No 47. COMPARISON OF INDEX II OF GSN 70 63.36 63.24 60 47.82 47.89 50 40 MALE 30 FEMALE 20 10 0 RIGHT SIDE LEFT SIDE INDEX II OF GSN It was observed that There is no significant difference between right and left side of both sexes. Significant difference is noted between male and female with mean difference of 15 in the Index II of GSN. 75 7. INDEX III OF GREATER SCIATIC NOTCH A.MALE On calculating the index III using formula Index III= Posterior segment/Widthx100, it was found out in right and left side is 36.54 and 36.52 with standard deviation of 1.98 and 2.07 respectively Table No 63. INDEX III OF GREATER SCIATIC NOTCH IN MALE MAXIMUM MINIMUM MEAN STANDARD MALE INDEX III INDEX III INDEX III DEVIATION RIGHT SIDE 38.5 32.8 36.54 1.98 LEFT SIDE 39.5 33.3 36.52 2.07 Chart No 47. INDEX III OF GREATER SCIATIC NOTCH IN MALE 45 38.5 39.5 40 36.54 36.52 32.8 35 33.3 30 25 20 MALE RIGHT SIDE 15 MALE LEFT SIDE 10 1.98 5 2.07 0 MAXIMUM MINIMUM MEAN STANDARD DEVIATION INDEX III OF GSN B.FEMALE On calculating the index III using formula Index III= Posterior segment/Widthx100, it was found out in female right and left side is 52.06 and 51.99 with standard deviation of 2.89 and 2.49 respectively 76 Table No 64. INDEX III OF GREATER SCIATIC NOTCH IN FEMALE MAXIMUM MINIMUM MEAN STANDARD FEMALE INDEX III INDEX III INDEX III DEVIATION RIGHT SIDE 55.6 47.1 52.05 2.89 LEFT SIDE 55.4 48.7 51.99 2.49 Chart No 48. INDEX III OF GREATER SCIATIC NOTCH IN FEMALE 60 55.6 55.4 52.05 51.99 48.7 50 47.1 40 30 20 10 2.89 2.49 0 MAXIMUM MINIMUM MEAN STANDRAD DEVIATION INDEX III OF GSN C. COMPARISON OF INDEX III OF GSN Table No 65. INDEX III OF GSN RIGHT SIDE 95% INDEXIII (N=25) CONFIDENCE MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN LOWER UPPER DEVIATION MALE 36.54 1.98 -15.51 -16.92 -14.10 <0.001 FEMALE 52.05 2.89 ¶Independent Sample T-test 77 Table No 66. INDEX III OF GSN LEFT SIDE 95% INDEXIII (N=25) CONFIDENCE MEAN P- GENDER INTERVAL DIFFERENCE VALUE¶ STD. MEAN LOWER UPPER DEVIATION MALE 36.52 2.07 -15.47 -16.77 -14.17 <0.001 FEMALE 51.99 2.49 ¶Independent Sample T-test Chart No 49. COMPARISON OF INDEX III OF GSN 60 52.05 51.99 50 36.54 36.52 40 30 MALE 20 FEMALE 10 0 RIGHT SIDE LEFT SIDE INDEX III OF GSN It was observed that There is no significant difference between right and left side of both sexes. There is significant difference between males and females was noted with mean difference of 15 in both bone and radiological study for Index III of GSN. 78 Discussion DISCUSSION The findings of the present study were compared with findings of other similar studies conducted in different parts in India and in other countries. BONE STUDY 1. WIDTH OF GREATER SCIATIC NOTCH 1) Rajashree Sheelawant Raut et al35 (2013) found that the mean width of GSN in males and females were 35.72mm and 43.5mm respectively. 2) Suma Dnyanesh et al43 (2013) observed that the mean width of GSN in male and female were 39.61mm and 47.1 mm respectively. 3) Sanjeev Kumar Jain et al37 (2013) stated that the mean width of GSN in males and females were 33.8mm and 45mm respectively. 4) Apoorva Tripathi et al3 (2014) stated that the mean width of GSN in males and females were 44.75 mm and 55.6 mm respectively. Table No 67. WIDTH OF GREATER SCIATIC NOTCH MEAN SAMPLE MALE FEMALE STUDY POPULATION DIFFERENCEOF SIZE (mm) (mm) WIDTH(mm) Rajashree 1. Sheelawant 183 Aurangabad 35.72 43.5 7.78 Raut et al (2013) Suma 2. Dnyanesh et 100 Karnataka 39.615 47.1 7.49 al (2013) Sanjeev 3. Kumar Jain et 46 Moradabad 33.8 45 11.2 al (2013) Apoorva 4. Tripathi et al 100 Haryana 44.75 48.38 3.55 (2014) PRESENT 5. 40 Tamil Nadu 44.1 55.68 11.5 STUDY 79 Chart No 50. WIDTH OF GREATER SCIATIC NOTCH 60 55.68 47.165 48.38 50 43.5 45 44.75 44.1 39.61 40 35.72 33.8 30 mm 20 MALE FEMALE 10 0 Rajashree suma Sanjeev Apoorva present Sheelawant dnyanesh et Kumar Jain tripathi et al study(2018) Raut et al al (2013) et al (2013) (2014) (2013) WIDTH OF GSN In the present study, there is mean difference of 11.2mm in the width of GSN found between males and females which correlate with Sanjeev Kumar Jain study in Moradabad population. ‘p’ value of width of GSN was found to be less than 0.001 which was extremely statistically significant. The width of the greater sciatic notch was more in females in previous studies. Wider female pelvis accounts for more width because of child bearing nature. Thus, this important parameter may be solely and commonly may be used for sex determination. 80 2. DEPTH OF GREATER SCIATIC NOTCH 1) Shamer Singh et al40 (1978) found that the mean depth in males and females were 25.77mm and 25.39mm respectively. 2) Suma Dnyanesh et al43 (2013) observed that the mean depth of GSN in males and females were 32.03mm and 33.90mm respectively. 3) Sanjeev Kumar Jain et al37 (2013) found that the mean depth of GSN in males and females were 26.05mm and 24.45mm respectively. 4) Apoorva Tripathi et al3 (2014) stated that the mean depth of GSN in males and females were 26.27mm and 25.38mm respectively. Table No 68. DEPTH OF GREATER SCIATIC NOTCH SAMPLE MALE FEMALE MEAN STUDY POPULATION SIZE (mm) (mm) Difference) Shamer Singh 1. 200 North Indian 25.77 25.39 0.38 et al (1978) Suma 2. Dnyanesh et al 100 Karnataka 32.03 33.90 1.87 (2013) Sanjeev 3. Kumar Jain et 46 Moradabad 26.05 24.45 1.65 al (2013) Apoorva 4. Tripathi et al 100 Haryana 26.27 25.38 0.89 (2014) PRESENT 5. 40 Tamil Nadu 28.91 30.41 1.5 STUDY(2018) 81 Chart No 51. DEPTH OF GREATER SCIATIC NOTCH 33.9 30.41 35 32.03 25.39 24.45 25.38 28.91 30 25.77 26.05 26.27 25 20 mm 15 male 10 female 5 0 Shamer Singh Suma Sanjeev Apoorva PRESENT et al (1978) Dnyanesh et Kumar Jain et tripathi et al STUDY(2018) al (2013) al (2013) (2014) DEPTH OF GSN In this present study there was mean difference of 1.5mm in depth of GSN between males and females which correlates with Sanjeev Kumar Jain study There is no much difference between the depth of GSN between males and females. This parameter is useful for sex determination but less reliability. 3. ANTERIOR SEGMENT OF GREATER SCIATIC NOTCH Table No 69. ANTERIOR SEGMENT OF GREATER SCIATIC NOTCH SAMPLE MEAN STUDY POPULATION MALE FEMALE SIZE DIFFERNCE PRESENT 1. STUDY 40 Tamil Nadu 31.49 39.55 8.06 (2018) 82 Chart No 52. ANTERIOR SEGMENT OF GREATER SCIATIC NOTCH 39.55 40 31.49 30 mm male 20 female 10 0 PRESENT STUDY(2018) ANT SEGMENT OF GSN There is statistically significant difference between males and females with mean difference of 8.06mm in the anterior segment of GSN was found, thus, this parameter can be used for sex determination. 4. POSTERIOR SEGMENT OF GREATER SCIATIC NOTCH 1) Shamer Singh et al40 (1978) found that the mean width of posterior segment of GSN in males and females were 6.22mm and 15.98mm respectively. 2) Shiaval Shah et al38 (2011) observed that that the mean width of posterior segment of GSN measured in males and females were 6.83mm and 12.48mm respectively. 3) Suma Dnyanesh et al43 (2013) stated that the mean width of posterior segment of GSN in males and females were 11.23mm and 21.77mm respectively. 4) Rajashree Sheelawant Raut et al 35(2013) found that the mean width of posterior segment of GSN was 8.92 mm in male and 17.93 mm in females. 5) Apoorva Tripathi et al3 (2014) stated that that the mean width of posterior segment of GSN in males and females were 6.22mm and 15.94mm respectively. 83 TABLE No 70. POSTERIOR SEGMENT OF GREATER SCIATIC NOTCH SAMPLE MALE FEMALE MEAN STUDY POPULATION SIZE (mm) (mm) DIFFERENCE Shamer Singh 1. 200 North Indian 6.22 15.98 9.76 et al (1978) Shiaval shah 2. 268 Gujarat 6.83 12.48 5.65 et al ( 2011) Suma 3. Dnyanesh et al 100 Karnataka 11.23 21.77 10.54 (2013) Rajashree Sheelawant 4. 183 Aurangabad 8.92 17.93 9.01 Raut et al (2013) Apoorva 5. Tripathi et al 100 Haryana 6.22 15.94 9.72 (2014) PRESENT 6. 40 Tamil Nadu 11.81 16.2 4.39 STUDY(2018) Chart No 53. POSTERIOR SEGMENT OF GREATER SCIATIC NOTCH 25 21.77 17.93 20 15.98 15.94 16.2 15 12.48 11.82 mm 11.23 8.92 10 6.22 6.83 6.22 male 5 female 0 Shamer Shiaval shah Suma Rajashree Apoorva PRESENT Singh et al et al ( 2011) Dnyanesh et Sheelawant tripathi et al STUDY(2018) (1978) al (2013) Raut et al (2014) (2013) POST SEGMENT OF GSN In the present study of posterior segment of GSN, there was mean difference of 4.39mm between males and females was found which correlates with the Shiaval Shah et al study There is mean difference of 4mm to 11mm in the post segment of GSN between males and females in other studies 84 Posterior segment of GSN is more in females than in males in the previous studies conducted on GSN. Thus, this parameter is extremely useful for sex determination. 5. INDEX I OF GSN 1. Hideo Takahashi et al44 (1959) observed that Index I of GSN for males and females were 48.15 and 58.22 respectively. 2. Shamer Singh40 (1978) stated that the Index I of GSN for males and females were 64.8 and 53.33 respectively. 3. Shival Shah et al38 (2011) found that the Index I of GSN in males and females were 63.48 and 52.54 respectively. 4. Gohil Dilip et al14 (2013) stated that the mean Index I of GSN for male and females were 67.95 and 58.93 respectively. 5. Apoorva Tripathi et al3 (2014) stated that the Index I of GSN for males and females were 64.78 and 53.66 respectively. Table No 71. INDEX I OF GREATER SCIATIC NOTCH SAMPLE STUDY POPULATION MALE FEMALE DIFFERENCE SIZE Hideo Takahashi et 1. 165 Japanese 48.25 58.2 9.95 al (1959) 2. Shamer Singh et al 200 North Indian 64.8 53.33 11.5 (1978) Shival shah et al 3. 268 Gujarat 63.48 52.54 11.24 ( 2011) Gohil Dilip et al 4. 108 Gujarat 67.95 58.93 9.02 (2013) Apoorva Tripathi 5. 100 Haryana 64.78 53.66 11.12 et al (2014) PRESENT 6. 40 Tamil Nadu 61.54 52.8 8.74 STUDY(2018) 85 Chart No 54. INDEX I OF GREATER SCIATIC NOTCH 80 67.95 64.8 63.48 64.78 58.2 61.54 58.93 53.66 52.8 60 48.25 53.33 52.54 40 male 20 female 0 Hideo Shamer Singh Shiaval shah Gohil Dilip et Apoorva PRESENT Takahashi et et al (1978) et al ( 2011) al (2013) tripathi et al STUDY(2018) al (1959) (2014) INDEX I OF GSN In the present study of Index I of GSN, there is statistically significant difference between males and females which was 8.74 and correlates with Ghoul Deli et al study. There is significant difference of 8 to 12 noted in the Index I of GSN between males and females useful for sex determination. 6. INDEX II OF GSN Table No 72. INDEX II OF GREATER SCIATIC NOTCH SAMPLE MEAN STUDY POPULATION MALE FEMALE SIZE DIFFERNCE PRESENT 1. 40 Tamil Nadu 70.40 71.25 0.85 STUDY(2018) 86 Chart No 55. INDEX II OF GREATER SCIATIC NOTCH 71.25 71.4 71.2 71 70.8 70.4 male 70.6 female 70.4 70.2 70 69.8 PRESENT STUDY(2018) INDEX II OF GSN In the present study, there is mean difference of 0.85 in Index II of GSN between males and females which was statistically insignificant. 7. INDEX III OF GSN 1. Shiaval shah et al38 (2011) stated that the Index III of GSN in males and females were 17.52 and 29.14 respectively. 2. Gohil Dilip et al14 (2013) found that the mean Index III in males and females were 30.22 and 42.14 respectively. Table No 73. INDEX III OF GREATER SCIATIC NOTCH SAMPLE STUDY POPULATION MALE FEMALE DIFFERENCE SIZE Shiva shah et 1. 268 Gujarat 17.52 29.14 11.62 al ( 2011) Gohil Dilip et 2. 108 Gujarat 30.22 42.14 11.92 al (2013) PRESENT 3. 40 Tamil Nadu 26.52 29.33 2.81 STUDY(2018) 87 Chart No 56. INDEX III OF GREATER SCIATIC NOTCH 50 42.14 40 30.22 29.33 29.14 26.525 30 17.52 male 20 female 10 0 Shiaval shah et al Gohil Dilip et al PRESENT ( 2011) (2013) STUDY(2018) INDEX III OF GSN In the present study, there is mean difference of 2.81 in Index III was found between males and females which will be useful for sex determination. 8.TOTAL ANGLE OF GREATER SCIATIC NOTCH 1. Shiaval Shah et al38 (2011) stated that the total angle of GSN for males and females were 69.45 and 82.85 respectively. 2. Abhishek Prasad Sinha ET al41 (2013) observed that the total angle of GSN in males and females were 51.47and 68.43 degrees respectively. 3. Rajashree Sheelawant Raut et al35 (2013) stated that the total angle of GSN in males and females were 62.91 and 79.93 degrees respectively. 4. Krupa Daniel et al24 (2014) observed that the total angle of GSN in males and females were 71 and 74 degrees respectively. 88 Table No 74. TOTAL ANGLE OF GREATER SCIATIC NOTCH SAMPLE POPULA MALE FEMALE STUDY DIFFERENCE SIZE TION (DEGREE) (DEGREE) Shival shah et al ( 69.45 1. 268 Gujarat 82.85 13.4 2011) Abhishek Prasad Bansbishn 2. 154 51.47 68.43 16.96 Sinha et al(2013) upur Rajashree Aurangab 3. Sheelawant Raut 183 62.91 79.93 17.02 ad et al (2013) Krupp Daniel et 4. 100 China 71 74 3 al (2014) PRESENT Tamil 5. 40 56.9 65.25 8.35 STUDY Nadu Chart No 56. TOTAL ANGLE OF GREATER SCIATIC NOTCH 82.85 90 79.93 80 69.45 71 74 68.43 62.91 65.25 70 56.9 60 51.47 50 40 male DEGREE 30 female 20 10 0 Shival shah et Abhishek Rajashree Krupp Daniel PRESENT al ( 2011) Prasad Sinha Sheelawant et al (2014) STUDY et al(2013) Raut et al (2013) TOTAL ANGLE OF GSN It was observed that in the present study total angle was more for females than males. There is difference in angle of 13 to 17 degree between males and females in the previous studies. 89 9. POSTERIOR ANGLE OF GREATER SCIATIC NOTCH 1. Hides Takahashi et al44 (1959) found that the posterior angle of GSN for males and females were 13.87 and 32 degrees respectively. 2. Shamer Singh et al40 (1978) stated that the posterior angle of GSN for males and females were 13.06 and 32.06 degrees respectively. 3. Shiaval Shah et al38 (2011) stated that the posterior angle of GSN for males and females were 13.06 and 32.15 degrees respectively. 4. Suma Dhyanesh et al43 (2013) observed that the mean posterior angle of GSN for males and females were 19.29 and 33.10 degrees respectively. Table No 75. POSTERIOR ANGLE OF GREATER SCIATIC NOTCH SAMPLE STUDY POPULATION MALE FEMALE DIFFERENCE SIZE Hideo 1. Takahashi et al 165 Japanese 13.87 32 18.13 (1959) Shamer Singh 2. 200 North Indian 13.06 32.06 19 et al (1978) Shival shah et 3. 268 Gujarat 13.06 32.15 19.09 al ( 2011) Suma 4. Dhyanesh et 100 Karnataka 19.29 33.10 13.81 al (2013) PRESENT 5. 40 Tamil Nadu 23.2 31.5 8.3 STUDY(2018) Chart No 58. POSTERIOR ANGLE OF GREATER SCIATIC NOTCH 40 32 32.06 32.15 33.1 31.5 30 23.2 19.29 DEGREE 20 13.87 13.06 13.06 male female 10 0 Hideo Shamer Shival shah Suma PRESENT Takahashi et Singh et al et al ( 2011 Dhyanesh et STUDY(2018) al (1959) (1978) al (2013 POSTERIOR ANGLE OF GSN 90 In the present study it was found that in females the posterior angle was more when compared to males with mean difference of 8.3 degree. Posterior angle was more for females in previous study conducted on GSN. This parameter is of great use when determining sex. 10. PRESENCE OR ABSENCE OF PIRIFORM TUBERCLE In the present study the incidence of piriform tubercle in hip bone of males and females were 50% in both sides. RADIOLOGICAL STUDY 1. WIDTH OF GREATER SCIATIC NOTCH 1. S. C. Okeseimiema et al 31(2012) found that mean width of GSN in males and females were 42.24mm and 50.73mm respectively. 2. Z Alizadeh et al48 (2013) stated that mean width of GSN for males and females were 55.9mm and 62.45mm respectively”. 3. Berjina Farooq Naqshi et al4 (2016) in their study he found that the mean width for males and females were 55.4mm and 63.3mm respectively. Table No 76. WIDTH OF GREATER SCIATIC NOTCH SAMPLE MALE FEMALE MEAN STUDY POPULATION SIZE (mm) (mm) DIFFERENCE S. C. Okeseimiema 1. 518 South Nigerian 42.24 50.73 8.49 et al(2012) Z Alizadeh et al 2. 64 North Indian 55.9 62.45 6.55 (2013) Berjina Farooq 3. 50 North Indian 55.4 63.3 7.9 Naqshi et al (2016) 4. PRESENT STUDY 50 Tamil Nadu 41.34 54.56 13.22 91 Chart No 59. WIDTH OF GREATER SCIATIC NOTCH 70 62.45 63.3 55.9 55.4 54.56 60 50.73 50 42.24 41.34 40 mm 30 male 20 female 10 0 S. C. Z Alizadeh et Berjina Farooq PRESENT Okeseimiema al (2013) Naqshi et al STUDY et al(2012) (2016) WIDTH OF GSN In the present study the width of GSN is wider in females than males with mean difference of 13.45. Previous studies also showed wider GSN in females with mean difference of 8 to 9. 2. DEPTH OF GREATER SCIATIC NOTCH 1. S. C. Okeseimiema et al 31 (2012) stated that the mean depth of GSN in males and females were 15.60mm and 14.91mm respectively. 2. Z Alizadeh et al48 (2013) found that the mean depth on right side for males and females were 21.9mm and 24.05mm respectively. 3. Berjina Farooq Naqshi et al4 (2016) in their study he observed that the mean depth of males and females were 21.4mm and 24.1 mm respectively. 92 Table No 77. DEPTH OF GREATER SCIATIC NOTCH SAMPLE MALE FEMALE MEAN STUDY POPULATION SIZE (mm) (mm) DIFFERENCE S. C. Okeseimiema 1. 518 South Nigerian 15.60 14.91 0.69 et al(2012) Z Alizadeh et al 2. 64 North Indian 21.9 24.05 2.1 (2013) Berjina Farooq 3. 50 North Indian 21.4 24.1 2.7 Naqshi et al (2016) 4. PRESENT STUDY 50 Tamil Nadu 25.44 26.67 1.23 Chart No 60 . DEPTHOF GREATER SCIATIC NOTCH 30 24.05 24.1 25.44 26.67 25 22.1 21.4 20 15.6 14.91 15 mm male 10 female 5 0 S. C. Z Alizadeh et Berjina Farooq PRESENT Okeseimiema al (2013) Naqshi et al STUDY et al(2012) (2016) DEPTH OF GSN In the present study the depth of GSN was more for females than males with mean difference of 1.47. In other studies depth of GSN, the mean difference ranges from 0.5 to 2. 93 3. ANTERIOR SEGMENT OF GREATER SCIATIC NOTCH Table No 78. ANT SEGMENT OF GREATER SCIATIC NOTCH SAMPLE MALE FEMALE MEAN STUDY POPULATION SIZE (mm) (mm) DIFFERNCE PRESENT 1. STUDY 50 Tamil Nadu 26.1 26.18 0.08 (2018) Chart No 61. ANT SEGMENT OF GREATER SCIATIC NOTCH 26.18 26.18 26.16 26.1 26.14 male 26.12 mm female 26.1 26.08 26.06 present study (2018) ANT SEGMENT OF GSN In the present study of anterior segment of GSN there is mean difference of 0.08mm which is insignificant. 4. POSTERIOR SEGMENT OF GREATER SCIATIC NOTCH 1. S.C. Okeseimiema et al31 (2012) found that the mean posterior segment of GSN for males and females were 14.65mm and 21.39mm respectively. 2. Z Alizadeh et al48 (2013) observed that the mean posterior segment of GSN for males and females were 22.5mm and 29mm respectively. 94 3. Berjina Farooq Naqshi et al4 (2016) stated that the mean posterior segment of GSN for males and females were 22.9mm and 29.2mm respectively. Table No 79 . POSTEROIOR SEGMENT OF GREATER SCIATIC NOTCH SAMPLE MALE FEMALE STUDY POPULATION DIFFERENCE SIZE (mm) (mm) S.C. Okeseimiema et 1. 518 South Nigerian 14.65 21.39 6.74 al(2012) Z Alizadeh et al 2. 64 North Indian 22.5 29 6.5 (2013) Berjina Farooq 3. 50 North Indian 22.9 29.2 6.3 Naqshi et al (2016) 4. PRESENT STUDY 50 Tamil Nadu 15.13 26.37 11.24 Chart No 62. POSTEROIOR SEGMENT OF GREATER SCIATIC NOTCH 29 29.2 30 26.37 22.5 22.9 25 21.39 20 14.65 15.13 15 mm male 10 female 5 0 S. C. Z Alizadeh et al Berjina Farooq present Okeseimiema (2013) Naqshi et al study(2018) et al(2012) (2016) POST SEGMENT OF GSN In the present study there is mean difference of 11.3mm found between males and females in the post segment of GSN. There is mean difference of 5 to 7mm in post segment of GSN in other studies, females had wider posterior segment. 95 5. INDEX I OF GSN 1. S. C. Okeseimiema et al31 (2012) found that the values of Index I for males and females were 38.81 and 30.10 respectively. 2. Z Alizadeh et al48 (2013) stated that the mean values of Index I on GSN for males and females were 34.91 and 40.97 respectively. 3. Berjina Farooq Naqshi et al4 (2016) observed the mean values of Index I for males and females were 38.69 and 38.02 respectively. Table No 80. INDEX I OF GREATER SCIATIC NOTCH SAMPLE MALE FEMALE MEAN STUDY POPULATION SIZE (mm) (mm) DIFFERENCE S. C. 1. Okeseimiema 518 South Nigerian 38.81 30.10 8.71 et al(2012) Z Alizadeh et 2. 64 North Indian 34.91 40.97 6.06 al (2013) Berjina Farooq 3. Naqshi et al 50 North Indian 38.69 38.02 0.67 (2016) PRESENT 4. 50 Tamil Nadu 60.91 49.47 11.44 STUDY Chart No 63. INDEX I OF GREATER SCIATIC NOTCH 60.91 70 49.47 60 38.81 40.97 38.02 50 34.91 38.69 40 30.1 30 20 male 10 female 0 S. C. Z Alizadeh et Berjina Farooq PRESENT Okeseimiema al (2013) Naqshi et al STUDY et al(2012) (2016) INDEX I OF GSN In the present study Of Index I of GSN, there is significant difference of 11.44 between males and females which correlates with Z Alizadeh et al study. 96 6. INDEX II OF GSN Table No 81 INDEX II OF GREATER SCIATIC NOTCH SAMPLE MEAN STUDY POPULATION MALE FEMALE SIZE DIFFERNCE PRESENT 50 Tamil Nadu 63.3 47.85 15.72 STUDY(2018) Chart no 64. INDEX II OF GREATER SCIATIC NOTCH 63.3 47.85 70 60 50 male 40 30 female 20 10 0 present study(2018) INDEX II OF GSN In the present study of Index II of GSN, there is significant difference of 15.5 was found between males and females. Thus, this parameter is of use in sex determination. 7. INDEX III OF GSN 1. S. C. Okeseimiema et al31 (2012) stated that the mean Values of Index III for males and females were 34.55 and 42.18 respectively. 2. Z Alizadeh et al48 (2013) observed that the mean Values of Index III for males and females were 40.68 and 46.6 respectively. 97 3. Berjina Farooq Naqshi et al4 (2016) found that the mean Values of Index III for males and fem3ales were 41.44 and 46.16 respectively. Table No 82 . INDEX III OF GREATER SCIATIC NOTCH SAMPLE MEAN STUDY POPULATION MALE FEMALE SIZE DIFFERENCE S. C. Okeseimiema 1. 518 South Nigerian 34.55 42.18 7.63 et al(2012 Z Alizadeh et al 2. 64 North Indian 40.68 46.6 5.98 (2013) Berjina Farooq 3. 50 North Indian 41.44 46.16 4.72 Naqshi et al (2016) PRESENT 4. 50 Tamil Nadu 36.53 52.02 15.49 STUDY Chart no 65 .INDEX III OF GREATER SCIATIC NOTCH 60 52.02 46.6 46.16 50 42.18 40.68 41.44 36.53 40 34.55 30 male 20 female 10 0 S. C. Z Alizadeh et Berjina PRESENT Okeseimiema al (2013) Farooq Naqshi STUDY et al(2012) et al (2016) INDEX III OF GSN In the present study of Index III of GSN it was found that there is significant difference of 15.52 between males and females. In the previous study there is mean difference of 4 to 8 was found between males and females in Index III of GSN. 98 Conclusion Figure No .13 GSN Female Male CONCLUSION The following conclusion was drawn: The mean width of the GSN was significantly wider in females compared to males in both bone and radiographic study. There was no significant difference in the mean depth of the GSN between males and females. The mean width of anterior segment and posterior segment of GSN was significantly greater in females compared to males in bone study. The Index I ( ratio of depth and width) of the GSN was significantly higher in males than females. There was no significant difference in Index II (ratio of anterior segment and width) and Index III (ratio of posterior segment and width) of the GSN between males and females. The total angle and the posterior angle of the GSN were significantly higher in females than males in both bone and radiographic study. The study of morphology and morphometry of the GSN in hip bone is of paramount importance in sex determination when a bone of unknown sex is found. The width of GSN, anterior segment of GSN, posterior segment of GSN, Index I of GSN, total angle of GSN, posterior angle of GSN are good sex discriminators. 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MASTER CHART - BONE MEASUREMENTS (MALE HIP BONE) anterior posterior presence or absence width depth index I indexII index iii total angle posterior angle male segment segment of piriform tubercle right left right left right left right left right left right left right left right left right left right left 1 42.8 42.7 31.1 30.8 31.7 32.6 11.1 10.1 42.6 72.1 74 76.3 25.9 23.6 60 56 20 21 no no 2 47.7 47.5 33 30 36.1 36.8 11.2 10.7 69.7 63.1 76.3 77.4 23.6 22.5 60 50 26 30 yes yes 3 44.5 44.3 30 32 32 30.7 12.5 13.6 67.4 72.2 71.9 69.3 28 30.6 52 56 26 21 no no 4 45.9 45.1 23 21 33.6 33.9 12.3 11.2 50.1 46.5 73.2 75.1 26.7 24.8 71 68 28 30 yes yes 5 42.2 42.7 31 21 27.9 29.1 14.3 13.9 73.4 49.1 66.1 68.1 33.7 32.5 48 51 18 19 no no 6 42.2 41.9 22 20 28.8 27.8 13.4 14.1 52.1 47.7 68.2 66.3 31.7 33.6 58 49 22 26 no no 7 42.5 42.4 28 22 28 27 10 11 68.8 51.8 68.8 63.6 23.5 25.9 55 58 19 26 no no 8 44.2 43.8 28 28 24 26 11 11 63.3 63.9 54.2 59.3 24.8 25.1 58 47 25 28 yes yes 9 44.9 43.8 33.1 32.9 32.7 32.4 12.2 11.4 73.7 75.1 72.8 73.9 27.3 26 55 59 19 21 yes yes 10 45.7 45.2 29.4 28.9 35.1 34.6 10.6 10.7 64.3 63.9 76.8 76.5 23.1 23.6 59 68 17 22 yes yes MASTER CHART - BONE MEASUREMENTS (FEMALE HIP BONE) anterior posterior presence or absence width depth index I indexII index iii total angle posterior angle male segment segment of piriform tubercle right left right left right left right left right left right left right left right left right left right left 1 47.7 47.8 32 23 30.6 30.6 18.1 17.2 67 48.1 62.8 64 37.9 35.9 69 66 30 36 no no 2 53.9 53.7 32 33 39.7 38.5 14.2 15.2 59.3 61.4 73.6 71.6 26.3 28.3 56 56 26 31 no no 3 61.3 61.9 40 39 43.1 42.6 18.2 19.3 65.2 63 70.3 68.8 29.6 31.1 59 60 25 30 no no 4 56.4 56.2 29 23 46.2 46.3 10.5 9.9 51.4 40.9 81.9 82.3 18.6 17.6 69 68 29 29 yes yes 5 59.3 59.4 31.1 31.3 41.3 42.4 18 17 52.4 52.6 69.6 71.3 30.3 28.6 64 66 28 30 yes yes 6 50.1 57.7 29.6 27.7 32.9 41.4 17.2 16.3 59 53.5 65.6 80 34.3 31.7 66 70 34 33 no no 7 48.7 49.2 27.7 27.4 35 35 13.7 14.2 56.8 55.6 71.8 71.1 28.1 29.1 70 68 38 35 yes yes 8 57.3 58.2 26.3 27.1 39.1 39.9 18.2 18.3 45.8 47.2 68.2 68 31.7 31.4 88 79 39 36 yes yes 9 59.2 59.1 25.3 26.2 41.7 41.4 17.5 17.7 42.5 44.3 70.4 70.6 29.5 29.9 58 59 32 30 no no 10 58.2 58.3 27.2 28.3 41.8 41.6 16.4 16.7 41.5 48.5 71.8 71.3 28.1 28.6 52 62 28 31 no no MASTER CHART - RADIOLOGICAL MEASUREMENTS (MALE HIP BONE) width depth anterior segment posterior segment index I index II indexIII male right left right left right left right left right left right left right left 1 39.1 39.2 25.6 25.6 24.5 24.5 14.6 14.7 65.4 65.3 62.6 62.5 37.3 37.5 2 40.2 40.3 24.8 24.9 24.7 24.9 15.5 15.4 61.6 61.7 61.4 61.7 38.5 38.2 3 41.2 41.2 25.6 25.5 25.8 25.6 15.4 15.6 62.1 61.8 62.6 62.1 37.3 37.8 4 39.3 39.5 26.3 26.2 24.5 24.8 14.8 14.7 66.9 66.3 62.3 62.7 37.6 37.2 5 40.3 40.4 24.2 24.3 25.6 25.7 14.7 14.7 60 60.1 63.5 63.6 36.4 36.3 6 41.9 42.2 24.2 24.2 26.7 26.8 15.2 15.4 57.7 57.3 63.7 63.5 36.2 36.4 7 39.3 40.1 25.2 25.3 25.1 25.3 14.2 14.8 64.1 63 63.8 63 36.1 36.9 8 40.3 40.4 26.3 26.3 25.1 25.1 15.2 15.3 65.2 65 62.2 62.1 37.7 37.8 9 42.2 42.3 25.6 25.7 27 26.7 15.2 15.6 60.6 60.7 63.9 63.1 36 36.8 10 43.2 43.2 25.2 24.8 29 28.8 14.2 14.4 58.3 57.4 67.1 66.6 32.8 33.3 11 39.2 39.4 25.3 25.2 23.4 23.8 15.8 15.6 64.5 63.9 59.6 60.4 40.3 39.5 12 39.5 40.3 24.2 24.5 24.2 25 15.3 15.3 61.2 60.7 61.1 62 38.7 37.9 13 42.3 42.3 25.3 24.9 27.4 27.2 14.9 15.1 59.8 58.8 64.7 64.3 35.2 35.6 14 42.5 42.4 25.6 25.8 26.9 26.9 15.6 15.5 60.2 60.8 63.2 63.4 36.7 36.5 15 44.2 44.4 24.8 24.7 29.9 29.9 14.3 14.5 56.1 55.6 67.6 67.3 32.3 32.6 16 43.2 43.5 24.6 24.5 27.9 28.2 15.3 15.3 56.9 56.3 64.5 64.8 35.4 31.5 17 39.4 40.3 25.7 25.6 24.2 24.6 15.2 15.7 65.2 63.5 61.4 61 38.5 38.9 18 40.5 41.2 25.4 25.3 25.7 26.7 14.8 14.5 62.7 61.4 63.4 64.8 36.5 35.1 19 42.5 41.3 25.6 25.5 26.3 24.9 16.2 16.4 60.2 61.7 61.8 60.2 38.1 39.7 20 43.2 42.9 24.3 24.2 29 28.4 14.2 14.5 56.2 56.4 67.1 66.2 32.8 33.7 21 41.2 41.3 25.2 25.5 25.3 25.5 15.9 15.8 61.1 61.7 61.4 61.7 38.5 38.2 22 40.8 40.4 24.8 24.5 26 25.8 14.8 14.6 60.7 60.6 63.7 63.8 36.2 36.1 23 39.9 40.1 25.3 25.4 24.6 24.8 15.3 15.3 63.4 63.3 61.6 61.8 38.3 38.1 24 42.2 42.5 25.6 25.4 27.4 27.3 14.8 15.2 60.6 59.7 64.9 64.2 35 35.7 25 44.4 44.2 24.8 24.9 28.8 28.4 15.6 15.8 55.8 56.3 64.8 64.2 35.1 35.7 MASTER CHART - RADIOLOGICAL MEASUREMENTS (FEMALE HIP BONE) width depth anterior segment posterior segment index I index II indexIII male right left right left right left right left right left right left right left 1 55.3 55.8 26.7 26.5 26.8 27.2 28.5 28.6 48.2 47.4 48.4 48.7 51.5 51.2 2 53.2 53.2 27.8 27.8 23.6 23.7 29.6 29.5 52.2 52.2 44.3 44.5 55.6 55.4 3 54.2 54.5 25.6 25.6 25.7 25.8 28.5 28.7 74.2 46.9 47.4 47.3 52.5 52.6 4 53.2 54.2 26.4 26.5 23.7 24.6 29.5 29.6 49.6 48.8 44.5 45.3 55.4 54.6 5 55.6 55.8 26.8 26.7 27.1 27.1 28.5 28.7 48.2 47.8 48.7 48.5 51.2 51.4 6 57.3 58.3 28.7 28.7 28.7 29.9 28.6 28.4 50 49.2 50 51.2 49.9 48.7 7 58.3 58.4 26.5 26.5 29.8 29.9 28.5 28.5 45.4 45.3 51.1 51.1 48.8 48.8 8 56.2 55.9 24.4 24.4 29.7 29.2 26.5 26.4 43.4 43.6 52.8 52.2 47.1 47.2 9 54.4 54.5 28.4 28.5 24.8 25.6 29.6 28.9 52.2 52.2 45.5 46.9 54.4 53 10 55.7 54.3 25.6 25.4 27 25.8 28.7 28.5 45.9 46.7 48.4 47.5 51.5 52.4 11 56.3 57.2 26.3 26.4 26.7 28.6 29.6 28.6 46.7 46.1 47.4 50 52.5 50 12 57.3 56.9 23.3 25.4 29.8 29 27.5 27.9 40.6 44.6 52 50.9 47.9 49 13 54.3 54.3 28.4 28.6 25.8 25.8 28.5 28.5 52.3 52.6 47.5 47.5 52.4 52.4 14 55.9 55.8 27.4 27.6 27.6 27.3 28.3 28.5 49 49.4 49.3 48.9 50 51 15 56.4 55.9 28.5 28.6 28 27.3 28.4 28.6 50 51.1 49.6 48.8 50 51.1 16 54.2 54.5 27.4 27.5 24.5 25 29.7 29.5 50 50.4 45.2 45.8 54.7 54.1 17 52.5 53.4 26.5 26.7 23.8 24.8 28.7 28.6 50.4 50 45.3 46.4 54.6 53.5 18 55.9 54.7 26.4 26.8 27.2 26.2 28.7 28.5 47.2 48.8 48.6 47.8 51.3 52.1 19 48.4 50.5 26.8 26.4 19 20.9 29.4 29.6 55.3 52.2 39.2 41.3 60.7 58.6 20 52.3 52.4 26.3 26.8 24.8 24.6 27.5 27.8 50.2 51.1 47.4 46.9 52.5 53 21 51.4 51.4 25.6 25.8 24.5 24.6 26.9 26.8 49.8 50 47.6 47.8 52.3 52.1 22 56.3 55.8 26.7 26.9 27.8 27.2 28.5 28.6 47.4 48.2 49.3 48.7 50.6 51.2 23 51.1 49.9 27.5 27.8 24.6 23 26.5 26.9 53.8 57.7 48.1 46 51.8 53.9 24 53.4 53.2 25.4 25.5 24.9 24.6 28.5 28.6 47.5 47.9 46.6 46.2 53.3 53.7 25 54.2 54.3 25.6 25.4 27.8 27.8 26.4 26.5 47.2 46.7 51.2 51.1 48.7 48.8