What Is the Relevance of the Tip-Apex Distance as a Predictor of Lag Screw Cut-Out?

Goffin, Jérôme M.; Jenkins, Paul J.; Ramaesh, Rishi; Pankaj, Pankaj; Simpson, A. H. R. W.

doi:10.1371/journal.pone.0071195

Cited by 20 publications

(13 citation statements)

References 16 publications

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“…On one hand, there is a large amount of literature supporting a TAD value of 25 mm or less [15,17,[27][28][29], but on the other several authors have highlighted that Baumgaertner's TAD cut-off of 25 mm is not supported by clinical evidence. Yam et al raised the traditional TAD cut-off from 25 mm to 27 mm [18], and others have reported that a limit of 25 mm has no biomechanical justi cation and should in fact be adjusted according to femur head size [18, [32][33].…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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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“…Watson questioned the rationale of the TAD value, because many patients still had complications of cut‐out even with an ideal TAD value in his study. For this problem, early in the study of Goffin et al ,. it was found that lag screw cut‐out occurs because the bone superior to the lag screw thread is too weak to sustain compressive strains exerted by the lag screw.…”

Section: Discussionmentioning

confidence: 99%

Management of Low‐Energy Basicervical Proximal Femoral Fractures by Proximal Femoral Nail Anti‐Rotation

Wang

et al. 2019

Orthopaedic Surgery

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Objective: To evaluate clinical and radiological outcomes of proximal femoral nail anti-rotation (PFNA-II) devices and demonstrate the effectiveness of PFNA-II for the treatment of basicervical fractures in elderly patients. Methods:A retrospective review of all patients treated with PFNA-II for a proximal femoral fracture between January 2013 and February 2017 at three different institutions (Shanghai General Hospital, Shanghai Punan Hospital and Shanghai Seventh People's Hospital) was conducted. The X-ray films were strictly reviewed by three trauma surgeons and a professional radiology doctor. Patients over 60 years of age who met the following criteria were included: (i) sustained low-energy trauma; (ii) a two-part fracture; (iii) fracture line located at the base of the femoral neck and that was medial to the intertrochanteric line and exited above the lesser trochanter but was more lateral than a classic transcervical fracture. Follow-up time should be longer than 6 months. A total of 52 patients who met the inclusion criteria were selected. The average age at diagnosis was 75.1 years (range, 63-91 years); 13 patients were men and 39 were women. The same proximal femoral nail anti-rotation devices and the same surgical procedures were applied to all patients. Postoperative radiographic union time and modified Harris hip scores were used as major indicators for evaluating the effectiveness of surgery. Results:The average follow-up period was 22.5 months (18.5, 23.9, and 21.2 months, respectively) and radiographic unions were observed at an average of 19.6 weeks (range, 12-28 weeks). The patients were evaluated immediately after surgery, as well as 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively. Of the 49 patients, 38 had good reduction qualities (75.5%), 9 acceptable (18.3%), and 3 poor (6.1%). Radiographic union was confirmed in all fractures at an average of 19.6 weeks (range, 12-28 weeks). The mean Harris hip score was 84.9 (range, 65-99): excellent in 9 patients (18.36%), good in 30 (61.22%), medium in 8 (16.32%), and poor in 2 (4.08%). Slight persistent pain occurred in 3 patients, but these patients could still walk with the help of a cane. Two patients had symptoms of excessive telescoping. Eight patients experienced postoperative medical complications, mainly pneumonia and urinary tract infection.Conclusion: Based on the clinical and radiological outcomes, the PFNA-II devices provide strong rotational stability and excellent clinical prognosis, and are an appropriate treatment option for basicervical proximal femoral fracture in elderly patients.

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“…Some studies measured the BMD of the femoral head using the contralateral side (non-fractured side) with clinical CT images, 17 but it is not clear if the BMD is the same as the fractured side since there seems to be a side-to-side morphologic difference even in normal hips, 18 and moreover, it is difficult to measure the local BMD from clinical CT images with its resolution. On the other hand, some reports evaluated the local BMD in the femoral heads of the fractured side using μCT to assess the bone quality at the lag screw position, 8,11 but the BMD was only measured in the proximal and center planes, perpendicular to the femoral neck axis. It is expected that the local BMD parallel to the femoral neck axis would be more relevant to the position where the lag screws are inserted as well as more relevant to the fixation strength.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Although it has been reported in a cadaveric study that the bone mineral density (BMD) of the femoral head strongly correlates with the load at cutout 8,9 and the stability of the lag screw is related to the bone quality where the screw is inserted, few reports analyzed the BMD distribution of the femoral head. [10][11][12][13] Furthermore, no reports measured the local BMD according to the area where the screw is inserted and little is known about the relationship between the TAD and local BMD. 11 Therefore, the purposes of this study were (1) to clarify the distribution of the BMD in the femoral head with the use of the micro quantitative computed tomography (CT) and (2) to analyze the relationship between the TAD and local BMD.…”

Section: Introductionmentioning

confidence: 99%

“…[10][11][12][13] Furthermore, no reports measured the local BMD according to the area where the screw is inserted and little is known about the relationship between the TAD and local BMD. 11 Therefore, the purposes of this study were (1) to clarify the distribution of the BMD in the femoral head with the use of the micro quantitative computed tomography (CT) and (2) to analyze the relationship between the TAD and local BMD.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The distribution of bone mineral density in the femoral heads of unstable intertrochanteric fractures

Uemura

Takao

Otake

et al. 2018

J Orthop Surg (Hong Kong)

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What Is the Relevance of the Tip-Apex Distance as a Predictor of Lag Screw Cut-Out?

Cited by 20 publications

References 16 publications

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

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

Management of Low‐Energy Basicervical Proximal Femoral Fractures by Proximal Femoral Nail Anti‐Rotation

The distribution of bone mineral density in the femoral heads of unstable intertrochanteric fractures

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