Cut-out of the Cervical Screw on Pertrochanteric Fractures

Study Overview
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Brief Summary
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Pertrochanteric fractures are a highly relevant topic not only because of the high frequency or age of the population concerned, but also because of comorbidity (osteoporosis, malnutrition, decreased physical activity, decreased visual acuity, neurological deficits, asthenia, disorders of the equilibrium and impaired reflexes) and the mortality associated with this type of fractures. The cut-out of the cervical screw is a mechanical complication common to different means of osteosynthesis of pertrochanteric fractures, this complication significantly increases the morbidity. From January 2013 to May 2019, out of a total of 340 patients having had surgery for pertrochanteric fracture, 12 cases of cervical screw cut-out were recorded within the Brugmann University Hospital. The average follow-up after surgery was 18 months. This study analyses different parameters and their link with cervical screw cut-outs, and compares the results with the ones published in the scientific literature.

Official Title
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Cut-out of the Cervical Screw on Pertrochanteric Fractures: Retrospective Analysis of 12 Cases

Conditions
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Pertrochanteric Fracture

Intervention / Treatment
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* Other: Data extraction from medical files


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients admitted for a pertrochanteric and subtrochanteric fracture of the femur treated by cerebrospinal nailing with all the methods of fixation of the head (blade or screw) and who evolved to a cut-out of the cervical screw. Exclusion Criteria: Fractures treated by open osteosynthesis Fractures operated with good radiological outcome Incomplete or non useable medical files

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| surgery for a pertrochanteric fracture<br>Patients having had surgery for a pertrochanteric fracture at the CHU Brugmann Hospital between January 2013 and May 2019. | Other: Data extraction from medical files<br>* Data extraction from medical files<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Ender Classification | Ender classification of the fracture. I: stable basal-cervical fracture. II: stable pertrochanteric fracture. III: unstable intertrochanteric fracture. IV: unstable subtrochanteric fracture. V: unstable trochantero-diaphyseal fracture | 5 minutes | 
| Bone quality | Presence of osteoporosis or pathologies inside the bone (yes/no) | 5 minutes | 
| Type of osteosynthesis | Material used. Choice between: short/long gamma nail, long/short PFNA nail, long/short Affixus nail | 5 minutes | 
| Correct positioning of the screw | Correct positioning of the screw on radiological images (yes/no) | 5 minutes | 
| Delay between fracture and screw cut-off | Delay between fracture and screw cut-off | up to 18 months | 
| Tip Apex Distance (TAD) | TAD is a measure of how close the tip of the lag screw lies to the femoral apex. | 5 minutes | 
| Parker ratio | This method involves recording the superior, inferior, anterior and posterior borders of the femoral head. The ratio is calculated in both the AP and lateral views to give a value within a range of 0 to 100 for each view. In the AP view, 0 is considered to be the most inferior screw placement and 100 is considered to be the most superior pin placement. In the lateral view, 0 is considered to be the most posterior screw placement and 100 is considered to be the most anterior pin placement. | 5 minutes | 
| Age | Age of the patient | 5 minutes | 
| Sex | Sex of the patient | 5 minutes |