# Accurate Intraoperative Estimation of Tip-Apex Distance in the Cephalomedullary Fixation of Proximal Femoral Fractures

## TL;DR

This paper introduces a simple method to estimate the tip-apex distance during hip fracture surgery, aiming to improve accuracy and reduce operative time.

## Contribution

A novel intraoperative technique for estimating tip-apex distance using the screw's root diameter in cephalomedullary nailing.

## Key findings

- The proposed method is simple and effective for estimating tip-apex distance during surgery.
- Using the screw's root diameter can help reduce operative time and improve accuracy in cephalomedullary fixation.
- The technique may contribute to a lower cutout rate by maintaining TAD below 25 mm.

## Abstract

Cephalomedullary nailing systems, including the Trochanteric Femoral Nailing-ADVANCED™ (TFNA) (DePuy Synthes, Raynham, Massachusetts, United States), are widely utilised for stabilising proximal femoral fractures. A pivotal aspect of the procedure involves ensuring adequate tip-apex distance (TAD) of the lag screw below 25 mm, a measure that substantially diminishes the cutout rate.

We introduce a simple method to accurately estimate the intraoperative TAD in TFNA fixation. This technique relies on the known diameter of the shaft of the screw (the root diameter), just proximal to the threaded section.

The new technique is simple, easy, and effective in potentially reducing operative time and improving the accuracy of estimating TAD during cephalomedullary hip fracture stabilisation surgery.