Correlation Between Proximal Femoral Cortical Index,Cortical Thickness And Senile Femoral Intertrochanteric Fracture

Objective: To retrospectively analyze the relationship between the stable of senile intertrochanteric fractures and the proximal femoral cortical thickness,proximal femoral cortical index(FCI),alkaline phosphatase(ALP),and healthy neck shaft angle(NSA).Explore the biological mechanism of the stability of senile intertrochanteric fractures and provide new ideas for clinical research.Methods: Retrospective analysis of 69 patients with senile intertrochanteric fractures who met the inclusion criteria in the First Affiliated Hospital of Hainan Medical College from January 2015 to December 2018.First,according to the Tronzo-Evans method,the type I and II are defined as stable group(group A),and type III,type IV and type V are unstable group(group B).There are 24 patients in group A,11 males and 13 females,aged 66-87 years old,with an average of 77.7±6.6 years old.There are 45 patients in group B,20 males and 25 females,aged 76-89 years,with an average of 81.4±3.8 years old.The width of the proximal femur and the width of the medullary cavity were measured by the pelvic anteroposterior.The thickness of the proximal femur was obtained by subtracting the two values.The FCI is the ratio of the thickness of the proximal femur and the width of the proximal femur.In order to reduce the influence of external rotation deformity on the measurement results after intertrochanteric fracture,the data of the FCI and the proximal femoral cortical thickness were measured by X-ray films after fracture reduction.The NSA of the patient’s healthy side was measured through the pelvic anterior piece and measured three times in succession.The differences of FCI、cortical thickness、NSA and ALP in the proximal femur between the A group and B group are compared.Correlation analysis was performed between FCI、femoral cortical thickness and patient age.The differences in FCI and proximal femoral cortical thickness were compared before and after fracture reduction in 69 patients.Results: In 69 cases,group A: the proximal femur cortical thickness of the patient’s affected side is 15.30±3.08 mm,the proximal femur cortical thickness of the patient’s healthy side is 15.70±3.10 mm,the FCI of the affected side is 0.51±0.07,the FCI of the healthy side is 0.51±0.08,and the NSA is 134.38±5.89°,ALP is 92.86±22.67U/L,Group B: the thickness of the proximal femur of the patient’s affected side is15.30±2.56 mm,the thickness of the proximal femur the patient’s healthy side is15.31±2.67 mm,the FCI of the affected side is 0.46±0.08,the FCI of the healthy side is 0.48±0.08,and the NSA is 135.46±5.33°,ALP is 108.82±34.82 U/L.In the group A,the FCI is larger than those of in group B,the difference was statistically significant(P<0.05);There was no significant difference in the cortex thickness of the affected side between group A and B(P>0.05).The ALP value of group A is smaller than that of group B,the difference was statistically significant(P<0.05);There was no significant difference in the healthy FCI、the thickness of the proximal femur cortex and NSA between the two groups(P>0.05).There were no significant differences in bilateral FCI and proximal femoral cortical thickness between 69 fracture patients(P>0.05),the FCI and proximal femoral cortical thickness measured before fracture reduction were significantly smaller than those measured after reduction(P<0.05).There was a negative correlation between the patient’s age and the FCI.Conclusion:1.FCI is significantly different between fracture stability group and non-stable group,which can be used as an important reference index for predicting the risk of senile intertrochanteric fracture.2.There was no significant relationship between the FCI and the proximal femoral cortical thickness with fracture stability.The fracture stability of the patient cannot be analyzed by the measured data of the contralateral side.3.There was no significant difference in the FCI and the thickness of proximal femoral cortex between the two sides of the affected patients.External rotation deformity after intertrochanteric fractures will have a greater impact on the cortical judgment on X-ray films.Care should be taken to avoid misjudgment in clinical work.4.There is a negative correlation between FCI and age.As the age increases,FCI gradually decreases.5.There is no significant correlation between NSA and fracture stability.ALP is positively correlated with fracture stability.The more unstable the fracture,the higher the ALP value.