Late postoperative analysis of the tip-apex distance (TAD) in pertrochanteric fractures: is there an accommodation of the implant within the bone?

Aihara, Leandro Jun; Nanni, Rafael Augusto; Carvalho, Marina Sousa; Zamboni, Caio; Durigan, Jorge Rafael; Neto, José Soares Hungria; Mercadante, Marcelo Tomanik; Christian, Ralph Walter; Hungria, José Octávio Soares

doi:10.1016/s0020-1383(17)30776-3

Cited by 5 publications

(5 citation statements)

References 19 publications

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“…These findings have an important impact on clinical practice. Aihara et al suggested the importance of advocating weight-bearing restrictions in those patients at high risk of cut-out 31 . Pending validation and further studies, the new TAD and CalTAD cut-offs we propose would seem to be a safer and more selective method for the establishment of weight-bearing and mobilization restrictions, allowing these restrictions to be imposed on a smaller patient cohort.…”

Section: Discussionmentioning

confidence: 99%

New tip-apex distance and calcar-referenced tip-apex distance cut-offs may be the best predictors for cut-out risk after intramedullary fixation of proximal femur fractures

Caruso,

Corradi,

Caldaria

et al. 2022

Sci Rep

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Cut-out is one of the most common mechanical failures in the internal fixation of trochanteric hip fractures. The tip-apex distance (TAD), and the calcar-referenced tip apex distance (CalTAD) are the radiographic parameters that most predict the risk of cut-out. The optimal CalTAD value has not yet been defined, but the optimal TAD value is reported as 25 mm or less. However, this cut-off is highly specific but poorly sensitive. The aim of this study was to determine highly specific and sensitive TAD and CalTAD values and shed light on the role of other clinical variables. A total of 604 patients were included in this retrospective cross-sectional study. For each patient the following data were recorded: number of cut-out, AO/OTA classification, quality of the reduction, type of nail, cervicodiaphyseal angle, type of distal locking, post-operative weight-bearing, TAD and CalTAD values, and the position of the screw head in the femoral head according to the Cleveland system. The incidence of cut-out across the sample was 3.1%. The median TAD in the cut-out group was 38.72, while in the no cut-out group it was 22.16. The median CalTAD in the cut-out group was 39.34, while in the no cut-out group it was 22.19. The cut-off values for TAD and CalTAD with highest value of sensitivity and specificity for the risk of cut-out were 34.8 and 35.2, respectively. The incidence of cut-out can be reduced by performing careful minimal reduction and ensuring stable fixation by avoiding TAD > 34.8 mm and CalTAD > 35.2 mm.

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Section: Discussionmentioning

confidence: 99%

New tip-apex distance and calcar-referenced tip-apex distance cut-offs may be the best predictors for cut-out risk after intramedullary fixation of proximal femur fractures

Caruso,

Corradi,

Caldaria

et al. 2022

Sci Rep

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show abstract

“…These ndings have an important impact on clinical practice. Aihara et al suggested the importance of advocating weight-bearing restrictions in those patients at high risk of cut-out [34]. Pending validation, the new TAD and CalTAD cut-offs we propose would seem to be a safer and more selective method for the establishment of weight-bearing and mobilization restrictions, allowing these restrictions to be imposed on a smaller patient cohort.…”

Section: Discussionmentioning

confidence: 83%

Which TAD and CALTAD Cut-Offs Best Predict Cut-Out Risk for Intramedullary Fixation of Proximal Femur Fractures?

Caruso¹,

Corradi²,

Caldaria³

et al. 2021

Preprint

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Purpose: Cut-out is one of the most common mechanical failures in the internal fixation of trochanteric hip fractures. The tip-apex distance (TAD), and the calcar-referenced tip apex distance (CalTAD) are the radiographic parameters that most predict the risk of cut-out. The optimal CalTAD value has not yet been defined, but the optimal TAD value is reported as 25 mm or less. However, this cut-off is highly specific but poorly sensitive. The aim of this study was to determine highly specific and sensitive TAD and CalTAD values and shed light on the role of other clinical variables.Methods: A total of 604 patients were included in this retrospective cross-sectional study. For each patient the following data were recorded: number of cut-out, AO/OTA classification, quality of the reduction, type of nail, cervicodiaphyseal angle, type of distal locking, post-operative weight-bearing, TAD and CalTAD values, and the position of the screw head in the femoral head according to the Cleveland system.Results: The incidence of cut-out across the sample was 3.1%. The median TAD in the cut-out group was 38.72, while in the no cut-out group it was 22.16. The median CalTAD in the cut-out group was 39.34, while in the no cut-out group it was 22.19. The cut-off values for TAD and CalTAD with highest value of sensitivity and specificity for the risk of cut-out were 34.8 and 35.2, respectively. Conclusions: The incidence of cut-out can be reduced by performing careful minimal reduction and ensuring stable fixation by avoiding TAD>34.8mm and CalTAD>35.2 mm.

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“…TADs larger than 25 mm have been shown to serve as an accurate indicator of future protrusion of a lag screw through the femoral head (cut-out) 58. The TAD has been shown to be reproducible to within 2–3 mm between measurements57 59 and highlighted to change by 2–3 mm over time 60. A change in TAD of more than 10 mm has therefore been selected as a reference level which represents failure of the IM device to maintain fracture stability.…”

Section: Methods and Analysismentioning

confidence: 99%

Proximal Femoral Nail Unlocked versus Locked (ProFNUL): a protocol for a multicentre, parallel-armed randomised controlled trial for the effect of femoral nail mode of lag screw locking and screw configuration in the treatment of intertrochanteric femur fractures

et al. 2020

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IntroductionIntertrochanteric fractures are common fragility injuries in the elderly. Surgical fixation using intramedullary devices are one of the widely used management options. To date, evidence demonstrating the effects of lag screw configuration and the mode of lag screw locking in these devices is lacking. The purpose of this study is to investigate whether the lag screw configuration (single vs integrated dual interlocking screw) and the mode of lag screw locking (static vs dynamic) of a femoral nail device result in differences in clinical and functional outcomes.Methods and analysisA multicentre, pragmatic, single-blinded randomised controlled trial (RCT) with a three-arm parallel group design is proposed. Nine-hundred patients with intertrochanteric fractures (A1 and A2 AO/OTA) will be randomised to fracture treatment using a Gamma3 nail (Stryker; proximally dynamic) or a Trigen Intertan nail (Smith & Nephew) in a dynamic or static lag screw configuration. The primary outcome measure consists of radiological evidence of construct failure within 6 months following surgery, with failure being defined as breakage of the femoral nail or distal locking screw, a change in tip-apex distance of more than 10 mm or lag screw cut-out through the femoral head. Secondary outcomes include surgical data (operation time, fluoroscopy time), complications (surgical site infection, reoperation, patient death), return to mobility and home circumstances, functional independence, function and pain. Patients who are able to walk independently with or without a mobility aid and are able to answer simple questions and follow instructions will be asked to participate in three dimensional gait analysis at 6 weeks and 6 months to assess hip biomechanics from this cohort. Additional secondary measures of gait speed, hip range of motion, joint contact and muscle forces and gross activity monitoring patterns will be obtained in this subgroup.Ethics and disseminationThe Central Adelaide Local Health Network Human Research Ethics Committee has approved the protocol for this RCT (HREC/17/RAH/433). The results will be disseminated via peer-reviewed publications and presentations at relevant conferences.Trial registration numberACTRN12618001431213.

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Late postoperative analysis of the tip-apex distance (TAD) in pertrochanteric fractures: is there an accommodation of the implant within the bone?

Cited by 5 publications

References 19 publications

New tip-apex distance and calcar-referenced tip-apex distance cut-offs may be the best predictors for cut-out risk after intramedullary fixation of proximal femur fractures

New tip-apex distance and calcar-referenced tip-apex distance cut-offs may be the best predictors for cut-out risk after intramedullary fixation of proximal femur fractures

Which TAD and CALTAD Cut-Offs Best Predict Cut-Out Risk for Intramedullary Fixation of Proximal Femur Fractures?

Proximal Femoral Nail Unlocked versus Locked (ProFNUL): a protocol for a multicentre, parallel-armed randomised controlled trial for the effect of femoral nail mode of lag screw locking and screw configuration in the treatment of intertrochanteric femur fractures

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