Tip-apex distance as a risk factor for cut-out in cephalic double-screw nailing of intertrochanteric femur fractures

Michele Coviello; Antonella Abate; Giuseppe Maccagnano; Francesco Ippolito; Vittorio Nappi; Andrea M Abbaticchio; Elio Caiaffa; Vincenzo Caiaffa

doi:10.1302/2633-1462.56.BJO-2023-0163.R1

Tip-apex distance as a risk factor for cut-out in cephalic double-screw nailing of intertrochanteric femur fractures

Bone Jt Open. 2024 Jun 2;5(6):457-463. doi: 10.1302/2633-1462.56.BJO-2023-0163.R1.

Authors

Michele Coviello¹, Antonella Abate², Giuseppe Maccagnano¹, Francesco Ippolito², Vittorio Nappi², Andrea M Abbaticchio³, Elio Caiaffa³, Vincenzo Caiaffa²

Affiliations

¹ Department of Clinical and Experimental Medicine, Orthopaedics Unit, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy.
² Orthopaedic and Traumatology Unit, "Di Venere" Hospital, Bari, Italy.
³ Department of Basic Medical Sciences, Orthopaedic and Trauma Unit, Neurscience and Sense Organs, School of Medicine, AOU Consorziale Policlinico, University of Bari "Aldo Moro", Bari, Italy.

PMID: 38823797
PMCID: PMC11144064
DOI: 10.1302/2633-1462.56.BJO-2023-0163.R1

Abstract

Aims: Proximal femur fractures treatment can involve anterograde nailing with a single or double cephalic screw. An undesirable failure for this fixation is screw cut-out. In a single-screw nail, a tip-apex distance (TAD) greater than 25 mm has been associated with an increased risk of cut-out. The aim of the study was to examine the role of TAD as a risk factor in a cephalic double-screw nail.

Methods: A retrospective study was conducted on 112 patients treated for intertrochanteric femur fracture with a double proximal screw nail (Endovis BA2; EBA2) from January to September 2021. The analyzed variables were age, sex, BMI, comorbidities, fracture type, side, time of surgery, quality of reduction, pre-existing therapy with bisphosphonate for osteoporosis, screw placement in two different views, and TAD. The last follow-up was at 12 months. Logistic regression was used to study the potential factors of screw cut-out, and receiver operating characteristic curve to identify the threshold value.

Results: A total of 98 of the 112 patients met the inclusion criteria. Overall, 65 patients were female (66.3%), the mean age was 83.23 years (SD 7.07), and the mean follow-up was 378 days (SD 36). Cut-out was observed in five patients (5.10%). The variables identified by univariate analysis with p < 0.05 were included in the multivariate logistic regression model were screw placement and TAD. The TAD was significant with an odds ratio (OR) 5.03 (p = 0.012) as the screw placement with an OR 4.35 (p = 0.043) in the anteroposterior view, and OR 10.61 (p = 0.037) in the lateral view. The TAD threshold value identified was 29.50 mm.

Conclusion: Our study confirmed the risk factors for cut-out in the double-screw nail are comparable to those in the single screw. We found a TAD value of 29.50 mm to be associated with a risk of cut-out in double-screw nails, when good fracture reduction is granted. This value is higher than the one reported with single-screw nails. Therefore, we suggest the role of TAD should be reconsidered in well-reduced fractures treated with double-screw intramedullary nail.