Significance of hip rotation on measurement of ‘Tip Apex Distance’ during fixation of extracapsular proximal femoral fractures

Kumar, Arvind; Parmar, Vinay; Kolpattil, S.; Humad, S.; Williams, Susan; Harper, W. M.

doi:10.1016/j.injury.2006.12.002

Cited by 23 publications

(15 citation statements)

References 11 publications

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“…There are more cases of femoral fracture reported than tibial fracture [5][6][7][8][9]. In previous studies, the reported incidence rate of torsional malalignment ranged from 8.3% to 58%.…”

Section: Discussionmentioning

confidence: 99%

Torsional malalignment, how much significant in the trochanteric fractures?

Kim

Lee

Chang

et al. 2015

Injury

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“…There are more cases of femoral fracture reported than tibial fracture [5][6][7][8][9]. In previous studies, the reported incidence rate of torsional malalignment ranged from 8.3% to 58%.…”

Section: Discussionmentioning

confidence: 99%

Torsional malalignment, how much significant in the trochanteric fractures?

Kim

Lee

Chang

et al. 2015

Injury

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“…TAD had previously been found to be correlated to the amount of hip rotation [6]. In light of this result, the axis of the femoral neck was assumed to be parallel to the coronal plane, i.e.…”

Section: Discussionmentioning

confidence: 99%

“…If 3D data is the only information available, for instance coming from a CT scan, CAD software or a finite element (FE) model, this formulation can model the rotations of the C-arm in order to recover numerically the components of TAD in the missing AP and lateral views. Such a tool could also help to measure TAD more accurately in clinical trials (from a 3D scan of the hip), since TAD was shown to be heavily dependent on hip rotation [6], and therefore associated with potentially large errors when calculated from AP and lateral views.…”

Section: Introductionmentioning

confidence: 99%

What Is the Relevance of the Tip-Apex Distance as a Predictor of Lag Screw Cut-Out?

et al. 2013

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Using a simple mathematical formulation, the relationship between the position of the lag screw tip (relevant to both intramedullary and extramedullary devices) and the concept of tip-apex distance (TAD) was derived. TAD is widely used in operating theaters as a surgical guideline in relation to the fixation of trochanteric fractures, and in clinical studies as a predictor of lag screw cut-out. In order to visualize better this concept, the locus of points having the same TAD was plotted and the dependence of TAD on the location of the lag screw tip was also reported. It was shown that TAD should be adjusted for the size of the femoral head (a variable which varies a lot according to the sex of the patient) while no correlation was found between TAD and bone morphometry indices obtained from micro-CT data (BV/TV and Tb.Th). Therefore, these results seem to suggest that TAD lacks mechanical justification and that predictors which are based on mechanical properties, such as bone density, should be investigated further.

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“…A screw that appears to lie very close to the joint surface on a radiograph may have actually perforated the femoral head while still appearing to be located within the head[6]. Similarly, if a screw is inserted too close to the scaphoid waist cortex, the screw may have also penetrated that portion of the waist.…”

Section: Introductionmentioning

confidence: 99%

The Scaphoid Safe Zone: A Radiographic Simulation Study to Prevent Cortical Perforation Arising from Different Views

Hong

Chang

et al. 2017

PLoS ONE

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PurposeThe purpose of this study was to simulate and calculate the probability of iatrogenic perforation of the scaphoid cortical bone when internal fixation appeared to be safe on radiographs. The results will assist surgeons in determining proper screw placement.MethodsThirty scaphoids were reconstructed using computed tomography data and image-processing software. Different central axes were determined by the software to simulate the surgical views. The safe zone (SZ) and risk zone (RZ) were identified on the axial projection radiographs by comparing the scaphoid bone stenosis measured by the fluoroscopic radiographs with a three-dimensional reconstruction of the scaphoid stenosis. Each original axial projection radiograph was zoomed and compiled to match a calculated average image. The RZ, SZ, and probability of perforations in various quadrants were calculated.ResultsUsing a volar view (approach), the mean risks of cortical perforation were 25% with screws and 36% with k-wires. Using a dorsal view (approach), the mean risks of cortical perforation were 18% with screws and 30% with k-wires. A high risk of perforation was detected at the ulnar–dorsal zone.ConclusionSurgeons should be wary of screws that appear to lie close to the scaphoid cortex on both anteroposterior (AP) and lateral radiographs, particularly in the ulnar–dorsal and radial–dorsal quadrants, because such screws are likely to perforate the cortex. The position of the internal fixator should be assessed using a diagram outlining the various SZs. Therapeutic, Level III.

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Significance of hip rotation on measurement of ‘Tip Apex Distance’ during fixation of extracapsular proximal femoral fractures

Cited by 23 publications

References 11 publications

Torsional malalignment, how much significant in the trochanteric fractures?

Torsional malalignment, how much significant in the trochanteric fractures?

What Is the Relevance of the Tip-Apex Distance as a Predictor of Lag Screw Cut-Out?

The Scaphoid Safe Zone: A Radiographic Simulation Study to Prevent Cortical Perforation Arising from Different Views

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