Comparison of the predictive value of tip-apex distance and calcar referenced tip-apex distance in treatment of femoral intertrochanteric fractures with Asian type proximal femoral nail fixation / 中国修复重建外科杂志

Objective: To compare the predictive value of the two concepts for complications by comparing the incidences of surgical complications associated with different tip-apex distance (TAD) and calcar referenced tip-apex distance (Cal-TAD) in the treatment of femoral intertrochanteric fractures with Asian type proximal femoral nail (APFN) fixation. Methods: A total of 188 cases of femoral intertrochanteric fractures treated with APFN fixation between January 2014 and December 2018 were collected according to inclusion criteria. TAD and Cal-TAD were measured on the X-ray film at immediate after operation; the patients were divided into two groups according to the measurement results: 0.05). During the follow-up, 6 patients (5.04%) with TAD<25 mm, 10 patients (14.49%) with TAD≥25 mm had complications, and 1 patient (0.70%) with Cal-TAD<25 mm and 15 patients (32.61%) with Cal-TAD≥25 mm had complications. There were significant differences in the incidence of complication between the patients with different TAD, between the patients with different Cal-TAD, and between patients with TAD<25 mm and Cal-TAD<25 mm ( P<0.05). Conclusion: In the operation of femoral intertrochanteric fracture with APFN fixation, surgical complications can be significantly reduced when TAD or Cal-TAD was controlled within 25 mm, Cal-TAD is more significant in the prediction of postoperative complications.

Tip-apex distance and calcar-referenced tip-apex distance used as a predictor of screws cutout from the femoral head / 中华创伤骨科杂志

Intertrochanteric fracture,a common kind of injury in orthopaedic surgery,often requires surgical intervention,especially the unstable ones.Since far back in 1995,Baumgaertner et al.recommended using the distance between the screw tip and femoral head apex (tip-apex distance,TAD) as a predictor of the risk of lag screw cutout,the importance of TAD has been recognized by orthopaedic surgeons.This concept has been widely accepted in practice,and even used as a standard in determining the helical blade position.It is not clear,however,whether the helical blade system is equal to lag screws in terms of TAD.After the limitations of TAD had been reported,Kuzyk et al.proposed a tip-apex distance referenced from the calcar (Cal-TAD) as a predictor of lag screw cutout to improve the concept further.In this article,these concepts and the latest clinical applications of TAD and Cal-TAD are reviewed based on the publications available.