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Bony Spurs Projecting in the Obturator Foramen Folia Morphol. Vol. 71, No. 2, pp. 125–127 Copyright © 2012 Via Medica C A S E R E P O R T ISSN 0015–5659 www.fm.viamedica.pl Bony spurs projecting in the obturator foramen R. Singh Department of Anatomy, CSM Medical University, Lucknow, UP, India [Received 8 December 2011; Accepted 21 February 2012] The obturator foramen is large oval aperture in males or irregularly triangular aperture in females in the hipbone, situated anteroinferior to the acetabulum between the pubis and ischium. The dry bone under study is a male left sided hipbone. It contains the obturator groove through which the obturator nerve and vessels pass. During analysis of hipbones in the osteology laboratory of CSM Medical University Lucknow, UP, India, a hipbone was found in which bony spurs or exostoses were projecting from the margins into the obturator foramen. These bony projections in the obturator foramen constitute a new anatomical variant in the hipbone, as they have not been reported before. These bony spurs may impinge on the obturator nerve and vessels causing neurovascular complications and also trauma to the soft tissues during biome- chanical movements. In addition, these bony spurs may cause spasms of the obturator internus and externus muscles, causing groin pain. These bony pro- jections may also lead to misinterpretation of radiographs. Thus, knowledge of these bony spurs is of paramount importance to anatomists, surgeons, sport physicians, and radiologists. (Folia Morphol 2012; 71, 2: 125–127) Key words: hipbone, bony spur, obturator foramen, pubis, ischium INTRODUCTION Bony spurs detected projecting in the obturator The obturator foramen is defined as a large oval foramen are a rare variant and unreported, so this or irregularly triangular opening in the hipbone an- was the first and only finding in the Indian popula- teroinferior to the acetabulum between the pubis tion. There is no literature available on these bony and ischium. The shape of the obturator foramen is projections. However, separate anomalies relating oval in males and triangular in females. The obtura- to the obturator foramen are reported as a double tor foramen is covered by obturator membrane in obturator foramen from an X-ray study [2] and as normal anatomy. The left sided hipbone under study a triplicate obturator foramen [1] from a dry bone possessed an oval shaped obturator foramen and study. These exostoses provide new anatomical fea- the ischiopubic rami was everted; therefore, it was tures to enhance knowledge, thus widening the a male hipbone. The obturator canal gives passage anatomical field, and have a great deal of clinical to the obturator nerve and vessels. The margins of implications; hence the study was carried out. the obturator foramen give rise to the obturator externus from the dorsal surface and the obturator CASE REPORT internus from the pelvic surface. In the obturator During routine osteology demonstration classes canal the obturator artery and nerve divide into an- of MBBS students of CSM Medical University, Luc- terior and posterior divisions. These divisions of the know, UP, India, a left sided male hipbone obtained artery form a circle over the obturator membrane. from the osteology laboratory of the Department Address for correspondence: Dr. R. Singh, Ass. Prof., Department of Anatomy, CSM Medical University, Lucknow, UP, India, fax: 0522-2257539, e-mail: [email protected] 125 Folia Morphol., 2012, Vol. 71, No. 2 Figure 1. Bony spurs; OF — obturator foramen; BS — bony spurs in obturator foramen; MU — medial upper bony outgrowth from upper margin of obturator foramen; LU — lateral upper bony outgrowth from upper margin of obturator foramen; ML — medial lower bony out- growth from lower margin of obturator foramen; LL — lateral lower bony outgrowth from lower margin of obturator foramen. of Anatomy was detected with bony spurs project- The study of a dry hipbone was taken up in ing from the margin of the obturator foramen. this case. The bony spurs were observed project- Two bony spurs project from the superior mar- ing in the obturator foramen. The kinematics of gin (Fig. 1). The medial one is 1.5 cm from the obtu- biomechanical movements of the legs communi- rator canal, and the distance between the two spurs cate stress to the lateral rotator muscles. These is 1.2 cm. The length of the medial spur is 1 cm and muscles, if pierced by bony spurs, may produce that of the lateral spur is 1.6 cm. The medial spur is trauma and spasm to surrounding structures dur- directed medially and downward, and the lateral one ing movements, causing pain or other clinical is directed downward and laterally. Two spurs complications. project from the anteroinferior margin (Fig. 1). The Probable causes of bony spurs medial spur is irregular and directed superiorly and its length is 1.2 cm, and the lateral one is directed The situations in which a person leans towards slightly medially and its length is 0.7 cm. These bony the left during walking, playing, or other activi- spurs are detected in the left dry male hipbone, and ties may cause additional stress on the lateral ro- the innominate bone is not associated with any other tator muscles due to non-uniform distribution of abnormality. weight of the body. In this situation, the short lateral rotators, particularly the obturator exter- DISCUSSION nus and obturator internus, are excessively used The left-sided male dry hipbone under study leading to micro trauma in the obturator mus- possesses an oval shaped obturator foramen; there- cles. This may cause tearing of the periosteum fore, it is a male hipbone. The obturator foramen is and activation of osteocytes. These osteocytes associated with the obturator canal. The obturator may lay down the bone resulting in exostoses or nerve and artery pass through the obturator canal bony spurs. Similarly, the obturator membrane where these structures divide into anterior and pos- may ossify due to over stretching, giving rise to terior divisions. The two divisions of the obturator bony spurs. Moreover, the formation of bony artery form a circle over the obturator membrane spurs may be attributed to calcium metabolism [6]. Its margins on the pelvic and dorsal surfaces disorders. give origin to the obturator internus and obturator These bony spurs are more likely to occur in externus, respectively. Both of these muscles are sportspersons due to their kinematic and biome- short, lateral rotators of the thigh. chanical activities. Apart from this, exostoses may 126 R. Singh, Bony spurs also be caused in pathological conditions like po- formation may be of use to anthropologists to iden- lio, dislocation of the hip joint, and paralysis of tify sportspersons and individuals suffering from the gluteus maximus and minimus. polio or if there is paralysis of the gluteus medius As it is a dry bone laboratory work, no family and minimus or dislocation of the hip joint, as bony history of the bone holder can be obtained. No lite- spurs in the obturator foramen are formed in these rature genetic or embryological study is available. conditions. Pelvic osteotomy also requires prior Therefore, the theory of genetic cause is not under- anatomical knowledge of the obturator foramen. stood. Bony spurs may also lead to misinterpretation of radiographs. Thus, knowledge of these bony spurs The clinical significance of bony spurs is of paramount importance to anatomists for new These bony spurs may impinge the obturator variants, neurosurgeons, sports physicians, anthro- nerve and vessels leading to neurovascular compli- pologists, and radiologists. cations when subjected to kinematics or biome- chanical movements of the left leg. Besides neu- REFERENCES rovascular complications, these bony spurs may 1. Das S, Suri R, Kapur V (2006) A triplicate obturator fo- lead to groin pain and spasm of the obturator in- ramen. Folia Morphol, 65: 164–166. ternus and externus muscles. Pubalgia observed in 2. Karantanas A, Velesiotou K, Sakellariou E (2002) Dou- ble obturator foramen. Am J Roentgenol, 178: 245. sportspersons [4] may also be related to these bony 3. Moore KL, Dalley AF, Agur Anne MR (2010) Clinically spurs. Groin pain occurs due to involvement of flex- oriented anatomy. 6th Ed. Lippincott Williams and ors and adductors in sports such as sprinting and Wilkins, Baltimore. base stealing in baseball [3], and bony spurs may 4. Omar Imran M, Zogra Adam C, Kavanagh Eoin C, be a possible cause of this pain. The obturator re- Koulouris G, Meyers WC (2008) Athletic pubalgia and gion has been used for cystocele repair by a syn- sports hernia: optimal MRI technique and findings. Ra- thetic vaginal mesh, which is secured anteriorly diographics, 28: 1415–1438. 5. Shafik A (1982) Obturator foramen approach II. A new through the obturator foramen [7]. This region is surgical approach for management of short-pedicled also a route for the management of short-pedicled undescended testicles. Am J Surg, 144: 381–384. undescended testicles [5]. The bony spurs present 6. William PL, Bannister LH, Berry MM, Collins P, Dyson M, in the obturator foramen may interfere with cysto- Dussek JE, Ferguson MWJ (1995) Gray’ anatomy. 38th Ed. cele repair and management of short-pedicled un- Churchil Livingstone, Edinburgh. descended testicles if the surgeon is unaware of 7. Yan A, Anne M, Karine A, Vanessa F, Christophe P, Anne T, Patrick M (2004) Cystocele repairing by a syn- the presence of bony spurs. There is also a chance thetic vaginal mesh secured anteriorly through the of misdiagnosis of pain in patients by a physician/ obturator foramen. Eur J Obstes Gynecol Reprod Biol, /surgeon if exostoses are an unknown fact. The in- 115: 90–94. 127.
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