Varus displacement of intertrochanteric femur fractures on injury radiographs is associated with screw cutout

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ORIGINAL ARTICLE

Varus displacement of intertrochanteric femur fractures on injury radiographs is associated with screw cutout Jihyo Hwang1 · Michael Hadeed2 · Travis Sapp3 · Cyril Mauffrey2 · Kenneth J. Koval4 · George H. Haidukewych5 · Joshua L. Langford5   · Joshua A. Parry2 Received: 10 August 2020 / Accepted: 17 October 2020 © Springer-Verlag France SAS, part of Springer Nature 2020

Abstract Introduction  The purpose of this study was to determine if varus displacement of intertrochanteric femur fractures on injury radiographs is associated with screw cutout after fixation. Methods  A retrospective review performed at two urban level 1 trauma centers identified 334 patients with intertrochanteric femur fractures treated with either a cephalomedullary nail (CMN) or a sliding hip screw (SHS). Median patient age was 75 years, 69% were female and 46% had unstable fractures. Varus fracture displacement on injury radiographs, defined as the most proximal aspect of the femoral head being at or below the most proximal aspect of the greater trochanter, was present in 38% of patients. Screw cutout was recorded. Results  Varus displacement was associated with unstable fracture patterns (62% vs. 37%, difference (D) 25%, 95% confidence interval (CI) 15–35%), female gender (77% vs. 64%, D 13%, CI 3–22%) and poor/adequate reductions (54% vs. 41%, D 13%, CI 2–23%). Cutout occurred in 9 (3%) patients, 8 of which had varus displacement. There was no detectable difference, with wide confidence intervals, between patients that did and did not experience cutout in terms of age, gender, unstable fractures, implants, tip-apex distance (TAD) or poor/adequate reductions. On univariate and multivariate analysis, varus displacement was the only variable associated with cutout. Patients with and without varus displacement had a cutout incidence of 6 and 0.5% (Odds ratio 13, CI 1.6–108). Conclusion  Intertrochanteric fractures presenting with varus displacement were more likely to experience cutout. This potential risk factor for cutout warrants further study. Level of evidence  Level 3, retrospective cohort. Keywords  Varus displacement · Cutout · Intertrochanteric femur fracture · Tip-apex distance · Cephalomedullary nail · Sliding hip screw

Introduction * Joshua A. Parry [email protected] 1



Department of Orthopaedics, Gangnam Sacred Heart Hospital, University of Hallym School of Medicine, Seoul, Republic of Korea

2



Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver Health, 777 Bannock St, MC 0188, Denver, CO, USA

3

Florida State College of Medicine, Orlando, FL, USA

4

Department of Orthopaedics, Memorial Hospital, Gulfport, MS, USA

5

Department of Orthopaedics, Orlando Health, Orlando, FL, USA



In modern series, the incidence of cutout after intertrochanteric fracture fixation with cephalomedullary nails (CMN) or sliding hip screws (SHS) is low, ranging from 1 to 5% [1–3] Risk factors for cutout after intertrochanteric fracture fixation have been st