Luka Hodnik (Ljubljana / SI), Črt Benulič (Ljubljana / SI), Miha Kisilak (Ljubljana / SI), Vesna Puketa (Ljubljana / SI), Aleš Fischinger (Ljubljana / SI)
Abstract text (incl. references and figure legends)
Background and purpose — Intramedullary nailing has become standard for unstable trochanteric fractures. Research has led to modification of existing implants, such as the DePuy Synthes TFN-ADVANCED™ (TFNA) which is replacing the existing PFNA nail. At our institution, complications with the TFNA blade mechanism have been observed.
TFNA introduced new static vs. dynamic blade locking options. We hypothesized that the blade locking mechanism modification increases friction and impairs blade movement. The purpose of this article was to confirm our hypothesis.
Patients and methods — We compared trochanteric fracture fixation between both nails to determine the amount of blade sliding. All trochanteric fractures treated at our institution with the TFNA since its introduction in early 2022 were retrospectively reviewed for fixation failure, tip-to-apex distance (TAD), and lateral blade migration (LBM). Sliding failure was defined as central protrusion (cut through). A PFNA control group based on a similar cohort has been established for comparison.
Results — After exclusion, 96 patients were identified in TFNA and 90 in the PFNA group.
The mean LBM was 6.1mm in the TFNA and 4.8mm in PFNA group. The difference was 1,3 mm (21,3%).
Mean TAD was 17,7mm in the TFNA and 20,1mm in PFNA group. The difference was 2,4 mm (22%).
The PFNA group has a higher incidence (14%) of high TAD compared to TFNA group (11%).
Cut-through was observed in five patients ( 5 %) in the TFNA and one patient (1 %) in the PFNA group respectively. The total complication rate, requiring revision surgery was 7% in the TFNA group and 1% in the PFNA group.
Interpretation — Our hypothesis regarding the TFNA sliding mechanism was incorrect. Although we did observe a higher incidence of cut-through in the TFNA group it seems the sliding mechanism is not the reason for failure and further research on the topic is required.
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