Evidence map›Paper›PMID 39585420›Full record

ArticleEuropean journal of orthopaedic surgery & traumatology : orthopedie traumatologie2024

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.

Germán Garabano, Andres Juri, Leonel Perez Alamino, Joaquin Anibal Rodriguez, Cesar Angel Pesciallo

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Article in European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

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7citing papers in PubMed
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7 citing papers in PubMed.

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5 · Who and what money

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5 authors.

Germán GarabanoOrthopaedic and Trauma Surgery Department, British Hospital of Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina. ggarabano@gmail.com.ORCID http://orcid.org/0000-0001-5936-0607
Andres JuriOrthopaedic and Trauma Surgery Department, British Hospital of Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina.
Leonel Perez AlaminoOrthopaedic and Trauma Surgery Department, British Hospital of Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina.
Joaquin Anibal RodriguezOrthopaedic and Trauma Surgery Department, British Hospital of Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina.
Cesar Angel PescialloOrthopaedic and Trauma Surgery Department, British Hospital of Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThe optimal positioning of the cephalic screw in intertrochanteric fractures (ITFs) is crucial for minimizing the risk of cut-out. This study assesses the predictive value of the tip-to-apex distance (TAD) and tip-to-apex distance referenced to calcar (calTAD) for cut-outs in patients undergoing fixation with cephalomedullary nails.

methodWe analyzed 158 consecutive patients aged over 65 years (mean 83.6 ± 15.9) with intertrochanteric hip fractures who underwent cephalomedullary nailing between January 2016 and July 2022. Receiver operating characteristic (ROC) curves were used to determine the optimal cut-off points for TAD and calTAD. Uni- and multivariate logistic regression analyses were conducted to identify independent predictors of cut-out, considering demographic data, comorbidities, fracture type (AO/OTA), reduction quality (according to Baumgartner classification), TAD, and calTAD.

resultsCut-out occurred in 12 patients (7.5%). ROC analysis identified 18.99 mm as the optimal cut-off for TAD (sensitivity 83.3%, specificity 63.7%; area under the curve-AUC- 0.703, p = 0.009) and 24.95 mm for calTAD (sensitivity 100%, specificity 82.9%, AUC = 0.906, p =  < 0.0001). Univariate analysis revealed no significant differences in demographics, fracture type, or reduction quality between patients with and without cut-outs. Multivariate analysis identified calTAD > 24.95 mm as the only independent predictor of cut-out, with an Odds ratio of 24.62 (95% Confidence Interval 27.61-68.92, p = 0.001).

conclusionOur findings suggest that calTAD is a helpful measure for predicting cut-outs in intertrochanteric fracture fixation using cephalomedullary nails in the context of good fracture reduction. Surgeons should aim to keep calTAD values below 24.95 mm to reduce the risk of cut-out, as values above this threshold significantly increase the risk.

Indexed as

Bone NailsFracture Fixation, IntramedullaryHip FracturesAgedAged, 80 and overBone ScrewsFemaleHumansMaleRetrospective StudiesROC CurveCephalomedullary nailingIntertrochanteric fractureLag screw positionTip-apex distance referenced to calcar (calTAD)Tip-apex distance (TAD)

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PMID39585420

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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.