Trochanteric Fixation Nail Research Articles

Assessment of the outcome of fracture intertrochanteric femur treated by trochanteric fixation nail in the elderly population

<p class="abstract"><strong>Background:</strong> Intertrochanteric fractures femur in elderly population are more commonly forbidden high morbidity. The surgical stabilization together with early rehabilitation is the main challenge. The elderly population have poor bone mass quality and also the chances of complications like nonunion or implant failure are more with conventional procedures. Stable fixation and early rehabilitation is the main aim in intertrochanteric fractures. The aim is to assess the functional outcome of intertrochanteric fractures femur managed by trochanteric fixation nail (TFN) in the elderly population.</p><p class="abstract"><strong>Methods:</strong> The study includes 40 patients, 30 male and 10 female, with fracture intertrochanteric femur treated with TFN from September 2018 to May 2019 at Yashoda Superspeciality Hospital, Nehrunagar, Ghaziabad. The patients were evaluated at 4, 8, 12 weeks postoperatively and assessed by the Modified Harris hip score. Classification used is AO classification.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean age of patients was 64 years. The mean duration of surgery was 48±10 min. The Harris hip score was 96.90±4.60, which is better than scores from other implants used for intertrochanteric fractures femur.</p><p class="abstract"><strong>Conclusions:</strong> In this study, we conclude that TFN is a good choice in managing the intertrochanteric fractures, having higher bone union rate and less union time. The period of immobilization is decreased, early weight bearing and less complications.</p>

Confounding variables affecting long term results of standard two screw cephalomedullary nail in intertrochanteric fractures of femur

<p><strong>Background: </strong>Inter trochanteric fractures of femur are common fractures in the elderly. The aim of the study was to assess the long-term functional outcome of patients treated with trochanteric fixation nail (TFN) for inter trochanteric femur fractures and to determine variables which affect the final outcome of surgery at the end of five years.</p><p><strong>Methods: </strong>The study was done at tertiary centre in central India with 152 patients who sustained intertrochanteric femur fracture. The patients were followed up at 6 weeks, 6 months, 1 year, 2 years and 5 years after the surgery. The assessment of pain, functional activity, walking ability and range of motion were assessed by Harris hip score at 6 months, 1 year, 2 years and 5 years.</p><p><strong>Results: </strong>The good/excellent outcome at the end of 5 years was found in 84% of cases. Patients with age less than 65 years and male patients had better outcome at the end of five years. Some of the complications encountered with this type of implant were z effect, delayed union, screw back-out/breakage, varus collapse which affected the final outcome.</p><p><strong>Conclusions: </strong>TFN is effective treatment technique for inter trochanteric fractures of femur worldwide. There are some complications which can occur with this type of implant in early post-operative period but still long-term follow-up of patients suggested that the fracture pattern, preoperative mobility status, timing of surgery, post op mobilization also plays a key role in determining functional outcome of patients.</p>

Trochanteric fixation nail advanced with helical blade and cement augmentation: early experience with a retrospective cohort.

Intra-articular screw cut-out is a potential complication of intertrochanteric femur fracture fixation with a cephalomedullary nail. Cement augmentation of fixation in the proximal segment offers the prospect of increased stability and fewer complications, but clinical experience with non-resorbable cement is limited. To determine the handling properties and efficacy of this new technique, we performed a retrospective propensity-matched cohort of forty-four geriatric intertrochanteric femur fractures treated with a cephalomedullary nail with (n = 11) or without (n = 33) augmentation with non-resorbable cement injected into the proximal segment. In the patients treated with cement augmentation, at minimum 3-month follow-up, there were no instances of intra-articular cut-out, and no increase in re-operation compared to conventional fixation. Cement augmentation appears to be safe and effective in geriatric intertrochanteric femur fractures to mitigate risk of cut-out.

Biomechanical evaluation of internal fixation for the treatment of comminuted subtrochanteric femur fractures

BackgroundSeveral biomechanical studies on subtrochanteric femur fractures have reported that use of an intramedullary nail is superior to extramedullary implant. However, the optimal choice of intramedullary nail for the treatment of comminuted subtrochanteric femur fracture remains unclear. Here, we evaluated the biomechanical properties of comminuted subtrochanteric femur fracture treated with four different internal fixations. MethodsA comminuted subtrochanteric femur fracture model was created with a 2-cm gap below the lessor trochanter in 20 synthetic femurs. The fractures were fixed with one of four implants - Antegrade Femoral Nail (AFN), Trochanteric Fixation Nail Advanced with a femoral neck blade (TFNA blade), TFNA with a femoral neck screw (TFNA screw), and the reversed distal femoral locking compression plate (DF-LCP) - all manufactured by DePuy Synthes. Axial compression tests and torsion tests were performed and the stiffness of each implant was compared. ResultsFor compression, the TFNA blade, TFNA screw, and AFN provided significantly higher stiffness than DF-LCP (p < 0.001, p < 0.001, p = 0.001, respectively), and the TFNA blade provided significantly higher stiffness than AFN (p = 0.049). For torsion, there were no significant differences among the groups in internal rotation, while the TFNA screw had significantly lower torsional stiffness than the AFN, TFNA blade and DF-LCP in external rotation (p = 0.036, p = 0.034, p = 0.037, respectively). ConclusionsThese findings could help to provide biomechanical evidence regarding choice of implant for the treatment of comminuted subtrochanteric femur fracture. The TFNA blade may be more suitable for the treatment of comminuted subtrochanteric femur fracture.

Implant Fracture Analysis of the TFNA Proximal Femoral Nail.

Mechanical failure of intramedullary nails is rare. This investigation was prompted by a series of cases of observed breakage of the recently introduced TFNA Proximal Femoral Nailing System (TFN [Trochanteric Fixation Nail]-Advanced; DePuy Synthes) in our region. Laboratory analysis and case data are presented, in contribution to post-market surveillance. Medical and imaging records from the 3 public tertiary orthopaedic trauma hospitals in Western Australia were reviewed. Relevant data of patients in whom breakage of the TFNA implant occurred between 2016 and 2018 were collected and analyzed. Laboratory review of retrieved implants was conducted at the Centre for Implant Technology and Retrieval Analysis (CITRA) in Western Australia. A total of 16 cases of TFNA implant breakage were recorded and analyzed. The predominant OTA/AO fracture classification was 31A3 (12 cases, 75%). The reduction quality was good in 10 cases, acceptable in 4 cases, and poor in 2 cases. The mean time to failure (and standard deviation) was 5.0 ± 2.2 months (range, 2.2 to 9.8 months). The treatment modality for the breakage was revision nailing in 11 cases, arthroplasty in 3, and nonoperative management in 2. All nails broke at the proximal screw aperture, with 1 nail additionally breaking at the distal aperture. Of 8 patients treated with a second TFNA implant for nail breakage, 3 (38%) returned with breakage of the revision implant. Laboratory analysis of the broken nails demonstrated a unique fracture pattern, with a stepped propagation pathway. This study represents the largest series, to our knowledge, of proximal femoral nail breakages in the published English literature and is the first that we are aware of to involve laboratory analysis of the TFNA implant. Changes to the nail design and/or alloy may have contributed to the observed cases of breakage, and this study will be followed by an evaluation of breakage rates in comparison with those of previous generations of nailing systems. We advise close clinical and radiographic surveillance of patients with unstable hip fracture patterns who undergo osteosynthesis with use of a TFNA implant. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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

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.

Commentary on an Article by van Leur et al., "Trochanteric Fixation Nail® with Helical Blade Compared with Femoral Neck Screw for Operative Treatment of Intertrochanteric Femoral Fractures".

Commentary on an Article by van Leur et al., "Trochanteric Fixation Nail® with Helical Blade Compared with Femoral Neck Screw for Operative Treatment of Intertrochanteric Femoral Fractures".

Gait Analysis After Intertrochanteric Hip Fracture: Does Shortening Result in Gait Impairment?

To determine the association between fracture collapse with altered gait after intertrochanteric (IT) fracture using the trochanteric fixation nail (TFN) and helical blade. Prospective cohort study. Academic Level I trauma center. Seventy-two patients with IT hip fractures (OTA/AO 31) treated between 2012 and 2016. The average age was 79.7 years (range, 51-94 years); there were 59 women and 13 men. All patients were treated with cephalomedullary nailing using the TFN (DePuy-Synthes, West Chester, PA) with a helical blade. At follow-up appointments, temporospatial gait parameters were measured and recorded. Radiographs were analyzed at the time of surgery and at each follow-up visit. Amount of radiographic femoral neck shortening was measured radiographically. Patients completed the Harris Hip Score, visual analog scale for pain, Short Form-36 Physical Component Score, and Short Form-36 Mental Component Score. The mean length of follow-up between the surgery and the gait analysis was 8.6 months (±0.7 months). The mean amount of shortening was 4.7 mm (±0.6 mm). Out of the 72 patients analyzed, there were 15 patients (20.8%) who shortened more than 8 mm, 7 patients (9.7%) who shortened 10 mm or more, and 2 patients (2.8%) who shortened more than 20 mm. Mean shortening was 3.0 mm for stable OTA/AO 31-A1 fractures, whereas the unstable patterns (OTA/AO 31-A2, 31-A3) demonstrated a mean shortening of 5.9 mm (P = 0.02). There was significant correlation between increased shortening and decreased cadence (P = 0.008), increased double support time (P < 0.001), decreased step length (P = 0.001), and increased single support asymmetry (P = 0.04) during gait analysis. The threshold of 8 mm of shortening predicted decreased cadence (P = 0.008), increased double support time (P < 0.001), and decreased step length (P = 0.006). Analysis of patient-reported outcome scores, including the Harris Hip Score, visual analog scale, SF-36 Physical Component Score, and SF-36 Mental Component Score, revealed no significant association with shortening. Results from this study indicate that shortening after cephallomedullary nailing of IT hip fractures using the TFN with a helical blade is associated with altered gait, specifically decreased cadence, increased double support time, decreased step length, and increased single support time asymmetry. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Outcomes of proximal femoral nail in subtrochanteric femur fractures through medial entry

Introduction: Subtrochanteric Fractures of Femur accounts for 10-34% of all hip fractures. Several Methods of treatment of this Fractures have been reported like DHS (Dynamic hip screw), Angled blade Plate, Proximal Femur Locking Plate and Intramedullary devices. Currently Intramedullary Devices like Proximal Femur Nail are used by many giving satisfactory results in subtrochanteric femur fractures. In such situation as Suggested by Richardu et. el. slight medial entry leads to valgus alignment which is desired along with the anatomical reduction while nailing subtrochanteric fractures. In the study conducted by perez et al. Suggested that slight more medial entry also protected abductors and caused no damage. Materials and Methodology•All the patients of subtrochanteric femur fractures treated with long proximal femur nail through medial entry will be called for follow up and data is collected as per the performa •Functional assessment will be done using Harris Hip Score.Discussion: Utiizing the tip of the trochanter as a starting point led to both varus and valgus malalignments.Using the Trochanteric Fixation Nail (TFN) with a lateral to the tip of the trochanter, starting point demonstrated 6.83° varus and a gap of 8.03 mm. A medial starting point resulted in 6.6° valgus with a mean gap of 3.88 mm and a tip starting point showed 0.3° varus and 3.56 mm of gapping. In the above conducted study there was a valgus angulation at the proximal femur due to medial entry of the proximal femur nail.Conclusion: From this sample study, we conclude that Proximal Femoral Nail through medial entry is a good method for the treatment of Subtrochanteric fractures of femur provided optimal reduction of the fracture and good positioning of the nail and screws are achieved.

Helical Blade Versus Screw Fixation in the Treatment of Hip Fractures With Cephalomedullary Devices: Incidence of Failure and Atypical "Medial Cutout".

To evaluate the rates and mechanisms of failure for cephalomedullary nail fixation using helical blade versus screw fixation and to identify the predictors of failure. Retrospective study. Community teaching hospital. A total of 126 patients were treated with cephalomedullary fixation for low-energy hip fractures. All procedures used the Trochanteric Fixation Nail (Synthes) with either a helical blade [71 (56.3%)] or screw [55 (43.7%)]. Failures, defined by nonunion, hardware cutout, and need for revision surgery were independently reviewed by a fellowship-trained orthopaedic trauma surgeon for an assessment of reduction quality and hardware placement. Seven failures of fixation (5.6%) occurred, all of which used a helical blade. Five failures resulted from medial migration of the helical blade through the femoral head, whereas 2 resulted from typical superolateral cutout and varus collapse. There was no difference in the average tip apex distance between the cases using blade versus screw fixation or between failures and the remainder of the cohort. Basicervical fractures had a significantly higher rate of failure than other fracture patterns. This study showed a higher failure rate with use of the blade and supports the use of screw fixation in these fractures. In addition, we confirm an atypical mode of failure, lateral migration of the femoral head with protrusion of the helical blade, which contributes significantly to the overall failure rate of this implant and occurs despite appropriate fracture reduction and hardware placement. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Is trochanteric fixation nail a better implant in the management of intertrochanteric fracture in elderly compared to dynamic hip screw

Background: Intertrochanteric fractures are the most common fractures in elderly and have devastating sequence if not managed properly. The ultimate goal in the management of Intertrochanteric fracture is early mobilization of patients to prevent morbidity and mortality. Early mobilization primarily depends on the implant used & stability of the surgical construct. The purpose of this study is to compare the functional and radiological outcome of intertrochanteric fractures in elderly & osteoporotic patients managed with Dynamic Hip Screw (DHS) & Trochanteric Fixation Nail (TFN). Materials and Methods: The present study was carried out at Rajah Muthiah Medical College & Hospital from June 2016 to May 2017. 20 patients of age more than 60 years with intertrochanteric factures of femur were treated with Trochanteric Fixation nail (10 cases) and Dynamic Hip Screw (10 cases). Discussion: Individual cases were followed up for at least 24 weeks to one year and during each & every follow up visit clinical, radiological, functional outcomes were documented, analyzed, evaluated and compared. In our study of 10 patients, we had 8 patients (40%) with stable type of fracture pattern and 12 patients (60%) cases were of unstable fracture pattern. 5 patients underwent DHS and 3 patients underwent TFN in the stable category of 8.Whereas 5 patients underwent DHS and 7 patients underwent TFN in unstable Intertrochanteric fracture group of 12 patients. Results: The Average time taken for union was about 16 weeks (Range: 12 to 20 weeks) and full weight bearing correlated well with the time of fracture union. Conclusion: We conclude that the fracture pattern& experience of the surgeon are the primary determinants of implants choice & primary fixation of intertrochanteric fractures aid early rehabilitation and return back to activities of daily living.

Extent and Morbidity of Lateralization of a Trochanteric Fixation Nail Blade.

This study examined the incidence and risk factors associated with lateral helical blade migration and trochanteric pain with the trochanteric fixation nail. A retrospective review was performed of 141 cases of pertrochanteric femur fracture treated with a trochanteric fixation nail at a level I trauma center over a period of 42 months. Exclusion criteria included follow-up of less than 60 days, preexisting osteonecrosis of the femoral head, and prophylactic trochanteric fixation nail treatment. Patient demographics, operative findings, and radiographic findings were recorded. Medical records were reviewed to identify symptomatic hardware. Overall, 27 patients (19.1%) were symptomatic, and 3 (2.1%) required revision surgery for blade prominence. Of the patients, 42 (30%) had lateralization of greater than 1 cm, and 16 of these (38.1%) were symptomatic (P<.02). A risk factor for lateralization was AO classification, with 46.1% of type A2 fractures showing lateralization of greater than 1 cm. The quality of calcar reduction nearly reached statistical significance, and 44.8% of patients who had inadequate reduction had lateralization of greater than 1 cm compared with 26.4% of patients who had adequate reduction (P=.054). Lateralization of greater than 1 cm was directly associated with the presence of symptoms (P<.001) and removal of hardware because of trochanteric pain (P=.007). Multivariate analysis showed that increasing tip-apex distance, inadequate calcar reduction, and greater fracture severity were predictive of excessive lateralization of greater than 1 cm. Nearly 20% of patients had lateral hip pain associated with cephalomedullary fixation. Final lateralization of the helical blade of greater than 1 cm was a very strong predictor of symptoms. During preoperative counseling, surgeons should caution patients about this relatively frequent and likely underreported complication. [Orthopedics. 2017; 40(5):e886-e891.].

Clinical study of functional outcome of intertrochanteric fracture treated by Trochanteric fixation nail (TFN) in North Indian population: A prospective study

Background: Trochanteric fixation nail (TFN) is a newer device used for the treatment of the intertrochanteric femoral fracture. This study reports the outcome in such fractures treated by using the TFN at northern part of India. Materials & Methods: In a prospective study from October 2014 to September 2016, we included 64 patients (38 female, 36 male; mean age 59.25years; range 21 to 80 years) who were treated with the TFN for intertrochanteric hip fractures and followed up minimum of six months. According to the AO/OTA classification, there were 14 cases of type 31A1, 42 cases of type 31A2, and 08 cases of type 31A3 fractures. The patients were evaluated clinically (Harris hip score) and radiographically for a minimum period of six months with all complications were recorded. Results: In our series, most of the patients sustained trauma after simple fall (87.5%) and 12.5% as a result of road traffic accident (RTA).Fractures were classified according to AO/OTA classification, 14 patients had 31-A1 type of fracture, 42 had 31-A2 type of fracture and rest 8 had 31-A3 type of fracture. Mean average delay for surgery was 11.56 days (range 3 to 27 days). Out of 64 patient post-operative radiograph showed near anatomic reduction in 60 patients. We found 6 cases of intraoperative complication in the form of 2 cases of fixation in varus and 4 cases of loss of reduction. We found 8 cases of post-operative complication in which 2 cases of superficial and deep wound infection and 6 cases of varus malunion. No fractures of the femoral shaft, Z-Effect and reverse Z-Effect were noticed. We did not encountered any case of implant failure or avascular necrosis of femoral head. All the patient shows radiological union in our study with mean time of union was 11.02 weeks (12-18 weeks). According to harris hip score, we had good to excellent results in 88%, fair to poor result in 12% of cases. Conclusions: With proper patient selection, good instrumentation, image intensifier and surgical technique, TFN is a good choice in the management of intertrochanteric fractures leading to high rate of bone union and good functional result with minimal soft tissue damage.

Functional Outcome of Unstable Intertrochanteric Femur Fracture Patients Treated with Trochanteric Fixation Nail

Introduction: Intertrochanteric fractures are disabling injuries that most commonly affect the elderly population. These fractures have a tremendous impact on both the health-care system and society in general. These fractures can be managed by conservative methods, but mal-union and complications of prolonged immobilization are the result. Thus, surgery by internal fixation is the ideal choice. Dynamic hip screw was the gold standard treatment for intertrochanteric fractures before intramedullary devices were developed. These devices have the advantage of being an intramedullary fixation device, shorter lever arm of devices causing less tensile strain on the implant, controlled fracture impaction due to the incorporation of sliding hip screw, shorter operative duration, and less soft tissue dissection. In view of these consideration, this study of management of unstable intertrochanteric fractures using trochanteric fixation nail (TFN) is taken up to assess the outcome in terms of adequacy of fixation and results. Methods: In a retrospective controlled study, 40 patients of unstable intertrochanteric fracture were treated by TFN. Mean age group of the patient was 61.78 years. 26 cases showed union at 3 months, 13 cases showed union at 4 months, and 1 case showed union at 5 months duration. Results: Functional results were assessed in the 40 cases available for follow-up. Excellent results were noted in 10 cases, good in 27 cases, fair in 3 cases, and none had poor result. Anatomical results were assessed by presence or absence of shortening and range of movements. 37 cases had good results and 3 had poor result. Conclusion: At present, we consider that the TFN is a good minimally invasive implant for unstable intertrochanteric fracture when closed reduction is possible. Technical and mechanical complications were mostly related to the operative technique and the type of fracture and pre-operative reduction of the fracture. Keywords: Shortening, trochanteric fixation nail, unstable intertrochanteric fractures.

Trochanteric fixation nail in inter trochanteric fractures of femur in adult population

Introduction: Intertrochanteric fractures in the elderly are common fractures with high morbidity and mortality. Moreover, its surgical stabilization with early rehabilitation remains a persistent challenge. These patients have poor bone quality and conventional osteosynthetic procedures frequently lead to nonunion and metal failure. The primary goals of treatment are stable fixation and early rehabilitation. The aim of this study was to evaluate the functional outcome, complications of intertrochanteric fractures treated with trochanteric fixation nail (TFN). Materials and Methods: This retrospective study was conducted on the total of 50 patients with fracture intertrochanteric femur and treated with TFN from July 2011 to August 2016. The patients evaluated at 6 months, 1–4 years postoperatively and assessed using the Modified Harris hip score. Results: The mean age of patients was 59.78 ± 16.58 years. There were 37 males and 13 females. The mean duration of surgery was 40.40 ± 20.86 min. The mean union time was 2.20 ± 0.50 months. One (2%) patient developed deep venous thrombosis, whereas 1 (2%) patient had back out of stabilizing screw and 1 (2%) patient had implant failure. The Harris hip score at 1-year and 4-year follow-up was 92.12 and 97.92, respectively, which is slightly better than scores from other implants used for similar fracture. Conclusion: For intertrochanteric fracture fixation, trochanteric femur nail offers good functional outcome with early ambulation and weight bearing with a high rate of union and minimal complications.

Outcomes and Complications of Intertrochanteric Fractures Treated with Trochanteric Fixation Nail: A Study of 138 Patients

Outcomes and Complications of Intertrochanteric Fractures Treated with Trochanteric Fixation Nail: A Study of 138 Patients

Comparison between Functional Outcome of Intertrochanteric Fractures treated with Trochanteric Fixation Nail versus short Proximal Femoral Nail

Introduction: Intertrochanteric fractures are one of the most common fractures of the hip and have been recognized since the time of Hippocrates. The incidence of intertrochanteric fracture is rising because of increasing number of senior citizens with osteoporosis and also the increasing number of road traffic accidents. For stable intertrochanteric fractures dynamic hip screw was accepted as the gold standard. For unstable fractures intramedullary has been preferred recently. In this study we look to compare two types of intramedullary nails for unstable intertrochanteric fracture. Aim of the StudyTo compare the functional outcome of Intertrochanteric fractures treated with Trochanteric fixation nail versus Short proximal femoral nail. Materials & MethodsA prospective study done at the Department of Orthopaedics, Rajah Muthiah Medical College & Hospital, Annamalai University, Chidambaram. Patient with Intertrochanteric fractures were treated with TFN and short PFN. Follow up was done at regular intervals for a period of 18 months. Results & ConclusionDuring the period of study, fifty patients with unstable Intertrochanteric fracture were admitted. Out of which 30 patients were treated with TFN and 20 patients were treated with short PFN. Average age of patients was 65.07 years for patients treated with TFN and 68.50 years for patients treated with PFN.Overall mean time of radiological fracture union was 15 weeks (range 13-18). Mean hospital stay was 13 days (range 12 to 18 days).Average Modified Harris Hip Score was 88.25 for patients treated with TFN and 89.25 for patients treated with PFN. In our study, Patients with Unstable intertrochanteric fracture treated with TFN & PFN had results that were comparable with each other but the difference was that when the fracture was extending below lesser trochanter trochanteric fixation nail could not be used.

The Utility of the Tip-Apex Distance in Predicting Axial Migration and Cutout With the Trochanteric Fixation Nail System Helical Blade: Erratum.

The Utility of the Tip-Apex Distance in Predicting Axial Migration and Cutout With the Trochanteric Fixation Nail System Helical Blade: Erratum.

The Utility of the Tip–Apex Distance in Predicting Axial Migration and Cutout With the Trochanteric Fixation Nail System Helical Blade

Objectives: To determine whether a tip–apex distance (TAD) <20 mm is associated with a higher rate of axial migration and perforation with the Trochanteric Fixation Nail (TFN) System helical blade implant. Design: Retrospective. Setting: Level I Trauma Center. Participants: Four hundred forty-three patients surgically treated for proximal femur fractures were identified through a query of Current Procedural Terminology code 27245 from January 2009 to February 2013. A total of 258 patients treated with the TFN helical blade system were included in the study. Main Outcome Measured: The association of axial migration and perforation with the measured TAD. Results: The overall rate of mechanical complications was 10.1%. The average TAD was 20.4 mm. Axial perforation occurred in 8 patients (3.4%). Axial migration up to subchondral bone without perforation occurred in 3 patients (1.1%). Only 1 fracture failed in varus (0.38%). There was a significant difference in the rates of combined axial migration and perforation with a TAD <20 mm (P = 0.03). Logistic regression model demonstrated increased odds for combined axial cutout and migration with TAD less than 20 (odds ratio = 1.15, P = 0.01). Conclusions: A TAD <20 mm was associated with an increased frequency of axial migration and cutout with the TFN helical blade. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

The Utility of the Tip–Apex Distance in Predicting Axial Migration and Cutout With the Trochanteric Fixation Nail System Helical Blade

To determine whether a tip-apex distance (TAD) <20 mm is associated with a higher rate of axial migration and perforation with the Trochanteric Fixation Nail (TFN) System helical blade implant. Retrospective. Level I Trauma Center. Four hundred forty-three patients surgically treated for proximal femur fractures were identified through a query of Current Procedural Terminology code 27245 from January 2009 to February 2013. A total of 258 patients treated with the TFN helical blade system were included in the study. The association of axial migration and perforation with the measured TAD. The overall rate of mechanical complications was 10.1%. The average TAD was 20.4 mm. Axial perforation occurred in 8 patients (3.4%). Axial migration up to subchondral bone without perforation occurred in 3 patients (1.1%). Only 1 fracture failed in varus (0.38%). There was a significant difference in the rates of combined axial migration and perforation with a TAD <20 mm (P = 0.03). Logistic regression model demonstrated increased odds for combined axial cutout and migration with TAD less than 20 (odds ratio = 1.15, P = 0.01). A TAD <20 mm was associated with an increased frequency of axial migration and cutout with the TFN helical blade. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.