Comparison of morphological features in the femur between femoral neck fractures and femoral intertrochanteric fractures

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

Background and Objectives: The incidence of proximal femoral fractures is escalating rapidly, generating a significant challenge for healthcare systems globally and, carrying serious social and economic implications. The primarily object of this study was to discover potential distinguishing factors between fractures occurring in the femoral neck and trochanteric region. Materials and Methods: We performed a prospective cohort study of the radiographic images of 70 people over 65 years of age who were admitted to the orthopedic department with hip fracture and who fulfilled our eligibility criteria. Neck Length (NL), Offset Lenth (OL), Hip Axis Length (HAL), Neck Shaft Angle (NSA), Wiberg Angle (WA), Acetabular Angle (AA), Femoral Neck Diameter (FND), Femoral Head Diameter (FHD), Femoral Shaft Diameter (FSD), Femoral Canal Diameter (FCD) and Tonnis classification were recorded. For the comparison of the categorical variables, Pearson's χ2 criterion was used, while Student's t-test was applied for the comparison of means of quantitative variables across fracture types. Results: There were no statistically significant variances observed while comparing the selected geometric parameters of the proximal femur with the type of fracture. This finding was reaffirmed in relation to age, gender, and Tonnis classification. However, a moderate correlation was noted, revealing comparatively reduced values of HAL, FHD, and FND in women as opposed to men. Conclusions: The inability of our research to establish the differentiative geometric factors between femoral neck and trochanteric fractures underscores the need for further investigations, which would take into consideration the intrinsic characteristics of the proximal femur.

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

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.

Incidence and risk factors of acute kidney injury after femoral neck fracture in elderly patients: a retrospective case-control study

Background

Hip fracture is highly associated with disability and consequently, mortality in the elderly population. Postoperative acute kidney injury (AKI) is not unusual and is associated with considerable morbidity and mortality. We aimed to determine the incidences and potential risk factors for postoperative AKI in elderly patients with femoral neck fracture.

Methods

We retrospectively evaluated patients over 65 years of age who had been subjected to surgery for femoral neck fracture at Peking University People's Hospital from January 2015 to December 2019. Demographic characteristics and potential risk factors were collected. AKI was defined according to the Kidney Disease Improving Global Outcomes Guidelines (KDIGO).

Results

A total of 308 elderly patients with femoral neck fracture were included in the study. The overall incidence of postoperative AKI was 12% (37 cases). Through binary logistic regression analysis, adjusted for age, intraoperative blood loss and BMI, we identified that early postoperative albumin levels, hemoglobin changes and intraoperative hypotension are independent risk factors for postoperative AKI. The model considering the three factors can improve accuracy of predicting the possibility of developing AKI. The patients with AKI had a significantly higher mortality of 40.5% than those without AKI (24.0%, p < 0.001)

Conclusion

The incidence of postoperative AKI in elderly patients with femoral neck fracture was 12%. Independent risk factors for postoperative AKI included hemoglobin changes, early postoperative hypoalbuminemia and intraoperative hypotension. At the same time, postoperative AKI significantly increased mortality in elderly patients with femoral neck fracture. Taking multiple possible factors into consideration can better predict the possibility of elderly patients developing AKI after surgery.

Can Lateral Offset Be Used as a Predictive Marker for Proximal Femur Disorders?

PURPOSE

When the lateral offset (LO) changes, the forces acting on the head and neck of the femur change. Increase or decrease in LO can cause instability and possible dislocation of the implant. In addition, when the offset is reduced, more force is needed to balance the pelvis by the abductor muscles, and the force that occurs along the hip joint increases and causes wear and tear. In this study we aimed to investigate whether there is a correlation between LO and proximal femur morphology, and according to the results we aimed to investigate whether the LO can be used as a predictive marker for the risk of femoral neck fractures, osteoarthritis or femoroacetabular impingement.

METHODS

Femur length, femur neck length, femoral neck-shaft angle (NSA), anteroposterior (a-p) and superoinferior (s-i) diameters of femoral head and neck, and LO were measured on 82 dry adult femora of unknown age and gender from Turkish population.

RESULTS

There was no statistically significant correlation between the LO and a-p and s-i diameters of femoral head or neck. However, there was found statistically significant correlation between LO and femoral NSA (p < 0.01), femoral neck length (p < 0.05) and femur length (p < 0.01).

CONCLUSION

High LO values can be used as an indicator for neck fractures, a negative marker for OA, but LO does not appear to be used as an indicator for FAI.

CCD angle & hip fractures - Predictor of fracture symmetry?

Background

Hip fracture caused by fall is a common injury of the elderly. The risk of sustaining a contralateral hip fracture has been reported to be 5-10%. Aging society heightens the need of efficient prevention tools. To be able to cope with this demand, understanding of biomechanics of hip fractures are mandatory. Previous studies suggest that geometry of the proximal femur could play an important role for fracture probability and fracture type. Thus, analysis of hip geometry could play an important role in the prediction and prevention of bilateral hip fractures. Aim of this study was to elucidate the influence of caput collum diaphyseal angle on the fracture type of proximal femur.

Material and methods

In a retrospective analysis, data of patients with an acute hip fracture who underwent surgical treatment within five years were included. Data was separated into two groups: (I) intra capsular femur fracture (femoral neck fractures) and (II) extra capsular femur fracture (inter- and subtrochanteric femur fractures). Occurrence of a bilateral fracture, age, gender, weight, height and caput collum diaphyseal angle (standardized measurement of the opposite joint on preoperative digital x-rays) of each group were further analyzed.

Results

Data of 448 patients were included ((I): 250 vs. (II): 198 patients). Group (I) showed a significant higher mean caput collum diaphyseal angle of 133.9 ± 7.0° (mean ± standard deviation) compared to group (II) with 127.6 ± 6.1° (F (1, 451) = 106.5, p = 0.00). In group (I) 0 patients had a caput collum diaphyseal angle <120° (varus), 214 patients (86%) 120°-140° and 35 patients (14%) angle>140° (valgus). In contrast, in group (II) 21 patients (10%) had a caput collum diaphyseal angle <120° (varus), 175 patients (86%) 120°-140° and 7 patients (4%) >140° (valgus). 52 patients had a bilateral hip fracture. 36 patients (69%) sustained a bilateral hip fracture of the same fracture type.

Conclusion

Patients with an intra capsular proximal femur fracture showed a significantly higher caput collum diaphyseal angle compared to patients with an extra capsular proximal femur fracture. Moreover, intra capsular femur fractures are correlated with an indifferent (120-140°) or valgus (>140°) femoral neck configuration. Extra capsular femur fractures correlate with an indifferent (120-140°) or varian femoral neck configuration (<120°). The results support the assumption that the caput collum diaphyseal angle has an influence on fracture type of the proximal femur. This could possibly be a predictor for the fracture type of the contralateral hip (second fracture). Based on this, present data may benefit prosthetists in developing new and more efficient hip protectors.

Level of evidence

Level III. Retrospective comparative study.

Does hip morphology correlate with proximal femoral fracture type?

PURPOSE

To determine if boney morphology influences the anatomic location of hip fractures in elderly patients.

METHODS

All patients with hip fractures between 2008 and 2012 who had hip radiographs taken prior to the fracture were reviewed. Fractures were classified as intracapsular or extracapsular and hip morphology was measured on the pre-fracture x-rays. Hip morphology was determined by alpha angle, lateral central edge angle, acetabular index, neck-shaft angle, hip axis length, femoral neck diameter, Tönnis classification for hip osteoarthritis (OA) and the presence of a crossover sign.

RESULTS

148 subjects (78.4% female, age 83.5 years) with proximal femur fractures were included. 44 patients (29.7%) had intracapsular fractures and 104 (70.3%) had extracapsular fractures. 48% of patients had previous hip fractures on the contralateral side and 74.6% had the same type of fracture bilaterally. The rates of bilateral intracapsular and extracapsular fractures were similar (33.7% vs. 40.9% respectively, p = 0.39). Extracapsular fractures had a statically significant higher neck-shaft angle, a shorter hip axis length, a narrower femoral neck diameter and a higher grade of Tönnis classification of OA (p = 0.04, 0.046, 0.03, 0.02 respectively). Acetabular coverage and the proximal femoral head-neck junction, which were evaluated by lateral centre-edge angle (LCEA), acetabular index and the presence of a crossover sign, did not correlate with fracture type. The alpha angle > 40° had a statistically significant higher likelihood for extracapsular fractures (p = 0.013).

CONCLUSIONS

Acetabular coverage and proximal femoral head-neck junction morphology, were found to partially correlate with the location of hip fractures and do not fully elucidate fracture type susceptibility.

Association of abductor hip muscle atrophy with fall-related proximal femur fractures in the elderly

OBJECTIVE

The purpose of this study was to evaluate an association between fall-related intertrochanteric or femoral neck fractures and gluteus medius and minimus atrophy, furthermore, to find a correlation of whether any difference between femoral neck or intertrochanteric fracture and degree of muscle atrophy MATERIALS AND METHODS: A retrospective review of 230 patients with intertrochanteric or femoral neck fracture, aged > 65 years, and 60 age- matched controls was performed. We assessed gluteus medius and minimus atrophy and calculated the cross-sectional area (CSA) and ratio of lean muscle to adipose infiltration (M/A ratio) for each muscle.

RESULTS

The atrophy scores for the g.medius and g.minimus muscles on the fractured side were significantly higher than scores on the healthy side and scores in the control group. The atrophy scores for the g.medius on the healthy side were not significantly different from scores in the control group. The atrophy scores for g.medius were significantly different between the fractured side and the healthy side for all ages, the atrophy scores for g.minimus was significantly different in the patients aged over 75. There was no significant difference in the following parameters between the fractured side and healthy side of the patients aged 65 - 75 years; the atrophy score, CSA and M/A ratio. The patients have a lower CSA and M/A ratio on the fractured side than on the healthy side and lower CSA and M/A ratio than in the control group. However, there were no significant differences in the M/A ratio between the healthy side and the control group. CSA was not significantly different between the fractured side and healthy side in the male patients and in the patients with lower BMI (<30). There was no significant difference in the atrophy scores between subjects with intertrochanteric versus femoral neck fractures, the CSAs of the g.medius and g.minimus were significantly different between the intertrochanteric fracture and femoral neck fracture groups.

CONCLUSIONS

The fractured sides showed greater g.medius and g.minimus muscle atrophy, which may be a predictor of fall-related hip fractures in the elderly. Gluteal muscle volume may be associated with proximal femur fracture subtype.

Treatment comparison of femoral shaft with femoral neck fracture: a meta-analysis

Background

To compare the efficacy and complications between reconstruction nail and hollow screw+plate in patients with femoral shaft and femoral neck fracture.

Methods

The full text of studies on clinical efficacy involving reconstruction nail and hollow screw+plate was retrieved from multiple databases. Review Manager 5.0 was adopted for meta-analysis, sensitivity analysis, and bias analysis. The meta-analysis was conducted with respect to the operation time, blood loss, healing time of the femoral shaft, healing time of the femoral neck, and complications. Finally, 10 studies met the eligibility criteria, including 991 patients.

Results

The meta-analysis suggested better characteristics for the reconstruction nail compared with the hollow screw+plate regarding operation time (OR = − 82.41, 95% CI [− 91.72, − 73.10], P < 0.00001; P for heterogeneity < 0.00001, I² = 98%), blood loss (OR = − 388.01, 95% CI [− 422.95, − 353.06], P < 0.00001; P for heterogeneity < 0.00001, I² = 99%), healing time of femoral shaft (MD = − 3.89, 95% CI [− 4.74, − 3.05], P < 0.00001; P for heterogeneity < 0.00001, I² = 99%), healing time of femoral neck (MD = − 4.04, 95% CI [− 4.33, − 3.75], P < 0.00001; P for heterogeneity = 0.008, I² = 60%), and complications (OR = 0.47, 95% CI [0.31, 0.73], P = 0.0006; P for heterogeneity = 1.00, I² = 0%).

Conclusion

This meta-analysis shows that a reconstruction nail is a more efficient and safer treatment than a hollow screw+plate for patients with femoral shaft and femoral neck fracture.

Comparison of Proximal Femoral Geometry and Risk Factors between Femoral Neck Fractures and Femoral Intertrochanteric Fractures in an Elderly Chinese Population

Background

Few studies have investigated the differences in proximal femoral geometry and risk factors between patients with different types of hip fracture, especially in elderly Chinese. This study aimed to assess the differences in proximal femoral geometry parameters between patients with femoral neck fractures and patients with intertrochanteric fractures to provide guidance for individualized customized prosthesis and accurate reconstruction of proximal femurs in elderly Chinese patients.

Methods

We retrospectively studied the electronic medical records of 198 elderly patients over 65 years of age who were admitted to the orthopedic department with hip fractures between January 2017 and December 2017 in The Third Hospital, Hebei Medical University. Age, fracture site, gender, and proximal femoral geometry parameters (neck shaft angle [NSA], center edge angle [CEA], femoral head diameter [FHD], femoral neck diameter [FND], femoral neck axial length [FNAL], hip axial length [HAL], and femoral shaft diameter [FSD]) were recorded. Student's t-test was used to compare the continuous variables, Chi-square test was used to analyze categorical variables, and multiple logistic stepwise regression analysis was used to evaluate the influencing factors of hip fracture type.

Results

Statistically significant differences in NSA (137.63 ± 4.56° vs. 132.07 ± 4.17°, t = 1.598, P < 0.001), CEA (37.62 ± 6.77° vs. 43.11 ± 7.09°, t = 5.597, P < 0.001), FND (35.21 ± 3.25 mm vs. 34.09 ± 3.82 mm, t = 2.233, P = 0.027), and FNAL (99.30 ± 7.91 mm vs. 103.58 ± 8.39 mm, t = 3.715, P < 0.001) were found between the femoral neck fracture group and femoral intertrochanteric fracture group. FHD, FND, FSD, HAL, and FNAL were different between sexes (all P < 0.001). The greater NSA was the risk factor for femoral neck fractures (odds ratio [OR]: 0.70, P < 0.001), greater CEA and longer FNAL were risk factors for femoral intertrochanteric fractures (OR: 1.15, 1.17, all P < 0.001), and greater FND was a protective factor for femoral intertrochanteric fractures (OR: 0.74, P < 0.001).

Conclusions

We demonstrate differences in geometric morphological parameters of the proximal femur in different hip fracture types, as well as an effect of sex. These differences should be considered in the selection of prostheses for fracture internal fixation and hip replacements. These data could help guide the design of individualized customized prostheses and improve the accurate reconstruction of the proximal femur for elderly Chinese hip fracture patients.