Barra Amariel E, Barrios Carlos
School of Doctorate, Valencia Catholic University, Valencia, Spain.
Institute for Research on Musculoskeletal Disorders, Valencia Catholic University, Valencia, Spain.
Front Surg. 2024 Aug 14;11:1438858. doi: 10.3389/fsurg.2024.1438858. eCollection 2024.
Cut-out, a biomechanical complication, is one of the most common causes of internal fixation failure of trochanteric hip fractures. The tip-apex distance (TAD) and the calcar-referenced tip-apex distance (CalTAD) have been suggested as the radiographic parameters that most predict the risk of cut-out. The purpose of this study was to check whether these two factors could predict implant cut-out in a series 398 of intertrochanteric hip fractures, treated by dynamic intramedullary nailing with the Trigen Intertan short nail.
We reviewed 398 consecutive intertrochanteric fractures included in a prospective study and treated in a single private hospital by the same surgeon. The radiographic parameters were obtained from anteroposterior (AP) and axial hip plain radiographs before surgery, immediately postoperatively, and every 3 weeks after surgery until 3 months postoperatively, and every month until the 6-month follow-up. The concept of medial cortex support (MCS) was also analyzed as a criterion for evaluating the quality of fracture reduction.
The overall cut-out rate was 2.3% (9/398). The significant parameters in the univariate analysis were AO fracture type, quality of fracture reduction ( = 0.02), TAD ( < 0.001), CalTAD ( = 0.001), and quality of reduction. No statistically significant relationships were observed between the occurrence of cut-out and sex, age, fracture side, and American Society of Anesthesiologists type. Varus collapse and cut-out were only found in cases of negative MCS (22.2% and 77.8%, respectively). Multivariate analysis showed that only TAD showed an independent significant relationship to cut-out ( < 0.001). In this study, CalTAD has no predictive value in the multivariable analysis.
Our findings differed from those in previous reported studies suggesting that CalTAD is the best predictor of cut-out. According to our data, careful optimal reduction ensuring stable fixation with TAD >25 mm reduced the occurrence of cut-out after dynamic intramedullary nailing of intertrochanteric fractures.
穿出是一种生物力学并发症，是股骨转子间骨折内固定失败的最常见原因之一。尖顶距（TAD）和参照股骨距的尖顶距（CalTAD）已被认为是最能预测穿出风险的影像学参数。本研究的目的是检验这两个因素能否预测398例采用Trigen Intertan短钉动力髓内钉治疗的股骨转子间骨折患者的植入物穿出情况。
我们回顾了一项前瞻性研究中连续纳入的398例股骨转子间骨折患者，这些患者均在一家私立医院由同一位外科医生进行治疗。影像学参数在术前、术后即刻以及术后每3周直至术后3个月、术后每1个月直至6个月随访时，从前后位（AP）和髋关节轴位平片获取。内侧皮质支撑（MCS）的概念也作为评估骨折复位质量的标准进行了分析。
总体穿出率为2.3%（9/398）。单因素分析中的显著参数为AO骨折类型、骨折复位质量（P = 0.02）、TAD（P < 0.001）、CalTAD（P = 0.001）以及复位质量。穿出的发生与性别、年龄、骨折侧别和美国麻醉医师协会分级之间未观察到统计学上的显著关系。内翻塌陷和穿出仅在MCS为阴性的病例中发现（分别为22.2%和77.8%）。多因素分析显示，只有TAD与穿出存在独立的显著关系（P < 0.001）。在本研究中，CalTAD在多变量分析中无预测价值。
我们的研究结果与先前报道的研究结果不同，先前研究表明CalTAD是穿出的最佳预测指标。根据我们的数据，通过仔细进行最佳复位并确保TAD > 25 mm的稳定固定，可降低股骨转子间骨折动力髓内钉固定术后穿出的发生率。
