Fraz Noor, Hafiz Muhammad Nasir, Shahbaz Ahmad, Jugdesh Kumar, Sijad Ahmed Mahar

Does Tip Apex Distance Predict Implant Failure in Stable Intertrochanteric Fractures of Femur?

Fraz Noor, Hafiz Muhammad Nasir, Shahbaz Ahmad, Jugdesh Kumar, Sijad Ahmed Mahar



Aim : To assess the rate of implant failure in stable intertrochanteric fractures of femur in elderly patients treated with the dynamic hip screw with a tip apex distance.

Study design: Descriptive Place and duration of study: Department of Orthopaedic, Sahara Medical College, Narowal from 12th August 2019 to 11th February 2020.

Methodology: Sixty patients with implant failure. Patients of both genders, age more than 50 years, closed undisplaced intertrochanteric fractures (AO/OTA 31A1) identified on preoperative radiograph and history of fall were included. Those patients who have fracture shaft of femur, bone mineral density less than 2 standard deviation on DEXA scan, open intertrochanteric fractures, polytrauma and advanced osteoporosis as diagnosed by X-ray were excluded from the study. All patients were underwent dynamic hip screw fixation.

Results: Thirty six (60%) were males and 24 (40%) patients were females with mean age 59.9±12.7 years. Mean body mass index of the patients was 26.7±3.8 kg/m2. Thirty seven cases (61.7%) had right side fracture and rest 23 patients (38.3%) had left sided fractures. The tip apex distance <20mm was found among 35 patients (58.3%) in which frequency of implant failure was among 3 cases (8.6%). Among 15 patients (25%) had tip apex distance 20-30mm in which implant failure measured among 5 cases (33.3%) and 10 patients (16.7%) had tip apex distance >40mm in which implant failure observed among 1 patient (10%). Falling was the most common reason of injury in which 51 cases (85%) found, 6 injuries (10%) due to road traffic accident and 3 cases (5%) had other reason of injury.

Conclusion: The tip apex distance 20-40mm increased the rate of the implant failure of the dynamically fixed dynamic hip screw, with stable femoral intertrochanteric fracture.

Keywords: Tip apex distance, Implant failure, Intertrochanteric fracture, Dynamic hip screw.

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