The Utility of the Tip–Apex Distance in Predicting Axial Migration and Cutout With the Trochanteric Fixation Nail System Helical Blade. Issue 6 (June 2016)

• Record Type: Journal Article
• Authors: Flores, Stephen A.; Woolridge, Adam; Caroom, Cyrus; Jenkins, Mark
• Is Part Of: Journal of orthopaedic trauma. Volume 30:Issue 6(2016)
• Publication Date: 2016-06
• Subjects: tip–apex distance -- TAD -- intertrochanteric femur fracture -- hip fracture -- axial migration -- axial cutout -- mechanical failure -- complications -- TFN -- Trochanteric fixation nail -- cutout -- cut out -- cutout -- helical blade -- medial migration -- medial cutout; Orthopedics -- Periodicals; Wounds and injuries -- Periodicals; Orthopedics -- Periodicals; Wounds and Injuries -- therapy -- Periodicals; Periodicals; 617.47044
• DOI: 10.1097/BOT.0000000000000505
• Languages: English
• ISSNs: 0890-5339

Abstract

Abstract : Objectives: To determine whether a tip–apex distance (TAD) <20 mm is associated with a higher rate of axial migration and perforation with the Trochanteric Fixation Nail (TFN) System helical blade implant. Design: Retrospective. Setting: Level I Trauma Center. Participants: Four hundred forty-three patients surgically treated for proximal femur fractures were identified through a query of Current Procedural Terminology code 27245 from January 2009 to February 2013. A total of 258 patients treated with the TFN helical blade system were included in the study. Main Outcome Measured: The association of axial migration and perforation with the measured TAD. Results: The overall rate of mechanical complications was 10.1%. The average TAD was 20.4 mm. Axial perforation occurred in 8 patients (3.4%). Axial migration up to subchondral bone without perforation occurred in 3 patients (1.1%). Only 1 fracture failed in varus (0.38%). There was a significant difference in the rates of combined axial migration and perforation with a TAD <20 mm ( P = 0.03). Logistic regression model demonstrated increased odds for combined axial cutout and migration with TAD less than 20 (odds ratio = 1.15, P = 0.01). Conclusions: A TAD <20 mm was associated with an increased frequency of axial migration and cutout with the TFN helical blade. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.