SIngh Index.pptx

Singh Index

1. Singh Index

2. Type 1, stable (two-part); Type 2, unstable comminuted; Type 3, unstable reverse obliquity; Type 4, intertrochanteric–subtrochanteric with two planes of fracture. Boyd and Griffin Classification

3. Intertrochanteric Femoral Fracture

4. 5 Trabecular Types in Proximal Femur Principal Compression Secondary Compression Primary Tensile Secondary Tensile Intertrochanteric As osteoporosis progresses, this trabeculae get thinner and eventually disappear

5. Primary Compressive/ Principal Compression From superior femoral head to medial neck STRONGEST CANCELLOUS BONE SUPPORTS BODY WEIGHT Secondary Compressive/ Secondary Compression Oriented along lines of stress in the proximal femur Primary Tensile/ Principle Tensile Form Inferior of the femoral head to the lateral cortex Secondary Tensile Oriented along lines of stress in lateral proximal femur Greater Trochanteric Oriented along lines of stresses within the greater trochanter Ward’s Triangle Area of relative few trabeculae within the femoral neck

6. Grades of The Singh Index Grade 6: The five trabecular groups are visible. Grade 5: The principal tensile and principal compressive (medial) group are reduced, and Ward's triangle appears prominent. Grade 4: The principal tensile group is greatly reduced but still connects the lateral cortex to the femoral neck. Grade 3: The principal tensile group is interrupted; this grade indicates definite osteoporosis. Grade 2: The only group present is principal compressive trabeculae. Grade 1: The principal compressive group appears greatly reduced; this grade indicates severe osteoporosis. Grade 3 and below indicate definite osteoporosis. ( Bucholz et al. (2006)

7. Singh Index The six grade of the Singh index: grade 1 the principal compressive trabeculae are reduced in number and are no longer prominent ; grade 2 the principal compressive trabeculae are seen prominently. The others have been more or less absorbed; grade 3 there is a break in the continuity of the principal tensile trabeculae ; grade 4 the principal tensile trabeculae is reduced (markedly) but still can be traced from the lateral cortex to the upper part of the femoral neck ; grade 5 the principal tensile trabecula is accentuated . Ward’s triangle appears prominent; grade 6 all trabecular groups are visible on the radiographic image . The upper end of the femur seems completely occupied by cancellous bone

8. Primary blood supply to the femoral head: Cervical Arteries Cervical arteries originate from extracapsular ring at the base of the femoral neck Extracapsular ring formed by: Lateral femoral circumflex artery (anterior) Medial femoral circumflex artery (posterior)  DOMINANT MFCA descends inferiorly along the ligament of Weitbrecht supplying the infero -medial portion of femoral head Foveal artery (branch of obturator a., lies between ligamentum teres) minor contribution to the head Vascularization of the Femoral Head