Importance of Tip Apex Distance in Management of Intertrochanteric Hip Fractures by The Use of DHS

Background: Hip fractures in older adults most commonly involve the femoral neck and intertrochanteric regions. Early surgical fixation followed by mobilization is essential to limit complications such as thromboembolism and pneumonia. The dynamic hip screw (DHS) remains a standard technique for stabilizing intertrochanteric fractures. Among the factors influencing fixation success, the tip–apex distance (TAD) has been identified as a key radiographic measurement that correlates with implant stability and the risk of cut-out.
Objective: To evaluate the efficacy of TAD in prediction of both clinical and radiological outcomes in patients undergoing DHS fixation for intertrochanteric fractures.
Patients and Methods: A retrospective analysis was performed on 100 consecutive cases managed at Helmya Hospital, Cairo, between July 2021 and July 2022. All patients received DHS fixation for intertrochanteric fractures. Preoperative evaluation included clinical and radiological assessment. Postoperative TAD was measured on standard anteroposterior and lateral radiographs. Pain and function were assessed using the visual analogue scale (VAS), and radiographic follow-up continued for 12 months, focusing on screw cut-out.
Results: The study included 76 females and 24 males, with a mean age of 65 years. There was a statistical significance correlation between larger TAD values and screw cut-out rates (P < 0.01). Postoperative VAS scores improved significantly (P < 0.001). Two cases (10%) developed screw cut out.
Conclusion: TAD is a reliable indicator of fixation success in DHS treated intertrochanteric fractures. Achieving a TAD within the optimal range intraoperative significantly lowers the risk of screw cut out and improves outcomes.