Key result
Tip-apex distance >25 mm linked to ~264-fold higher implant cut-out risk after PFNA.
Why the study?
Implant cut-out is the commonest post-fixation complication of intertrochanteric fractures, increasing morbidity and healthcare burdens in the geriatric population, prompting an analysis of risk factors to prevent its occurrence.
What are the risk factors for implant cut-out in patients with intertrochanteric fractures treated with a short PFNA nail?
Cohort (n=203)
No
What are the risk factors for implant cut-out in patients with intertrochanteric fractures treated with a short PFNA nail?
Effect estimate: OR 263.53
p-value: p=<0.001
Tip-Apex Distance ≥25 mm significantly increases the likelihood of implant cut-out following PFNA for intertrochanteric fractures.
Supports TAD monitoring to mitigate cut-out after PFNA; hypothesis-generating pending prospective validation.
Background Implant cut-out is the commonest post-fixation complication of intertrochanteric fractures. It increases socioeconomic and healthcare burdens as well as patient morbidity in its geriatric population. This study identifies cut-out risk factors to prevent its occurrence. Materials and Methods This is a retrospective analysis of 203 patients with intertrochanteric fractures treated with a short Proximal Femur Nail Antirotation (PFNA) nail from April 2021 to March 2022 at a major Hong Kong tertiary hospital. Variables studied included gender, age, pre-morbidities, fracture side, fracture type, reduction quality, Tip-Apex Distance (TAD), and Cleveland 9 zones. Results The cut-out rate was 2.72%. Significant risk factors included male gender (p = 0.036), chronic kidney disease (p = 0.039), and TAD≥25 mm (p < 0.001). Cut-out likelihood increased 263.53 times with a TAD>25 mm. Patients with good reduction quality had significantly lower cut-out rates (p = 0.018). Conclusion Both preoperative and operative variables affect cut-out rates. Optimizing TAD and reduction quality is crucial.
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Kinglam et al. (2025) conducted a cohort in Intertrochanteric hip fractures (n=203). Proximal Femur Nail Antirotation (PFNA) system was evaluated on Implant cut-out (OR 263.53, p=<0.001). A Tip-Apex Distance >25 mm increased the likelihood of implant cut-out 263.53 times following treatment of intertrochanteric fractures with a Proximal Femur Nail Antirotation system (p<0.001).
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