Skip to main content

Advertisement

SpringerLink
Log in

Trochanteric fractures: Tip-Apex distance, Calcar Tip-Apex distance, and Chang criteria—a multiple variable analysis

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Failure of osteosynthesis is a common complication of the nailing of trochanteric fractures which typically occurs through form of cut-out. Tip-Apex distance (TAD), Calcar Tip-Apex distance (CalTAD), and Chang criteria are validated variables to predict failure of cephalomedullary nailing. This is a retrospective study which analyzes treatment of trochanteric fractures from 2018 to 2020 (n = 296) evaluating postoperative radiographs and factors of mechanical failure. Our objective was to assess correlation among these variables and their influence on mechanical failure, either individually or creating a new score. Our results support the CalTAD and Chang’s criteria as valid predictors of mechanical failure. Furthermore, they empathize the importance of fracture reduction and proper placement of cervical screw. To our knowledge, this is the first study performing multivariate analysis including these 3 variables.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Rapp K et al (2019) Epidemiology of hip fractures: systematic literature review of German data and an overview of the international literature. Z Gerontol Geriatr 52:10–16

    Article  PubMed  Google Scholar 

  2. Silva J et al (2018) Epidemiological trends of proximal femoral fractures in the elderly population in Portugal. Acta Med Port 31:562–567

    Article  Google Scholar 

  3. BI MH. https://www.spms.min-saude.pt/2018/03/bi-mh/

  4. Morri M et al (2018) What factors are associated with the recovery of autonomy after a hip fracture? A prospective, multicentric cohort study. Arch Phys Med Rehabil 99:893–899

    Article  PubMed  Google Scholar 

  5. Magaziner J, Chiles N, Orwig D (2015) Recovery after hip fracture: interventions and their timing to address deficits and desired outcomes-evidence from the Baltimore hip studies. Nestle Nutr Inst Workshop Ser 83:71–81

    Article  PubMed  PubMed Central  Google Scholar 

  6. Parker MJ (1992) Cutting-out of the dynamic hip screw related to its position. J Bone Jt Surg Br 74:625

    Article  CAS  Google Scholar 

  7. Kashigar A et al (2014) Predictors of failure for cephalomedullary nailing of proximal femoral fractures. Bone Jt J 96B:1029–1034

    Article  Google Scholar 

  8. Baumgaertner MR, Solberg BD (1997) Awareness of tip-apex distance reduces failure of fixation of trochanteric fractures of the hip. J Bone Jt Surg Ser B 79:969–971

    Article  CAS  Google Scholar 

  9. Kuzyk PRT et al (2010) A biomechanical analysis of lag screw position in the femoral head for cephalomedullary nails used to fix unstable peritrochanteric fractures. Inj Extra 41:153–154

    Article  Google Scholar 

  10. Mao W et al (2019) Comparison of Baumgaertner and Chang reduction quality criteria for the assessment of trochanteric fractures. Bone Jt Res 8:502–508

    Article  Google Scholar 

  11. Cleveland M, Bosworth DM, Thompson FR, Wilson HJJ, Ishizuka T (1959) A ten-year analysis of intertrochanteric fractures of the femur. J Bone Jt Surg Am 41-A:1399–1408

    Article  CAS  Google Scholar 

  12. Caruso G et al (2017) A six-year retrospective analysis of cut-out risk predictors in cephalomedullary nailing for pertrochanteric fractures: can the tip-apex distance (TAD) still be considered the best parameter? Bone Jt Res 6:481–488

    Article  CAS  Google Scholar 

  13. De Bruijn K, Den Hartog D, Tuinebreijer W, Roukema G (2012) Reliability of predictors for screw cutout in intertrochanteric hip fractures. J Bone Jt Surg Ser A 94:1266–1272

    Article  Google Scholar 

  14. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM (1995) The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am 77(7):1058–1064. https://doi.org/10.2106/00004623-199507000-00012

  15. Lopes-Coutinho L, Dias-Carvalho A, Esteves N, Sousa R (2020) Traditional distance ‘tip-apex’ vs. new calcar referenced ‘tip-apex’—which one is the best peritrochanteric osteosynthesis failure predictor? Injury. https://doi.org/10.1016/j.injury.2020.01.024

    Article  Google Scholar 

  16. Karapınar L, Turgut A, Kumbaracı M, Koca A (2021) Evaluation of the quadrants of femoral neck-head in the cephalomedullary fixation of intertrochanteric fractures with a helical blade: is inferior posterior quadrant also safe? A clinical study. Jt Dis Relat Surg 32:93–100

    PubMed  PubMed Central  Google Scholar 

  17. Çepni Ş et al (2022) Tip–neck distance ratio as a novel predictor for failure in cephalomedullary nailing of unstable trochanteric fractures (UTF). Arch Orthop Trauma Surg 142:2619–2626

    Article  PubMed  Google Scholar 

  18. Aicale R, Maffulli N (2018) Greater rate of cephalic screw mobilisation following proximal femoral nailing in hip fractures with a tip-apex distance (TAD) and a calcar referenced TAD greater than 25 mm. J Orthop Surg Res 13:1–9

    Article  Google Scholar 

  19. Yam M, Chawla A, Kwek E (2017) Rewriting the tip apex distance for the proximal femoral nail anti-rotation. Injury 48:1843–1847

    Article  PubMed  Google Scholar 

  20. Goffin JM, Pankaj P, Simpson AH (2013) The importance of lag screw position for the stabilization of trochanteric fractures with a sliding hip screw: a subject-specific finite element study. J Orthop Res 31:596–600

    Article  PubMed  Google Scholar 

  21. Huang J, Gao X, Yang Y (2022) Risk factors for cut-outs in geriatric intertrochanteric fractures with cephalomedullary nailing after obtaining acceptable reduction: a case–control study. BMC Musculoskelet Disord 23:1–8

    Article  Google Scholar 

  22. Song H, Chang SM, Hu SJ, Du SC, Xiong WF (2022) Calcar fracture gapping: a reliable predictor of anteromedial cortical support failure after cephalomedullary nailing for pertrochanteric femur fractures. BMC Musculoskelet Disord 23:1–9

    Article  Google Scholar 

  23. Li S et al (2016) A mathematical simulation of the tip-apex distance and the calcar-referenced tip-apex distance for intertrochanteric fractures reduced with lag screws. Injury 47:1302–1308

    Article  PubMed  Google Scholar 

  24. Chang SM et al (2015) Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg 135:811–818

    Article  PubMed  PubMed Central  Google Scholar 

  25. Yoon YC, Oh CW, Sim JA, Oh JK (2020) Intraoperative assessment of reduction quality during nail fixation of intertrochanteric fractures. Injury 51:400–406

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal

    João Pedro Gomes Reis, António Lemos Lopes, Ricardo Jorge Branco, Rita Sapage, Rita Andreia Sousa & Diogo Sousa

Authors
  1. João Pedro Gomes Reis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. António Lemos Lopes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ricardo Jorge Branco
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rita Sapage
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rita Andreia Sousa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Diogo Sousa
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All the authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by JPGR, RAMS, and DMS. The first draft of the manuscript was written by JPGR, and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to João Pedro Gomes Reis.

Ethics declarations

Conflict of interest

None of the named authors and co-authors has conflict of interests either financial or non-financial to declare with this study. The present study complies with the current laws of our institution and our country.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Reis, J.P.G., Lopes, A.L., Branco, R.J. et al. Trochanteric fractures: Tip-Apex distance, Calcar Tip-Apex distance, and Chang criteria—a multiple variable analysis. Arch Orthop Trauma Surg 143, 7035–7041 (2023). https://doi.org/10.1007/s00402-023-05018-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-023-05018-2

Keywords

Search

Navigation