Singh Index and Ward's Triangle

Changes in Trabecular Pattern of the Upper End of the Femur as an Index of Osteoporosis
Manmohan Singh et al
JBJS 1970

Grade 6 - All normal trabeculae are visible
Grade 5 - accentuation of the principal compressive and principal tensile trabeculae
- Ward's triangle looks empty
Grade 4 - tensile trabeculae are reduced
- Ward's triangle opens up laterally
- border line between osteoporotic and normal bone
Grade 3 - break in the continuity of the priciple tensile group
- definite osteoporosis
Grade 2 - principal compressive trabeculae are the only prominent trabeculae
Grade 1 - all trabeculae are reduced

The Normal Trabecular Pattern
1. Principal compressive group
2. Secondary compressive group
3. Greater trochanter group
4. Principal tensile group
5. Secondary tensile group

Wards Triangle (first described 1838)
An area in the neck between the principal compressive, secondary compressive and primary tensile group

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