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Kostick, 1963
Kostick, 1963
393-402 393
With 2 plates
Printed in Great Britain
Bony facets and imprints, particularly of the femur, have been described by many
authors. Their incidence in various races has been recorded by Charles (1893),
Parsons (1914), Walmsley (1915), Pearson & Bell (1919), Meyer (1924 a), and others.
Recently, Schofield (1959) describes them in the Maori femur. Most of these
authors have used exhumed material, for which accurate records are rarely available.
The state of preservation of exhumed material varies greatly, and if only a part of
the skeleton is available sexing and ageing may be difficult or impossible. It is
unsuitable material on which to base observations concerning, for example, precise
bone markings, structure and texture. Dodgers (1931) has used fresh material of
known age and sex. Fresh material allows observation of the cartilage coated
articular surfaces, but not of the underlying bone.
For the purpose of this study specially prepared bones (series A) were used. They
provided a standard of uniform osteological quality and served as a control for the
study of the exhumed material (series I.D.H.), in which bone preservation varied
greatly.
MATERIALS AND METHODS
Observations have been recorded on two series comprising in all 738 adult
femora: series A from specially prepared skeletons and series I.D.H. from exhumed
skeletons. All the material is in the skeletal museum, University College, Ibadan,
Nigeria.
Series A (Table 1). This consists of the femora from complete skeletons, prepared
from fresh undissected material in the department. The preparation is carried out
in four stages:
(1) Initial stripping. The entire skeleton is stripped of all soft material. Dis-
articulations are effected at occipito-atlantal, lumbo-sacral, hip, knee, ankle, tibio-
fibular, sterno-clavicular, shoulder, elbow, wrist, radio-ulnar, and temporo-
mandibular, joints. The parts are then placed in tap water in special containers.
Maceration is allowed to proceed for 1 week at 105° F.
(2) Fine stripping. After maceration, the containers are emptied, with suitable
precautions to prevent loss of teeth, terminal phalanges, etc., and the bones are
fine stripped of all maceration resistant material, chiefly collagenous.
(3) Boiling. After fine stripping the bones are boiled in soap and water for 1 hr.,
following which they are dried and bleached in the sun.
(4) Immersion in 95 % alcohol degreasingg). They are then immersed in 95 %
* Present address: University of Saskatchewan, Saskatoon, Canada.
26 Anat. 97
394 E. L. KOSTICK
'industrial spirit' for 48 hr., again dried and bleached in the sun. The procedure is
repeated, this time immersing the bones in alcohol for only 24 hr.
This process gives clean dry bones. They sometimes retain their articular cartilage
(P1. 1, fig. 4). The teeth are replaced in their appropriate sockets.
Number, sex, tribe, and age are recorded. Some of the subjects have hospital
records. Unfortunately, the stated age is unreliable, since registration of births is
not compulsory. An attempt is made to confirm and estimate the age, by noting:
(1) the appearance of the body prior to maceration; (2) the degree of ossification
and epiphyseal fusion; (3) the state of eruption and attrition of the teeth. In
Nigerians, the molars usually erupt before 21 years (commonly 16-17 years).
Marked attrition may be present as early as 30 years. Thus it is only possible to
give an approximate estimated age; they were mainly young adult. In 143 'stated'
ages the average was 35-13 years (S.D. 8.56).
In series A observations have been made on 209 pairs of male and 73 pairs of
female femora, giving a total of 564 femora.
Series I.D.H. This consists of the femora from skeletons, exhumed from the
cemetery of the old Infectious Diseases Hospital, Ibadan, which was excavated to
make way for the present University College Hospital. A cemetery plan has been
available but there are no records of age, tribe or sex. The material has been sexed
from accepted typical sex characters of innominate bone, skull, sternum and limb
bones. Since most parts of the skeleton are present, a reasonable assessment of sex
has been possible. Like series A, series I.D.H. is estimated to be mostly early adult,
below 40 years of age.
In series I.D.H. observations have been made on 15 left and 15 right female
femora, and 73 left and 71 right male femora giving a total of 174. In addition to
series A and I.D.H. a collection of 238 foetal and young skeletons has been examined.
Fresh knee and hip joints have been dissected and observed. Use has also been
made of dissecting room material.
TERMINOLOGY
The articular lamella is cortical bone which underlies the articular cartilage
(Johnston, Davies & Davies, 1958).
Facets and imprints of femora 395
OBSERVATIONS
(1) Facets and imprints at the upper end of the femur
Poirier's facet (PI. 1, figs. 1, 3-5). This is a facet produced by an extension of the
articular surface of the head on to the anterior surface of the neck. Sometimes a
ridge, known as the cervical eminence, runs from the femoral tubercle (superior
cervical tubercle), along the antero-superior aspect of the neck, to the head. When
it extends on to the medial end of the ridge the facet is prominent (see Testut, 1904).
If the ridge is absent Poirier's facet is likely to be lacking also.
In some specimens in series A it is obvious that articular cartilage extends on to
the facet. The presence of cartilage is often taken as a prerequisite for a Poirier's
facet but this is not the original description (Poirier, 1911; Odgers, 1931; Schofield,
1959). In conformity with these and other authors a continuity of the articular
lamella on to the neck is taken as acceptable evidence of a Poirier's facet. It may
also occur with an imprint as shown in PI. 1, figs. 3 and 5.
Anterior cervical imprint (PI. 1, figs. 2, 5). This occurs on the anterior and inferior
aspects of the medial part of the neck, adjacent to the head. It is also known as the
fossa of Allen, the imprint of Berteaux, and sometimes again ascribed to Poirier.
For the present study, it has been convenient to divide these imprints into two types,
A and B. A somewhat similar division is given by Pearson & Bell (1919). Odgers
(1931) differentiates three types: depressions, slight erosions, marked erosions.
Type A. This is an ulcer-like excavation, exhibiting a floor and edges. In some
cases it has a clean punched-out appearance, with sharp edges and a depressed
floor; in others it is more irregular. The distal edge, that is the edge of the imprint
away from the femoral head, may be more prominent, making a transverse ridge
more or less parallel to the trochanteric line. This is Walmsley's (1915) capsular
ridge (P1. 1, fig. 2). The ridge divides the neck into a medial and a lateral portion,
each with a bony surface of differing texture. Meyer (1924a) describes the ridge
as being congruent with the bony acetabular rim, since it resembles this in shape.
When the dry bones are articulated the ridge acts like a 'door-stop'.
The floor of the imprint may show various bony appearances: (1) trabeculated,
(2) finely honeycombed like cancellous bone, (3) very smooth, and (4) very rarely
hypertrophic usually in association with a periarticular osteoarthritis. The above
features are also present on exhumed material and are not the result of violent
maceration.
Type B (P1. 1, fig. 3). This is a pleomorphic type, presenting as a discontinuity in
the normal bony appearance of the neck, and unlike type A it is not definitely
circumscribed. It may show a 'moth-eaten' or worn cancellous appearance, as
though the cortical bone had been gradually erased. This seems to occur only in
young bones, 14-22 years, when epiphyseal union is present. It is situated on the
antero-inferior aspect of the neck adjacent to the epiphyseal margin. When a large
series of bones are examined one is left with the impression that this teenage
imprint is a precursor of the ulcer type. This would agree with Odgers's (1931)
observation that the imprint deepens with age.
Posterior cervical (acetabular) imprint (PI. 1, fig. 6). This has been noted par-
ticularly by Walmsley (1915), as a facet resembling Poirier's, occurring on the
26.2
396 E. L. KoSTICK
posterior aspect of the neck. It may be limited laterally by a tubercle which sometimes
borders the medial edge of the shallow groove for the obturator externus tendon.
Other facets and imprints. Schofield (1959) describes, in the Maori femur, a
crescentic depression surrounding the antero-superior margin of the fovea. This
perifoveal depression had been observed on a number of bones. When well marked
it is C-shaped, the arc of the C on a radius about 1-3 cm. from the centre of the
fovea. The open part of the C points towards the lesser trochanter. The fovea,
almost always oval, has an everted lower lip like a lightly marginated spout, the
tip of which also points to the lesser trochanter. It appears that the C-shaped
depression is due to an unduly prominent margin of the acetabular fossa. However,
Little, Pimm & Trueta (1958) show the inside of the C as the non-weight-bearing
cartilage. In this respect it is interesting to observe that the articular lamella in
the floor of the depression is thin and often shows fine perforations.
The eversion of the foveal margin is due to the ligamentum teres as it ascends
vertically into the fovea. This eversion was present in foetal and young material.
In the 5-month foetus or younger the fovea is a notch in the postero-inferior margin
of the head.
(2) Facets and imprints on the lower end of the femur
Charles's facet (PI. 2, fig. 7). This is a smooth facet above and behind the medial
epicondyle and extending to the adductor tubercle. Pearson & Bell (1919) have had
difficulty in defining it and exclude it from their series. In the present series the
designation of Charles's facet was limited to a facet on the lower epiphysis (P1. 2,
fig. 7), bounded above and laterally by the epiphyseal line. It may continue on to
the neighbouring shaft; its cartilage is continuous with the articular cartilage of the
condyle and that of the tibial imprint described below.
The facet is for that part of the gastrocnemius bursa which usually communicates
with the joint with further extension into the overlying bursa of the semimem-
branosus. Frazer (1948) shows the area as part of the origin of the medial head of
the gastrocnemius. The presence of cartilage would suggest a bursa rather than a
muscle origin. However, in young and foetal bones, the site of Charles's facet gave
origin to part of the medial head of the gastrocnemius. This would suggest that the
gastrocnemius is forced on to the capsule and neighbouring shaft by the growing
bursa (but see Wood Jones, 1944).
Tibial imprint (P1. 2, figs. 7, 9, 13). This is on the posterior aspect of the lower
extremity of the femoral diaphysis, usually most marked above the medial condyle.
More rarely it occurs above the lateral condyle. Above the medial condyle it
borders on Charles's facet and their cartilages may be continuous, as described
above. It usually presents as a depressed 'thumb-print' impression unlike the
'punched-out' cervical imprint.
Occasionally there is another 'thumb-print' impression in the tuberculated
roughness for the medial head of the gastrocnemius. Its causation is puzzling; it
could be due to a contained fabella forced against the popliteal surface in an acutely
flexed knee joint. This is suggested despite the fact that fabellae are twice as com-
mon on the lateral side, and, in the fully ossified form, nine times more common on
the lateral than the medial side.
Facets and imprints offemora 397
Osteochondritic imprint (P1. 2, figs. 7, 13). At this point it is convenient to record
a remarkable feature in series A. The upper posterior part of the lateral condyle of
certain femora shows either a hole or plaque-like bony excrescence. Sometimes it is
of pin-hole size, at other times it is a cavity filled with bony debris and floored with
sclerotic bone. The articular lamella is always primarily affected. The cartilage is
usually flattened or worn at the site; this is best seen in the fresh specimen. The
femoral condyle is often facetted or flattened at the site of the lesion. It is usually
bilateral, occasionally occurring with a similar lesion on the posterior part of the
medial condyle. The lesion occurs at the place of contact between the tibial and
femoral condyles in the acutely flexed knee joint. Such flexion normally occurs in
the squatting position. It is suggested that this is an osteochondritis dessicans of
the adult type (Smillie, 1960) (see PI. 2, fig. 7). This is a hitherto undescribed site for
osteochondritis dessicans in the knee joint in current literature. Its incidence is
given in Tables 3 and 4. Further description and the consideration of its aetiology
are beyond the scope of this paper.
Martin'sfacet (P1. 2, fig. 10). This is a crescentic facet formed by extension of the
trochlear surface on to the lateral aspect of the lateral condyle, sometimes giving
the lateral trochlear margin a bevelled appearance. It is present in varying degree
in nearly all the femora.
L. R. L. and R. L. R. L. and R.
Type A or B Male 29 29 29 59 56 57
ant. cervical Female 45 45 45 50 53 52
imprint Male and female 33 33 33 58 55 56
Ulcer. Male 12 10 11 33 30 32
Type A Female 20 22 21 29 33 30
imprint Male and female 14 13 14 33 30 32
Pleomorphic. Male 17 19 18 25 25 25
Type B Female 25 23 24 21 20 20
imprint Male and female 19 20 20 25 25 25
Poirier's Male 57 55 56 71 76 72
facet Female 38 38 38 46 58 52
Male and female 52 51 51 67 73 70
Supratrochlear facet and imprint (PI. 2, fig. 11). The facet is produced by the
extension of the superior margin of the lateral trochlear surface on to the neighbour-
ing shaft. It is at or just above the point of maximum anterior projection of the
lateral condyle. Instead of a facet an imprint or tuberosity may be present. When
the imprint is marked, it conforms somewhat to the suprapatellar imprint or fossa
described by Meyer (1924b) (P1. 2, fig. 11). It is almost always bilateral, occurring
at the site at which an osteochondritic lesion may be expected.
Peritrochlear groove (PI. 2, fig. 8). Sometimes the medial trochlear margin is
raised, forming the edge of a gutter-like groove, in which run periarticular vessels.
398 E. L. KOSTICK
It becomes deeper and almost converted into a tunnel in a periarticular osteo-
arthritis. It extends from the supratrochlear area (often depressed) to a notch
usually present which demarcates the trochlea from the condylar surface (PI. 2,
fig. 8).
I am grateful and indebted to Prof. Alastair G. Smith, for the use of his material
and guidance. I would also like to thank Mr D. G. Stuart, F.I.M.L.T., for his
patient help with the photographs.
REFERENCES
AEGERTER, E. & KIRKPATRICK, J. A. (1958). Orthopaedic Diseases. Philadelphia and London:
W. B. Saunders Co.
CAVE, A. J. E. & PoRTEous, C. J. (1958 a). The attachments of the m. semimembranosus. J. Anat.,
Lond., 92, 638.
CAVE, A. J. E. & PoRTEous, C. J. (1958 b). A note on the semimembranosus muscle. Ann. R. Coll.
Surg. Engl. 24, 251-256.
CHARLES, R. H. (1893). The influence of function as exemplified in the lower extremity of the
Panjabi. J. Anat., Lond., 28, 1-18.
FRAZER, J. E. (1948). The Anatomy of the Human Skeleton. London: J. and A. Churchill Ltd.
JOHNSTON. T. B., DAVIES, D. V. & DAVIES, F. (1958). In Gray's Anatomy, 32nd edition. London:
Longmans Green and Co.
LITTLE, K., PiMM, L. H. & TRUETA, J. (1958). Osteoarthritis of the hip. An electron microscope
study. J. Bone. Jt. Surg. 40B, 123-131.
MARTIN, C. P. (1932). Some variations of the lower end of the femur which are especially prevalent
in the bones of primitive people. J. Anat., Lond., 66, 352-362.
MEYER, A. W. (1924a). The 'Cervical Fossa' of Allen. Amer. J. Phys. Anthrop. 7, 257-269.
MEYER, A. W. (1924b). Patellar supracondylar fossae. Amer. J. Phys. Anthrop. 7, 271-273.
MEYER, A. W. (1934). The genesis of the fossa of Allen and associated structures. Amer. J. Anat.
55, 469-510.
ODGERS, P. N. B. (1931). Two details of the neck of the femur: (1) the eminentia, (2) the empreinte.
J. Anat., Lond., 65, 352-362.
PARSONS, F. G. (1914). The characters of the English thigh bone. J. Anat., Lond., 48, 238-267.
PEARSON, K. & BELL, J. (1919). A study of the long bones of the English skeleton. Part I. The
femur. Drap. Co. Mem. Biom. Ser. 10, 1-224.
POIRIER, P. (1911). Traits d'anatomie humaine (Poirier & Charpy), vol. I. Paris: Masson et Cie.
402 E. L. KoSTICK
SCHOFIELD, G. (1959). Metric and morphological features of the femur of the New Zealand Maori.
J. R. Anthrop. Inst. 89, 89-105.
SMILLIE, I. S. (1960). Osteochondritis Dessicans. Edinburgh and London: E. and S. Livingstone.
TESTUT, L. (1904). Traits d'anatomie humaine, 5th edition. Paris: 0. Doin.
WALMSLEY, T. (1915). Observations on certain structural details of the neck of the femur.
J. Anat., Lond., 49, 805-318.
WOOD JONES, F. (1944). Structure and Function as seen in the Foot. London: Bailliere, Tindall
and Cox.
EXPLANATION OF PLATES
PLATE 1
Fig. 1. Right femur. Upper end, anterior aspect. Tip of pointer A in a Poirier's facet.
Fig. 2. Left femur. Upper end, anterior aspect. Pointer A shows the 'Ridge' bounding the
extensive imprint as marked by B.
Fig. 8. Right femur. Upper end, anterior aspect. A shows a Poirier's facet in addition to the
'teen-age' imprint shown by B. Note the epiphyseal line of the trochanter.
Fig. 4. Left femur. Upper end, anterior aspect. Note cartilage is still on the head. A small tag
above and in front of pointer A extends into the facet.
Fig. 5. Right femur. Upper end, anterior aspect. Poirier's facet shown by A, coexisting with an
ulcer-type imprint indicated by B.
Fig. 6. Right femur. Upper end, posterior aspect. A shows a posterior facet (of Walmsley). The
greater trochanter is broken above its fossa.
PLATE 2
Fig. 7. Left femur. Lower end. Posterior aspect. A shows a lateral tibial imprint, B a medial
tibial imprint, C shows a typical osteochondritic imprint on the lateral condyle at the squatting
site. A Charles's facet is also shown at D.
Fig. 8. Left femur. Lower end. Oblique medial aspect. The pointer A lies along a peritrochlear
groove.
Fig. 9. Left femur. Lower end. Pointer A shows a thumb-print type of tibial imprint above the
medial condyle.
Fig. 10. Right femur. Lower end. Lateral aspect. Pointer A shows a Martin's facet.
Fig. 11. Right femur. Lower end. Anterior aspect. A supra-trochlear fossa or imprint is shown
by pointer A.
Fig. 12. Left femur. Lower end. Anterior aspect. Pointer A shows upper lateral trochlear margin
extending on to the shaft.
Fig. 13. Right femur. Lower end. Posterior view. A shows a tibial imprint and B the bony
plaque in an osteoarthritis bone. Compare with Fig. 7.
Fig. 14. Left tibia. Upper end. Posterior aspect. A shows the tubercle which is received into the
tibial imprint. B points to the groove caused by the semimembranosus.
Journal of Anatomy, Vol. 97, Part 3 Plate 1
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E. L. KOSTICK