Can radiographs of hip fractures predict subsequent hip fractures? A shape modeling analysis

David Neilly, Sameer K Khan (Corresponding Author), Jennifer S Gregory, Richard M Aspden, James D Hutchison, David J Deehan

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Introduction The geometrical shape of the proximal femur has previously been shown to predict primary hip fractures. Hip fractures are routinely diagnosed on plain radiographs of the pelvis, and these have both hips viewable. We have investigated if statistical shape modelling of the uninvolved hip on plain radiographs, at the time of the first hip fracture episode, could predict a subsequent ‘second fracture’ on that (uninvolved) side. Materials and methods 60 radiographs taken at the time of the index hip fracture were blinded and separated into two arms; patients sustaining one hip fracture only (n = 30), and those who went on to sustain a second fracture (n = 30), over the three-year follow-up period. Two separate shape models were used for these groups and compared using t-tests or Mann–Whitney U-tests, along with Cohen's d to measure the effect size of each measure. Results We found no statistically significant difference in the shape of the femur between the first fracture and second fracture group (p > 0.05) and no results reached a “medium” effect size (Cohen's d <0.5). Conclusions Shape modelling is feasible and can be applied in the routine clinical setting. However, we were unable to elucidate any predictive value in this relatively small sample. A reliable radiograph-based method of identifying patients at risk of second fracture would be of value in planning prevention, service provision, and cost analysis. Further work is required and a study with more patients might exclude the type 2 error in our work.
Original languageEnglish
Pages (from-to)1543-1546
Number of pages4
Issue number7
Early online date2 May 2016
Publication statusPublished - Jul 2016

Bibliographical note

Conflict of interest statement
The authors do not have any conflict of interests to declare.


  • Hip fracture
  • Radiographs
  • Shape modelling


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