Comparison of cutout risk factors between single- and doublescrew proximal nails in intertrochanteric femur fractures - a multicentric study

Abstract

<p><strong>Aim</strong> <br />Significant risk factors for femoral nail cutout are well-documented, primarily in the context of single-screw proximal nails.<br />However, it remains uncertain whether those same risk factors are applicable when considering different implant devices. The aim of this retrospective cohort study was to compare cutout risk factors between single- versus double-screw proximal femoral nails. <br /><strong>Methods</strong> <br />Patients over the age of 75 with intertrochanteric femur fractures (AO Classification 31-A1 or 31-A2) were included in the multicentre study. A study group was treated with a double-screw nail, while a control group received single-screw device. Demographic data, surgical time (min), fracture pattern, distal locking, reduction quality, comorbidities, tip-apex distance (TAD) and 12-month functional scores was collected.<br /><strong>Results</strong> <br />Two hundred patients were enrolled, 100 for each group.<br />Nine patients experienced a cutout complication, five in the study<br />and four in the control group. The main differences were in distal locking configurations (p<0.05) and in TAD values (p<0.05). The TAD value was higher in the study than in the control group (30.40±0.89 versus 26.79±1.79). No differences at 12-month follow up were reported according to functional scores.<br /><strong>Conclusion</strong> <br />This study provides insights into the choice of nail systems for intertrochanteric femur fractures, highlighting the importance of distal locking configurations and TAD values. The double screw nail exhibits quite a tolerance by having a higher<br />average TAD value. These findings may guide clinical decisionmaking in the treatment of this challenging fracture type.</p>