Extracapsular Hip #s: Operative Management - Chris Huber 16/8/2000

Baumgaertner MR.  Solberg BD.

Awareness of tip-apex distance reduces failure of fixation of trochanteric fractures of the hip.

J Bone Joint Surg Br.  79(6):969-71, 1997 Nov.

"Central and deep" screw placement gives optimal fixation.  Focusing surgeons minds on reducing the Tip-Apex distance (sum on AP + lateral) to < 25mm gave better reductions and fewer failures.

Prospective and retrospective groups.

We compared the results of the surgical treatment of trochanteric hip fractures before and after surgeons had been introduced to the tip-apex distance (TAD) as a method of evaluating screw position. There were 198 fractures evaluated retrospectively and 118 after instruction. The TAD is the sum of the distance from the tip of the screw to the apex of the femoral head on anteroposterior and lateral views. This decreased from a mean of 25 mm in the control group to 20 mm in the study group (p = 0.0001). The number of mechanical failures by cut-out of the screw from the head decreased from 16 (8%) in the control group at a mean of 13 months to none in the study group at a mean of eight months (p = 0.0015). There were significantly fewer poor reductions in the study group. Our study confirms the importance of good surgical technique in the treatment of trochanteric fractures and supports the concept of the TAD as a clinically useful way of describing the position of the screw.

Bridle SH.  Patel AD.  Bircher M.  Calvert PT.

St Georges Hospital, Tooting, London, England.

Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw.

J Bone Joint Surg Br.  73(2):330-4, 1991 Mar.

Gamma nail for IT # made no difference in op time, blood loss, morbidity, length of stay. Also 4 femoral shaft #s in Gamma group (one intraop). Extra strength of Gamma nail prob not needed for IT # unless reverse oblique or subtrochanteric.

Prospective and randomised.

We have prospectively compared the fixation of 100 intertrochanteric fractures of the proximal femur in elderly patients with random use of either a Dynamic Hip Screw (DHS) or a new intramedullary device, the Gamma nail. We found no difference in operating time, blood loss, wound complications, stay in hospital, place of eventual discharge, or the patients' mobility at final review. There was no difference in failure of proximal fixation. However, in four cases fracture of the femur occurred close to the Gamma nail, requiring further major surgery.