ABSTRACT
BACKGROUND: Prior reports of the DePuy Synthes Trochanteric Fixation Nail Advanced (TFNA) revealed a potential mode of fatigue failure at the proximal screw aperture following fixation of extracapsular hip fractures. We sought to compare the revision risk between the TFNA and its prior-generation forebear, the Trochanteric Fixation Nail (TFN). METHODS: A retrospective cohort study was performed using data from a U.S. integrated health-care system's hip fracture registry. The study sample comprised patients who underwent cephalomedullary nail fixation for hip fracture with a TFN (n = 4,007) or TFNA (n = 3,972) from 2014 to 2019. We evaluated the charts and radiographs for patients who underwent any revision. Multivariable Cox regression was used to evaluate the risk of revision related to the index fracture. RESULTS: At the 3-year follow-up, the cumulative probability of revision related to the index fracture was 1.8% for the TFN and 1.9% for the TFNA. After adjustment for covariates, no difference was observed in revision risk (hazard ratio [HR], 1.18 [95% confidence interval (CI), 0.80 to 1.75]; p = 0.40) for the TFNA compared with the TFN. The TFNA was associated with a higher risk of revision for nonunion than the TFN (HR, 1.86 [95% CI, 1.11 to 3.12]; p = 0.018). At the 3-year follow-up, implant breakage was 0.06% for the TFN and 0.2% for the TFNA; with regard to aperture failures related to the index fracture, there were 1 failure for the TFN group and 3 failures for the TFNA group. CONCLUSIONS: In a large cohort from a U.S. hip fracture registry, the TFNA had an overall revision rate that was similar to that of the earlier TFN, with implant breakage being a rare revision reason for both groups. Chart and radiographic review found that the TFNA was associated with a higher risk of revision for nonunion. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Subject(s)
Fracture Fixation, Intramedullary , Hip Fractures , Bone Nails , Cohort Studies , Fracture Fixation, Intramedullary/adverse effects , Hip Fractures/surgery , Humans , Retrospective StudiesSubject(s)
Evidence-Based Medicine , Hip Fractures/surgery , Orthopedics , Practice Guidelines as Topic , Societies, Medical , Aged , Humans , United StatesABSTRACT
Hip fractures in elderly men present many significant challenges and are a leading cause of morbidity and mortality in this age group. A multidisciplinary team approach before surgical intervention is the most efficient way to manage this patient group and achieve the best possible outcome while attempting to return patients to their previous level of function. Timely surgical intervention allows the patient's early mobilization and decreases the risk of potential complications in the postoperative period. Patient education and close follow-up are necessary to ensure compliance with the rehabilitation protocol as well as the prevention of future fractures.
Subject(s)
Accidental Falls/prevention & control , Arthroplasty, Replacement, Hip , Bone Screws , Fracture Fixation, Internal , Hip Fractures/surgery , Age Factors , Aged , Aged, 80 and over , Frail Elderly , Hip Fractures/classification , Hip Fractures/epidemiology , Hip Fractures/rehabilitation , Humans , Incidence , Male , Morbidity , Pain Measurement , Postoperative Complications , Risk Factors , Treatment OutcomeABSTRACT
Hip fractures in the elderly are usually caused by low-energy trauma, such as a fall from standing. These fractures involve the femoral neck or the intertrochanteric region of the proximal femur. Timely surgical intervention provides superior outcomes. Newer fracture fixation implants and improved design of prosthetic replacements have contributed to progress in the management of these fractures. However, post-fracture osteoporosis evaluation by the primary care physician is equally important.