Cortical bone thickness on preoperative CT scans as predictor of bone quality in distal femur fractures: a retrospective study in Caucasians

TY - JOUR

T1 - Cortical bone thickness on preoperative CT scans as predictor of bone quality in distal femur fractures: a retrospective study in Caucasians

AU - Huppke, Calvin M

AU - Fahlbusch, Hendrik

AU - Frosch, Karl-Heinz

AU - Krause, Matthias

AU - von Rehlingen-Prinz, Fidelius

N1 - © 2023. The Author(s).

PY - 2024/2

Y1 - 2024/2

N2 - AIM: Distal femur fractures (DFF) are rare, but associated with high complication rates and mortality, particularly in patients with osteoporosis. To improve preoperative assessment, we analyzed if cortical bone thickness on CT and AP radiographs is associated with clinical parameters of bone quality.METHODS: Retrospective single-center study of adult patients presenting at a level-one trauma center, with a DFF between 2011 and 2020. Clinical parameters for bone quality, such as age, sex, body mass index (BMI), energy impact level of trauma, and known history of osteoporosis, were assessed. Mean cortical bone thickness (CBTavg) on AP radiograph was determined using a previously published method. Cortical thickness on CT scan was measured at 8 and 14 cm proximal to the articular surface of the lateral condyle.RESULTS: 71 patients (46 females) between 20 and 100 years were included in the study. Cortical thickness determined by CT correlated significantly with CBTavg measurements on AP radiograph (Spearman r = 0.62 to 0.80; p < 0.001). Cortical thickness was inversely correlated with age (Spearman r = - 0.341 to - 0.466; p < 0.001) and significantly associated with trauma impact level and history of osteoporosis (p =  < 0.001). The CT-based values showed a stronger correlation with the clinical parameters than those determined by AP X-ray.CONCLUSION: Our results showed that cortical thickness of the distal femur correlates with clinical parameters of bone quality and is therefore an excellent tool for assessing what surgical care should be provided. Interestingly, our findings indicate that cortical thickness on CT is more strongly correlated with clinical data than AP radiograph measurements.

AB - AIM: Distal femur fractures (DFF) are rare, but associated with high complication rates and mortality, particularly in patients with osteoporosis. To improve preoperative assessment, we analyzed if cortical bone thickness on CT and AP radiographs is associated with clinical parameters of bone quality.METHODS: Retrospective single-center study of adult patients presenting at a level-one trauma center, with a DFF between 2011 and 2020. Clinical parameters for bone quality, such as age, sex, body mass index (BMI), energy impact level of trauma, and known history of osteoporosis, were assessed. Mean cortical bone thickness (CBTavg) on AP radiograph was determined using a previously published method. Cortical thickness on CT scan was measured at 8 and 14 cm proximal to the articular surface of the lateral condyle.RESULTS: 71 patients (46 females) between 20 and 100 years were included in the study. Cortical thickness determined by CT correlated significantly with CBTavg measurements on AP radiograph (Spearman r = 0.62 to 0.80; p < 0.001). Cortical thickness was inversely correlated with age (Spearman r = - 0.341 to - 0.466; p < 0.001) and significantly associated with trauma impact level and history of osteoporosis (p =  < 0.001). The CT-based values showed a stronger correlation with the clinical parameters than those determined by AP X-ray.CONCLUSION: Our results showed that cortical thickness of the distal femur correlates with clinical parameters of bone quality and is therefore an excellent tool for assessing what surgical care should be provided. Interestingly, our findings indicate that cortical thickness on CT is more strongly correlated with clinical data than AP radiograph measurements.

KW - Adult

KW - Female

KW - Humans

KW - Retrospective Studies

KW - Bone Density

KW - Absorptiometry, Photon

KW - Femoral Fractures, Distal

KW - Osteoporosis

KW - Tomography, X-Ray Computed

KW - Cortical Bone

KW - Femur/diagnostic imaging

U2 - 10.1007/s00402-023-05131-2

DO - 10.1007/s00402-023-05131-2

M3 - SCORING: Journal article

C2 - 38049535

VL - 144

SP - 731

EP - 740

JO - ARCH ORTHOP TRAUM SU

JF - ARCH ORTHOP TRAUM SU

SN - 0936-8051

IS - 2

ER -