ArticleArchives of orthopaedic and trauma surgery2025
Predictive indicators of proximal femur nail antirotation device cut-out in intertrochanteric fractures: introduction of a novel radiographic parameter.
Article in Archives of orthopaedic and trauma surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.
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Who cites it
3 citing papers in PubMed, 1 synthesis or guideline pooled it.
- 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
- Comparison of the predictive performance of Chang and Baumgaertner reduction quality criteria for cutout complication in geriatric unstable intertrochanteric femur fractures.BMC musculoskeletal disorders · 2026Article
- Deltoid Tuberosity Index as a Predictor of Hip Fracture Risk in Older Adults.Geriatric orthopaedic surgery & rehabilitation · 2026Article
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3 authors.
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Abstract
introductionCut-out remains the predominant complication after proximal femoral nail antirotation (PFNA) fixation in intertrochanteric fractures, significantly affecting clinical outcomes. Established predictive parameters, such as tip-apex distance (TAD) and calcar-referenced TAD (CalTAD), offer valuable insights but have limitations. This study introduces a novel radiographic parameter-the discrepancy between preoperatively estimated and intraoperatively selected lag screw length-and assesses its predictive value in implant cut-out. MATERIALS AND
methodsIn this retrospective cohort study, 276 patients undergoing PFNA fixation for intertrochanteric fractures from January 2019 to June 2023 were analyzed. Patients were classified into cut-out (n = 20, 7.2%) and uneventful healing (n = 256, 92.8%) groups. Demographics, AO/OTA fracture classification, TAD, CalTAD, shaft-neck angle, reduction quality, and the discrepancy between preoperative radiographic estimates of lag screw length (based on contralateral hip measurements) and actual intraoperative lengths were evaluated. Statistical methods included ROC analysis and multivariate logistic regression modeling.
resultsTAD (median 31.5 vs. 23.0 mm, p < 0.001) and CalTAD (median 40.9 vs. 31.4 mm, p < 0.001) were significantly greater in the cut-out group. The novel screw length discrepancy parameter demonstrated significant predictive accuracy (AUC = 0.818), with a difference exceeding 3 mm (shorter screw) strongly associated with cut-out risk (OR = 63.0, p < 0.001). Multivariate analysis identified CalTAD > 38.55 mm (OR = 14.2, p = 0.004) and screw length discrepancy > 3 mm (shorter than estimated) as independent predictors for cut-out.
conclusionsThis study introduces a novel predictor of cut-out in PFNA-treated intertrochanteric fractures: discrepancy exceeding 3 mm between preoperatively estimated and intraoperatively selected lag screw length. Incorporating contralateral hip measurements into preoperative planning protocols may improve surgical precision and decrease the risk of implant failure. Prospective validation studies are recommended to further confirm clinical applicability.
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