ORIGINAL RESEARCH article
Front. Surg.
Sec. Orthopedic Surgery
This article is part of the Research TopicNavigating Uncertainty in Polytrauma and Associated Spine InjuriesView all 3 articles
Association Between Spinopelvic Parameters and Clinical Outcomes Following Hip Fracture: An Observational Retrospective Study
Provisionally accepted
- 1Istanbul Kartal Dr.Lutfi Kirdar Education and Research Hospital, Istanbul, Türkiye
- 2Fatih Sultan Mehmet Egitim ve Arastirma Hastanesi, Istanbul, Türkiye
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Background: Femoral neck fractures carry a substantial risk of complications such as varus malalignment, avascular necrosis and the need for reoperation. While traditional prognostic factors have been extensively studied, the relevance of postoperative spinopelvic characteristics after internal fixation remains unclear. This study evaluated whether spinopelvic parameters measured on standardized postoperative radiographs are associated with adverse outcomes. Methods: Ninety-six patients aged 18 to 60 years who underwent internal fixation for femoral neck fractures were analysed. Demographic variables, fracture characteristics, fixation type and postoperative complications were recorded retrospectively. Sacral slope, pelvic tilt, pelvic incidence and sacral slope difference were measured on lateral lumbosacral radiographs obtained at the six month follow-up. Associations with varus deformity, avascular necrosis and reoperation were assessed using univariable and multivariable logistic regression. Results: Sacral slope difference demonstrated consistent associations with all major complications. Patients with higher sacral slope difference had significantly greater rates of varus deformity, avascular necrosis and reoperation. Higher pelvic tilt was associated with avascular necrosis, and higher pelvic incidence was associated with reoperation. Several multivariable analyses met exploratory criteria due to limited events per variable, and these results should be interpreted with caution. Interobserver reliability for all spinopelvic measurements was excellent. Conclusions: Spinopelvic parameters, particularly sacral slope difference, were associated with key complications after internal fixation of femoral neck fractures. These postoperative measurements may help identify patients who could benefit from closer follow-up, although they should not be interpreted as predictive factors. Prospective studies are required to validate these associations and clarify their clinical relevance. Level of Evidence Retrospective cohort study, Level III
Keywords: Femoral neck fracture, Pelvic incidence, PelvicTilt, Sacral slope, Sacral slope difference, spinopelvic parameters
Received: 28 Oct 2025; Accepted: 10 Feb 2026.
Copyright: © 2026 Süleyman Abul, Sevim, Hekim, Kayaalp and Eceviz. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Omer Faruk Sevim
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