Predictors of screw cutout in the surgical fixation of peritrochanteric hip fractures: A retrospective cohort study

Objectives: This study aimed to evaluate the impact of the tip-apex distance (TAD) and other reported risk factors on the screw cutout rate. Methods: This study retrospectively reviewed electronic medical records from January 2016 to December 2018 to analyze the relationship between TAD and implant cutout failure rate in patients with peritrochanteric (PT) fractures who underwent cephalomedullary nail (CMN) or dynamic hip screw (DHS) fixation. Secondary factors analyzed included age, body mass index (BMI), fracture stability, posterolateral fragment presence, post-operative radiographic reduction, implant type, and screw position. Results: A total of 68 patients (40 DHS, 28 CMN cases) were included in the study, with a mean age of 64 +/- 20 years and a BMI of 25.5. Most of the included patients (65%; 44) were males. An overall cohort screw cutout rate of 7.3% (5 cases) was observed. The patient's age, BMI, fracture classification (stability), implant type, and the level of the operating surgeon did not influence the screw cutout rate (P = NS). However, a TAD >= 25 mm (P = 0.02), lag screw position (P = 0.03), and fracture reduction in anteroposterior (P = 0.02) and lateral views (P P = 0.024) showed statistically significant results. Conclusion: This study demonstrated that a TAD of >= 25 mm, lag screws malposition, and inappropriately reduced fracture in post-operative radiographs are significant risk factors for screw cutout in DHS and CMN fixation of PT fractures.