Abstract：
BACKGROUND: It is irresponsible if we disregard reduction quality to talk about cut-outs in intertrochanteric fractures (ITF) with internal fixation. The aim of this study is to analyze the risk-factors for cut-outs in geriatric ITF with cephalomedullary nailing after obtaining acceptable reduction.
METHODS: In order to investigate the risk-factors for cut-outs in geriatric ITF after obtaining acceptable reduction, we retrospectively reviewed 367 patients who underwent cephalomedullary nail for ITF in our department between September 2016 and December 2021. Potential variables including demographic data and radiological parameters (namely the fracture type, Singh index, lateral wall fracture, cephalic nail position, Parker\'s ratio index, tip-apex-distance (TAD), and calcar-referenced TAD (CalTAD)) were collected. Logistic regression analysis was performed to identify the significant risk factors for cut-outs.
RESULTS: One hundred twenty-one patients were suitable for this study. Of the 121 cases, nine cases (7.4%) were observed with cut-out or pending cut-out. We found that Age (adjusted odds ratio (OR) 1.158, 95% confidence interval (CI) 1.016 to 1.318, p = 0.028), lateral wall fracture (adjusted OR 11.07, 95%CI 1.790 to 68.380, p = 0.01), and CalTAD (adjusted OR 1.277, 95%CI 1.005 to 1.622, p = 0.045) were independent risk-factors for cut-outs.
CONCLUSIONS: Age, lateral wall fracture and CalTAD are independent risk-factors for cut-outs in geriatric ITF with cephalomedullary nailing after obtaining acceptable reduction. In order to avoid cut-outs, an optimal CalTAD is necessary even obtaining acceptable reduction, especially in the over-aged patients with lateral wall fracture.
METHODS: In order to investigate the risk-factors for cut-outs in geriatric ITF after obtaining acceptable reduction, we retrospectively reviewed 367 patients who underwent cephalomedullary nail for ITF in our department between September 2016 and December 2021. Potential variables including demographic data and radiological parameters (namely the fracture type, Singh index, lateral wall fracture, cephalic nail position, Parker\'s ratio index, tip-apex-distance (TAD), and calcar-referenced TAD (CalTAD)) were collected. Logistic regression analysis was performed to identify the significant risk factors for cut-outs.
RESULTS: One hundred twenty-one patients were suitable for this study. Of the 121 cases, nine cases (7.4%) were observed with cut-out or pending cut-out. We found that Age (adjusted odds ratio (OR) 1.158, 95% confidence interval (CI) 1.016 to 1.318, p = 0.028), lateral wall fracture (adjusted OR 11.07, 95%CI 1.790 to 68.380, p = 0.01), and CalTAD (adjusted OR 1.277, 95%CI 1.005 to 1.622, p = 0.045) were independent risk-factors for cut-outs.
CONCLUSIONS: Age, lateral wall fracture and CalTAD are independent risk-factors for cut-outs in geriatric ITF with cephalomedullary nailing after obtaining acceptable reduction. In order to avoid cut-outs, an optimal CalTAD is necessary even obtaining acceptable reduction, especially in the over-aged patients with lateral wall fracture.
摘要：
背景：如果我们无视复位质量来谈论股骨转子间骨折（ITF）内固定的切口，那是不负责任的。这项研究的目的是分析在获得可接受的减少量后，采用头端髓内钉进行老年ITF切除的危险因素。
方法：为了调查老年ITF在获得可接受的减少量后出现切口的危险因素，我们回顾性分析了2016年9月至2021年12月在我们部门接受头端髓内钉治疗的367例患者.潜在变量，包括人口统计数据和放射学参数（即骨折类型，辛格指数,侧壁断裂,头甲位置，帕克比率指数，尖端-顶点距离(TAD),收集calcar参考的TAD(CalTAD)。进行Logistic回归分析以确定切口的重要危险因素。
结果：一百二十一名患者适合本研究。在121个案例中，观察到9例(7.4%)有切除或等待切除。我们发现年龄(调整后的优势比(OR)1.158，95%置信区间(CI)1.016至1.318，p=0.028)，侧壁骨折（校正OR11.07，95CI1.790至68.380，p=0.01），和CalTAD（校正OR1.277，95CI1.005至1.622，p=0.045）是切口的独立危险因素。
结论：年龄，外侧壁骨折和CalTAD是老年ITF患者在获得可接受的复位后进行头端髓内钉切开的独立危险因素。为了避免断流,即使获得可接受的还原，最优的CalTAD也是必要的，尤其是在年龄较大的外侧壁骨折患者中。
方法：为了调查老年ITF在获得可接受的减少量后出现切口的危险因素，我们回顾性分析了2016年9月至2021年12月在我们部门接受头端髓内钉治疗的367例患者.潜在变量，包括人口统计数据和放射学参数（即骨折类型，辛格指数,侧壁断裂,头甲位置，帕克比率指数，尖端-顶点距离(TAD),收集calcar参考的TAD(CalTAD)。进行Logistic回归分析以确定切口的重要危险因素。
结果：一百二十一名患者适合本研究。在121个案例中，观察到9例(7.4%)有切除或等待切除。我们发现年龄(调整后的优势比(OR)1.158，95%置信区间(CI)1.016至1.318，p=0.028)，侧壁骨折（校正OR11.07，95CI1.790至68.380，p=0.01），和CalTAD（校正OR1.277，95CI1.005至1.622，p=0.045）是切口的独立危险因素。
结论：年龄，外侧壁骨折和CalTAD是老年ITF患者在获得可接受的复位后进行头端髓内钉切开的独立危险因素。为了避免断流,即使获得可接受的还原，最优的CalTAD也是必要的，尤其是在年龄较大的外侧壁骨折患者中。
