Could the HU value of the femoral head be used to distinguish between different types of hip fracture, and to predict the severity of intertrochanteric fractures？

Background As the global population ages, hip fractures have become a significant public health concern. Although computed tomography (CT)-derived Hounsfield units (HU) offer a new perspective for assessing bone density, their value in predicting hip fracture type and stability remains unclear. This study aims to investigate whether femoral head Hounsfield unit (HU) values can distinguish between femoral neck and intertrochanteric fractures, and whether they can be used to predict the complexity of intertrochanteric fractures. Methods A total of 234 hip fracture patients (117 with femoral neck fractures and 117 with intertrochanteric fractures) were selected based on inclusion and exclusion criteria. The mean HU value of the femoral head was measured on preoperative CT images. Based on the AO/OTA classification, intertrochanteric fractures were categorized as either stable (A1.1-A2.1) or unstable (A2.2-A3). Statistical comparisons were performed using independent-samples t-tests, chi-square tests and analysis of variance. Results No significant difference in overall HU values was observed between the femoral neck fracture group and the intertrochanteric fracture group. However, within the intertrochanteric fracture subgroup, HU values for unstable fractures were significantly lower than for stable fractures. Mean HU values were significantly higher in male patients than in females, with this difference persisting in both stable and unstable fracture groups. The subgroup with the lowest bone density was female patients with unstable fractures. Conclusion Although femoral head HU values cannot distinguish between femoral neck and intertrochanteric fractures, they can be used to predict intertrochanteric fracture stability and identify high-risk patients.