The predictive value of proximal femoral CT attenuation in intramedullary fixation failure of intertrochanteric fractures: a retrospective cohort analysis.

UNLABELLED: This study investigated whether low hip bone density (as measured by CT scans) can predict implant failure in hip fracture patients undergoing nail fixation. Based on an analysis of 143 cases, patients with CT Hounsfield units below 27.6 HU had a significantly higher risk of failure. This preoperative metric offers a quantifiable tool to guide surgical decisions and improve outcomes in patients with fragile bones.

PURPOSE: To determine whether reduced proximal femoral computed tomography (CT) Hounsfield units constitute an independent risk factor for internal fixation failure after intramedullary nail fixation for intertrochanteric fractures.

METHODS

In this retrospective cohort study, patients who underwent intramedullary fixation for intertrochanteric fractures were categorized into fixation failure and non-failure groups on the basis of follow-up outcomes. Demographic, clinical, and imaging parameters were analyzed, with a focus on proximal femoral CT values measured in Hounsfield units (HU). Logistic regression models were employed to identify independent risk factors, while receiver operating characteristic (ROC) curve analysis established optimal CT value thresholds for predicting failure.

RESULTS

Among the 143 enrolled patients, 21 (14.7%) developed fixation failure. Compared with the control group, the failure group exhibited significantly lower proximal femoral CT Hounsfield units (14.6(19.4) HU vs. 46.9(37.3) HU; P < 0.001). Multivariate analysis demonstrated that each 1 HU increase in CT value reduced the risk of failure by 5.1% (P < 0.001). ROC analysis revealed 27.6 HU as the optimal predictive threshold, yielding 81% sensitivity and 86% specificity.

CONCLUSION

Proximal femoral CT Hounsfield units below 27.6 HU significantly predict internal fixation failure in patients with intertrochanteric fractures treated with intramedullary nails, providing a quantifiable preoperative risk assessment tool.