1. Femoral Geometry and Bone Quality Influence on Fracture Patterns of the Proximal Femur
23053
Andris Džeriņš1,3, Valts Boginskis3, Pēteris Studers1,2, Matīss Zolmanis2
1 Riga Stradiņš University, Joint Laboratory of Traumatology and Orthopaedics, Latvia
2 Hospital of Traumatology and Orthopaedics, Latvia
3 Ziemeļkurzemes Regional Hospital, Latvia
Introduction
Results
Proximal femoral fractures (PFF) have a significant impact on patient quality of life, walking function, mortality rates and the health care system1
10% will sustain a contralateral fracture 2,3
In clinical pratice peritrochanteric and femoral neck fracture patients usually injured the hip region by falling on one side
Femoral neck fractures and peritrochanteric fractures have different treatment methods
Most common injury mechanism in all groups- falling on one side (97.4%)
Women more commonly injured their hips than men (72.7% vs. 27.3%)
Mean age was ±10.23 years
Group 1 had significantly larger femoral shaft width than fracture group patients (30.70±1.83 vs ±3.15 ) (p=0.04) and greater cortical thickness index (0.51±0.07 vs.0.47±0.06) (p=0.01)
Group 1 did not have any cases with SI≤ 3 (indicating osteoporosis) 0.0% vs. 38.3% (p<0.001)
Group 2 had lower grade SI than Group 3 patients (p<0.001)
Group 3 had significantly narrower femoral necks than Group 2 (32.06±3.74 vs ±3.61) (p=0.001)
All other quantitative and qualitative parameters did not differ between groups 1 1b 2a 2
TOS Archive
Image 1. Femoral Neck Fracture Image 2. Pertrochanteric Fracture 4
Conclusions
Elderly women are at a higher risk of sustaining a PFF
Proximal femoral geometry could affect the fracture type by changing the distribution of the traumatic force in bone
Lower femoral neck width is a femoral neck fracture risk factor
Specific parameters of the proximal femur such as femoral shaft width, femoral neck width could be used to identify patients who are at the risk of fracture in the future
Lower Singh index is a pertrochanteric fracture risk factor
Specific markers of osteoporosis which are detectable in plain radiographs (SI, CTI) could be used before performing osteodensitometry to identify high-risk patients
TOS archive
Image 3. Measurments of the Proximal Femur4
Aim of the project
To determine, can femoral geometry and the degree of osteoporosis (detectible in plain X-rays) affect the probability of sustaining a pertrochanteric or femoral neck fracture
Materials and methods
154 patients (aged ≥60 years) with low-energy PFF admitted to the Hospital of Traumatology and Orthopedics during year 2017
They were devided into 3 groups:
Group 1- no fracture (n=34)
Group 2- pertrochanteric fracture (n=52)
Group 3- femoral neck fracture (n=68)
Patient age, gender, injury mechanism and radiological measurements including hip axis length, femoral neck axis length, femoral head diameter, femoral neck width, neck shaft angle,femoral shaft width, cortical thickness index (CTI) and Singh index (SI) were measured on the contralateral leg using the Impax-Orthopaedic-Tools program.
References
Innocenti M, Civinini R, Carulli C, Matassi F. Proximal femural fractures: epidemiology. Clin Cases Miner Bone Metab. 2009;6(2):117-9.
Ballane G, Cauley JA, Luckey MM, Fuleihan Gel-H. Secular trends in hip fractures worldwide: opposing trends East versus West. J Bone Miner Res Aug;29(8):
Aloia JF, Flaster ER. Estimating the risk of fracture in osteopenic patients. The Endocrinologist. 1995;5:397–402.
Fajar JK, Taufan T, Syarif M, Azharuddin A. Hip geometry and femoral neck fractures: A meta-analysis. J Orthop Translat. 2018;13:1-6.