Wagener Nele, Giebel Gregor, Rarreck Felix, Diekhoff Torsten, Hardt Sebastian
Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Department of Orthopaedic Surgery, Charitéplatz 1, 10117, Berlin, Germany.
Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany.
J Clin Orthop Trauma. 2025 Apr 2;65:103007. doi: 10.1016/j.jcot.2025.103007. eCollection 2025 Jun.
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.
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.
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.
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.
股骨近端骨折在老年人中很常见，会导致高死亡率、生活质量下降和巨大的医疗负担。随着人口老龄化，其发病率正在上升，预计到2050年骨质疏松性骨折每年将达到600万例，花费254亿美元。预计85岁以上人群的股骨近端骨折将增加351%。通过影像学准确进行骨折定位，结合了解股骨头大小和患者特定因素，可改善术前规划和治疗效果。本研究探讨股骨头大小与骨折定位之间的关系。
一项回顾性队列研究分析了2010年至2022年期间治疗的400例股骨近端骨折患者的数据。骨折分为内侧、外侧、转子间或转子下骨折。通过X线片测量股骨头形态，并进行包括卡方检验、t检验、方差分析和逻辑回归在内的统计分析，以确定骨折定位的预测因素。
不同骨折类型的股骨头面积（FHA）差异显著，外侧骨折的平均FHA最大（2355.95mm/cm，P = 0.047）。骨关节炎患病率也有所不同（P = 0.028），在转子下骨折中最高（17%，Kellgren&Lawrence 3-4级）。外侧骨折患者的平均年龄为71.05岁，较年轻（P < 0.001），而转子间骨折患者的平均年龄为79.52岁（P < 0.001）。股骨头的垂直径（P < 0.001）和水平径（P = 0.028）也存在显著差异。
较大的股骨头与外侧骨折相关，而转子间骨折多见于老年患者。转子下骨折与较小的股骨头和晚期骨关节炎相关。
