Background: One of the most common injuries and an important cause of mortality and morbidity in the elderly is intertrochanteric fracture. The dynamic hip screw (DHS) is one of the best procedures for fixation of these fractures; however, using DHS is accompanied by failure risk. Objectives: Therefore, with the purpose of reducing failure risk, this study aimed to evaluate the correlation between post-operation CTD and TAD, NSA changes in patients with intertrochanteric fractures. Methods: In this case series study, patients with intertrochanteric fracture treated with DHS between September 2015 and January 2016 were included. The exclusion criteria were pathologic fracture, multiple fractures, greater trochanter fracture, soft-tissue issues, A3OTA type, patients who missed the follow-up period, history of previous hip fracture or dislocation, and TAD>25mm. Ultimately, 24 patients were included in this study. Two surgeons reviewed the anteroposterior (AP) and lateral (Lat) radiographs. The measures of TAD, CTD, and NSA after six-months of follow-up were assessed. In addition, variables such as demographic data, fracture side, duration of operation, blood loss volume, weight bearing day, and Harris hip score (HHS) were analyzed. The relationship between post-operation CTD and TAD, NSA changes after six months of follow-up was analyzed. All data was analyzed using SPSS 20 software (SPSS, IBM Inc., USA). The significance level for all tests was considered to be 0.05. Results: This study evaluated 24 patients. The mean age of the patients was 69.9 ± 12.00 years, and 15 (62.5%) of them were male. No significant correlations were seen in the collected data, especially CTD and NSA changes after six-months of follow-up (p>0.05). Maximum and minimum TAD values after surgery were 25.6 and 11.0, respectively. Maximum and minimum TAD values at the six-month follow-up were 34.9 and 11.0, respectively. Mean TAD was constant at 19.8±5.3 in postoperative and follow-up measurements. This shows that patients experienced increases in TAD and others experienced decreases in TAD within the six months of follow-up. Conclusion: The results showed that despite the abnormal CTD after surgery, the risk of TAD changes increased. Generally, TAD is a well-established radiographic measurement for predicting the risk of cut-out. CTD and TAD can be used together or separately to predict the risk of DHS screw cut-out in patients with intertrochanteric fractures in future studies.
Paganini-Hill A, Chao A, Ross RK, Henderson BE. Exercise andother factors in the prevention of hip fracture: the Leisure Worldstudy. Epidemiology. 1991;2(1):1625.
Rockwood CA, Green DP, Bucholz RW. Rockwood and Green's fractures in adults. 7th ed. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2010.
Aashish Raghu, Pavankumar H Patil, Hiranya Kumar. Study of the functional outcome following surgical management of intertrochanteric fractures with either proximal femoral nailing or dynamic hip screw fixation. International Journal of Orthopaedics Sciences. 2019; 5(2): 1050-1054.
Minos Tyllianakis, Andreas Panagopoulos, Andreas Papadopoulos et al. Treatment of extracapsular hip fractures with the proximal femoral nail (PFN): Long term results in 45 patients. Acta Orthop. Belg. 2004; 70:444-454.
Geller JA, Saifi C, Morrison TA, Macaulay W. Tip-apexdistance of intramedullary devices as a predictor of cut-out failurein the treatment of peri-trochanteric elderly hip fractures. Int Orthop. 2010;34(5):719–722.
Baumgaertner MR, Curtin SL. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am. 1995;77(7):1058-64.
Baumgaertner M, Solberg B. Awareness of Tip-Apex Distance reduces failure of fixation of trochanteric fractures of the hip. J Bone Joint Surg. 1997;79-B:969–71.
Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure offixation of peritrochanteric fractures of the hip. J Bone JointSurg Am. 1995; 77(7):1058-64.
Madsen JE, Naess L, Aune AK, Alho A, Ekeland A, Strømsøe K. Dynamic hip screw with trochanteric stabilizing plate in the treatment of unstable proximal femoral fractures: a comparative study with the gamma nail and compression hip screw. J Orthop Trauma. 1998; 12(4): 241–248.
Sommers MB1, Roth C. A laboratory model to evaluate cutout resistance of implants forpertrochanteric fracture fixation.J Orthop Trauma. 2004;18(6):361-8.
Bannister GC, Gibson AG. The fixation and prognosis of trochanteric fractures: Arandomized prospective controlled trial.Clin Orthop Relat Res. 1990;(254):242-6.
Parmar V, Kumar S, Aster A, Harper WH. Review of methodsto quantify lag screw placement in hip fracture fixation. Acta Orthop Belg. 2005; 71:260-3.
Gagała J, Kołodziej R, Blacha J, Blicharski T. [Intramedullarylocked nailing in the treatment of proximal femoral fractures].Chir Narzadow Ruchu Ortop Pol. 2006; 71:211-5.
De Bruijn K, den Hartog D, Reliability of predictors for screw cutout in intertrochanteric hip fractures.J Bone Joint Surg Am. 2012;94(14): 1266-72.
Güven M, Yavuz U. Importance of screw position in intertrochanteric femoral fractures treated by dynamic hip screw. Orthopedics & Traumatology: Surgery & Research. 2010;96(1):21- 7.
Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. Thevalue of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am. 1995; 77: 1058-64.
Andruszkow H, Frink M, Frömke C, Matityahu A, Zeckey C, Mommsen P, et al. Tip apex distance, hip screw placement, and neck shaft angle as potential risk factors for cut-out failure of hip screws after surgical treatment of intertrochanteric fractures. International orthopaedics. 2012;36(11):2347-54.
Omeroglu H, Ucar DH, Tumer Y. A new measurement method for the radiographic assessment of the proximal femur: the center-trochanter distance. Acta Orthop Traumatol Turc. 2004;38(4):261-4.
Babhulkar SS. Management of trochanteric fractures. Ind J Orthop. 2006; 40:210-8.
Kumar AJ, Parmar VN, Kolpattil S, Humad S, Williams SC, Harper WM. Significance of hip rotation on measurement of‘Tip Apex Distance’ during fixation of extracapsularproximalfemoral fractures. Injury. 2007; 38:792-6.
Hartholt KA, van Beeck EF, Polinder S, van der Velde N, vanLieshout EM, Panneman MJ, et al. Societal consequences of falls in the older population: injuries,healthcare costs, and long-term reduced quality of life. J Trauma. 2011;71(3):748–753.
Chirodian N, Arch B, Parker MJ. Sliding hip screw fixationof trochanteric hip fractures: outcome of 1024 procedures. Injury. 2005;36(6):793–800.
Hsueh KK, Fang CK, Chen CM, Su YP, Wu HF, Chiu FY. Risk factors in cutout of sliding hip screw in intertrochantericfractures: an evaluation of 937 patients. Int Orthop. 2010;34(8):1273–76.
Barton TM, Gleeson R, Topliss C, Greenwood R, Harries WJ, Chesser TJ. A comparison of the long gamma nail withthe sliding hip screw for the treatment of AO/OTA 31- A2 fracturesof the proximal part of the femur: a prospective randomized trial. J Bone Joint Surg Am. 2010;92(4):792–98.
Bojan AJ, Beimel C, Speitling A, Taglang G, Ekholm C, Jönsson A. 3066 consecutive Gamma Nails. 12 years experience at a single centre. BMC Musculoskeletal Disorders. 2010;11(1):133.
Mereddy P, Kamath S, Ramakrishnan M, Malik H, Donnachie N. The AO/ASIF proximal femoral nail antirotation(PFNA): a new design for the treatment of unstable proximalfemoral fractures. Injury. 2009; 40(4):428–432.
Verhofstad MH, van der Werken C. DHS osteosynthesis for stable pertrochanteric femur fractures with a two-hole side plate. Injury. 2004; 35(10):999–1002.
Omeroğlu H, Ucar DH, Tümer Y. A new measurement method for the radiographic assessment of the proximal femur: the center-trochanter distance. Acta orthopaedica et traumatologica turcica. 2004; 38(4):261-4.
Goffin JM, Jenkins PJ, Ramaesh R, Pankaj P, Simpson AH. What is the relevance of the tip-apex distance as a predictor of lag screw cut-out?. PloS one. 2013;8(8):e71195.
Kane P, Vopat B, Heard W, Thakur N, Paller D, Koruprolu S, et al. Is tip apex distance as important as we think? A biomechanical study examining optimal lag screw placement. Clinical Orthopaedics and Related Research. 2014;472(8):2492-8.
Amini MH, Feldman JJ, Weinlein JC. High Complication Rate in Young Patients With High- Energy Intertrochanteric Femoral Fractures. Orthopedics. 2017;40(2):e293-9.
Ebrahimpour, A., Karimi, A., Sadighi, M., Sajjadi, M., Okhovatpour, M. A., Irani, A., & Zandi, R. (2019). Correlation between Post-Operation Center-Trochanteric Distance (CTD) and Tip Apex Distance (TAD) changes in Intertrochanteric Fractures Treated by Dynamic Hip Screw. Trauma Monthly, 24(6), 32-37. doi: 10.30491/tm.2019.104271
Adel Ebrahimpour; Amin Karimi; Mehrdad Sadighi; Mohammadreza Sajjadi; Mohammad Ali Okhovatpour; Amir Irani; Reza Zandi. "Correlation between Post-Operation Center-Trochanteric Distance (CTD) and Tip Apex Distance (TAD) changes in Intertrochanteric Fractures Treated by Dynamic Hip Screw". Trauma Monthly, 24, 6, 2019, 32-37. doi: 10.30491/tm.2019.104271
Ebrahimpour, A., Karimi, A., Sadighi, M., Sajjadi, M., Okhovatpour, M. A., Irani, A., Zandi, R. (2019). 'Correlation between Post-Operation Center-Trochanteric Distance (CTD) and Tip Apex Distance (TAD) changes in Intertrochanteric Fractures Treated by Dynamic Hip Screw', Trauma Monthly, 24(6), pp. 32-37. doi: 10.30491/tm.2019.104271
Ebrahimpour, A., Karimi, A., Sadighi, M., Sajjadi, M., Okhovatpour, M. A., Irani, A., Zandi, R. Correlation between Post-Operation Center-Trochanteric Distance (CTD) and Tip Apex Distance (TAD) changes in Intertrochanteric Fractures Treated by Dynamic Hip Screw. Trauma Monthly, 2019; 24(6): 32-37. doi: 10.30491/tm.2019.104271