Document Type: RESEARCH PAPER

Authors

1 Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

 
Background: Some studies have previously shown that geometry of proximal femur can affect the probability of fracture and type of fracture. It happens since the geometry of the proximal femur determines how a force is applied to its different parts. In this study, we have compared proximal femur’s geometric characteristics in femoral neck (FNF), intertrochanteric (ITF) and Subtrochanteric (STF) fractures.

Methods:
In this study, 60 patients who had hip fractures were studied as case studies. They were divided into FNF, ITF and STF groups based on their fracture types (20 patients in each group). Patients were studied with x-ray radiography and CT scans. Radiological parameters including femoral neck length from lateral cortex to center of femoral head (FNL), diameter of femoral head (FHD), diameter of femoral neck (FND), femoral head neck offset (FHNO), neck-shaft angle (alpha), femoral neck anteversion (beta) were measured and compared in all three groups.

Results:
Amount of FNL was significantly higher in STF group compared to FNF (0.011) while ITF and STF as well as FNT and ITF did not show a significant different. Also, FND in FNF group was significantly lower than the other two groups, i.e. ITF and STF. In other cases there were no instances of significant statistical difference.

Conclusion:
Hip geometry can be used to identify individuals who are at the risk of fracture with special pattern. Also, it is important to have more studies in different populations and more in men.

Keywords

1. Karlsson KM, Sernbo I, Obrant KJ, Redlund-Johnell I,
Johnell O. Femoral neck geometry and radiographic
signs of osteoporosis as predictors of hip fracture.
Bone. 1996; 18(4):327-30.
2. Chappard C, Bousson V, Bergot C, Mitton D,
Marchadier A, Moser T, et al. Prediction of femoral
fracture load: cross-sectional study of texture
analysis and geometric measurements on plain
radiographs versus bone mineral density. Radiology.
2010; 255(2):536-43.
3. Pulkkinen P, Jamsa T, Lochmuller EM, Kuhn V,
Nieminen MT, Eckstein F. Experimental hip fracture
load can be predicted from plain radiography by
combined analysis of trabecular bone structure and
bone geometry. Osteoporos Int. 2008; 19(4):547-58.
4. Thevenot J, Pulkkinen P, Kuhn V, Eckstein F, Jamsa
T. Structural asymmetry between the hips and its
relation to experimental fracture type. Calcif Tissue
Int. 2010; 87(3):203-10.
5. Gnudi S, Ripamonti C, Lisi L, Fini M, Giardino R,
Giavaresi G. Proximal femur geometry to detect and
distinguish femoral neck fractures from trochanteric
fractures in postmenopausal women. Osteoporos
Int. 2002; 13(1):69-73.
6. Crabtree N, Lunt M, Holt G, Kroger H, Burger H, Grazio
S, et al. Hip geometry, bone mineral distribution, and
bone strength in European men and women: the
EPOS study. Bone. 2000; 27(1):151-9.
7. Hassankhani EG, Omidi-Kashani F, Hajitaghi H,
Hassankhani GG. How to Treat the Complex Unstable
Intertrochanteric Fractures in Elderly Patients? DHS
or Arthroplasty. Archives of Bone and Joint Surgery.
2014 Sep;2(3):174-9. PubMed PMID: 25386578. eng.
8. Beck TJ, Looker AC, Ruff CB, Sievanen H, Wahner
HW. Structural trends in the aging femoral neck and
proximal shaft: analysis of the third national health
and nutrition examination survey dual-energy
X-ray absorptiometry data. J Bone Miner Res. 2000;
15(12):2297-304.
9. Faulkner KG, Cummings SR, Black D, Palermo L,
Gluer CC, Genant HK. Simple measurement of
femoral geometry predicts hip fracture: the study
of osteoporotic fractures. J Bone Miner Res. 1993;
8(10):1211-7.
10. Gregory JS, Testi D, Stewart A, Undrill PE, Reid
DM, Aspden RM. A method for assessment of the
shape of the proximal femur and its relationship
to osteoporotic hip fracture. Osteoporos Int. 2004;
15(1):5-11.
11. Keyak JH, Rossi SA, Jones KA, Les CM, Skinner HB.
Prediction of fracture location in the proximal femur
using finite element models. Med Eng phys. 2001;
23(9):657-64.
12. Gregory JS, Testi D, Stewart A, Undrill PE, Reid
DM, Aspden RM. A method for assessment of the
shape of the proximal femur and its relationship
to osteoporotic hip fracture. Osteoporos Int. 2003;
15(1):5-11.
13. Pulkkinen P, Eckstein F, Lochmuller EM, Kuhn
V, Jamsa T. Association of geometric factors and
failure load level with the distribution of cervical vs.
Trochanteric hip fractures. J Bone Miner Res. 2006;
21(6):895-901.
14. Bouxsein ML, Szulc P, Munoz F, Thrall E, Sornay-
Rendu E, Delmas PD. Contribution of trochanteric
soft tissues to fall force estimates, the factor of risk,
and prediction of hip fracture risk. J Bone Miner Res.
2007; 22(6):825-31.
15. Rudman KE, Aspden RM, Meakin JR. Compression
or tension? The stress distribution in the proximal
femur. Biomed Eng online. 2006; 5(1):12-9.
16. Flicker L, Faulkner KG, Hopper JL, Green RM,
Kaymacki B, Nowson CA, et al. Determinants of hip
axis length in women aged 10-89 years: a twin study.
Bone. 1996; 18(1):41-5.
17. Bowey A, Andrew B. Proximal femoral geometry and
hip fracture patterns. A multi-centre comparative
radiological study from southern Australia and
western Scotland. J Bone Joint Surg. 2010; 92(SUPP
II):271-2.
18. Karasik D, Dupuis J, Cupples LA, Beck TJ, Mahaney MC,
Havill LM, et al. Bivariate linkage study of proximal
hip geometry and body size indices: the framingham
study. Calcif Tissue Int. 2007; 81(3):162-73.
19. Martens M, van Audekercke R, de Meester P, Mulier
JC. The mechanical characteristics of the long bones
of the lower extremity in torsional loading. J Biomech.
1980; 13(8):667-76.
20. Alonso CG, Curiel MD, Carranza FH, Cano RP, Perez
AD. Femoral bone mineral density, neck-shaft angle
and mean femoral neck width as predictors of hip
fracture in men and women. Multicenter Project
for Research in osteoporosis. Osteoporos Int. 2000;
11(8):714-20.
21. Woodhead HJ, Kemp AF, Blimkie CJR, Briody JN,
Duncan CS, Thompson M, et al. Measurement of
midfemoral shaft geometry: repeatability and
accuracy using magnetic resonance imaging and

dual-energy X-ray absorptiometry. J Bone Miner Res.
2001; 16(12):2251-9.
22. Nakamura T, Turner CH, Yoshikawa T, Slemenda
CW, Peacock M, Burr DB, et al. Do variations in hip
geometry explain differences in hip fracture risk
between Japanese and white Americans. J Bone
Miner Res. 1994; 9(7):1071-6.
23. Greendale GA, Young JT, Huang MH, Bucur A, Wang
Y, Seeman T. Hip axis length in mid-life Japanese and
Caucasian U.S. residents: no evidence for an ethnic
difference. Osteoporos Int. 2003; 14(4):320-5.
24. Partanen J, Jamsa T, Jalovaara P. Influence of the upper
femur and pelvic geometry on the risk and type of
hip fractures. J Bone Miner Res. 2001; 16(8):1540-6.