Proximal femoral morphometry and its association with hip fracture patterns: a systematic review with meta-analysis

Clinical Snapshot

Key Findings

• P Value: Multiple significant associations: p < 0.001 for neck-shaft angles and Wiberg angles; p = 0.012-0.048 for various parameters

• Effect Size: Not reported - only statistical significance provided

• Primary Outcome: Association between proximal femoral morphometry and hip fracture patterns

• Nnt Or Sensitivity: Angular parameters (neck-shaft angle, Wiberg angle) provided most robust fracture pattern stratification

• Confidence Interval: Not reported

Clinical Application

High - uses standard anteroposterior radiographs available in all Australian healthcare settings Highly relevant given Australia's ageing population and high hip fracture rates. Could inform TGA-approved imaging protocols and support RACGP guidelines for fracture risk assessment. May complement PBS-funded bone density scanning Elderly patients at risk of hip fractures, particularly those undergoing radiographic assessment

Abstract

PURPOSES: Proximal femoral fractures (PFFs) represent a major cause of morbidity and mortality in the elderly population. Beyond bone mineral density, proximal femoral (PF) and hip joint (HJ) morphometry have been implicated in fracture susceptibility and fracture pattern. However, the relative contribution of individual geometric parameters remains incompletely defined. The purpose of this study was to systematically evaluate the association between PF and HJ morphometry and hip fracture (HF) patterns, and to assess the predictive value of radiographic morphometric parameters derived from standard anteroposterior radiographs. MATERIALS AND METHODS: A systematic review with meta-analysis was conducted in accordance with PRISMA guidelines. PubMed and MEDLINE databases were searched up to September 2025 for observational studies reporting radiographic morphometric parameters in patients with unilateral PFFs. Statistical meta-analysis was performed with random-effect models to compare intracapsular-ICF/subcapital-SCF fractures with intertrochanteric (ITF) and extracapsular (ECF) fracture patterns. RESULTS: Twenty-two studies comprising 4184 patients (77.8% female; pooled mean age 77.4 years) were included. Meta-analysis using a random-effects model revealed that ITF were significantly associated with a smaller femoral head diameter (p < 0.001) and increased medial neck cortex thickness (p = 0.021) compared with ICF. ECF demonstrated significantly longer femoral neck axis length (p = 0.012), increased horizontal offset (p = 0.048), smaller absolute offset (p = 0.026) and shorter hip axis length (p = 0.026) than ICFs. Angular parameters provided the most robust stratification. ITFs and ECFs exhibited significantly lower (more varus) neck-shaft angles (p < 0.001) and significantly higher Wiberg angles (p < 0.001) compared with the ICF group. CONCLUSIONS: PF and HJ morphometry are associated with distinct HF patterns, independently of bone mineral density. Simple linear and angular measurements obtained from standard anteroposterior radiographs may assist fracture pattern stratification, risk assessment, and preoperative planning in elderly patients.

References

1. 1.Kotzias, D., Giovanoulis, V., Koutserimpas, C., Triantafyllou, G., Veizi, E., Arkoudis, N. A., Tsakotos, G., Troupis, T., & Piagkou, M. (2026). Proximal femoral morphometry and its association with hip fracture patterns: a systematic review with meta-analysis. Surgical and Radiologic Anatomy, Article 03113-8. https://doi.org/10.1007/s00068-026-03113-8