The effect of pre-fracture proximal femur geometry on hip fracture type in elderly patients

Abstract

This study aimed to analyze the relationship between fracture type by determining data on the geometry of the proximal femur in the pre-fracture period in patients over 65 years of age who had hip fractures as a result of low-energy trauma. A total of 127 patients who were admitted to the hospital for reasons other than hip pathology within 1 year before the occurrence of hip fracture and who had an anterior-posterior pelvic X-ray were included in the study. Measurements were made to evaluate the proximal femur geometry, neck shaft angle, central edge angle, femoral head diameter, femoral neck diameter, femoral neck length, femoral offset length, femoral neck axial length, hip axis length, and femoral shaft diameter. As a result of these measurements, analyses were performed to determine the relationship between the control group and fracture types. The mean Neck shaft angle scores were significantly higher in both fracture types than in the control group ( P = .034, P = .002). The mean Femoral offset length values of both fracture types were lower than those of the control group ( P = .002, P = .011, respectively). Multiple logistic regression analysis revealed that the risk of collum femoris fracture increased as the Femoral head diameter value increased. (OD = 0.21, P = .002). The geometric parameters of the proximal femur play an important role in the formation of hip fracture types. Therefore, differences in proximal femur geometry in hip fracture types should be considered, and patient-focused choices should be made regarding the surgical procedures and implants to be used during fracture fixation.

Distinctive Geometrical Traits of Proximal Femur Fractures—Original Article and Review of Literature

“…This remark is supported by authors that examined the BMD in the femoral neck region [56,57]. The parameter of the FND has been a subject of doubt among authors, as certain studies suggest that shorter values are associated with FTF [21,44], while others with FNF [11,43]. Lastly, our study did not prove any important association between the FND values and type of hip fracture.…”

“…In accordance with the previous mentioned assumption, in the event of a lateral fall, it is observed that the lateral area of the proximal femur comes into contact with the periphery of the acetabulum, which in this particular scenario, exhibits a more lateralized position. The force applied to sustain the hip under such circumstances could plausibly result in a FTF [43]. However, within our study sample, we did not manage to establish this association, as no statistically significant difference was observed between the groups.…”

“…Consequently, the angle tends to increase in cases of degenerative arthritis. Previous studies conducted by Yamauch et al [42], Cukurlu et al [43] and Hu et al [21] have supported the hypothesis that in the event of a side fall, the acetabular rim impinges distally on the femoral neck, exerting a substantial force on a more lateral region of the proximal femur, which can potentially lead to FTF. In addition, these studies have confirmed a noteworthy correlation between the severity of hip osteoarthritis, in terms of narrowed joint The Wiberg angle is delineated by the intersection of a line that transects the center of the femoral head and extends to the most lateral edge of the acetabulum, encompassing any osteophytes, with a line that is vertical to the center of the femoral head [29] (Figure 2).…”

“…Both of these parameters must be Neck Length (NL) is defined as the distance between the anatomical axis of the femur and the central point of the femoral head. On the other hand, Offset is described as the length of a line extending horizontally from the center of the femoral head and intersecting the anatomical axis of the femur [43] (Figure 1). Both of these parameters must be properly restored during the intraoperative procedure, as this addresses the tension of the surrounding soft tissues of the hip and ensures the right length of the limb.…”