ArticleBMC geriatrics2026
Lag screw cutout risk factors in geriatric intertrochanteric femur fractures.
Article in BMC geriatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLag screw cutout remains the most frequent mechanical failure after proximal femoral nailing (PFN) for geriatric intertrochanteric femur fractures and is strongly influenced by bone quality, reduction, and implant positioning. This study aimed to evaluate these domains comprehensively and to identify independent predictors of cutout.
methodsIn this retrospective cohort study, patients aged ≥ 65 years who underwent PFN (single implant design, APFN
resultsA total of 371 patients (mean age 78.8 ± 6.95 years; 66% female) met inclusion criteria. Cutout occurred in 48 patients (12.9%) at a mean of 6.29 ± 5.52 weeks. The cutout group demonstrated significantly poorer bone quality (Singh index 2.56 ± 0.51 vs. 3.70 ± 0.67; p < 0.001), greater varus fixation (NSA 126.6° vs. 131.7°; p < 0.001), higher TAD and CalTAD (both p < 0.001), and a higher proportion of center-anterior zone lag screw position (p < 0.001), which conferred increased risk (Odds ratio-OR 6.26; p < 0.001), whereas center-center zone was protective (OR 0.32; p < 0.001). CalTAD showed the highest discriminative performance for cutout (AUC 0.757; cutoff 26 mm; sensitivity 63.8%, specificity 75%). In logistic regression analysis, only Singh index (OR 0.009; 95% CI 0.001-0.060; p < 0.001) and NSA (OR 0.830; 95% CI 0.710-0.971; p = 0.020) remained independent predictors.
conclusionIn geriatric intertrochanteric femur fractures treated with PFN, osteoporosis severity and varus fixation are the strongest independent predictors of cutout complication. Meticulous avoidance of varus reduction and anterior lag screw placement combined with rigorous assessment of bone quality may decrease cutout risk.
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