171 Tip-Apex Distance in Extracapsular Neck of Femur Fractures Treated with Sliding Hip Screws: A Systematic Review
D GuniaAbstract
Introduction
Extracapsular neck of femur (NOF) fractures, prevalent in elderly populations, are commonly treated with Sliding Hip Screw (SHS) fixation. The Tip-Apex Distance (TAD), introduced by Baumgaertner et al., is a critical metric in fixation success. A TAD ≤25mm has been associated with reduced risk of screw cut-out and fixation failure.
Aim
This aims to evaluate the relationship between TAD and clinical outcomes in patients undergoing SHS fixation for extracapsular NOF fractures.
Method
A systematic search of PubMed, Cochrane Library, and Embase was conducted for studies published between 1995-2023. Inclusion criteria comprised studies assessing TAD in extracapsular fractures fixed with SHS, with defined thresholds and reported outcomes such as screw cut-out rates and reoperations. Data extraction and quality assessment followed standardized protocols, with assessment via the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool.
Results
Fifteen studies comprising 3,000 patients met the inclusion criteria. The average TAD was 23mm, with a mean patient age of 75 years. Screw cut-out rates were significantly higher (10–20%) for TAD >25mm compared to 1–5% for TAD ≤25mm. Studies reported improved functional outcomes and reduced revision rates when TAD thresholds were optimized. While TAD was a key predictor, factors such as fracture stability and surgeon experience also influenced outcomes.
Conclusions
A TAD ≤25mm is strongly correlated with lower fixation failure rates in SHS treatment of extracapsular neck of femur fractures. Accurate screw placement and intraoperative measurement of TAD are essential for minimizing complications. Further research should explore TAD's role in alternative fixation methods and patient outcomes.