Analysis of trabecular distribution of the proximal femur in patients with fragility fractures

Yaogang Lu,Yongqiang Hao,Minghui Wang,Lei Wang,Ziping Wang,Shengfang Ge

doi:10.1186/1471-2474-14-130

Abstract

BackgroundMulti-detector computed tomography (MDCT) was used in order to assess the trabecular distribution of proximal femur and its relationship with hip fragility fractures.MethodsA total of 99 elderly women were scanned by MDCT including: 27 trochanteric hip fractures (group A), 40 femoral neck fractures (group B), and 32 non-fractures (group C). A mid-coronal MPR image of the proximal femur was reconstructed for every patient by e-Film95 software. Four regions of interest (ROI) were chosen in the images including compressive trabecula (ComT), tensile trabecula (TenT), trochanteric trabecula (TroT) and Ward's triangle (WT) region. The mean CT values were measured by the software.ResultsThe mean age was 81.44, 74.10 and 69.25 years for groups A, B and C, respectively. There was significant inter-group differences based on one-way ANOVA (P<0.05). The CT values in the four ROIs had significant differences in the groups except for TenT between group A and B (P>0.05). After the age adjustment with ANCOVA, the mean CT values of TroT and WT were significantly lower in group A as compared to that of the group B (P<0.05). However, there were no significant differences for ComT and TenT between groups A and B (P>0.05).ConclusionsThe occurrence of femoral neck fracture was closely related to the degeneration of ComT and TenT. Trochanteric hip fractures were associated with a more severe degeneration in TroT as well as an enlargement of WT region besides the ComT and TenT degeneration. We concluded that the hip fragility fractures might be predicted by the measurement of the mean CT values in ComT, TenT, TroT and WT region.

Highlights

Multi-detector computed tomography (MDCT) was used in order to assess the trabecular distribution of proximal femur and its relationship with hip fragility fractures
We found that the distribution of trabeculae in the proximal femur was extremely asymmetric
Secondary compressive trabeculae and tensile trabeculae were shown in the reformatted image (Figure 2A), but the greater trochanteric trabeculae could not be clearly detected

Summary

Introduction

Multi-detector computed tomography (MDCT) was used in order to assess the trabecular distribution of proximal femur and its relationship with hip fragility fractures. The elderly may develop fragility fractures after minor injuries, the most common of which is a hip fracture. Hip fragility fractures are defined [1] as the fracture that are caused by sideway falls from a standing height. They have a slow initial velocity on the greater trochanter and mainly include trochanteric hip and femoral neck fractures. The impact forces on the hip of the elderly people during the falls from a standing height, on average, exceed the strength of their femurs by approximately 50% [2].

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