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No difference between lag screw and helical blade for cephalomedullary nail cut-out a systematic review and meta-analysis

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Abstract

Introduction

Cephalomedullary nail (CMN) cut-out is a severe complication of treatment of intertrochanteric femur fractures. This study aimed to identify modifiable risk factors predictive of implant cut-out including: CMN proximal fixation type (lag screw vs. helical blade), tip-apex distance (TAD), reduction quality, nail length, screw location, and surgeon fellowship training.

Methods

A systematic review of the published literature was conducted on Pubmed/MEDLINE and Cochrane Library databases for English language papers (January 1st, 1985–May 10th, 2020), with 21 studies meeting inclusion/exclusion criteria. Studies providing quantitative data comparing factors affecting CMN nail cut-out were included, including fixation type (lag screw vs. helical blade), tip-apex distance (TAD), reduction quality, nail length, and screw location. Twelve studies were included and graded by MINOR and Newcastle–Ottawa Scale to identify potential biases. Meta-analysis and pooled analysis were conducted when possible with forest plots to summarize odds ratios (OR) and associated 95% confidence interval (CI).

Results

There was no difference in implant cut-out rate between lag screws (n = 745) versus helical blade (n = 371) (OR: 1.03; 95% CI: 0.25–4.23). Pooled data analysis revealed TAD > 25 mm (n = 310) was associated with higher odds of increased cut-out rate relative to TAD < 25 mm (n = 730) (OR: 3.72; 95% CI: 2.06–6.72).

Conclusion

Our review suggests that cephalomedullary implant type (lag screw vs. helical blade) is not a risk factor for implant cut-out. Consistent with the previous literature, increased tip-apex distance > 25 mm is a reliable predictor of implant cut-out risk. Suboptimal screw location and poor reduction quality are associated with increased risk of screw cut-out.

Level of evidence

Level III.

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Funding

No funding was required for this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Maimonides Medical Center, 4803 10th Avenue, Brooklyn, NY, 11219, USA

    Mitchell Ng, Ivan Golub, Matthew Ciminero & Kevin K. Kang

  2. Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 45219, USA

    Nihar S. Shah

  3. Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, 9500 Euclid Avenue, Mailcode A41, Cleveland, OH, 44195, USA

    Kevin Zhai, Ahmed K. Emara & Nicolas S. Piuzzi

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  1. Mitchell Ng
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  2. Nihar S. Shah
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Corresponding author

Correspondence to Nicolas S. Piuzzi.

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Conflict of interest

The present review of the literature did not require patient interaction, interventions, or consent. Ferghana Partners Inc: Paid consultant. ISCT: Board or committee member, Journal of Hip Surgery: Editorial or governing board, Journal of Knee Surgery: Editorial or governing board, Orthopaedic Research Society: Board or committee member, RegenLab: Research support, Zimmer: Research support, Brooklyn Orthopaedic Society: Board or committee member, DePuy, A Johnson & Johnson Company: Paid consultant, Ahmed K. Emara, Nihar Shah, Matthew Ciminero, Kevin Zhai, and Ivan Golub have nothing to disclose.

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The present systematic review of the literature did not require institutional review board approval.

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Ng, M., Shah, N.S., Golub, I. et al. No difference between lag screw and helical blade for cephalomedullary nail cut-out a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 32, 1617–1625 (2022). https://doi.org/10.1007/s00590-021-03124-8

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  • DOI: https://doi.org/10.1007/s00590-021-03124-8

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