Observational studyScientific reports2022
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.
Observational study in Scientific reports, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 1 of them a synthesis that pooled it.
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Who cites it
32 citing papers in PubMed, 1 synthesis or guideline pooled it, 35 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
- Internal-locking intramedullary nails (talons, claws, wings, wedge-locks, endopins): a mechanics-guided scoping review of designs, failure signatures, and technique imperatives.BMC musculoskeletal disorders · 2026Article
- Predictive accuracy of a general-purpose artificial intelligence model for cut-out following proximal femoral nailing.Archives of orthopaedic and trauma surgery · 2026Article
- Article
- Influence of cephalomedullary nail length and caput-collum-diaphyseal angle on tip-apex distance and early mechanical cut-out in trochanteric femur fractures.BMC musculoskeletal disorders · 2026Article
- Retrospective study of mechanical complications after cephalomedullary nail implantation from 2019 to 2024 following per-, sub- or intertrochanteric femur fractures.Archives of orthopaedic and trauma surgery · 2026Article
- Patient-specific anatomical alignment relative to the contralateral collodiaphyseal angle as an independent predictor of screw cut-out after proximal femoral nailing.Journal of orthopaedic surgery and research · 2026Article
- 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
- Subcapital Femoral Neck Fracture Despite Cement-Augmented Cephalomedullary Nail Fixation for an Osteoporotic Intertrochanteric Fracture: A Case Report and Position- and Sliding-Based Decision Guide.Clinics and practice · 2025Article
- The positioning of cephalon medullary nailing correlated with hidden blood loss during the perioperative period in patients with intertrochanteric fractures: A retrospective study.Chinese journal of traumatology = Zhonghua chuang shang za zhi · 2025Article
- [Osteosynthesis of subtrochanteric femoral fractures in adults].Chirurgie (Heidelberg, Germany) · 2025Article
- Biomechanical Analysis of Fixation Strength in Unstable Intertrochanteric Femoral Fracture Models Based on the Caput-Collum-Diaphyseal Angle of Cephalomedullary Nails and Position of Lag Screws.Journal of clinical medicine · 2025Article
- Evaluation of reduction quality and implant positioning in intertrochanteric fracture fixation: A review of key radiographic parameters.World journal of orthopedics · 2025Review
- The RESCUE Technique: A Mnemonic Acronym to Enhance Outcomes in Nail Fixation of Extracapsular Hip Fractures.Journal of clinical medicine · 2025Article
- Are Tip-Apex Distance and Surgical Delay Associated with Increased Risk of Complications and Mortality Within the First Two Years After Surgery for Femoral Neck Fractures?Journal of clinical medicine · 2025Article
- Larger nail-shaft gap as a potential risk factor of femoral head varus in patients treated with proximal femoral nail antirotation fixation: a retrospective, observational, single-center study with corresponding numerical simulation.Quantitative imaging in medicine and surgery · 2025Article
- Predictive indicators of proximal femur nail antirotation device cut-out in intertrochanteric fractures: introduction of a novel radiographic parameter.Archives of orthopaedic and trauma 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
- The lowest HU value on transverse planes: a predictive factor for cranial adjacent vertebral fracture risk after percutaneous vertebroplasty.Quantitative imaging in medicine and surgery · 2025Article
- Analysis of factors affecting the surgical efficacy for elderly intertrochanteric fracture.Frontiers in surgery · 2025Article
Corrections and comments
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Authors and funding
9 authors at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
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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