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

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 hypothesis...

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Autores principales: Selim, Amr, Al-Hadithy, Nawfal, Diab, Nader M., Ahmed, Abdulla Mohamed, Kader, Khaled Fawzy Abdel, Hegazy, Mohamed, Azeem, Hazem Abdel, Barakat, Ahmed Samir
Formato: Online Artículo Texto
Lenguaje:English
Publicado: EDP Sciences 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10515705/
https://www.ncbi.nlm.nih.gov/pubmed/37737668
http://dx.doi.org/10.1051/sicotj/2023026
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author Selim, Amr
Al-Hadithy, Nawfal
Diab, Nader M.
Ahmed, Abdulla Mohamed
Kader, Khaled Fawzy Abdel
Hegazy, Mohamed
Azeem, Hazem Abdel
Barakat, Ahmed Samir
author_facet Selim, Amr
Al-Hadithy, Nawfal
Diab, Nader M.
Ahmed, Abdulla Mohamed
Kader, Khaled Fawzy Abdel
Hegazy, Mohamed
Azeem, Hazem Abdel
Barakat, Ahmed Samir
author_sort Selim, Amr
collection PubMed
description 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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spelling pubmed-105157052023-09-23 Proposal of a modified tip apex distance for prediction of lag screw cut-out in trochanteric hip fractures Selim, Amr Al-Hadithy, Nawfal Diab, Nader M. Ahmed, Abdulla Mohamed Kader, Khaled Fawzy Abdel Hegazy, Mohamed Azeem, Hazem Abdel Barakat, Ahmed Samir SICOT J Original Article 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. EDP Sciences 2023-09-20 /pmc/articles/PMC10515705/ /pubmed/37737668 http://dx.doi.org/10.1051/sicotj/2023026 Text en © The Authors, published by EDP Sciences, 2023 https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0 (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Selim, Amr
Al-Hadithy, Nawfal
Diab, Nader M.
Ahmed, Abdulla Mohamed
Kader, Khaled Fawzy Abdel
Hegazy, Mohamed
Azeem, Hazem Abdel
Barakat, Ahmed Samir
Proposal of a modified tip apex distance for prediction of lag screw cut-out in trochanteric hip fractures
title Proposal of a modified tip apex distance for prediction of lag screw cut-out in trochanteric hip fractures
title_full Proposal of a modified tip apex distance for prediction of lag screw cut-out in trochanteric hip fractures
title_fullStr Proposal of a modified tip apex distance for prediction of lag screw cut-out in trochanteric hip fractures
title_full_unstemmed Proposal of a modified tip apex distance for prediction of lag screw cut-out in trochanteric hip fractures
title_short Proposal of a modified tip apex distance for prediction of lag screw cut-out in trochanteric hip fractures
title_sort proposal of a modified tip apex distance for prediction of lag screw cut-out in trochanteric hip fractures
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10515705/
https://www.ncbi.nlm.nih.gov/pubmed/37737668
http://dx.doi.org/10.1051/sicotj/2023026
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