Intertrochanteric fracture fixation with Dynamic Hip Screw: Is tip-apex distance measurement useful for predicting fixation failure?
- Author:
Goh KL
;
Zamzuri Z
;
Mohd Ariff S
;
Mohamed Azril MA
- Publication Type:Original Article
- Keywords:
Intertrochanteric fracture, dynamic hip screw, tip-apex distance, screw cut-out.
- From:
The International Medical Journal Malaysia
2016;15(1):31-34
- CountryMalaysia
- Language:English
-
Abstract:
Introduction: Application of dynamic hip screw (DHS) implant for the treatment of unstable
intertrochanteric fractures continues to raise concern related to risk of lag screw cut-out with or without
subsequent damage to the acetabulum. Measurement of tip-apex distances (TAD) has been recommended to
guide the optimal placement of lag screw and to predict subsequent risk of screw cut-out. In this study, the
value of TAD was evaluated to verify its usefulness. Methods: This is a retrospective study of 33 consecutive
patients with intertrochanteric fracture treated with DHS. Demographic data of the patients were traced
from their case notes. Post-operative radiographs were reviewed by focusing on measurement of TAD on
anteroposterior and lateral radiographs. Radiographs at one year follow-up were reviewed to depict any
fixation-related failure or complication. Results: Fifty two percent of patients did not achieved the
recommended TAD of ≤ 25mm. The mean post-operative TAD was 25.9mm and elderly patients were likely
to achieve TAD of ≤ 25mm. The overall complication rate of 6% was attributed to screw cut-out in two
cases. The unstable left-sided fracture was identified to be a potential risk for screw cut-out or migration.
Conclusion: TAD is a valuable measurement to guide optimal placement of lag screw during DHS fixation of
intertrochanteric fracture.
