Risk factors for cut-out of double lag screw fixation in proximal femoral fractures

Büyükdoğan, Kadir; Çağlar, Ömür; Isik, Samet; Tokgözoğlu, Mazhar; Atilla, Bülent

doi:10.1016/j.injury.2016.11.018

Cited by 36 publications

(25 citation statements)

References 32 publications

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“…None of these variables displayed a significant statistical correlation with cut-out in the multivariate statistical analysis. Similar results were also found in other recent studies, suggesting that these variables are still able to increase the risk of cut-out, but only if associated with stronger predictive factors 14 , 28 – 30 .…”

Section: Discussionsupporting

confidence: 90%

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: Discussionsupporting

confidence: 90%

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

“…That being said, none of these variables displayed a signi cant statistical correlation with cut-out in the multivariate statistical analysis. Similar results were also found in other recent studies, suggesting that these variables are still able to increase the risk of cutout, but only if associated with stronger predictive factors [14,[24][25][26].…”

Section: Discussionsupporting

confidence: 90%

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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“…Implant failure has a major impact on mortality and morbidities among elderly individuals with intertrochanteric fractures [9]. Although many studies have focused on risk factors for implant failure in intertrochanteric fractures, most of these studies focused on unstable fractures [7, 10, 11]. Unstable fractures include some AO/OTA 31-A2 and A3 fractures; however, AO/OTA 31-A3 fractures have unique biomechanical characteristics distinct from other intertrochanteric fractures [2, 12].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for implant failure in reverse oblique and transverse intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA)

et al. 2019

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BackgroundThe incidence of intertrochanteric hip fracture is expected to increase as the global population ages. It is one of the most important causes of mortality and morbidities in the geriatric population. The incidence of reverse oblique and transverse intertrochanteric (AO/OTA 31-A3) fractures is relatively low; however, the incidence of implant failure in AO/OTA 31-A3 fractures is relatively high compared with that in AO/OTA 31-A1 and A2 fractures. To date, the risk factors for implant failure in AO/OTA 31-A3 fractures treated with proximal femoral nail antirotation (PFNA) have remained ambiguous. The purpose of this study was to identify the predictive factors of implant failure in AO/OTA 31-A3 fractures treated with PFNA.MethodsThe data of all patients who underwent surgery for trochanteric fractures at our institution between January 2006 and February 2018 were retrospectively reviewed. All AO/OTA 31-A3 fractures treated with PFNA were included. Logistic regression analysis of potential predictors of implant failure was performed. Potential predictors included age, sex, body mass index, fracture type, reduction method, status of posteromedial support and lateral femoral wall, reduction quality, tip-apex distance and position of the helical blade in the femoral head.ResultsOne hundred four (9.3%) patients with AO/OTA 31-A3 fractures were identified. Forty-five patients with AO/OTA 31-A3 fractures treated with PFNA were suitable for our study. Overall, implant failure occurred in six (13.3%) of forty-five patients. Multivariate analysis identified poor reduction quality (OR, 28.70; 95% CI, 1.91–431.88; p = 0.015) and loss of posteromedial support (OR, 18.98; 95% CI, 1.40–257.08; p = 0.027) as factors associated with implant failure.ConclusionsPoor reduction quality and loss of posteromedial support are predictors of implant failure in reverse oblique and transverse intertrochanteric fractures treated with PFNA.

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Risk factors for cut-out of double lag screw fixation in proximal femoral fractures

Cited by 36 publications

References 32 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?

Risk factors for implant failure in reverse oblique and transverse intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA)

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