First results with the Trochanter Fixation Nail (TFN): A report on 120 cases

Department of Trauma Surgery, Klinikum Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany.
Archives of Orthopaedic and Trauma Surgery (Impact Factor: 1.6). 01/2007; 126(10):706-12. DOI: 10.1007/s00402-006-0117-6
Source: PubMed


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% [7] local wound infection; 1.6% [2] 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.

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    • "The incidence of neck screw cutout has reduced considerably with improvements in the surgical technique but still remains the most common mode of fixation failure56 with IM implants. The proximal femur nail antirotation (PFNA) was developed aiming to reduce this complication and initial studies have shown promise.78 With this background, we analyzed our results with the PFNA in low velocity trochanteric fractures in the elderly. "
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    ABSTRACT: The proximal femur nail antirotation (PFNA) is the recent addition to the growing list of intramedullary implants for trochanteric fracture fixation. The initial results in biomechanical and clinical studies have shown promise. We report our results of low velocity trochanteric fractures internally fixed by proximal femur nail antirotation. A prospective study was conducted to assess the results of 122 elderly patients with low velocity trochanteric fractures [39 - stable (AO; 31-A1) and 83 - unstable (AO; 31-A2 and A3)] treated with PFNA from December 2008 to April 2010. Followup functional and radiological assessments were done. Results obtained were compared between stable and unstable fracture patterns using statistical tools. The mean followup was 21 months (12-28 months). 11 patients were lost in followup. Union was achieved in all but one patient. Varus collapse was seen in 14 patients and helical blade cut out in one patient. Stable and satisfactorily reduced fractures had a significantly better radiological outcome. Functional outcome measures were similar across fracture patterns. 65% of the patients returned to their preinjury status. The overall complication rate was also significantly higher in unstable fractures. Good results with relatively low complication rates can be achieved by PFNA in trochanteric fractures in the elderly. Attention to implant positioning, fracture reduction and a good learning curve is mandatory for successful outcomes.
    Indian Journal of Orthopaedics 09/2012; 46(5):556-60. DOI:10.4103/0019-5413.101036 · 0.64 Impact Factor
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    • "Clinical complications include the rotation of the femoral head and the cut-out phenomenon of the fracture fixation bolt (cutting out rate 3-18%). Previously we investigated the fixation of several proximal femur osteosyntheses using clinical and experimental studies indicating that a helical blade shows a better fixation of proximal femur fractures [5-7]. A recent study also concluded that a helical blade leads to a superior anchorage with a reduction in cut-out complications [8]. "
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    ABSTRACT: Since cut-out still remains one of the major clinical challenges in the field of osteoporotic proximal femur fractures, remarkable developments have been made in improving treatment concepts. However, the mechanics of these complications have not been fully understood.We hypothesize using the experimental data and a theoretical model that a previous rotation of the femoral head due to de-central implant positioning can initiate a cut-out. In this investigation we analysed our experimental data using two common screws (DHS/Gamma 3) and helical blades (PFN A/TFN) for the fixation of femur fractures in a simple theoretical model applying typical gait pattern on de-central positioned implants. In previous tests during a forced implant rotation by a biomechanical testing machine in a human femoral head the two screws showed failure symptoms (2-6Nm) at the same magnitude as torques acting in the hip during daily activities with de-central implant positioning, while the helical blades showed a better stability (10-20Nm).To calculate the torque of the head around the implant only the force and the leverarm is needed (N [Nm] = F [N] * × [m]). The force F is a product of the mass M [kg] multiplied by the acceleration g [m/s2]. The leverarm is the distance between the center of the head of femur and the implant center on a horizontal line. Using 50% of 75 kg body weight a torque of 0.37Nm for the 1 mm decentralized position and 1.1Nm for the 3 mm decentralized position of the implant was calculated. At 250% BW, appropriate to a normal step, torques of 1.8Nm (1 mm) and 5.5Nm (3 mm) have been calculated.Comparing of the experimental and theoretical results shows that both screws fail in the same magnitude as torques occur in a more than 3 mm de-central positioned implant. We conclude the center-center position in the head of femur of any kind of lag screw or blade is to be achieved to minimize rotation of the femoral head and to prevent further mechanical complications.
    BMC Musculoskeletal Disorders 04/2011; 12(1):79. DOI:10.1186/1471-2474-12-79 · 1.72 Impact Factor
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    ABSTRACT: Hintergrund Die Periimplantatfraktur des Schenkelhalses tritt als schwerwiegende Komplikation der osteosynthetischen Versorgung sowohl der pertrochantären Femur- als auch der Schenkelhalsfraktur auf. Aufgrund des demografischen Wandels und der weiter steigenden Lebenserwartung in den Industrieländern nimmt die Inzidenz der hüftgelenknahen Fraktur stetig zu. Entsprechend muss auch in zunehmendem Maß mit dem Auftreten von Primär- und Sekundärkomplikationen nach deren operativer Versorgung gerechnet werden. Therapie Die implantatassoziierte Fraktur des Schenkelhalses stellt eine Indikation zur operativen Revision dar. Vor jedem Revisionseingriff hat jedoch zwingend die kritische Analyse der individuellen Komplikationssituation zu erfolgen. Erst im Anschluss daran ist die spezifische Planung eines Revisionseingriffs möglich. Zementaugmentierte Verfahren erlangen dabei eine zunehmende Bedeutung sowohl in der Primärversorgung als auch in der Revisionssituation. Resümee Der vorliegende Beitrag bietet eine Übersicht über die Problematik der periimplantären Fraktur am Schenkelhals, Vermeidungsstrategien zur Prävention sowie Möglichkeiten der operativen Behandlung.
    Trauma und Berufskrankheit 03/2013; 15(1). DOI:10.1007/s10039-013-1934-9
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