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

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

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.

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Authors and Affiliations

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

    Jihyo Hwang

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

    Michael Hadeed, Cyril Mauffrey & Joshua A. Parry

  3. Florida State College of Medicine, Orlando, FL, USA

    Travis Sapp

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

    Kenneth J. Koval

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

    George H. Haidukewych & Joshua L. Langford

Authors
  1. Jihyo Hwang
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  2. Michael Hadeed
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  3. Travis Sapp
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  4. Cyril Mauffrey
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  5. Kenneth J. Koval
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  6. George H. Haidukewych
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  7. Joshua L. Langford
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  8. Joshua A. Parry
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Corresponding author

Correspondence to Joshua A. Parry.

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Conflict of interest

Joshua Langford is on the editorial board of the journal of orthopaedic trauma; receives royalties from advanced orthopaedic solutions; has stock options with core orthopaedics; and is a paid consultant for Orthogrid and stryker. Kenneth Koval is a paid speaker or consultant for Biomet and Stryker; and receives publishing royalties from Wolters Kluwer health. George Haidukewych in on the editorial or governing board of the journal of orthopaedic trauma; receives royalties from and is a paid consultant for Biomet, Depuy and Synthes; and has stock or stock options from orthopediatrics. The remaining authors have nothing to disclose. Cyril Mauffrey has the following disclosures: Abbott: Other financial or material support; Carbofix: Research support; current opinion in orthopaedics: Editorial or governing board; DePuy, A Johnson & Johnson Company: Other financial or material support; International Orthopaedics: Editorial or governing board; La Societe Internationale de Chirurgie Orthopedique et de Traumatologie: Board or committee member; Orthopaedic Trauma Association: Board or committee member; osteomed: Research support; Patient safety in surgery: Editorial or governing board; Springer: Publishing royalties, financial or material support; Stryker: Paid consultant; Unpaid consultant; The European journal of orthopaedic surgery and traumatology: Editorial or governing board. Joshua Parry has the following disclosures: The European journal of orthopaedic surgery and traumatology: Editorial or governing board. None of the remaining authors have anything to disclose.

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Hwang, J., Hadeed, M., Sapp, T. et al. Varus displacement of intertrochanteric femur fractures on injury radiographs is associated with screw cutout. Eur J Orthop Surg Traumatol 31, 683–687 (2021). https://doi.org/10.1007/s00590-020-02820-1

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  • DOI: https://doi.org/10.1007/s00590-020-02820-1

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