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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Risk modeling of femoral neck fracture based on geometric parameters of the proximal epiphysis
Anna D Shitova, Olga N Kovaleva, Anna V Olsufieva, Inchekhanum A Gadzhimuradova, Dmitry D Zubkov, Mikhail O Kniazev, Tatyana S Zharikova, Yury O Zharikov
Anna D Shitova, Inchekhanum A Gadzhimuradova, Dmitry D Zubkov, International School “Medicine of the Future”, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Moscow, Russia
Olga N Kovaleva, Tatyana S Zharikova, Yury O Zharikov, Department of Human Anatomy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Moscow, Russia
Anna V Olsufieva, Department of Biomedical Disciplines of the Faculty of Medicine, Nonstate Educational Private Institution of Higher Education "Moscow Financial and Industrial University “Synergy”, Moscow 125190, Moscow, Russia
Mikhail O Kniazev, Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Moscow, Russia
Author contributions: Shitova AD, Zubkov DD, Gadzhimuradova IA and Kniazev MO are responsible for measurement of bone parameters; Shitova AD, Olsufieva AV, Zubkov DD, Gadzhimuradova IA and Kniazev MO are responsible for data collection and analysis; Shitova AD, Olsufieva AV, Zubkov DD, Gadzhimuradova IA and Zharikova TS did the literature review; Shitova AD and Zubkov DD graphing in AutoCad2018; Zharikova TS created the figures; Kovaleva ON and Zharikov YO: project manager and scientific advisor.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the I.M. Sechenov First Moscow State Medical University (Sechenov University).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis of the X-ray images and anonymous clinical data that were obtained after each patient agreed to treatment by written consent. Cadaver material (70 femurs) was bequeathed to the Department of Human Anatomy by people and their relatives from 20 to 35 years ago, when these objects were designated for educational purposes for morphological departments.
Conflict-of-interest statement: All authors report no relevant conflict of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Yury O Zharikov, MD, PhD, MBA, Associate Professor, Department of Human Anatomy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Mokhovaya Street 11, p. 10, Moscow 125009, Moscow, Russia. dr_zharikov@mail.ru
Received: September 23, 2021
Peer-review started: September 23, 2021
First decision: December 2, 2021
Revised: December 12, 2022
Accepted: July 26, 2022
Article in press: July 26, 2022
Published online: August 18, 2022
BACKGROUND
Fractures of the proximal femur epiphysis are problematic for state health care because they are associated with severe medical and social problems and high morbidity and mortality rates.
AIM
To model the potential risk of hip fracture via femur geometric parameters.
METHODS
Seventy educational cadaveric femurs from people aged 14 to 80 years, 10 X-ray images from the records of the Human Anatomy Department and 10 X-ray images from the Department of Traumatology, Orthopedics and Disaster Surgery of Sechenov University, were evaluated. The parameters of the fractured bone were measured using images captured with a Canon d60 camera. The projection values of the proximal epiphysis of the cadaveric femurs and geometric parameters of the bones shown in the X-ray images were measured with Autodesk software (AutoCAD 2018). Analysis of the video frames showing bone rotation reveal that the greater trochanter can be inscribed in a parallelepiped, where one of the faces is parallel to the plane of view in the frontal standard projection and is rectangular. The angle of bone rotation obtained by turning the cube corresponded to the angle measured with the second technique. This reliable method of calculating the rotation of the bone relative to the anterior projection was employed in subsequent calculations. The geometric parameters of the femur were measured using X-ray images according to the proposed method.
RESULTS
The geometric parameters of 70 femurs were analyzed, and correlation coefficients were calculated. Our measurement results were compared with those reported by other authors. The potential influence of femur geometry on force distribution in the proximal epiphysis of the femur was described, and a 2-dimensional model of the femur epiphysis associated with minimal neck fracture risk was provided. The assessment of the geometric parameters of the femoral epiphysis indicated the greatest risk of a varus fracture of the neck if the angle of the minimal resistance zone (AMRZ) index > 24° and the neck-shaft angle (NSA) < 127.5°. In contrast, the minimum risk was observed at AMRZ < 14° and NSA > 128.87°.
CONCLUSION
The proposed method provides the potential femur neck fracture risk based on geometric parameters.
Core Tip: The neck-shaft angle (NSA) and angle of the minimal resistance zone [the area located in Ward's triangle (AMRZ)] were most associated with femoral neck fracture risk, and a method for calculating the true value of these parameters and risk stratification was developed. Assessment of the geometric parameters of the femoral epiphysis revealed the greatest risk of a varus fracture of the neck if the AMRZ index > 24° and NSA < 127.5°. In contrast, the minimum risk was observed at AMRZ < 14° and NSA > 128.87°.
