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Association between hip joint morphology and acetabular fracture in polytrauma patients: a CT-based case-control
Misagh Osquee Asanjani1, Arsalan Ranjbar2, Masoud Zeynalzadeh1
1Department of Orthopaedics, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran.
Background:
Acetabular fractures in non-osteoporotic adults result from high-energy trauma, yet not all patients with comparable pelvic impact sustain these injuries. Patient-specific acetabular morphology may influence fracture susceptibility by altering load transmission.
Methods:
We conducted a CT-based case-control study in adults aged 18-65 years after high-energy trauma. Cases were polytrauma patients with acetabular fractures; controls were polytrauma patients with clear pelvic trauma but without acetabular, pelvic-ring, or sacral fractures. Measured CT parameters included anterior/posterior/superior acetabular sector angles (AASA, PASA, SASA), acetabular anteversion, acetabular width/depth, and medial acetabular wall thickness. Derived ratios (e.g., AASA/SASA) were analyzed. Group comparisons used Mann-Whitney tests; logistic regression estimated odds ratios (ORs).
Results:
Among 84 patients (47 cases, 37 controls), cases demonstrated higher AASA (66.86° ± 9.40 vs 60.46° ± 7.25; p = 0.0007), lower acetabular anteversion (15.26° ± 4.30 vs 19.35° ± 5.94; p = 0.0009), and thinner medial acetabular wall (5.55 ± 1.13 mm vs 6.27 ± 1.22 mm; p = 0.0068). Key ratios including AASA/SASA (0.538 ± 0.075 vs 0.486 ± 0.056; p = 0.0004) and wall/depth (0.160 ± 0.033 vs 0.180 ± 0.029; p = 0.0018) also differed significantly. In multivariable analysis, each 1° increase in anteversion was associated with lower fracture odds (OR 0.854; 95% CI 0.753-0.968; p = 0.0135), and each 1 mm increase in wall thickness was associated with ~ 47% lower odds (OR 0.534; 95% CI 0.342-0.834; p = 0.0058). A ratio-based model yielded similar findings.
Conclusions:
In non-osteoporotic polytrauma patients, lower acetabular anteversion and reduced medial acetabular wall thickness are independently associated with acetabular fracture, while increased relative anterior coverage (AASA/SASA) further stratifies risk. These CT-measurable morphologic factors may help explain individual fracture susceptibility after comparable trauma exposure.
