University of Oulu

Gebre, R.K., Hirvasniemi, J., Lantto, I. et al. Discrimination of Low-Energy Acetabular Fractures from Controls Using Computed Tomography-Based Bone Characteristics. Ann Biomed Eng 49, 367–381 (2021).

Discrimination of low-energy acetabular fractures from controls using computed tomography-based bone characteristics

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Author: Gebre, Robel K.1; Hirvasniemi, Jukka2; Lantto, Iikka3,4;
Organizations: 1Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
2Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
3Division of Orthopaedic and Trauma Surgery, Oulu University Hospital, Oulu, Finland
4Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
5Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.3 MB)
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Language: English
Published: Springer Nature, 2021
Publish Date: 2020-08-11


The incidence of low-energy acetabular fractures has increased. However, the structural factors for these fractures remain unclear. The objective of this study was to extract trabecular bone architecture and proximal femur geometry (PFG) measures from clinical computed tomography (CT) images to (1) identify possible structural risk factors of acetabular fractures, and (2) to discriminate fracture cases from controls using machine learning methods. CT images of 107 acetabular fracture subjects (25 females, 82 males) and 107 age-gender matched controls were examined. Three volumes of interest, one at the acetabulum and two at the femoral head, were extracted to calculate bone volume fraction (BV/TV), gray-level co-occurrence matrix and histogram of the gray values (GV). The PFG was defined by neck shaft angle and femoral neck axis length. Relationships between the variables were assessed by statistical mean comparisons and correlation analyses. Bayesian logistic regression and Elastic net machine learning models were implemented for classification. We found lower BV/TV at the femoral head (0.51 vs. 0.55, p = 0.012) and lower mean GV at both the acetabulum (98.81 vs. 115.33, p < 0.001) and femoral head (150.63 vs. 163.47, p = 0.005) of fracture subjects when compared to their matched controls. The trabeculae within the femoral heads of the acetabular fracture sides differed in structure, density and texture from the corresponding control sides of the fracture subjects. Moreover, the PFG and trabecular architectural variables, alone and in combination, were able to discriminate fracture cases from controls (area under the receiver operating characteristics curve 0.70 to 0.79). In conclusion, lower density in the acetabulum and femoral head with abnormal trabecular structure and texture at the femoral head, appear to be risk factors for low-energy acetabular fractures.

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Series: Annals of biomedical engineering
ISSN: 0090-6964
ISSN-E: 1573-9686
ISSN-L: 0090-6964
Volume: 49
Pages: 367 - 381
DOI: 10.1007/s10439-020-02563-4
Type of Publication: A1 Journal article – refereed
Field of Science: 3111 Biomedicine
Funding: Open access funding provided by University of Oulu including Oulu University Hospital. This study was financially supported by CINOP Global through the NICHE project NICHE/ETH/246 funded by EP-Nuffic (Netherlands). This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska Curie Grant Agreement No 707404.
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