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Incidence of Third Trochanter and Hypotrochanteric Fossa in Human Femora in Indian Population

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Incidence of Third Trochanter and Hypotrochanteric Fossa in Human Femora in Indian Population Page 1 of 4 Research study Incidence of third trochanter and hypotrochanteric fossa Anatomy in human femora in Indian population. S Ghosh1*, M Sethi1, N Vasudeva1 Abstract The knowledge of the occurrence stabilization and control of the thigh Introduction would be crucial for the diagnosis and indicating medio-lateral reinforcement Third trochanter is described as an management of pertrochanteric to resist high mechanical stress in erect 5 oval tubercle at the superior end of fractures and also in the study of posture and locomotion. Different the gluteal tuberosity. The importance microevolutionary trends in the varieties of impressions are seen at the of the third trochanter in anthropometric and comparative site of the insertion of gluteus maximus studies of humans. ranging from rounded or oblong pertrochanteric fractures have been recently hypothesized to be correlated tubercle, Third Trochanter, to a ridge or with the fracture break lines in Introduction a prolonged elevation, Gluteal pertrochanteric fractures. The third In many anthropometric studies the tuberosity, or a groove known as trochanter may function to provide third trochanter and the Hypotrochanteric Fossa. Most increased skeletal mass as a hypotrochanteric fossa are commonly commonly seen gluteal tuberosity is reinforcement mechanism for the used non metric variations of the well described in textbooks of anatomy. proximal diaphysis in response to postcranial skeleton. They serve for Hence the study analysed the presence increased ground reaction force. The descriptive purposes of the proximal of third trochanter and hypotrochanteric fossa is considered end of the femur in various ethnic hypotrochanteric fossa in an Indian population. to be a varied manifestation of the groups. The third trochanter functions attachment of gluteus maximus to provide an attachment area for the present on the posterior superior part ascending tendon of the gluteus Materials and methods of the femoral diaphysis. Due to the maximus. This skeletal variant, when The study was conducted on 152 adult paucity of literature on the incidences present, occurs as an oblong, rounded dried femora collected from the disclosure. of third trochanter and or conical, roughened or smoothened osteology museum of the department of hypotrochanteric fossa in Indian bony elevation which may be Anatomy, Maulana Azad Medical population, this study was continuous with the gluteal ridge and College, New Delhi, India. The presence undertaken. is manifested as a distinct femoral of third trochanter and Materials and methods entity.1 The correlation between hypotrochanteric fossa was noted and preparation, readapprovedpreparation, and finalthemanuscript. The study was conducted on 152 adult muscle insertions and topography of photographed by a SONY DIGITAL t dried femora in the Department of break lines in pertrochanteric CAMERA HX7 against a dark Anatomy, Maulana Azad Medical fractures of the proximal femur has background. For this study, the third College, New Delhi, India. The positive been recently discussed. A study trochanter is defined as the osseous findings were photographed. The suggested that bone covered only with tubercle in the superior part of the significance of the correlation was periosteum with no reinforcing gluteal tuberosity. It was present lateral found out using Chi-square test. elements of the attachments of to the line connecting the highest point Results muscles and ligaments, represent of the greater trochanter and the In our study, third trochanter and the minor resistance for onset of superior bifurcation of the linea aspera. Conflict of interests: None declared. hypotrochanteric fossa were found to fractures. Variability in the sizes and Each trait was analysed for side and occur in 6.6% and 31.6% of the total shapes of pertrochanteric fracture gender. The results were processed bones assessed. The hypotrochanteric fragments depend on variability of the using SPSS version 17.0 for significance declared. fossa was seen significantly higher on locations and sizes of soft tissue of the findings using p value and Chi- right side. Both the traits were found attachment areas at specified sites on square test. to be more in males. the proximal femur.2 In this regard the Conclusion osseous, cartilaginous and tendinous Results This study dealt with the incidence of complex of the third trochanter could The tabulated (Table 1) and graphic third trochanter and hypotrochanteric be a preventive factor and representation of the occurrence of the fossa in the Indian population due to determinant of the fracture location three manifestations at the attachment 3,4 scant previous literature. and shape. The strong entheseal of Gluteus maximus i.e. third development in the femoral trochannter, gluteal tuberosity (Figure All authors All contributedandconception to design, manuscrip All authorsAll abide by the Associationfor MedicalEthics (AME) ethical rules of *Corresponding author attachment of the gluteus maximus 4) and hypotrochanteric fossa has been Competinginterests: None Email: [email protected] suggest a strong mechanical effort of shown the joint in extension, lateral 1Maulana Azad Medical College, New Delhi, India Licensee OAPL (UK) 2014. Creative Commons Attribution License (CC-BY) FOR CITATION PURPOSES: Ghosh S, Sethi M, Vasudeva N. Incidence of third trochanter and hypotrochanteric fossa in human femora in Indian population. OA Case Reports 2014 Feb 25;3(2):14. Page 2 of 4 Research study Table 1: Incidences of various traits in male and female right and left femora Number of femur Trait Males Females Incidence Right Left Right Left Third Trochanter 3 4 1 2 6.6% Gluteal Toberosity 18 15 16 12 40.1% Fossa 16 10 16 6 31.6% Hypotrochanterica were present in 31.6 % of the total pertrochanteric fracture. They Figure 1: Left male Femur showing femora analysed. (Table 1) It was suggested that absence of reinforcing smooth oblong elevated third found to be significantly high on the elements of muscle and ligamentous trochanter. right side. (Table 2) The gender attachments, represented sites for the differences for the trait were beginning of fractures.2 Previous prominent in males. (Table 3) literatures in Indian populations on the third trochanter are scanty. Our study found it significant enough to report the Discussion incidence in an Indian population. The The third trochanter has been incidence of the third trochanter in our described to be significant in study is 6.6% with left sided anthropometric, comparative and predominance; it also displays a gender disclosure. functional studies. It plays an variation, being higher in males. Our important role as a useful landmark results are comparable to a study done for biomechanical and densitometry on excavated femora from Poland studies as the access point of choice to which showed an incidence of 6.2%. approach the medullary cavity. However they did not take any gender preparation,read andapproved the finalmanuscript. Recently workers have hypothesized or side variations into consideration.3 t that muscle insertions and ligament Another study which reported the side attachments have an impact on the variations in Whites and Negroes, course of typical break lines in the documented higher incidence on the area of the trochanteric mass. They right side in the White and on the left conducted a radiologic evaluation of side in the Negro population; it also patients suffering from reported the trait to be more common pertrochanteric fractures and found a in females in both Whites and Negroes.6 potential morphological correlate The fossa hypotrochanterica is a fossa, Conflict of interests: None declared. Figure 2: Left female Femur showing between muscle insertions and the groove or pit at the site of insertion of roughened oval elevation third course of the break line in a typical trochanter. declared. Table 2: Chi square test significance of side variation of the trait in Figure 5 for better correlation. The third trochanter (Figure 1 and Figure 2) was present in 6.6% of the femora. Trait Right Left Significance (Table 1) Although the incidence was higher on the left side it was not Third Trochanter 4 6 0.57 statistically significant. (Table 2) It demonstrated a gender variation being higher in males (p value not Hypotrochanteric Fossa 32 16 0.005* significant) (Table 3). The Competinginterests: None authorsAll contributed conceptionto and design, manuscrip authorsAll abide by the Associationfor MedicalEthics (AME) ethical rules of Hypotrochanteric fossae (Figure 3) * Significant at 1 % level of significance Licensee OAPL (UK) 2014. Creative Commons Attribution License (CC-BY) FOR CITATION PURPOSES: Ghosh S, Sethi M, Vasudeva N. Incidence of third trochanter and hypotrochanteric fossa in human femora in Indian population. OA Case Reports 2014 Feb 25;3(2):14. Page 3 of 4 Research study The third trochanter may perhaps serve Table 3: Chi square test significance of gender variation of the trait to increase attachment surface area for Trait Male Female Significance the gluteal musculature thereby providing greater efficiency of contraction. Gluteus maximus function Third Trochanter 7 3 0.191 may exert a mechanical loading on the third trochanter thereby altering surface morphology. The presence of Hypotrochanteric Fossa 26 22 0.485 bony crests, ridges and tuberosities are directly correlated to the function of 14 Gluteus Maximus on the femur. The It was also higher in males but not of contiguous muscle activity. presence of gluteal ridge,
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