Trochanteric Fixation Nail^® with Helical Blade Compared with Femoral Neck Screw for Operative Treatment of Intertrochanteric Femoral Fractures

Abstract

PurposeThis study was performed to compare outcomes of the Trochanteric Fixation Nail (TFN®) with a helical blade versus TFN® with a femoral neck screw for the treatment of intertrochanteric femoral fractures.Materials and MethodsA single center, retrospective cohort study. Patients (>18 years of age) with an intertrochanteric femoral fracture, who were operated on between January 1, 2012 and December 31, 2016 were included. Primary and secondary outcome measures were cut-out rate and intervention variables, respectively. Data from X-ray examinations and patient medical files were collected and analyzed. The chi-square test or Student's t-test were used for statistical analysis.ResultsA total of 631 patients were surgically treated for an intertrochanteric femoral fracture. Of this group, 239 patients (37.9%) were treated with a TFN® with helical blade and 392 patients (62.1%) with a TFN® with femoral neck screw. There were no statistically significant differences between the baseline characteristics of both groups. A total of 17 (2.7%) cut-outs were recorded, with no statistically significant difference between the two groups (P=0.19). Additionally, there were no statistically significant differences in the secondary outcome measures between the two groups.ConclusionThere are no statistically significant differences in primary and secondary outcomes following treatment of intertrochanteric femur fracture with the TFN® helical blade or TFN® femoral neck screw. These findings suggest that the choice of collum implant for the surgical treatment of intertrochanteric femur fractures cannot be made based on the surgical outcomes of the two implants evaluated here.

Does the Helical Blade Lead to Higher Rates of Fixation Failure as Compared to Lag Screw in the Cephalomedullary Nailing Treatment of Hip Fractures? A Systematic Review and Meta-Analysis

“…The mean MINORS score for methodological quality assessment was 19 of the 24 (range: 18-24) (Table 1). Regarding the 8 main evaluation parameters, 8 of the 12 studies received a point deduction for their retrospective study design, 3,5,9,10,[15][16][17]19 and 10 of the 12 studies received a point deduction because they did not clearly describe the unbiased assessment of their end point. 3,5,9,10,[15][16][17]19,21,22 Two studies received a point deduction because they had a loss to followup rate of more than 5% of the initial patients.…”

“…Regarding the 8 main evaluation parameters, 8 of the 12 studies received a point deduction for their retrospective study design, 3,5,9,10,[15][16][17]19 and 10 of the 12 studies received a point deduction because they did not clearly describe the unbiased assessment of their end point. 3,5,9,10,[15][16][17]19,21,22 Two studies received a point deduction because they had a loss to followup rate of more than 5% of the initial patients. 20,21 All studies, except one, received a point deduction because they lacked a prospective calculation of the study size.…”

“…20,21 All studies, except one, received a point deduction because they lacked a prospective calculation of the study size. 3,5,9,10,[15][16][17][19][20][21][22] No deductions were made in the additional criteria domains.…”

“…We extracted data regarding the number of fixation failures in both blade-type and screw-type CMNs from 11 studies. 3,5,9,10,[15][16][17][18][19][20][21] The overall fixation failure rate was significantly higher in the helical blade group than in the lag screw group, with a pooled OR of 1.88 (95% CI: 1.09-3.23, P = 0.02; Fig. 2).…”

“…Of the 12 included studies, there were 3 RCTs 18,20,22 and one prospective cohort study, 21 whereas the other 8 were retrospective cohort studies. 3,5,9,10,[15][16][17]19 In total, 2331 cases of hip fractures treated using CMN were reported, including 1084 treated using a helical blade and 1247 treated using a screw-type device. Of the included studies, the titanium trochanteric fixation nail (TFN; DePuy Synthes) and proximal femoral nail antirotation (PFNA; DePuy Synthes) were used as blade-type devices, whereas the TFN, Gamma-3 nail (G3; Stryker), and intertrochanteric-subtrochanteric fixation system (Zimmer) were used as screw-type devices.…”