Use of the trochanteric fixation nail advanced (TFNA) may increase the risk for nail breakage and early breakage time compared to other frequently used implants

Abstract

Background: Cephalomedullary nails (CMN) are widely used for fixation of unstable pertrochanteric fractures. In 2018, the Depuy Synthes Trochanteric Fixation Nail - Advanced (TFNA) implant was introduced at a level I academic trauma center. Subsequently, clinical concerns were raised about the use of the TFNA due to reports of nail breakage. The purpose of this study was to investigate the risk of nail breakage between TFNA and other nail models. Long term outcomes following nail failure were evaluated. Methods: A retrospective cohort study was conducted using data of 1665 patients who had undergone a CMN procedure between 2014 and 2020. Data were handpicked from patient records. The nail breakage and breakage time of the TFNA were compared to the TFN, PFNA, Gamma3, and Intertan using cox regression analysis and logistic regression analysis. Long term outcomes were evaluated by assessing Oxford Hip Scores (OHS). Results: The number of cephalomedullary nails were as follows: TFNA 754 (45.3 %), Gamma3 462 (27.7 %), PFNA 234 (14.1 %), TFN 211 (12.7 %), and Intertan 4 (0.2 %). A total of 21 (1.3 %) nails broke during the follow-up period. The TFNA broke the most often with 15 cases (2.0 %), followed by the Gamma3 with five cases (1.1 %) and the PFNA with one case (0.4 %). Overall, the mean (SD) nail breakage time was 222 (148) days. However, for the TFNA, Gamma3 and PFNA, the mean breakage times were 177 days (110), 292 (153) and 545, respectively. In logistic regression analysis we observed significant difference between TFNA and non-TFNA group. The odds ratio (OR) for nail breakage in TFNA group was 2.66 [95 % Ci, 1.01–6.99, p = 0.047]. The mean (SD) one year OHS for Total Hip Arthroplasty after nail breakage and overall OHS for re-osteosynthesis was 38.6 (9.8) and 36.3 (7.8), respectively. Conclusions: Our study provides evidence suggesting that the TFNA may be associated with an increased risk of nail breakage compared to other nail models. It should be noted that implant breakage is a relatively infrequent complication. Long-term outcomes following secondary procedures were comparable between THA and re-osteosynthesis.