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. 2022 Mar;16(1):103-111.
doi: 10.5704/MOJ.2203.015.

Predicting the Anatomical Location of Neck of Femur Fractures in Osteoporotic Geriatric Indian Population

M R Thirunthaiyan  1 , K Mukherjee  1 , Tkr Prashanth  1 , D R Kumar  1
Affiliations

Predicting the Anatomical Location of Neck of Femur Fractures in Osteoporotic Geriatric Indian Population

M R Thirunthaiyan et al. Malays Orthop J. 2022 Mar.

Abstract

Introduction: Neck of femur fractures are quite common fractures in the elderly. Though a lot is spoken about the various modes of management of these fractures across different age groups, hardly any literary support mentioning their distribution, location and pattern can be found. In this study, we aim to find whether the Singh index, as a marker of osteoporosis on digital radiographs, can predict the location of neck of femur fractures in the elderly population.

Materials and methods: We accessed 556 fractured hip radiographs in our institution over the past 5 years (20152020) and correlated with the Singh index, as a marker of degree of osteoporosis, on pre-operative pelvis digital radiographs. Mid coronal CT cuts were also corroborated with the radiographic findings. A control group was set up and 361 radiographs were evaluated in the study group.

Results: A total of 124 transcervical fractures (73%) were in Singh index 4, while 76 subcapital fractures (70%) were in Singh index 3. A total of 166 fractures (66%) were found in transcervical region in the age group of 60 to 80 years, while 80 fractures (74%) were in the subcapital region in patients above 80 years.

Conclusion: We concluded that transcervical fractures were more common in patients with Singh index 4 (p<0.001) and subcapital more common in patients with Singh index 3(p<0.001). There was also a shift in location of the fractures from the transcervical region to the subcapital region with age above 80 years (p<0.001).

Keywords: Singh index; fracture; neck of femur; osteoporosis.

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Figures

Fig. 1:
Fig. 1:
(a) Pictorial depiction of proximal femur trabecular pattern (b) Pelvis radiograph depicting the trabecular pattern of proximal femur.
Fig. 2:
Fig. 2:
Case example, 80-year-old female, illustrating the trabecular pattern in proximal femur as evident on (a) pelvis radiograph (b) mid coronal CT cuts (c) magnified normal left hip for better visualisation of trabeculae. Hip graded as Singh index 3 based on trabecular pattern.
Fig. 3:
Fig. 3:
Illustration depicting method applied in dividing the neck of femur into three anatomical zones.
Fig. 4:
Fig. 4:
Case example from control group showing a 53-year-old female with Singh index 4 having a left hip basicervical fracture (a) pelvis radiograph AP (b) mid coronal CT image (c) traction internal rotation view of left hip.
Fig. 5:
Fig. 5:
(a, b, c) Radiographs depicting 82-year-old female with Singh index grading 3 who sustained a subcapital fracture.
Fig. 6:
Fig. 6:
(a, b, c) Radiographs depicting 66-year-old female with Singh index grading 4 who sustained a transcervical fracture.
See this image and copyright information in PMC

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References

    1. Bhandari M, Devereaux PJ, Tornetta P 3rd, Swiontkowski MF, Berry DJ, Haidukewych G et al. Operative management of displaced femoral neck fractures in elderly patients. An international survey. J Bone Joint Surg Am. 2005;87(9):2122–30. doi: 10.2106/JBJS.E.00535. doi: - DOI - PubMed
    1. Wilkins K. Health care consequences of falls for seniors. Health Rep. 1999;10(4):47–55. (ENG); 47-57(FRE). - PubMed
    1. Augat P, Bliven E, Hackl S. Biomechanics of Femoral Neck Fractures and Implications for Fixation. J Orthop Trauma. 2019;33(Suppl 1):S27–32. doi: 10.1097/BOT.0000000000001365. doi: - DOI - PubMed
    1. Sahoo B, Agrawal AC, Kar BK, Sakale H, Yadav SK, Mittal S. Classification of fracture neck of femur. J Orthop Dis Traumatol. 2018;1(1):5–7. doi: 10.4103/jodp.JODP_15_18. doi: - DOI
    1. Garden RS. Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br. 1961;43-B(4):647–63. doi: 10.1302/0301-620X.43B4.647. doi: - DOI

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