International orthopaedics · 2026
Preoperative magnetic resonance imaging biomarkers of soft tissue injury and their association with postoperative outcomes in intertrochanteric femoral fractures: A retrospective study.
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Wu Jingwei, Wang Peng, Lu Shibao
Аннотация
BACKGROUND: Intertrochanteric fractures of the femur are often accompanied by soft tissue injuries, but their impact on postoperative functional recovery remains unclear. Preoperative magnetic resonance imaging (MRI) can accurately assess the state of soft tissues, but the independent prognostic value of relevant imaging biomarkers still requires high-quality evidence for verification.
OBJECTIVE: To explore the association between the biomarkers of soft tissue injury evaluated by preoperative MRI in patients with intertrochanteric femoral fractures and the postoperative functional outcomes, to screen the key imaging predictors, and to construct a robust predictive model.
METHODS: A retrospective analysis was conducted on patients with intertrochanteric femoral fractures who underwent surgical treatment at our hospital from January 1, 2023 to December 31, 2024. The patients were divided into the favourable prognosis group (≥ 80 points) and the unfavourable prognosis group (< 80 points) based on the Harris score at one year postoperative follow-up. Propensity score matching (1:1, cut-off value = 0.02) was used to balance the age, gender, fracture type, underlying diseases, waiting time for surgery, and internal fixation method between the two groups. After matching, 64 cases were included in each group (a total of 128 cases). Preoperative MRI examinations included: the ratio of fat infiltration area of the gluteus minimus muscle; the depth grading of the tear of the gluteus medius muscle; the relative signal intensity ratio of oedema of the femoral quadratus muscle; the continuous score of the posterior medial support complex injury; the maximum diameter of the bursa of the greater trochanter; the volume of haematoma of the fascia latae muscle; and the grading of injury of the obturator internus muscle fascia. Variables with p < 0.10 were selected for multivariate Logistic regression analysis using the backward stepwise method, and independent risk factors were identified. The multicollinearity (VIF < 5) was tested to ensure the stability of the model. The discrimination was evaluated by the receiver operating characteristic curve (ROC), and the calibration was evaluated by the Hosmer-Lemeshow test. Sensitivity analysis (changing the matching ratio and conducting 1000 Bootstrap resampling) was performed to verify the robustness of the results, and the interaction test was used to explore whether there were synergistic or antagonistic effects among the biomarkers.
RESULTS: The baseline data of the two groups after PSM were balanced and comparable (p > 0.05). Multivariate analysis showed that the ratio of fat infiltration area in the gluteus minimus muscle (OR = 3.24, 95% CI: 1.58-6.65, p = 0.001), the relative signal intensity ratio of femoral quadratus muscle oedema (OR = 2.87, 95% CI: 1.33-6.18, p = 0.007), and the continuous score of the posterior medial support complex injury (OR = 4.05, 95% CI: 1.92-8.54, p < 0.001) were independent risk factors for poor postoperative prognosis. The area under the curve of the prediction model combining these three indicators was 0.87 (95% CI: 0.80-0.93), with good calibration (Hosmer-Lemeshow p = 0.62), which was significantly better than a single indicator. The interaction analysis did not find any significant synergistic effect among these variables (p > 0.05).
CONCLUSION: The preoperative MRI assessment of fat infiltration in the gluteus minimus muscle, oedema in the quadratus femoris muscle, and injury to the posterior medial support complex are key imaging biomarkers for predicting the functional prognosis of femoral intertrochanteric fractures. Combined assessment can effectively predict the prognosis and provide a basis for early risk stratification.
OBJECTIVE: To explore the association between the biomarkers of soft tissue injury evaluated by preoperative MRI in patients with intertrochanteric femoral fractures and the postoperative functional outcomes, to screen the key imaging predictors, and to construct a robust predictive model.
METHODS: A retrospective analysis was conducted on patients with intertrochanteric femoral fractures who underwent surgical treatment at our hospital from January 1, 2023 to December 31, 2024. The patients were divided into the favourable prognosis group (≥ 80 points) and the unfavourable prognosis group (< 80 points) based on the Harris score at one year postoperative follow-up. Propensity score matching (1:1, cut-off value = 0.02) was used to balance the age, gender, fracture type, underlying diseases, waiting time for surgery, and internal fixation method between the two groups. After matching, 64 cases were included in each group (a total of 128 cases). Preoperative MRI examinations included: the ratio of fat infiltration area of the gluteus minimus muscle; the depth grading of the tear of the gluteus medius muscle; the relative signal intensity ratio of oedema of the femoral quadratus muscle; the continuous score of the posterior medial support complex injury; the maximum diameter of the bursa of the greater trochanter; the volume of haematoma of the fascia latae muscle; and the grading of injury of the obturator internus muscle fascia. Variables with p < 0.10 were selected for multivariate Logistic regression analysis using the backward stepwise method, and independent risk factors were identified. The multicollinearity (VIF < 5) was tested to ensure the stability of the model. The discrimination was evaluated by the receiver operating characteristic curve (ROC), and the calibration was evaluated by the Hosmer-Lemeshow test. Sensitivity analysis (changing the matching ratio and conducting 1000 Bootstrap resampling) was performed to verify the robustness of the results, and the interaction test was used to explore whether there were synergistic or antagonistic effects among the biomarkers.
RESULTS: The baseline data of the two groups after PSM were balanced and comparable (p > 0.05). Multivariate analysis showed that the ratio of fat infiltration area in the gluteus minimus muscle (OR = 3.24, 95% CI: 1.58-6.65, p = 0.001), the relative signal intensity ratio of femoral quadratus muscle oedema (OR = 2.87, 95% CI: 1.33-6.18, p = 0.007), and the continuous score of the posterior medial support complex injury (OR = 4.05, 95% CI: 1.92-8.54, p < 0.001) were independent risk factors for poor postoperative prognosis. The area under the curve of the prediction model combining these three indicators was 0.87 (95% CI: 0.80-0.93), with good calibration (Hosmer-Lemeshow p = 0.62), which was significantly better than a single indicator. The interaction analysis did not find any significant synergistic effect among these variables (p > 0.05).
CONCLUSION: The preoperative MRI assessment of fat infiltration in the gluteus minimus muscle, oedema in the quadratus femoris muscle, and injury to the posterior medial support complex are key imaging biomarkers for predicting the functional prognosis of femoral intertrochanteric fractures. Combined assessment can effectively predict the prognosis and provide a basis for early risk stratification.