ArticleJournal of orthopaedic surgery and research2026
Measurement of the principal compressive trabeculae in the midcoronal plane of proximal femur and its significance in lag screw fixation.
Article in Journal of orthopaedic surgery and research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundWith the development of osteoporosis, the principal compressive trabeculae (PCT) of proximal femur is preferentially retained and regarded as the main loadbearing structure of the femoral head. However, the significance of PCT in lag screw fixation has not been clarified. MATERIALS AND
methodsThe CT data of intact proximal femurs from 93 elderly patients were reconstructed with a personalized threshold segmentation method. The midcoronal plane of proximal femur was established, in which the PCT contour was extracted, and the analytical screw-tracts were created. The relative CT values of PCT in different screw-tracts were compared. The relationship between PCT and lag screws was analyzed by measuring the effective anchoring length (EAL), the maximum screwing depth (MSD) and the upper edge length (UEL) in each screw-tracts.
resultsContinuous PCT contours were extracted in the midcoronal plane from all models. The relative CT value of the upper PCT (1.59 ± 0.21) was significantly lower than that of the middle and lower PCT (1.94 ± 0.32 and 1.92 ± 0.36, respectively). The mean EAL of the upper screw-tract was 20.79 ± 2.71 mm, which was significantly higher than that of the middle and lower screw-tracts (19.52 ± 3.19 mm and 19.10 ± 4.51 mm, respectively). The mean MSD of the lower screw-tract was 36.96 ± 3.62 mm, which was significantly higher than that of the upper and middle screw-tracts (22.52 ± 2.98 mm and 31.40 ± 2.80 mm, respectively). The mean UEL of the middle screw-tract was 22.46 ± 4.76 mm, which was significantly higher than that of the upper and lower screw-tracts (14.26 ± 4.02 mm and 19.81 ± 3.87 mm, respectively). Strong correlations were found between the patient's height and the MSD of the middle and lower screw-tracts (R = 0.543 and R = 0.568 respectively).
conclusionsFor the elderly, the PCT is the main load-bearing structure between the femoral head and neck, and should be regarded as the target for lag screw fixation. Both the middle and lower PCT can provide ideal screw-tracts for lag screw fixation. In order to obtain the maximum anchoring strength, the upper positioned lag screw should be placed deep, while the lower positioned should be placed shallow.
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