Thalmann Ben Hannes, Latz David, Schiffner Erik, Jungbluth Pascal, Windolf Joachim, Grassmann Jan
Department of Trauma and Hand Surgery, University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany.
J Orthop. 2021 Feb 12;24:1-4. doi: 10.1016/j.jor.2021.02.012. eCollection 2021 Mar-Apr.
Hip fracture caused by fall is a common injury of the elderly. The risk of sustaining a contralateral hip fracture has been reported to be 5-10%. Aging society heightens the need of efficient prevention tools. To be able to cope with this demand, understanding of biomechanics of hip fractures are mandatory. Previous studies suggest that geometry of the proximal femur could play an important role for fracture probability and fracture type. Thus, analysis of hip geometry could play an important role in the prediction and prevention of bilateral hip fractures. Aim of this study was to elucidate the influence of caput collum diaphyseal angle on the fracture type of proximal femur.
In a retrospective analysis, data of patients with an acute hip fracture who underwent surgical treatment within five years were included. Data was separated into two groups: (I) intra capsular femur fracture (femoral neck fractures) and (II) extra capsular femur fracture (inter- and subtrochanteric femur fractures). Occurrence of a bilateral fracture, age, gender, weight, height and caput collum diaphyseal angle (standardized measurement of the opposite joint on preoperative digital x-rays) of each group were further analyzed.
Data of 448 patients were included ((I): 250 vs. (II): 198 patients). Group (I) showed a significant higher mean caput collum diaphyseal angle of 133.9 ± 7.0° (mean ± standard deviation) compared to group (II) with 127.6 ± 6.1° (F (1, 451) = 106.5, p = 0.00). In group (I) 0 patients had a caput collum diaphyseal angle <120° (varus), 214 patients (86%) 120°-140° and 35 patients (14%) angle>140° (valgus). In contrast, in group (II) 21 patients (10%) had a caput collum diaphyseal angle <120° (varus), 175 patients (86%) 120°-140° and 7 patients (4%) >140° (valgus). 52 patients had a bilateral hip fracture. 36 patients (69%) sustained a bilateral hip fracture of the same fracture type.
Patients with an intra capsular proximal femur fracture showed a significantly higher caput collum diaphyseal angle compared to patients with an extra capsular proximal femur fracture. Moreover, intra capsular femur fractures are correlated with an indifferent (120-140°) or valgus (>140°) femoral neck configuration. Extra capsular femur fractures correlate with an indifferent (120-140°) or varian femoral neck configuration (<120°). The results support the assumption that the caput collum diaphyseal angle has an influence on fracture type of the proximal femur. This could possibly be a predictor for the fracture type of the contralateral hip (second fracture). Based on this, present data may benefit prosthetists in developing new and more efficient hip protectors.
Level III. Retrospective comparative study.
跌倒导致的髋部骨折是老年人常见的损伤。据报道，对侧髋部骨折的风险为5%-10%。老龄化社会增加了对有效预防工具的需求。为了能够满足这一需求，必须了解髋部骨折的生物力学。先前的研究表明，股骨近端的几何形状可能对骨折概率和骨折类型起重要作用。因此，髋部几何形状分析在双侧髋部骨折的预测和预防中可能发挥重要作用。本研究的目的是阐明头颈干角对股骨近端骨折类型的影响。
在一项回顾性分析中，纳入了五年内接受手术治疗的急性髋部骨折患者的数据。数据分为两组：（I）囊内股骨骨折（股骨颈骨折）和（II）囊外股骨骨折（转子间和转子下股骨骨折）。进一步分析每组双侧骨折的发生率、年龄、性别、体重、身高和头颈干角（术前数字化X线片上对侧关节的标准化测量）。
纳入448例患者的数据（（I）组：250例 vs.（II）组：198例）。（I）组的平均头颈干角为133.9±7.0°（平均值±标准差），显著高于（II）组的127.6±6.1°（F(1, 451)=106.5，p=0.00）。在（I）组中，0例患者的头颈干角<120°（内翻），214例患者（86%）为120°-140°，35例患者（14%）的角度>140°（外翻）。相比之下，在（II）组中，21例患者（10%）的头颈干角<120°（内翻），175例患者（86%）为120°-140°，7例患者（4%）>140°（外翻）。52例患者发生双侧髋部骨折。36例患者（69%）双侧髋部骨折为同一骨折类型。
与囊外近端股骨骨折患者相比，囊内近端股骨骨折患者的头颈干角显著更高。此外，囊内股骨骨折与中性（120-140°）或外翻（>140°）股骨颈形态相关。囊外股骨骨折与中性（120-140°）或内翻股骨颈形态（<120°）相关。结果支持头颈干角对股骨近端骨折类型有影响的假设。这可能是对侧髋部（第二次骨折）骨折类型的一个预测指标。基于此，目前的数据可能有助于假肢师开发新的、更有效的髋部保护器。
III级。回顾性比较研究。
