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. 2013 Apr 9:14:130.
doi: 10.1186/1471-2474-14-130.

Analysis of trabecular distribution of the proximal femur in patients with fragility fractures

Yaogang Lu  1 , Lei Wang, Yongqiang Hao, Ziping Wang, Minghui Wang, Shengfang Ge
Affiliations

Analysis of trabecular distribution of the proximal femur in patients with fragility fractures

Yaogang Lu et al. BMC Musculoskelet Disord. .

Abstract

Background: Multi-detector computed tomography (MDCT) was used in order to assess the trabecular distribution of proximal femur and its relationship with hip fragility fractures.

Methods: A total of 99 elderly women were scanned by MDCT including: 27 trochanteric hip fractures (group A), 40 femoral neck fractures (group B), and 32 non-fractures (group C). A mid-coronal MPR image of the proximal femur was reconstructed for every patient by e-Film95 software. Four regions of interest (ROI) were chosen in the images including compressive trabecula (ComT), tensile trabecula (TenT), trochanteric trabecula (TroT) and Ward's triangle (WT) region. The mean CT values were measured by the software.

Results: The mean age was 81.44, 74.10 and 69.25 years for groups A, B and C, respectively. There was significant inter-group differences based on one-way ANOVA (P<0.05). The CT values in the four ROIs had significant differences in the groups except for TenT between group A and B (P>0.05). After the age adjustment with ANCOVA, the mean CT values of TroT and WT were significantly lower in group A as compared to that of the group B (P<0.05). However, there were no significant differences for ComT and TenT between groups A and B (P>0.05).

Conclusions: The occurrence of femoral neck fracture was closely related to the degeneration of ComT and TenT. Trochanteric hip fractures were associated with a more severe degeneration in TroT as well as an enlargement of WT region besides the ComT and TenT degeneration. We concluded that the hip fragility fractures might be predicted by the measurement of the mean CT values in ComT, TenT, TroT and WT region.

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Figures

Figure 1
Figure 1
Reformating the mid-coronol image of proximal femur. (A) The Transverse section of femoral neck. The green line is the center of the femoral neck; (B) A mid-coronol MPR image of proximal femur is reformatted through the green line.
Figure 2
Figure 2
The location of the trabeculae and Ward's Triangle region internal proximal femur. (A) A mid-coronol image of proximal femur reveals: principal compressive trabecula; principal tensile trabecula; secondary compressive trabecula; secondary tensile trabecula and Ward’s Triangle region. (B) A transverse section of femoral neck reveals: principal compressive trabecula and Ward's Triangle region.
Figure 3
Figure 3
Four regions of interest (ROI) and the axes of the coordinate system used to position them. A=Compressive trabecula ROI (ComT); B=Tensile trabecula ROI (TenT); C=Trochanteric trabecula ROI (TroT); D= Ward's triangle ROI (WT); E=The center of femoral neck and F=The base of femoral neck.
Figure 4
Figure 4
The mean CT values of four ROIs in five different age (50–99 years) groups. We found that CT values of four ROIs significantly decreased for the patient over 70 years old.
Figure 5
Figure 5
The mean CT values of four ROI for four patients with different age. (A) A 45-year-old middle age woman; (B) A 67-year-old no-fracture patient; (C) A 75-year-old woman with femoral neck fracture and (D) A 82-year-old woman with trochanteric hip fracture.
See this image and copyright information in PMC

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