Impact of Bone Cement Augmentation on the Fixation Strength of TFNA Blades and Screws

Abstract

Background and Objectives: Hip fractures constitute the most debilitating complication of osteoporosis with steadily increasing incidences in the aging population. Their intramedullary nailing can be challenging because of poor anchorage in the osteoporotic femoral head. Cement augmentation of Proximal Femoral Nail Antirotation (PFNA) blades demonstrated promising results by enhancing cut-out resistance in proximal femoral fractures. The aim of this study was to assess the impact of augmentation on the fixation strength of TFN-ADVANCEDTM Proximal Femoral Nailing System (TFNA) blades and screws within the femoral head and compare its effect when they are implanted in centre or anteroposterior off-centre position. Materials and Methods: Eight groups were formed out of 96 polyurethane low-density foam specimens simulating isolated femoral heads with poor bone quality. The specimens in each group were implanted with either non-augmented or cement-augmented TFNA blades or screws in centre or anteroposterior off-centre positions, 7 mm anterior or posterior. Mechanical testing was performed under progressively increasing cyclic loading until failure, in setup simulating an unstable pertrochanteric fracture with a lack of posteromedial support and load sharing at the fracture gap. Varus-valgus and head rotation angles were monitored. A varus collapse of 5° or 10° head rotation was defined as a clinically relevant failure. Results: Failure load (N) for specimens with augmented TFNA head elements (screw/blade centre: 3799 ± 326/3228 ± 478; screw/blade off-centre: 2680 ± 182/2591 ± 244) was significantly higher compared with respective non-augmented specimens (screw/blade centre: 1593 ± 120/1489 ± 41; screw/blade off-centre: 515 ± 73/1018 ± 48), p < 0.001. For both non-augmented and augmented specimens failure load in the centre position was significantly higher compared with the respective off-centre positions, regardless of the head element type, p < 0.001. Augmented off-centre TFNA head elements had significantly higher failure load compared with non-augmented centrally placed implants, p < 0.001. Conclusions: Cement augmentation clearly enhances the fixation stability of TFNA blades and screws. Non-augmented blades outperformed screws in the anteroposterior off-centre position. Positioning of TFNA blades in the femoral head is more forgiving than TFNA screws in terms of failure load.

[Retracted] Clinical Analysis of Surgical Treatment of Senile Intertrochanteric Fracture Based on Intelligent Knowledge of Health Care

“…In addition, some studies have also pointed out that due to the lack of medical care knowledge of elderly patients, they choose to stay in bed for a long time, so as not to affect their postoperative recovery, which is easy to cause muscle atrophy and joint stiffness. Therefore, popularizing medical care knowledge is also of great significance to such patients [ 6 ]. The aging of the population will directly lead to the rapid growth of the medical and health care needs of the elderly and form greater pressure on social medical resources [ 7 ].…”

Comparison of Helical Blade Systems for Osteoporotic Intertrochanteric Fractures Using Biomechanical Analysis and Clinical Assessments

“…The current study focuses on the design of a helical blade in a two-nail system. The helical blade in the TFNA provides a cement augmentation option that allows bone cement to penetrate through small holes in the helical blade onto the femoral head to increase the load to failure [20]. However, the cement option is not yet available in our region, and without cement, the core diameter may have a significant effect on stability.…”

Cost-Effectiveness of Cement Augmentation Versus No Augmentation for the Fixation of Unstable Trochanteric Fractures

“…Optimizing implant design is crucial to avoid these complications. The Proximal Femoral Nail Antirotation (PFNA) (DePuy Synthes) 14 and TFN-ADVANCED Proximal Femoral Nail System (TFNA) (DePuy Synthes) 15 were developed to improve the rotational and angular stability of these nails for fracture fixation. The helical blade (the head element of the PFNA and TFNA) compacts the surrounding cancellous bone during insertion, enhancing the biomechanical anchorage [15][16][17] .…”

“…The Proximal Femoral Nail Antirotation (PFNA) (DePuy Synthes) 14 and TFN-ADVANCED Proximal Femoral Nail System (TFNA) (DePuy Synthes) 15 were developed to improve the rotational and angular stability of these nails for fracture fixation. The helical blade (the head element of the PFNA and TFNA) compacts the surrounding cancellous bone during insertion, enhancing the biomechanical anchorage [15][16][17] . Cement augmentation has been associated with improved anchorage of the head element of the nail in the femoral head and greater cut-out resistance [18][19][20][21] .…”