Risk factors for cut-throughs in intertrochanteric hip fracture fixation Tip-Apex Distance (TAD) <10 mm and Apex-to-Center <4 mm

Objectives

TAD > 25 mm is a risk factor for cut-out in intramedullary nailing. Less attention has been given to the risk factors for central cut-through and the possible outcomes of TAD <10 mm. Furthermore, the risk of cut-through depending on minimum depth on either anterior-posterior (AP) or lateral views has not been explored. The goal of this study is to outline the parameters that increase risk of cut-through in intertrochanteric hip fractures.

Methods

A retrospective review of 2128 intertrochanteric hip fractures admitted to a single level 1 academic trauma center from 2014 – 2023 was conducted. Variables included patient and operative characteristics, fracture fixation device, fracture type based on OTA/AO 2018 classification, TAD, neck-shaft angle and radiographic and clinical outcomes.

Results

TAD <10 millimeters carried a significantly higher risk for lag screw and blade cut-through. Cut-through risk increased significantly when either AP or lateral apex-to-center distance was <4 millimeters, including when comparing fracture reduction quality for a cohort including sliding hip screws, lag screws and blades. Cut-out complications in this cohort only occurred with a TAD >10 mm and was significantly more likely to occur with TAD >25 mm, similar to prior studies.

Conclusion

TAD optimization between 10 and 25 mm reduces risk of both cut-out and cut-through and maintenance of 4 mm of distance between apex-to-center distance may help decrease the risk of cut-through complications.