Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 May 2;13(1):106.
doi: 10.1186/s13018-018-0814-1.

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

Rocco Aicale  1 , Nicola Maffulli  2   3
Affiliations

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

Rocco Aicale et al. J Orthop Surg Res. .

Abstract

Background: To ascertain whether the tip-apex distance (TAD), calcar referenced TAD (CalTAD), and the sum of both (TADcalTAD) are predictive measurements of mobilisation of the cephalic screw in patients with trochanteric hip fractures.

Methods: Between 2014 and 2015, 68 patients (mean age 86 years, 45 females, 23 males) with a trochanteric hip fracture underwent intramedullary nailing. The TAD and CalTAD were measured, and for each parameter, we calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).

Results: There is evidence of a statistically significant association between a TAD and CalTAD greater than 25 mm and a TADcalTAD greater than 50 mm and mobilisation of the cephalic screw. All measurements have similar sensitivity, but the TAD presents the highest specificity (p < 0.01).

Conclusion: To avoid the risk of mobilisation of the cephalic screw and possible subsequent failure of the construct, surgeons should strive for a TAD and CalTAD less than 25 mm and a TADcalTAD less than 50 mm when using intramedullary fixation.

Keywords: CalTAD; Fracture; Hip; TAD; TADcalTAD.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

All patients provided signed informed consent. In accordance with Italian law, ethics committee approval was not obtained, as the study was purely retrospective, with no changes to standard clinical practice. According to Italian law, when patients sign an informed consent for an operation, they automatically consent to be included in studies detailing the outcomes of their treatment.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

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

Figures

Fig. 1
Fig. 1
Schematic drawing of TAD measurement (a, b), CalTAD measurement (c) and TADcalTAD
Fig. 2
Fig. 2
The distribution of lag screw positions in the femoral head and numbers of mobilisations for each position
Fig. 3
Fig. 3
Radiograph of Zimmer nail with cephalic screw with TAD lower than 25 mm for 31-A3
Fig. 4
Fig. 4
Mobilisation of the cephalic screw according to tip–apex distance (TAD) (mm)
Fig. 5
Fig. 5
Mobilisation of the cephalic screw according to calcar referenced tip–apex distance (CalTAD) (mm)
Fig. 6
Fig. 6
Mobilisation of the cephalic screw according to TADcalTAD (mm)
Fig. 7
Fig. 7
Radiographs of Zimmer nail with cephalic screw with TAD between 25 and 30 mm during surgery and after 5 months with mobilisation of the cephalic screw for a fracture 31-A2
Fig. 8
Fig. 8
Radiographs of InterTan nail with cephalic screw with TAD greater than 35 mm during surgery and after 5 months with valgus mobilisation of the intramedullary nail for a fracture 31-A1
See this image and copyright information in PMC

References

    1. Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int. 1997;7:407–413. doi: 10.1007/PL00004148. - DOI - PubMed
    1. Johnell O, Kanis JA. An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int. 2004;15:897–902. doi: 10.1007/s00198-004-1627-0. - DOI - PubMed
    1. Lubitz J, Riley G, Newton M. Outcomes of surgery among the Medicare aged: mortality after surgery. Health Care Financ Rev. 1985;6:103–115. - PMC - PubMed
    1. Rose S, Maffulli N. Hip fractures. An epidemiological review. Bull Hosp Jt Dis. 1999;58:197–201. - PubMed
    1. Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81:646–656. - PMC - PubMed