A comprehensive morphometric and morphological analysis of fovea capitis femoris and femoral head parameters according to gender

A comprehensive morphometric and morphological analysis of fovea capitis femoris and femoral head parameters according to gender | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A comprehensive morphometric and morphological analysis of fovea capitis femoris and femoral head parameters according to gender Esra SEN, Sinem Nur SEVER, Begumhan TURHAN, Mustafa Tolga CİRAK, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4429644/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose This study aimed to examine the morphometric properties of the fovea capitis femoris (FCF), including its location on the femoral head, shape varieties, and correlation with gender-specific femoral head parameters. Methods Seventy-two (n = 72) dry femurs were used. The morphometric features of these bones were assessed based on gender. While some of the FCF and femoral head parameters were measured on dry bones using calipers, others were measured using ImageJ software (Version 1.53q) on digital images. Results All parameters were similar in both genders except FHD-V and FHA (p > 0.05). FHD-V and FHA values were higher in males (p 0.05). Foramina localization was mainly central (51.4%). Five of the femoral heads have no foramina (6.9%). Four types of FCF were identified and most of them were oval type (61.1%). It was found that only 5.6% of FCFs were in the posteroinferior squad, and the vast majority were in posterosuperior squads. Conclusion The findings indicated that a few femoral head parameters were connected to the morphometric traits, localization, and shape types of the FCF. It was noted that there were gender-specific differences in a few parameters. Our research is expected to benefit anthropological sciences, radiological applications, and orthopaedics. Femur head hip joint ligamentum capitis femoris round ligament of femur Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION Fovea capitis femoris (FCF) is an area on the femoral head, usually located in the posteroinferior of the femoral head. It provides attachment sites for the ligamentum teres, which is also known as the ligamentum capitis femoris or round ligament of the hip [ 1 ]. The transverse acetabular ligament, a non-cartilaginous extension of the labrum at the inferior side of the hip, is where the ligamentum teres inserts after emerging from the FCF. Although role of the ligamentum teres in maintaining hip stability is debatable, isolated damage to the ligament may be the cause of hip pain. It was stated that generally, 4–15% of sports-related injuries occur in the ligamentum teres. The ligament's lesions include fractures at the attachment site to the FCF and the congenital absence of the ligament [ 2 – 4 ]. The ligamentum teres can be located nearly to the fovea capitis femoris. That's why FCF is clinically important in the pre-surgical diagnosis of ligamentum teres lesions [ 2 ]. Some previous studies found that patients with hip dislocation could have a tear of the ligamentum teres, but there could have been isolated cases of intact or partially torn ligamentum teres on arthroscopy after dislocation. In one way or another, dislocations typically cause disruptions to the arterial supply of the head. The femoral head can be perfused by 2–4 arteries, which arise from the deep branch of the medial femoral circumflex artery. Mostly, the head is supplied by the lateral circumflex femoral artery. The profunda femoris artery contributes to the medial femoral circumflex artery, supplying the main blood supply to the femoral head [ 5 – 7 ]. The obturator artery, a branch of the anterior division of the internal iliac artery, travels down and forward along the lateral pelvic wall and passes through the obturator canal to form iliac, vesical, and pubic branches within the pelvis. It then divides into anterior and posterior branches that supply the medial compartment of the thigh. The acetabular branch entering the hip joint originates from the posterior branch [ 8 ]. The foveolar artery, also known as the ligamentum teres artery, is a small artery that arises from the obturator artery and only perfuses the perifoveal region. In adults, it usually remains vestigial and makes a negligible contribution [ 6 ]. The ligamentum teres artery attaches itself to the fovea after descending from the posterior branch of the obturator artery [ 9 ]. There are also other structures, such as nutrient foramina, which are located in the FCF and the entrance to the arteries that supply the femoral head. Avascular necrosis is one of the causes of the negative development and formation of the femoral head in cases that affect the FCF. In addition, an excess of nutrient foramina reduces the likelihood of developing osteonecrosis [ 6 ]. Hip dysplasia and osteoarthrosis have been related to modifications in the morphometric structure and location of the FCF in the hip joint [ 10 – 12 ]. As the femoral head is supplied by vessels that travel through the FCF, the features of the anatomical structures on the head of the femur are considered potential factors in avascular necrosis. FCF is regarded as a significant anatomical structure for arthroscopic procedures, surgical interventions, radiological examination of the hip joint, and morphometric and morphological properties of the proximal femur [ 13 , 14 ]. Several studies evaluating the vascular structures of the ligamentum teres and femoral head were conducted [ 12 – 14 , 16 ]. The morphological and morphometric features of the FCF by gender and its relationship with femoral parameters have not been extensively studied in the literature. In this study, it was aimed to analyze gender-dependent morphometric and morphological characteristics of the FCF to determine its precise position, size, morphological types, and relationship with the parameters of the proximal femur by gender. MATERIAL AND METHODS Morphometric analysis of fovea capitis femoris and femoral head parameters were performed on 72 adult dry femora (34 right and 38 left) at the Anatomy Department of Hitit University, Çorum. The bones with any deformity on the proximal femur that could affect the objective measurements were excluded from the study. Gender records of the bones included in the study were available. These consisted of 38 male and 34 female femurs. Determination of the morphometric and morphological evaluation of the FCF and proximal femur was performed according to the methods reported in previous studies [ 15 , 17 ]. Morphometric and morphological analysis of the FCF and femoral head was performed on digital images of the bone using the ImageJ 1.53 software (National Institutes of Health, Bethesda, MD). Anteroposterior, craniocaudal, and mediolateral digital photographs were obtained using a tripod-fixed digital camera (Canon EOS 800D). To ensure the accuracy of the measurements, a reference scale bar was placed next to the bones. The reference scale bar was introduced to the ImageJ program to provide calibration of the morphometric measurements for each sample. Measurements of the Femoral Head Parameters The femoral head center, the femoral neck axis, and the femoral shaft anatomical axis were defined according to previous studies [ 18 – 20 ]. Vertical diameter, anterior-posterior diameter, femoral head area, and neck-shaft angle (femoral inclination angle) were measured as femoral head parameters. Center of the femoral head The most appropriate circle was obtained according to the femoral head of each sample by drawing a circle around the femoral head using the ImageJ (Version 1.53q) program. Anatomical shaft axis of the femur It was identified as a segment that joins the midpoints of the proximal diaphysis at the trochanter minor's lower edge and the distal diaphysis at the femoral condyles' upper edge. Femoral neck axis It was described as the segment joining the midpoint of the intertrochanteric line to the center of the femoral head. Femoral inclination angle (FIA) The angle was obtained between the femoral neck axis and the shaft axis on anteroposterior digital images. This angle is known as the FIA which represents the medial inclination of the proximal femur. It is also referred to as the collodiaphyseal angle or the neck-shaft angle. (Fig. 1 ). INSERT Fig. 1 HERE……………………………………………………………………… Vertical diameter of the femoral head (FHD-V) It was obtained by drawing a line between the upper and lower two points with the highest vertical convexity of the femoral head. Anteroposterior diameter of the femoral head (FHD-AP) It was obtained by drawing a line between the most anterior and posterior points of the femoral head. Femoral head area (AREA-FH) It was measured on mediolateral images as the area of the circular shape encircling the femoral head (Fig. 2 ). INSERT Fig. 2 HERE……………………………………………………………………… Measurement of the FCF parameters The longitudinal diameter, transverse diameter, depth, area, and localization of the FCF were measured on mediolateral images according to previous studies. The longitudinal diameter, transverse diameter, area, and localization of the FCF were measured using ImageJ software (Version 1.53q). Depth of the FCF was measured using digital caliper. Longitudinal length of the fovea capitis femoris (LL-FCF) It was measured as the longest diameter of the FCF. Transverse length of the fovea capitis femoris (TL-FCF) It was measured as the shortest diameter of the FCF. Area of FCF (A-FCF) The surface area of the circular shape surrounding the head of the femur was measured on mediolateral images. Depth of fovea (D-FCF) It was measured as distance between surface and deepest point of the FCF. A caliper was used to help with the measurement. Number and localization of foramina (FN) The number of vascular foramina in the FCF was analyzed by naked eye. The foramina closer to the center were classified as central, and those closer to the edge were classified as peripheral. Morphological types of the FCF The four morphological shapes of the FCF were determined as oval, round (circular), triangular, and piriform types according to previous studies. To distinguish oval and round types, the foveal index equation was used which was reported by Perumal et al. (FI = TLFCF/LLFCF × 100). (Fig. 3 ). INSERT Fig. 3 HERE……………………………………………………………………… The location of the FCF The femoral head was divided into 4 compartments on mediolateral images using two horizontal and vertical lines passing through the center to localize the FCF. These compartments were determined as anterosuperior, anteroinferior, posterosuperior, and posteroinferior. Six different location types of FCF was determined according to the location of the FCF in these compartments (Fig. 4 ). INSERT Fig. 4 HERE……………………………………………………………………… Gender determination Gender determination was performed by considering the degree of strength and size of the long bones and the general structure of the linea aspera in the femur by an anthropologist [ 21 ]. Inter and intra observer coefficient error Each measurement was repeated three times and average of these measurements was recorded as mean values. To minimize inter-observer coefficient error, 10% of the analyses were re-measured by a different researcher [ 22 ]. Data analysis Study data were analyzed using SPSS (version 25.0; SPSS, Chicago, IL, USA). The normality of data was assessed with skewness, kurtosis values, and histogram graphics. The percentages of the localization types, shape types of the FCF, and location of the foramina were determined. Student’s t test was used to examine the significance of differences between genders. Categorical variables were analyzed by Pearson’s chi-square test. Pearson correlation test was used to emphasize the correlations between parameters. The absolute value of the correlation coefficient (r) was defined as weak correlation if it was between 0.2–0.4 and moderate correlation if it was between 0.4–0.6. A p < 0.05 was determined as the level of statistical significance. RESULTS Total of 72 dry femurs including 34 female (47.2%) and 38 (52.8%) male femurs were evaluated. Thirty-four of all femurs were the right bones of the extremities. The mean measurement values of all femurs (n = 72) in terms of LL-FCF, TL-FCF, FHD-V, FHD-AP, D-FCF, FHA, A-FCF, FHA/A-FCF, FIA and FN are 1.53 ± 0.68, 1.09 ± 0.45, 4.66 ± 0.55, 3.82 ± 0.40, 2,78 ± 1.29, 13.14 ± 2.84, 1.21 ± 0.58, 13.11 ± 12.31, 124.17 ± 15.50, 8.77 ± 6.80 respectively. Measurement values of the bones along with standard deviations (SD) were presented in Table 1 . All parameters were similar in both genders except FHD-V and FHA (p > 0.05). FHD-V and FHA values were higher in males (p 0.05). Moreover, the values of measured parameters were similar on both sides (p > 0.05). The FCF was only in the posteroinferior quadrant at a rate of 5.6%. Table 1 Morphometric measurements of femurs according to the gender Parameters Female (Mean ± SD) Male (Mean ± SD) All individuals (Mean ± SD) T p LL-FCF (mm) 16.4 ± 9 14.3 ± 3.9 1,53 ± 0,68 1.331 0.207 TL-FCF (mm) 11.3 ± 5.3 10.5 ± 3.6 1,09 ± 0,45 0.712 0.488 FHD-V (mm) 43.8 ± 4.8 49.1 ± 4.9 4,66 ± 0,55 -4.561 0.001* FHD-AP (mm) 36.9 ± 3.2 39.4 ± 4.3 3,82 ± 0,40 -2.767 0.007 D-FCF (mm) 25.6 ± 12.9 29.8 ± 12.8 2,78 ± 1,29 -1.376 0.173 FHA (mm 2 ) 1162 ± 249 1450 ± 243 13,14 ± 2,84 -4.939 0.001* A-FCF (mm 2 ) 122 ± 59 120 ± 59 1,21 ± 0,58 0.158 0.875 FHA/A-FCF 10.67 ± 7.54 15.3 ± 15.16 13,11 ± 12,31 -1.609 0.112 FIA (º) 122.78 ± 20.56 125.41 ± 8.98 124,17 ± 15,50 -0.717 0.476 FN 9.23 ± 7.16 8.36 ± 6.54 8,77 ± 6,80 0.537 0.593 LL-FCF : Longitudinal length of fovea capitis femoris, TL-FCF : Transverse length of fovea capitis femoris, FHD-V : Femoral head vertical diameter, FHD-AP : Antero-posterior diameter of femoral head, D-FCF : Depth of fovea, FHA : Femoral head area, A-FCF : Area of fovea capitis femoris, FIA : Neck-shaft angle, FN : Foramina number, *p < 0.05 is statistically significant, Independent sample t-test Morphological types of the fovea were determined as oval, circular, triangular, and piriform according to the morphological characteristics of the fovea. The foramina localization was mainly at central (51.4%). Five of the femoral heads have no foramina (6.9%) (Table 2 ). There was no significant difference between the shape types of the FCF, foramina localization and localization of foramina in terms of percentage distribution on the female and male genders (Chi-square (χ2): 6.264, 0.222, 3.789 respectively, p > 0.05). There was a moderate correlation between A-FCF and FHA (r = .457, p = 0.001), and a weak correlation between A-FCF and FN (r = .359, p = 0.001). Table 2 The number of cases and percentage distribution of the shape types of the FCF in terms of genders Fovea shape type Oval Round Triangular Piriform Female 19 6 2 7 Male 25 1 6 6 Total n (%) 44 (61.1) 7 (9.7) 8 (11.1) 13 (18.1) Foramina localization None Central Peripheral Female 2 17 15 Male 3 20 15 Total n (%) 5 (6.9) 37 (51.4) 30 (41.7) Localization of fovea Type 1 Type 2 Type 3 Type 4 Type 5 Type 6 Female 6 10 6 3 7 2 Male 12 10 6 1 5 4 Total n (%) 18 (25) 20 (27.8) 12 (16.7) 4 (5.6) 12 (16.7) 6 (8.3) 1 : Centered at the posterosuperior of the head; 2 : Mainly centered at the posterosuperior of the head, additionally located inside the borders of the anterosuperior quadrant. 3 : Mainly centered at the posterosuperior of the head and additionally located inside the borders of all quadrants except the anteroinferior, 4 : Mainly centered at the posteroinferior of the head and additionally at all quadrants, 5 : Mainly centered at the posterosuperior and located inside the borders of the posteroinferior of the head, 6 : Mainly centered at posterosuperior and additionally located at all quadrants, n: number of cases Additionally, all the morphometric measurements of femurs according to the side were similar as shown in Table 3 (p > 0.005). Table 3 Morphometric measurements of femurs according to the side Parameters Right (Mean ± SD) Left (Mean ± SD) T P LL-FCF (mm) 1.37 ± 0.32 1.68 ± 0.87 -1.941 0.056 TL-FCF (mm) 1.08 ± 0.35 1.10 ± 0.52 -0.165 0.869 FHD-V (mm) 4.76 ± 0.54 4.57 ± 0.54 1.511 0.135 FHD-AP (mm) 3.78 ± 0.44 3.86 ± 0.36 -0.790 0.432 D-FCF (mm) 2.60 ± 1.16 2.94 ± 1.39 -1.135 0.260 FHA (mm 2 ) 12.96 ± 2.39 13.29 ± 3.21 -0.487 0.628 A-FCF (mm 2 ) 1.10 ± 0.51 1.31 ± 0.63 -1.573 0.120 FHA/A-FCF 14.35 ± 14.62 12 ± 9.87 0.807 0.422 FIA (º) 121.77 ± 20.59 126.31 ± 8.55 -1.247 0.217 FN 9.17 ± 6.99 8.42 ± 6.71 0.467 0.642 LL-FCF : Longitudinal length of fovea capitis femoris, TL-FCF : Transverse length of fovea capitis femoris, FHD-V : Femoral head vertical diameter, FHD-AP : Antero-posterior diameter of femoral head, D-FCF : Depth of fovea, FHA : Femoral head area, A-FCF : Area of fovea capitis femoris, FIA : Neck-shaft angle, FN : Foramina number, *p < 0.05 is statistically significant, Independent sample t-test DISCUSSION In the current study, in which we detailedly examined the localization of FCF on the femoral head, the shape types, and the morphometric properties of bones according to gender, most of the evaluated parameters were found to be similar in both genders. It was observed that the localization of the FCF was mostly centered posterosuperiorly to the femoral head but, at the same time, overflowing beyond a little anterosuperiorly. Four different types of FCF were identified, and most of them were oval. Upon reviewing the literature, it is observed that numerous studies have examined the relationships between the proximal femur parameters. Numerous data have been obtained from these studies, which looked into several clinical issues relating to proximal femur parameters, gender, race, and right-left side differences in the hip joint [ 18 , 23 – 27 ]. Another purpose of evaluating FCF and proximal femur parameters is to guide anthropological research. Although a complete pelvis is not always available, it is one of the most important structures used in anthropology to determine the gender of skeletal remains. In such cases, long bones, such as the femur, a robust bone, have been used to determine gender. In addition to various points on the proximal femur, also the FCF has been used as a landmark in such studies [ 28 , 29 ]. However, in the bone studies that we found, there was not much discussion about the association between FCF and proximal femur parameters according to gender. Regarding the localization of FCF, we found six types of foveal localization in our study, while five types of foveal localization were determined in the previous studies [ 2 , 14 , 15 , 24 , 30 ]. In our study, consistent with others, the fovea was located slightly posterior to the femoral head. Furthermore, in our study, FCF was located in the posteroinferior quadrant in only 5.6% of cases, which is quite low when compared to the rate in other studies. In our study, the center of the fovea was mostly posterosuperior to the femoral head. In the study of Yarar et al., this fovea was mostly centered posteroinferiorly and extended only to the anteroinferior quadrant. Likewise, in Gölpınar's study, the center was mainly located in the posteroinferior quadrant [ 30 , 31 ]. In our study, the most common localization type was the type with a posterosuperior center that extended only to the anterosuperior quadrant. Similar to our study, previous studies have reported that the shape type of FCF is generally oval in shape [ 2 , 24 , 30 ]. Perumal et al. reported that the majority of FCF shapes are oval, but also stated circular and triangular shape types [ 16 ]. Yarar et al. defined the piriform shape type in addition to the defined types in previous studies and found four types of FCF shapes similar to our study [ 31 ]. Similar to the study of Yarar et al., Gölpınar determined the four types of FCF and stated that the most common type was oval [ 30 ]. The rate of oval-shaped FCF in our study is very small when compared to the rate in the study of Perumal et al. and higher than the studies of Yarar et al. and Gölpınar. Some studies evaluating FCF dimensions have measured the largest diameter of the FCF (TL-FCF) in axial and coronal sections on computed tomography or magnetic resonance images (MRI) [ 11 , 12 , 16 ]. In asymptomatic volunteers, the width of FCF found by Bensler et al. did not contain similar results to our findings. In their study on MRI, Bensler et al. showed that the FCF width was larger in males [ 12 ]. Bertsatos et al. found that the maximum diameter of FCF was larger in males than females [ 26 ]. Similarly, Ceynowa et al. found that FCF width was larger in males [ 12 ]. In our study, no significant difference was observed between genders in terms of foveal width (TL-FCF). These studies were carried out on fresh cadavers or living persons. Therefore, considering that the articular cartilage structure and ligamentous structures were preserved in these cases, it is usual that the TL-FCF found in these studies would be different from the values found in our study. The mean FCF longitudinal length in our study was 15.35 ± 6.88 mm, while this value was 15.25 ± 2.86 mm in the study of Yarar et al. In the study of Gupta et al. on dry bones, the mean FCF longitudinal length was 15.94 ± 3.37 mm. The mean transverse length of the FCF was 12.00 ± 2.17 mm in the study by Yarar et al. and 11.38 ± 2.35 mm in the study by Gupta et al. In our study, the mean value was 10.92 ± 4.51 mm. [ 31 , 32 ]. The number of foramina was higher in the center than in the periphery, which is consistent with the findings of Perumal et al. Additionally, as a distinguishing feature of our study from the Perumal’s study, there was no difference between males and females in terms of the number and location of foramina. In our study, the number of vascular foramina in the fovea was strongly related to the size of the FCF, as well as the area of the femoral head. As the femoral head area increased, so did the foveal area. It was seen that thr bones with a larger area appear to have more vascular foramina. In this respect, our findings are similar to those of Perumal et al. [ 15 ]. Furthermore, the femoral head area was found to be larger in males than females. Because it is known that when the foveal area increases as the femoral head area increases in our study, the number of foramina is expected to be greater in males than in females. However, our study found no difference in the number of foramina between the sexes. It was found that the risk of avascular necrosis decreased as the number of foramina increased in a study by gender independently [ 10 ]. Another study found that male are more likely than female to develop avascular necrosis [ 33 ]. Lai et al. found that the incidence of avascular necrosis was not different between genders, which may be similar to our finding that the number of foramina was not different between genders [ 34 ]. In our study, we found no differences in the number of foramina between genders. Given the relationship between the number of foramina and avascular necrosis, it is reasonable to expect that avascular necrosis does not differ by gender. Additionally, we would like to emphasize that 6.9% of the specimens were devoid of vascular foramina. According to Philippon et al., the absence of vascular foramina could be caused by a congenital absence of the ligamentum teres. This rate was calculated at 10% in their study [ 36 ]. This rate was 24% in the Perumal et al. study. More histological investigations are required to address this, according to Perumal et al. [ 15 ]. This is because it's possible that these bones still contain smaller foramina (< 200 microns) that are invisible to the human eye. Late et al. examined the vertical length of the femoral head on dry bones without taking gender into account and found no difference between the right and left bones [ 36 ]. Similarly, no difference was observed between the vertical lengths of the right and left bones in our study. However, the vertical lengths of the right and left bones were significantly greater in males than females. In our study, A-FCF and FHA were evaluated together. To the best of our knowledge there are a few studies in which these two parameters were evaluated together and compared to each other [ 15 , 26 , 31 ]. In the study by Bertsatos et al., which is the only existing study and they did not compare the data according to gender, A-FCF was found to be larger in males than in females [ 26 ]. In our study, we observed that the size of A-FCF did not vary according to gender. Previous studies have indicated that changes in the morphometric structure of the FCF and its position in the hip joint are clinically important. For example, in patients with hip dysplasia, the position of the FCF has been reported at a higher localization level in the femoral head [ 13 , 37 ]. In the fixation process for femoral neck fractures, the rotational position of the femoral head can be determined according to the FCF localization [ 12 , 38 ]. In fact, in the "Pipkin classification" of femoral injuries, the type of injury (Type I and Type II) is determined by the position of the fracture in relation to the FCF [ 39 ]. In addition, the "femoral tunnel drilling technique" is used in surgical procedures for ligamentum capitis femoris reconstruction. In this method, the channel created by opening the femoral neck passes through the center of the FCF [ 26 , 27 ]. The hip rotation center (HRC) is an important component that significantly influences the clinical outcomes after total hip replacement [ 19 ]. In conclusion, we believed that FCF localization is very important for both surgical and clinical examination processes. We think that it will be useful for the surgeon during surgical procedures to understanding the connection between the femoral head center or HRC and FCF localization. Also, it should also be taken into account that the femoral head center defined on dry bone and on medical images may be different from eachother. Comparative studies using dry bones and 3D images may be useful to better understanding of the relationship between HRC and FCF. Late et al. found no significant difference in femoral inclination angle between the right and left dry femurs independent of gender [ 40 ]. The findings of Late et al. are similar to the findings of our study and there was no significant difference in femoral inclination angle between the right and left femur bones and also in terms of genders. In another study in which the lower extremity was examined with computed tomography, no significant difference was determined between the neck-shaft angle in terms of gender [ 12 ]. In our study, there was no significant difference between femoral neck-shaft angle between male and females. Femoral inclination angle, one of the angular parameters of the femur, has been associated with many clinical problems in the literature. It is known that FIA is increased in idiopathic scoliosis, cerebral palsy, poliomyelitis, hip dislocation and congenital subluxation, whereas it is decreased in femoral head epiphyseal slippage, Perthes disease, intertrochanteric fracture and congenital coxa vara [ 40 , 41 ]. Limitations This study has some limitations. The right and left femur could not be matched to see if they belonged to the same person. The ethnic origin of the bones was also unknown. As there was no record of age, the changes in the evaluations with age could not be examined. Furthermore, the sample size remained small because some femurs of known gender could not be included in the measurements because of a lack of bone integrity. CONCLUSION In this study, the bone morphology of FCF in 72 femurs was analyzed according to gender. Males had higher FHD-V and FHA values. There was no discernible difference in the mean values of foramina, LL-FCF, TL-FCF, and A-FCF between the genders, despite the fact that the mean values were higher in females. Furthermore, when the measured parameters were analyzed in terms of sides, the values obtained were comparable. Only 5.6% of the FCF were located in the posteroinferior quadrant, whereas the majority were located in the posterosuperior quadrant, which is in contrast to the findings of most studies on the morphological characteristics of the femur. The morphological types of the fovea were identified as oval, circular, triangular, and piriform based on the fovea's physical characteristics. The majority of foramina localization was in the center. The fovea capitis femoris did not contain any foramina. The shape types, foramina localization, and foramina localization of FCF in male and female gender did not significantly differ in percentage terms. A-FCF and FHA showed a moderate correlation, while A-FCF and FN showed a weak correlation. We think that the results of this investigation could offer valuable insights for both medical and anthropological settings. Declarations Author Contribution This study was designed by E.S., B.T., S.S., M.G. and M.C. E.S. carried out the analyses. B.T. and M.G. supervised the project. E.S., B.T., M.G., S.S. and M.C. wrote, edited and approved the manuscript. E.S. and S.S. prepared figures 1-4. M.C. and M.G. contributed to the data collection of the study. All authors critically revised the manuscript. Source (s) of support: This research received no specific grant from any funding agency, commercial or non for-profit sectors. CONFLICT OF INTEREST STATEMENT The authors declare no conflict of interest. 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BMC Musculoskelet Disord 24(1):742. https://doi.org/10.1186/s12891-023-06863-3 Quiñones-Rodríguez JI, Acevedo-Arroyo AN, Santiago-Negrón CL, Garcés-Torres LF, Fonseca-Salgado C (2022) A Bipartite Obturator Artery with Multiple Pelvic Branching-A Gynecologic Approach. Diagnostics (Basel Switzerland) 12(11):2614. https://doi.org/10.3390/diagnostics12112614 Rajive AV, Pillay M (2015) A Study of Variations in the Origin of Obturator Artery and its Clinical Significance. J Clin Diagn research: JCDR 9(8):AC12–AC15. https://doi.org/10.7860/JCDR/2015/14453.6387 Zhao K, Zhang F, Quan K, Zhu B, Li G, Mei J (2021) Insufficient blood supply of fovea capitis femoris, a risk factor of femoral head osteonecrosis. J Orthop Surg Res 16(1):414. https://doi.org/10.1186/s13018-021-02564-6 Bensler S, Agten CA, Pfirrmann CWA, Sutter R (2018) Osseous spurs at the fovea capitis femoris-a frequent finding in asymptomatic volunteers. Skeletal Radiol 47(1):69–77. https://doi.org/10.1007/s00256-017-2763-x Ceynowa M, Rocławski M, Pankowski R, Mazurek T (2019) The position and morphometry of the fovea capitis femoris in computed tomography of the hip. Surg radiologic anatomy: SRA 41(1):101–107. https://doi.org/10.1007/s00276-018-2097-y Beltran LS, Mayo JD, Rosenberg ZS, De Tuesta MD, Martin O, Neto LP, Sr, Bencardino JT (2012) Fovea alta on MR images: is it a marker of hip dysplasia in young adults? AJR Am J Roentgenol 199(4):879–883. https://doi.org/10.2214/AJR.11.8193 Mandell JC, Marshall RA, Weaver MJ, Harris MB, Sodickson AD, Khurana B (2017) Traumatic Hip Dislocation: What the Orthopedic Surgeon Wants to Know. Radiographics: Rev publication Radiological Soc North Am Inc 37(7):2181–2201. https://doi.org/10.1148/rg.2017170012 Perumal V, Woodley SJ, Nicholson HD (2017) The morphology and morphometry of the fovea capitis femoris. Surg radiologic anatomy: SRA 39(7):791–798. https://doi.org/10.1007/s00276-016-1810-y Eliopoulos C, Murton N, Borrini M (2015) Sexual dimorphism of the fovea capitis femoris in a medieval population from Gloucester, England. Global J Anthropol Res 2(2):9–14. http://dx.doi.org/10.15379/2410-2806.2015.02.02.02 Unnanuntana A, Toogood P, Hart D, Cooperman D, Grant RE (2010) Evaluation of proximal femoral geometry using digital photographs. J Orthop research: official publication Orthop Res Soc 28(11):1399–1404. https://doi.org/10.1002/jor.21119 Verma M, Joshi S, Tuli A, Raheja S, Jain P, Srivastava P (2017) Morphometry of Proximal Femur in Indian Population. J Clin Diagn research: JCDR 11(2):AC01–AC04. https://doi.org/10.7860/JCDR/2017/23955.9210 Yi LH, Li R, Zhu ZY, Bai CW, Tang JL, Zhao FC, Zheng X, Guo KJ (2019) Anatomical study based on 3D-CT image reconstruction of the hip rotation center and femoral offset in a Chinese population: preoperative implications in total hip arthroplasty. Surg radiologic anatomy: SRA 41(1):117–124. https://doi.org/10.1007/s00276-018-2143-9 Wu CC (2017) Is clinical measurement of anatomic axis of the femur adequate? Acta Orthop 88(4):407–410. https://doi.org/10.1080/17453674.2017.1304788 White TD, Folkens ve, P. A (2005) The human bone manuel. Elsevier Academic Pastor-Pons I, Lucha-López MO, Barrau-Lalmolda M, Rodes-Pastor I, Rodríguez-Fernández ÁL, Hidalgo-García C, Tricás-Moreno JM (2020) Interrater and Intrarater Reliability of Cranial Anthropometric Measurements in Infants with Positional Plagiocephaly. Child (Basel Switzerland) 7(12):306. https://doi.org/10.3390/children7120306 De Sousa E, Fernandes RMP, Mathias MB, Rodrigues MR, Ambram AJ, Babinski MA (2010) Morphometric study of the proximal femur extremity in Brazilians. Int J Morphol 28(3):835–840 Bardakos NV, Villar RN (2009) The ligamentum teres of the adult hip. J Bone Joint Surg Br Vol 91(1):8–15. https://doi.org/10.1302/0301-620X.91B1.21421 Cerezal L, Arnaiz J, Canga A, Piedra T, Altónaga JR, Munafo R, Pérez-Carro L (2012) Emerging topics on the hip: ligamentum teres and hip microinstability. Eur J Radiol 81(12):3745–3754. https://doi.org/10.1016/j.ejrad.2011.04.001 Bertsatos A, Chovalopoulou ME, Giannaki K, Valakos E (2018) Morphological variation of the femoral head fovea capitis. Eur J Anat 22:397–402 Garabekyan T, Chadayammuri V, Pascual-Garrido C, Mei-Dan O (2016) Junction Arthrosc techniques 5(1):e143–e147. https://doi.org/10.1016/j.eats.2015.10.020 . All-Arthroscopic Ligamentum Teres Reconstruction With Graft Fixation at the Femoral Head-Neck Albanese J, Eklics G, Tuck A (2008) A metric method for sex determination using the proximal femur and fragmentary hipbone. J Forensic Sci 53(6):1283–1288. https://doi.org/10.1111/j.1556-4029.2008.00855.x King CA, Işcan MY, Loth SR (1998) Metric and comparative analysis of sexual dimorphism in the Thai femur. J Forensic Sci 43(5):954–958 Gölpınar M (2022), September 22 Fovea Capitis Femoris’in Morfometrik ve Morfolojik Değerlendirilmesi. Medical Records-international Medical Journal. https://doi.org/10.37990/medr.1107706 Yarar B, Malas MA, Çizmeci G (2020) The morphometry, localization, and shape types of the fovea capitis femoris, and their relationship with the femoral head parameters. Surg radiologic anatomy: SRA 42(10):1243–1254. https://doi.org/10.1007/s00276-020-02508-5 Gupta M, Devadas D, Sahni C, Nayak A, Tiwari PK, Mishra A (2022) Morphometric Analysis of the Proximal Femur With Its Clinical Correlation in Eastern Uttar Pradesh Region. Cureus 14(9):e28780. https://doi.org/10.7759/cureus.28780 Lin G, Yang D, Sui W (2022) Clinical Effect of Open Reduction and Internal Fixation for Femoral Neck Fracture in Young Adults and Related Factors of Femoral Head Necrosis. Journal of environmental and public health, 2022, 2974830. https://doi.org/10.1155/2022/2974830 (Retraction published J Environ Public Health. 2023;2023:9753273) Lai SW, Lin CL, Liao KF (2020) Evaluating the association between avascular necrosis of femoral head and oral corticosteroids use in Taiwan. Medicine 99(3):e18585. https://doi.org/10.1097/MD.0000000000018585 Philippon MJ, Rasmussen MT, Turnbull TL, Trindade CA, Hamming MG, Ellman MB, Harris M, LaPrade RF, Wijdicks CA (2014), December 1 Structural Properties of the Native Ligamentum Teres. Orthopaedic Journal of Sports Medicine, 2(12), 232596711456196. https://doi.org/10.1177/2325967114561962 Late SV, Keche H (2022) Morphometric Study of Proximal End of the Fully Ossified Human Femur: A Cross-Sectional Study. Cureus 14(9):e29188. https://doi.org/10.7759/cureus.29188 Luthra JS, Al-Habsi S, Al-Ghanami S, Ghosh S, Al-Muzahemi K (2019) Understanding Painful Hip in Young Adults: A Review Article. Hip pelvis 31(3):129–135. https://doi.org/10.5371/hp.2019.31.3.129 Kurylo JC, Templeman D, Mirick GE (2015) The perfect reduction: approaches and techniques. Injury 46(3):441–444. https://doi.org/10.1016/j.injury.2014.11.027 Chen CY, Hsu SL, Hsu CH, Liu HC, Lu YD (2023) Pipkin Type I and II femoral head fractures: internal fixation or excision?-from the hip arthroscopy perspective. J hip preservation Surg 10(1):31–36. https://doi.org/10.1093/jhps/hnad002 Ripamonti C, Lisi L, Avella M (2014) Femoral neck shaft angle width is associated with hip-fracture risk in males but not independently of femoral neck bone density. Br J Radiol 87(1037):20130358. https://doi.org/10.1259/bjr.20130358 Boese CK, Dargel J, Oppermann J, Eysel P, Scheyerer MJ, Bredow J, Lechler P (2016) The femoral neck-shaft angle on plain radiographs: a systematic review. Skeletal Radiol 45(1):19–28. https://doi.org/10.1007/s00256-015-2236-z Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4429644","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":306669323,"identity":"e0570fb3-963c-468b-8755-edd30d7dd1e7","order_by":0,"name":"Esra SEN","email":"","orcid":"","institution":"Başkent University","correspondingAuthor":false,"prefix":"","firstName":"Esra","middleName":"","lastName":"SEN","suffix":""},{"id":306669324,"identity":"a4b3047b-6d7e-4075-bbe9-4a64c1de9ec0","order_by":1,"name":"Sinem Nur SEVER","email":"","orcid":"","institution":"Atilim University","correspondingAuthor":false,"prefix":"","firstName":"Sinem","middleName":"Nur","lastName":"SEVER","suffix":""},{"id":306669325,"identity":"e3766040-b1da-44b7-b1c1-a806213c95ef","order_by":2,"name":"Begumhan TURHAN","email":"data:image/png;base64,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","orcid":"","institution":"Başkent 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08:36:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4429644/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4429644/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":57630038,"identity":"309bb5d4-8544-407d-8244-a95dfd7a98f0","added_by":"auto","created_at":"2024-06-03 14:39:12","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":299443,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA: \u003c/strong\u003eAnteroposterior image, \u003cstrong\u003eB\u003c/strong\u003e: craniocaudal image\u003c/p\u003e","description":"","filename":"Figure1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4429644/v1/287c94c039c13ed36945b2aa.jpeg"},{"id":57630039,"identity":"c2837dd5-c761-4564-83bb-ed8f045e6eac","added_by":"auto","created_at":"2024-06-03 14:39:12","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":478174,"visible":true,"origin":"","legend":"\u003cp\u003eMediolateral view of the femur\u003c/p\u003e","description":"","filename":"Figure2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4429644/v1/2efa2f089e6201cb2b97052a.jpeg"},{"id":57630037,"identity":"9763ca1d-93fb-487b-af43-6eacecc37ce7","added_by":"auto","created_at":"2024-06-03 14:39:11","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":450919,"visible":true,"origin":"","legend":"\u003cp\u003eThe morphological shape types of the fovea capitis femoris\u003c/p\u003e","description":"","filename":"Figure3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4429644/v1/983416e5d645cc8fb5f6eef5.jpeg"},{"id":57630040,"identity":"83670d26-9543-4f80-b673-f3454cb40eb0","added_by":"auto","created_at":"2024-06-03 14:39:13","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":499947,"visible":true,"origin":"","legend":"\u003cp\u003eThe localization types of the FCF on mediolateral view of femoral head\u003c/p\u003e","description":"","filename":"Figure4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4429644/v1/abb42544104dec57c78333e3.jpeg"},{"id":58060287,"identity":"c6cc1c8d-de31-4ff3-a5ff-166ab8c993b8","added_by":"auto","created_at":"2024-06-10 15:19:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2530199,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4429644/v1/5ab45ed3-7bad-4ed5-921d-9afd20c0f11a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A comprehensive morphometric and morphological analysis of fovea capitis femoris and femoral head parameters according to gender","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eFovea capitis femoris (FCF) is an area on the femoral head, usually located in the posteroinferior of the femoral head. It provides attachment sites for the ligamentum teres, which is also known as the ligamentum capitis femoris or round ligament of the hip [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The transverse acetabular ligament, a non-cartilaginous extension of the labrum at the inferior side of the hip, is where the ligamentum teres inserts after emerging from the FCF. Although role of the ligamentum teres in maintaining hip stability is debatable, isolated damage to the ligament may be the cause of hip pain. It was stated that generally, 4\u0026ndash;15% of sports-related injuries occur in the ligamentum teres. The ligament's lesions include fractures at the attachment site to the FCF and the congenital absence of the ligament [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The ligamentum teres can be located nearly to the fovea capitis femoris. That's why FCF is clinically important in the pre-surgical diagnosis of ligamentum teres lesions [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSome previous studies found that patients with hip dislocation could have a tear of the ligamentum teres, but there could have been isolated cases of intact or partially torn ligamentum teres on arthroscopy after dislocation. In one way or another, dislocations typically cause disruptions to the arterial supply of the head. The femoral head can be perfused by 2\u0026ndash;4 arteries, which arise from the deep branch of the medial femoral circumflex artery. Mostly, the head is supplied by the lateral circumflex femoral artery. The profunda femoris artery contributes to the medial femoral circumflex artery, supplying the main blood supply to the femoral head [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The obturator artery, a branch of the anterior division of the internal iliac artery, travels down and forward along the lateral pelvic wall and passes through the obturator canal to form iliac, vesical, and pubic branches within the pelvis. It then divides into anterior and posterior branches that supply the medial compartment of the thigh. The acetabular branch entering the hip joint originates from the posterior branch [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The foveolar artery, also known as the ligamentum teres artery, is a small artery that arises from the obturator artery and only perfuses the perifoveal region. In adults, it usually remains vestigial and makes a negligible contribution [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The ligamentum teres artery attaches itself to the fovea after descending from the posterior branch of the obturator artery [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere are also other structures, such as nutrient foramina, which are located in the FCF and the entrance to the arteries that supply the femoral head. Avascular necrosis is one of the causes of the negative development and formation of the femoral head in cases that affect the FCF. In addition, an excess of nutrient foramina reduces the likelihood of developing osteonecrosis [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Hip dysplasia and osteoarthrosis have been related to modifications in the morphometric structure and location of the FCF in the hip joint [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. As the femoral head is supplied by vessels that travel through the FCF, the features of the anatomical structures on the head of the femur are considered potential factors in avascular necrosis. FCF is regarded as a significant anatomical structure for arthroscopic procedures, surgical interventions, radiological examination of the hip joint, and morphometric and morphological properties of the proximal femur [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral studies evaluating the vascular structures of the ligamentum teres and femoral head were conducted [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The morphological and morphometric features of the FCF by gender and its relationship with femoral parameters have not been extensively studied in the literature. In this study, it was aimed to analyze gender-dependent morphometric and morphological characteristics of the FCF to determine its precise position, size, morphological types, and relationship with the parameters of the proximal femur by gender.\u003c/p\u003e"},{"header":"MATERIAL AND METHODS","content":"\u003cp\u003eMorphometric analysis of fovea capitis femoris and femoral head parameters were performed on 72 adult dry femora (34 right and 38 left) at the Anatomy Department of Hitit University, \u0026Ccedil;orum. The bones with any deformity on the proximal femur that could affect the objective measurements were excluded from the study. Gender records of the bones included in the study were available. These consisted of 38 male and 34 female femurs. Determination of the morphometric and morphological evaluation of the FCF and proximal femur was performed according to the methods reported in previous studies [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Morphometric and morphological analysis of the FCF and femoral head was performed on digital images of the bone using the ImageJ 1.53 software (National Institutes of Health, Bethesda, MD). Anteroposterior, craniocaudal, and mediolateral digital photographs were obtained using a tripod-fixed digital camera (Canon EOS 800D). To ensure the accuracy of the measurements, a reference scale bar was placed next to the bones. The reference scale bar was introduced to the ImageJ program to provide calibration of the morphometric measurements for each sample.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eMeasurements of the Femoral Head Parameters\u003c/h2\u003e \u003cp\u003eThe femoral head center, the femoral neck axis, and the femoral shaft anatomical axis were defined according to previous studies [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Vertical diameter, anterior-posterior diameter, femoral head area, and neck-shaft angle (femoral inclination angle) were measured as femoral head parameters.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eCenter of the femoral head\u003c/h2\u003e \u003cp\u003eThe most appropriate circle was obtained according to the femoral head of each sample by drawing a circle around the femoral head using the ImageJ (Version 1.53q) program.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eAnatomical shaft axis of the femur\u003c/h2\u003e \u003cp\u003eIt was identified as a segment that joins the midpoints of the proximal diaphysis at the trochanter minor's lower edge and the distal diaphysis at the femoral condyles' upper edge.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eFemoral neck axis\u003c/h2\u003e \u003cp\u003eIt was described as the segment joining the midpoint of the intertrochanteric line to the center of the femoral head.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eFemoral inclination angle (FIA)\u003c/h2\u003e \u003cp\u003eThe angle was obtained between the femoral neck axis and the shaft axis on anteroposterior digital images. This angle is known as the FIA which represents the medial inclination of the proximal femur. It is also referred to as the collodiaphyseal angle or the neck-shaft angle. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eINSERT\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cb\u003eHERE\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eVertical diameter of the femoral head (FHD-V)\u003c/h2\u003e \u003cp\u003eIt was obtained by drawing a line between the upper and lower two points with the highest vertical convexity of the femoral head.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eAnteroposterior diameter of the femoral head (FHD-AP)\u003c/h2\u003e \u003cp\u003eIt was obtained by drawing a line between the most anterior and posterior points of the femoral head.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eFemoral head area (AREA-FH)\u003c/h2\u003e \u003cp\u003eIt was measured on mediolateral images as the area of the circular shape encircling the femoral head (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eINSERT\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cb\u003eHERE\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eMeasurement of the FCF parameters\u003c/h2\u003e \u003cp\u003eThe longitudinal diameter, transverse diameter, depth, area, and localization of the FCF were measured on mediolateral images according to previous studies. The longitudinal diameter, transverse diameter, area, and localization of the FCF were measured using ImageJ software (Version 1.53q). Depth of the FCF was measured using digital caliper.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLongitudinal length of the fovea capitis femoris (LL-FCF)\u003c/h2\u003e \u003cp\u003eIt was measured as the longest diameter of the FCF.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTransverse length of the fovea capitis femoris (TL-FCF)\u003c/h2\u003e \u003cp\u003eIt was measured as the shortest diameter of the FCF.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eArea of FCF (A-FCF)\u003c/h2\u003e \u003cp\u003eThe surface area of the circular shape surrounding the head of the femur was measured on mediolateral images.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eDepth of fovea (D-FCF)\u003c/h2\u003e \u003cp\u003eIt was measured as distance between surface and deepest point of the FCF. A caliper was used to help with the measurement.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eNumber and localization of foramina (FN)\u003c/h2\u003e \u003cp\u003eThe number of vascular foramina in the FCF was analyzed by naked eye. The foramina closer to the center were classified as central, and those closer to the edge were classified as peripheral.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eMorphological types of the FCF\u003c/h2\u003e \u003cp\u003eThe four morphological shapes of the FCF were determined as oval, round (circular), triangular, and piriform types according to previous studies. To distinguish oval and round types, the foveal index equation was used which was reported by Perumal et al. (FI\u0026thinsp;=\u0026thinsp;TLFCF/LLFCF \u0026times; 100). (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eINSERT\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e \u003cb\u003eHERE\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eThe location of the FCF\u003c/h2\u003e \u003cp\u003eThe femoral head was divided into 4 compartments on mediolateral images using two horizontal and vertical lines passing through the center to localize the FCF. These compartments were determined as anterosuperior, anteroinferior, posterosuperior, and posteroinferior. Six different location types of FCF was determined according to the location of the FCF in these compartments (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eINSERT\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e \u003cb\u003eHERE\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eGender determination\u003c/h2\u003e \u003cp\u003eGender determination was performed by considering the degree of strength and size of the long bones and the general structure of the linea aspera in the femur by an anthropologist [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eInter and intra observer coefficient error\u003c/h2\u003e \u003cp\u003eEach measurement was repeated three times and average of these measurements was recorded as mean values. To minimize inter-observer coefficient error, 10% of the analyses were re-measured by a different researcher [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eStudy data were analyzed using SPSS (version 25.0; SPSS, Chicago, IL, USA). The normality of data was assessed with skewness, kurtosis values, and histogram graphics. The percentages of the localization types, shape types of the FCF, and location of the foramina were determined. Student\u0026rsquo;s t test was used to examine the significance of differences between genders. Categorical variables were analyzed by Pearson\u0026rsquo;s chi-square test. Pearson correlation test was used to emphasize the correlations between parameters. The absolute value of the correlation coefficient (r) was defined as weak correlation if it was between 0.2\u0026ndash;0.4 and moderate correlation if it was between 0.4\u0026ndash;0.6. A p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was determined as the level of statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eTotal of 72 dry femurs including 34 female (47.2%) and 38 (52.8%) male femurs were evaluated. Thirty-four of all femurs were the right bones of the extremities. The mean measurement values of all femurs (n\u0026thinsp;=\u0026thinsp;72) in terms of LL-FCF, TL-FCF, FHD-V, FHD-AP, D-FCF, FHA, A-FCF, FHA/A-FCF, FIA and FN are 1.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68, 1.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45, 4.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55, 3.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40, 2,78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.29, 13.14\u0026thinsp;\u0026plusmn;\u0026thinsp;2.84, 1.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58, 13.11\u0026thinsp;\u0026plusmn;\u0026thinsp;12.31, 124.17\u0026thinsp;\u0026plusmn;\u0026thinsp;15.50, 8.77\u0026thinsp;\u0026plusmn;\u0026thinsp;6.80 respectively. Measurement values of the bones along with standard deviations (SD) were presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. All parameters were similar in both genders except FHD-V and FHA (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). FHD-V and FHA values were higher in males (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Although the mean values of LL-FCF, TL-FCF, A-FCF, and foramina number were higher in females, there was not a significant difference between the genders (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Moreover, the values of measured parameters were similar on both sides (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The FCF was only in the posteroinferior quadrant at a rate of 5.6%.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMorphometric measurements of femurs according to the gender\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAll individuals\u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLL-FCF (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e16.4\u0026thinsp;\u0026plusmn;\u0026thinsp;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e14.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e1,53\u0026thinsp;\u0026plusmn;\u0026thinsp;0,68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.331\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.207\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTL-FCF (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e11.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e1,09\u0026thinsp;\u0026plusmn;\u0026thinsp;0,45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.712\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.488\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFHD-V (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e43.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e49.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4,66\u0026thinsp;\u0026plusmn;\u0026thinsp;0,55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-4.561\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFHD-AP (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e36.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e39.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e3,82\u0026thinsp;\u0026plusmn;\u0026thinsp;0,40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-2.767\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eD-FCF (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e25.6\u0026thinsp;\u0026plusmn;\u0026thinsp;12.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e29.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e2,78\u0026thinsp;\u0026plusmn;\u0026thinsp;1,29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-1.376\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.173\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFHA (mm\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1162\u0026thinsp;\u0026plusmn;\u0026thinsp;249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1450\u0026thinsp;\u0026plusmn;\u0026thinsp;243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13,14\u0026thinsp;\u0026plusmn;\u0026thinsp;2,84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-4.939\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eA-FCF (mm\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e122\u0026thinsp;\u0026plusmn;\u0026thinsp;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e120\u0026thinsp;\u0026plusmn;\u0026thinsp;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e1,21\u0026thinsp;\u0026plusmn;\u0026thinsp;0,58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.875\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFHA/A-FCF\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e10.67\u0026thinsp;\u0026plusmn;\u0026thinsp;7.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e15.3\u0026thinsp;\u0026plusmn;\u0026thinsp;15.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13,11\u0026thinsp;\u0026plusmn;\u0026thinsp;12,31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-1.609\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFIA (\u0026ordm;)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e122.78\u0026thinsp;\u0026plusmn;\u0026thinsp;20.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e125.41\u0026thinsp;\u0026plusmn;\u0026thinsp;8.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e124,17\u0026thinsp;\u0026plusmn;\u0026thinsp;15,50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.717\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.476\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFN\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e9.23\u0026thinsp;\u0026plusmn;\u0026thinsp;7.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e8.36\u0026thinsp;\u0026plusmn;\u0026thinsp;6.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e8,77\u0026thinsp;\u0026plusmn;\u0026thinsp;6,80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.537\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.593\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eLL-FCF\u003c/b\u003e: Longitudinal length of fovea capitis femoris, \u003cb\u003eTL-FCF\u003c/b\u003e: Transverse length of fovea capitis femoris, \u003cb\u003eFHD-V\u003c/b\u003e: Femoral head vertical diameter, \u003cb\u003eFHD-AP\u003c/b\u003e: Antero-posterior diameter of femoral head, \u003cb\u003eD-FCF\u003c/b\u003e: Depth of fovea, \u003cb\u003eFHA\u003c/b\u003e: Femoral head area, \u003cb\u003eA-FCF\u003c/b\u003e: Area of fovea capitis femoris, \u003cb\u003eFIA\u003c/b\u003e: Neck-shaft angle, \u003cb\u003eFN\u003c/b\u003e: Foramina number, *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 is statistically significant, Independent sample t-test\u003c/p\u003e \u003cp\u003eMorphological types of the fovea were determined as oval, circular, triangular, and piriform according to the morphological characteristics of the fovea. The foramina localization was mainly at central (51.4%). Five of the femoral heads have no foramina (6.9%) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere was no significant difference between the shape types of the FCF, foramina localization and localization of foramina in terms of percentage distribution on the female and male genders (Chi-square (χ2): 6.264, 0.222, 3.789 respectively, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). There was a moderate correlation between A-FCF and FHA (r\u0026thinsp;=\u0026thinsp;.457, p\u0026thinsp;=\u0026thinsp;0.001), and a weak correlation between A-FCF and FN (r\u0026thinsp;=\u0026thinsp;.359, p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe number of cases and percentage distribution of the shape types of the FCF in terms of genders\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eFovea shape type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eOval\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRound\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTriangular\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003ePiriform\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e44 (61.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e13 (18.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eForamina localization\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003eCentral\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cb\u003ePeripheral\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e5 (6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e37 (51.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e30 (41.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLocalization of fovea\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eType 1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eType 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eType 3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eType 4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eType 5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u003cb\u003eType 6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (27.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e6 (8.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cb\u003e1\u003c/b\u003e: Centered at the posterosuperior of the head; \u003cb\u003e2\u003c/b\u003e: Mainly centered at the posterosuperior of the head, additionally located inside the borders of the anterosuperior quadrant. \u003cb\u003e3\u003c/b\u003e: Mainly centered at the posterosuperior of the head and additionally located inside the borders of all quadrants except the anteroinferior, \u003cb\u003e4\u003c/b\u003e: Mainly centered at the posteroinferior of the head and additionally at all quadrants, \u003cb\u003e5\u003c/b\u003e: Mainly centered at the posterosuperior and located inside the borders of the posteroinferior of the head, \u003cb\u003e6\u003c/b\u003e: Mainly centered at posterosuperior and additionally located at all quadrants, n: number of cases\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAdditionally, all the morphometric measurements of femurs according to the side were similar as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e (p\u0026thinsp;\u0026gt;\u0026thinsp;0.005).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMorphometric measurements of femurs according to the side\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLL-FCF (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.941\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTL-FCF (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.869\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFHD-V (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.511\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.135\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFHD-AP (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.790\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.432\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eD-FCF (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.260\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFHA (mm\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.96\u0026thinsp;\u0026plusmn;\u0026thinsp;2.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.29\u0026thinsp;\u0026plusmn;\u0026thinsp;3.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.628\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eA-FCF (mm\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.573\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFHA/A-FCF\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.35\u0026thinsp;\u0026plusmn;\u0026thinsp;14.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u0026thinsp;\u0026plusmn;\u0026thinsp;9.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.807\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.422\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFIA (\u0026ordm;)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e121.77\u0026thinsp;\u0026plusmn;\u0026thinsp;20.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126.31\u0026thinsp;\u0026plusmn;\u0026thinsp;8.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.217\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFN\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.17\u0026thinsp;\u0026plusmn;\u0026thinsp;6.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.42\u0026thinsp;\u0026plusmn;\u0026thinsp;6.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.467\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.642\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eLL-FCF\u003c/b\u003e: Longitudinal length of fovea capitis femoris, \u003cb\u003eTL-FCF\u003c/b\u003e: Transverse length of fovea capitis femoris, \u003cb\u003eFHD-V\u003c/b\u003e: Femoral head vertical diameter, \u003cb\u003eFHD-AP\u003c/b\u003e: Antero-posterior diameter of femoral head, \u003cb\u003eD-FCF\u003c/b\u003e: Depth of fovea, \u003cb\u003eFHA\u003c/b\u003e: Femoral head area, \u003cb\u003eA-FCF\u003c/b\u003e: Area of fovea capitis femoris, \u003cb\u003eFIA\u003c/b\u003e: Neck-shaft angle, \u003cb\u003eFN\u003c/b\u003e: Foramina number, *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 is statistically significant, Independent sample t-test\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn the current study, in which we detailedly examined the localization of FCF on the femoral head, the shape types, and the morphometric properties of bones according to gender, most of the evaluated parameters were found to be similar in both genders. It was observed that the localization of the FCF was mostly centered posterosuperiorly to the femoral head but, at the same time, overflowing beyond a little anterosuperiorly. Four different types of FCF were identified, and most of them were oval.\u003c/p\u003e \u003cp\u003eUpon reviewing the literature, it is observed that numerous studies have examined the relationships between the proximal femur parameters. Numerous data have been obtained from these studies, which looked into several clinical issues relating to proximal femur parameters, gender, race, and right-left side differences in the hip joint [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan additionalcitationids=\"CR24 CR25 CR26\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Another purpose of evaluating FCF and proximal femur parameters is to guide anthropological research. Although a complete pelvis is not always available, it is one of the most important structures used in anthropology to determine the gender of skeletal remains. In such cases, long bones, such as the femur, a robust bone, have been used to determine gender. In addition to various points on the proximal femur, also the FCF has been used as a landmark in such studies [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. However, in the bone studies that we found, there was not much discussion about the association between FCF and proximal femur parameters according to gender.\u003c/p\u003e \u003cp\u003eRegarding the localization of FCF, we found six types of foveal localization in our study, while five types of foveal localization were determined in the previous studies [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In our study, consistent with others, the fovea was located slightly posterior to the femoral head. Furthermore, in our study, FCF was located in the posteroinferior quadrant in only 5.6% of cases, which is quite low when compared to the rate in other studies. In our study, the center of the fovea was mostly posterosuperior to the femoral head. In the study of Yarar et al., this fovea was mostly centered posteroinferiorly and extended only to the anteroinferior quadrant. Likewise, in G\u0026ouml;lpınar's study, the center was mainly located in the posteroinferior quadrant [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In our study, the most common localization type was the type with a posterosuperior center that extended only to the anterosuperior quadrant.\u003c/p\u003e \u003cp\u003eSimilar to our study, previous studies have reported that the shape type of FCF is generally oval in shape [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Perumal et al. reported that the majority of FCF shapes are oval, but also stated circular and triangular shape types [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Yarar et al. defined the piriform shape type in addition to the defined types in previous studies and found four types of FCF shapes similar to our study [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Similar to the study of Yarar et al., G\u0026ouml;lpınar determined the four types of FCF and stated that the most common type was oval [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The rate of oval-shaped FCF in our study is very small when compared to the rate in the study of Perumal et al. and higher than the studies of Yarar et al. and G\u0026ouml;lpınar.\u003c/p\u003e \u003cp\u003eSome studies evaluating FCF dimensions have measured the largest diameter of the FCF (TL-FCF) in axial and coronal sections on computed tomography or magnetic resonance images (MRI) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In asymptomatic volunteers, the width of FCF found by Bensler et al. did not contain similar results to our findings. In their study on MRI, Bensler et al. showed that the FCF width was larger in males [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Bertsatos et al. found that the maximum diameter of FCF was larger in males than females [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Similarly, Ceynowa et al. found that FCF width was larger in males [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In our study, no significant difference was observed between genders in terms of foveal width (TL-FCF). These studies were carried out on fresh cadavers or living persons. Therefore, considering that the articular cartilage structure and ligamentous structures were preserved in these cases, it is usual that the TL-FCF found in these studies would be different from the values found in our study. The mean FCF longitudinal length in our study was 15.35\u0026thinsp;\u0026plusmn;\u0026thinsp;6.88 mm, while this value was 15.25\u0026thinsp;\u0026plusmn;\u0026thinsp;2.86 mm in the study of Yarar et al. In the study of Gupta et al. on dry bones, the mean FCF longitudinal length was 15.94\u0026thinsp;\u0026plusmn;\u0026thinsp;3.37 mm. The mean transverse length of the FCF was 12.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.17 mm in the study by Yarar et al. and 11.38\u0026thinsp;\u0026plusmn;\u0026thinsp;2.35 mm in the study by Gupta et al. In our study, the mean value was 10.92\u0026thinsp;\u0026plusmn;\u0026thinsp;4.51 mm. [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe number of foramina was higher in the center than in the periphery, which is consistent with the findings of Perumal et al. Additionally, as a distinguishing feature of our study from the Perumal\u0026rsquo;s study, there was no difference between males and females in terms of the number and location of foramina. In our study, the number of vascular foramina in the fovea was strongly related to the size of the FCF, as well as the area of the femoral head. As the femoral head area increased, so did the foveal area. It was seen that thr bones with a larger area appear to have more vascular foramina. In this respect, our findings are similar to those of Perumal et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Furthermore, the femoral head area was found to be larger in males than females. Because it is known that when the foveal area increases as the femoral head area increases in our study, the number of foramina is expected to be greater in males than in females. However, our study found no difference in the number of foramina between the sexes. It was found that the risk of avascular necrosis decreased as the number of foramina increased in a study by gender independently [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Another study found that male are more likely than female to develop avascular necrosis [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Lai et al. found that the incidence of avascular necrosis was not different between genders, which may be similar to our finding that the number of foramina was not different between genders [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. In our study, we found no differences in the number of foramina between genders. Given the relationship between the number of foramina and avascular necrosis, it is reasonable to expect that avascular necrosis does not differ by gender. Additionally, we would like to emphasize that 6.9% of the specimens were devoid of vascular foramina. According to Philippon et al., the absence of vascular foramina could be caused by a congenital absence of the ligamentum teres. This rate was calculated at 10% in their study [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. This rate was 24% in the Perumal et al. study. More histological investigations are required to address this, according to Perumal et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This is because it's possible that these bones still contain smaller foramina (\u0026lt;\u0026thinsp;200 microns) that are invisible to the human eye.\u003c/p\u003e \u003cp\u003eLate et al. examined the vertical length of the femoral head on dry bones without taking gender into account and found no difference between the right and left bones [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Similarly, no difference was observed between the vertical lengths of the right and left bones in our study. However, the vertical lengths of the right and left bones were significantly greater in males than females. In our study, A-FCF and FHA were evaluated together. To the best of our knowledge there are a few studies in which these two parameters were evaluated together and compared to each other [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In the study by Bertsatos et al., which is the only existing study and they did not compare the data according to gender, A-FCF was found to be larger in males than in females [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In our study, we observed that the size of A-FCF did not vary according to gender.\u003c/p\u003e \u003cp\u003ePrevious studies have indicated that changes in the morphometric structure of the FCF and its position in the hip joint are clinically important. For example, in patients with hip dysplasia, the position of the FCF has been reported at a higher localization level in the femoral head [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. In the fixation process for femoral neck fractures, the rotational position of the femoral head can be determined according to the FCF localization [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. In fact, in the \"Pipkin classification\" of femoral injuries, the type of injury (Type I and Type II) is determined by the position of the fracture in relation to the FCF [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In addition, the \"femoral tunnel drilling technique\" is used in surgical procedures for ligamentum capitis femoris reconstruction. In this method, the channel created by opening the femoral neck passes through the center of the FCF [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The hip rotation center (HRC) is an important component that significantly influences the clinical outcomes after total hip replacement [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In conclusion, we believed that FCF localization is very important for both surgical and clinical examination processes. We think that it will be useful for the surgeon during surgical procedures to understanding the connection between the femoral head center or HRC and FCF localization. Also, it should also be taken into account that the femoral head center defined on dry bone and on medical images may be different from eachother. Comparative studies using dry bones and 3D images may be useful to better understanding of the relationship between HRC and FCF.\u003c/p\u003e \u003cp\u003eLate et al. found no significant difference in femoral inclination angle between the right and left dry femurs independent of gender [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. The findings of Late et al. are similar to the findings of our study and there was no significant difference in femoral inclination angle between the right and left femur bones and also in terms of genders. In another study in which the lower extremity was examined with computed tomography, no significant difference was determined between the neck-shaft angle in terms of gender [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In our study, there was no significant difference between femoral neck-shaft angle between male and females. Femoral inclination angle, one of the angular parameters of the femur, has been associated with many clinical problems in the literature. It is known that FIA is increased in idiopathic scoliosis, cerebral palsy, poliomyelitis, hip dislocation and congenital subluxation, whereas it is decreased in femoral head epiphyseal slippage, Perthes disease, intertrochanteric fracture and congenital coxa vara [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has some limitations. The right and left femur could not be matched to see if they belonged to the same person. The ethnic origin of the bones was also unknown. As there was no record of age, the changes in the evaluations with age could not be examined. Furthermore, the sample size remained small because some femurs of known gender could not be included in the measurements because of a lack of bone integrity.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn this study, the bone morphology of FCF in 72 femurs was analyzed according to gender. Males had higher FHD-V and FHA values. There was no discernible difference in the mean values of foramina, LL-FCF, TL-FCF, and A-FCF between the genders, despite the fact that the mean values were higher in females. Furthermore, when the measured parameters were analyzed in terms of sides, the values obtained were comparable. Only 5.6% of the FCF were located in the posteroinferior quadrant, whereas the majority were located in the posterosuperior quadrant, which is in contrast to the findings of most studies on the morphological characteristics of the femur. The morphological types of the fovea were identified as oval, circular, triangular, and piriform based on the fovea's physical characteristics. The majority of foramina localization was in the center. The fovea capitis femoris did not contain any foramina. The shape types, foramina localization, and foramina localization of FCF in male and female gender did not significantly differ in percentage terms. A-FCF and FHA showed a moderate correlation, while A-FCF and FN showed a weak correlation. We think that the results of this investigation could offer valuable insights for both medical and anthropological settings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eThis study was designed by E.S., B.T., S.S., M.G. and M.C. E.S. carried out the analyses. B.T. and M.G. supervised the project. E.S., B.T., M.G., S.S. and M.C. wrote, edited and approved the manuscript. E.S. and S.S. prepared figures 1-4. M.C. and M.G. contributed to the data collection of the study. All authors critically revised the manuscript.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSource (s) of support:\u0026nbsp;\u003c/strong\u003eThis research received no specific grant from any funding agency, commercial or non for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONFLICT OF INTEREST STATEMENT\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePorthos Salas A, O'Donnell JM (2015) Ligamentum teres injuries- an observational study of a proposed new arthroscopic classification. 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Skeletal Radiol 45(1):19\u0026ndash;28. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00256-015-2236-z\u003c/span\u003e\u003cspan address=\"10.1007/s00256-015-2236-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Femur head, hip joint, ligamentum capitis femoris, round ligament of femur","lastPublishedDoi":"10.21203/rs.3.rs-4429644/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4429644/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThis study aimed to examine the morphometric properties of the fovea capitis femoris (FCF), including its location on the femoral head, shape varieties, and correlation with gender-specific femoral head parameters.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eSeventy-two (n\u0026thinsp;=\u0026thinsp;72) dry femurs were used. The morphometric features of these bones were assessed based on gender. While some of the FCF and femoral head parameters were measured on dry bones using calipers, others were measured using ImageJ software (Version 1.53q) on digital images.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAll parameters were similar in both genders except FHD-V and FHA (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). FHD-V and FHA values were higher in males (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Although the mean values of LL-FCF, TL-FCF, A-FCF, and foramina number were higher in females, there was not a significant difference between genders (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Foramina localization was mainly central (51.4%). Five of the femoral heads have no foramina (6.9%). Four types of FCF were identified and most of them were oval type (61.1%). It was found that only 5.6% of FCFs were in the posteroinferior squad, and the vast majority were in posterosuperior squads.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe findings indicated that a few femoral head parameters were connected to the morphometric traits, localization, and shape types of the FCF. It was noted that there were gender-specific differences in a few parameters. Our research is expected to benefit anthropological sciences, radiological applications, and orthopaedics.\u003c/p\u003e","manuscriptTitle":"A comprehensive morphometric and morphological analysis of fovea capitis femoris and femoral head parameters according to gender","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-03 14:39:06","doi":"10.21203/rs.3.rs-4429644/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"953ebef0-d480-498e-9bd8-d13a05dfd0d1","owner":[],"postedDate":"June 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-10T15:11:41+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-03 14:39:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4429644","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4429644","identity":"rs-4429644","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}