Radiographic Evaluation of Femoral Sagittal Bowing by Region Growing Territory Method

Background: The curvature of the femur is critical in orthopedic practice, but it can be ignored when using the same implant for femoral fractures, which can lead to concerns such as periprosthetic fractures. Objectives: Our study aims to fill this gap by reporting femoral curvature in sagittal planes X-rays in Taiwanese population. Materials and Methods: In the present study, 723 lateral femur X-rays were examined at Taipei Medical University-Shuang Ho Hospital from January 2022 to January 2023. The study included 51 patients. With the aid of specialist software and Digital Imaging and Communications in Medicine format photographs, the curvature of the femoral and medullary canals was automatically measured. A physician measured each index three times, using both descriptive and inferential statistical techniques. The intraclass correlation coefficient was used to evaluate the dependability of the results. Results: The average radii of curvature of the entire femur, proximal, middle, and distal segments were 1275 mm, 656 mm, 1141 mm, and 769 mm, respectively. Notably, at the middle part of the femur, the radius of curvature of the femur outline significantly differed from that of the medullary canal (1259 ± 472 mm vs. 1023 ± 476 mm, P = 0.013). There was no gender differences across all femoral segments. However, individuals under 60 years old exhibited significantly straighter femurs compared to those aged above 60 years, with significant differences observed in both the femur outline radii (1467 mm vs. 1230 mm, P = 0.031) and the medullary canal radii (1401 mm vs. 1147 mm, P = 0.039). Conclusions: Our study reveals variations in femoral curvature among Taiwanese individuals, emphasizing the importance of customizing orthopedic implants for better surgical outcomes. Establishing a comprehensive femoral curvature database in Taiwan and collaborating with manufacturers to develop specialized implants are crucial next steps to enhance surgical results.