171 Tip-Apex Distance in Extracapsular Neck of Femur Fractures Treated with Sliding Hip Screws: A Systematic Review
Bibliographic record
Abstract
Abstract 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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.010 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".