Proximal Hip Fracture: Radiological Evaluation and Comparison of Trochanteric and Sub-capital Fractures

Introduction:
Proximal femur fractures are common in the older population and related to bone quality. Our work evaluates bone parameters from pelvic AP radiographs in patients with trochanteric and sub-capital fractures to determine if different morphology exists for each type of fracture.

Methods:
Data from 237 medical records was extracted from patients who arrived at our hospital with trochanteric and sub-capital femoral fractures. Descriptive data and radiological evaluation of Calcar to Canal Ratio (CCR), Cortical Thickness Index (CTI), and DORR classification were measured by two observers and statistically evaluated.

Results:
A total of 202 patients were found to be eligible for the study. The mean patient age was 81.41±7.27. The mean age of the trochanteric group was significantly higher than that in the sub-capital group, p=0.005. There were no statistically significant differences in gender and comorbidities. CCR showed significance, CTI and DORR classification did not show the difference (p=0.001, p=0.78, and p=0.98). A high degree of reliability was shown for all measurements. The ICC for CTI and CCR was 0.791 and 0.770 (p<0.001) and Cronbach`s Alpha of 0.815 0.796, respectively. Logistic regression was significant to CCR predicted 60.4% of correct forecasting, OR 0.011, 95 % CI, (p=0.001), for CTI 48% of correct forecasting, OR 0.615, (p=0.78).

Discussion:
In our study, we examined the possible radiographic parameters that may predict the fracture type. Younger patients tended to have sub-capital fractures rather than trochanteric. Most of our patients were in their 80s and had trochanteric fractures. We found that CCR is significant from all examined parameters, implying that higher results correlate with trochanteric fractures.