Beyond 25 millimetres makes the difference: a prospective  study on tip apex distance in dynamic hip screw treatment of intertrochanteric fractures

Nadir Shah; Akshay M. Abhyankar; Niranjan S. Ghag; Santosh Ghoti; Kushal Gohil; Shubham Dakhode

doi:10.18203/issn.2455-4510.IntJResOrthop20243113

Authors

Nadir Shah Department of Orthopaedics, Grant Government Medical College and Sir J.J. Group of Hospital, Mumbai, Maharashtra, India
Akshay M. Abhyankar Department of Orthopaedics, Grant Government Medical College and Sir J.J. Group of Hospital, Mumbai, Maharashtra, India
Niranjan S. Ghag Department of Orthopaedics, Grant Government Medical College and Sir J.J. Group of Hospital, Mumbai, Maharashtra, India
Santosh Ghoti Department of Orthopaedics, Grant Government Medical College and Sir J.J. Group of Hospital, Mumbai, Maharashtra, India
Kushal Gohil Department of Orthopaedics, Grant Government Medical College and Sir J.J. Group of Hospital, Mumbai, Maharashtra, India
Shubham Dakhode Department of Orthopaedics, Grant Government Medical College and Sir J.J. Group of Hospital, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20243113

Keywords:

Intertrochanteric fractures, Dynamic hip screw, Tip apex distance, Screw cut-out

Abstract

Background: The tip apex distance (TAD) is a key indicator of screw cut-out risk in dynamic hip screw (DHS) treatment for intertrochanteric fractures. This study sought to assess the prognostic significance of TAD in intertrochanteric fractures managed with DHS.

Methods: This prospective observational study encompassed 50 patients with intertrochanteric fractures who had DHS fixing treatment. TAD was measured on postoperative radiographs. Patients were followed clinically and radiologically for a minimum of 3 months. The primary outcome was screw cut-out.

Results: The mean TAD was 25.5 mm, with a range of 10 to 47 mm. Four screw cut-outs were seen, all in patients with TAD exceeding 35 mm. The mean TAD was 24.18 mm for successfully treated fractures, in contrast to 40.89 mm for those who experienced cut-out. No cut-outs were seen with TAD <25 mm. The inferior-central region of the femoral head was the predominant site for screw placement, occurring in 30% of cases.

Conclusions: TAD is a dependable predictor of screw cut-out risk in DHS fixation of intertrochanteric fractures. Maintaining a TAD <25 mm and screw position in the inferior-central zone of the femoral head may help minimize cut-out risk. Surgeons should aim for proper screw placement and consider TAD when treating these fractures.

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References

Cooper C, Campion G, Melton LJ 3rd. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992;2(6):285-9.

Dhanwal DK, Dennison EM, Harvey NC, Cooper C. Epidemiology of hip fracture: Worldwide geographic variation. Indian J Orthop. 2011;45(1):15-22.

Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev. 2008;(3):CD000093.

Chirodian N, Arch B, Parker MJ. Sliding hip screw fixation of trochanteric hip fractures: outcome of 1024 procedures. Injury. 2005;36(6):793-800.

Hsueh KK, Fang CK, Chen CM, Su YP, Wu HF, Chiu FY. Risk factors in cutout of sliding hip screw in intertrochanteric fractures: an evaluation of 937 patients. Int Orthop. 2010;34(8):1273-6.

Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am. 1995;77(7):1058-64.

Geller JA, Saifi C, Morrison TA, Macaulay W. Tip-apex distance of intramedullary devices as a predictor of cut-out failure in the treatment of peritrochanteric elderly hip fractures. Int Orthop. 2010;34(5):719-22.

Davis TR, Sher JL, Horsman A, Simpson M, Porter BB, Checketts RG. Intertrochanteric femoral fractures. Mechanical failure after internal fixation. J Bone Joint Surg Br. 1990;72(1):26-31.

Kuzyk PR, Zdero R, Shah S, Olsen M, Waddell JP, Schemitsch EH. Femoral head lag screw position for cephalomedullary nails: a biomechanical analysis. J Orthop Trauma. 2012;26(7):414-21.

Johnson LJ, Cope MR, Shahrokhi S, Tamblyn P. Measuring tip-apex distance using a picture archiving and communication system (PACS). Injury. 2008;39(7):786-90.

De Bruijn K, den Hartog D, Tuinebreijer W, Roukema G. Reliability of predictors for screw cutout in intertrochanteric hip fractures. J Bone Joint Surg Am. 2012;94(14):1266-72.

Bridle SH, Patel AD, Bircher M, Calvert PT. Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg Br. 1991;73(2):330-4.