A tip-apex distance (TAD) greater than 25 mm is a strong predictor of screw cut-out in patients with intertrochanteric femoral fracture treated with a dynamic hip screw (DHS). We aim to show you a simple and reliable way to check this.

By calculating the sum of the distance from the tip of the screw to the apex of the femoral head on anteroposterior and lateral views the TAD is found. X-rays often have magnification errors and therefore measuring tools in digital x-ray systems will be inaccurate. The original method of calculating the TAD uses the known diameter of the screw to avoid magnification errors.

We found that due to the no-cylindrical shape of the screw shaft there is potential of an inaccurate measurement. By using the distance across the highest points of the thread a more accurate TAD can be calculated.

The distance across the highest points of the threads in all three of the most commonly used DHSs in the UK is 13 mm. If the measured distance from the tip of the screw to the apex of the femoral head in both the anteroposterior and lateral views is less than the measured distance across of the treaded diameter of the screw then the surgeon knows the TAD is less than 26 mm. This method can be used intraoperatively to check the TAD by looking at the fluoroscopy images in these two views.

Posterior soft tissue repair is often performed in Total Hip Arthroplasty (THA). Many reports have shown the advantage of posterior soft tissue repair in reducing their prosthetic hip dislocation rates.

We describe an easy and inexpensive way of passing sutures through small drill holes in the Greater Trocanter to re-attach muscle, tendon and capsule in a posterior soft tissue repair.

By using a reversed monofilament suture on a straight needle held in artery forceps and passing this in a retrograde direction through a drill hole, a suture capturing device is produced.

By capturing the long ends of sutures tied in the short external rotators and the posterior capsule of the hip through 2 drill holes in the Greater Trochanter, a posterior soft tissue repair can be performed. We have used this technique successfully in over 100 consecutive THAs.

We conclude that the use of a monofilament suture used in the manner describe is an excellent and inexpensive way to aid in a posterior soft tissue repair in THAs. This is done without the cost of an additional dedicated suture passing device. The suture could also be used in the skin closure if desired.