ArticleJournal of clinical orthopaedics and trauma2019
Tip-apex distance and other predictors of outcome in cephalomedullary nailing of unstable trochanteric fractures.
Article in Journal of clinical orthopaedics and trauma, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 25 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 2 syntheses or guidelines pooled it, 37 citations in OpenAlex.
- Comparison of integrated dual-lag screw versus single lag screw cephalomedullary nails for intertrochanteric femoral fractures: a systematic review and meta-analysis.Journal of orthopaedic surgery and research · 2026Pooled it
- No difference between lag screw and helical blade for cephalomedullary nail cut-out a systematic review and meta-analysis.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2022Pooled it
- Review
- Single lag screw cephalomedullary nail angle-anatomy mismatch is associated with immediate postoperative malreduction after intertrochanteric hip fracture fixation.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2026Article
- Lag screw cutout risk factors in geriatric intertrochanteric femur fractures.BMC geriatrics · 2026Article
- Article
- Inferior Screw Referenced Calcar Tip Apex Distance as the Most Accurate Predictor of Mechanical Cut Out in Dual-Screw Proximal Femoral Nails.Medicina (Kaunas, Lithuania) · 2025Article
- Modifying the reduction quality criteria of the Baumgaertner classification may increase its performance in predicting mechanical failure after intertrochanteric nailing.OTA international : the open access journal of orthopaedic trauma · 2025Article
- "Virtual Lateral Wall" Technique to Overcome Nail Entry Pathway Errors and Optimize Success of Intramedullary Nailing in Pertrochanteric Fractures.Orthopaedic surgery · 2025Article
- Predicting mechanical complications in proximal femoral nailing for elderly patients: a radiological scoring system based on a single-centre retrospective cohort with 586 cases.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Article
- Predicting cut-out in intertrochanteric fractures fixed with cephalomedullary nails: the role of tip-to-apex distance referenced to calcar (calTAD)--A retrospective analysis of 158 cases.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2024Article
- Design innovation and rationale of the intramedullary implants for treating Intertrochanteric fractures: A review.Journal of clinical orthopaedics and trauma · 2024Article
- Finite element analysis of fixation stability according to reduction position for internal fixation of intertrochanteric fractures.Scientific reports · 2024Article
- The Effect of Intraoperative Patient Positioning on the Success of Intertrochanteric Fracture Surgery in Older Patients.Medicina (Kaunas, Lithuania) · 2024Article
- Poor usability of computer-assisted navigation for hip fracture surgery.Archives of orthopaedic and trauma surgery · 2024Article
- Cut-Through versus Cut-Out: No Easy Way to Predict How Single Lag Screw Design Cephalomedullary Nails Used for Intertrochanteric Hip Fractures Will Fail?Hip & pelvis · 2023Article
- How to place a cephalomedullary screw when visualization is obscured by the jig in peritrochanteric hip fractures using "peek radiographs."Journal of clinical orthopaedics and trauma · 2023Article
- What Is the Best Treatment Choice for Concomitant Ipsilateral Femoral Neck and Intertrochanteric Fracture? A Retrospective Comparative Analysis of 115 Consecutive Patients.Journal of personalized medicine · 2022Article
- The predictive value of the Singh index for the risk of InterTAN intramedullary fixation failure in elderly patients with intertrochanteric fractures.BMC musculoskeletal disorders · 2022Article
- Risk factors for cut-outs in geriatric intertrochanteric fractures with cephalomedullary nailing after obtaining acceptable reduction: a case-control study.BMC musculoskeletal disorders · 2022Article
Corrections and comments
- Erratum issued
- Erratum issued
- Erratum issued
- Erratum issued
Authors and funding
4 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCephalomedullary nails are presently the gold standard in management of unstable trochanteric fractures. The tip-apex distance (TAD) is one of the most important factors that determines success or failure of fixation, but was described originally in context of an extramedullary hip screw. Cephalomedullary nails use a different biomechanical approach to fixation; and it is hypothesized that the TAD rule may not apply similarly with these. The aim of this study is to assess whether a high TAD correlates with poor outcomes with cephalomedullary nails, and to elucidate other factors that may predict such outcome.
methodsWe retrospectively reviewed the clinical and radiographic records of patients with intertrochanteric fractures, treated at our institution over a 2-year period. Those with unstable fractures (31.A2 and 31.A3), and who were treated with cephalomedullary nails were included in the study. The TAD and the position of the device in the femoral head (Cleveland index) were assessed. Other factors that could influence outcome like age, gender, AO fracture type, restoration of neck-shaft angle and degree of osteoporosis were analysed. Radiographic records of up-to at-least 3 months post-operatively were assessed for complications.
resultsAfter applying the exclusion criteria, 75 patients were included in the analysis. The overall rate of complications was 12%. They occurred in two major patterns - varus collapse and cut-out occurred in 5 patients (6.67%), and device migration in 4 patients (5.33%). The average TAD of patients with cut-out was 28.78 mm, compared to 19.44 mm in those without cut-out (
conclusionAs with extramedullary devices, TAD, along with sub-optimal device positioning and poor restoration of neck-shaft angle is a useful predictor of cut-out even with cephalomedullary nails, negating the initial hypothesis. The above factors in combination have a more significant effect than any one factor in isolation to cause varus collapse and implant cut-out. However these do not affect Z effect, reverse Z effect or other types of device migration seen especially with dual-screw nails.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.