Orthopedic Surgery and Traumatology Service, Hospital Universitario Fundación Alcorcon, 28922 Alcorcón, Spain.
Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain.
Medicina (Kaunas). 2024 Apr 26;60(5):718. doi: 10.3390/medicina60050718.
: This retrospective cohort study analyzes mechanical complications in hip fracture surgery using the Trochanteric Fixation Nail-Advanced (TFNA) implant. It investigates the correlation of these complications with demographic, intraoperative, and radiological factors, aiming to identify associated risk factors and suggest improvements in clinical surveillance and treatment strategies. : We enrolled 253 patients diagnosed with pertrochanteric hip fractures treated between 2017 and 2021, with 126 meeting the criteria for a minimum 6-month follow-up. Data on demographics, American Anesthesia Association Classification (ASA), comorbidities, AO/OTA [AO (Arbeitsgemeinschaft für Osteosynthesefragen)/OTA (Orthopedic Trauma Association)] fracture classification, procedural details, and time to failure were collected. Radiographs were evaluated for reduction quality, the tip-apex distance (TAD), progressive varus deviation, and identification of mechanical complications. Statistical analysis was performed using SPSS software. : The predominant AO/OTA fracture classification was 31A2 in 67 cases (52.7%). Reduction quality was deemed good or acceptable in 123 cases (97.6%). The mean time to failure was 4.5 months (range: 2.2-6). The average TAD was 18 mm (range: 1.2-36), with a mean progressive varus deviation of 2.44° (range: 1.30-4.14). A good or acceptable reduction quality was observed in 97.6% of cases. Mechanical complications occurred in 21.4% of patients, with significant associations found with the lateral cortex fracture, use of a TFNA implant with a 130° angle, open reduction, and absence of prior osteoporosis treatment. : The study provides insights into mechanical complications in proximal femur fractures treated with the TFNA nail, emphasizing the need for enhanced clinical and radiographic surveillance, especially in patients without osteoporosis treatment. Our findings support the necessity for further clinical studies comparing these outcomes with other implant designs and underscore the importance of personalized treatment strategies to reduce complication rates.
: 本回顾性队列研究分析了使用 Trochanteric Fixation Nail-Advanced（TFNA）植入物治疗髋部骨折手术中的机械并发症。研究了这些并发症与人口统计学、手术中和影像学因素的相关性，旨在确定相关的危险因素，并提出改进临床监测和治疗策略。 : 我们纳入了 2017 年至 2021 年间诊断为股骨转子间骨折的 253 例患者，其中 126 例符合至少 6 个月随访标准。收集了人口统计学、美国麻醉医师协会分类（ASA）、合并症、AO/OTA（Arbeitsgemeinschaft für Osteosynthesefragen/OTA（骨科创伤协会））骨折分类、手术细节和失效时间的数据。对 X 线片进行评估，以评估复位质量、尖端顶点距离（TAD）、进行性内翻偏差和机械并发症的识别。使用 SPSS 软件进行统计学分析。 : 主要的 AO/OTA 骨折分类是 67 例 31A2（52.7%）。123 例（97.6%）复位质量良好或可接受。平均失效时间为 4.5 个月（范围：2.2-6）。平均 TAD 为 18mm（范围：1.2-36），平均进行性内翻偏差为 2.44°（范围：1.30-4.14）。97.6%的病例复位质量良好或可接受。机械并发症发生在 21.4%的患者中，与外侧皮质骨折、使用 130°角度的 TFNA 植入物、切开复位和未进行骨质疏松治疗显著相关。 : 本研究提供了关于使用 TFNA 钉治疗股骨近端骨折的机械并发症的见解，强调需要加强临床和影像学监测，特别是在没有骨质疏松治疗的患者中。我们的发现支持需要进一步的临床研究，比较这些结果与其他植入物设计，并强调制定个性化治疗策略以降低并发症发生率的重要性。
