Risk factors for hip fractures: the role of femoral and acetabular morphology in predicting proximal femur fracture types.

Abstract

Due to demographic shifts and an increasing proportion of older adults at higher fracture risk, the overall burden of proximal femur fractures has risen significantly in recent years, placing a burden on patients and healthcare systems. Despite extensive research on hip fracture epidemiology and treatment, the specific influences of femoral and acetabular parameters on fracture localisation remain underexplored. This study evaluates the impact of these parameters on proximal femur fracture localisation. This retrospective cohort study analysed data from 400 patients with proximal femur fractures, including medial and lateral femoral neck fractures (FNFs), pertrochanteric, and subtrochanteric fractures, treated at a university hospital between 2010 and 2022. Radiographic measurements of femoral head size and other morphological parameters were conducted using pre-operative pelvic radiographs. Statistical analyses included multivariate logistic regression. A larger head-radius vertical (HRV) was associated with an increased risk of lateral FNFs (OR 1.11; <i>p</i> = 0.007). A lower Femoral Head Protrusion Index (FHEI) significantly increased the risk of lateral (OR 0.87; <i>p</i> < 0.001), pertrochanteric (OR 0.88; <i>p</i> < 0.001), and subtrochanteric fractures (OR 0.86; <i>p</i> < 0.001). Femur canal width was associated with a higher risk of pertrochanteric fractures (OR 1.17; <i>p</i> = 0.001), and a smaller lateral centre edge angle (LCEA) correlated with higher risks of lateral (OR 0.92; <i>p</i> = 0.021) and pertrochanteric fractures (OR 0.92; <i>p</i> = 0.018). Additionally, a higher body mass index (BMI) was significantly associated with subtrochanteric fractures (or 1.07; <i>p</i> = 0.020). The study identified key variables associated with proximal femur fracture localisation. Morphological parameters such as HRV, FHEI, canal width, and LCEA, as well as BMI for subtrochanteric fractures, significantly influence fracture localisation, highlighting their importance for personalised risk assessment and preventive strategies.