Tip-Apex Distance as a Predictor of Failure Following Cephalo-Medullary Fixation for Unstable Fractures of the Proximal Femur

Walton, Michael; Barnett, Andrew; Jackson, Mark
June 2008
European Journal of Trauma & Emergency Surgery;Jun2008, Vol. 34 Issue 3, p273
Academic Journal
Current research has been unable to confirm that intramedullary fixation provides greater stability for unstable fracture configurations of the proximal femur than extra-medullary devices. We present a retrospective analysis of the outcome of proximal femoral fractures treated with the Proximal Femoral Nail (PFN, Synthes) with particular reference to implant position and adequacy of reduction. Between May 2002 and October 2004, 61 patients with low-energy unstable proximal femoral fractures underwent surgery at a mean 2.4 days. Mean age was 78 years, 74% were female. Four (6.9%) implants failed secondary to proximal cut out of the hip screw. All of the failures occurred in patients who had sustained AO/OTA type 31. A3 fractures. In patients with A3 fracture patterns, there is a significant relationship between increasing Tip-Apex distance (p = 0.023), varus mal-reduction (p = 0.038) and failure; 46% patients died within 12 months of surgery. The PFN is a satisfactory implant in the management of unstable proximal femoral fractures, however accurate reduction and implant position are essential to provide the best conditions for union and to prevent implant failure.


Related Articles

  • Cystic Adventitial Degeneration of the Ilio-Femoral Artery and Vein. Ohta, Takashi; Hirai, Masafumi; Matsubara, Junichi; Shionoya, Shigehiko; Iwata, Hisashi // Vascular Surgery;Mar/Apr1984, Vol. 18 Issue 2, p119 

    Presents a case report of cystic adventitial degeneration of the external iliac and common femoral arteries and the femoral vein. Medical history; Result of an intraoperative arteriography; Other cases of cystic adventitial degeneration of the artery.

  • Injecting drug use via femoral vein puncture: preliminary findings of a point-of-care ultrasound service for opioid-dependent groin injectors in treatment.  // Harm Reduction Journal;2012, Vol. 9 Issue 1, p6 

    The article presents a study related to the ultrasound scanning for examining the effects by groin injectors (GIs), in femoral injecting sites for assessing the health of the veins. It mentions 'groin injecting,' as a cause of risk and harm and is prevalent in Great Britain. The paper provides a...

  • Is the Wave Plate Still a Salvage Procedure for Femoral Non-union? Results of 75 Cases Treated with a Locked Wave Plate. Schulz, Arndt; Faschingbauer, Maximilian; Seide, Klaus; Schuemann, Uwe; Mayer, Martin; Jürgens, Christian; Wenzl, Michael // European Journal of Trauma & Emergency Surgery;Apr2009, Vol. 35 Issue 2, p127 

    To analyse the results of the treatment of aseptic femoral non-unions using a singular locked implant. Consecutive case series. A level-1 trauma center with a high number of specialist referrals. The study is based on a consecutive series of patients with prospective data evaluation. From 1993...

  • Femoro-femoral bypass for repeat open-heart surgery. Merin, O.; Silberman, S.; Brauner, R.; Munk, Y.; Shapira, N.; Falkowski, G.; Dzigivker, I.; Bitran, D. // Perfusion;1998, Vol. 13 Issue 6, p455 

    Repeat open-heart operations are becoming more frequent with a patient population at higher risk. Sternal re-entry poses the risk of possible damage to vital structures. These include laceration of the myocardium, especially the right ventricle, tearing of patent grafts and internal mammary...

  • Partial cardiopulmonary bypass for the treatment of profound accidental hypothermic circulatory collapse. Wong, P. S.; Pugsley, W. B. // Journal of the Royal Society of Medicine;Oct1992, Vol. 85 Issue 10, p640 

    The article presents the case report of a middle-aged man with profound accidental hypothermia, who was found collapsed in the street. On arrival in hospital he was in asystole and there was no spontaneous respiration. An incision was made in the right groin exposing the femoral artery and vein....

  • femoral hernia. Peters, Michael // BMA A-Z Family Medical Encyclopedia;2004, p302 

    An encyclopedia entry for the term "femoral hernia" is presented. It refers to a kind of hernia which is found in the groin area, where the femoral artery and femoral vein pass from the lower abdomen to the thigh. It notes that overweight women or those who have had several pregnancies are prone...

  • Effect of a biplanar osteotomy on primary stability following high tibial osteotomy: a biomechanical cadaver study. Pape, Dietrich; Lorbach, Olaf; Schmitz, Christian; Busch, Lüder C.; Van Giffen, Nicolien; Seil, Romain; Kohn, Dieter M. // Knee Surgery, Sports Traumatology, Arthroscopy;Feb2010, Vol. 18 Issue 2, p204 

    Open-wedge high tibial osteotomy (HTO) is becoming increasingly popular for the treatment of varus gonarthrosis in the active patient. The various implants used in HTO differ with regard to its design, the fixation stability and osteotomy technique. It is assumed that the combination of a plate...

  • Prolonged external fixation of the tibia. Uhl, Richard L. // Orthopedics;Nov2004, Vol. 27 Issue 11, p1169 

    This article presents a case study of a left grade 3B open tibia fracture and closed midshaft radius and ulna fractures on the right fracture in a 38-year-old man. From the time of injury until removal for approximately 4 years after with minimal pin-site care, the pin tracts did not develop the...

  • Pseudo-aneurysm of the Lateral Circumflex Femoral Artery. Kakarala, Gopikrishna K.; Van Rensburg, Lee; Parker, Martyn // European Journal of Trauma;Oct2006, Vol. 32 Issue 5, p480 

    We describe an unusual case of pseudo-aneurysm of the lateral circumflex femoral artery following fixation of an undisplaced intracapsular neck of femur fracture. We highlight the need for a high index of suspicion and the value of angiography as the investigation of choice.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics