J Korean Orthop Assoc.  2017 Aug;52(4):319-326. 10.4055/jkoa.2017.52.4.319.

Risk Factors of Cut-Out in Treatment of Femoral Intertrochanteric Fractures by Proximal Femur Nail

Affiliations
  • 1Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea. dhkim8311@gnu.ac.kr

Abstract

PURPOSE
The purpose of this study is to evaluate the risk factors for the occurrence of cut-out of proximal femoral nail by a lag screw as the treatment for intertrochanteric fractures.
MATERIALS AND METHODS
A total of 151 patients (76 males and 75 females; mean age, 73.7±12.1 years), who were diagnosed with intertrochanteric fracture at Gyeongsang National University Hospital between January 2011 and March 2016, with a follow-up of at least for 6 months were included in this retrospective study. Various risk factors, such as demographic data, osteoporosis, collodiaphyseal angle (CDA) (≤130° or >130°), tip-apex distance (TAD) (≤25 mm or >25 mm), and the position of lag screw in the femur head (quadrant) related to the occurrence of cut-out were taken into consideration. The strength of association for each factor was determined through the calculation of the odds ratio (OR), within the 95% confidence interval (CI). First, we performed univariate logistic regression analyses for all variables; then, we performed a multivariate logistic regression analysis, using only the significant variables that had resulted from the univariate analysis.
RESULTS
Among the 151 cases, the occurrence of cut-out was observed in 14 cases (9.3%). In a univariate analysis, the fracture patterns based on the AO/OTA classification (p=0.045), CDA (p<0.001) and the position of lag screw in the femur head (quadrant) (p=0.001) showed a significant association with the occurrence of the cut-out. However, TAD was not significantly associated with the cut-out (p=0.886). Various factors, which were significant in univariate analyses, were included in multivariate analyses. In multivariate analyses, CDA (OR, 12.291; 95% CI, 2.559-59.034; p=0.002), and quadrant (OR, 7.194; 95% CI, 1.712-30.303; p=0.007) were significantly associated with the cut-out.
CONCLUSION
Valgus reduction and proper position of lag screw were critical for the prevention of occurrence of cut-out when treating intertrochanteric fracture using proximal femur nail.

Keyword

femur; trochanteric fractures; complication; risk factors

MeSH Terms

Classification
Female
Femur Head
Femur*
Follow-Up Studies
Hip Fractures*
Humans
Logistic Models
Male
Multivariate Analysis
Odds Ratio
Osteoporosis
Retrospective Studies
Risk Factors*

Figure

  • Figure 1 Determination of the quadrant on anteroposterior view (A) and lateral view (B).


Cited by  1 articles

The Effect of Valgus Reduction on the Position of the Blade of the Proximal Femoral Nail Antirotation in Intertrochanteric Hip Fractures
Eui Yub Jung, In Taek Oh, Sang Yeup Shim, Byung Ho Yoon, Yerl Bo Sung
Clin Orthop Surg. 2019;11(1):36-42.    doi: 10.4055/cios.2019.11.1.36.


Reference

1. Hagino H, Yamamoto K, Ohshiro H, Nakamura T, Kishimoto H, Nose T. Changing incidence of hip, distal radius, and proximal humerus fractures in Tottori Prefecture, Japan. Bone. 1999; 24:265–70.
Article
2. Richmond J, Aharonoff GB, Zuckerman JD, Koval KJ. Mortality risk after hip fracture. J Orthop Trauma. 2003; 17:53–6.
Article
3. Koval KJ, Aharonoff GB, Rokito AS, Lyon T, Zuckerman JD. Patients with femoral neck and intertrochanteric fractures. Are they the same? Clin Orthop Relat Res. 1996; 330:166–72.
Article
4. Barton TM, Gleeson R, Topliss C, Greenwood R, Harries WJ, Chesser TJ. A comparison of the long gamma nail with the sliding hip screw for the treatment of AO/OTA 31-A2 fractures of the proximal part of the femur: a prospective randomized trial. J Bone Joint Surg Am. 2010; 92:792–8.
5. Schipper IB, Steyerberg EW, Castelein RM. . Treatment of unstable trochanteric fractures. Randomised comparison of the gamma nail and the proximal femoral nail. J Bone Joint Surg Br. 2004; 86:86–94.
6. Haidukewych GJ, Israel TA, Berry DJ. Reverse obliquity fractures of the intertrochanteric region of the femur. J Bone Joint Surg Am. 2001; 83:643–50.
Article
7. Sadowski C, Lübbeke A, Saudan M, Riand N, Stern R, Hoff-meyer P. Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95 degrees screw-plate: a prospective, randomized study. J Bone Joint Surg Am. 2002; 84:372–81.
8. Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev. 2010; 9:CD000093.
Article
9. Riina J, Tornetta P 3rd, Ritter C, Geller J. Neurologic and vascular structures at risk during anterior-posterior locking of retrograde femoral nails. J Orthop Trauma. 1998; 12:379–81.
Article
10. Mavrogenis AF, Panagopoulos GN, Megaloikonomos PD. . Complications after hip nailing for fractures. Orthopedics. 2016; 39:e108–16.
Article
11. Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures: management and current controversies. Instr Course Lect. 2004; 53:441–54.
12. Kim WY, Han CH, Park JI, Kim JY. Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis. Int Orthop. 2001; 25:360–2.
Article
13. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am. 1995; 77:1058–64.
Article
14. Wu CC, Shih CH, Chen WJ, Tai CL. Treatment of cutout of a lag screw of a dynamic hip screw in an intertrochanteric fracture. Arch Orthop Trauma Surg. 1998; 117:193–6.
Article
15. Cleveland M, Bosworth DM, Thompson FR, Wilson HJ Jr, Ishizuka T. A ten-year analysis of intertrochanteric fractures of the femur. J Bone Joint Surg Am. 1959; 41:1399–408.
Article
16. Yu J, Zhang C, Li L. . Internal fixation treatments for intertrochanteric fracture: a systematic review and meta-analysis of randomized evidence. Sci Rep. 2015; 5:18195.
Article
17. Shen J, Hu C, Yu S, Huang K, Xie Z. A meta-analysis of percutenous compression plate versus intramedullary nail for treatment of intertrochanteric HIP fractures. Int J Surg. 2016; 29:151–8.
Article
18. Long H, Lin Z, Lu B. . Percutaneous compression plate versus dynamic hip screw for treatment of intertrochanteric hip fractures: a overview of systematic reviews and update meta-analysis of randomized controlled trials. Int J Surg. 2016; 33:1–7.
Article
19. Pajarinen J, Lindahl J, Savolainen V, Michelsson O, Hirven-salo E. Femoral shaft medialisation and neck-shaft angle in unstable pertrochanteric femoral fractures. Int Orthop. 2004; 28:347–53.
Article
20. Hsueh KK, Fang CK, Chen CM, Su YP, Wu HF, Chiu FY. Risk factors in cutout of sliding hip screw in intertrochanteric fractures: an evaluation of 937 patients. Int Orthop. 2010; 34:1273–6.
Article
21. Parker MJ. Valgus reduction of trochanteric fractures. Injury. 1993; 24:313–6.
Article
22. Andruszkow H, Frink M, Frömke C, et al. Tip apex distance, hip screw placement, and neck shaft angle as potential risk factors for cut-out failure of hip screws after surgical treatment of intertrochanteric fractures. Int Orthop. 2012; 36:2347–54.
Article
23. Kuzyk PR, Zdero R, Shah S, Olsen M, Waddell JP, Schemitsch EH. Femoral head lag screw position for cephalomedul-lary nails: a biomechanical analysis. J Orthop Trauma. 2012; 26:414–21.
24. Davis TR, Sher JL, Horsman A, Simpson M, Porter BB, Checketts RG. Intertrochanteric femoral fractures. Mechanical failure after internal fixation. J Bone Joint Surg Br. 1990; 72:26–31.
Article
25. Den Hartog BD, Bartal E, Cooke F. Treatment of the unstable intertrochanteric fracture. Effect of the placement of the screw, its angle of insertion, and osteotomy. J Bone Joint Surg Am. 1991; 73:726–33.
Article
26. Geller JA, Saifi C, Morrison TA, Macaulay W. Tip-apex distance of intramedullary devices as a predictor of cut-out failure in the treatment of peritrochanteric elderly hip fractures. Int Orthop. 2010; 34:719–22.
Article
27. Herman A, Landau Y, Gutman G, Ougortsin V, Chechick A, Shazar N. Radiological evaluation of intertrochanteric fracture fixation by the proximal femoral nail. Injury. 2012; 43:856–63.
Article
28. Mingo-Robinet J, Torres-Torres M, Martínez-Cervell C, et al. Comparative study of the second and third generation of gamma nail for trochanteric fractures: review of 218 cases. J Orthop Trauma. 2015; 29:e85–90.
29. Kraus M, Krischak G, Wiedmann K. . Clinical evaluation of PFNA® and relationship between the tip-apex distance and mechanical failure. Unfallchirurg. 2011; 114:470–8.
30. Kane P, Vopat B, Heard W. . Is tip apex distance as important as we think? A biomechanical study examining optimal lag screw placement. Clin Orthop Relat Res. 2014; 472:2492–8.
Article
Full Text Links
  • JKOA
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr