Vol. 10, Issue 3 (2024)

Introduction: The increase in geriatric population in India has led to a rise in intertrochanteric fractures, especially among elderly females with osteoporotic bones. Effective surgical intervention is essential to restore mobility and function. Among various implants, the Proximal Femoral Nail Anti-Rotational (PFNA2) has shown promising results due to its biomechanical advantages. A crucial factor for the success of these implants is the Tip Apex Distance (TAD), which is the sum of the distances from the tip of the lag screw to the apex of the femoral head on anteroposterior (AP) and lateral radiographs.
Methods and Materials: A retrospective study was conducted of 30 patients presenting with intertrochanteric fractures and treated with PFNA2 at KD Medical College, Hospital, and Research Centre between January 2022 and December 2023. The data included patient demographics, site of fracture, implant used, duration of surgery, Boyd Griffin classification, Modified Harris Hip Score evaluations at 1,3, 6&12 months, blood loss, complications, pre- and post-operative radiographs and TAD Score.
Results: The mean TAD was 16 mm, ranging from 10 mm to 24 mm. Patients with a TAD of less than 25 mm had significantly better clinical outcomes and fewer complications. The study observed that maintaining a TAD between 20-25 mm significantly reduced the likelihood of failures of PFNA.
Discussion: TAD is a critical determinant of the stability and success of fracture fixation with PFNA2. Our findings align with previous studies, emphasizing the importance of maintaining a TAD of less than 25 mm to minimize mechanical failures. This study underscores the need for precise surgical technique and careful postoperative monitoring to ensure optimal outcomes.