Three-Dimensional Reconstruction Modeling of the Spatial Displacement, Extent and Rotational Orientation of Undisplaced Femoral Neck Fractures

Fu, Xin; Xu, Ge‐Liang; Li, Zhijun; Du, Chenxing; Han, Zhe; Zhang, Tao; Ma, Xiaofang

doi:10.1097/md.0000000000001393

Cited by 10 publications

(7 citation statements)

References 40 publications

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“…Some scholars have pointed out that the Garden classification has serious limitations in predicting the prognosis of FNF, which lacks a hierarchical correlation with the incidence of complications 25–27 . In our study, HDA was introduced into the typing system of CDAC, and the concept of CDA was defined, which was groundbreaking.…”

Section: Discussionmentioning

confidence: 95%

“…Combined Deflection Angle Classification Some scholars have pointed out that the Garden classification has serious limitations in predicting the prognosis of FNF, which lacks a hierarchical correlation with the incidence of complications. [25][26][27] In our study, HDA was introduced into the typing system of CDAC, and the concept of CDA was defined, which was groundbreaking. Through the simple pelvis orthophoto and the affected side HIP axial photo, the spatial displacement of the femoral head after FNF can be clarified.…”

Section: Complications Of Fnfmentioning

confidence: 99%

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Combined Deflection Angle Classification: A Novel Typing System of Adult Femoral Neck Fracture

Zhang

Yuan

Wei

et al. 2022

Orthopaedic Surgery

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Objective Femoral neck fracture (FNF) is a common clinical trauma with high mortality and disability rates. Furthermore, its incidence increases exponentially with increasing age. Existing classifications have some disadvantages. Thus, this study aimed to establish a novel typing system for FNF. Methods We retrospectively analyzed all adult patients with FNF admitted to our hospital between December 2015 and November 2017 for cannulated screw internal fixation. The study population was divided into the femoral varus offset group (VAR) and the valgus offset group (VAL). The data collected included sex, age, affected side, injury mode, body mass index, complications, pelvic incidence (PI), hip deflection angle (HDA), combined deflection angle (CDA), and neck shaft angle. Statistical analysis was conducted to determine the correlation between complications and deviation angles. A novel typing system was developed and compared with the Garden classification to detect its superiority. Results A total of 108 patients were recruited, with 59 patients in the VAR and 49 patients in the VAL groups. The incidence of complications in the VAR group was significantly higher than that in the VAL group (P < 0.05). Moreover, there were more male participants in the VAR group. Compared with the VAL group, the VAR group had significantly higher PI, HDA, and CDA (P < 0.05). The CDA classification (CDAC) was defined, with CDA as the main criterion and HDA as the supplementary criterion. Furthermore, there was a hierarchical correlation between the actual incidence of complications and the typing level, which was increased in CDAC but not in the Garden classification. This showed that CDAC was more accurate. Conclusion A novel typing system, CDAC, for FNF was established, which was more accurate than the Garden classification. We suggest combining CDAC and Garden classifications for the preoperative diagnosis, treatment selection, and prognostic evaluation for patients with FNF.

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Section: Discussionmentioning

confidence: 95%

Section: Complications Of Fnfmentioning

confidence: 99%

Combined Deflection Angle Classification: A Novel Typing System of Adult Femoral Neck Fracture

Zhang

Yuan

Wei

et al. 2022

Orthopaedic Surgery

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“…To achieve the best possible alignment, the computer software used an iterative closest point (ICP) algorithm to minimize the distance between corresponding points. This process requires manual input of at least 3 corresponding regions on the 2 models, and, to improve the precision of the ICP alignment, we used 7 anatomical landmarks as previously described 8 .…”

Section: Methodsmentioning

confidence: 99%

“…Three-dimensional computed tomography (3D-CT) imaging has gained popularity as a diagnostic tool and also may improve the reliability of fracture classifications 6,7 . Furthermore, a recent study indicated that 3D-CT models describe the displacement of Garden type-I and II femoral neck fractures more precisely than radiographs 8 . We recently demonstrated that 3D-CT models are both valid and reliable when used to evaluate linear displacement of the femoral head 9 .…”

mentioning

confidence: 99%

Cross-Table Lateral Radiographs Accurately Predict Displacement in Valgus-Impacted Femoral Neck Fractures

Temmesfeld

Dolatowski

Borthne

et al. 2019

JBJS OA

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Background: Femoral neck fractures are classified as nondisplaced (Garden types I and II) or displaced (Garden types III and IV) on the basis of anteroposterior radiographs. Cross-table lateral radiographs are important in the assessment of Garden type-I and II fractures as posterior tilt of the femoral head may influence treatment results. A posterior tilt of >20° has been associated with an increased risk of treatment failure after internal fixation, although the precision of these measurements has not been validated. Therefore, the purpose of the present study was to compare cross-table lateral radiographs with 3-dimensional computed tomographic (3D-CT) reconstructions of Garden type-I and II femoral neck fractures. Methods: Twenty-three patients presenting with Garden type-I and II femoral neck fractures that were verified on anteroposterior radiographs underwent CT scanning immediately after radiographic examination. 3D models of the fractured and uninjured femora were reconstructed from the CT images, and displacement of the 3D models was determined by superimposing the fractured and uninjured femora. We defined a coordinate system with its origin at the center of the uninjured femoral head with the x axis oriented medially; the y axis, posteriorly; and the z axis, cranially. Correlations between lateral radiographs and 3D models were assessed with the Spearman rank coefficient, mean difference, and limits of agreement. Results: Posterior tilt of the femoral head on lateral radiographs was strongly correlated with displacement of the femoral head along the y axis of the 3D models, with a correlation coefficient of 0.86 (p < 0.001). Correlations between the findings on lateral radiographs and displacements along the x or z axis were weak, with coefficients of −0.30 (p = 0.18) and 0.21 (p = 0.34), respectively. The mean difference between displacement on lateral radiographs and displacement along the y axis of the 3D models was smaller, and demonstrated a smaller limits-of-agreement interval, compared with the x or z axis. Conclusions: Our results demonstrated a strong correlation between posterior displacement of the femoral head on lateral radiographs and displacement along the y axis in 3D models of Garden type-I and II femoral neck fractures. This finding indicates that lateral radiographs provide an accurate assessment of posterior tilt.

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“…Then the femoral head was separated and simulated to a ball. We regarded the center of the ball as the center of the femoral head [16]. The transverse slice at the level of apex of the lesser trochanter was defined as slice T0.…”

Section: Measurementsmentioning

confidence: 99%

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

Fan¹,

Li²,

Gong³

et al. 2017

Arch Med Sci Civil Dis

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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.

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Three-Dimensional Reconstruction Modeling of the Spatial Displacement, Extent and Rotational Orientation of Undisplaced Femoral Neck Fractures

Cited by 10 publications

References 40 publications

Combined Deflection Angle Classification: A Novel Typing System of Adult Femoral Neck Fracture

Combined Deflection Angle Classification: A Novel Typing System of Adult Femoral Neck Fracture

Cross-Table Lateral Radiographs Accurately Predict Displacement in Valgus-Impacted Femoral Neck Fractures

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

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