PFNA vs TFNA osteosynthesis in neck of femur fractures: Comparison of Helical blade proximal fixation failure

Title : PFNA vs TFNA osteosynthesis in neck of femur fractures: Comparison of Helical blade proximal fixation failure

Abstract:

Background: The Trochanteric Fixation Failure- Advanced (TFNA) was introduced into Arrowe Park Hospital in 24/11/2021 following replacement of the Proximal femoral nail antirotation (PFNA) system. The TFNA system was upgraded with improvements in the nail and helical blade design. The aim of our study was to assess the failure rates between helical blade fixation in PFNA and TFNA systems.

Methods: A retrospective study reviewed patients who underwent intramedullary nail fixation with PFNA and TFNA systems for intertrochanteric and subtrochanteric neck of femur fractures between January 2019 - February 2024. Exclusion criteria: Tumour prophylactic fixation, pathological fracture, atypical bisphosphonate fractures, short nails, proximal femur/shaft fractures, revision surgery. The primary outcome measure was proximal fixation failure defined as non-union, implant fracture, blade cut out, blade back out, blade head penetration, severe collapse >20mm. Radiographs were reviewed by two senior orthopaedic registrars to define failure and tip apex distance (TAD) was measured. Radiographs were reviewed after a minimum 6month post-operative period. Chi-squared test performed for statistical analysis using SPSS.

Results: A total of 515 IM nail fixation were performed during study period (PFNA 279, TFNA 236). No differences in demographics were observed. The failure rate was 6.8% for PFNA and 5.5% for TFNA, no statistical difference was observed (p=0.53). There was no difference in TAD between groups. Most failures were observed in 31A3 and subtrochanteric fractures. Reoperation rates were highest for blade back out in the PFNA group (3/4) and blade cut out in the TFNA group (2/4).

Conclusion: Proximal fixation using helical blade in IM Nailing for neck of femur fractures is a stable construct in the upgraded TFNA system. Failure rates were found to be similar to nailing systems using lag screw fixation.

Biography:

Mathew Farrugia studied for a Doctor of Medicine and Surgery, MD at the University of Malta and graduated in 2016. While completing his foundation programme in Scotland, he undertook a Masters in Surgical Sciences at the University of Edinburgh which he graduated in 2019. He was then appointed into a core surgical training programme in Liverpool during which he worked to pursue a career in Trauma and Orthopaedics. After this he was successfully appointed as a Specialty Training in Trauma and Orthopaedics and is currently completing his training in the North-West, Mersey deanery.