Functional outcome of intertrochanteric fractures treated with proximal femoral nailing and role of tip apex distance: A retrospective study

Abstract

Background: Intertrochanteric fractures of femur are one of the most commonly encountered fractures in day today orthopaedic practice. Since the introduction of proximal femoral nail, it has become an implant of choice for fixation of intertrochanteric fractures owing to their better outcomes with stable fixation and rotational stability in unstable fractures. The role of Tip-Apex Distance was clearly established with the Dynamic Hip Screw but there was inadequate data to establish the same with the use of a Proximal Femur Nail. Aims: To determine the role of tip apex distance and evaluate the functional outcome of intertrochanteric fractures treated with proximal femoral nailing. Methods: A Retrospective study of 60 patients who had intertrochanteric fractures treated with the PFN between December 2016 and December 2019. Post-operative radiographs of the affected hip in AP and Lateral view were taken and the Tip-Apex Distance was calculated in both the views by measuring the distance from the tip of the lag screw to the apex of the femoral head. Result: The Average Tip-Apex Distance was found to be 23.5mm ranging between 19 mm to 28 mm. It was noted that 6 patients had a Tip-Apex Distance of more than 25 mm and 2 patients had a Tip-Apex Distance of less than 19 mm. Conclusion: We conclude that a Tip-Apex Distance of ≤ 25 mm has a better predictive value in determining the outcome of intertrochanteric fractures treated with proximal femoral nailing.