Predictors of cut-out after cephalomedullary nail fixation of pertrochanteric fractures: a retrospective study of 813 patients

Murena, Luigi; Moretti, Antonio; Meo, F; Saggioro, Enrico Mendes; Barbati, Giulia; Ratti, Chiara; Canton, Gianluca

doi:10.1007/s00402-017-2863-z

Cited by 64 publications

(54 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There are several studies in literature related to the complications that can develop postoperatively, such as non-union, delayed union, implant failure, proximal screw cut-out, and Z-effect [ 23 ]. In the current study, cut-out was seen in 1 patient of group 1 and in 2 patients of group 2.…”

Section: Discussionmentioning

confidence: 99%

The relationship between the type of unstable intertrochanteric femur fracture and mobility in the elderly

et al. 2018

View full text Add to dashboard Cite

BackgroundThe purpose of this study was to assess the impact of uniform anti-rotational proximal femoral intramedullary nail (APFN) use on patient mobility status with the treatment of two different unstable intertrochanteric femur fracture groups of geriatric patients.MethodsThe study included patients aged > 65 years who underwent surgery with APFN. Group 1 comprised AO classification, AO/OTA 31-A22, and A23 patients, and group 2, A31 and A32 patients. The demographic data of the patients, postoperative complications, follow-up, mortality status, postoperative reduction, tip-apex distance (TAD), and the Parker-Palmer mobility (PPM) score were evaluated.ResultsThere were no statistically significant differences between the groups in terms of gender, affected side, time from trauma to surgery, ASA score, anesthesia type, duration of hospitalization, duration of surgery, TAD values, reduction values, or mortality rate. The average age of patients in group 2 was significantly higher than that of patients in group 1 (p < 0.05). The mobility scores of group 1 patients were significantly higher than those of group 2 (p < 0.05).ConclusionsWhile no relationship was found between the TAD values and the reduction status of the cases, the PPM scores of the AO 31 A3 cases were determined to be significantly worse. Therefore, fractures with a preoperative classification of AO type 31 A3 can be expected to have worse results than A2 ITF fractures. The fracture type seems to have as great an effect as other factors on the postoperative mobility score.

show abstract

Section: Discussionmentioning

confidence: 99%

The relationship between the type of unstable intertrochanteric femur fracture and mobility in the elderly

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Both the specific, as well as the overall, cut-out rates in this series concur with current literature. Various methods have been developed to assess the optimal placement of the lag screw and therefore minimize the risk of cut-out [27,28,31,32]. TAD and Parker’s ratio showed to be the most accurate predictors of this complication [27,32].…”

Section: Discussionmentioning

confidence: 99%

“…Various methods have been developed to assess the optimal placement of the lag screw and therefore minimize the risk of cut-out [27,28,31,32]. TAD and Parker’s ratio showed to be the most accurate predictors of this complication [27,32]. According to Kashigar et al, who introduced the calTAD, this parameter should surpass the TAD in predictive value [28].…”

Section: Discussionmentioning

confidence: 99%

Migration of the Lag Screw after Intramedullary Treatment of AO/OTA 31.A2.1-3 Pertrochanteric Fractures Does Not Result in Higher Incidence of Cut-Outs, Regardless of Which Implant Was Used: A Comparison of Gamma Nail with and without U-Blade (RC) Lag Screw and Proximal Femur Nail Antirotation (PFNA)

Lang

Breuer

Beiglboeck

et al. 2019

JCM

View full text Add to dashboard Cite

The best intramedullary nail for the treatment of unstable AO/OTA 31.A2.1-3 fractures remains uncertain. A total of 237 patients (45 male, 192 female) were eligible for the assessment with an average age of 81.9 ± 10.5 years and a minimum follow-up of six months. We assessed the cut-out rate, the TAD and calTAD (Tip Apex distance) of three different implants. An overall cut-out rate of 2.5% (n = 6) was observed. The cut-out rate was 1.2% (n = 1) in the Proximal Femur Nail Antirotation (PFNA) group, 3.7% (n = 3) in the Gamma Nail group and 2.9% (n = 2) in the Gamma3® with a U-Blade (RC) lag-screw group. The TAD and calTAD differed between the cut-out and non-cut group—20.0 mm vs. 18.5 mm and 13.1 mm vs. 15.3 mm, respectively. A significantly higher TAD of 32.5 mm could be seen in the cut-out after PFNA (p < 0.0001). The only significant change in follow-up using Parker’s ratio was observed in the PFNA group (p < 0.0001). The rate of patients requiring surgery after complications was 8.4% (n = 20) without any significant difference between the three groups. The PFNA blade showed significant migration within the femoral head, however the cut-out rate remained the smallest compared to Gamma3 with or without additional U-Blade (RC) lag screw.

show abstract

“…Under carefully selected indications among different implants, satisfactory surgical outcomes could be achieved by following the principles of fracture reduction for these fractures [18,19]. Although some studies emphasized CalTAD as a better indicator than TAD [13,20], TAD > 25 mm was still found to be one of the independent risk factors for xation failure in intramedullary nails [20,21]. However, the relationships between positions of a lag screw or helical blade, TAD, and CalTAD affecting radiological outcomes are still undetermined.…”

Section: Introductionmentioning

confidence: 99%

Similarities between Inferior-Center and Center-Center Lag Screw Positions in Femoral Intertrochanteric Fracture Surgeries

Yeh

Liu

Chou

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The center-center lag screw position has been widely accepted as the optimal lag screw/helical blade position in femoral intertrochanteric fracture surgery to achieve a tip-apex distance (TAD) less than 25 mm. Despite the inferior-center lag screw/helical blade position having some biomechanical advantages, and the emergence of calcar-referenced tip-apex distance (CalTAD), the clinical differences between the two commonly placed lag screw/helical blade positions remain unclear. This study aimed to (1) report radiological outcomes in managing geriatric femoral intertrochanteric fractures, (2) identify the influences of positions of lag screw/helical blade, and (3) identify the relationship between implants and the values of TAD and CalTAD.Methods: We retrospectively assessed the clinical and radiographic findings of geriatric patients (age ≥ 55 years) who underwent surgery for acute closed femoral intertrochanteric fractures during 1-year period and were followed up a minimum of 6 months. The radiographic parameters and incidences of fixation failure were compared between the different lag screw and helical blade positions (center-center vs. inferior-center). Subgroup analyses of different implant types (extramedullary and intramedullary) were also performed for comparisons for different lag screw positions, and TAD and CalTAD beyond the normal standard value of 25 mm.Results: A total of 206 patients were included during the study period, with a 7.8% fixation failure. There were no differences in incidences of fixation failure between the commonly inserted lag screw/helical blade positions (center-center vs. inferior-center), regardless of the implant types. Those with a TAD > 25 mm had significantly higher incidence of fixation failure than those with a TAD ≤ 25 mm in the extramedullary plate (17.0% vs. 1.2%, p = 0.001), but not in the intramedullary nails (16.1% vs. 4.4%, p = 0.08). There were no significant differences in incidences of fixation failure between CalTAD ≤ 25 mm and CalTAD > 25 mm in either extramedullary or intramedullary implants. Conclusion: Although TAD > 25 mm might increase the fixation failure rate in extramedullary plates, an inferior-center lag screw/helical blade position could achieve comparable radiographic results as a center-center position after osteosynthesis for geriatric femoral intertrochanteric fractures.

show abstract

Predictors of cut-out after cephalomedullary nail fixation of pertrochanteric fractures: a retrospective study of 813 patients

Abstract: The results of the present study demonstrate that good quality of reduction and correct position of the lag screw are likely to decrease the risk of cut-out complication. A nomogram for cut-out prediction is proposed for clinical validation.

Cited by 64 publications

References 20 publications

The relationship between the type of unstable intertrochanteric femur fracture and mobility in the elderly

The relationship between the type of unstable intertrochanteric femur fracture and mobility in the elderly

Similarities between Inferior-Center and Center-Center Lag Screw Positions in Femoral Intertrochanteric Fracture Surgeries

Contact Info

Product

Resources

About