Clinical and Radiologic Outcome of Intertrochanteric Fracture Treatment Using TFNA (Trochanteric Fixation Nail-Advanced)

Hyeon Joon Lee; Hyun Bai Choi; Ba Rom Kim; Seung Hwan Jo; Sang Hong Lee

doi:10.12671/jkfs.2021.34.3.105

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Original Article Clinical and Radiologic Outcome of Intertrochanteric Fracture Treatment Using TFNA (Trochanteric Fixation Nail-Advanced): Hyeon Joon Lee, Hyun Bai Choi, Ba Rom Kim, Seung Hwan Jo, Sang Hong Lee; Journal of Musculoskeletal Trauma 2021;34(3):105-111.
DOI: https://doi.org/10.12671/jkfs.2021.34.3.105
Published online: July 31, 2021

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Abstract

Purpose
This study evaluated the clinical and radiological outcomes of TFNA (Trochanteric Fixation NailAdvanced; Depuy Synthes) for the treatment of proximal femur fractures.
Materials and Methods
This was a retrospective study of 64 patients diagnosed with a proximal femur fracture from January 2019 to November 2019. The patient’s demographic data, preoperatively and postoperatively Koval grade, modified Harris hip score, EQ-5D (Euro-Qol-5 Dimension), sliding and advancement of the blade, radiologic outcome, and complications were investigated.
Results
Fifty patients were available for evaluation at one year postoperatively. The patients reported the following: the Koval grade decreased after surgery; the modified Harris hip score decreased from 78.56±8.88 to 72.74±6.59 (p=0.149); the mean EQ-5D decreased from 0.75±0.09 to 0.72±0.06 (p=0.000). Satisfactory reduction was achieved on a postoperative radiographic examination in 47 patients in six months. Complications occurred in seven cases.
Conclusion
TFNA is considered an appropriate implant for treating intertrochanteric fractures of the femur with a minimum follow-up of one year.

Keywords: Femur, Intertrochanteric fractures, Cephalomedullary nail, Trochanteric Fixation Nail-Advanced

J Korean Fract Soc. 2021 Jul;34(3):105-111. Korean.
Published online Jul 23, 2021.
https://doi.org/10.12671/jkfs.2021.34.3.105

Original Article

Clinical and Radiologic Outcome of Intertrochanteric Fracture Treatment Using TFNA (Trochanteric Fixation Nail-Advanced)

Hyeon Joon Lee

, M.D., Hyun Bai Choi

, M.D., Ba Rom Kim

, M.D., Seung Hwan Jo

, M.D. and Sang Hong Lee

, M.D.

Author information

Author notes

- Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju, Korea.
Correspondence to: Sang Hong Lee, M.D. Department of Orthopaedic Surgery, College of Medicine, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Korea. Tel: +82-62-220-3147, Fax: +82-62-226-3379, Email: shalee@chosun.ac.kr

Received April 19, 2021; Revised May 02, 2021; Accepted July 06, 2021.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study evaluated the clinical and radiological outcomes of TFNA (Trochanteric Fixation Nail-Advanced; Depuy Synthes) for the treatment of proximal femur fractures.

Materials and Methods

This was a retrospective study of 64 patients diagnosed with a proximal femur fracture from January 2019 to November 2019. The patient's demographic data, preoperatively and postoperatively Koval grade, modified Harris hip score, EQ-5D (Euro-Qol-5 Dimension), sliding and advancement of the blade, radiologic outcome, and complications were investigated.

Results

Fifty patients were available for evaluation at one year postoperatively. The patients reported the following: the Koval grade decreased after surgery; the modified Harris hip score decreased from 78.56±8.88 to 72.74±6.59 (p=0.149); the mean EQ-5D decreased from 0.75±0.09 to 0.72±0.06 (p=0.000). Satisfactory reduction was achieved on a postoperative radiographic examination in 47 patients in six months. Complications occurred in seven cases.

Conclusion

TFNA is considered an appropriate implant for treating intertrochanteric fractures of the femur with a minimum follow-up of one year.

Keywords

Femur, Intertrochanteric fractures, Cephalomedullary nail, Trochanteric Fixation Nail-Advanced

Figures

Fig. 1
Pelvis anteroposterior radiograph of the left hip of a 65-year-old male. (A) Preoperative radiograph shows a comminuted intertrochanteric fracture (AO/OTA 31-A2.3). (B) Immediate postoperative radiograph after fixation, using extra-medullary reduction. (C) Six-month follow-up X-ray shows the complete union of the fracture.

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Fig. 2
Doppelt's method to measure lateral sliding of the blade and migration; a correction factor was applied. Correction factor=c/C, extent of lateral sliding=(a-A)×c/C, extent of blade migration=(B-b)×c/C.

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Fig. 3
Pelvis anteroposterior radiographs of the right hip of an 81-year-old female. (A) Preoperative radiographs show an intertrochanteric fracture (AO/OTA 31-A2.2). (B, C) Immediate postoperative radiograph after fixation, Fish mouth phenomenon^*. (D) Two-month follow-up X-ray shows the penetration of the blade out of the femoral head, fixation failure. (E) Revision to bipolar hemiarthroplasty and returned to walking independently. ^*Fish mouth phenomenon: Nailing in a comminuted fracture in the greater trochanter might cause the fish mouth phenomenon, which results in varus angulation and shortening that can progress to fixation failure.

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Fig. 4
(A) Photographs of the TFNA (Trochanteric Fixation Nail-Advanced). Small proximal diameter and lateral ‘relief cut’ design avoids impingement on the lateral cortex, preserving bone in the insertion area, potentially reducing the risk of fracture displacement. (B) ‘Bump cut’ design (black arrows) of the proximal hole provides improved fatigue strength compared to the existing nail and helps prevent nail breakage. Oblique lateral end of the blade lie flush to the lateral cortex to reduce the protrusion into the soft tissue. (C) PFNA (proximal femoral nail antirotation). (D) Gamma 3 trochanteric nail.

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Tables

Table 1
Patients' Demographic Characteristics (n=50)

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Table 2
Radiologic Outcomes

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Table 3
Screw Sliding and Advancement Distance according to the AO/OTA Classification

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Notes

Financial support:This study was supported by research fund from Chosun University Hospital, 2019.

Conflict of interests:None.

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Citations

Citations to this article as recorded by

GS Hip Nail versus Affixus Hip Fracture Nail for the Intramedullary Nailing of Intertrochanteric Fractures
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Clinical and Radiologic Outcome of Intertrochanteric Fracture Treatment Using TFNA (Trochanteric Fixation Nail-Advanced)

J Korean Fract Soc. 2021;34(3):105-111. Published online July 31, 2021

DOI: https://doi.org/10.12671/jkfs.2021.34.3.105