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Background <p>With 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.</p> Materials and methods <p>The 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.</p> Results <p>Continuous 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&#xa0;mm, which was significantly higher than that of the middle and lower screw-tracts (19.52 ± 3.19&#xa0;mm and 19.10 ± 4.51&#xa0;mm, respectively). The mean MSD of the lower screw-tract was 36.96 ± 3.62&#xa0;mm, which was significantly higher than that of the upper and middle screw-tracts (22.52 ± 2.98&#xa0;mm and 31.40 ± 2.80&#xa0;mm, respectively). The mean UEL of the middle screw-tract was 22.46 ± 4.76&#xa0;mm, which was significantly higher than that of the upper and lower screw-tracts (14.26 ± 4.02&#xa0;mm and 19.81 ± 3.87&#xa0;mm, respectively). Strong correlations were found between the patient’s height and the MSD of the middle and lower screw-tracts (<i>R</i> = 0.543 and <i>R</i> = 0.568 respectively).</p> Conclusions <p>For 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.</p>

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Measurement of the principal compressive trabeculae in the midcoronal plane of proximal femur and its significance in lag screw fixation

  • 期刊论文

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  • 发表日期：

    2026年3月3日

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  • Xuedong Bai,
  • Weilu Gao,
  • Changsen Yang,
  • Hao Zhang,
  • Jiantao Li

摘要

Background

With 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 methods

The 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.

Results

Continuous 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).

Conclusions

For 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.