Morphological Assessment of Proximal Femoral Radiography Prior to Subsequent Hip fracture in Elderly: Comparison between Femoral Neck and Intertrochanteric Fracture

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Witit Pothong
Nath Adulkasem


Background: Subsequent contralateral fragility hip fracture (SCHF) is a significant issue in aging population. Morphological assessment of proximal femoral radiography correlates with bone density before treatment or surgery.

Objective: To investigate the differences of radiographic morphologic parameters of proximal femur between subsequence contralateral fragility femoral neck fracture (FNF) and intertrochanteric fracture (ITF).

Material and methods: A retrospective cohort study was conducted among unilateral fragility hip fracture patients who underwent surgical treatment in Lamphun Hospital between January 2016 to December 2021 and had SCHF. Anteroposterior radiographs of both hips taken at the time of the initial hip fracture were used to determine the canal-calcar ratio (CCR), cortical thickness index (CTI), canal flare index (CFI) and morphological cortical index (MCI) of the non-fracture site. Baseline characteristics and radiographic morphologic parameters were compared between the subsequence contralateral FNF group and ITF group. Univariable logistic regression analysis was employed to determine the odds ratio of the morphologic parameters to predict the SCHF event.

Results: There were 424 patients enrolled in the study and 47 (11.1%) experienced SCHF. Among these, 33 cases (70.2%) were in ITF group and 14 cases (29.8%) were in FNF group. There was no significant difference between the two groups in any of the radiographic morphologic parameters. In patients who developed subsequent contralateral FNF, CFI <3.0 showed the highest odds ratio (OR 23.4, 95% CI 6.3–86.9). CTI <0.56 in male and <0.62 in male demonstrated the perfect prediction in all patients who sustained  subsequent contralateral ITF.

Conclusion: In elderly hip fractures, the radiologic morphologic parameters (CTI, CFI, CCR, MCI) had no difference between subsequent contralateral FNF and ITF. The parameter with the greatest odds ratio in patients with FNF was CFI <3.0. CTI 0.56 in males and 0.62 in males were the parameters seen in all patients with subsequent contralateral ITF.


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Pothong, W., & Adulkasem, N. . (2023). Morphological Assessment of Proximal Femoral Radiography Prior to Subsequent Hip fracture in Elderly: Comparison between Femoral Neck and Intertrochanteric Fracture. Lampang Medical Journal, 44(1), 1–8. Retrieved from
Original Article


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