Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Orthopaedics and Traumatology
Published in: European Orthopaedics and Traumatology 4/2015

01-12-2015 | Original Article

Internal fixation of intertrochanteric fractures using the percutaneous compression plate: the event of cutting out and its prediction by the tip-apex-distance

Authors: B. Schmidt-Rohlfing, M. Hofman, N. Heussen

Published in: European Orthopaedics and Traumatology | Issue 4/2015

Login to get access

Abstract

Introduction

In a recent study, the analyzed percutaneous compression plate (PCCP) data identified the tip-apex-distance (TAD) as the most valuable risk factor for the reoperation rate and in particular for the event of cutting out of the cephalic screws after internal fixation of intertrochanteric fractures. However, it is unknown which potential distance between the tip of the screws and the apex of the femoral head is most valuable in predicting the event of cutting out. As the PCCP device has two cephalic screws, there are at least three different distances which can be measured, including the distance between the tip of the lower screw and the apex of the femoral head, the distance between the center of the line between the two cephalic screws and the apex, and finally between the tip of the upper screw and the apex. Our study was motivated by the question which measurement can provide the best results for the prediction of the event of cutting out of the cephalic screws.

Patients and methods

The digitalized postoperative X-ray films of 174 patients with 174 PCCP implants were analyzed, and we obtained three different measurements for every patient. The primary outcome was the proportion of those patients with a cutting out of the screws. A univariate logistic regression was performed to assess the impact of the TAD on the event of cutting out. To describe the degree of consistency among measurements, we calculated an intra-class correlation coefficient (ICC) and the corresponding 95 % confidence limits. For each of the different measurements, we performed a receiver operating characteristic (ROC) curve analysis and calculated the area under the curve (AUC) and the corresponding 95 % confidence limits. In order to identify the most valuable distance measure, we added pairwise comparisons of the AUCs.

Results

Out of 174 patients, six patients (3.4 %) were reoperated due to cutting out of the cephalic screws. In the univariate logistic regression model, the p value was 0.0012 (OR 0.874; 95 % CI 0.806 to 0.948). The ROC curve analysis showed similar results for the different measurements; however, the highest AUC value was obtained for the center position.

Conclusions

In conclusion, all three measurements provide similar results and are suitable to predict the risk of cutting out of the cephalic screws.
Literature
1.
Gotfried Y (2000) Percutaneous compression plating of intertrochanteric hip fractures. J Orthop Trauma 14:490–495CrossRefPubMed
2.
Shen J, Luo F, Sun D, Huang Q, Xu J, Dong S, Xie Z (2015) Mid-term results after treatment of intertrochanteric femoral fractures with percutaneous compression plate (PCCP). Injury 46:347–357CrossRefPubMed
3.
Langford J, Pillai G, Ugliailoro AD et al (2011) Perioperative lateral trochanteric wall fractures: sliding hip screw versus percutaneous compression plate for intertrochanteric hip fractures. J Orthop Trauma 25:191–195CrossRefPubMed
4.
Palm H, Jacobsen S, Sonne-Holm S, Gebuhr P, Hip Fracture Study Group (2007) Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg Am 89:470–475CrossRefPubMed
5.
Brandt S, Lefever S, Janzing H et al (2002) Percutaneous compression plating (PCCP) versus the dynamic hipscrew for pertrochanteric hip fractures: preliminary results. Injury 33:413–418CrossRefPubMed
6.
Janzing H, Houben B, Brandt S et al (2002) The Gotfried PerCutaneous Compression Plate versus the Dynamic Hip Screw in the treatment of pertrochanteric hip fractures: minimal invasive treatment reduces operative time and postoperative pain. J Trauma 52:293–298CrossRefPubMed
7.
Peyser A, Weil Y, Brocke L et al (2007) A prospective, randomised study comparing the percutaneous compression plate and the compression hip screw for the treatment of intertrochanteric fractures of the hip. J Bone Joint Surg (Br) 88:1210–1217CrossRef
8.
Yang E, Qureshi S, Trokhan S et al (2011) Gotfried percutaneous compression plating compared with sliding hip screw fixation of intertrochanteric hip fractures: a prospective randomized study. J Bone Joint Surg Am 92:942–947
9.
Zhang L, Shen J, Yu S, Huang Q, Xie Z (2014) Percutaneous compression plate versus dynamic hip screw for treatment of intertrochanteric Hip fractures: a meta-analyse of five randomized controlled trials. ScientificWorldJournal 10:512512
10.
Cheng T, Zhang GY, Liu T et al (2012) A meta-analysis of percutaneous compression plate 343 versus sliding hip screw for the management of intertrochanteric fractures of the hip. J Trauma Acute Care Surg 72:1435–1443CrossRefPubMed
11.
Panesar S, Mirza S, Bharadwaj G et al (2008) The percutaneous compression plate versus the dynamic hip screw: a meta-analysis. Acta Orthop Belg 74:38–48PubMed
12.
Baumgaertner M, Curtin S, Lindskog D et al (1995) The value of the tip-apex distance in predicting failure of fixation of pertrochanteric fractures of the hip. J Bone Joint Surg Am 77:1058–1064PubMed
13.
Schmidt-Rohlfing B, Heussen N, Knobe M, Pfeifer R, Kaneshige JR, Pape HC (2013) Reoperation rate after internal fixation of intertrochanteric femur fractures with the percutaneous compression plate: what are the risk factors? J Orthop Trauma 27:312–317CrossRefPubMed
14.
Hanley J, McNeil B (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–36CrossRefPubMed
15.
Zweig MH, Campbell G (1993) Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem 39:561–577PubMed
Metadata
Title
Internal fixation of intertrochanteric fractures using the percutaneous compression plate: the event of cutting out and its prediction by the tip-apex-distance
Authors
B. Schmidt-Rohlfing
M. Hofman
N. Heussen
Publication date
01-12-2015
Publisher
Springer Berlin Heidelberg
Published in
European Orthopaedics and Traumatology / Issue 4/2015
Print ISSN: 1867-4569
Electronic ISSN: 1867-4577
DOI
https://doi.org/10.1007/s12570-015-0327-x

Other articles of this Issue 4/2015

European Orthopaedics and Traumatology 4/2015 Go to the issue

Case Report

Anatomic healing of a humeral shaft fracture despite failure of plate fixation—locking plates are a good idea

Original Article

Persistent pain and depression after hip fracture strongly correlate with poor outcomes

Original Article

Failure of a properly positioned tantalum rod for treatment of early femoral head necrosis and conversion to total hip arthroplasty

Original Article

Prevalence of the different lumbar back pain etiologies in Spain: results from a large observational study in 306 centers (the SMILE study)

Original Article

Blood-pressure changes and outcomes associated with cemented bipolar hemiarthroplasty for displaced femoral-neck fractures

Original Article

Therapeutic subclassification of type IV capitellum fracture: a new approach