Objective

To discover the key evaluation tool of the cephalic fixation position for predicting implant failures in geriatric intertrochanteric fracture (ITF) patients treated with internal fixations after achieving an acceptable reduction.

Methods

We measured the geriatric ITF patients undergoing single-screw cephalomedullary nailing (CMN) fixation surgery after obtaining the acceptable reduction (including anatomical reduction and positive medial cortex support reduction) in our treatment group between September 2016 and March 2020 by using four kinds of cephalic fixation position evaluation tools including Cleveland zone system, Parker’s ratio index, tip–apex distance (TAD), calcar-referenced TAD (CalTAD), and analyzed which were the key evaluation tools for measurement of cephalic fixation position for prediction of implant failures in geriatric ITF patients with internal fixations.

Results

Seventy-four ITF patients treated with single-screw CMN fixation after obtaining the acceptable reduction were enrolled in this study. Of the 74 patients, nine cases were observed with implant failures. There were six cases of cut-out and three of pending cut-out. We found that TAD (odds ratio (OR)=1.149; 95% confidence interval (CI), 1.00–1.32; P=.046) and CalTAD (OR=1.140; 95% CI, 1.00–1.30; P=.037) were risk factors for implant failures by univariate analysis, while only CalTAD (OR=1.200; 95% CI, 1.032–1.395; P=.018) was the independent risk factor for implant failures by multivariate analysis. The Kappa coefficient (κ) of CalTAD was .976 (95% CI, .966–.984) by ICC analysis. The ROC analysis showed that the best cut-off value of CalTAD was 23.76 mm with a sensitivity of 77.8% and specificity of 72.3% (area under the curve, AUC =.775; P = .001).

Conclusions

CalTAD is the key evaluation tool for measurement of cephalic fixation position for predicting implant failures in geriatric ITF patients treated with single-screw CMN after obtaining the acceptable reduction.

中文翻译：

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CalTAD 是测量头部固定位置的关键评估工具，用于预测老年股骨粗隆间骨折患者在实现可接受的复位后内固定物的切除

客观的

发现头部固定位置的关键评估工具，用于预测老年股骨粗隆间骨折（ITF）患者在达到可接受的复位后接受内固定治疗的植入物失败。

方法

我们测量了 2016 年 9 月至 2020 年 3 月期间我们治疗组接受单螺钉头髓钉 (CMN) 固定手术的老年 ITF 患者在获得可接受的复位（包括解剖复位和正内侧皮质支持复位）后使用四种头颅固定位置评估工具包括 Cleveland zone system、Parker's ratio index、tip-apex distance (TAD)、calcar-referenced TAD (CalTAD)，并分析了哪些是用于预测老年 ITF 植入物失败的头部固定位置测量的关键评估工具内固定患者。

结果

本研究招募了 74 名 ITF 患者在获得可接受的复位后接受单螺钉 CMN 固定。在 74 名患者中，观察到 9 例种植体失败。有 6 起停产案和 3 起待停产案。我们发现 TAD（优势比 (OR)=1.149；95% 置信区间 (CI)，1.00–1.32；P=.046）和 CalTAD（OR=1.140；95% CI，1.00–1.30；P=.037）单变量分析是种植体失败的危险因素，而多变量分析只有 CalTAD（OR=1.200；95% CI，1.032-1.395；P=.018）是种植体失败的独立危险因素。通过 ICC 分析，CalTAD 的 Kappa 系数 (κ) 为 0.976 (95% CI, 0.966–.984)。ROC 分析显示，CalTAD 的最佳截断值为 23.76 mm，灵敏度为 77.8%，特异性为 72.3%（曲线下面积，AUC =.775；P = .001）。

结论

CalTAD 是测量头部固定位置的关键评估工具，用于预测接受单螺钉 CMN 治疗的老年 ITF 患者在获得可接受的复位后植入物失败。