Association of CT-Derived Psoas Muscle Parameters and Trochanteric Subcutaneous Fat Thickness With Intertrochanteric Fracture Stability in Older Adults
Abstract
Background Unstable intertrochanteric femur fractures are associated with increased morbidity and more complex surgical management than stable fractures. Although computed tomography (CT)-derived body composition parameters have been linked to frailty, mortality, and hip fracture risk, their association with fracture stability remains unclear. This study aimed to investigate the relationship between CT-derived psoas muscle measurements, trochanteric subcutaneous fat thickness, and fracture stability in older adults with intertrochanteric fractures. Methods This retrospective cohort study included 154 patients aged ≥65 years who underwent surgery for intertrochanteric femur fractures following low-energy same-level falls between January 2021 and January 2024. Fractures were classified as stable (31-A1) or unstable (31-A2/A3) according to the AO/OTA classification. Total psoas muscle cross-sectional area (CSA), psoas muscle attenuation, and trochanteric subcutaneous fat thickness were measured on preoperative CT images. Multivariate logistic regression was performed after adjustment for age, sex, body mass index (BMI), and Charlson Comorbidity Index (CCI). Results Seventy-five patients (48.7%) had stable fractures and 79 (51.3%) had unstable fractures. Compared with the stable group, patients with unstable fractures had significantly lower trochanteric subcutaneous fat thickness, total psoas CSA, and psoas muscle attenuation (all p < 0.001). In multivariate analysis, subcutaneous fat thickness (OR=0.888, 95% CI: 0.841–0.937; p< 0.001), total psoas CSA (OR=0.809, 95% CI: 0.701–0.932; p=0.003), and psoas muscle attenuation (OR=0.886, 95% CI: 0.816–0.962; p=0.004) were significantly associated with fracture instability. Age, sex, BMI, and CCI were not significantly associated with fracture instability. Conclusion Lower trochanteric subcutaneous fat thickness, reduced total psoas muscle CSA, and lower psoas muscle attenuation were associated with unstable intertrochanteric fracture patterns in older adults. These findings highlight the potential role of trochanteric subcutaneous fat thickness and psoas muscle characteristics in fracture instability.
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BibTeX
@article{dadir2026association,
title = {{Association of CT-Derived Psoas Muscle Parameters and Trochanteric Subcutaneous Fat Thickness With Intertrochanteric Fracture Stability in Older Adults}},
author = {İbrahim Halil Dadir MD and İsmail Duran MD and Adnan Arslan MD and Yunus Oklu MD and Yunus Can Ünal MD and Ömer Faruk Yıldırım MD},
journal = {Geriatric Orthopaedic Surgery \& Rehabilitation},
year = {2026},
month = oct,
doi = {10.1177/21514593261499010},
url = {https://doi.org/10.1177/21514593261499010},
note = {CC BY},
}
RIS
TY - JOUR
TI - Association of CT-Derived Psoas Muscle Parameters and Trochanteric Subcutaneous Fat Thickness With Intertrochanteric Fracture Stability in Older Adults
AU - İbrahim Halil Dadir MD
AU - İsmail Duran MD
AU - Adnan Arslan MD
AU - Yunus Oklu MD
AU - Yunus Can Ünal MD
AU - Ömer Faruk Yıldırım MD
PY - 2026
DA - 2026/10/24
JO - Geriatric Orthopaedic Surgery & Rehabilitation
DO - 10.1177/21514593261499010
UR - https://doi.org/10.1177/21514593261499010
AB - Background Unstable intertrochanteric femur fractures are associated with increased morbidity and more complex surgical management than stable fractures. Although computed tomography (CT)-derived body composition parameters have been linked to frailty, mortality, and hip fracture risk, their association with fracture stability remains unclear. This study aimed to investigate the relationship between CT-derived psoas muscle measurements, trochanteric subcutaneous fat thickness, and fracture stability in older adults with intertrochanteric fractures. Methods This retrospective cohort study included 154 patients aged ≥65 years who underwent surgery for intertrochanteric femur fractures following low-energy same-level falls between January 2021 and January 2024. Fractures were classified as stable (31-A1) or unstable (31-A2/A3) according to the AO/OTA classification. Total psoas muscle cross-sectional area (CSA), psoas muscle attenuation, and trochanteric subcutaneous fat thickness were measured on preoperative CT images. Multivariate logistic regression was performed after adjustment for age, sex, body mass index (BMI), and Charlson Comorbidity Index (CCI). Results Seventy-five patients (48.7%) had stable fractures and 79 (51.3%) had unstable fractures. Compared with the stable group, patients with unstable fractures had significantly lower trochanteric subcutaneous fat thickness, total psoas CSA, and psoas muscle attenuation (all p < 0.001). In multivariate analysis, subcutaneous fat thickness (OR=0.888, 95% CI: 0.841–0.937; p< 0.001), total psoas CSA (OR=0.809, 95% CI: 0.701–0.932; p=0.003), and psoas muscle attenuation (OR=0.886, 95% CI: 0.816–0.962; p=0.004) were significantly associated with fracture instability. Age, sex, BMI, and CCI were not significantly associated with fracture instability. Conclusion Lower trochanteric subcutaneous fat thickness, reduced total psoas muscle CSA, and lower psoas muscle attenuation were associated with unstable intertrochanteric fracture patterns in older adults. These findings highlight the potential role of trochanteric subcutaneous fat thickness and psoas muscle characteristics in fracture instability.
SN - 2151-4593
SN - 2151-4585
ER -