Re-understanding the value of the tip-apex distance theory in guiding treatment of intertrochanteric femoral fracture / 中华创伤杂志

ABSTRACT

Intertrochanteric femoral fracture occurs frequently in elderly osteoporotic patients, with high disability and mortality, for which surgical treatment is necessary. Common surgical modalities for intertrochanteric femoral fracture include intramedullary and extramedullary internal fixation systems, but neither can avoid the complications like internal fixation cut-out or internal fixation cut-through of the femoral head after surgery. The tip-apex distance theory was once considered to be of great significance in avoiding internal fixation cut-out, with the mainstream view was that screw cut-out could be avoided to the maximum extent when the tip-apex distance was ≤25 mm. However, internal fixation that meets the criteria of the tip-apex distance theory may also show cut-out and "Z-effect" in clinical practice, which lacks a reasonable explanation. Based on the lever balance reconstruction theory and the buttress-stretch effect, the author re-understands the value of the tip-apex distance theory in guiding treatment of intertrochanteric femoral fracture, hoping to propose an enlightenment for the treatment of intertrochanteric femoral fracture.