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. 2017 Jan-Mar;8(1):68-72.
doi: 10.1016/j.jcot.2016.09.009. Epub 2016 Sep 29.

Can TAD and CalTAD predict cut-out after extra-medullary fixation with new generation devices of proximal femoral fractures? A retrospective study

Gaetano Caruso  1 , Mattia Andreotti  1 , Carlotta Pari  1 , Francesco Soldati  1 , Alessandro Gildone  1 , Vincenzo Lorusso  1 , Leo Massari  1
Affiliations

Can TAD and CalTAD predict cut-out after extra-medullary fixation with new generation devices of proximal femoral fractures? A retrospective study

Gaetano Caruso et al. J Clin Orthop Trauma. 2017 Jan-Mar.

Abstract

Background: Intramedullary and extramedullary strategies of pertrochanteric fracture fixation are still controversial, but new percutaneous devices may give advantages regarding operative time, blood loss and rate of cardiovascular complications. We retrospectively analyze our cases regarding Anteversa® plate (Intrauma, Turin, Italy) fixation of pertrochanteric femoral fractures, focusing on the correlation between two radiographical parameters (tip-apex distance "TAD" and calcar referenced tip-apex distance "CalTAD") and the occurrence of cut-out. The purpose of this study was to determine if these predicting factors of cut-out are reliable in the treatment of proximal femoral fractures with the Anteversa plate.

Methods: A series of 77 patients with 53 31-A1 fracture types and 24-A2 fractures completed a 12-month-follow-up. Clinical outcomes were evaluated according to Parker-Palmer Mobility Score at the final follow-up. TAD and CalTAD were considered to determine their correlation with cut-out events.

Results: The mean Parker-Palmer Score was 6.94 in A1 group and 7.41 in A2 group (p = 0.47). Mean value of TAD index was 29.58, 29.81 in the A1 group and 29.08 in the A2 group, and mean value of CalTAD index was 30.87, 31.03 in the A1 group and 30.50 in the A2 group. We observed 3 cases of implant cut-out. We shared our sample in two groups, one group with TAD and CalTAD indices lower than 25 mm and another group higher than 25 mm to evaluate how the Palmer Parker score changed and no statistical differences were found between the two groups.

Conclusions: Taking into consideration that good clinical results were obtained for TAD and CalTAD values superior to 25 mm, the prognostic value of 25 mm of TAD and CalTAD indices might not be appropriate to this new percutaneous plate.

Keywords: Calcar referenced tip-apex distance (CalTAD); Cut-out; Extramedullary devices; Pertrocahanteric fracture; Tip-apex distance (TAD).

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Figures

Fig. 1
Fig. 1
A patient with pertrochanteric fractures 31-A2 (A, B) treated with Anteversa® plate, anteroposterior view (C) and lateral view (D).
Fig. 2
Fig. 2
(A) Tip-apex distance calculated on anteroposterior radiograph (TAD ap); (B) Tip-apex distance as referenced to the calcar calculated on the anteroposterior radiograph (CalTAD ap); (C) Tip-apex distance calculated on the lateral radiograph (TAD lat); (D) Tip-apex distance (TAD); (E) Calcar referenced tip-apex distance (CalTAD). D true is the known diameter of the lag screw (8 mm). D ap is the calculated diameter of the lag screw on the anteroposterior radiograph. D lat is the calculated diameter of the lag screw on the lateral radiograph.
Fig. 3
Fig. 3
Chart showing the distribution of TAD values and frequencies of cut-outs.
Fig. 4
Fig. 4
Chart showing the distribution of CalTAD values and frequencies of cut-outs.
See this image and copyright information in PMC

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