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