Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec 1;34(12):632-638.
doi: 10.1097/BOT.0000000000001843.

Association of Perioperative Computed Tomography Hounsfield Units and Failure of Femoral Neck Fracture Fixation

Erik A Lund  1 , Rahul Samtani  2 , Mark Winston  3 , Paul A Anderson  2 , Paul S Whiting  2 , Robert V O'Toole  4 , Scott Hetzel  5 , Christopher J Doro  2
Affiliations

Association of Perioperative Computed Tomography Hounsfield Units and Failure of Femoral Neck Fracture Fixation

Erik A Lund et al. J Orthop Trauma. .

Abstract

Objectives: To determine whether Hounsfield units (HUs) measured on perioperative computed tomographic scans are associated with radiographic outcomes and reoperations after femoral neck fracture fixation.

Design: Retrospective cohort study.

Setting: Level I trauma center.

Patients: One hundred fourteen patients age ≥18 years, who presented to a Level I trauma center, and who underwent surgical fixation of intracapsular femoral neck fracture and had perioperative computed tomographic scans and adequate follow-up.

Intervention: None.

Main outcome measurements: Screw penetration, femoral neck shortening >5 mm, and revision surgery.

Results: A median follow-up was 23 months. An HU measurement of the femoral head was significantly associated with screw penetration and femoral neck shortening but not revision surgery. Patients with middle femoral head HU measurements <146 had 17 times (95% confidence interval: 4.32-78.9, P < 0.001) increased odds of screw penetration. Greater than 5 mm shortening was seen in patients with HUs <212.5 in the low head section by an odds ratio of 7.8 (95% confidence interval: 2.15-33.0, P = 0.014).

Conclusion: Outcome differences regarding screw penetration and femoral neck shortening related to the HU or densities of femoral head and neck at the time of fracture are significant. These findings can help the clinician with developing a treatment plan for either arthroplasty or fixation of a femoral neck fracture based on objective bone quality measurements rather than relying on an arbitrary age recommendation.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PubMed Disclaimer

Conflict of interest statement

R. V. O′Toole is a paid consultant for CoorsTek, Imagen, and Smith & Nephew, receives stock options from Imagen, and receives royalties from CoorsTek, not related to this study. The remaining authors report no conflict of interest.

References

    1. Hansen D, Bazell C, Pelizzari P, et al. Medicare Cost of Osteoporotic Fractures the Clinical and Cost Burden of an Important Consequence of Osteoporosis. www.millman.com; 2019. Available at: http://assets.milliman.com/ektron/Medicare_cost_of_osteoporotic_fracture.... Accessed December 11, 2019.
    1. Anderson PA, Polly DW, Binkley NC, et al. Clinical use of opportunistic computed tomography screening for osteoporosis. J Bone Joint Surg Am. 2018;100:2073–2081.
    1. Lotz JC, Gerhart TN, Hayes WC. Mechanical properties of trabecular bone from the proximal femur: a quantitative CT study. J Comput Assist Tomogr. 1990;14:107–114.
    1. Swiontkowski MF, Harrington RM, Keller TS, et al. Torsion and bending analysis of internal fixation techniques for femoral neck fractures: the role of implant design and bone density. J Orthop Res. 1987;5:433–444.
    1. Stankewich CJ, Chapman J, Muthusamy R, et al. Relationship of mechanical factors to the strength of proximal femur fractures fixed with cancellous screws. J Orthop Trauma. 1996;10:248–257.