Scarlat M
Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Général d'Hyères, BP 82, 83407 Hyères Cedex.
Rev Chir Orthop Reparatrice Appar Mot. 2002 May;88(3):257-63.
Proximal femoral fractures are the most severe medical and social consequence of osteoporosis. The bone loss in the proximal femur can be assessed with the Singh Index, which represents a cheap and reproducible method and which quantifies the osteoporosis on a 1-6 scale. The purpose of the study is to correlate the Singh Index with the anatomical forms of fracture (extra and intracapsular) in a series of patients.
Three hundred consecutive patients over 60 years were operated for a proximal femur fracture. 284 radiological records were included in the study. They were classified in 4 age groups (60-69, 70-79, 80-89, 90 and more). The anatomic forms were classified following the AO scheme in extracapsular (A1, A2, A3) and respectively intracapsular fractures (B1, B2, B3). For each case the Singh Index was assessed twice on a standard AP view of the controlateral hip by a single examiner.
There were 154 extracapsular fractures and 130 intracapsular fractures. The average Singh Index was 2.6/6. It decreases from 3.7/6 for males and 3.2/6 for females in age between 60-69 to 1.6 for males and 1.3 for females over 90. In all age groups females are more osteoporotic (0.3-0.5 of difference, p=0.003). The extracapsular fractures presented with a lower average Singh Index (2,34/6) compared to the intracapsular types 2,55/6 (excepting the impacted coxa-valga B1. This finding is seen in both male (2,50 vs 2,66) and female patients (2,33 vs 2,48).
In this series patients with extracapsular proximal femur fractures show a lower Singh Index compared to the intracapsular types (p=0.03). The choice for the type of osteosynthesis or arthroplasty should take into account the mechanical solidity of the femur.
