Tip to apex distance in femoral intertrochanteric fractures: a systematic review

Prospective randomized study comparing two cephalomedullary nails for elderly intertrochanteric fractures: Zimmer natural nail versus proximal femoral nail antirotation II

“…Unfortunately, not all patients who undergo cephalomedullary nailing experienced good clinical outcomes despite the availability of various implant designs and meticulous surgical techniques because of a combination of factors such as medical comorbidities, fracture type, and bone quality [19]. Moreover, it has to be noticed that lag screw cut-out, one of the most common risk factors of fixation failure after the treatment of intertrochanteric hip fractures, is deeply associated with implant position, which is expressed as a combination of TAD and Cleveland zone [4,20] as well as fracture reduction quality. In the current study, we simultaneously analyzed the clinical predictors of screw or blade cut-out in the two treatment groups.…”

Proximal femoral nail antirotation and third-generation Gamma nail: which is a better device for the treatment of intertrochanteric fractures?

“…TAD, which represents both the position and depth of a screw in the femoral neck and head, was shown to be the most important predictive factor for the occurrence of a cutout. (12,13) Geller et al reported a high incidence (44%) of cutouts in intertrochanteric fractures that were surgically fixed with a TAD of > 25 mm. (14) However, no fixation failure was observed in our series, possibly due to the small number of intertrochanteric fractures that were surgically fixed with a TAD of > 25 mm.…”

Common complications in hip fracture surgery: Tips/tricks and solutions to avoid them

“…Values of TAD greater than 45 mm have been correlated with 60% risk of cut out. In a recent systematic review Rubio-Avila et al [10] quantified the association between the TAD and the cut out failure in intertrochanteric fractures. The Relative Risk of cut out in patients with TAD > 25 mm was 12.71.…”

“…Specific parameters that can have an impact on outcome following hip fracture surgery include the inherent poor bone quality, the specifics of reduction -implant selection -fixation, the need of fixation augmentation, and the challenges in rehabilitation and pain management [10]. Along with medical complications, fracture fixation failure has detrimental effects on the overall health of the patient [11].…”