Introduction: The most widely accepted method for measuring bone mineral density (BMD) is Dual-energy X-ray Absorptionmetry (DXA). However, the need for relatively expensive equipment and trained personnel lower the accessibility of DXA as a routine screening tool. Plain pelvic X-ray radiography is a simple and inexpensive examination. In principal, the gray level of the bone in the X-ray radiograph is related to BMD. However, several factors render plain X-ray radiographs of the hip unsuitable for BMD measurements, mainly the variability in X-ray exposure levels and the soft tissue surrounding the bone. In this study, we aimed to develop new modifications of plain X-ray radiography of the proximal femur.

Patients and methods: The study population consisted of 18 women with an average age of 77 years (range 57–96 years) who were hospitalized due to a low-energy fracture of the neck of the femur. Each patient’s contralateral hip was radiographed with an aluminium step-wedge positioned near the hip as a standard reference, using a computerized radiography system. A DXA examination of the same hip followed the plain radiograph. On each radiograph, regions of interest (ROI) were determined in concordance with the ROI of the DXA examination. The mean gray level was measured for each ROI. The neck-shaft angle and the femoral head diameter were also measured.

Results: Comparing the gray levels of the plain radiograph with the BMD levels obtained by the DXA revealed a coefficient ratio of R=0.499. Correction of the gray levels using the step wedge as a standard reference revealed a ratio of R=0.576. If further correction was made with measurement of the soft tissue gray levels, a ratio of R=0.708 was obtained. Using the anatomical measurements (neck-shaft angle and femoral head diameter), a ratio of R=0.948 was obtained.

Conclusion: This study shows that a plain digital radiograph of the pelvis can provide valuable information concerning the bone mineral content of the proximal femur, which is comparable to the results of the DXA examination. Ultimately, the research can lead to the development of a fast, available and relatively inexpensive technique to diagnose osteoporosis.

Introduction: Minimally invasive surgery (MIS) is associated with reduced postoperative morbidity and faster recovery of function. The PerCutaneous Compression Plate (PCCP) device was recently developed by Got-fried as a MIS technique for the fixation of osteoporotic hip fractures. PCCP provides rotational stability by means of two hip screws, and lateral cortical support by a proximal extension of the plate and by the relatively small diameter (9.3 mm) of the hip screws. The purpose of this prospective study is to compare the outcome of PCCP to the “gold standard” Compression Hip Screw (CHS) device.

Methods: 104 Patients with intertrochanteric fractures were randomized to be treated by PCCP (50 patients) or CHS (53 patients). One patient was switched from PCCP to CHS during surgery. Inclusion criteria were age above 60, close fracture reduction, no pathological fracture, and no surgical procedure in the same leg in the last year.

Results: The groups were comparable in patient age, gender, ASA, length of surgery and hospital stay. Operative blood loss was 177.8 ml in the PCCP group and 371.3 ml in the CHS group (p< 0.0001). At the 6^th week clinic visit, patients in the PCCP group were able to bear more weight on the injured leg than patients in the CHS group (p< 0.03). Mortality during the first year follow-up period was 10% in the PCCP group and 24.5% in the CHS group (p~0.05). Analysis of X-ray radiographs revealed collapse in 4% of the patients in PCCP group and 19% in CHS group (p< 0.01).

Conclusions: Our results suggest that PCCP provides some of the advantages of MIS: reduced blood loss, as well as improves the stability of fracture fixation, demonstrated by improved early weight bearing and less fracture collapse. We found a trend for decreased first year mortality rate.