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Value of Proximal Femur Geometry in Predicting Occult Hip Fracture

Background and Objectives: Patients with occult hip fractures are a difficult subgroup to treat. MRI is the gold standard for diagnosing occult proximal femur fractures but is costly and may not be readily available in an emergency setting. The purpose of this study was to determine whether changes...

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Autores principales: Bökeler, Ulf, Liener, Ulrich, Vogeley, Nils, Mayer, Benjamin, Horsch, Cornelia, Tröster, Fridolin, Eschbach, Daphne, Ruchholtz, Steffen, Knauf, Tom
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10673107/
https://www.ncbi.nlm.nih.gov/pubmed/38004036
http://dx.doi.org/10.3390/medicina59111987
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author Bökeler, Ulf
Liener, Ulrich
Vogeley, Nils
Mayer, Benjamin
Horsch, Cornelia
Tröster, Fridolin
Eschbach, Daphne
Ruchholtz, Steffen
Knauf, Tom
author_facet Bökeler, Ulf
Liener, Ulrich
Vogeley, Nils
Mayer, Benjamin
Horsch, Cornelia
Tröster, Fridolin
Eschbach, Daphne
Ruchholtz, Steffen
Knauf, Tom
author_sort Bökeler, Ulf
collection PubMed
description Background and Objectives: Patients with occult hip fractures are a difficult subgroup to treat. MRI is the gold standard for diagnosing occult proximal femur fractures but is costly and may not be readily available in an emergency setting. The purpose of this study was to determine whether changes in the proximal femur geometry can predict the likelihood of an occult hip fracture in patients presenting with hip pain following a ground-level fall. Material and Methods: Patients admitted to the hospital with a clinical suspicion of a hip fracture but initial negative radiographs over a seven-year period were included. All patients were additionally investigated with an MRI scan, and retrospectively, six radiologic parameters were obtained on plain radiographs: The cortical thickness index (CTI), the canal to calcar ratio (CCR), the canal flare index (CFI), the morphological cortical index (MCI), the canal bone ratio (CBR) and the canal bone aria ratio (CBAR). Subsequently the result of the plain radiographic indices of the patients with a negative MRI (Group A, no occult fracture) were compared to those with a positive MRI (Group B, occult fracture). Results: A total of 78 patients (59 female, 19 male) could be included in the study. The mean age was 82 years. The univariate analyses revealed a poor predictive ability of all radiological parameters with AUC values ranging from 0.515 (CBR) to 0.626 (CTI), whereas a multivariate prognostic model demonstrated improved prognosis (AUC = 0.761) for the CTI (p = 0.024), CBAR (p = 0.074) and CRR (p = 0.081) as the most promising predictive radiological parameters. Conclusions: Single radiologic indices obtained from conventional X-rays of the proximal femur have a weak predictive value in detecting occult fractures of the hip and cannot be used as clinical decision-making factors.
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spelling pubmed-106731072023-11-11 Value of Proximal Femur Geometry in Predicting Occult Hip Fracture Bökeler, Ulf Liener, Ulrich Vogeley, Nils Mayer, Benjamin Horsch, Cornelia Tröster, Fridolin Eschbach, Daphne Ruchholtz, Steffen Knauf, Tom Medicina (Kaunas) Article Background and Objectives: Patients with occult hip fractures are a difficult subgroup to treat. MRI is the gold standard for diagnosing occult proximal femur fractures but is costly and may not be readily available in an emergency setting. The purpose of this study was to determine whether changes in the proximal femur geometry can predict the likelihood of an occult hip fracture in patients presenting with hip pain following a ground-level fall. Material and Methods: Patients admitted to the hospital with a clinical suspicion of a hip fracture but initial negative radiographs over a seven-year period were included. All patients were additionally investigated with an MRI scan, and retrospectively, six radiologic parameters were obtained on plain radiographs: The cortical thickness index (CTI), the canal to calcar ratio (CCR), the canal flare index (CFI), the morphological cortical index (MCI), the canal bone ratio (CBR) and the canal bone aria ratio (CBAR). Subsequently the result of the plain radiographic indices of the patients with a negative MRI (Group A, no occult fracture) were compared to those with a positive MRI (Group B, occult fracture). Results: A total of 78 patients (59 female, 19 male) could be included in the study. The mean age was 82 years. The univariate analyses revealed a poor predictive ability of all radiological parameters with AUC values ranging from 0.515 (CBR) to 0.626 (CTI), whereas a multivariate prognostic model demonstrated improved prognosis (AUC = 0.761) for the CTI (p = 0.024), CBAR (p = 0.074) and CRR (p = 0.081) as the most promising predictive radiological parameters. Conclusions: Single radiologic indices obtained from conventional X-rays of the proximal femur have a weak predictive value in detecting occult fractures of the hip and cannot be used as clinical decision-making factors. MDPI 2023-11-11 /pmc/articles/PMC10673107/ /pubmed/38004036 http://dx.doi.org/10.3390/medicina59111987 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Bökeler, Ulf
Liener, Ulrich
Vogeley, Nils
Mayer, Benjamin
Horsch, Cornelia
Tröster, Fridolin
Eschbach, Daphne
Ruchholtz, Steffen
Knauf, Tom
Value of Proximal Femur Geometry in Predicting Occult Hip Fracture
title Value of Proximal Femur Geometry in Predicting Occult Hip Fracture
title_full Value of Proximal Femur Geometry in Predicting Occult Hip Fracture
title_fullStr Value of Proximal Femur Geometry in Predicting Occult Hip Fracture
title_full_unstemmed Value of Proximal Femur Geometry in Predicting Occult Hip Fracture
title_short Value of Proximal Femur Geometry in Predicting Occult Hip Fracture
title_sort value of proximal femur geometry in predicting occult hip fracture
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10673107/
https://www.ncbi.nlm.nih.gov/pubmed/38004036
http://dx.doi.org/10.3390/medicina59111987
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