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Abstract
Purpose
The purpose of this study is to evaluate the risk factors for the occurrence of cut-out of proximal femoral nail by a lag screw as the treatment for intertrochanteric fractures.
Materials and Methods
A total of 151 patients (76 males and 75 females; mean age, 73.7±12.1 years), who were diagnosed with intertrochanteric fracture at Gyeongsang National University Hospital between January 2011 and March 2016, with a follow-up of at least for 6 months were included in this retrospective study. Various risk factors, such as demographic data, osteoporosis, collodiaphyseal angle (CDA) (≤130˚ or >130˚), tip-apex distance (TAD) (≤25 mm or >25 mm), and the position of lag screw in the femur head (quadrant) related to the occurrence of cut-out were taken into consideration. The strength of association for each factor was determined through the calculation of the odds ratio (OR), within the 95% confidence interval (CI). First, we performed univariate logistic regression analyses for all variables; then, we performed a multivariate logistic regression analysis, using only the significant variables that had resulted from the univariate analysis.
Results
Among the 151 cases, the occurrence of cut-out was observed in 14 cases (9.3%). In a univariate analysis, the fracture patterns based on the AO/OTA classification (p=0.045), CDA (p<0.001) and the position of lag screw in the femur head (quadrant) (p=0.001) showed a significant association with the occurrence of the cut-out. However, TAD was not significantly associated with the cut-out (p=0.886). Various factors, which were significant in univariate analyses, were included in multivariate analyses. In multivariate analyses, CDA (OR, 12.291; 95% CI, 2.559-59.034; p=0.002), and quadrant (OR, 7.194; 95% CI, 1.712-30.303; p=0.007) were significantly associated with the cut-out.
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Table 1
Demographic Data of the Patients in Each Group
Table 2
Distribution of Fractures according to AO the Classification*
Table 3
Analysis of Postoperative Neck-Shaft Angle Difference to the Un-Injured Side
| Difference to contralateral side | Total | Cut-out frequency |
|---|---|---|
| <-5° (varus) | 8 | 5 (62.5) |
| -5°–0° | 34 | 4 (11.8) |
| 0°–5° | 53 | 3 (5.7) |
| 5°–10° | 40 | 1 (2.5) |
| >10° (valgus) | 16 | 1 (6.3) |
Table 4
The Statistical Outcomes of the Present Study
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