Interim Results of a Multicentre Cohort Using a Fenestrated Spiral Blade Cephalomedullary Device with or without Cementation

Abstract

Introduction: Newer-generation proximal femoral nail allows cement augmentation to enhance bone anchorage. Our study investigated whether cement augmentation in the TFN-Advanced Proximal Femoral Nailing System (TFNA) reduces the rate of cut-out/cut-through and excessive blade sliding. Methods: This was a multicentre retrospective cohort study conducted between September 2015 and March 2019. Inclusion criteria were pertrochanteric fracture (AO/OTA classification type 31 A1, A2, A3), age ≥50 years, low energy trauma, and treated with TFNA. Primary outcomes were the rates of implant cut-out, cut-through, and mortality. Secondary outcome was the degree of fracture collapse represented by blade sliding on X-ray. Confounding factors such as patient demographics, fracture characteristics, fracture reduction quality, and fixation quality were accounted for. Results: In all, 75 patients met the inclusion criteria, with 41 patients in the cement augmented (CA) group and 34 patients in the non-cement augmented (NCA) group. There was no statistically significant difference between the two groups in patient demographics, fracture characteristics, and reduction quality. There were more posteriorly positioned blades in the NCA group (20.6% vs 4.9%; p=0.039). There was a lower rate of cut-out or cut-through (11.8% vs 0%; p=0.026) and less fracture collapse in the CA group (3.6 mm vs 2.0 mm; p=0.029). Conclusion: There was a lower rate of cut-out or cut-through and less fracture collapse in the CA group.