Femoral Neck Research Articles

Traumaplasty: When and How to Perform Acute Arthroplasty for Fractures Around the Hip in the Elderly Patient

Acute fractures around the hip are prevalent injuries associated with potentially devastating outcomes. The growing utilization of arthroplasty for femoral neck fractures in the elderly is likely a result of improvements in reoperation rates and postoperative function. Compared to hemiarthroplasty, total hip arthroplasty is associated with a slight functional benefit that is unlikely noticeable for many patients, as well as minimal differences in complications and patient reported outcome measures. However, the evidence supporting cement use in femoral stem fixation is robust. Multiple high power randomized controlled trial-based studies indicate cement fixation brings more predictable outcomes and fewer reoperations. In the setting of acute acetabular fracture, total hip arthroplasty is a favorable approach for elderly patients and fracture patterns associated with increased risk of revision after open reduction and internal fixation. Variations in patient characteristics and fracture patterns demand careful consideration whenever selecting the optimal treatment. In fracture patient populations, comanagement is an important consideration when seeking to reduce complications and promote cost-effective quality care.

Comparison of intraoperative outcomes in excision arthroplasty with or without partial tenotomy of deep gluteal muscle in dogs

Background: Excision arthroplasty is a commonly performed surgical technique for treating coxofemoral luxation in dogs. Favourable outcomes have been reported in dogs up to 15 kg. Aim: This study aimed to compare the intraoperative findings of two surgical approaches i.e., with or without partial deep gluteal muscle tenotomy in the excision arthroplasty in dogs. Methods: A total of 15 dogs having average body weight 15.6 kg (3.5-26) and 29.5 months (6-72) of age were brought to the Veterinary Surgery Clinics at University Veterinary Hospital, Samsun, Turkey with traumatic coxofemoral luxation or femur head/neck fracture. Craniolateral incision was used to approach the craniodorsal aspect of the hip joint in all cases. Myotomy of the superficial gluteal muscle and partial tenotomy of the deep gluteal was performed in one group. While blunt dissection approach was performed for elevation of gluteal muscles in another group. Results: Fifteen dogs (myotomy and tenotomy in 8 dogs and without tenotomy in 7 dogs) were diagnosed having lesions along with coxofemoral luxation in 9 cases, femoral neck fracture in 5 cases and caput femur fracture in 1 case. Partial tenotomy improved the exposure of joint capsule and femur neck. Discussion and Conclusion: The remnants of femoral neck after excision arthroplasty may contact the acetabulum and cause pain in the postoperative period. By applying the partial deep gluteal muscle tenotomy technique, surgeons can readily expose joint capsule, femoral head, femoral neck, and great and lesser trochanter.

The association of gender-affirming hormone therapy duration and body mass index on bone mineral density in gender diverse adults

IntroductionFeminizing and masculinizing gender-affirming hormone therapy (fGAHT, mGAHT) results in bone mineral density (BMD) maintenance or improvement over time in transgender and gender diverse (TGD) adults. Mostly European TGD studies have explored GAHT’s impact on BMD, but the association of BMI and BMD in TGD adults deserves further study. ObjectiveTo determine whether GAHT duration or BMI are associated with BMD and Z-scores among TGD young adults. MethodsCross-sectional study of nonsmoking TGD adults aged 18–40 years without prior gonadectomy or gonadotropin-releasing hormone agonist (GnRHa) therapy taking GAHT for > 1 year. BMD and Z-scores were collected from dual-energy x-ray absorptiometry. Associations between femoral neck, total hip, and lumbar spine BMDs and Z-scores and the predictors, GAHT duration and BMI, were estimated using linear regression. ResultsAmong 15 fGAHT and 15 mGAHT, mean BMIs were 27.6 +/- standard deviation (SD) 6.4 kg/m2 and 25.3 +/- 5.9 kg/m2, respectively. Both groups had mean BMDs and Z-scores within expected male and female reference ranges at all three sites. Higher BMI among mGAHT was associated with higher femoral neck and total hip BMDs (femoral neck: β = 0.019 +/- standard error [SE] 0.007 g/cm2, total hip: β = 0.017 +/- 0.006 g/cm2; both p < 0.05) and Z-scores using male and female references. GAHT duration was not associated with BMDs or Z-scores for either group. ConclusionsZ-scores in young, nonsmoking TGD adults taking GAHT for > 1 year, without prior gonadectomy or GnRHa, and with mean BMIs in the overweight range, were reassuringly within the expected ranges for age based on male and female references. Higher BMI, but not longer GAHT duration, was associated with higher femoral neck and total hip BMDs and Z-scores among mGAHT. Larger, prospective studies are needed to understand how body composition changes, normal or low BMIs, and gonadectomy affect bone density in TGD adults.

Causal relationship between intervertebral disc degeneration and osteoporosis: a bidirectional two-sample Mendelian randomization study.

The relationship between intervertebral disc degeneration (IVDD) and osteoporosis (OP), diagnosed primarily using bone mineral density (BMD), remains unclear so far. The present study, therefore, aimed to investigate the potential relationship between osteoporosis and intervertebral disc degeneration using Mendelian randomization and genome-wide association analyses. Specifically, the impact of bone mineral density on the development of intervertebral disc degeneration was evaluated. The genome-wide association studies (GWAS) summary data of OP/BMDs and IVDD were collected from the FinnGen consortium, the GEFOS consortium, and MRC-IEU. The relationship between IVDD and OP was then explored using TSMR. The inverse-variance weighted (IVW) method was adopted as the primary effect estimate, and the reliability and stability of the results were validated using various methods, including MR-Egger, weighted median, simple mode, weighted mode, and MR-PRESSO. No significant causal relationship was observed between OP and IVDD (IVW, P > 0.05) or between femoral neck BMD (FA-BMD) and IVDD when OP and FA-BMD were used as exposures. However, increased levels of total body BMD (TB-BMD) and lumbar spine BMD (LS-BMD) were revealed as significant risk factors for IVDD (TB-BMD: IVW, OR = 1.201, 95% CI: 1.123-1.284, P = 8.72 × 10-8; LS-BMD: IVW, OR = 1.179, 95% CI: 1.083-1.284, P = 1.43 × 10-4). Interestingly, both heel BMD (eBMD) and femur neck BMD (FN-BMD) exhibited potential causal relationships (eBMD: IVW, OR = 1.068, 95% CI: 1.008-1.131, P = 0.0248; FN-BMD, IVW, OR = 1.161, 95% CI: 1.041-1.295, P = 0.0074) with the risk of IVDD. The reverse MR analysis revealed no statistically causal impact of IVDD on OP and the level of BMD (P > 0.05). OP and the level of FA-BMD were revealed to have no causal relationship with IVDD. The increased levels of TB-BMD and LS-BMD could promote the occurrence of IVDD. Both eBMD and FN-BMD have potential causal relationships with the risk of IVDD. No significant relationship exists between IVDD and the risk of OP. Further research is warranted to comprehensively comprehend the molecular mechanisms underlying the impact of OP and BMD on IVDD and vice versa.

Predictors of long-term mortality in older patients with hip fractures managed by hemiarthroplasty: a 10-year study based on a population registry in Saxony, Germany.

Mortality of patients with a femoral neck fracture is high, especially within the first year after surgery, but also remains elevated thereafter. The aim of this study was to identify factors potentially associated with long-term mortality in patients homogeneously treated with hemiarthroplasty for femoral neck fracture. This retrospective cohort study was performed at a single level 1 national trauma center at the university hospital of Leipzig (Saxony, Germany). The study time-window was January 1, 2010 to December 31, 2020. Primary outcome measure was mortality depending on individual patient-related characteristics and perioperative risk factors. Inclusion criteria was a low-energy femoral neck fracture (Garden I-IV) in geriatric patients 60 years of age or older that were primarily treated with bipolar hemiarthroplasty. Date of death or actual residence of patients alive was obtained from the population register of the eastern German state of Saxony, Germany. The outcome was tested using the log-rank test and plotted using Kaplan-Meier curves. Unadjusted and adjusted for other risk factors such as sex and age, hazard ratios were calculated using Cox proportional hazards models and presented with 95% confidence intervals (CI). The 458 included patients had a median age of 83 (IQR 77-89) years, 346 (75%) were female and 113 (25%) male patients. Mortality rates after 30 days, 1, 5 and 10 years were 13%, 25%, 60% and 80%, respectively. Multivariate regression analysis revealed age (HR = 1.1; p < 0.001), male gender (HR = 1.6; p < 0.001), ASA-Score 3-4 vs. 1-2 (HR = 1.3; p < 0.001), dementia (HR = 1.9; p < 0.001) and a history of malignancy (HR = 1.6; p = 0.002) as independent predictors for a higher long-term mortality risk. Perioperative factors such as preoperative waiting time, early surgical complications, or experience of the surgeon were not associated with a higher overall mortality. In the present study based on data from the population registry from Saxony, Germany the 10-year mortality of older patients above 60 years of age managed with hemiarthroplasty for femoral neck fracture was 80%. Independent risk factors for increased long-term mortality were higher patient age, male gender, severe comorbidity, a history of cancer and in particular dementia. Perioperative factors did not affect long-term mortality.

Femoral Neck Shaft Angle Measurement for Differentiating Femoral Head Stress Fracture from Avascular Necrosis

Objective: The study aimed to evaluate whether the measurement of Femoral Neck Shaft Angle (FNSA) can be helpful in differentiating femoral head Stress Fracture (SF) from Avascular Necrosis (AVN). Methods: From September 2019 to April 2022, sixty-four patients [median age 32.0 years, interquartile range (IQR) 23.0–39.0 years] who underwent both hip radiograph and Magnetic Resonance Imaging (MRI) and diagnosed as femoral head SF or AVN were included in our retrospective study. Patients were divided into as having either femoral head SF (n = 34) or AVN (n = 30). The FNSA was measured in anteroposterior hip radiography. Continuous values were compared using the Mann-Whitney U test. The assessment of the predictive value of FNSA for femoral head SF was performed by Receiver Operating Characteristic (ROC) analysis. Results: The FNSA was significantly higher in patients with SF (median 133.5°, IQR 128.0–136.7°) than those with AVN (median 127.5°, IQR 124.0–132.0°) (p = 0.001). In addition, the FNSA was significantly higher in SF femurs (median 134.8°, IQR 129.2–137.4°) than in contralateral normal femurs (median 127.1°, IQR 124.3–132.5°) in patients with unilateral femoral head SF (n = 30) (p &lt; 0.001). In ROC analysis, the sensitivity, specificity, and Area Under the Curve (AUC) for predicting the femoral head SF were 77.3%, 63.3%, and 0.785 (95% confidence interval: 0.666–0.905), respectively, at a cutoff of 130.2°. Conclusion: Increased FNSA was associated with femoral head SF; thus, measurement of FNSA could be helpful for differentiating femoral head SF from AVN.

Treatment reality of distal radius fractures in a center

Distal radius fractures are the third most common type of fracture in Germany after fractures of the femoral neck and peritrochanteric femoral fractures. In 2019 a total of 72,087 cases were registered with an incidence of 106 cases per 100,000 inhabitants (81,570 fractures of the femoral neck, 73,785 peritrochanteric fractures). Many of these fractures are surgically treated also in this hospital but with controversial views on the optimal treatment. Against the background of the coronavirus disease 2019 (COVID-19) pandemic, disappearing personnel resources and the political pressure to form centers and a switch to outpatient treatment, the authors ask the question what the treatment reality in this hospital looks like and whether the general changes in the framework conditions also have an affect in this context. This is not a strictly scientific study but a stocktaking without any claims of completeness and the retrospective evaluation of a larger data pool with all its weaknesses. On the contrary, the data provide interesting aspects that are explained in detail in the individual sections.

Association of serum sclerostin levels with marrow adiposity in postmenopausal women with glucocorticoid-induced osteoporosis

BackgroundGlucocorticoids and sclerostin act as inhibitors of the Wnt signaling pathway, thereby hindering bone formation. Given the pathway's intricate association with mesenchymal stem cells, the hypothesis suggests that heightened sclerostin levels may be intricately linked to an augmentation in marrow adiposity induced by glucocorticoids. This study endeavored to delve into the nuanced relationship between circulating sclerostin and bone marrow adipose tissue in postmenopausal women grappling with glucocorticoid-induced osteoporosis (GIO).MethodsIn this cross-sectional study, 103 patients with autoimmune-associated diseases underwent glucocorticoid treatment, boasting an average age of 61.3 years (standard deviation 7.1 years). The investigation encompassed a thorough assessment, incorporating medical history, anthropometric data, biochemical analysis, and dual-energy X-ray absorptiometry measurements of lumbar and femoral bone mineral density (BMD). Osteoporosis criteria were established at a T-score of -2.5 or lower. Additionally, MR spectroscopy quantified the vertebral marrow fat fraction.ResultsBMD at the femoral neck, total hip, and lumbar spine showcased an inverse correlation with marrow fat fraction (r = –0.511 to – 0.647, P < 0.001). Serum sclerostin levels exhibited a positive correlation with BMD at various skeletal sites (r = 0.476 to 0.589, P < 0.001). A noteworthy correlation emerged between circulating sclerostin and marrow fat fraction at the lumbar spine (r = –0.731, 95% CI, –0.810 to –0.627, P < 0.001). Multivariate analysis brought to light that vertebral marrow fat fraction significantly contributed to sclerostin serum concentrations (standardized regression coefficient ß = 0.462, P < 0.001). Even after adjusting for age, body mass index, physical activity, renal function, BMD, and the duration and doses of glucocorticoid treatment, serum sclerostin levels maintained a significant correlation with marrow fat fraction.ConclusionsCirculating sclerostin levels exhibited a noteworthy association with marrow adiposity in postmenopausal women grappling with GIO.

Intraoperative Hypoxemia in the Right Lateral Decubitus Position: A Case Report

Platypnea-Orthodeoxia syndrome (POS), an exceptionally uncommon condition, is characterized by decreased oxygen saturation in an upright posture with corresponding improvement in the supine position. Recently, an 85-year-old female patient presented for surgery due to a left femoral neck fracture. Following successful tracheal intubation and anesthesia induction, the ventilator indicated an airway pressure of 15mmHg. While in the right lateral decubitus position, the patient developed hypoxia despite normal arterial blood pressure and symmetrical breath sounds. Attempts to alleviate the hypoxia through pure oxygen ventilation, tympanic lung ventilation, and high-frequency ventilation were unsuccessful. Subsequently, there was a notable decrease in both blood pressure and heart rate, prompting an immediate halt to the surgery and repositioning the patient to the supine position. This resulted in the normalization of the patient&amp;apos;s heart rate, oxygen saturation, and blood pressure. To investigate the etiology, a TEE probe was inserted, revealing the presence of a patent foramen ovale (PFO) and a significant right-to-left shunt while the patient was in the lateral position. The procedure was performed in a specific right lateral decubitus position. This case may represent a unique manifestation of POS syndrome, expanding the differential diagnosis for intraoperative position-related hypoxemia. Given the severe hypoxemia observed with intraoperative positional changes, a strong suspicion of POS syndrome is warranted.

Osteological profiling of femoral diaphysis and neck in aquatic, semiaquatic, and terrestrial carnivores and rodents: effects of body size and locomotor habits.

The increased limb bone density documented previously for aquatic tetrapods has been proposed to be an adaptation to overcome buoyancy during swimming and diving. It can be achieved by increasing the amount of bone deposition or by reducing the amount of bone resorption, leading to cortical thickening, loss of medullary cavity, and compaction of trabecular bone. The present study examined the effects of locomotor habit, body size, and phylogeny on the densitometric, cross-sectional, and biomechanical traits of femoral diaphysis and neck in terrestrial, semiaquatic, and aquatic carnivores, and in terrestrial and semiaquatic rodents (12 species) by using peripheral quantitative computed tomography, three-point bending, and femoral neck loading tests. Groupwise differences were analyzed with the univariate generalized linear model and the multivariate linear discriminant analysis supplemented with hierarchical clustering. While none of the individual features could separate the lifestyles or species adequately, the combinations of multiple features produced very good or excellent classifications and clusterings. In the phocid seals, the aquatic niche allowed for lower femoral bone mineral densities than expected based on the body mass alone. The semiaquatic mammals mostly had high bone mineral densities compared to the terrestrial species, which could be considered an adaptation to overcome buoyancy during swimming and shallow diving. Generally, it seems that different osteological properties at the levels of mineral density and biomechanics could be compatible with the adaptation to aquatic, semiaquatic, or terrestrial niches.

Computed tomography-based automated 3D measurement of femoral version: Validation against standard 2D measurements in symptomatic patients.

To validate 3D methods for femoral version measurement, we asked: (1) Can a fully automated segmentation of the entire femur and 3D measurement of femoral version using a neck based method and a head-shaft based method be performed? (2) How do automatic 3D-based computed tomography (CT) measurements of femoral version compare to the most commonly used 2D-based measurements utilizing four different landmarks? Retrospective study (May 2017 to June 2018) evaluating 45 symptomatic patients (57 hips, mean age 18.7 ± 5.1 years) undergoing pelvic and femoral CT. Femoral version was assessed using four previously described methods (Lee, Reikeras, Tomczak, and Murphy). Fully-automated segmentation yielded 3D femur models used to measure femoral version via femoral neck- and head-shaft approaches. Mean femoral version with 95% confidence intervals, and intraclass correlation coefficients were calculated, and Bland-Altman analysis was performed. Automatic 3D segmentation was highly accurate, with mean dice coefficients of 0.98 ± 0.03 and 0.97 ± 0.02 for femur/pelvis, respectively. Mean difference between 3D head-shaft- (27.4 ± 16.6°) and 3D neck methods (12.9 ± 13.7°) was 14.5 ± 10.7° (p < 0.001). The 3D neck method was closer to the proximal Lee (-2.4 ± 5.9°, -4.4 to 0.5°, p = 0.009) and Reikeras (2 ± 5.6°, 95% CI: 0.2 to 3.8°, p = 0.03) methods. The 3D head-shaft method was closer to the distal Tomczak (-1.3 ± 7.5°, 95% CI: -3.8 to 1.1°, p = 0.57) and Murphy (1.5 ± 5.4°, -0.3 to 3.3°, p = 0.12) methods. Automatic 3D neck-based-/head-shaft methods yielded femoral version angles comparable to the proximal/distal 2D-based methods, when applying fully-automated segmentations.

Vertebral and Femoral Bone Mineral Density (BMD) Assessment with Dual-Energy CT versus DXA Scan in Postmenopausal Females.

This study aimed to demonstrate the potential role of dual-energy CT in assessing bone mineral density (BMD) using hydroxyapatite-fat material pairing in postmenopausal women. A retrospective study was conducted on 51 postmenopausal female patients who underwent DXA and DECT examinations for other clinical reasons. DECT images were acquired with spectral imaging using a 256-slice system. These images were processed and visualized using a HAP-fat material pair. Statistical analysis was performed using the Bland-Altman method to assess the agreement between DXA and DECT HAP-fat measurements. Mean BMD, vertebral, and femoral T-scores were obtained. For vertebral analysis, the Bland-Altman plot showed an inverse correlation (R2: -0.042; RMSE: 0.690) between T-scores and DECT HAP-fat values for measurements from L1 to L4, while a good linear correlation (R2: 0.341; RMSE: 0.589) was found for measurements at the femoral neck. In conclusion, we demonstrate the enhanced importance of BMD calculation through DECT, finding a statistically significant correlation only at the femoral neck where BMD results do not seem to be influenced by the overlap of the measurements on cortical and trabecular bone. This outcome could be beneficial in the future by reducing radiation exposure for patients already undergoing follow-up for chronic conditions.

Assessment of regional and total skeletal metabolism using 18F-NaF PET/CT in patients with chronic kidney disease.

The study aims to assess regional and total bone metabolic activity in patients with chronic kidney disease using Na[18F]F PET and correlation between semi-quantitative indices and blood parameters. Seventy-two subjects (mean age 61.8 ± 13.8years) were included. Of these 24/72 patients had end-stage renal disease (ESRD) (GFR < 15mL/min/1.73 m2), 38/72 had chronic kidney disease (CKD) (GFR between 60 and 15mL/min/1.73 m2), and 10/72 were controls with normal renal function. All subjects underwent Na[18F]F PET-CT with a dose activity of 0.06mCi/Kg. Regional and total skeletal metabolism were assessed with mean SUVs in a skeletal volume of interest (VOI), bone to soft tissue index (B/S), global SUV mean (GSUV mean) of the whole bone, and uptake in the femoral neck. Statistically significant differences were observed in a number of 18F-NaF metrics like femoral neck metabolism in CKD and ERSD groups in comparison to control in right (P = 0.003) and left femur (P = 0.006), bone to soft tissue index in the femur (P = 0.016) and GSUV5 (P = 0.006). There is also a significant difference in SUV mean in lumbar vertebrae (L1-L4) among CKD, ESRD, and controls. There was a moderate correlation between 18F-NaF PET scan uptake and blood parameters such as ALP and PTH. Na[18F]F uptake parameters were significantly different in low versus high bone turnover state. The assessment of total skeleton and regional metabolism and bone turnover in CKD patients is feasible with Na[18F]F PET. Na[18F]F can help to detect early changes in bone metabolism and assess the progression of bone disease in this complex condition. Quantification with Na[18F]F PET might provide better assessment of the bone turnover. The difference in Na[18F]F uptake in CKD compared to controls is likely related to a change in bone turnover which, however, requires further validation.

Clinical Efficacy of Bisphosphonates in Treating Osteoporosis in Diabetes Patients: A Meta-Analysis.

The aim of the study was to explore the clinical efficacy of bisphosphonates in patients with osteoporosis in diabetes patients by meta-analysis. Six databases were systematically searched from inception to January 30,2023. Studies evaluating the treatment of diabetic osteoporosis with bisphosphonates were included. Key outcome measures, such as bone mineral density (BMD), bone metabolism markers, pain improvement, and safety assessments, were extracted and analyzed. STATA MP V17.0 was used to calculate the combined effect size. After searching Chinese and English databases, 15 studies met the inclusion criteria of this study. The results of the meta-analysis showed that the BMD of patients with osteoporosis in diabetes increased significantly after bisphosphonate treatment, and the lumbar BMD increased by 0.08 g/cm² (95% CI: 0.05-0.11). Femoral neck BMD increased by 0.06 g/cm² (95% CI: 0.01-0.11); Ward's triangle BMD increased 0.07 g/cm² (95% CI: 0.04-0.09); and trochanter BMD increased by 0.06 g/cm² (95% CI: 0.04-0.08). In addition, bone alkaline phosphatase increased 1.95 μg/l (95% CI: 1.18-2.72), while serum tartrate-resistant acid phosphatase-5b decreased 1.28 U/l (95% CI: -1.81-0.75). Moreover, improvements in pain were statistically significant. The effects of bisphosphonates on osteocalcin (MD: -0.07; 95% CI: -1.12-1.25), serum calcium (MD: 0.01; 95% CI: -0.03-0.04), serum phosphorus (MD: 0.04; 95% CI: -0.03-0.10) and medication safety (OR: 1.75; 95% CI: 1.29-2.37) were not statistically significant. Bisphosphonates have a significant positive effect on bone mineral density and bone metabolism in patients with osteoporosis in diabetes and have good safety.

Skeletal muscle index based on CT at the 12th thoracic spine level can predict osteoporosis and fracture risk: a propensity score-matched cohort study.

Multiple studies have shown that skeletal muscle index (SMI) measured on abdominal computed tomography (CT) is strongly associated with bone mineral density (BMD) and fracture risk as estimated by the fracture risk assessment tool (FRAX). Although some studies have reported that SMI at the level of the 12th thoracic vertebra (T12) measured on chest CT images can be used to diagnose sarcopenia, it is regrettable that no studies have investigated the relationship between SMI at T12 level and BMD or fracture risk. Therefore, we further investigated the relationship between SMI at T12 level and FRAX-estimated BMD and fracture risk in this study. A total of 349 subjects were included in this study. After 1∶1 propensity score matching (PSM) on height, weight, hypertension, diabetes, hyperlipidemia, hyperuricemia, body mass index (BMI), age, and gender, 162 subjects were finally included. The SMI, BMD, and FRAX score of the 162 participants were obtained. The correlation between SMI and BMD, as well as SMI and FRAX, was assessed using Spearman rank correlation. Additionally, the effectiveness of each index in predicting osteoporosis was evaluated through the receiver operating characteristic (ROC) curve analysis. The BMD of the lumbar spine (L1-4) demonstrated a strong correlation with SMI (r = 0.416, p < 0.001), while the BMD of the femoral neck (FN) also exhibited a correlation with SMI (r = 0.307, p < 0.001). SMI was significantly correlated with FRAX, both without and with BMD at the FN, for major osteoporotic fractures (r = -0.416, p < 0.001, and r = -0.431, p < 0.001, respectively) and hip fractures (r = -0.357, p < 0.001, and r = -0.311, p < 0.001, respectively). Moreover, the SMI of the non-osteoporosis group was significantly higher than that of the osteoporosis group (p < 0.001). SMI effectively predicts osteoporosis, with an area under the curve of 0.834 (95% confidence interval 0.771-0.897, p < 0.001). SMI based on CT images of the 12th thoracic vertebrae can effectively diagnose osteoporosis and predict fracture risk. Therefore, SMI can make secondary use of chest CT to screen people who are prone to osteoporosis and fracture, and carry out timely medical intervention.

Femoral Neck Fractures with Concomitant Ipsilateral Femoral Shaft Fractures in Young Adults &lt;50 Years Old: A Multicenter Comparison of 80 Cases vs. Isolated Femoral Neck Fractures

OBJECTIVES: To analyze patients, injury pattern, and treatment of femoral neck fractures in young patients with femoral neck fractures associated with shaft fractures (assocFNFs) to improve clinical outcomes. The secondary goal was to compare this injury pattern to that of young patients with isolated femoral neck fractures (isolFNFs). METHODS: Design: Retrospective multicenter cohort series Setting: 26 North American Level-1 trauma centers Level of Evidence: Level III Patient Selection Criteria: Skeletally mature patients, &lt;50 years old, treated with operative fixation of a femoral neck fracture with or without an associated femoral shaft fracture. Outcome Measures and Comparisons: The main outcome measurement was treatment failure defined as nonunion, malunion, avascular necrosis, or subsequent major revision surgery. Odds ratios for these modes of treatment were also calculated. RESULTS: Eighty assocFNFs and 412 isolFNFs evaluated in the study were different in terms of patients, injury patterns, and treatment strategy. AssocFNF patients were younger (33.3±8.6 vs. 37.5±8.7 years old, p&lt;0.001), greater in mean BMI (29.7 vs. 26.6, p&lt;0.001), and more frequently displaced (95% vs. 73%, p&lt;0.001), “vertically oriented” Pauwels’ type 3, p&lt;0.001 (84% vs. 43%) than for isolFNFs, with all p values &lt;0.001. AssocFNFs were more commonly repaired with an open reduction (74% vs. 46%, p&lt;0.001) and fixed angle implants (59% vs. 39%) (p&lt;0.001). Importantly, treatment failures were less common for assocFNFs compared to isolFNFs (20% vs. 49%, p&lt;0.001) with lower rates of failed fixation/ nonunion and malunion (p&lt;0.001 and p=0.002, respectively). Odds of treatment failure (OR=0.270, 95% CI=0.15-0.48, p&lt;0.001), nonunion (OR=0.240, 95% CI=0.10-0.57, p&lt;0.001), and malunion (OR=0.920, 95% CI=0.01-0.68, p=0.002) were also lower for assocFNFs. Excellent or good reduction was achieved in 84.2% of assocFNFs reductions and 77.1% in isolFNFs (p=0.052). AssocFNFs treated with fixed angled devices performed very well, with only 13.0% failing treatment compared to 51.9% in isolFNFs treated with a fixed angle constructs (p=&lt;0.001) and 33.3% in assocFNFs treated with multiple cannulated screws (p=0.034). The study also identified the so-called “shelf sign”, a transverse ≥6mm medial-caudal segment of the neck fracture (forming an acute angle with the vertical fracture line) in 54% of assocFNFs and only 9% of isolFNFs (p&lt;0.001). AssocFNFs with a shelf sign failed in only 5 of 41 (12%) of cases. CONCLUSIONS: AssocFNFs in young patients are characterized by different patient factors, injury patterns, and treatments, than for isolFNFs, and have a relatively better prognosis despite the need for confounding treatment for the associated femoral shaft injury. Treatment failures among assocFNFs repaired with a fixed angled device occurred at lower rate compared to isolFNFs treated with any construct type, and assocFNFs treated with multiple cannulated screws. The radiographic “shelf sign” was found as positive prognostic sign in more than half of assocFNFs and predicting a high rate of successful treatment. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Application of machine learning algorithms to identify people with low bone density.

Osteoporosis is becoming more common worldwide, imposing a substantial burden on individuals and society. The onset of osteoporosis is subtle, early detection is challenging, and population-wide screening is infeasible. Thus, there is a need to develop a method to identify those at high risk for osteoporosis. This study aimed to develop a machine learning algorithm to effectively identify people with low bone density, using readily available demographic and blood biochemical data. Using NHANES 2017-2020 data, participants over 50 years old with complete femoral neck BMD data were selected. This cohort was randomly divided into training (70%) and test (30%) sets. Lasso regression selected variables for inclusion in six machine learning models built on the training data: logistic regression (LR), support vector machine (SVM), gradient boosting machine (GBM), naive Bayes (NB), artificial neural network (ANN) and random forest (RF). NHANES data from the 2013-2014 cycle was used as an external validation set input into the models to verify their generalizability. Model discrimination was assessed via AUC, accuracy, sensitivity, specificity, precision and F1 score. Calibration curves evaluated goodness-of-fit. Decision curves determined clinical utility. The SHAP framework analyzed variable importance. A total of 3,545 participants were included in the internal validation set of this study, of whom 1870 had normal bone density and 1,675 had low bone density Lasso regression selected 19 variables. In the test set, AUC was 0.785 (LR), 0.780 (SVM), 0.775 (GBM), 0.729 (NB), 0.771 (ANN), and 0.768 (RF). The LR model has the best discrimination and a better calibration curve fit, the best clinical net benefit for the decision curve, and it also reflects good predictive power in the external validation dataset The top variables in the LR model were: age, BMI, gender, creatine phosphokinase, total cholesterol and alkaline phosphatase. The machine learning model demonstrated effective classification of low BMD using blood biomarkers. This could aid clinical decision making for osteoporosis prevention and management.

Correlation between femoral offset, rotation center and leg length discrepancy after total hip arthroplasty based on digital analysis

CT scans combined with Mimics software were used to measure femoral offset (FO), rotation center height (RCH) and lower leg length discrepancy (LLD) following total hip arthroplasty (THA), and the relationship between FO, RCH and LLD after THA is discussed. Retrospective analysis was performed on 40 patients with unilateral THA who met standard cases from October 2020 to June 2022. There were 21 males and 19 females, 18 patients on the left side and 22 patients on the right side, aged range from 30 to 81 years old, with an average age of (58.90 ±14.13) years old, BMI ranged from 17.3 to 31.5 kg·m-2 with an average of (25.3±3.4) kg·m-2. There were 30 cases of femoral head necrosis (Ficat type Ⅳ), 2 cases of hip osteoarthritis (Tönnis type Ⅲ), 2 cases of developmental hip dislocation combined with end-stage osteoarthritis (Crowe type Ⅲ), and 6 cases of femoral neck fracture (Garden type Ⅳ). Three-dimensional CT reconstruction of pelvis was taken preoperative and postoperative, and three-dimensional reconstruction model was established after processing by Mimics software. FO, RCH and LLD were measured on the model. The criteria for FO reconstruction were as follows:postoperative bilateral FO difference less than 5 mm;the standard for equal length of both lower limbs was as follows:postoperative LLD difference less than 5 mm. Bilateral FO difference was positively correlated with LLD (r=0.744, P<0.001). Chi-square test was performed between the FO reconstructed group and the non-reconstructed eccentricity group:The results showed that the isometric ratio of lower limbs in the FO reconstructed group was significantly higher than that in the FO reconstructed group (χ2=6.320, P=0.012). The bilateral RCH difference was significantly negatively correlated with LLD(r=-0.877, P<0.001). There is a linear relationship between bilateral FO difference and bilateral RCH difference and postoperative LLD, and the linear regression equation is satisfied:postoperative LLD=0.038x-0.099y+0.257(x:postoperative bilateral FO difference, y:postoperative bilateral RCH difference; Unit:cm), F=77.993, R2=0.808, P=0.009. After THA, LLD increased with the increase of FO and decreased with the increase of RCH. The effect of lower limb isometric length can be obtained more easily by reconstruction of FO. There is a linear relationship between the bilateral FO difference and the bilateral RCH difference after THA and LLD, and the regression equation can provide a theoretical reference for judging LLD.

Mortality in fracture of the distal femoral bone (review)

Distal femur fractures in the elderly can lead to the exacerbation of chronic diseases and fatal outcomes similar to those observed in femoral neck fractures in the same category of individuals. Thus, this study aimed to determine the factors influencing the mortality of patients with distal femur fractures based on the analysis of foreign studies and results of treated patients. Review of foreign literature was conducted using the databases of medical publications PubMed, CyberLeninka, Google Scholar, Scopus, Medline, and Cochrane among articles in English, Chinese, Italian, and Russian, as well as through the Web of Knowledge. We analyzed publications for the last 10 years. Evaluation of treated patients included patients aged 60 years with distal femoral fractures between 2021 and 2023. Analysis of the literature data showed that distal femur fractures are accompanied by high mortality in patients in the first years after injury (from 18% to 35%), commonly in elderly patients without surgical treatment (90%–100%), and the presence of several concomitant diseases accompanied by contractures of the femur, knee joint, and false joint and displacement or fracture of the metal retainer. Early surgical treatment (first 48 h) is an effective treatment method that significantly reduces mortality after distal femur fracture (by 2.8 times).

P164 Fracture risk in axial spondyloarthritis: a retrospective analysis of the use of the Fracture Risk Assessment Tool in a cohort of affected patients

Abstract Background/Aims Fractures are common in axial spondyloarthritis (axSpA) patients. The FRAX (Fracture Risk Assessment Tool) score is a validated tool for the assessment of fracture risk. Unlike axSpA, rheumatoid arthritis (RA) is counted as a risk factor in FRAX. The primary aim was to calculate a FRAX score in a cohort of axSpA patients. In addition, a second FRAX score was determined by ticking the “RA risk” as positive on the second assessment. Methods Data were examined on a cohort of axSpA patients attending the St James’s Hospital Spondylitis service. Bone mineral density was assessed at the neck of femur on the patient’s dual x-ray absorptiometry (DXA). This, plus the individual patient’s risk factors, were added to the FRAX score calculator. The analysis was then repeated with the RA risk box ticked as positive. The effect of such an adjustment (taking account of their diagnosis of axSpA) on the fracture risk status of these patients was made to assess if this resulted in an additional number of patients within the cohort being at risk of fracture. A patient with a 10-year hip fracture risk of &amp;gt; 3% or 10-year major osteoporotic fracture risk of &amp;gt; 20% is high risk. Results Table 1 summarises the characteristics of the cohort. All (100%) of the patients met ASAS axSpA criteria and 85% met Modified New York (mNY) criteria for ankylosing spondylitis. Five patients had known osteoporosis and an additional 9 patients were classified as being at increased fracture risk using the FRAX Tool. A further 7 patients could be classified as being at increased fracture risk when the FRAX was adjusted for the axSpA diagnosis, by ticking the RA risk box as positive. Conclusion Fracture risk is a significant issue in patients with axSpA; however, this risk is frequently under-recognised. The use of the FRAX score improves the detection of those at fracture risk, and its use should be strongly encouraged in all rheumatology clinics managing axSpA patients. When the same weighting is given to axSpA as RA, there is a further increase in the identification of patients at risk of fractures. Disclosure P. Mulkerrin: None. F. O'Shea: None. G. Fitzgerald: None.