The Value of the Tip - Apex Distance in Predicting Failure of Fixation of Intertrochanteric Fractures of the Hip

Abstract Background: The center-center lag screw position has been widely accepted as the optimal lag screw/helical blade position in femoral intertrochanteric fracture surgery to achieve a tip-apex distance (TAD) less than 25 mm. Despite the inferior-center lag screw/helical blade position having some biomechanical advantages, and the emergence of calcar-referenced tip-apex distance (CalTAD), the clinical differences between the two commonly placed lag screw/helical blade positions remain unclear. This study aimed to (1) report radiological outcomes in managing geriatric femoral intertrochanteric fractures, (2) identify the influences of positions of lag screw/helical blade, and (3) identify the relationship between implants and the values of TAD and CalTAD.Methods: We retrospectively assessed the clinical and radiographic findings of geriatric patients (age ≥ 55 years) who underwent surgery for acute closed femoral intertrochanteric fractures during 1-year period and were followed up a minimum of 6 months. The radiographic parameters and incidences of fixation failure were compared between the different lag screw and helical blade positions (center-center vs. inferior-center). Subgroup analyses of different implant types (extramedullary and intramedullary) were also performed for comparisons for different lag screw positions, and TAD and CalTAD beyond the normal standard value of 25 mm.Results: A total of 206 patients were included during the study period, with a 7.8% fixation failure. There were no differences in incidences of fixation failure between the commonly inserted lag screw/helical blade positions (center-center vs. inferior-center), regardless of the implant types. Those with a TAD > 25 mm had significantly higher incidence of fixation failure than those with a TAD ≤ 25 mm in the extramedullary plate (17.0% vs. 1.2%, p = 0.001), but not in the intramedullary nails (16.1% vs. 4.4%, p = 0.08). There were no significant differences in incidences of fixation failure between CalTAD ≤ 25 mm and CalTAD > 25 mm in either extramedullary or intramedullary implants. Conclusion: Although TAD > 25 mm might increase the fixation failure rate in extramedullary plates, an inferior-center lag screw/helical blade position could achieve comparable radiographic results as a center-center position after osteosynthesis for geriatric femoral intertrochanteric fractures.

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Value of Tip Apex Distance In Fixation of Intertrochanteric Fractures by Dynamic Hip Screw.

Zagazig University Medical Journal ◽

10.21608/zumj.2020.20966.1650 ◽

2020 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Ramy Samy ◽

Hosam Khairy ◽

Aly Elalfy ◽

ahmed elmalt

Keyword(s):

Dynamic Hip Screw ◽

Intertrochanteric Fractures ◽

Hip Screw ◽

Tip Apex Distance

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Treatment of Unstable Intertrochanteric Fractureswith Proximal Femoral Nail Antirotation II: Our Experience in Indian Patients§

The Open Orthopaedics Journal ◽

10.2174/1874325001509010456 ◽

2015 ◽

Vol 9 (1) ◽

pp. 456-459 ◽

Cited By ~ 5

Author(s):

G.N. Kiran Kumar ◽

Gaurav Sharma ◽

Kavin Khatri ◽

Kamran Farooque ◽

Devendra Lakhotia ◽

...

Keyword(s):

Operative Time ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Femoral Nail ◽

Tip Apex Distance ◽

The Mean ◽

Postoperative Fracture ◽

Fracture Stability

Introduction:Unstable intertrochanteric fractures are difficult to manage and the choice of implant is critical for fracture fixation. The purpose of this study was to evaluate the functional and radiological outcome of proximal femoral nail antirotationII (PFNA II) in the treatment of unstable intertrochanteric fractures.Materials and Methods:We reviewed 45 patients of unstable intertrochanteric fractures, who were treated with the PFNA II between 2011 and 2013. Of which, 3 patients were died within 6 months of follow up. Hence, 42 patients were available for the study including 26 men and 16 women. The mean age was 61 years (range, 35 -90). Clinical evaluation was done using Harris hip score. The position of the blade in the femoral head was evaluated using Cleveland zones and tip apex distance. The fracture reduction was assessed using the Garden Alignment Index and postoperative fracture gap (mm) measurement.Results:The mean follow up period was 15.3 months (range, 9-27). Excellent to good results were accounted for 78% of cases according to Harris hip score. No cases of cut out or breakage of the implant noted. Implant removal was done in 2 patients due to persistent anterior thigh pain.Conclusion:We recommend PFNA II for fixation of unstable intertrochanteric fractures with less operative time and low complication rate. However, proper operative technique is important for achieving fracture stability and to avoid major complications.

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Comparison of clinical outcomes with proximal femoral nail anti-rotation versus InterTAN nail for intertrochanteric femoral fractures: A meta-analysis

10.21203/rs.3.rs-21889/v1 ◽

2020 ◽

Author(s):

Wei Liu ◽

Guangrong Ji ◽

Jie Liu

Keyword(s):

Observational Studies ◽

Femoral Shaft Fracture ◽

Femoral Shaft ◽

Shaft Fracture ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Femoral Nail ◽

Tip Apex Distance ◽

Intertan Nail

Abstract Objective: To access the efficacy and safety of proximal femoral nail anti-rotation (PFNA) and InterTAN nail for intertrochanteric femoral fractures.Methods: According to the Cochrane systemic analysis method, randomized control trials (RCTs) and retrospective comparative observational studies which were related to the comparison of PFNA and InterTAN nail in the treatment of the elderly with intertrochanteric fractures were retrieved. Data were independently extracted from the included studies by two reviewers and analyzed using RevMan 5.3 , and the quality of the studies was assessed.Results: Two RCTs and seven observational studies were recruited, which consisted of 681 patients with PFNA and 651 patients with InterTAN nail. The meta-analyses showed no significant differences between the two approaches on Harris Hip Score, operation time, blood loss, time to union, mean hospital stay, union problems, intraoperative complications, hematoma, infection, other complication in both RCTs and observational studies. In terms of other outcomes, for the RCTs, results showed that there were shorter tip–apex distance, reduced pain at thigh or hip in InterTAN nail than in PFNA; however, InterTAN nail was not superior to PFNA in cutout, reoperation, and femoral shaft fracture; for observational studies, the risk of the screw migration (RR=5.13, 95%CI: [1.33,19.75], P=0.02), cutout (RR=3.26, 95%CI: [1.64,6.47], P=0.0008), the varus collapse of the femoral head (RR=7.19, 95%CI: [2.18,23.76], P=0.001), femoral shaft fracture (RR=5.73, 95%CI: [2.24,14.65], P=0.0003) treated by InterTAN nail were significantly decreased, compared with those by PFNA; however, no significant differences was observed in the aspects of tip–apex distance and pain at thigh or hip between these two groups.Conclusion: Analysis of a large number of relevant clinical indicators available shows that InterTAN nail has better clinical manifestation than PFNA in treating unstable femoral intertrochanteric fractures.

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Functional and radiological outcomes of intertrochanteric fractures treated with proximal femoral nail

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20203721 ◽

2020 ◽

Vol 6 (5) ◽

pp. 1001

Author(s):

Mayur Chopra ◽

Sanjay Kumar Srivastava ◽

Sumit Kumar ◽

Deepak Kumar Mishra

Keyword(s):

Weight Bearing ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Radiological Outcome ◽

Neck Length ◽

Neck Shaft Angle ◽

Femoral Nail ◽

Shaft Angle ◽

Tip Apex Distance

Background: Hip fracture is one of the most invalidating diseases affecting geriatric populations and in fall related fractures, they lead to most severe morbidity and mortality. Their surgical treatment allows stable fracture fixation which allows the early weight bearing. Many devices have been developed, yet mechanical failures still occur. The aim of this study was to assess the functional and radiological outcomes of intertrochanteric fractures treated with proximal femoral nail.Methods: 46 patients with intertrochanteric fractures fixed with proximal femoral nail were assessed. Functional outcome was measured by Harris hip score (HHS) and lower extremity functional scale (LEFS) and radiological outcome was measured by tip apex distance (TAD), any changes in neck shaft angle, neck length and the offset as compared to uninjured hip.Results: The tip apex distance on the postoperative X-ray was found to be 22.02±2.499 mm, change in the neck length as compared to the uninjured hip was found to be 1.507±1.1808 and change in the offset and neck shaft angle was 1.470±1.0126 and -1.602±1.5992 respectively. The LEFS was found to be 70.63±6.584 whereas the HHS was found to be 90.35±7.593Conclusions: With the increase in TAD the functional and radiological outcome worsens. It was also seen that the cutoff of 25 mm stands true in predicting the outcome of the patients with PFN in intertrochanteric fractures. Hence, the TAD should be routinely measured and if found more than 25 mm then proper precautions like delayed weight bearing may be advised.

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