Keywords : Tip-apex distance (TAD)
Does the traditional tip-apex distance hold good for PFN-A?
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 1, Pages 909-924
Introduction : Unstable intertrochanteric femoral fractures are common in the elderly, and the incidence of these fractures is continuously increasing worldwide. The aim of the surgical treatment of these fractures is to achieve stable fracture fixation that will allow early weight bearing. Intramedullary device like the proximal femoral nail antirotation has shown a superior cut-out resistance, which may translate into fewer cut-outs in the clinical setting and better functional outcome.
Methods : A prospective study done between October 2018 to October 2019 which included 30 patients with pertrochanteric fractures and were fixed with cephalomedullary nail with a helical blade.
Results : Twenty(66.7%) females and ten(33.3%) males with majority of subjects were in the age group, 71 to 80 years (40%). Mode of injury was self-fall in 93.3% and RTA in 6.7%. 36.7% were A1, 56.7% were A2 and 6.7% were A3 classification. In the study among those with TAD <25, 60% had excellent, 20% had good, 12% had fair and 8% had poor outcome. The implant related complications in our study was significantly less.
Conclusion: The study concludes that TAD of less than 25mm with centre-centre placement of the helical blade showed an excellent to good functional outcome and early post operative mobilization. From our study we believe that TAD rule <25mm should not apply for PFN-A. Although other studies have shown the importance of the tip-apex distance, our study does not recommend it.