The importance of surgical education in the accuracy of implant placement during hip fracture fixation
Studies have found that tip apex distance (TAD) is the strongest independent predictor of lag screw cut-out following hip fracture fixation. The objective of this study was to understand the importance of introducing the concept of TAD to surgeons. The null hypothesis was that there were no differences between fractures fixed before awareness of TAD compared with fractures fixed after awareness of TAD.
Materials and Methods
This study involved assessing 75 consecutive radiographs retrospectively (before introduction of “tip apex distance” to surgeons) and 83 consecutive radiographs prospectively (after introduction of “tip apex distance” to surgeons). Radiographs were measured using a radiograph digitizer and software.
Average TAD in radiographs measured retrospectively was 22.6 mm compared with 9.7 mm in radiographs analysed prospectively (P ≤ 0.001). The power of this study was 97%.
This study demonstrates that introducing the concept of “TAD” to surgeons, will improve the accuracy of lag screw placement during fixation of an extracapsular fracture. The improvements in lag screw placement will undoubted reduce cut-out of the implant post-surgery.
- Parker MJ (1992) Cutting-out of the dynamic hip screw related to its position. J Bone Joint Surg Br 74(4):625
- Baumgaertner MR, Curtin SL et al (1995) The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg—Am Vol 77(7):1058–1064 (see comment)
- Parker M, Handoll H (2004) Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures. Cochrane Database Syst Rev (1):CD000093
- Kumar AJ, Parmar VN, Kolpattil S, Humad S, Williams SC, Harper WM (2007) Significance of hip rotation on measurement of ‘Tip Apex Distance’ during fixation of extracapsular proximal femoral fractures. Injury 38(7):792–796 CrossRef
- The importance of surgical education in the accuracy of implant placement during hip fracture fixation
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- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Journal of Orthopaedics and Traumatology
Volume 10, Issue 2 , pp 59-61
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- Springer Milan
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- Hip fracture
- Tip apex distance
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