PROXIMAL FEMORAL GEOMETRY AND HIP FRACTURE PATTERNS. A MULTI-CENTRE COMPARATIVE RADIOLOGICAL STUDY FROM SOUTHERN AUSTRALIA AND WESTERN SCOTLAND

Abstract

Introduction: Geometry of the proximal femur has been identified as a risk factors for hip fracture. It is also suggested that the geometry of the proximal femur can influence the fracture type.

Aims: To identify if proximal geometry and hip fractures are related in two different population groups. Scotland–Monklands General Hospital, Lanarkshire–and Australia -Flinders Medical Centre, Adelaide.

Methods: Retrospective comparison of length and width of the femoral necks in 200 hip fracture patients. 100 patients in the Australian group and 100 patients in the Scottish group were analysed. 50 intracapsular and 50 intertrochanteric fractures were included in each group. All measurements where made from standardised digital anteroposterior radiographs. We attempted to correlate the length and width of the femoral neck with the fracture type.

Results: The populations were matched for age and sex, with the majority of fractures sustained by women. The results for the both populations show that a patient sustaining an intracapsular fracture is more likely to have a longer femoral neck (mean 40.56mm; Scottish population, 39mm; Australian population) than one sustaining an intertrochanteric fracture (mean 31.70mm; Scottish population, 29mm; Australian population) [P < 0.0001]. The femoral neck was also narrower in the intracapsular group. This was significant in Scottish population (mean 38.56mm, P < 0.03), but not in the Australian population (mean 38.3mm, P = 0.067). We also found that men had longer, wider femoral necks (P < 0.0001) compared to the female group.

Discussion: We found that hip fracture pattern is linked to proximal femoral geometry. This relationship is statistically significant in both population groups. Anthropologically, as the human race evolves and people get taller, their femoral neck lengths are increasing. This could translate into a change in the number and type of hip fractures. Intracapsular fractures may predominate and this could have implications on both treatment outcomes and resources for hip fracture patients.