The influence of acetabular morphology on prediction of proximal femur fractures types in an elderly population

Impact of femoral head size on the localization of proximal femur fractures: Retrospective analysis of 400 cases

Background

Proximal femur fractures are prevalent among the elderly, leading to high mortality, reduced quality of life, and significant healthcare burdens. The incidence is rising with demographic ageing, with osteoporotic fractures projected to reach 6 million annually by 2050, costing $25.4 billion. A 351 % increase in proximal femur fractures among individuals over 85 years is expected. Accurate fracture localization through imaging, combined with understanding femoral head size and patient-specific factors, improves preoperative planning and outcomes. This study explores the relationship between femoral head size and fracture localization.

Methods

A retrospective cohort study analyzed data from 400 patients with proximal femur fractures treated between 2010 and 2022. Fractures were classified as medial, lateral, pertrochanteric, or subtrochanteric. Radiographs measured femoral head morphology, and statistical analyses, including chi-square tests, t-tests, ANOVA, and logistic regression, identified predictors of fracture localization.

Results

Femoral head area (FHA) varied significantly across fracture types, with lateral fractures having the largest mean FHA (2355.95 mm2/cm2, p = 0.047). Osteoarthritis prevalence differed (p = 0.028), being highest in subtrochanteric fractures (17 %, Kellgren & Lawrence grade 3-4). Lateral fractures had a younger mean age of 71.05 years (p < 0.001), while pertrochanteric fractures averaged 79.52 years (p < 0.001). Vertical (p < 0.001) and horizontal (p = 0.028) femoral head diameters also differed significantly.

Conclusion

Larger femoral heads are associated with lateral fractures, whereas pertrochanteric fractures occur in older patients. Subtrochanteric fractures correlate with smaller femoral heads and advanced osteoarthritis.

Comparative analysis of elbow radiographic measurements in patients with supracondylar humerus fractures and healthy controls

BACKGROUND

Supracondylar humeral fractures (SCHF) are the second most common fractures in childhood and can lead to short- and long-term complications. Despite their prevalence, the anatomical factors that predispose children to SCHF remain unclear. This study aimed to determine whether there are significant morphological differences in the elbow by comparing the radiographic angular measurements of the contralateral elbows of patients with SCHF to those of patients with distal radius fractures (DRF) and a healthy control group. We sought to explore if these morphological variations contribute to the occurrence of SCHF.

AIM

To determine radiological parameters that may predispose to pediatric elbow fractures.

METHODS

Radiographs of 78 SCHF patients were analyzed for angular measurements of the contralateral elbow. Two control groups were used: 98 healthy children and 40 patients with DRF. Angular measurements included Baumann angle (BA), humeroulnar angle (HUA), humerus metaphysis-diaphysis angle (HMDA), humerus shaft-condylar angle (HSCA), and lateral capitellohumeral angle. Only BA, HUA, and HMDA were measured in the DRF group. Statistical analysis was performed to compare differences among groups.

RESULTS

Significant differences were found in elbow measurements between SCHF and control groups (P < 0.05). However, the mean values for all groups fell within the ranges described in the literature.

CONCLUSION

While statistically significant differences were found in elbow morphology between SCHF patients and controls, these differences don't translate into clinically meaningful morphological deviations.

FPG Score: A Rapid Admission-Based Tool for Predicting In-Hospital Mortality in Elderly Hip Fracture Patients

OBJECTIVE

Hip fractures in elderly patients are a major public health concern, associated with high morbidity and mortality. Early identification of high-risk patients is crucial to guide clinical decision-making, optimize resource allocation, and improve outcomes. However, existing risk prediction models, such as the Nottingham Hip Fracture Score (NHFS) and the Charlson Comorbidity Index (CCI), require laboratory or postoperative data, delaying risk stratification. This study aims to develop and validate the FPG score, a novel and simplified tool for predicting intrahospital mortality in elderly patients undergoing surgery for proximal femur fractures, using only admission data available at triage.

MATERIALS AND METHODS

This single-center, observational cohort study was conducted in two phases: a retrospective derivation phase (2015-2019) and a prospective validation phase (2020-2022). Patients aged ≥ 65 years with proximal femur fractures (AO 31A, 31B) undergoing surgical treatment were included. Exclusions involved pathological, periprosthetic, and femoral head fractures (31C). Data on demographics, comorbidities, vital signs, and laboratory values were collected at Emergency Unit triage. The primary outcome was intrahospital mortality. Univariate and multivariate logistic regression identified predictors, and ROC analysis assessed the FPG score's predictive performance, with AUC, sensitivity, and specificity evaluated using SPSS v25 and MedCalc v18.

RESULTS

In the retrospective phase, 1984 patients (median age: 83.5 years, 28.7% male) were analyzed, with an observed intrahospital mortality of 3.8% (77 patients). The FPG score demonstrated an AUC of 0.79, outperforming NHFS and CCI. A score > 2 was associated with a > 50% mortality risk, with 61% sensitivity and 80% specificity. In the validation cohort (752 patients, 4.8% mortality), the FPG score maintained strong predictive performance (AUC = 0.751).

CONCLUSION

The FPG score provides a rapid, objective, and clinically applicable tool for mortality risk assessment in elderly patients with hip fractures, allowing for immediate triage-based decision-making. Unlike NHFS and CCI, it does not require laboratory or post-admission data, making it particularly useful in emergency settings. Its integration into clinical practice may enhance patient management, improve resource allocation, and facilitate early intervention. While the score has been validated in a single-center study, further multicenter validation is needed to confirm its broader applicability. Future research should explore the integration of frailty indices and laboratory markers to refine its predictive accuracy.

Subchondral fatigue fracture of the femoral head in young military recruits: Potential risk factors

BACKGROUND

Subchondral fatigue fracture of the femoral head (SFFFH) mainly occurs in young military recruits and might be confused with osteonecrosis of the femoral head. However, less research focuses on the risk factor for SFFFH.

AIM

To evaluate the intrinsic risk factors for SFFFH in young military recruits.

METHODS

X-ray and magnetic resonance imaging data were used for analysis. Acetabular anteversion of the superior acetabulum, acetabular anteversion of the center of the acetabulum (AVcen), anterior acetabular sector angle (AASA), posterior acetabular sector angle, superior acetabular sector angle, neck-shaft angle (NSA), inferior iliac angle (IIA), and ischiopubic angle were calculated. Then, logistic regression, receiver operating characteristic curve analysis, and independent samples t-test were performed to identify the risk factors for SFFFH.

RESULTS

Based on the results of logistic regression, age [odds ratio (OR): 1.33; 95% confidence interval (95%CI): 1.12-1.65; P = 0.0031] and treatment timing (OR: 0.86; 95%CI: 0.75-0.96; P = 0.015) could be considered as the indicators for SFFFH. AVcen (P = 0.0334), AASA (P = 0.0002), NSA (P = 0.0007), and IIA (P = 0.0316) were considered to have statistical significance. Further, AVcen (OR: 1.41; 95%CI: 1.04-1.95) and AASA (OR: 1.44; 95%CI: 1.21-1.77), especially AASA (area under curve: 66.6%), should be paid much more attention due to the higher OR than other indicators.

CONCLUSION

We have for the first time unveiled that AASA and age could be key risk factors for SFFFH, which further verifies that deficient anterior coverage of the acetabulum might be the main cause of SFFFH.

Increased prevalence of femoroacetabular impingement on the elderly with fractures of the proximal femur

Objectives: Femoroacetabular impingement (FAI) has been recently related to several pathologies, besides chondral injury and hip arthritis. We aim to investigate the prevalence of FAI morphology in an elderly cohort hospitalized due to a proximal femur fracture and compare these findings to a control group. We hypothesize that limited medial rotation due to FAI’s morphology could increase stresses to the proximal femur, acting as a facilitating mechanism for fractures in this region. Therefore, a higher prevalence of FAI morphology would be present in the study group. Methods: A retrospective cross-sectional study was performed based on the analysis of radiographic images in AP and lateral views of the fractured hip. Firstly, we have set to measure FAI prevalence in an elderly cohort victimized by fractures of the proximal by measures of the alpha, Tönnis, and lateral center edge angles of a hundred consecutive patients hospitalized for proximal femur fractures. Secondly, we have analyzed the possible relationship between the FAI subtypes and the type of fracture. Finally, we have compared this sample’s data with that of a similar control cohort not affected by fracture. Results: The cohort in this study displayed a higher prevalence of pathological changes in the Tönnis, center-edge, and alpha angles with odds ratios of 3.41, 2.56, and 4.80, respectively (with statistical significance). There was also a significant relationship between cam-type FAI and intertrochanteric fractures, corroborating our initial hypotheses. Conclusions: This study demonstrated that a cohort of older patients affected by fractures of the proximal femur had an increased prevalence of radiographic signs of femoroacetabular impingement. Furthermore, this is the first study demonstrating a statistically significant relationship of cam-type FAI with intertrochanteric fractures, suggesting a possible cause and effect relationship.

The association between anterior femoroacetabular impingement and femoral neck fractures: An observational study

The impact between acetabulum and femoral neck is another possible mechanism of femoral neck fracture.Direct trauma of the greater trochanter may not be able to fully explain the mechanism underlying femoral neck fracture. In this study, we sought to investigate whether anterior femoroacetabular impingement are associated with femoral neck fractures.A total of 36 patients with femoral neck fracture who had undergone total hip arthroplasty or hemiarthroplasty were included in this study. These patients were divided into 2 groups: labrum tear group and normal labrum group. Patients' age, gender, body mass index, muscle injury, injury pattern, trauma severity, femoral head-neck offset, femoral head-neck ratio, Cam deformity alpha angle, acetabular anteversion, femoral head diameter, acetabular index, cortical index, hip axis length, and neck stem angle were recorded and analyzed. SPSS 18.0 software was used for statistical analyses.According to intraoperative findings, 22 patients exhibited a labrum tear. Magnetic resonance imaging examination revealed bone contusion on the anterolateral margin of the acetabulum with muscle damage surrounding the hip. Among 14 cases without a labrum tear, no bone contusion and obvious muscle injury were found on the anterolateral margin of the acetabulum. Notably, muscle injury, injury pattern, trauma severity and femoral head-neck offset differed significantly (P < .05) between labrum tear and normal labrum groups.Previous studies have focused more on direct lateral trauma. In this study, the impact between acetabulum and femoral neck is another possible mechanism besides lateral impact. Specifically, the abnormal anatomy of the hip, such as femoral head-neck offset, may promote the fracturing process.