Traditional distance “tip-apex” vs. new calcar referenced “tip-apex” - which one is the best peritrochanteric osteosynthesis failure predictor?

Lopes-Coutinho, Luís; Dias-Carvalho, André; Esteves, Nuno; Sousa, Ricardo

doi:10.1016/j.injury.2020.01.024

Cited by 26 publications

(15 citation statements)

References 24 publications

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“…In 2012, Kuzyk et al identified a new parameter associated with lag-screw cut-out risk, which they termed the calcar tip–apex distance (CalTAD), defined as the distance between the lag screw tip and the calcar femorale 16 . However, no definitive CalTAD cut-off has yet been established 13 , 16 , and CalTAD does not appear to be superior than TAD in predicting cut-out 24 , 25 .…”

Section: Discussionmentioning

confidence: 93%

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: 93%

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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“…There is consensus in the literature that individual differences and geometrical characteristics correlated to the precise cut-off value. 20,21 Moreover, the same as Kashigar and Kane, 10,22 we postulate that a smaller CalTAD is likely to reduce the risk of implant failures.…”

Section: Caltad Is More Reasonable To Predict Implant Failuresmentioning

confidence: 67%

CalTAD is the Key Evaluation Tool for Measurement of Cephalic Fixation Position for Predicting Cut-Out in Geriatric Intertrochanteric Fracture Patients with Internal Fixations after Achieving Acceptable Reduction

Yang

Huang

Gao

2022

Geriatr Orthop Surg Rehabil

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Objective To discover the key evaluation tool of the cephalic fixation position for predicting implant failures in geriatric intertrochanteric fracture (ITF) patients treated with internal fixations after achieving an acceptable reduction. Methods We measured the geriatric ITF patients undergoing single-screw cephalomedullary nailing (CMN) fixation surgery after obtaining the acceptable reduction (including anatomical reduction and positive medial cortex support reduction) in our treatment group between September 2016 and March 2020 by using four kinds of cephalic fixation position evaluation tools including Cleveland zone system, Parker’s ratio index, tip–apex distance (TAD), calcar-referenced TAD (CalTAD), and analyzed which were the key evaluation tools for measurement of cephalic fixation position for prediction of implant failures in geriatric ITF patients with internal fixations. Results Seventy-four ITF patients treated with single-screw CMN fixation after obtaining the acceptable reduction were enrolled in this study. Of the 74 patients, nine cases were observed with implant failures. There were six cases of cut-out and three of pending cut-out. We found that TAD (odds ratio (OR)=1.149; 95% confidence interval (CI), 1.00–1.32; P=.046) and CalTAD (OR=1.140; 95% CI, 1.00–1.30; P=.037) were risk factors for implant failures by univariate analysis, while only CalTAD (OR=1.200; 95% CI, 1.032–1.395; P=.018) was the independent risk factor for implant failures by multivariate analysis. The Kappa coefficient (κ) of CalTAD was .976 (95% CI, .966–.984) by ICC analysis. The ROC analysis showed that the best cut-off value of CalTAD was 23.76 mm with a sensitivity of 77.8% and specificity of 72.3% (area under the curve, AUC =.775; P = .001). Conclusions CalTAD is the key evaluation tool for measurement of cephalic fixation position for predicting implant failures in geriatric ITF patients treated with single-screw CMN after obtaining the acceptable reduction.

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“…Some authors however find discrepancies with these values [ 22 ], from anatomical differences and depending on the size of the femoral head, sex, and anthropometric characteristics [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Zimmer Natural Nail and ELOS nails in pertrochanteric fractures

et al. 2021

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Background Pertrochanteric fractures of the femur in the elderly are very common. As the average age of the population increases, the incidence of such fractures also raises, resulting in high healthcare costs. The type of surgical devices employed for their surgical management influences these costs. Methods A comparative clinical study was conducted on patients operated by one single surgeon between December 2018 and November 2020 in a high-volume regional referral centre. All patients who received a Zimmer Natural Nail (ZNN) or ELOS devices were included. Results In 119 (66.48%) of the 179 fractures, a ZNN nail was used. Post-operatively, the TAD (tip-to-apex distance) was measured at an average value of 17.05 (4.42–41.85) mm and the CalTAD (calcar-referenced TAD) at an average of 20.76 (10.82–43.63) mm. The mean hospitalization time was 10.19 (4–22) days. In the other 60 trochanteric fractures, an ELOS nail was used. Post-operative imaging indicated a TAD of 19.65 (5.08–31.4) mm and a CalTAD of 22.86 mm (12.66–33.77). The average time of the operation was 45.82 (20–110) min. The average period of hospitalization was 10.45 (5–24) days. Conclusion Both devices give similar results in terms of short-term post-operative outcome and hospitalization. The price difference between the devices does not translate in different short-term results on the operated patients.

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Traditional distance “tip-apex” vs. new calcar referenced “tip-apex” - which one is the best peritrochanteric osteosynthesis failure predictor?

Cited by 26 publications

References 24 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

CalTAD is the Key Evaluation Tool for Measurement of Cephalic Fixation Position for Predicting Cut-Out in Geriatric Intertrochanteric Fracture Patients with Internal Fixations after Achieving Acceptable Reduction

Zimmer Natural Nail and ELOS nails in pertrochanteric fractures

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