Purpose: Purpose of the study is to compare the changing Tip Apex Distance (TAD) and therefore the cut out development risk during fracture healing in two different types of implant.

Materials and Methods: 166 patients with intertrochanteric femur fracture were operated with proximal femoral nail between the years 1999 and 2006 in our clinic. 117 patients with avaible radiological data were studied. Group I defined as PFN, had 90 patients. Median age was 74.2 (25–93) years, 44 female and 46 male. Grup II defined as PFN-A had 27 patients. Median age was 75 (33–88) years, 18 females, 9 males. The mean of following time of patients was 48 months (12–84 months). We measured in AP radiograph the tip-apex distance (TAD) both of early postop and fracture healing time.

Results: In group I change in TAD was observed in 70 (%77.7) patients. Average TAD change rate was %29 (%4–%230). In group II, change in TAD was observed in 15 (%55.6) patients, and the average TAD change rate was %12 (%5–%40). Among Group I, 3 patients had a revision surgery with cut-out complications (%3.3). Among Group II no patient had cut out complication.

Discussion: While cut out was developed in 3 PFN patients, no cut-out was observed in any of PFN-A patients. Among the patients without cut-out development, 77.7 % of PFN patients and 55.6 % of PFN-A were under cut out risk. Average TAD change rate was 29% in PFN Group whereas 12% in PFN-A Group. When TAD change rates are considered, no cut-out was determined in PFN-A Group while its development risk was lower. When we investigate the cut out complication, the 3 cut out complications (%3.3) was seen in PFN. PFN-A group had no cut out complications.

Objectives : To assess the results of our patients injured of intracapsular neck fracture of the femur osteosynthesed by cannulated screws; which could not have been operated within the ideal time because of various problems.

Materials & Methods: Fifty-two patients are accepted to the study from September 1991 to January 2008 which they had intracapsular neck fractures of femur caused by an injury and treated with the cannulated screws after 24 hours from the injury. Of the 52 patients, 22 were women (42,3%) and 30 were men (57,7%). The mean postinjury time of the patients was 125,6 (26–360) hours. Four patients had Garden type 1 (7,7%), 13 patients had Garden type 2 (25%), 24 patients had Garden type 3 (46,2%), and 11 patients had Garden type 4 (21,1%) intracapsular neck fractures. Fourty-two patients (80,8%) had gone to closed reduction, and 10 patients (19,2%) had gone to open reduction and they all were osteosynthesed with the cannulated screws. The reduction success is assessed by the x-rays. The mean follow-up time was 92,2 (15–179) months.

Results : The reduction success was moderate in 3 patients (5,8%), was good in 23 patients (44,2%), and was excellent in 26 patients (50%). There was no poor reduction success in any of the patients. The complications seen in the patients were; 6 AVN, 1 nonunion, 1 malunion, 2 reduction failure, 1 infection.

Conclusion : The patients with the intracapsular neck fractures of the femur could not have been operated within the ideal time because of life threatening poly-traumas, the late reference of patients to our clinic, and failing to establish ideal implant and operation circumstances in a timely manner. We believe that osteosynthesis with cannulated screw should not be discarded as a method of treatment even postinjury time exceeds 6 hours in intracapsular femoral neck fractures.