First results with the Trochanter Fixation Nail (TFN): a report on 120 cases
ABSTRACT A complication rate between 4-18% for the conventional osteosynthesis of the proximal femur fracture continues to be unacceptable even if increasing age and co-morbidity of patients are taken into account. Therefore, new intramedullary techniques are under development, and we here report our results with the novel trochanteric fixation nail (TFN). During the study period (March 2003-February 2004) all patients with a trochanteric fracture Type A1-A3 (AO/ASIF classification) were eligible for the study, and 120 patients (mean age 81 years, range 47-100; male/female 1:4) subsequently enrolled. Most frequent was the (according to the AO classification) A.2.1. type of fracture (n=39) and the A.2.2. fracture (n= 39). Operation time from cut to stitch was 45 mins (minimal 21/maximal 194). Thirty-seven (31%) postoperative X-rays were classified as very good, 60 (50%) as good, 18 (15%) as satisfying and five (4%) as bad post-reposition results according to the Garden Alignment Index. The clinical results were documented by the time of hospital stay, postoperative mobilization and time of rehabilitation compared to the old social status. Time to hospital discharge was 17 days (9 /25). Overall complication rate was 7.5% (9 patients) with 5.8%  local wound infection; 1.6%  cutting out of the helical blade through the cortex of the femoral head. We had three (2.5%) hospital deaths in our patient group. We conclude that TFN is a safe and reliable technique. Compared with techniques like PFN and Gamma-nail, clinical results are excellent with less complications.
SourceAvailable from: PubMed Central[Show abstract] [Hide abstract]
ABSTRACT: The importance of the tip-apex distance (TAD) to predict the risk of a cut-out of fixed angle hip implants has been widely discussed in the scientific literature. Intra-operative determination of TAD is difficult and can be hampered by image quality, body habitus, and image projection. The purpose of this paper is to evaluate, through a cadaveric study, a novel computer assisted surgery system (ADAPT), which is intended for intraoperative optimisation of lag screw positioning during antegrade femoral nailing. A 3D measure for optimal lag screw position, the tip-to-head-surface distance (TSD) in 3D space, is introduced.BMC Musculoskeletal Disorders 05/2014; 15(1):189. DOI:10.1186/1471-2474-15-189 · 1.90 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Unstable proximal femoral fractures are common and challenging for the orthopaedic surgeon. Often, these are treated with intramedullary nails. The most common mode of failure of any device to treat these fractures is cut-out. The Synthes proximal femoral nail antirotation (PFNA) is unique because it is the only proximal femoral intramedullary nail which employs a helical blade in lieu of a lag screw. The optimal tip-apex distance is 25 mm or less for a dynamic hip screw. The optimal blade tip placement is not known for the PFNA.Aim: The aim of this study is to determine if the traditional tip-apex distance rule (<25 mm) applies to the PFNA. A retrospective study of all proximal femoral fractures treated with the PFNA in Western Australian public teaching hospitals between August 2006 and October 2007 was performed. Cases were identified from company and theatre implant use records. Patient demographic data was obtained from hospital records. Fractures were classified according to Arbeitsgemeinschaft fur Osteosynthesefragen/Association for the Study of Internal Fixation. Fracture reduction, distal locking type and blade position within the head (tip-apex distance and Cleveland zone) were recorded from the intraoperative and immediate postoperative radiographs. Postoperative radiographs obtained in the routine treatment of patients were studied for review looking primarily for cut-out. Clinical outcomes were measured with the Oxford hip score. One hundred eighty-eight PFNAs were implanted during the study period, with 178 cases included in this study. Ninety-seven patients could be followed up clinically. There were 18 surgical implant-related failures (19%). The single most common mode of failure was cut-out in six cases (6.2%). Three cut-outs (two medial perforation and one varus collapse) occurred with tip-apex distance (TAD) less than 20 mm. There was no cut-out in cases where the TAD was from 20--30 mm. There were three implant-related failures (nail fracture, missed nail and loose locking screw), four implant-related femoral fractures, two non-unions, two delayed unions and one loss of reduction. The PFNA is a suitable fixation device for the treatment of unstable proximal femoral fractures. There were still a relatively large number of cut-outs, and the tip-apex distance in the failures showed a bimodal distribution, not like previously demonstrated with dynamic hip screw. We propose that the helical blade behaves differently to a screw, and placement too close to the subchondral bone may lead to penetration through the head.Journal of Orthopaedic Surgery and Research 10/2013; 8(1):35. DOI:10.1186/1749-799X-8-35 · 1.58 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: This meta-analysis was conducted to investigate whether helical blade implant system had advantages in terms of cut-out rate when compared to screw implant system for trochanteric fractures of elderly population. The databases of MEDLINE, Cochrane Library and OVID were searched from inception to September 2013, and all randomized controlled trials comparing outcomes between helical blade system and screw system in treating trochanteric fractures were selected. Three researchers assessed the methodological quality and extracted data of the enrolled studies independently. Data were analysed using Review Manager 5.1 version. Six studies including 759 patients were involved. Results revealed that compared with screw group, blade group had similar outcomes of "centre-centre" position (95 % CI 0.89-1.06, P = 0.48) and tip-apex distance (95 % CI-0.08 to 1.31, P = 0.08). Cut-out and other complications were also comparable between the two groups (95 % CI 0.34-1.54, P = 0.41; 95 % CI 0.73-1.32, P = 0.90). Operation time and fluoroscopy time of blade group were significantly less than that of screw group (95 % CI -5.13 to -3.70, P < 0.00001; 95 % CI -32.50 to -27.07, P < 0.00001). Outcome of post-operative function was similar between two groups (95 % CI 0.94-1.15, P = 0.45). Blade group required less operation time and fluoroscopy time than that of screw group treating trochanteric fractures in the elderly, but the differences observed could be biased due to grouping and other limitations. Outcomes of cut-out complication, other complications, position of implant and post-operative function were similar between two groups.European Journal of Orthopaedic Surgery & Traumatology 02/2014; 24(8). DOI:10.1007/s00590-014-1429-9 · 0.18 Impact Factor