Comparison of Femoral Morphology and Bone Mineral Density between Femoral Neck Fractures and Trochanteric Fractures

Abstract

Background Many studies that analyzed bone mineral density (BMD) and skeletal factors of hip fractures were based on uncalibrated radiographs or dual-energy xray absorptiometry (DXA). Questions/purposes Spatial accuracy in measuring BMD and morphologic features of the femur with DXA is limited. This study investigated differences in BMD and morphologic features of the femur between two types of hip fractures using quantitative computed tomography (QCT). Patients and Methods Forty patients with hip fractures with normal contralateral hips were selected for this study between 2003 and 2007 (trochanteric fracture, n = 18; femoral neck fracture, n = 22). Each patient underwent QCT of the bilateral femora using a calibration phantom. Using images of the intact contralateral femur, BMD measurements were made at the point of minimum femoral-neck cross-sectional area, middle of the intertrochanteric region, and center of the femoral head. QCT images also were used to measure morphologic features of the hip, including hip axis length, femoral neck axis length, neck-shaft angle, neck width, head offset, anteversion of the femoral neck, and cortical index at the femoral isthmus.Results No significant differences were found in trabecular BMD between groups in those three regions. Patients with trochanteric fractures showed a smaller neck shaft angle and smaller cortical index at the femoral canal isthmus compared with patients with femoral neck fractures. Conclusions We conclude that severe osteoporosis with thinner cortical bone of the femoral diaphysis is seen more often in patients with trochanteric fracture than in patients with femoral neck fracture.

Cortical thickness in the intertrochanteric region may be relevant to hip fracture type

“…Kim et al [21] reported that patients with trochanteric fractures had lower BMD in the femoral neck region and femoral intertrochanteric region compared with the femoral fracture group. However, according to the data from the current study (see Table 2), there were no statistically significant differences of BMD in the femoral neck region, femoral intertrochanteric region, femoral Ward’s region, femoral intertrochanteric region, or total hip region between the two groups, which was corroborated by Maeda et al [22] and Johannesdottir et al [23]. Our previous study showed that BMD reduction was rather fast before patients reach 65, with the declining trend stagnating thereafter [5].…”

Comparison of clinical outcomes with three different intramedullary nailing devices in treatment of unstable trochanteric fractures

“…[3] Moreover, presence of a trochanteric fracture was further shown to be associated with higher mortality after hip fracture. [5] Surgery is the mainstay of treatment in fractures of the trochanteric region, and operation should be undertaken as early as possible to allow early mobilization of the patient.…”

Anteroposterior Thickening of the Femoral Neck With Aging Decreases the “Offset” in Men

“…Some studies show no significant difference in femoral neck width between those with femoral neck fractures and those without or between those with trochanteric fractures and those without. 5,10,15 However, one study did find an association with femoral neck fractures and a larger femoral head and neck in women. 4 Joint space width was also found to decrease at a significant rate over time in both sexes, but this was more pronounced in men.…”