BackgroundDynamic hip screw is still one of the most widely used devices for the fixation of extra-capsular neck of femur fractures. A recognised complication with this device, is the screw cut-out from the femoral head.The tip to apex distance has been shown to be the most reliable predicting factor of screw cut-out. A distance of less than 25 mm is generally predictive of a successful result. Aim The purpose of this audit was to assess the position of the lag screw, in dynamic hip screws performed in a district general hospital and to assess if the principle of tip to apex distance is put into practice. Method We used our theatre logbooks to retrospectively identify all consecutive patients who underwent DHS fixation over the period of Aug08- Nov08. The tipˇ˝apex distance for every DHS was measured using the intra-operative radiographs.The results were presented in a departmental audit meeting and the importance of tip- apex distance was emphasized.The audit cycle was repeated 3 months later between Mar09 and Jun09. ResultsIn the first cycle, 36 patients were studied. 9 out of 36 (25%) had a tip-apex distance of more than 25mm and there were 3 cut-outs requiring revision surgery.In the second cycle, 31 patients were studied. 5 out of 31 (16%) had a tip-apex distance of more than 25mm and there was 1 cut-out. ConclusionBy simply raising awareness and emphasising the importance of the tip-apex distance, we lowered our DHS cut-out rate, improving patientsˇ˝ safety and quality of life. We recommend that the tip-apex distance principle is emphasised and regularly re-enforced to all orthopaedic trainees, in order to improve the outcome of dynamic hip screws in patients with neck of femur fractures.