Introduction: Sliding screws has been described to use in hip fractures since 1950s. Failure of fixation varies from 16 – 23%. We aim to assess the effect of audit and re auditing the failure rate after introduction of the Tip apex distance concept since January 2000 to December 2004.

Methodology: We measured the tip apex distance in 161 (93 in the audit group and the rest re audit patients, 140 available for analysis. Their mean age at diagnosis 82.2 years [range 56.2–100.6 years] and male and female ratio was 1:6. Average time to Operation 1.7 days form the day of admission. The average Hospital Stay was 15.8 days

Result & discussion: We found that Patients had recorded Lag screw length 92.6mm [75–115], Side plate: 4 hole:6 hole = 4:1, Measured TAD 27.6 mm [6.3–66.4] in 140 patients,

The mean radiation time was 38.27 sec (7–71) and the dosage 0.68 Cgycm2 (0.93–2.06),

The mean Tip Apex Distance in the failed fixation group of 16 patients with cut out screw (13 in the audit group and 3 in the re audit group) is 43.05 [27.2–65.8]

Conclusion: We found the auditing and re auditing could potentially improve the surgical outcome. Although the Risk of cut out depends on many variable such as increasing age, Unstable fracture, poor reduction, high angle side plate 150deg, TAD is the stronger predictor than any other variable. This variable can be controlled by regular audit of the surgical practice.