Impact of femoral head size on the localization of proximal femur fractures: Retrospective analysis of 400 cases.

BACKGROUND

Proximal femur fractures are prevalent among the elderly, leading to high mortality, reduced quality of life, and significant healthcare burdens. The incidence is rising with demographic ageing, with osteoporotic fractures projected to reach 6 million annually by 2050, costing $25.4 billion. A 351 % increase in proximal femur fractures among individuals over 85 years is expected. Accurate fracture localization through imaging, combined with understanding femoral head size and patient-specific factors, improves preoperative planning and outcomes. This study explores the relationship between femoral head size and fracture localization.

METHODS

A retrospective cohort study analyzed data from 400 patients with proximal femur fractures treated between 2010 and 2022. Fractures were classified as medial, lateral, pertrochanteric, or subtrochanteric. Radiographs measured femoral head morphology, and statistical analyses, including chi-square tests, t-tests, ANOVA, and logistic regression, identified predictors of fracture localization.

RESULTS

Femoral head area (FHA) varied significantly across fracture types, with lateral fractures having the largest mean FHA (2355.95 mm/cm,  = 0.047). Osteoarthritis prevalence differed ( = 0.028), being highest in subtrochanteric fractures (17 %, Kellgren & Lawrence grade 3-4). Lateral fractures had a younger mean age of 71.05 years ( < 0.001), while pertrochanteric fractures averaged 79.52 years ( < 0.001). Vertical ( < 0.001) and horizontal ( = 0.028) femoral head diameters also differed significantly.

CONCLUSION

Larger femoral heads are associated with lateral fractures, whereas pertrochanteric fractures occur in older patients. Subtrochanteric fractures correlate with smaller femoral heads and advanced osteoarthritis.