title: Accuracy of the surgeon's eye: use of the tip-apex distance in clinical practice.
abstract: Tip-apex distance is a well described method for assessment of screw placement in dynamic hip screw fixation of proximal femoral fracture. A distance of <25mm is associated with a significantly lower rate of cut out of the fixation device. Measurement is frequently performed retrospectively, although there has been no demonstration as to what accuracy the surgeon has of estimating tip-apex distance from image intensifier images, whilst scrubbed in theatre. Thirty-one clinicians working within orthopaedic departments were tested in their ability to identify adequacy of tip-apex distance on a series of image intensifier images. Level of seniority, awareness of the concept of tip-apex distance and use of the concept in clinical practice were each assessed. The accuracy in identifying the correct TAD was 82.5% in consultants, 83.8% in registrars and 71.1% in Senior house officers (SHO). The method was used in clinical practice by 50% of consultants, 89% of registrars and none of the SHOs.
authors.affiliation: Department of Trauma & Orthopaedics, Broomfield Hospital, Court Road, Broomfield, Chelmsford, Essex CM1 7ET, United Kingdom. Electronic address: Jwrightortho@gmail.com.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Wright
authors.affiliation: Department of Trauma & Orthopaedics, Broomfield Hospital, Court Road, Broomfield, Chelmsford, Essex CM1 7ET, United Kingdom.
authors.forename: Steven
authors.initials: S
authors.lastname: Kahane
authors.affiliation: Department of Trauma & Orthopaedics, Broomfield Hospital, Court Road, Broomfield, Chelmsford, Essex CM1 7ET, United Kingdom.
authors.forename: Abdul
authors.initials: A
authors.lastname: Moeed
authors.affiliation: Department of Trauma & Orthopaedics, Broomfield Hospital, Court Road, Broomfield, Chelmsford, Essex CM1 7ET, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: MacDowell
mesh_terms: D001696:Biomechanical Phenomena; D001863:Bone Screws; D002983:Clinical Competence; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D017755:Prosthesis Fitting / Q000295:instrumentation / Q000379:methods*; D011859:Radiography; D015203:Reproducibility of Results; D012189:Retrospective Studies; D066231:Surgeons
keywords: Accuracy; Dynamic hip screw; Fracture; Hip; Image intensifier; Tip–apex distance