CalTAD is the Key Evaluation Tool for Measurement of Cephalic Fixation Position for Predicting Cut-Out in Geriatric Intertrochanteric Fracture Patients with Internal Fixations after Achieving Acceptable Reduction.

Abstract

ObjectiveTo 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.MethodsWe 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.ResultsSeventy-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).ConclusionsCalTAD 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.