Computed tomography-derived muscle metrics and functional outcomes after proximal femoral nailing in older women with intertrochanteric fractures

Fatih Erdem; Mustafa Çeltik

doi:10.19161/etd.1962939

TR EN

Yaşlı kadın hastalarda intertrokanterik femur kırığı sonrası proksimal femoral çivileme: BT-türevli kas parametreleri ile fonksiyonel sonuçların ilişkisi

Abstract

Amaç: İntertrokanterik femur kırığı nedeniyle proksimal femoral çivi (PFN) ile tedavi edilen 65 yaş ve üzeri kadın hastalarda bilgisayarlı tomografi (BT) ile ölçülen psoas, gluteus maksimus ve gluteus medius-minimus kaslarının kesitsel alan (KA) ve radyolojik dansite (Hounsfield ünitesi, HU) değerlerinin postoperatif fonksiyonel skorlarla ilişkisini incelemektir. Gereç ve Yöntem: İntertrokanterik femur kırığı nedeniyle PFN ile tedavi edilen 65 yaş ve üzeri 63 kadın hasta retrospektif olarak incelendi. BT ölçümleri standart aksiyel kesitlerde elle çizim yöntemiyle yapıldı. Fonksiyonel değerlendirmede Fonksiyonel Ambulasyon Sınıflaması (FAC), Parker Mobilite Skoru, Barthel İndeksi ve Modifiye Harris Kalça Skoru (mHHS) kullanıldı. Analizler önceden tanımlanmış analiz planındaki 24 karşılaştırma için Benjamini-Hochberg FDR düzeltmeli Spearman korelasyonu, yaş ve ASA için düzeltilmiş HC3 sağlam doğrusal regresyon ve klinik anlamlı eşiklerde ROC eğrisi altında kalan alan (AUC) analizlerini içerdi. Bulgular: Ortanca yaş 74 yıl (ÇAA 67,5-82,0); ortanca takip 9 ay. Gluteus maksimus KA, Barthel (rho=0,34, p=0,007) ve FAC (rho=0,30, p=0,015) ile pozitif korelasyon gösterdi. Eksploratuvar gluteal KA kompoziti Barthel ile benzer veya hafif daha güçlü ilişki gösterdi (rho=0,35, p=0,005). Gluteus maksimus KA, FAC≥4 ayırımında AUC=0,71 (%95 GA 0,55-0,85); gluteus medius-minimus KA, Barthel≥90 ayırımında AUC=0,73 (0,60-0,85). FDR düzeltmesinden sonra hiçbir ilişki anlamlı kalmadı. Yaş, ASA ve kırık öncesi ambulasyona eklendiğinde gluteal KA kompozitinin inkremental R²'si yalnızca %0,5-2,2 idi. Sonuç: BT-türevli gluteal kas miktarı, PFN sonrası fonksiyonel iyileşme ile en tutarlı nominal ilişkiyi gösteren parametreydi; ancak FDR düzeltmesi sonrası hiçbir ilişki anlamlı kalmadı ve rutin klinik prediktörlerin ötesindeki inkremental değeri sınırlıydı. Önerilen kesim noktaları hipotez oluşturucu niteliktedir ve prospektif doğrulama gerektirir.

Keywords

Computed tomography-derived muscle metrics and functional outcomes after proximal femoral nailing in older women with intertrochanteric fractures

Abstract

Aim: To examine whether computed tomography (CT)-derived cross-sectional area (CSA) and radiodensity (Hounsfield units, HU) of the psoas, gluteus maximus, and gluteus medius-minimus are associated with postoperative function in women aged ≥65 years treated with a proximal femoral nail (PFN) for intertrochanteric fracture. Materials and Methods: Sixty-three women aged ≥65 years undergoing PFN fixation for intertrochanteric fracture were analyzed retrospectively. Muscle measurements were obtained on standardized axial CT slices by manual tracing. Function was assessed with the Functional Ambulation Classification (FAC), Parker Mobility Score, Barthel Index, and modified Harris Hip Score (mHHS). Analyses included Spearman correlations with Benjamini-Hochberg false discovery rate (FDR) correction (24 comparisons in a predefined plan), HC3 robust linear regression adjusted for age and ASA, and area under the receiver-operating-characteristic curve (AUC) at clinically meaningful thresholds. Results: The median age was 74 years (IQR 67.5-82.0); median follow-up nine months. Gluteus maximus CSA correlated with Barthel (rho=0.34, p=0.007) and FAC (rho=0.30, p=0.015); an exploratory gluteal CSA composite showed a slightly stronger correlation with Barthel (rho=0.35, p=0.005). Gluteus maximus CSA discriminated community ambulators (FAC≥4) with AUC=0.71 (95% CI 0.55-0.85), and gluteus medius-minimus CSA discriminated Barthel≥90 with AUC=0.73 (0.60-0.85). No association survived FDR correction. Added to age, ASA, and pre-fracture ambulation, the gluteal CSA composite contributed only 0.5-2.2% incremental R². Conclusions: CT-derived gluteal muscle quantity showed the most consistent nominal association with function after PFN, but no association survived FDR correction and incremental value beyond routine clinical predictors was limited. The proposed cut-offs are hypothesis-generating and require prospective validation.

Keywords

References

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Details

Primary Language

English

Subjects

Radiology and Organ Imaging

Journal Section

Research Article

Authors

Fatih Erdem ^*
0000-0001-9228-2866
Türkiye

Mustafa Çeltik
0000-0002-0517-6684
Türkiye

Publication Date

September 3, 2026

Submission Date

June 3, 2026

Acceptance Date

July 30, 2026

Published in Issue

Year 2026 Volume: 65 Number: 3

DOI

https://doi.org/10.19161/etd.1962939

IZ

https://izlik.org/JA59JW89PJ

Cite

RIS / Bibtex

APA

Erdem, F., & Çeltik, M. (2026). Computed tomography-derived muscle metrics and functional outcomes after proximal femoral nailing in older women with intertrochanteric fractures. Ege Tıp Dergisi, 65(3), 581-592. https://doi.org/10.19161/etd.1962939

AMA

1.Erdem F, Çeltik M. Computed tomography-derived muscle metrics and functional outcomes after proximal femoral nailing in older women with intertrochanteric fractures. EJM. 2026;65(3):581-592. doi:10.19161/etd.1962939

Chicago

Erdem, Fatih, and Mustafa Çeltik. 2026. “Computed Tomography-Derived Muscle Metrics and Functional Outcomes After Proximal Femoral Nailing in Older Women With Intertrochanteric Fractures”. Ege Tıp Dergisi 65 (3): 581-92. https://doi.org/10.19161/etd.1962939.

EndNote

Erdem F, Çeltik M (September 1, 2026) Computed tomography-derived muscle metrics and functional outcomes after proximal femoral nailing in older women with intertrochanteric fractures. Ege Tıp Dergisi 65 3 581–592.

IEEE

[1]F. Erdem and M. Çeltik, “Computed tomography-derived muscle metrics and functional outcomes after proximal femoral nailing in older women with intertrochanteric fractures”, EJM, vol. 65, no. 3, pp. 581–592, Sept. 2026, doi: 10.19161/etd.1962939.

ISNAD

Erdem, Fatih - Çeltik, Mustafa. “Computed Tomography-Derived Muscle Metrics and Functional Outcomes After Proximal Femoral Nailing in Older Women With Intertrochanteric Fractures”. Ege Tıp Dergisi 65/3 (September 1, 2026): 581-592. https://doi.org/10.19161/etd.1962939.

JAMA

1.Erdem F, Çeltik M. Computed tomography-derived muscle metrics and functional outcomes after proximal femoral nailing in older women with intertrochanteric fractures. EJM. 2026;65:581–592.

MLA

Erdem, Fatih, and Mustafa Çeltik. “Computed Tomography-Derived Muscle Metrics and Functional Outcomes After Proximal Femoral Nailing in Older Women With Intertrochanteric Fractures”. Ege Tıp Dergisi, vol. 65, no. 3, Sept. 2026, pp. 581-92, doi:10.19161/etd.1962939.

Vancouver

1.Fatih Erdem, Mustafa Çeltik. Computed tomography-derived muscle metrics and functional outcomes after proximal femoral nailing in older women with intertrochanteric fractures. EJM. 2026 Sep. 1;65(3):581-92. doi:10.19161/etd.1962939