Study of tip-apex distance vs calcar referenced tip-apex distance in predicting the cut-out risk after osteosynthesis of proximal femoral fracture

Abstract

This study evaluates postoperative outcomes related to cut-out complications in patients undergoing closed reduction and internal fixation with dynamic hip screw (CRIF+DHS) for intertrochanteric femur fractures. We measured the tip-apex distance (TAD) and calcar-referenced tip-apex distance (CAL-TAD) using anteroposterior (AP) and lateral views of the pelvis in 45 patients, analyzing the cut-out risk using Parker's index. Radiographic measurements were compared to determine their correlation with clinical outcomes. Among the patients, two cases of screw cut-out were documented, highlighting an average TAD of 26.76 mm and an average CAL-TAD of 29.03 mm. Our findings suggest that maintaining a TAD under 26.76 mm and a CAL-TAD under 29.03 mm, along with optimal screw positioning, may reduce the risk of cut-out complications.