Tip apex distance - Is it enough to predict implant failure in trochanteric fractures
Journal Title: Indian Journal of Orthopaedics Surgery - Year 2017, Vol 3, Issue 4
Abstract
Introduction: The tip-apex distance (TAD) is the sum of the distances from the tip of lag screw to apex of the femoral head on both AP and lateral radiographs. A TAD of greater than 25 mm is considered to be an accurate predictor of lag screw cut-out when dynamic hip screws are used to treat intertrochanteric hip fractures. The purpose of this study was to determine the factors affecting the clinical outcomes of trochanteric fractures treated surgically. Materials and Methods: This retrospective study included 124 patients. The TAD values of this cohort were analysed from post-operative radiographs. The fractures were classified according to severity and the post-operative reduction and their affection to cut out rates was determined. These were correlated with functional status and inability to achieve fracture union at a mean follow-up of 12 months. Results: Good reduction was obtained in 28 cases of type 1 fractures while all the fractures which had poor reduction were type 2 fractures. All type 1 fractures united at a mean of 12 months. Overall 14 patients experienced lag screw cut-out, all of which were type 2 fractures. Discussion: The number of cut-outs had direct correlation to the severity of fractures and the TAD. While using dynamic hip screws, surgeons should try to achieve a TAD less than 25 mm to avoid lag screw cut-out. Though TAD plays a vital role in predicting implant failure in trochanteric fractures, quality of bone, fracture pattern, placement of screw etc also influence the outcome.
Authors and Affiliations
Biswajit Sahu, Alok Prusty, Barsha Tudu
Keywords
Related Articles
- EP ID EP295159
- DOI 10.18231/2395-1362.2017.0075
- Views 72
- Downloads 0
Hemiarthroplasty of Hip – A prospective study for Conservation of Blood Loss
Background: Hemiarthroplasty of hip joint is a very commonly performed surgery. Several studies have been done which support the use of tranexamic acid in total knee joint replacements and few in total hip replacements....
Functional outcome of Primary total knee replacement in severe flexion deformity and without flexion deformity knee – A comparative study
Aims & Objectives: To know the functional outcome of Primary TKR in Severe fixed flexion deformity of knee compared with TKR in knees without fixed flexion deformity (FFD). Materials & Methods: This is a prospective stud...
Use of bone allografts in the management of upper limb fractures and their complications – A prospective study
Background: In comparison with the lower extremity, there is relative dearth of literature reporting clinical results of allograft in upper limb. Most studies have reported on use of allografts in upper limb reconstructi...
To asses the union time and pin track infection rate in ilizarov fixator using the Russian and rancho hybrid fixation technique
Introduction The treatment of complex proximal tibial fractures with ilizarov external fixators is slowly gaining more popularity and acceptability in traumatology complex tibial plateau fractures pose a significant risk...
Abductor weakness in intertrochantric fractures operated with PFN and its management
Introduction Intertrochanteric hip fractures are common with advancing age PFN is now increasingly used to fix unstable intertrochantric fractures however it does not fix greater trochanter Gluteus medius and gluteus min...