Treatment of Incompletely Displaced Femoral Neck Fractures Using Trochanteric Fixation Nail-Advanced(TFNA) in Patients over 50 years of Age.

Abstract

Objectives: To analyze the outcomes of patients with femoral neck fractures aged 50 years or older treated with Trochanteric Fixation Nail-Advanced (TFNA; DePuy Synthes, Paoli, PA) to determine the stability of fracture fixation and the effectiveness of the treatment.

Methods: Design: Retrospective cohort study.

Setting: Single level I trauma center.

Patient selection criteria: Patients aged 50 years or older who underwent fixation with TFNA helical blade for femoral neck fractures (OTA/AO 31-B) and were followed for more than 1 year were included.

Outcome measures and comparisons: Radiological examinations were evaluated to determine bone union, femoral neck shortening, development of avascular necrosis (AVN) of the femoral head, and breakage of metal fixation. A comparison was made between patients with femoral neck shortening (>5 mm) and those without (<5 mm).

Results: A total of 45 patients were included in this study. The mean age of the patients was 70.2 (50-89) years, and 68.9% were females. No early postoperative complications, such as postoperative infection, deep vein thrombosis, or pulmonary embolism, were observed. All patients achieved bone union within 23 weeks. The average femoral neck shortening was 2.6 mm (0-16.8), with femoral neck shortening >5 mm observed in 7 patients (15.6%). Significant femoral neck shortening was observed in patients with displaced fractures compared to non-displaced fractures (p=0.006). One patient developed AVN of the femoral head. No metal fixation failure was observed.

Conclusions: In patients aged 50 years or older, TFNA fixation for non-displaced femoral neck fractures demonstrated relatively minimal femoral neck shortening and a low complication rate, indicating that it is an effective technique for treating these fractures. However, for displaced fractures, surgeons should be mindful of the potential for excessive neck shortening and carefully select the surgical method.

Level of evidence: Therapeutic Level III.