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

Zhuang, Huafeng; Li, Yizhong; Lin, Johnson; Cai, Donglu; Cai, Sanjun; Yan, Lisheng; Yao, Xuedong

doi:10.1186/s12891-017-1669-z

Cited by 15 publications

(9 citation statements)

References 30 publications

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“…found that patients with femoral neck fractures usually have more than a threefold greater NSA than patients with trochanteric fractures. However, we did not find a difference in HAL and NSA between the two types of hip fracture, and the same results have been reported by Maeda et al. We presume that the different results reported in these studies originate from differences in race, measurements, and small numbers of subjects.…”

Section: Discussionsupporting

confidence: 86%

“…Furthermore, the cortical bone mainly contributes to bone strength. The strength of the femoral neck will decline by less than 10% if all cancellous bone is removed, and cortical thickness in the intertrochanteric region is very thin. This confirms that cortical bone plays a major role in strengthening the proximal femur, particularly cortical thickness at the IT region.…”

Section: Discussionmentioning

confidence: 72%

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Differences in Bone Mineral Density and Hip Geometry in Trochanteric and Cervical Hip Fractures in Elderly Chinese Patients

Liu

et al. 2019

Orthopaedic Surgery

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Objective To assess the differences in bone mineral density (BMD) and hip geometry in trochanteric and cervical hip fractures in elderly Chinese patients. Methods A consecutive series of 196 hip fracture patients aged over 50 years was recruited from November 2013 to October 2015, including 109 cases of cervical fractures (36 males and 73 females) and 87 cases of trochanteric fractures (34 males and 53 females). All patients were evaluated through dual‐energy X‐ray absorptiometry, and baseline characteristics, BMD and structural parameters were collected and reviewed. Results There were statistically significant differences in age, height, and body mass index between patients with each type of fracture, and patients with trochanteric fractures were older than those with cervical fractures, especially in women. The BMD in trochanteric fractures was markedly lower than in cervical fractures in all five sites of the hip by an approximate reduction of 10%, in both men and women. The cross‐sectional area, cross‐sectional moment of inertia, and the cortical thickness in the cervical fracture group were significantly higher than in the trochanteric fracture group. However, the buckling ratio of both the femoral neck and trochanteric region were significantly lower in the cervical fracture group. Age (/10 years), cross‐sectional moment of inertia in femoral neck and buckling ratio in trochanteric region were significant risk factors for trochanteric fractures compared with cervical fractures. Conclusions Compared with cervical hip fractures, patients with trochanteric fractures were older, had a lower BMD, and had less bone mechanical strength, especially in female patients. Age, femoral neck cross‐sectional moment of inertia (FNCSMI), and trochanteric region buckling ratio (ITBR) were stronger risk factors for trochanteric hip fractures than for cervical fractures.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 72%

Differences in Bone Mineral Density and Hip Geometry in Trochanteric and Cervical Hip Fractures in Elderly Chinese Patients

Liu

et al. 2019

Orthopaedic Surgery

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“…One challenge for future work in Singapore is to compare hip fracture mortality with mortality in a nonfracture cohort matched by CCI score.Compared with cervical fractures, trochanteric fractures are associated with advanced age and with higher CCI score,24 implying a more fragile group of patients. Hips fracturing at the trochanteric region have been documented to have reduced cortical thickness,25 bone mineral density, and bone mechanical strength 26. These fractures can vary in morphology, ranging from simple fractures to highly comminuted, unstable configurations.…”

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confidence: 99%

Risk Factors and Trends Associated With Mortality Among Adults With Hip Fracture in Singapore

et al. 2020

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IMPORTANCE Examining trends in mortality following hip fracture and its associated factors is important for population health surveillance and for developing preventive interventions. OBJECTIVE To examine temporal trends in, and risk factors associated with, mortality following hip fracture over 18 years in Singapore. DESIGN, SETTING, AND PARTICIPANTS This retrospective, population-based cohort study included men and women aged 50 years and older admitted to Singapore hospitals for first hip fracture identified and followed up from 2000 to 2017. Demographic information, fracture type, and Charlson Comorbidity Index (CCI) score were retrieved from nationwide claims data, and mortality data were from the National Death Registry. Data were analyzed from August 2018 to December 2019. MAIN OUTCOMES AND MEASURES Adjusted hazard ratios (aHRs) and their 95% confidence intervals were estimated using Cox proportional hazards regression. Kaplan-Meier life table methods were used to calculate survival following the hip fracture on a cohort basis. The crude survival over time since fracture was compared by sex, age group, ethnicity, CCI, and fracture type. Standardized mortality ratios (SMRs) were calculated using all-cause mortality obtained from Singapore population life tables. RESULTS Among 36 082 first inpatient admissions for hip fractures (mean [SD] patient age, 78.2 [10.1] years; 24 902 [69.0%] female; 30 348 [84.1%] Chinese, 2863 [7.9%] Malay, 1778 [4.9%] Indian, and 1093 [3.0%] other ethnicity), elevated rates of mortality were observed for male sex

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“…It has been presented in multiple studies that cortical thickness reduction may result in osteoporotic fractures. [17,18] Sah et al [19] presented that femurs with small radiographic cortical thickness indices had lower T-scores in DXA tests. They presented that finding a radiographic hip cortical thickness index with a value at or below 0.40 should be an alert for referral to osteoporosis evaluation and might be directly related to fracture.…”

Section: Discussionmentioning

confidence: 99%

What is the importance of canal-to-diaphysis ratio on osteoporosis-related hip fractures?

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Yapar

et al. 2019

Eklem Hastalik Cerrahisi

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ÖZAmaç: Bu çalışmada femoral subtrokanterik bölge kanaldiyafiz oranının kalça kırığı öncesi riskin belirlenmesinde yararlı olup olmadığı araştırıldı. Hastalar ve yöntemler: Çalışma grubu osteoporotik kalça kırıklı 116 hastadan (26 erkek, 90 kadın; ort. yaş 77.8 yıl; dağılım, 61-89 yıl), kontrol grubu ise 56 bireyden (11 erkek, 45 kadın; ort. yaş 75.3 yıl; dağılım, 60-83 yıl) oluştu. Çalışma grubundaki hastaların düz radyografilerinde kanaldiyafiz oranı ölçüldü. Etkilenen taraf ve sağlam tarafın sonuçları karşılaştırıldı. Ölçümlerin gözlemciler arasında güvenilirliğini sağlamak ve teknik hataları en aza indirmek için değerlendirmeler iki farklı ortopedik cerrah tarafından iki kere (iki hafta ara ile) yapıldı. Bulgular: Kalça kırıklı hastalarda kanal-diyafiz oranı aynı hastanın sağlam tarafına (p<0.001) ve kontrol deneklerine (p<0.001) göre anlamlı olarak artmıştı. Alıcı işletim karakteristik analizinin sonuçlarına göre, osteoporoz hastalarında kalça kırığını öngörmede kanal diyafiz oranı tanısal bir değere sahipti ve sınır değer yaklaşık 0.53 (duyarlılık: %81, özgüllük: %86) idi. 0.53'lük indeks, %89'luk intertrokanterik kalça kırığı riskini temsil eder. Sonuç: X-ışını cihazına düşük maliyetle rahatlıkla erişilebildiği için bu yöntem tüm hekimler tarafından kolayca uygulanabilir. Yüksek riskli hastalarda kalça kırığı riski belirlenmeli, osteoporoz değerlendirilmeli ve kırık gelişmeden gerekli önlemleri almak için tedaviye başlanmalıdır.Anahtar sözcükler: Kanal-diyafiz oranı, kırık riski, kalça kırığı, osteoporoz. ABSTRACTObjectives: This study aims to investigate whether the ratio of the canal-to-diaphysis in femoral subtrochanteric region is helpful in determining risk before hip fracture. Patients and methods: The study group consisted of 116 patients with osteoporotic hip fractures (26 males, 90 females; mean age 77.8 years; range, 61 to 89 years) and the control group consisted of 56 subjects (11 males, 45 females; mean age 75.3 years; range, 60 to 83 years). The canal-to-diaphysis ratio of patients in the study group was measured on plain radiographs. The results of the affected side and intact side were compared. To ensure the interobserver reliability of the measurements and to minimize technical errors, the assessments were performed twice (two weeks apart) by two different orthopedic surgeons.

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

Cited by 15 publications

References 30 publications

Differences in Bone Mineral Density and Hip Geometry in Trochanteric and Cervical Hip Fractures in Elderly Chinese Patients

Differences in Bone Mineral Density and Hip Geometry in Trochanteric and Cervical Hip Fractures in Elderly Chinese Patients

Risk Factors and Trends Associated With Mortality Among Adults With Hip Fracture in Singapore

What is the importance of canal-to-diaphysis ratio on osteoporosis-related hip fractures?

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