Does Proximal Hip Geometry Affect Fracture Type in The Elderly Population?

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Emrah Sayit, Nizametin Guzel, Asli Tanrivermis Sayit This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-859539/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The aim of this study was to determine the differences in proximal femoral geometric (PFG) parameters between patients with femoral neck fractures(FNFs) and patients with intertrochanteric fractures (ITFs). Methods We retrospectively evaluated 114 patients (33 FNFs, 81 ITFs.) who were hospitalized secondary to hip fractures. Patients were divided into two groups: patients with FNFs and patients with ITFs. The PFG parameters (the neck shaft angle, center-edge angle, femoral head diameter, femoral neck diameter, neck/head ratio, femoral neck axial length, femoral shaft diameter, hip axial length, and neck/hip length ratio) were measured on the hip joint radiographs. Results There were no statistically significant differences in age and gender between the FNF and ITF groups. In addition, there were no statistically significant differences in the PFG parameters between the FNF and ITF groups except in the neck/hip length ratio (NHLR) (0.86 ± 0.03 vs 0.84 ± 0.03, p = 0.05). When a 3-way multivariate analysis was performed according to gender, fracture type, and fracture site, the femoral head diameter, femoral neck diameter, femoral neck axial length, femoral shaft diameter, hip axial length, and NHLR were found to be greater in females than in males, and a statistically significant relationship was found between gender and these variables. Conclusion Only the NHLR was significantly higher in the ITF group, so this study revealed that a higher NHLR, which is the presence of a longer hip axis combined with a shorter neck axis, is a risk factor for ITF after a minor trauma. Orthopedics Orthopedic Surgery Hip Fracture Geometric Parameters Radiography Elderly Figures Figure 1 Introduction Hip fractures are the most serious complication of osteoporosis and are increasing annually in the elderly population. Despite advanced orthopedic treatment options, the morbidity and mortality of hip fractures remains high [ 1 ]. Hip fractures account for 7% of all body fractures in adults and 24% of elderly fractures [2.3]. The most common types of hip fractures in patients over 65 years of age are intracapsular femoral neck fractures (FNFs) and extracapsular intertrochanteric fractures (ITFs) [ 4 ]. The etiology, risk factors, characteristics, and treatment modalities of these two fracture types differ [ 1 ]. Although hip fractures due to osteoporosis are frequently seen in the elderly population, they can be seen at any age when a force exceeds the strength of the bone due to decreased bone mass and quality. A decrease in proximal femur strength increases the incidence of hip fractures in low-energy trauma and falls, especially in the elderly population [ 5 ]. In order to prevent osteoporotic hip fractures, it is crucial to know the various environmental and genetic factors that may contribute to fractures. The most commonly used method is measuring the bone mineral density (BMD) of various bones, which is useful for determining the risk of developing osteoporotic fractures [ 6 ]. Proximal femoral geometric (PFG) parameters are independent parameters that can be used to evaluate the structure of bones, such as their shape and size, and they can be used to determine the risk factors, such as low BMD, for developing osteoporotic fractures [ 6 ]. Previous reports have demonstrated associations between hip geometry and hip fracture risk in patients, especially elderly patients and postmenopausal women [ 7 – 10 ]. Although there is some disagreement, the hip axis length (HAL) and neck-shaft angle (NSA) have been shown to be increased in osteoporotic hip fractures [ 11 – 15 ]. While several studies have focused on the relationship between PFG parameters and hip fractures, there is a limited number of studies investigating the relationship between PFG parameters and hip fracture types. The aim of this study was to determine the differences in PFG parameters between FNFs and ITFs in elderly patients. Furthermore, we attempted to identify why some patients with similar age and bone quality who suffer from low-energy trauma have FNFs and some have ITFs. Methods Ethical approval This retrospective study was conducted in accordance with the Declaration of Helsinki and was approved by our hospital’s institutional review board. Informed consent was obtained from all patients prior to surgery. Patients From January 2018 to December 2018, 114 patients over 65 years of age who were admitted to the hospital with unilateral hip fractures after minor traumas, such as falls from a standing position or while walking, were included in the study. Of the 114 patients, 39 were male, and 75 were female with a mean age of 80.03 ± 7.73 years and 82.12 ± 7.28 years, respectively. The inclusion criteria were as follows: (1) age older than 65 years; (2) FNFs and ITFs; (3) unilateral fractures; (4) hip fractures caused by minor trauma; and (5) X‑ray films of the pelvis and proximal femur before and after operation with standard posture and sufficient quality. Patients with secondary fractures of the same hip; bilateral hip fractures; multiple fractures; pathological fractures; primary and secondary bone tumors; chemotherapy; radiotherapy; Paget’s disease; congenital dysplasia; and deformity of the femur and pelvis were excluded from the study. The medical records of the included patients were reviewed for characteristics such as age, gender, and the site of fracture using the hospital’s electronic medical record. Radiographic imaging and analysis The digital imaging and communication medicine (DICOM) files were retrieved from the picture archiving and communication system (PACS) and transferred to the workstation for review; all measurements were performed digitally by an experienced orthopedic surgeon. The standard radiographic view for the pelvis was obtained in the anterior-posterior (AP) direction with the patient in the supine position. Patients with incorrect positions and inadequate diagnostic information were excluded. The PFG parametres were measured from the normal side due to the broken anatomy of the fractured hip. Any asimetric hips were not included in the study. The PFG parameters were measured for all fractures using a RadiAnt DICOM viewer on pelvic radiographs. The NSA, center-edge angle (CEA), femoral head diameter (FHD), femoral neck diameter (FND), femoral neck axial length (FNAL), femoral shaft diameter (FSD), and HAL were examined from the AP pelvic radiography as described in the literature (16). The NSA is the angle between the derived axes of the femoral neck and shaft. The CEA is the angle between the midline of the femoral head to the outer edge of the acetabulum and the line through the vertical line of the femoral head. The FHD is defined as the maximum distance from the outer superior edge to the inner and inferior edge of the femoral head. The FND is the maximum distance from the superior to the inferior end of the femoral neck. The FNAL is defined as the junction of the lateral cortex of the femur and the apex of the femoral head with the anatomical axis of the femoral head and neck. The HAL is the distance from the greater trochanter to the inner pelvic brim with the anatomical axis of the femoral head and neck (Figure 1,2). Statistical analysis Statistical analyses were performed using IBM SPSS Statistics, ver. 23 (IBM Corporation, Armonk, NY, USA). To compare the two independent groups, the Student t-test was used. The Chi-Square test was used to test categorical variables. A multivariate analysis of variance (MANOVA) was used to evaluate the influence of the PFG parameters on gender and fracture type and site. The data are expressed as mean ± standard deviation (SD) and median (minimum–maximum). A p-value equal to or less than 0.05 was considered statistically significant. The relative technical error of measurement (rTEM) method was used for the agreement between observations. According to the analysis results, the rTEM value was 2.58, and the reliability value was 92.1%, which showed that intraobserver compliance was quite high. Results Of the 114 patients, 33 had FNFs (mean age: 80.48 ± 7.57 years), and 81 had ITFs (mean age: 81.78 ± 7.44 years). Of the 33 patients with FNFs, 13 (39.4%) were male (mean age: 80.69 ± 7.18 years), and 20 (60.6%) were female (mean age: 80.35 ± 7.99 years). Of the 81 patients with ITFs, 26 (32.1%) were male (mean age: 79.69 ± 8.11 years), and 55 (67.9%) were female (mean age: 82.76 ± 6.97 years). There were no statistically significant differences in age and gender between the FNF and ITF groups (p=0.40 and p=0.59, respectively). The PFG parameters of the hips of patients with FNFs and ITFs are shown in Table 1. The FNF group had larger NSAs, smaller CEAs, larger FHDs and FNDs, smaller FSDs, and greater FNALs and HALs compared to the ITF group. The FNF group had smaller NHRs, NHLR, and FSDs compared to the ITF group. There were no statistically significant differences in the PFG parameters between the FNF and ITF groups except in the NHLR (0.86 ± 0.03 vs 0.84 ± 0.03, p=0.05). The results of the multivariate analysis of the PFG parameters are shown in Table 2. Male patients had larger FHDs (58.7 ± 3.9 vs 52.1 ± 3.7 mm), FNDs (42.2 ± 4.5 vs 37.1 ± 4.3 mm), and FSDs (34.4 ± 2.9 vs 32 ± 3.1 mm) and greater HALs (132.4 ± 12.4 vs 114.4 ± 8.6 mm) and FNALs (110.3 ± 10.4 vs 98.7 ± 7.6 mm) compared to female patients. There was a significant difference in the PFG parameters between genders. Females had larger CEAs (39.22 ± 7.11° vs 37.52 ± 6.24°) and NHLRs (0.86 ± 0.02 vs 0.83 ± 0.02) compared to male patients. There was a significant difference in the CEA between genders. The NSAs in the male and female patients were 139.58 ± 9.86° and 139.79 ± 8.22°, respectively, and did not significantly differ. The NHRs in the male and female patients were 0.72 ± 0.06 and 0.71 ± 0.11, respectively, and did not significantly differ between genders. There were no statistically significant differences in fracture type interactions with gender, fracture site interactions with gender, or fracture type interactions with the fracture site. In addition, there were no statistically significant gender interactions with fracture type and site. Discussion Osteoporotic hip fractures include FNFs and ITFs, and these fractures are extremely common in the elderly population [10]. However, many differences have been reported between FNFs and ITFs, such as etiology, risk factors, and patient characteristics [1]. Pulkkinen et al. [17] reported that FNFs predominate at the lowest structural mechanical strength levels, whereas ITFs are more common at high failure loads, and females are more prone to FNFs than males. Recent studies revealed that the PFG parameters can show the susceptibility to hip fractures independent of BMD [5]. But, here, there were no statistically significant differences in age and gender between the FNF and ITF groups (p=0.40 and p=0.59, respectively). Lee et al. [5] analyzed the PFG parameters among 16 premenopausal women with minimal-trauma hip fractures and 80 age- and body mass index-adjusted controls. They revealed that a long hip axis and narrow NSA significantly increased fracture risk in a multiple logistic regression analysis using only the PFG parameters. They revealed that the HAL and NSA were BMD-independent predictors of hip fracture and hip geometry might be clinically useful for the identification of patients for whom active fracture prevention should be considered [5]. Han et al. [10] evaluated 197 women aged 65 years or older who had an osteoporotic hip fracture (FNF, 84 patients; ITF, 113 patients). A total of 551 women who visited the hospital to be tested for osteoporosis were included in the control group. The researchers measured the femur BMD and PFG parameters for all subjects and compared them between the control and fracture groups. They reported that there were no significant differences in the HAL and NSA between the control group and the fracture group. In our study, there were no significant differences between the FNF and ITF groups according to the HAL and NSA in the multivariate analysis, so our study revealed no significant relationship between the HAL or NSA and hip fracture type. Hu et al. [4] reported that the mean HAL of 101 patients with FNFs was 118.23 ± 8.73 mm, and the HAL of 97 patients with ITFs was 119.97± 10.29 mm. In our study, the mean HAL of 33 patients with FNFs was 123.5 ± 14.9 mm, and the HAL of 81 patients with ITFs was 119.3 ± 12.3 mm, but there were no statistically significant differences. We found that the hip axis was longer in the FNF group than in the ITF group, which contrasts the results from the study by Hu et al [4]. Hu et al. [4] found that the mean NSA of the 101 patients with FNFs was 137.63 ± 4.56°, and the mean NSA of the 97 patients with ITFs of the femur was 132.07 ± 4.17°, which was significantly different. They suggested that a greater NSA was a risk factor for FNF [4]. In our study, the mean NSA of 33 patients with FNFs was 140.12 ± 7.83°, and the NSA of 81 patients with ITFs of the femur was 139.55 ± 9.17°, but there were no statistically significant differences between fracture type. Han et al. [10] showed that femoral neck length (FNL) was significantly greater in the control group than in the FNF group (P<0.001). However, there were no statistically significant differences in the FNL between the control group and the ITF group (P=0.722). In addition, they reported that the FNL between both fracture groups was significantly shorter in the FNF group than in the ITF and control groups [10]. Lu et al. [18] reported that the FNAL of patients with ITFs of the femur was 90.68 mm, which was greater than that of the FNF group (88.64 mm). From the biomechanical point of view, the longer axis of the femoral neck causes the greater trochanter of the femur to protrude more, and thus, the possibility of ITF increases when an external force impacts the femoral trochanter. The long axis of the femoral neck and the high risk of proximal femoral fractures have been defined by most scholars [18]. The FNAL has an important role in internal fixation of the proximal femoral fracture and hip arthroplasty. Therefore, restoration of the normal FNAL prior to fracture has important clinical significance for accurate restoration of the normal hip geometric parameters and can improve hip function. In our study, the FNAL was longer in patients with femoral neck fractures (104.1 ± 11.1 mm) than in patients with ITFs (102 ± 9.9), but there were no statistically significant differences between fracture type. Han et al. [10] revealed that the femoral neck width (FNW) in the control group was significantly smaller than that in the FNF and ITF groups. However, we found no significant differences in the FNAL and FND between the two groups in our study. They reported that after adjusting for age, weight, and height, the odds ratio (OR) for fractures in the FNF group increased depending on a decrease in the FNAL, cross-sectional area (CSA), and femur BMD and an increase in the FNW. Furthermore, they revealed that the OR for fractures increased depending on a decrease in the CSA in the femoral neck and femur BMD and an increase in the FNW in the ITF group [10]. They suggested that an increase in the FNW might be a PFG parameter that plays a significant role as a risk factor for fracture independent of BMD. Hu et al. [4] evaluated 198 elderly patients over 65 years of age with hip fractures (FNF, 101 patients; ITF, 97 patients). They reported that the CEA were higher in men than in women. Also, they revealed that there was no statistically significant difference in CEA between the gender, but greater CEA was the risk factor for ITFs. In here, CEA was larger in woman than in men and CEA was greater in ITF group than in the FNF group, compatible with the literature. Hu et al. [4] showed statistically significant differences in the NSA between the FNF group and the ITF group. They revealed that a greater NSA was a risk factor for FNF. In our study, the FNF group had a greater NSA when compared to the ITF group, compatible with the literature. Also, they revelaed that FND is greater in FNF group than the ITF group, with a statistically significant difference [4]. They claimed that greater FND was a protective factor for the ITF group. In our study, FND was greater in the FNF group than the ITF group, without statistically significant difference. In our study, the FNF group had larger NSAs, smaller CEAs, larger FHDs and FNDs, smaller FSDs, and greater FNALs and HALs compared to the ITF group. The FNF group had smaller NHRs, NHLR, and FSDs compared to the ITF group. There were no statistically significant differences in the PFG parameters between the FNF and ITF groups except in the NHLR (0.86 ± 0.03 vs 0.84 ± 0.03, p=0.05). The limitation of this retrospective study is because of not having height, weight and BMI of the patients, the measurements could not be normalized. In conclusion, we evaluated the differences in geometric morphological parameters of the proximal femur in different hip fracture types and gender. Only the NHLR was significantly higher in the ITF group, so this study revealed that a higher NHLR, which is the presence of a longer hip axis combined with a shorter neck axis, is a risk factor for ITF after a minor trauma. List Of Abbreviations PFG Proximal femoral geometric FNF Femoral neck fractures ITF Intertrochanteric fractures NHLR Neck/hip length ratio BMD Bone mineral density HAL Hip axis length NSA Neck-shaft angle DICOM Digital imaging and communication medicine PACS Picture archiving and communication system AP Anterior-posterior CEA Center-edge angle FHD Femoral head diameter FND Femoral neck diameter FNAL Femoral neck axial length FSD Femoral shaft diameter MANOVA Multivariate analysis of variance SD Standard deviation rTEM Rrelative technical error of measurement FNL Femoral neck length FNW Femoral neck width OR Odds ratio CSA Cross-sectional area FT Fracture Type FS Fracture Site Declarations Funding: No organization sponsored the research. Availability of data and materials: All the data will be available upon motivated request to the corresponding author of the present paper. Ethics approval and consent to participate: This study was approved by the institutional review board (approval no. TUEK 37-2019 BADK/8-64) of the Samsun Education and Research Hospital. Patient consent for publication: Informed consent was obtained from all patients prior to surgery. Competing interests: The authors declare that they have no competing interests. References Im GI, Lim MJ. Proximal hip geometry and hip fracture risk assessment in a Korean population. Osteoporos Int. 2011;22:803–7. doi: 10.1007/s00198-010-1301-7 . Zhang YZ. A guide to hip fracture in adults. Chin J Surg. 2015;53:5762. doi: 10.3760/cma.j.issn.0529-5815.2015.01.014 . (in Chinese). Zhang YZ. Clinical Epidemiology of Orthopedic Trauma. New York: Thieme; 2012. Hu ZS, Liu XL, Zhang YZ. Comparison of Proximal Femoral Geometry and Risk Factors between Femoral Neck Fractures and Femoral Intertrochanteric Fractures in an Elderly Chinese Population. Chin Med J. 2018;131:2524–30. doi: 10.4103/0366-6999.244118 . 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Proximal Femoral Geometry as Fracture Risk Factor in Female Patients with Osteoporotic Hip Fracture. J Bone Metab. 2016;23(3):175–82. doi: 10.11005/jbm.2016.23.3.175 . Epub 2016 Aug 31. Duboeuf F, Hans D, Schott AM, Kotzki PO, Favier F, Marcelli C, et al. Different morphometric and densitometric parameters predict cervical and trochanteric hip fracture: the EPIDOS Study. J Bone Miner Res. 1997;12(11):1895–902. doi: 10.1359/jbmr.1997.12.11.1895 . Gregory JS, Aspden RM. Femoral geometry as a risk factor for osteoporotic hip fracture in men and women. Med Eng Phys. 2008;30(10):1275–86. doi: 10.1016/j.medengphy.2008.09.002 . Gnudi S, Ripamonti C, Lisi L, Fini M, GiardinoR, Giavaresi G. Proximal femur geometry to detect and distinguish femoral neck fractures from trochanteric fractures in postmenopausal women. Osteoporos Int. 2002;13(1):69–73. doi: 10.1007/s198-002-8340-2 . Faulkner KG, Cummings SR, Black D, Palmermo L, Glüer CC, Genant HK. 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Evaluation of proximal femoral geometry with computerized tomography in patients with hip fragility fractures. Chin J Osteoporos. 2011;3:19598. (in Chinese). Tables Table 1 Proximal femoral geometric parameters of the hips in patients with femoral neck fractures and intertrochanteric fractures. FNF (n = 33) ITF (n = 81) p Neck-Shaft Angle (°) 140.12 ± 7.83 139.55 ± 9.17 0.75 Center-Edge Angle (°) 37.34 ± 5.66 39.16 ± 7.24 0.19 Femoral Head Diameter (mm) 55.4 ± 5.2 54 ± 4.7 0.15 Femoral Neck Diameter (mm) 39.2 ± 5 38.7 ± 5 0.63 Neck/Head Ratio 0.71 ± 0.06 0.72 ± 0.11 0.53 Femoral Neck Axial Length (mm) 104.1 ± 11.1 102 ± 9.9 0.32 Femoral Shaft Diameter (mm) 32.7 ± 2.9 32.9 ± 3.4 0.83 Hip Axial Length (mm) 123.5 ± 14.9 119.3 ± 12.3 0.12 Neck/Hip Length Ratio 0.84 ± 0.03 0.86 ± 0.03 0.05 FNF: Femoral neck fracture, ITF: Intertrochanteric fracture Table 2 Multivariate analysis of proximal geometric parameters Gender FT FS Gender *FT Gender* FS FT*FS Gender*FT*FS Neck-Shaft Angle 0.77 0.76 0.53 0.85 0.96 0.50 0.62 Center-Edge Angle 0,44 0.47 0.28 0.26 0.12 0.50 0.75 Femoral Head Diameter 0.00 0.12 0.61 0.10 0.25 0.51 0.41 Femoral Neck Diameter 0.00 0.67 0.08 0.09 0.58 0.57 0.81 Neck/Head Ratio 0.56 0.60 0.27 0.51 0.91 0.81 0.52 Femoral Neck Axial Length 0.00 0.35 0.11 0.13 0.47 0.72 0.39 Femoral Shaft Diameter 0.00 0.28 0.08 0.71 0.78 0.69 0.66 Hip Axial Length 0.00 0.10 0.24 0.08 0.27 0.99 0.55 Neck/Hip Length Ratio 0.00 0.05 0.17 0.61 0.27 0.28 0.38 FT: Fracture Type, FS: Fracture Site (Left/ Right) Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-859539","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":51529448,"identity":"4174a325-6baa-4988-9c9c-815368a18369","order_by":0,"name":"Emrah Sayit","email":"","orcid":"","institution":"Samsun Education and Research Hospital: Samsun Egitim ve Arastirma Hastanesi","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Emrah","middleName":"","lastName":"Sayit","suffix":""},{"id":51529449,"identity":"7dabfd35-6571-47bd-b5c6-5697560657c9","order_by":1,"name":"Nizametin Guzel","email":"","orcid":"","institution":"Samsun Education and Research Hospital: Samsun Egitim ve Arastirma Hastanesi","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nizametin","middleName":"","lastName":"Guzel","suffix":""},{"id":51529450,"identity":"ecbaad13-de9b-4b49-b999-f80c2512e5c1","order_by":2,"name":"Asli Tanrivermis Sayit","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0003-2861-156X","institution":"Ondokuz Mayis University Faculty of Medicine: Ondokuz Mayis Universitesi Tip Fakultesi","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Asli","middleName":"Tanrivermis","lastName":"Sayit","suffix":""}],"badges":[],"createdAt":"2021-08-30 18:58:40","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-859539/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-859539/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13368494,"identity":"49a654c2-0126-4eae-b582-0a1bb1f59c11","added_by":"auto","created_at":"2021-09-14 16:10:06","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":87924,"visible":true,"origin":"","legend":"1a: The parameters of proximal femoral geometry demonstrated on the hip X-ray\n1b: The parameters of proximal femoral geometry demonstrated on the hip X-ray","description":"","filename":"Fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-859539/v1/ace06f9f8aed4e37388a8adf.jpg"},{"id":18271767,"identity":"5124040b-2150-4861-a12f-5572933cef57","added_by":"auto","created_at":"2022-02-16 08:57:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":343717,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-859539/v1/226b0371-ad8d-453f-99cf-cc689e70b3ba.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eDoes Proximal Hip Geometry Affect Fracture Type in The Elderly Population?\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHip fractures are the most serious complication of osteoporosis and are increasing annually in the elderly population. Despite advanced orthopedic treatment options, the morbidity and mortality of hip fractures remains high [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Hip fractures account for 7% of all body fractures in adults and 24% of elderly fractures [2.3]. The most common types of hip fractures in patients over 65 years of age are intracapsular femoral neck fractures (FNFs) and extracapsular intertrochanteric fractures (ITFs) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The etiology, risk factors, characteristics, and treatment modalities of these two fracture types differ [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough hip fractures due to osteoporosis are frequently seen in the elderly population, they can be seen at any age when a force exceeds the strength of the bone due to decreased bone mass and quality. A decrease in proximal femur strength increases the incidence of hip fractures in low-energy trauma and falls, especially in the elderly population [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In order to prevent osteoporotic hip fractures, it is crucial to know the various environmental and genetic factors that may contribute to fractures. The most commonly used method is measuring the bone mineral density (BMD) of various bones, which is useful for determining the risk of developing osteoporotic fractures [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Proximal femoral geometric (PFG) parameters are independent parameters that can be used to evaluate the structure of bones, such as their shape and size, and they can be used to determine the risk factors, such as low BMD, for developing osteoporotic fractures [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Previous reports have demonstrated associations between hip geometry and hip fracture risk in patients, especially elderly patients and postmenopausal women [\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Although there is some disagreement, the hip axis length (HAL) and neck-shaft angle (NSA) have been shown to be increased in osteoporotic hip fractures [\u003cspan additionalcitationids=\"CR12 CR13 CR14\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. While several studies have focused on the relationship between PFG parameters and hip fractures, there is a limited number of studies investigating the relationship between PFG parameters and hip fracture types.\u003c/p\u003e \u003cp\u003eThe aim of this study was to determine the differences in PFG parameters between FNFs and ITFs in elderly patients. Furthermore, we attempted to identify why some patients with similar age and bone quality who suffer from low-energy trauma have FNFs and some have ITFs.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical approval\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective study was conducted in accordance with the Declaration of Helsinki and was approved by our hospital\u0026rsquo;s institutional review board. Informed consent was obtained from all patients prior to surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePatients\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom January 2018 to December 2018, 114 patients over 65 years of age who were admitted to the hospital with unilateral hip fractures after minor traumas, such as falls from a standing position or while walking, were included in the study. Of the 114 patients, 39 were male, and 75 were female with a mean age of 80.03 \u0026plusmn; 7.73 years and 82.12 \u0026plusmn; 7.28 years, respectively. The inclusion criteria were as follows: (1) age older than 65 years; (2) FNFs and ITFs; (3) unilateral fractures; (4) hip fractures caused by minor trauma; and (5) X‑ray films of the pelvis and proximal femur before and after operation with standard posture and sufficient quality. Patients with secondary fractures of the same hip; bilateral hip fractures; multiple fractures; pathological fractures; primary and secondary bone tumors; chemotherapy; radiotherapy; Paget\u0026rsquo;s disease; congenital dysplasia; and deformity of the femur and pelvis were excluded from the study. The medical records of the included patients were reviewed for characteristics such as age, gender, and the site of fracture using the hospital\u0026rsquo;s electronic medical record.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eRadiographic imaging and analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe digital imaging and communication medicine (DICOM) files were retrieved from the picture archiving and communication system (PACS) and transferred to the workstation for review; all measurements were performed digitally by an experienced orthopedic surgeon. The standard radiographic view for the pelvis was obtained in the anterior-posterior (AP) direction with the patient in the supine position. Patients with incorrect positions and inadequate diagnostic information were excluded.\u0026nbsp;The PFG parametres were measured from the normal side due to the broken anatomy of the fractured hip. Any asimetric hips were not included in the study.\u0026nbsp;The PFG parameters were measured for all fractures using a RadiAnt DICOM viewer on pelvic radiographs. The NSA, center-edge angle (CEA), femoral head diameter (FHD), femoral neck diameter (FND), femoral neck axial length (FNAL), femoral shaft diameter (FSD), and HAL were examined from the AP pelvic radiography as described in the literature (16).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe NSA is the angle between the derived axes of the femoral neck and shaft. The CEA is the angle between the midline of the femoral head to the outer edge of the acetabulum and the line through the vertical line of the femoral head. The FHD is defined as the maximum distance from the outer superior edge to the inner and inferior edge of the femoral head. The FND is the maximum distance from the superior to the inferior end of the femoral neck. The FNAL is defined as the junction of the lateral cortex of the femur and the apex of the femoral head with the anatomical axis of the femoral head and neck. The HAL is the distance from the greater trochanter to the inner pelvic brim with the anatomical axis of the femoral head and neck (Figure 1,2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStatistical analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analyses were performed using IBM SPSS Statistics, ver. 23 (IBM Corporation, Armonk, NY, USA). To compare the two independent groups, the Student t-test was used. The Chi-Square test was used to test categorical variables. A multivariate analysis of variance (MANOVA) was used to evaluate the influence of the PFG parameters on gender and fracture type and site. The data are expressed as mean \u0026plusmn; standard deviation (SD) and median (minimum\u0026ndash;maximum). A p-value equal to or less than 0.05 was considered statistically significant. The relative technical error of measurement (rTEM) method was used for the agreement between observations. According to the analysis results, the rTEM value was 2.58, and the reliability value was 92.1%, which showed that intraobserver compliance was quite high.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOf the 114 patients, 33 had FNFs (mean age: 80.48 \u0026plusmn; 7.57 years), and 81 had ITFs (mean age: 81.78 \u0026plusmn; 7.44 years). Of the 33 patients with FNFs, 13 (39.4%) were male (mean age: 80.69 \u0026plusmn; 7.18 years), and 20 (60.6%) were female (mean age: 80.35 \u0026plusmn; 7.99 years). Of the 81 patients with ITFs, 26 (32.1%) were male (mean age: 79.69 \u0026plusmn; 8.11 years), and 55 (67.9%) were female (mean age: 82.76 \u0026plusmn; 6.97 years). There were no statistically significant differences in age and gender between the FNF and ITF groups (p=0.40 and p=0.59, respectively).\u003c/p\u003e\n\u003cp\u003eThe PFG parameters of the hips of patients with FNFs and ITFs are shown in Table 1. The FNF group had larger NSAs, smaller CEAs, larger FHDs and FNDs, smaller FSDs, and greater FNALs and HALs compared to the ITF group. The FNF group had smaller NHRs, NHLR, and FSDs compared to the ITF group. There were no statistically significant differences in the PFG parameters between the FNF and ITF groups except in the NHLR (0.86 \u0026plusmn; 0.03 vs 0.84 \u0026plusmn; 0.03, p=0.05).\u003c/p\u003e\n\u003cp\u003eThe results of the multivariate analysis of the PFG parameters are shown in Table 2. Male patients had larger FHDs (58.7 \u0026plusmn; 3.9 vs 52.1 \u0026plusmn; 3.7 mm), FNDs (42.2 \u0026plusmn; 4.5 vs 37.1 \u0026plusmn; 4.3 mm), and FSDs (34.4 \u0026plusmn; 2.9 vs 32 \u0026plusmn; 3.1 mm) and greater HALs (132.4 \u0026plusmn; 12.4 vs 114.4 \u0026plusmn; 8.6 mm) and FNALs (110.3 \u0026plusmn; 10.4 vs 98.7 \u0026plusmn; 7.6 mm) compared to female patients. There was a significant difference in the PFG parameters between genders. Females had larger CEAs (39.22 \u0026plusmn; 7.11\u0026deg; vs 37.52 \u0026plusmn; 6.24\u0026deg;) and NHLRs (0.86 \u0026plusmn; 0.02 vs 0.83 \u0026plusmn; 0.02) compared to male patients. There was a significant difference in the CEA between genders. The NSAs in the male and female patients were 139.58 \u0026plusmn; 9.86\u0026deg; and 139.79 \u0026plusmn; 8.22\u0026deg;, respectively, and did not significantly differ. The NHRs in the male and female patients were 0.72 \u0026plusmn; 0.06 and 0.71 \u0026plusmn; 0.11, respectively, and did not significantly differ between genders. There were no statistically significant differences in fracture type interactions with gender, fracture site interactions with gender, or fracture type interactions with the fracture site. In addition, there were no statistically significant gender interactions with fracture type and site.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOsteoporotic hip fractures include FNFs and ITFs, and these fractures are extremely common in the elderly population [10]. However, many differences have been reported between FNFs and ITFs, such as etiology, risk factors, and patient characteristics [1].\u003csup\u003e\u0026nbsp;\u003c/sup\u003ePulkkinen et al. [17]\u003csup\u003e\u0026nbsp;\u003c/sup\u003ereported that FNFs predominate at the lowest structural mechanical strength levels, whereas ITFs are more common at high failure loads, and females are more prone to FNFs than males. Recent studies revealed that the PFG parameters can show the susceptibility to hip fractures independent of BMD [5].\u003csup\u003e\u0026nbsp;\u003c/sup\u003eBut, here, there were no statistically significant differences in age and gender between the FNF and ITF groups (p=0.40 and p=0.59, respectively).\u003c/p\u003e\n\u003cp\u003eLee et al. [5]\u003csup\u003e\u0026nbsp;\u003c/sup\u003eanalyzed the PFG parameters among 16 premenopausal women with minimal-trauma hip fractures and 80 age- and body mass index-adjusted controls. They revealed that a long hip axis and narrow NSA significantly increased fracture risk in a multiple logistic regression analysis using only the PFG parameters. They revealed that the HAL and NSA were BMD-independent predictors of hip fracture and hip geometry might be clinically useful\u0026nbsp;for the identification of\u0026nbsp;patients for whom active fracture prevention should be considered [5]. \u0026nbsp;Han et al. [10]\u003csup\u003e\u0026nbsp;\u003c/sup\u003eevaluated 197 women aged 65 years or older who had an osteoporotic hip fracture (FNF, 84 patients; ITF, 113 patients). A total of 551 women who visited the hospital to be tested for osteoporosis were included in the control group. The researchers measured the femur BMD and PFG parameters for all subjects and compared them between the control and fracture groups. They reported that there were no significant differences in the HAL and NSA between the control group and the fracture group. In our study, there were no significant differences between the FNF and ITF groups according to the HAL and NSA in the multivariate analysis, so our study revealed no significant relationship between the HAL or NSA and hip fracture type.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHu et al. [4]\u003csup\u003e\u0026nbsp;\u0026nbsp;\u003c/sup\u003ereported that the mean HAL of 101 patients with FNFs was 118.23 \u0026plusmn; 8.73 mm, and the HAL of 97 patients with ITFs was 119.97\u0026plusmn; 10.29 mm. In our study, the mean HAL of 33 patients with FNFs was 123.5 \u0026plusmn; 14.9 mm, and the HAL of 81 patients with ITFs was 119.3 \u0026plusmn; 12.3 mm,\u0026nbsp;but there were no statistically significant differences. We found that the hip axis was longer in the FNF group than in the ITF group, which contrasts the results from the study by Hu et al [4].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHu et al. [4] found that the mean NSA of the 101 patients with FNFs was 137.63\u0026nbsp;\u0026plusmn; 4.56\u0026deg;, and the mean NSA of the 97 patients\u0026nbsp;with ITFs of the femur was\u0026nbsp;132.07 \u0026plusmn; 4.17\u0026deg;, which was\u0026nbsp;significantly different. They suggested that a greater NSA was a risk factor for FNF [4]. In our study, the mean NSA of 33 patients with FNFs was\u0026nbsp;140.12 \u0026plusmn; 7.83\u0026deg;, and the NSA\u0026nbsp;of 81 patients with ITFs of the femur was\u0026nbsp;139.55 \u0026plusmn; 9.17\u0026deg;,\u0026nbsp;but there were no statistically significant differences between fracture type.\u003c/p\u003e\n\u003cp\u003eHan et al. [10]\u003csup\u003e\u0026nbsp;\u003c/sup\u003eshowed that femoral neck length (FNL)\u0026nbsp;was significantly greater in the control group than in the FNF group (P\u0026lt;0.001). However, there were no statistically significant differences in the FNL between the control group and the ITF group (P=0.722). In addition, they reported that the FNL between both fracture groups was significantly shorter in the FNF group than in the ITF and control groups [10].\u003csup\u003e\u0026nbsp;\u0026nbsp;\u003c/sup\u003eLu et al. [18]\u003csup\u003e\u0026nbsp;\u003c/sup\u003ereported that the FNAL of patients with ITFs of the femur was 90.68 mm, which was greater than that of the FNF group (88.64 mm). From the biomechanical point of view, the longer axis of the femoral neck causes the greater trochanter of the femur to protrude more, and thus, the possibility of ITF increases when an external force impacts the femoral trochanter. The long axis of the femoral neck and the high risk of proximal femoral fractures have been defined by most scholars [18]. The FNAL has an important role in internal fixation of the proximal femoral fracture and hip arthroplasty. Therefore, restoration of the normal FNAL prior to fracture has important clinical significance for accurate restoration of the normal hip geometric parameters and can improve hip function. In our study, the FNAL was longer in patients with femoral neck fractures (104.1 \u0026plusmn; 11.1 mm) than in patients with ITFs (102 \u0026plusmn; 9.9), but there were no statistically significant differences between fracture type.\u003c/p\u003e\n\u003cp\u003eHan et al. [10] revealed that the femoral neck width (FNW) in the control group was significantly smaller than that in the FNF and ITF groups. However, we found no significant differences in the FNAL and FND between the two groups in our study. They reported that after adjusting for age, weight, and height, the odds ratio (OR) for fractures in the FNF group increased depending on a decrease in the FNAL, cross-sectional area (CSA), and femur BMD and an increase in the FNW. Furthermore, they revealed that the OR for fractures increased depending on a decrease in the CSA in the femoral neck and femur BMD and an increase in the FNW in the ITF group [10]. They suggested that an increase in the FNW might be a PFG parameter that plays a significant role as a risk factor for fracture independent of BMD.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHu et al. [4] evaluated 198 elderly patients over 65 years of age with hip fractures (FNF, 101 patients; ITF, 97 patients). They reported that the CEA were higher in men than in women. Also, they revealed that there was no statistically significant difference in CEA between the gender, but greater CEA was the risk factor for ITFs. In here, CEA was larger in woman than in men and CEA was greater in ITF group than in the FNF group, compatible with the literature.\u003c/p\u003e\n\u003cp\u003eHu et al. [4]\u003csup\u003e\u0026nbsp;\u003c/sup\u003eshowed statistically significant differences in the NSA between the FNF group and the ITF group. They revealed that a greater NSA was a risk factor for FNF. In our study, the FNF group had a greater NSA when compared to the ITF group, compatible with the literature. Also, they revelaed that FND is greater in FNF group than the ITF group, with a statistically significant difference [4]. They claimed that greater FND was a protective factor for the ITF group. In our study, FND was greater in the FNF group than the ITF group, without statistically significant difference.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn our study, the FNF group had larger NSAs, smaller CEAs, larger FHDs and FNDs, smaller FSDs, and greater FNALs and HALs compared to the ITF group. The FNF group had smaller NHRs, NHLR, and FSDs compared to the ITF group. There were no statistically significant differences in the PFG parameters between the FNF and ITF groups except in the NHLR (0.86 \u0026plusmn; 0.03 vs 0.84 \u0026plusmn; 0.03, p=0.05).\u003c/p\u003e\n\u003cp\u003eThe limitation of this retrospective study is because of not having height, weight and BMI of the patients, the measurements could not be normalized.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn conclusion, we evaluated the differences in geometric morphological parameters of the proximal femur in different hip fracture types and gender. Only the NHLR was significantly higher in the ITF group, so this study revealed that a higher NHLR, which is the presence of a longer hip axis combined with a shorter neck axis, is a risk factor for ITF after a minor trauma.\u003c/p\u003e"},{"header":"List Of Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ePFG\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eProximal femoral geometric\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eFNF\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFemoral neck fractures\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eITF\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntertrochanteric fractures\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eNHLR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNeck/hip length ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eBMD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBone mineral density\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eHAL\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHip axis length\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eNSA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNeck-shaft angle\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eDICOM\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDigital imaging and communication medicine\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ePACS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePicture archiving and communication system\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eAP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnterior-posterior\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCEA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCenter-edge angle\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eFHD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFemoral head diameter\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eFND\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFemoral neck diameter\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eFNAL\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFemoral neck axial length\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eFSD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFemoral shaft diameter\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eMANOVA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMultivariate analysis of variance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003erTEM\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRrelative technical error of measurement\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eFNL\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFemoral neck length\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eFNW\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFemoral neck width\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eOR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOdds ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCSA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCross-sectional area\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eFT\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFracture Type\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eFS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFracture Site\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNo organization sponsored the research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eAll the data will be available upon motivated request to the corresponding author of the present paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThis study was approved by the institutional review board (approval no. TUEK 37-2019 BADK/8-64) of the Samsun Education and Research Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient consent for publication:\u003c/strong\u003e Informed consent was obtained from all patients prior to surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eIm GI, Lim MJ. Proximal hip geometry and hip fracture risk assessment in a Korean population. Osteoporos Int. 2011;22:803\u0026ndash;7. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00198-010-1301-7\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang YZ. A guide to hip fracture in adults. Chin J Surg. 2015;53:5762. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3760/cma.j.issn.0529-5815.2015.01.014\u003c/span\u003e\u003c/span\u003e. (in Chinese).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang YZ. Clinical Epidemiology of Orthopedic Trauma. New York: Thieme; 2012.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu ZS, Liu XL, Zhang YZ. Comparison of Proximal Femoral Geometry and Risk Factors between Femoral Neck Fractures and Femoral Intertrochanteric Fractures in an Elderly Chinese Population. Chin Med J. 2018;131:2524\u0026ndash;30. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/0366-6999.244118\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee DH, Jung KY, Hong AR, Kim JH, Kim KM, Shin CS, et al. Femoral geometry, bone mineral density, and the risk of hip fracture in premenopausal women: a case control study. BMC Musculoskelet Disord. 2016;17:42. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12891-016-0893-2\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSosa NH, Athanasiadis G, Malouf J, Laiz A, Marin A, Herrera S, et al. Genetic Contribution of Femoral Neck Bone Geometry to the Risk of Developing Osteoporosis: A Family-Based Study. PLoS One. 2016;11(5):e0154833. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0154833\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTurner CH. Bone strength: Current concepts. Ann N Y Acad Sci. 2006;1068:429\u0026ndash;46. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1196/annals.1346.039\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavison KS, Siminoski K, Adachi JD, Hanley DA, Goltzman D, Hodsman AB, et al. Bone strength: The whole is greater than the sum of its parts. Semin Arthritis Rheum. 2006;36(1):2231. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.semarthrit.2006.04.002\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan der Meulen MC, Jepsen KJ, Mikić B. Understanding bone strength: Size isn\u0026rsquo;t everything. Bone. 2001;29(2):101\u0026ndash;4. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/s8756-3282(01)00491-4\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHan J, Hahn MH. Proximal Femoral Geometry as Fracture Risk Factor in Female Patients with Osteoporotic Hip Fracture. J Bone Metab. 2016;23(3):175\u0026ndash;82. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.11005/jbm.2016.23.3.175\u003c/span\u003e\u003c/span\u003e. Epub 2016 Aug 31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDuboeuf F, Hans D, Schott AM, Kotzki PO, Favier F, Marcelli C, et al. Different morphometric and densitometric parameters predict cervical and trochanteric hip fracture: the EPIDOS Study. J Bone Miner Res. 1997;12(11):1895\u0026ndash;902. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1359/jbmr.1997.12.11.1895\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGregory JS, Aspden RM. Femoral geometry as a risk factor for osteoporotic hip fracture in men and women. Med Eng Phys. 2008;30(10):1275\u0026ndash;86. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.medengphy.2008.09.002\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGnudi S, Ripamonti C, Lisi L, Fini M, GiardinoR, Giavaresi G. Proximal femur geometry to detect and distinguish femoral neck fractures from trochanteric fractures in postmenopausal women. Osteoporos Int. 2002;13(1):69\u0026ndash;73. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s198-002-8340-2\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFaulkner KG, Cummings SR, Black D, Palmermo L, Gl\u0026uuml;er CC, Genant HK. Simple measurement of femoral geometry predicts hip fracture: the study of osteoporotic fractures. J Bone Miner Res. 1993;8(10):1211\u0026ndash;17. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/jbmr.5650081008\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCummings SR, Cauley JA, Palermo L, Ross PD, Wasnich RD, Black D, et al. Racial differences in hip axis lengths might explain racial differences in rates of hip fracture. Study of Osteoporotic Fractures Research Group. Osteoporos Int. 1994;4(4):226\u0026ndash;9. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/BF01623243\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePulkkinen P, Eckstein F, Lochmuller EM, Kuhn V, Jamsa T. Association of geometric factors and failure load level with the distribution of cervical vs. trochanteric hip fractures. J Bone Miner Res. 2006;21(6):895\u0026ndash;901. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1359/jbmr.060305\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePulkkinen P, Partanen J, Jalovaara P, Jamsa T. Combination of bone mineral density and upper femur geometry improves the prediction of hip fracture. Osteoporos Int. 2004;15(4):274\u0026ndash;80. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00198-003-1556-3\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLu YG, Hao YQ, Shi DW, Wang X. Evaluation of proximal femoral geometry with computerized tomography in patients with hip fragility fractures. Chin J Osteoporos. 2011;3:19598. (in Chinese).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eProximal femoral geometric parameters of the hips in patients with femoral neck fractures and intertrochanteric fractures.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFNF (n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eITF (n\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeck-Shaft Angle (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e140.12\u0026thinsp;\u0026plusmn;\u0026thinsp;7.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e139.55\u0026thinsp;\u0026plusmn;\u0026thinsp;9.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCenter-Edge Angle (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e37.34\u0026thinsp;\u0026plusmn;\u0026thinsp;5.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e39.16\u0026thinsp;\u0026plusmn;\u0026thinsp;7.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemoral Head Diameter (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e55.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e54\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemoral Neck Diameter (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e39.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e38.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeck/Head Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemoral Neck Axial Length (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e104.1\u0026thinsp;\u0026plusmn;\u0026thinsp;11.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e102\u0026thinsp;\u0026plusmn;\u0026thinsp;9.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemoral Shaft Diameter (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e32.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e32.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHip Axial Length (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e123.5\u0026thinsp;\u0026plusmn;\u0026thinsp;14.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e119.3\u0026thinsp;\u0026plusmn;\u0026thinsp;12.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeck/Hip Length Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eFNF: Femoral neck fracture, ITF: Intertrochanteric fracture\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate analysis of proximal geometric parameters\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGender *FT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGender* FS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFT*FS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eGender*FT*FS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeck-Shaft Angle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCenter-Edge Angle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemoral Head Diameter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemoral Neck Diameter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeck/Head Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemoral Neck Axial Length\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemoral Shaft Diameter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHip Axial Length\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeck/Hip Length Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eFT: Fracture Type, FS: Fracture Site (Left/ Right)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hip, Fracture, Geometric Parameters, Radiography, Elderly","lastPublishedDoi":"10.21203/rs.3.rs-859539/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-859539/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe aim of this study was to determine the differences in proximal femoral geometric (PFG) parameters between patients with femoral neck fractures(FNFs) and patients with intertrochanteric fractures (ITFs).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe retrospectively evaluated 114 patients (33 FNFs, 81 ITFs.) who were hospitalized secondary to hip fractures. Patients were divided into two groups: patients with FNFs and patients with ITFs. The PFG parameters (the neck shaft angle, center-edge angle, femoral head diameter, femoral neck diameter, neck/head ratio, femoral neck axial length, femoral shaft diameter, hip axial length, and neck/hip length ratio) were measured on the hip joint radiographs.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere were no statistically significant differences in age and gender between the FNF and ITF groups. In addition, there were no statistically significant differences in the PFG parameters between the FNF and ITF groups except in the neck/hip length ratio (NHLR) (0.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03 vs 0.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03, p\u0026thinsp;=\u0026thinsp;0.05). When a 3-way multivariate analysis was performed according to gender, fracture type, and fracture site, the femoral head diameter, femoral neck diameter, femoral neck axial length, femoral shaft diameter, hip axial length, and NHLR were found to be greater in females than in males, and a statistically significant relationship was found between gender and these variables.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eOnly the NHLR was significantly higher in the ITF group, so this study revealed that a higher NHLR, which is the presence of a longer hip axis combined with a shorter neck axis, is a risk factor for ITF after a minor trauma.\u003c/p\u003e","manuscriptTitle":"Does Proximal Hip Geometry Affect Fracture Type in The Elderly Population?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-09-14 16:10:04","doi":"10.21203/rs.3.rs-859539/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"14faf4ab-d548-46ef-9171-f2af3c2db964","owner":[],"postedDate":"September 14th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":7170442,"name":"Orthopedics"},{"id":7170443,"name":"Orthopedic Surgery"}],"tags":[],"updatedAt":"2023-02-15T16:29:28+00:00","versionOfRecord":[],"versionCreatedAt":"2021-09-14 16:10:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-859539","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-859539","identity":"rs-859539","version":["v1"]},"buildId":"cBFmMYwuxLRRLfASyISRj","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}