Outcomes of Intertrochanteric Fracture Fixation Using the Trochanteric Fixation Nail Advanced (TFNA): A Retrospective Analysis

TL;DR

This study evaluates the effectiveness of using the TFNA system for treating hip fractures in elderly patients, showing good healing and low complication rates.

Contribution

The study provides empirical evidence on the clinical outcomes of TFNA fixation for intertrochanteric fractures in a large cohort.

Findings

TFNA fixation achieved excellent functional outcomes with a mean Harris Hip Score of 93.39.

Low revision and mortality rates (0.3% and 1.63%, respectively) were observed.

Radiographic scores indicated effective fracture healing over time.

Abstract

Background: Intertrochanteric hip fractures in the elderly pose a major healthcare burden due to their high morbidity, mortality, and economic impact. The Trochanteric Fixation Nail-Advanced™ (TFNA) Proximal Femoral Nailing System (DePuy Synthes, West Chester, PA, USA), a type of cephalomedullary device, has shown potential for improving outcomes in the management of these fractures. This study aimed to evaluate the functional and clinical outcomes of trochanteric fracture fixation via TFNA.

Methods: A retrospective, single-center observational study was conducted at a tertiary orthopaedic trauma hospital in India and included 368 patients who underwent femoral fixation with the TFNA system between January 2019 and December 2022. Radiological parameters (tip-apex distance [TAD], Radiographic Union Score for Hip [RUSH]), functional outcomes (Harris Hip Score [HHS]), surgical duration, intraoperative blood loss, complication and reoperation rates, and mortality were assessed at six weeks, three months, six months, and one year postoperatively.

Results: The mean age of the patients was 63.8 years, with 60.9% being male. The mean TAD was 14.9 mm at both six months and one year, and the mean RUSH score was 29.8 at six months and 30.0 at one year, reflecting effective fracture healing. The mean HHS was 93.39, with 92.8% achieving excellent functional outcomes. The average surgical time was 50.6 minutes, with mean blood loss of 128.4 mL. The revision rate was low (0.3%), and mortality rate was 1.63%.

Conclusions: TFNA fixation for intertrochanteric fractures yields excellent radiological and functional outcomes, with low complication and revision rates. Optimal implant placement and surgical technique are crucial for successful fracture management.