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Radiographic Thigh Muscle Measurements Are Independently Associated with 1-Year
Mortality Following Hip Fracture Surgery
#MMPMID41262432
Laane DWPM
; Wagner RK
; Wignakumar T
; Hu R
; Di Stefano MT
; Aydin F
; van Rossum du Chattel A
; González MR
; Mariyampillai M
; Kwon K
; Mandell J
; van der Velde D
; Weaver MJ
JB JS Open Access
2025[Oct]; 10
(4
): ? PMID41262432
show ga
BACKGROUND: Geriatric hip fractures remain associated with significant mortality
and morbidity. Identifying factors associated with such outcomes is an important
step for improvement of prognostication and supporting individualized care.
Sarcopenia is a known risk factor for mortality and thigh muscle measurements on
plain radiographs can serve as a proxy measure of sarcopenia. Therefore, the
objective was to determine whether radiographic thigh muscle measurements were
independently associated with 1-year mortality following hip fracture surgery.
METHODS: All consecutive patients aged 70 years or older undergoing operative
treatment for an isolated hip fracture at 2 urban Level 1 trauma centers between
2018 and 2020 with preoperative radiographs displaying the distal-and-middle
femur were included. Thigh muscle diameter and soft tissue size was measured on
anteroposterior and lateral radiographs using standardized anatomical landmarks.
Multivariable logistic regression was performed to determine if there were
independent associations with 1-year mortality for the variables assessed.
Inter-rater reliability for each measurement was evaluated by calculating
intraclass correlation coefficients (ICCs). RESULTS: One hundred ninety-nine
patients (median age 85 years, 68% female) were included. One-year mortality was
22%. After adjusting for age, sex, smoking status, preinjury living situation,
Charlson Comorbidity Index, frailty, and body mass index, a greater thigh muscle
diameter on anteroposterior radiographs was associated with lower odds of 1-year
mortality (adjusted odds ratio 0.74, 95% confidence interval 0.56-0.97, p =
0.028). There was no significant association with thigh muscle diameter on
lateral radiographs or with total soft tissue diameter on anteroposterior or
lateral radiographs. The ICCs demonstrated good-to-excellent reliability for all
radiographic measurements. CONCLUSION: Greater thigh muscle diameter measured on
anteroposterior radiographs was independently associated with decreased 1-year
mortality following hip fracture surgery, with each centimeter increase in
diameter being associated with an average reduction in odds of 26%. This finding
should be interpreted in the context of the limited sample size, homogenous
patient population, and range of observed thigh muscle sizes. Overall, these
results suggest that radiographic parameters may potentially serve to complement
currently used modalities, such as frailty assessment, in supporting
individualized care. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions
for Authors for a complete description of levels of evidence.
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