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Early Experience with the Trochanteric Fixation Nail-Advanced (TFN-A): A Descriptive Review of Thirty-Four Cases from a Single Center

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Indian Journal of Orthopaedics Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 26 January 2021

Abstract

Background

The Trochanteric Fixation Nail-Advanced (TFN-A) is offered as a “next-generation” solution to the ever-increasing incidence of pertrochanteric and intertrochanteric fractures. It aims to build upon the success of earlier-generation proximal femur implants, while at the same time attempting to address complications, like varus collapse, cut-out, implant failure and anterior cortical perforation/impingement. It also aims to provide the surgeon with flexibility by offering varied options under a single implant system.

Objectives

This descriptive study looked at the early outcomes of the TFN-A as used in a single trauma centre. It attempts to shed light on the question of whether the TFN-A is at least equivalent to more established proximal femur implants in terms of fixation while reducing complication rates.

Methods

Thirty-four patients who underwent fixation using the TFN-A at a single centre from October 2016 to July 2018 were retrospectively reviewed for this study. All surgeries were done by experienced orthopaedic surgeons. The decision for cement augmentation of the femoral head element was made on a case-to-case basis. Radiographs of the hip, pelvis and femora were taken to monitor fracture healing and evaluate post-fixation neck-shaft angle (NSA)/varus collapse, cut-out/cut-through, implant failure and anterior cortical impingement/perforation.

Results

All thirty-four patients had neck-shaft angles within 5 degrees of the contralateral hip immediately post-surgery. Two patients had varus collapse > 5 degrees on follow-up but did not progress to cut-out. Two patients had broken distal locking screws, albeit their fractures healed uneventfully. There were four cases of cement augmentation with “retrograde filling”, wherein most of the cement went into the femoral neck. No patients experienced distal anterior cortical impingement or perforation. All but one patient subsequently progressed to full weight-bearing.

Conclusion

Early experience with the TFN-A appears to suggest that it is at least comparable to preceding proximal femur nail devices in terms of fixation. Absence of anterior cortical impingement or perforation suggests that the TFN-A shows promise in addressing this issue. The incidence of “retrograde cement filling” is a previously unreported point of interest for head–neck element augmentation which requires further study.

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Authors and Affiliations

  1. Trauma Service, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore

    Joshua De Castro Unsay & Ivan Chua Tjun Huat

  2. Orthopaedic Surgery Department, Woodlands Health Campus, Singapore, Singapore

    Ernest Kwek Beng Kee

Authors
  1. Joshua De Castro Unsay
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  2. Ivan Chua Tjun Huat
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  3. Ernest Kwek Beng Kee
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Correspondence to Joshua De Castro Unsay.

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Unsay, J.D.C., Chua Tjun Huat, I. & Kwek Beng Kee, E. Early Experience with the Trochanteric Fixation Nail-Advanced (TFN-A): A Descriptive Review of Thirty-Four Cases from a Single Center. JOIO 54 (Suppl 2), 246–253 (2020). https://doi.org/10.1007/s43465-020-00219-y

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  • DOI: https://doi.org/10.1007/s43465-020-00219-y

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