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Published on: November 13, 2016
Comparison of cutout risk factors between single- and doublescrew proximal nails in intertrochanteric femur fractures
Michele Coviello1, Antonella Abate2, Giovanni Vicenti3
1Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy.
Comparing single-screw versus double-screw femoral nails for intertrochanteric fractures, this study found that while tip-apex distance (TAD) was higher with double-screw nails, both configurations showed similar functional outcomes. Distal locking and TAD were key factors influencing complications.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Geriatric Trauma
Background:
- Femoral nail cutout is a significant complication in treating intertrochanteric femur fractures.
- Risk factors for cutout are established for single-screw proximal nails but less clear for newer devices.
- Understanding implant-specific risk factors is crucial for optimizing treatment outcomes.
Purpose of the Study:
- To compare cutout risk factors between single-screw and double-screw proximal femoral nails.
- To evaluate the influence of implant design on complication rates in elderly patients with specific fracture types.
- To identify key surgical and patient factors associated with implant cutout.
Main Methods:
- Retrospective cohort study including 200 patients (≥75 years) with AO Classification 31-A1 or 31-A2 intertrochanteric femur fractures.
- Patients were treated with either a double-screw nail (study group, n=100) or a single-screw nail (control group, n=100).
- Data collected included demographics, surgical time, fracture pattern, distal locking, reduction quality, comorbidities, tip-apex distance (TAD), and 12-month functional scores.
Main Results:
- Nine patients (4.5%) experienced cutout complications (5 in the double-screw group, 4 in the single-screw group).
- Significant differences were observed in distal locking configurations (p<0.05) and tip-apex distance (TAD) (p<0.05) between the groups.
- The double-screw group had a higher average TAD (30.40±0.89 mm) compared to the single-screw group (26.79±1.79 mm).
- No significant differences in functional scores were reported at 12-month follow-up.
Conclusions:
- Distal locking configurations and TAD are critical factors influencing cutout risk in intertrochanteric femur fractures.
- The double-screw nail system demonstrated tolerance to a higher average TAD, suggesting potential for managing complex fractures.
- Findings may inform clinical decision-making regarding nail system selection for intertrochanteric fractures.
