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Use of a Trochanteric Fixation Nail-Advanced (TFNA) with cement augmentation for treatment of trochanteric fractures in patients greater than sixty five years of age

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Abstract

Purpose

Intramedullary nailing is the standard treatment of trochanteric fractures. Mechanical failure such as cut-out and cut-through are associated with high rates of revision surgery, functional impairment, and mortality. The aim of the study was to evaluate the rate of mechanical failure of the cement augmented screws of Trochanteric Fixation Nail-Advanced (TFNA) nails.

Patients and methods

A descriptive, retrospective, multi-operator, single-centre study was performed at our level 1 trauma centre between June 2019 and June 2020. Patients were included if they were > 65 years of age, presented with a trochanteric fracture treated with an augmented TFNA nail with 6 months of follow-up. The primary outcome was fixation failure rate (cut-out or cut-through) at three and six post-operative months. Secondary endpoints were intra-operative data, clinical scores, and radiographic analysis.

Results

Forty-five patients (38 women and 7 men) were analysed. The mean age was 82.84 years (65–102, 9.50). There were no instances of mechanical failure in our series, after either three or six months of follow-up. No patient exhibited cut-out or cut-through.

The mean amount of cement injected was 4.72 mL (3–6; 1.05). The mean length of surgery was 37.59 min (25–55; 6.48), and the mean intra-operative radiation exposure was 91.47 cGycm2 (25.04–201.81; 51.40) for a mean duration of 43.11 s (17–86; 16.81). The mean duration of hospitalisation was 6.38 days (2–11; 2.27).

Conclusions

Our clinical results suggest that cement-augmented TFNA screws can be successfully used in the management of trochanteric fractures in patients > 65 years of age.

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Authors and Affiliations

  1. Service d’Orthopédie Et de Traumatologie, CHRU Brest Cavale Blanche, Boulevard Tanguy Prigent, 29200, Brest, France

    Marie Fernandez, Yoann David, Frédéric Dubrana & Rémi Di Francia

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  1. Marie Fernandez
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  2. Yoann David
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  3. Frédéric Dubrana
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  4. Rémi Di Francia
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MF and YD. The first draft of the manuscript was written by MF, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Rémi Di Francia.

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Ethics approval

The study was approved by the local ethics committee (B2021CE.17).

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Informed consent to participate in the study has been obtained from participants.

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The authors declare no competing interests.

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Statement of the location where the work was performed:

This study was conducted at the Brest University Hospital:

Centre Hospitalier Régional Universitaire de Brest

Boulevard Tanguy Prigent

29200 Brest

France

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Fernandez, M., David, Y., Dubrana, F. et al. Use of a Trochanteric Fixation Nail-Advanced (TFNA) with cement augmentation for treatment of trochanteric fractures in patients greater than sixty five years of age. International Orthopaedics (SICOT) 46, 645–651 (2022). https://doi.org/10.1007/s00264-021-05282-0

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