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Open AccessArticle

New Computerized Method in Measuring the Sagittal Bowing of Femur from Plain Radiograph—A Validation Study

Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 11031, Taiwan
Division of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
Department of Orthopedics, National Taiwan University Hospital, Taipei City 10002, Taiwan
Anesthesia Department, Taipei Hospital, Ministry of Health and Welfare, New Taipei City 24213, Taiwan
Department of Computer Science and Information Engineering, National Taiwan University, Taipei City 10617, Taiwan
Department of Family Medicine, Renai Branch, Taipei City Hospital, Taipei City 10629, Taiwan
Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei City 10055, Taiwan
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(10), 1598;
Received: 29 August 2019 / Revised: 20 September 2019 / Accepted: 1 October 2019 / Published: 3 October 2019
(This article belongs to the Special Issue Orthopaedics: Medicine and Mechanisms)
Background: Mismatch of intramedullary nails with the bowing of femur is a frequent clinical finding. Previous studies showed inconsistent results. Methods: We present an algorithm of region growing territory method to get the radii of the anterior bowing of femur. We also tested it on ten radiographs. Plain radiographs of the lateral view of femur from five men and five women taken between January and August 2014 in Taipei Hospital were chosen randomly. The curvature of femur outline and medullary canal were measured for three times each. Radii of curvature of whole femur, proximal, middle and distal parts were calculated and analyzed. Results: The coefficient of variation of the 240 measurements ranged from 0.007 to 0.295 and averaged 0.088. The average radii of curvature of the whole, proximal, middle, and distal femur were 1318 mm, 752 mm, 1379 mm, and 599 mm, respectively. At the distal part of the femur, the radius of curvature of the femur outline (452 mm) was smaller than the medullary canal (746 mm) (p < 0.05). Women’s femur was straighter than men’s when we compared the whole length (1435 mm vs. 1201 mm, p < 0.05). The radii we calculated were smaller than the current intramedullary nails. Conclusion: The results showed that the inter-observer and intra-observer differences are acceptable, support the impression that different bowing conditions existed for Asians as compared to Caucasians, and also indicate the mismatch of current instruments to the curvature of femur. View Full-Text
Keywords: femur bowing; region growing territory method; bowing mismatch femur bowing; region growing territory method; bowing mismatch
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Liaw, C.-K.; Chen, Y.-P.; Wu, T.-Y.; Fuh, C.-S.; Chang, R.-F. New Computerized Method in Measuring the Sagittal Bowing of Femur from Plain Radiograph—A Validation Study. J. Clin. Med. 2019, 8, 1598.

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