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The Journal of Bone and Joint Surgery, Vol 77, Issue 7 1058-1064, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip
MR Baumgaertner, SL Curtin, DM Lindskog and JM Keggi
Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut 06520-8071, USA.
Failure of fixation of peritrochanteric fractures that have been treated
with a fixed-angle sliding hip-screw device is frequently related to the
position of the lag screw in the femoral head. A simple measurement has
been developed to describe the position of the screw. This measurement, the
tip-apex distance, is the sum of the distance from the tip of the lag screw
to the apex of the femoral head on an anteroposterior radiograph and this
distance on a lateral radiograph, after controlling for magnification. To
determine the value of this measurement in the prediction of so-called
cutout of the lag screw, 198 peritrochanteric fractures (193 patients) were
studied. The minimum duration of follow-up was three months (average,
thirteen months), during which period all of the fractures either healed or
had failure of the fixation. Of the nineteen failures that were identified,
sixteen were due to the device cutting out of the femoral head. The average
tip-apex distance was twenty-four millimeters (range, nine to sixty-three
millimeters) for the successfully treated fractures compared with
thirty-eight millimeters (range, twenty-eight to forty-eight millimeters)
for those in which the screw cut out (p = 0.0001). None of the 120 screws
with a tip-apex distance of twenty-five millimeters or less cut out, but
there was a very strong statistical relationship between an increasing
tip-apex distance and the rate of cutout, regardless of all other variables
related to the fracture.(ABSTRACT TRUNCATED AT 250 WORDS)
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