Unsay Joshua De Castro, Chua Tjun Huat Ivan, Kwek Beng Kee Ernest
Trauma Service, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
Orthopaedic Surgery Department, Woodlands Health Campus, Singapore, Singapore.
Indian J Orthop. 2020 Aug 20;54(Suppl 2):246-253. doi: 10.1007/s43465-020-00219-y. eCollection 2020 Dec.
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.
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.
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.
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.
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.
股骨转子间固定钉-进阶型（TFN-A）作为一种“下一代”解决方案，用于应对转子周围和转子间骨折发病率不断上升的问题。它旨在在早期股骨近端植入物成功的基础上加以改进，同时试图解决诸如内翻塌陷、穿出、植入物失败以及前皮质穿孔/撞击等并发症。它还旨在通过在单一植入系统下提供多种选择，为外科医生提供灵活性。
这项描述性研究观察了在单一创伤中心使用TFN-A的早期结果。它试图阐明TFN-A在固定方面是否至少等同于更成熟的股骨近端植入物，同时降低并发症发生率这一问题。
本研究回顾性分析了2016年10月至2018年7月在单一中心接受TFN-A固定治疗的34例患者。所有手术均由经验丰富的骨科医生完成。股骨头部件是否进行骨水泥强化是根据具体情况决定的。拍摄髋部、骨盆和股骨的X线片，以监测骨折愈合情况，并评估固定后颈干角（NSA）/内翻塌陷、穿出/穿透、植入物失败以及前皮质撞击/穿孔情况。
所有34例患者术后即刻颈干角与对侧髋关节相差均在5度以内。2例患者在随访时出现内翻塌陷>5度，但未进展为穿出。2例患者远端锁定螺钉断裂，不过其骨折愈合顺利。有4例采用“逆行填充”进行骨水泥强化，其中大部分骨水泥进入股骨颈。没有患者出现远端前皮质撞击或穿孔。除1例患者外，所有患者随后均进展至完全负重。
TFN-A的早期经验似乎表明，它在固定方面至少与先前的股骨近端钉装置相当。无前皮质撞击或穿孔表明TFN-A在解决这一问题方面具有前景。“逆行骨水泥填充”的发生率是股骨头-颈部件强化方面一个此前未报道的关注点，需要进一步研究。
