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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| Format: | Article |
| Language: | English |
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EDP Sciences
2023-01-01
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| Series: | SICOT-J |
| Subjects: | |
| Online Access: | https://www.sicot-j.org/articles/sicotj/full_html/2023/01/sicotj230053/sicotj230053.html |
| _version_ | 1797673432554405888 |
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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 | DOAJ |
| 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. |
| first_indexed | 2024-03-11T21:44:28Z |
| format | Article |
| id | doaj.art-4693461124b748efbe89689fb5a8d781 |
| institution | Directory Open Access Journal |
| issn | 2426-8887 |
| language | English |
| last_indexed | 2024-03-11T21:44:28Z |
| publishDate | 2023-01-01 |
| publisher | EDP Sciences |
| record_format | Article |
| series | SICOT-J |
| spelling | doaj.art-4693461124b748efbe89689fb5a8d7812023-09-26T10:13:33ZengEDP SciencesSICOT-J2426-88872023-01-0192810.1051/sicotj/2023026sicotj230053Proposal of a modified tip apex distance for prediction of lag screw cut-out in trochanteric hip fracturesSelim Amr0https://orcid.org/0000-0002-0174-6934Al-Hadithy Nawfal1Diab Nader M.2Ahmed Abdulla Mohamed3Kader Khaled Fawzy Abdel4Hegazy Mohamed5https://orcid.org/0000-0002-2575-2001Azeem Hazem Abdel6Barakat Ahmed Samir7https://orcid.org/0000-0002-6778-2364Cairo University HospitalsHillingdon HospitalCairo University HospitalsCairo University HospitalsCairo University HospitalsCairo University HospitalsCairo University HospitalsCairo University HospitalsIntroduction: 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.https://www.sicot-j.org/articles/sicotj/full_html/2023/01/sicotj230053/sicotj230053.htmltrochanteric fracturesdhslag screwtip apex distancefixation failurecut-out |
| spellingShingle | 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 SICOT-J trochanteric fractures dhs lag screw tip apex distance fixation failure cut-out |
| 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 | trochanteric fractures dhs lag screw tip apex distance fixation failure cut-out |
| url | https://www.sicot-j.org/articles/sicotj/full_html/2023/01/sicotj230053/sicotj230053.html |
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