Structural risk factors for low-energy acetabular fractures

Abstract In this study, we aimed to clarify proximal femur and acetabular structural risk factors associated with low-energy acetabular fractures in the elderly using three-dimensional (3D) computed tomography (CT). Pelvic bones and femurs were segmented and modeled in 3D from abdominopelvic CT images of 121 acetabular fracture patients (mean age 72 ± 12 years, range 50–98 years, 31 females and 90 males) and 121 age-gender matched controls with no fracture. A set of geometric parameters of the proximal femur and the acetabulum was measured. An independent-samples t-test or a Mann-Whitney U test was used for statistical analyses. The fractured side was used for proximal femur geometry, while the contralateral side was used for acetabular geometry. The neck shaft angle (NSA) was significantly smaller (mean 122.1° [95% CI 121.1°–123.2°] vs. 124.6° [123.6°–125.6°], p = 0.001) and the femoral neck axis length (FNALb) was significantly longer (78.1 mm [77.0–79.2 mm] vs. 76.0 mm [74.8–77.2 mm], p = 0.026) in the fracture group than in the controls when genders were combined. The NSA was significantly smaller both for females (120.2° [117.8°–122.6°] vs. 124.7° [122.5°–127.0°], p = 0.007) and for males (122.7° [121.5°–123.8°] vs. 124.6° [123.4°–125.7°], p = 0.006) in the fracture group. However, only males showed a significantly longer FNALb (80.0 mm [78.9–81.1 mm] vs. 77.8 mm [76.6–79.0 mm], p = 0.025). No statistically significant associations of acetabular geometry with fractures were found. However, the mean values of the acetabular angle of Sharp (34°), the lateral center-edge angle (40°), the anterior center-edge angle (62°), and the posterior center-edge angle (105°) indicated possible over-coverage. In conclusion, our findings suggest that proximal femur geometry is associated with low-energy acetabular fractures. Especially elderly subjects with an NSA smaller than normal have an increased risk of acetabular fractures