Structural asymmetry between the hips and its relation to experimental fracture type.

Abstract:

:Experimental analysis with paired femurs provides the opportunity to study within-person differences in fracture type and associated structural side differences. We hypothesized that different fracture types in the hips of a subject are associated with structural asymmetry. Bone mineral density (BMD) and structural measurements of paired cadaver femurs (32 females, 24 males) were performed before mechanical testing in a side-impact configuration. Fractures were classified (cervical or trochanteric) and differences in structural parameters, BMD, and failure load were evaluated between the left and right hips as well as between experimental fracture types. We observed larger dimensions (P < 0.05-0.01), thicker cortices (P < 0.05-0.001), and a smaller femoral shaft diameter (FSD) (P < 0.01) in the left hip than in the right. Seventeen pairs (30.4%) had trochanteric fractures on one side and cervical on the contralateral side. The asymmetric trochanteric fracture side had a higher head/neck diameter ratio (HD/ND) (P < 0.05) and a trend toward a lower neck-shaft angle (NSA) (P = 0.066) than its collateral cervical side in females and a lower HD and higher FSD (P < 0.05) in males. In females, asymmetric fracture cases displayed lower NSA (P < 0.001) and HD/ND (P < 0.01) than symmetric cervical ones. In males, asymmetric fracture cases showed larger dimensions than the other groups (P < 0.05-0.01). BMD increased from symmetric cervical to asymmetric and then to symmetric trochanteric cases (P < 0.05-0.01), with the experimental failure load showing a similar trend. In conclusion, intrasubject structural asymmetry is associated with asymmetric fracture types. Asymmetry should be considered when using the opposite side as control in clinical studies.

journal_name

Calcif Tissue Int

authors

Thevenot J,Pulkkinen P,Kuhn V,Eckstein F,Jämsä T

doi

10.1007/s00223-010-9388-6

subject

Has Abstract

pub_date

2010-09-01 00:00:00

pages

203-10

issue

3

eissn

0171-967X

issn

1432-0827

journal_volume

87

pub_type

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