Proximal Femur Region Research Articles

A prospective study of iatrogenic lateral wall fracture (ILWF) in intertrochanteric (IT) fracture femur patients, treated with dynamic hip screw (DHS) and its effect on stability of fracture

Intertrochanteric fractures accounts for nearly more than half of the fractures involving the proximal femur and the hip joint. This type of fracture is fairly common among the older strata of the population, due to the reduction of the skeletal mass and osteoporosis characteristically seen as age advances. There are a number of devices/implants that can be used for internal fixation of these fractures among them the Dynamic Hip Screw (DHS) with sliding plate is one such device. The lateral wall of the proximal femoral region is plays a key role in the stability of this fracture. The intact wall stabilizes the fracture. Thus a high level of attention and precaution should be taken to preserve the lateral wall during this procedure. In cases of iatrogenic lateral wall fractures, that happens intra operatively, the plan of the surgery changes as the presence of the lateral wall is vital for the stability and proper functioning of this device. This study deals with measuring circumference of the proximal femoral shaft and checking for the presence of the iatrogenic lateral wall fracture post operatively and to check if the occurrence can be predicted thus avoiding surgeries with the DHS device thus preventing disastrous complications. Keywords: Iatrogenic lateral wall fracture, Intertrochanteric fracture, Dynamic Hip Screw fixation.

News in Bone Modeling for Customized Hybrid Biological Prostheses Development

The complex biomechanics and morphologies of the femur proximal epiphysis are presented. The nature and fine morphology of the femur head and its structural behavior have been investigated. Isotropic and orthotropic trabecular structures have been associated with oriented compression and tensioned areas of the femur head FEM models. These isotropic/orthotropic trabecular morphologies and their allocations govern the stress and strain distribution in the overall proximal femur region. Finite element models of the femur biofidel were developed using a specific combination of segmentation with computed tomography and solid modeling tools capable of representing bone physiology and structural behavior. This biofidel Finite Element (FEM) model is used to evaluate the change in the physiological distribution of stress in the femoral prosthesis and to evaluate the new design criteria for biopsy. The use of femur proper biofidel modeling while enabling the explanation of physiological stress distribution elucidates the critical mechanical role of the trabecular bone that should be accounted for in the design new innovative more “biologic” prosthetic system. Biomimetics, biomechanics and tissue engineering are three multidisciplinary fields that have been considered in this research to achieve the goal of improving the reliability of prosthetic implants. The authors took these studies to gather the untapped potential of such advanced materials and design technologies by developing finite models of Biofidel elements capable of correctly mimicking the biomechanical behavior of the femur.

Surgical treatment of benign lesions and pathologic fractures of the proximal femur in children.

Benign lesions of the proximal femur region, such as simple bone cysts, aneurysmal bone cysts, and fibrous dysplasia, are common in children. Benign lesions may cause pathologic fractures, limb length inequities, and growth disturbances. Differential diagnoses, e.g., malignant bone tumors and osteomyelitis, are sometimes difficult to rule out. We aimed to evaluate outcomes in children with benign lesions of the proximal femur treated with curettage, bone grafting, and plate fixation. In this retrospective study, we included 30 children (median age 10.5years; range 1.1-17.8years) suffering from bone cysts and tumor-like lesions of the proximal femur region treated between 2002 and 2018. We analyzed plain X-ray images and CT scans in all children and obtained MRI scans in a selected group of children (63.3%). We examined histopathologic biopsy results for all bone lesions before initiating treatment. Surgical management comprised tumor curettage with adjuvant high-speed drilling and allogenic bone grafting supplemented by bone graft substitutes before plate fixation. Median follow-up interval was 87months (range 24-156months). We evaluated the healing of lesions according to Capanna's classification and rated functional outcomes according to Merle d'Aubigné and Postel score. Overall, 25 of 30 (83.3%) patients were admitted to hospital because of a pathologic fracture. We diagnosed simple bone cysts in 15 (50.0%) patients, aneurysmal bone cysts in 7 (23.5%) patients, and fibrous dysplasia in 8 (26.5%) patients. Bone consolidation was achieved in 22 of 30 (73.3%) patients after a mean of 5months (range 3-7months). The main complication was recurrence of the lesion in 4 of 30 (13.3%) patients. With respect to the Merle d'Aubigné and Postel scores, 17 of 30 (56.7%) patients obtained an excellent result (18 points), while 12 (40.0%) patients had a good result (15-17 points) and only 1 (3.3%) patient had a fair result (14 points). Surgical treatment of bone cysts and tumor-like lesions of the proximal femur by local resection or destruction of the lesion, followed by filling the defect with bone graft material and internal stabilization represents a safe and effective treatment option in children. Therapeutic, retrospective comparative study-Level III.

Trabecular prostheses

The complex biomechanics and morphology of the femur proximal epiphysis are presented. This specific region in the human femur is characterized by high flexibility compared to that of other primates, since evolved lighter and longer due to the human vertical position and more balanced loading. The nature and fine morphology of the femur head and its structural behavior have been investigated. Isotropic and orthotropic trabecular structures, which are not present in other primates, have been associated with compression and tension areas of the femur head. These isotropic/orthotropic trabecular morphologies and allocations govern the stress and strain distribution in the overall proximal femur region. Use of femur proper biofidel modeling while enabling the explanation of physiological stress distribution elucidates the critical mechanical role of the trabecular bone that should be accounted in the design of a new innovative more “biologic” prosthetic system.

Complication profile and revision concepts for megaprosthetic reconstruction following tumour resection at the hip

Tumourous destruction of the periacetabular region and the proximal femur is atypical consequence of either primary malignant bone tumour manifestation or skeletal metastatic diseases. Pathological fractures of the proximal femur and periacetabular regions due to primary manifestation or metastatic disorders are frequent. Presentation of the most common complications of tumour endoprostheses at the hip and a description of management strategies, including therapeutic recommendations and concepts for complication avoidance. The current knowledge and our own experience of complication management with the use of megaprostheses around the hip are presented. Compared to elective/primary total hip arthroplasty, megaprosthetic reconstructions following tumour resections have an increased rate of postoperative deep infections, dislocations, incidence of pathological and periprosthetic fractures and of deep vein thrombosis. The postoperative mortality and local tumour recurrence along with deep infections represent the most serious complications. In comparison to primary arthroplasty, the risk of failure and complications following tumour-endoprosthetic replacement is increased. Precise surgical planning and careful selection and preoperative preparation of suitable patients should be performed in close interdisciplinary cooperation with final decision-making on an interdisciplinary tumour board. Wide resection and advanced reconstruction, as well as complicated palliative stabilization due to malignant bone tumour growth around the hip joint should be performed in musculoskeletal tumour centres with profound expertise in osteosynthetic and endoprosthetic reconstruction and consecutive complication management of the pelvis and the proximal femur.

Fat distribution may predict intra- or extra-capsular hip fracture in geriatric patients after falling

IntroductionHip fractures can be divided into intra-capsular and extra-capsular fracture based on fracture location; these two types of fracture have different pathogeneses, treatments and prognoses. Many factors influence the patterns of hip fractures, including the injury mechanism, areal bone mineral density and the geometry of the hip. However, the relationship between body composition and hip fracture pattern has not yet been discussed.In this investigation, an analysis of the body compositions of geriatric patients with hip fractures were conducted to identify differences between fat and muscle distributions between patients with intra- and extra-capsular hip fractures. Material and methodsFrom December 2017 to February 2019, 139 patients with a hip fracture were prospectively enrolled in this study. The groups of patients that were diagnosed as having intra- and extra-capsular hip fractures were compared in terms of patient demographics, pre-operative laboratory data, bone mineral density (BMD) and body composition including muscle and fat distributions obtained using dual-energy X-ray absorptiometry (DXA) . ResultsEighty-six and 53 patients were diagnosed with intra-capsular and extra-capsular hip fractures, respectively. A significantly higher serum glucose level, a lower hemoglobin level, a lower T-score level in the proximal femur region, a lower T-score of all parts of interest, and a lower percentage fat content on the region of bilateral proximal hips (gynoid region) and in the lower limb region, were observed in patients with an extra-capsular hip fracture than in those with an intra-capsular hip fracture. However, with all confounding factors controlled for, only the T-score at the proximal femur, percentage fat content in the region of bilateral proximal hips and the ratio of android fat content to gynoid fat content (A/G ratio) are the most relevant factors in predicting the patterns of hip fracture in geriatric patients after falling. ConclusionThis work demonstrates that lower fat content in the region of bilateral proximal hips and a lower BMD on the proximal femur may predict greater vulnerability of geriatric patients to extra-capsular rather than intra-capsular hip fracture after a falling accident.

Age Distribution of Bone Mineral Density According to Quantitative Computed Tomography

Objective. To compare bone mineral density (BMD) values derived during one-year asynchronous quantitative computed tomography (QCT) in two urban polyclinics (UPs).Material and methods. The investigation enrolled women aged 40 to 85 years: 694 and 724 patients in UP А and UP B, respectively, who underwent QCT scanning of the proximal femur and spine. The BMD values were compared with the reference data embedded in the QCP software, by using the methods of regression analysis. Quantitative indicators were calculated using the Z-test. To standardize the indicators of QCT in UP A and UP B, cross-calibration was performed using a phantom.Results. Comparison of the obtained mean BMD values with the reference one for three regions of central densitometry established a statistically significant (p<0.05) decrease in the mean BMD values relative to the normative ones within the analyzed age range. The spine Z scores were – 0.37 SD in UP А and – 0.84 SD in UP B; the mean proximal femur Z scores were – 0.70 SD and – 1.22 SD in UP А and UP B, respectively; the mean femoral neck Z scores were – 0.54 SD and – 1.06 SD, respectively. The values of femoral neck and proximal femur BMD displayed pronounced correlations (r=0.83 in UP А and r=0.79 in UP B). Comparison of regression line coefficients in the proximal femur and spine regions revealed that the offset of a straight line was significantly lower in UP B than in UP А (p<0.05). There were no differences in the slope coefficients for these regions. The results of comparing the regression lines for the femoral neck were statistically insignificant for both the slope coefficient (p=0.576) and for the offset (p=0.056).Conclusion. Comparison of the authors' own results of the BMD study with the reference data has shown a statistically significant decrease in the obtained BMD values in two UPs. This may be associated with the different strategy of referral for QCT, as well as with some assumptions of this study.

The Physiological Characteristics of an 83-Year-Old Champion Female Master Runner.

To examine the cardiorespiratory, muscular, and skeletal characteristics of an 83-year-old champion female master athlete (called DL in this study) who had set multiple world running records in the 80-to-84-year-old age group. Measures of maximal oxygen uptake, maximal heart rate, maximal isometric torque for knee extensor muscles, thigh and triceps surae muscle volumes, and bone mineral density (BMD) of the proximal femur region were evaluated. Based on previously published equations, physiological age was determined for maximal oxygen uptake, maximal heart rate, and maximal isometric torque. Muscle volumes for the dominant leg were compared with previously published sex- and age-matched data using z scores. For BMD, T score and z score were calculated. DL had the highest maximal oxygen uptake (42.3mL·min-1·kg-1) ever observed for a female older than 80 years of age, which gave her a remarkable physiological age (27y). By contrast, she had a physiological age closer to her biological age for maximal isometric torque (90y) and maximal heart rate (74y). The z scores for thigh (0.4) and triceps surae (1.1) muscle volumes revealed that DL's leg muscles were affected almost as much as her sex- and age-matched peers. The T score (-1.7) for BMD showed that DL had osteopenia but no osteoporosis, and the z score (0.7) showed that DL's BMD was similar to that of females of the same age. This single case study shows that the remarkable cardiorespiratory fitness coupled with intensive endurance training observed in a female master athlete was not associated with specific preservation of her muscular and skeletal characteristics.

Predictions of Birmingham hip resurfacing implant offset - In vitro and numerical models

The number of hip resurfacing arthroplasty procedures has declined dramatically in recent years, for reasons related to the survival rate. Some studies suggest that metal particles are the main critical problem, but do not specify the effect of femoral position on the failure rate. The present study aims to analyze whether the positioning of the resurfacing head implant is important in the distribution of bone strains and in the risk of fracture of the femur.Three in vitro experimental models received the Birmingham hip resurfacing implant to replicate the total hip joint. The resurfacing head of the implanted models was placed in three different offset positions: in a positive offset, with the same femoral head center and in a negative offset.The numerical models were validated by correlating numerical and experimental results. Comparing experimental results from the implanted and intact femurs highlights a strain increase of up to 48% in the proximal medial femur region for positive offset and up to 18% in the neutral position. A reduction of 72% for negative offset (valgus position) was also measured experimentally.A significant change in strain distributions was observed with a resurfacing hip system and increased risk of neck fracture was found using the resurfacing head in positive offset. The iliac bone presents a high decrease in strains that will induce bone loss in the long term. Among the offset positions tested, results suggest that the negative offset (valgus position) and the natural position are the best equilibrated for better long-term results.

Total hip arthroplasty following failure of tantalum rod implantation for osteonecrosis of the femoral head with 5- to 10-year follow-up

BackgroundTotal hip arthroplasty (THA) with failure of tantalum rod implant for osteonecrosis of the femoral head (ONFH) will be the only choice for patients. However,it remains unknown whether tantalum rod implantation has an adverse effect on the survival time of implants following conversion to THA. The aim of this study was to retrospectively evaluate the clinical and radiographic outcomes of conversion to THA in patients who were previously treated with implantation of a tantalum rod.MethodsThis study included 31 patients (39 hips), who underwent conversion to THA due to failure of core decompression with an implanted tantalum rod. Among these 31 patients, 26 patients were male and five patients were female. The mean age of these patients was 49.3 years old (range: 36–64 years old). The control group included 33 patients (40 hips), who underwent total hip replacement without tantalum rod implantation. The hip Harris score, implant wear, osteolysis, radiolucencies and surgical complications were recorded during the follow-up. The distribution of tantalum debris in the proximal, middle and distal periprosthetic femoral regions, radiolucent lines and osteolysis were analyzed on post-operative radiographs.ResultsThere were no significant differences in Harris score, liner wear and complications between the two groups (P > 0.05). Osteolysis and radiolucent lines more likely occurred in patients with tantalum debris distributed in three regions than in one or two regions (P < 0.05).ConclusionsThe mid-term clinical outcome of patients who underwent THA with tantalum rod implantation was not different from those without a tantalum rod, suggesting that tantalum debris did not increase the liner wear rate. However, the distribution of periprosthetic tantalum debris in the proximal, middle and distal femoral regions may increase the risk of femoral osteolysis and radiolucent lines.

Ricci-flow based conformal mapping of the proximal femur to identify exercise loading effects

The causal relationship between habitual loading and adaptive response in bone morphology is commonly explored by analysing the spatial distribution of mechanically relevant features. In this study, 3D distribution of features in the proximal femur of 91 female athletes (5 exercise loading groups representing habitual loading) is contrasted with 20 controls. A femur specific Ricci-flow based conformal mapping procedure was developed for establishing correspondence among the periosteal surfaces. The procedure leverages the invariance of the conformal mapping method to isometric shape differences to align surfaces in the 2D parametric domain, to produce dense correspondences across an isotopological set of surfaces. This is implemented through a multi-parametrisation approach to detect surface features and to overcome the issue of inconsistency in the anatomical extent present in the data. Subsequently, the group-wise distribution of two mechanically relevant features was studied – cortical thickness and surface principal strains (simulation results of a sideways fall). Statistical inferences over the surfaces were made by contrasting the athlete groups with the controls through statistical parametric mapping. With the aid of group-wise and composite-group maps, proximal femur regions affected by specific loading groups were identified with a high degree of spatial localisation.

The medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall: a biomechanical study

BackgroundThe major objective of the present study is to investigate the differences in the load and strain changes in the intertrochanteric region of human cadaveric femora between the loss of medial or lateral wall and after treatment with proximal femoral nail antirotation (PFNA).MethodsAfter measuring the geometry of the proximal femur region and modeling the medial or lateral wall defect femoral models, six pairs of freshly frozen human femora were randomly assigned in the medial or lateral wall group. According to a single-leg stance model, an axial loading was applied, and the strain distribution was measured before and after PFNA implantation. The strains of each specimen were recorded at load levels of 350, 700, and 1800 N and the failure load. Paired t test was performed to assess the differences between two groups.ResultsThe failure mode of almost all defect model femora was consistent with that of the simulated type of intertrochanteric fractures. After the PFNA implantation, the failure mode of almost all stabilized femora was caused by new lateral wall fractures. The failure load of the lateral wall group for defect model femora was significantly higher than that of the medial wall group (p < 0.001). However, the difference disappeared after the PFNA was implanted (p = 0.990). The axial stiffness in all defect model femora showed the same results (p < 0.001). After the PFNA implantation, the axial stiffness of the lateral wall group remained higher than that of the medial wall group (p = 0.001). However, the axial stiffness of the lateral wall group showed that the femora removed from the lateral wall were higher than the PFNA-stabilized femora (p = 0.020). For the axial strain in the anterior wall after the PFNA implantation, the strain of the lateral wall group was significantly lower than that of the medial group (p = 0.003). Nevertheless, for the axial strain of the posterior wall after the PFNA implantation, the strain of the medial wall group was significantly lower than that of the lateral group (p < 0.001).ConclusionsIn summary, this study demonstrated that PFNA is an effective intramedullary fixation system for treating unstable intertrochanteric fractures. Compared with the lateral wall, the medial femoral wall is a more important part in the intertrochanteric region. We suggest that in treating intertrochanteric femoral fractures with medial wall fractures, the medial wall fragment should be reset and fixed as much as possible.

3D CAD/reverse engineering technique for assessment of Thai morphology: Proximal femur and acetabulum.

To assess morphological parameters of proximal femur and acetabulum in Thai population with three-dimensional measurement technique, and to analysis of collateral side symmetric, gender difference, and correlation between morphometric parameters. Investigation was performed in 240 femurs. All three-dimensional femur models were acquitted from 64-slice spiral CT scanner. Morphometric parameters under consideration included acetabular diameter, femoral head diameter, shaft isthmus location, intramedullary canal diameter, diaphyseal diameter, femoral head height, femoral neck isthmus, femoral neck length, neck shaft angle, bow angle, and anteversion angle. All parameters were measured based on functions and least-square regression function in CAD software. Obtained measured data were then used for analysis of collateral side symmetric, gender difference, correlation between morphometric parameters, and compared with other populations. Female had a smaller dimension compared with male in most of the parameters. No significant difference was observed between left and right femurs. High correlation pairs of morphometric parameters included femoral head diameter-acetabular diameter, femoral head diameter-neck isthmus diameter, femoral head diameter-diaphyseal diameter at shaft isthmus level, acetabular diameter-neck isthmus diameter, neck isthmus diameter-diaphyseal diameter at shaft isthmus level, and acetabular diameter-diaphyseal diameter at shaft isthmus level. Some morphometric parameters of Thai are smaller than other Caucasian, and some Asian nation, i.e. femoral head diameter, femoral neck length, and femoral head height. This study provides essential morphometric data for various orthopedic implant designs relating to proximal femur region.

Patient-specific finite element estimated femur strength as a predictor of the risk of hip fracture: the effect of methodological determinants.

SummaryA finite element modelling pipeline was adopted to predict femur strength in a retrospective cohort of 100 women. The effects of the imaging protocol and the meshing technique on the ability of the femur strength to classify the fracture and the control groups were analysed.IntroductionThe clinical standard to estimate the risk of osteoporotic hip fracture is based on the areal bone mineral density (aBMD). A few retrospective studies have concluded that finite element (FE)-based femoral strength is a better classifier of fracture and control groups than the aBMD, while others could not find significant differences. We investigated the effect of the imaging protocol and of the FE modelling techniques on the discriminatory power of femoral strength.MethodsA retrospective cohort of 100 post-menopausal women (50 with hip fracture, 50 controls) was examined. Each subject received a dual-energy absorptiometry (DXA) exam and a computed tomography (CT) scan of the proximal femur region. Each case was modelled a number of times, using different modelling pipelines, and the results were compared in terms of accuracy in discriminating the fracture and the control cases. The baseline pipeline involved local anatomical orientation and mesh morphing. Revised pipelines involved global anatomical orientation using a full-femur atlas registration and an optimised meshing algorithm. Minimum physiological (MPhyS) and pathological (MPatS) strengths were estimated for each subject. Area under the receiver operating characteristic (ROC) curve (AUC) was calculated to compare the ability of MPhyS, MPatS and aBMD to classify the control and the cases.ResultsDifferences in the modelling protocol were found to considerably affect the accuracy of the FE predictors. For the most optimised protocol, logistic regression showed aBMDNeck, MPhyS and MPatS to be significantly associated with the facture status, with AUC of 0.75, 0.75 and 0.79, respectively.ConclusionThe study emphasized the necessity of modelling the whole femur anatomy to develop a robust FE-based tool for hip fracture risk assessment. FE-strength performed only slightly better than the aBMD in discriminating the fracture and control cases. Differences between the published studies can be explained in terms of differences in the modelling protocol and cohort design.

Flexible Stem Trabecular Prostheses

The complex biomechanics and morphology of the femur proximal epiphysis are presented. This specific region in human femur is characterized by a high flexibility compared to that of other primates, since evolved lighter and longer due to the human verticalposition and more balanced loading. The nature and fine morphology of the femur head and its structural behavior have been investigated. Isotropic and orthotropic trabecular structures, which are not present in other primates, have been associated to compression and tensioned areas of the femur head. These isotropic/orthotropic trabecularmorphologies and allocationsgovern the stress and strains distribution in the overall proximal femur region. Useof femur proper biofidel modeling while enabling the explanationof physiological stress distribution elucidates the critical mechanical role of the trabecular bone that should be accounted in the design new innovative more "biologic" prosthetic system.

Therapeutic effect of osteogenically induced adipose derived stem cells on vascular deprivation-induced osteonecrosis of the femoral head in rabbits

ObjectiveTo explore the therapeutic effect of osteogenically induced adipose-derived stem cells (ADSCs) on vascular deprivation-induced osteonecrosis of the femoral head (ONFH) in rabbit model. MethodsVascular deprivation-induced ONFH was established by intramuscular injection of methylpre-dnisolone, and vascular occlusion of the capital femoral epiphysis by electrocoagulation in adult New Zealand white rabbits. Eight weeks after the establishment of vascular deprivation-induced ONFH, animals were randomly divided into three equal groups. In Group A (control), no therapy was given. In Group B, core decompression was performed by drilling a hole (1.2 mm in diameter) from the outer cortex 2.5 cm distal to the proximal end of the greater trochanter. In Group C, 1> <107 osteogenically induced ADSCs were resus-pended in 0.5 ml PBS, and then injected directly into the femoral head. Femoral head specimens were obtained at postoperative 8 weeks. The bone formation and three-dimensional microstructure of the femoral head was evaluated by micro-computed tomography scans (u-CT). Immu-nohistochemical analysis was performed to detect the expression of osteocalcin. Angiogenesis and repair of the femoral head were observed histologically. ResultsIn trabecular bone at the proximal femur region, the trabecular volume was higher in Group C (130.70 mm3± 4.33 mm3) than that in Groups A (101.07 mm3±7.76 mm3) and B (107.89 mm3±8.68 mm3, P<0.01). Bone volume was significantly increased in Group C (40.09 mm3±6.35 mm3) than in Groups A (29.65 mm3±4.61 mm3) and B (31.80 mm3± 4.01 mm3, P<0.01). The trabecular number was higher in Groups C (1.58±0.25) than other two groups (1.15±0.18, 1.16± 0.21, P<0.01). Bone mineral density showed statistically significant difference between Groups C and A or B (375.38± 23.06) mg HA/ccm, vs (313.73 ±19.30) mg HA/ccm and (316.09± 16.45) mg HA/ccm, P<0.01). Histological examination indicated that there was more new bone formation in Group C than in other groups. ConclusionTreatment with autologous osteogenically induced ADSCs transplantation results in an enhanced osteogenesis and microstructure of the vascular deprivation-induced osteonecrosis in rabbits.

Body Mass Index May Positively Correlate with Bone Mineral Density of Lumbar Vertebra and Femoral Neck in Postmenopausal Females.

BackgroundOur study aimed to explore the relationship between body mass index (BMI) and bone mineral density (BMD) of lumbar vertebra and femoral neck in postmenopausal females.Material/MethodsFrom September 2012 to September 2014, 236 healthy postmenopausal females who underwent physical examinations at the Women & Children’s Health Care Hospital of Linyi were enrolled into our study. These subjects were divided into 3 groups: underweight group, normal weight group, and overweight group. In addition, there were 2 age stratifications: <60 years old and ≥60 years old. DPX-L type dual-energy X-ray bone densitometry (American Lunar Company) was used to measure the BMD of lumbar vertebra and femoral neck in the recruited subjects. Pearson test was used for correlation analysis.ResultsBMDs and T-scores of lumbar vertebra (L1–L4), femoral neck, proximal femur, and Ward’s triangle region among the groups were ranked as follows: underweight group < normal weight group < overweight group. There were significant differences in body weight and BMI among the underweight, normal weight, and overweight groups (P<0.05). The T-scores of all examined anatomic locations showed significant differences between the underweight group and normal weight group, as well as between the underweight group and overweight group (both P<0.05). Only the T-scores of lumbar vertebra L2–L4 had significant differences between the normal weight group and overweight group (P<0.05). The BMDs of all anatomic components under study showed statistical differences in both age stratifications between the overweight group and underweight group, as well as between the overweight group and normal weight group (both P<0.05). When stratified above 60 years old, the BMDs of lumbar vertebra (L1, L2 and L4) showed statistical differences between the normal weight group and underweight group (P<0.05). Various factors could be ranked according to the absolute values of correlation coefficients as below: body weight, BMI, height, and age. Body weight, BMI, and height were positively correlated with the BMDs of all examined anatomic locations (P<0.05). However, age was negatively correlated with the various components of the body (lumbar vertebra L1, L2 and L4, femoral neck, proximal femur, Ward’s triangle region: P<0.05; lumbar vertebra L3: P>0.05).ConclusionsOur study provides evidence that body weight and BMI are important factors affecting BMD. Postmenopausal females with low BMI are more likely to have osteopenia, and are likely to develop osteoporosis. BMI can be used as an important index to prevent osteoporosis.

Characterizing the fall and association between functional independence and balance in the elderly following proximal femoral surgery

Introduction: Fractures in the proximal femoral region have a multicausal etiology and can be attributed to extrinsic factors and intrinsic factors. Objective: To characterize sociodemographics and the diseases of the elderly who sustained a proximal femoral fracture, as a result of falls from a standing height, and to study the relationship between balance and functional independence of these elderly. Method: This was a cross-sectional study conducted over a period of 12 months in a teaching hospital, with a sample of 89 elderly (≥ 60 years). Results: The characteristics of the elderly patients which demonstrated significance with functional independence were: the presence of nervous system disease, and/or mental and behavioral disorders (p = 0.001), and balance (p <0.001). Surgeries in the proximal femoral region occurred in females (67.3%), elderly patients ≥ 80 years of age (46.1%), and 60.7% underwent osteosynthesis. Conclusions: In relationship to functional independence, 23.6% of the elderly were classified as maximum dependence, 38.2% as minimum, and 38.2% as modified independence. The elderly gained balance significantly as they regained their functional independence, regardless of age, gender, and whether or not they presented with nervous system disease and/or mental and behavioral disorders.

Yasli Kalca Cevresi Kiriklarda Femur Basi Kemik Mineral Yogunlugunun Degerlendirilmesi

Objective: It is usually challenging to decide which hip fractures should be fixed and which should be replaced to avoid fixation failure and revision. Therefore, it may be of benefit to evaluate the bone mineral density of the fixation point of the femoral head preoperatively. In this study we tried to investigate the relationship between the bone mineral density (BMD) of the fixation point of femoral head, which is the primary compressive trabeculation area, and other parts of the proximal femur evaluated routinely during Dual-Energy X-ray absorptiometry (DXA) measurements. Methods: Retrieved femoral heads of 29 patients during hemiarthroplasty for hip fracture were evaluated using DXA. These results were correlated with the DXA measurements of proximal femora of uninvolved hips of patients. Results: Mean BMD values of retrieved femoral head primary compressive trabecular region (PC-BMD) values were 0.610 ± 11 (g/cm²). Although there were significant positive correlation of PC-BMD with neck, Ward's and total proximal femoral region as expected, highest correlation coefficient was calculated at femoral neck region. These results did not differ when patients were regrouped according to uninvolved side BMD values as osteoporotic and osteopenic. There were no difference in both sexes in this relationship between values of PC-BMD, neck BMD, Ward’s BMD and total BMD. Conclusion: As expected, a positive relationship was found between PC-BMD values and neck BMD, ward’s BMD and total BMD values with neck BMD revealing the highest correlation. Preoperative bone mineral densitometric evaluation of the uninvolved hip, especially the neck region seems to be helpful to evaluate the densitometric status of femoral head to predict early failure when fixation was attempted.

MASCG: Multi-Atlas Segmentation Constrained Graph method for accurate segmentation of hip CT images.

This paper addresses the issue of fully automatic segmentation of a hip CT image with the goal to preserve the joint structure for clinical applications in hip disease diagnosis and treatment. For this purpose, we propose a Multi-Atlas Segmentation Constrained Graph (MASCG) method. The MASCG method uses multi-atlas based mesh fusion results to initialize a bone sheetness based multi-label graph cut for an accurate hip CT segmentation which has the inherent advantage of automatic separation of the pelvic region from the bilateral proximal femoral regions. We then introduce a graph cut constrained graph search algorithm to further improve the segmentation accuracy around the bilateral hip joint regions. Taking manual segmentation as the ground truth, we evaluated the present approach on 30 hip CT images (60 hips) with a 15-fold cross validation. When the present approach was compared to manual segmentation, an average surface distance error of 0.30 mm, 0.29 mm, and 0.30 mm was found for the pelvis, the left proximal femur, and the right proximal femur, respectively. A further look at the bilateral hip joint regions demonstrated an average surface distance error of 0.16 mm, 0.21 mm and 0.20 mm for the acetabulum, the left femoral head, and the right femoral head, respectively.