Proposal of a modified tip apex distance for prediction of lag screw cut-out in trochanteric hip fractures.

IF 1.8 Q2 ORTHOPEDICS SICOT-J Pub Date : 2023-01-01 Epub Date: 2023-09-20 DOI:10.1051/sicotj/2023026
Amr Selim, Nawfal Al-Hadithy, Nader M Diab, Abdulla Mohamed Ahmed, Khaled Fawzy Abdel Kader, Mohamed Hegazy, Hazem Abdel Azeem, Ahmed Samir Barakat
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Abstract

Introduction: Lag screw cut-out is a serious complication of dynamic hip screw fixation of trochanteric hip fractures. The lag screw position has been acknowledged as one of the important factors affecting the lag screw cut-out. We propose a modification of the Tip Apex Distance (TAD) and hypothesise that it could improve the reliability of predicting lag screws cut-out in these injuries.

Materials and methods: A retrospective study was conducted for hip fracture entries in the period from Jan 2018 to July 2022. A hundred and nine patients were suitable for the final analysis. The modified TAD was measured in millimetres based on the sum of the traditional TAD in the lateral view and the net value of two distances in the AP view, the first distance is from the tip of the lag screw to the opposite point on the femoral head along the axis of the lag screw while the second distance is from that point to the femoral head apex. The first distance is a positive value, whereas the second distance is positive if the lag screw is superior and negative if inferior. A receiver operating characteristic curve was used to evaluate the reliability of the different parameters assessing the lag screw position within the femoral head.

Results: Reduction quality, fracture pattern as per the AO/OTA classification, TAD, Calcar Referenced TAD, Axis Blade Angle, Parker's ration in the AP view, Cleveland Zone 1, and modified TAD were statistically associated with lag screw cut-out. Among the tested parameters, the modified TAD had 90.1% sensitivity and 90.9% specificity for lag screw cut-out at a cut-off value of 25 mm with a P-value < 0.001.

Conclusion: The modified TAD had the highest reliability in the prediction of lag screw cut-out. A value ≤ 25 mm could potentially protect against lag screw cut-out in trochanteric hip fractures.

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改良尖端-顶点距离预测股骨粗隆骨折拉力螺钉切口的建议。
引言:股骨粗隆骨折动力髋螺钉内固定术中,滞后螺钉切口是一种严重的并发症。拉力螺钉的位置已被公认为影响拉力螺钉切口的重要因素之一。我们提出了对尖端-顶点距离(TAD)的修改,并假设它可以提高预测这些损伤中拉力螺钉切除的可靠性。材料和方法:对2018年1月至2022年7月期间的髋部骨折条目进行回顾性研究。109名患者适合进行最终分析。修正后的TAD是基于侧视图中传统TAD和AP视图中两个距离的净值之和以毫米为单位测量的,第一个距离是从拉力螺钉的尖端到股骨头上沿着拉力螺钉的轴线的相对点,而第二个距离则是从该点到股骨头顶点。第一距离是正值,而如果拉力螺钉是上的,则第二距离是正的,如果是下的,则为负的。受试者工作特性曲线用于评估股骨头内拉力螺钉位置的不同参数的可靠性。结果:复位质量、AO/OTA分类的骨折模式、TAD、Calcar参考TAD、轴刃角、AP视图中的Parker比率、Cleveland 1区和改良TAD与拉力螺钉切口具有统计学相关性。在测试的参数中,改良TAD对拉力螺钉切口的敏感性为90.1%,特异性为90.9%,截断值为25mm,P值为。结论:改良TAD在预测拉力螺钉切口方面具有最高的可靠性。≤25 mm的值有可能预防股骨粗隆骨折中拉力螺钉切口的发生。
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来源期刊
SICOT-J
SICOT-J ORTHOPEDICS-
CiteScore
3.20
自引率
12.50%
发文量
44
审稿时长
14 weeks
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