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Comparative evaluation of radiographic morphologic parameters for predicting subsequent contralateral fragility hip fracture

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Abstract

Purpose

Subsequent contralateral fragility hip fracture (SCHF) is one of the most serious conditions in osteoporotic patients due to high morbidity and mortality. This study aimed to investigate the predictive ability of radiographic morphologic parameters for SCHF in patients diagnosed with unilateral fragility hip fractures.

Methods

We conducted a retrospective observational study of unilateral fragility hip fracture patients between April 2016 and December 2021. Radiographic morphologic parameters, including canal-calcar ratio (CCR), cortical thickness index (CTI), canal-flare index (CFI), and morphological cortical index (MCI), were measured from patients’ contralateral proximal femur anteroposterior radiographic study to evaluate the risk of SCHF. Multivariable logistic regression analysis was employed to determine the adjusted predictive ability of the radiographic morphologic parameters.

Results

Of the included 459 patients, 49 (10.7%) experienced SCHF. All radiographic morphologic parameters demonstrated excellent performance in predicting SCHF. After being adjusted by patients’ age, BMI, visual impairment status, and dementia, CTI revealed the greatest adjusted odds ratio for SCHF of 35.05 (95% CI 7.34 to 167.39, p < 0.001) followed by CFI (OR = 13.32; 95% CI 6.50 to 27.32, p < 0.001), MCI (OR = 5.60; 95% CI 2.84 to 11.04, p < 0.001), and CCR (OR = 4.50; 95% CI 2.32 to 8.72, p < 0.001).

Conclusion

CTI demonstrated the greatest odds ratio for SCHF, followed by CFI, MCI, and CCR. These radiographic morphologic parameters could provide a preliminary prediction for SCHF in elderly patients presenting with unilateral fragility hip fractures.

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Data availability

The data that support the findings of this study are available from the corresponding author, N. A., upon reasonable request.

Code availability

Not applicable.

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Acknowledgements

The authors gratefully acknowledge Lamphun general hospital staff for their assistance with data collection. We want to express our sincere thanks to Dr. G. Lamar Robert, Ph.D., and Assoc. Prof. Dr. Chongchit Sripun Robert, Ph.D., for English editing the manuscript.

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Authors and Affiliations

  1. Orthopaedics Unit, Lamphun Hospital, Lamphun, Thailand

    Witit Pothong

  2. Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand

    Nath Adulkasem

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Contributions

Conceptualization, W. P., and N. A.; methodology, W. P., and N. A.; software, N. A.; validation, W. P.; formal analysis, N. A.; investigation, W. P.; data curation, W. P., and N. A.; writing—original draft preparation, W. P.; writing—review and editing, N. A.; visualization, N. A.; project administration, W. P. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Nath Adulkasem.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Lamphun General Hospital Ethics Committee (LPN 010/2565).

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The authors declare no competing interests.

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Pothong, W., Adulkasem, N. Comparative evaluation of radiographic morphologic parameters for predicting subsequent contralateral fragility hip fracture. International Orthopaedics (SICOT) 47, 1837–1843 (2023). https://doi.org/10.1007/s00264-023-05789-8

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  • DOI: https://doi.org/10.1007/s00264-023-05789-8

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