Syed Imaduddin, Tayeb Asim, Rahila Razzak.
The value of the tip-apex distance (TAD) in predicting failure of fixation of Intertrochanteric fractures of femur.
Pak J Surg Jan ;30(4):320-6.

Introduction: Th e intertrochanteric fracture is a common injury, and can be caused by high energy or low energy trauma; although the later is always the main source seen in elderly people. Th e favored treatment trend nowadays is closed reduction and fi xation with Dynamic Hip Screw (DHS, sliding hip screw with a fi xed angle i.e., 135o). With this treatment regimen, a high union rate and a low complication rate have been reported. Study Design: Prospective cross sectional study. Sett ing and Duration: Department of Orthopaedic Surgery, Dr. Ziauddin Hospital Karachi from January 2012 to January 2014. Methodology: Th is study was conducted on 80 admitt ed patients with intertrochanteric fracture of femur, age ranging from 22 – 95 years. All patients were treated with internal fi xation using 135o DHS aft er achieving closed anatomical reduction. Post-operative follow-up was undertaken in outpatient department for a period of minimum six months. Th e union of fracture or failure of fi xation was assessed on the basis of follow-up radiographs. Tip-Apex Distance (TAD) was calculated on pre and post-operative radiographs. Th e data base was developed on SPSS on the basis of fi lled in proforma. Th e frequency of mechanical failure of fi xation was presented by counts along with its percentage and 95% confi dence interval. Th e degree of association of TAD was tested by logistic regression analysis. Other confounding factors such as age, gender, quality of bone and mechanism of injury were tested for their association with failure of fi xation by chi-square test. Results: Th ere were 45 (56.3%) males and 35 (45.7%) female patients with a mean age of 62.4± 19.4 (22 – 90) and 65.1 (40 – 95) respectively. Male to female ratio was 1: 0.78. Among 80 patients, tip apex distance (TAD) < 25 mm was found in 50 patients out of whom implant failure occurred in one (2%) patient, followed by 22 patients had TAD of 25-49 mm out of whom, implant failure occurred in 8 (36.4%) patients. TAD of >49 mm was found in 8 patients and implant failure occurred in only one (12.5%) patient in this category of TAD. Data have shown signifi cant association of implant failure with TAD of 25-49 mm (p<0.001) Conclusion: Th e tip-apex distance of greater than 25mm is associated with increased rate of implant failure. Also increasing age of the patients and severe osteoporosis (Singh’s Index grade 1 to 3) are also associated with a signifi cantly increased risk of implant failure. )

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