title: Radiographic Review of Helical Blade Versus Lag Screw Fixation for Cephalomedullary Nailing of Low-Energy Peritrochanteric Femur Fractures: There is a Difference in Cutout.
abstract: OBJECTIVE
  To compare the rate of cutout of helical blades and lag screws in low-energy peritrochanteric femur fractures treated with a cephalomedullary nail (CMN).
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Overall, this study included 362 patients with an average age of 83 year old, a majority of whom were women, and had sustained a low-energy peritrochanteric femur fracture treated with a CMN. All patients had at least 3 months of clinical and radiographic follow, with an average follow-up of 11 months and a range of 3-88 months follow-up.
  
  
  METHODS
  Cephalomedullary nailing with the use of a helical blade or single lag screw for proximal fixation.
  
  
  METHODS
  Cutout of the helical blade or lag screw.
  
  
  RESULTS
  Twenty-two cutouts occurred, 14 (15.1%) of 93 patients with helical blades and 8 (3.0%) of 269 patients with lag screws. Cutout with the helical blade was significantly more frequent than with the lag screw (P = 0.0001). The average tip-apex distance (TAD) was significantly greater for those patients who experienced cutout both for the helical blades (23.5 vs. 19.7 mm; P = 0.0194) and lag screws (24.5 vs. 20.0 mm; P = 0.0197). An absolute TAD predictive of cutout could not be determined.
  
  
  CONCLUSIONS
  When the helical blade was used, implant cutout occurred at a significantly higher rate compared with lag screw fixation. There was not a threshold TAD that was predictive of cutout for either implant.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Advanced Orthopedics and Hand Surgery Institute, Wayne, NJ;†Department of Orthopedic Surgery, University of Rochester Medical Center, Rochester, NY; and‡Department of Orthopedic Surgery, Virginia Commonwealth University, Richmond, VA.
authors.forename: Lorraine C
authors.initials: LC
authors.lastname: Stern
authors.forename: John T
authors.initials: JT
authors.lastname: Gorczyca
authors.forename: Stephen
authors.initials: S
authors.lastname: Kates
authors.forename: John
authors.initials: J
authors.lastname: Ketz
authors.forename: Gillian
authors.initials: G
authors.lastname: Soles
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Humphrey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws / Q000145:classification / Q000706:statistics & numerical data*; D019544:Equipment Failure Analysis; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data*; D017102:Fracture Healing; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D015995:Prevalence; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016896:Treatment Outcome; D014768:Virginia / Q000453:epidemiology