Morphological characteristics of the proximal femur in elderly patients with hip fractures: a case-control study

Abstract

Introduction: Owing to the diverse design, measurement methods and ethnic differences, the influence of the proximal femur geometry on hip fractures is still unclear. Therefore, this study aimed to investigate morphological characteristics of the proximal femur in senile patients with hip fractures on three-dimensional images. Material and methods: One hundred and sixteen women and 38 men with hip fractures were included in the fracture group. The control group included 74 women and 63 men. The geometrical parameters of the proximal femur were measured after three-dimensional reconstruction. The femoral neck width (FNW), femoral neck length (FNL), femoral head height (FHH), femoral head diameter (FHD), neck shaft angle (NSA) and offset were measured and statistically analyzed. Results: The NSA in fracture cases was significantly larger than controls in both men and women (130.18 vs. 126.93, p = 0.001; 131.07 vs. 128.68, p < 0.001, respectively). Moreover, a lower total hip bone mineral density (BMD) in fracture cases was found in both sexes (0.725 vs. 0.812, p = 0.001; 0.743 vs. 0.830, p < 0.001, respectively). In multiple logistic regression analysis, a larger NSA and a lower total hip BMD were independent predictors for hip fractures in both men and women (OR = 1.143 and 1.171, p = 0.010 and 0.016, respectively). However, the FNL was an independent predictor for hip fractures only for women (OR = 1.201, 95% CI: 1.106-1.305, p < 0.001). Conclusions: A larger NSA and a lower BMD were independent predictors for hip fractures of senile patients in both sexes. Moreover, a longer FNL was an independent risk factor for patients with hip fractures in women. As a result, we hypothesized that the geometrical measurement of the proximal femur on three-dimensional images might be appropriate.