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

• Published in: Chinese medical journal Vol. 131; no. 21; pp. 2524 - 2530
• Main Authors: Hu, Zu-Sheng, Liu, Xian-Ling, Zhang, Ying-Ze
• Format: Journal Article
• Language: English
• Published: China Wolters Kluwer India Pvt. Ltd 05.11.2018; Medknow Publications and Media Pvt. Ltd; Lippincott Williams & Wilkins Ovid Technologies; Department of Orthopaedic Surgery, The Third Hospital, Hebei Medical University, Shijiazhuang, Hebei 050051, China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei 050051, China%Department of Nosocomial Infection, Anqing Hospital, Anhui Medical University, Anqing, Anhui 246003, China%Department of Orthopaedic Surgery, The Third Hospital, Hebei Medical University, Shijiazhuang, Hebei 050051, China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei 050051, China; Chinese Academy of Engineering, Beijing 100088, China; Medknow Publications & Media Pvt Ltd; Wolters Kluwer
• Subjects: Age; Aged; Aged, 80 and over; Asian Continental Ancestry Group - statistics & numerical data; Bone density; Care and treatment; Chinese Population; Elderly; Femoral Neck Fractures; Hip Geometry; Intertrochanteric Fractures of the Femur; Risk Factor; Disease; Elderly; Family medical history; Female; Femoral Neck Fractures - epidemiology; Femur - pathology; Fractures; Fractures (Injuries); Geometry; Geriatrics; Health aspects; Health risk assessment; Hip Fractures - pathology; Hip joint; Humans; Male; Morphology; Odds Ratio; Original; Osteoporosis; Prostheses; Prostheses and implants; Retrospective Studies; Risk Factors; Studies; Womens health; China; Femoral Neck Fractures; Chinese Population; Intertrochanteric Fractures of the Femur; Risk Factor; Elderly; Hip Geometry
• ISSN: 0366-6999; 2542-5641
• DOI: 10.4103/0366-6999.244118

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.