Outcomes of pertrochanteric femoral fracture fixation with the Trochanteric Femoral Nail-Advanced with and without cement augmentation: a comparative study

Abstract Introduction: Cephalomedullary devices are used for surgical fixation of pertrochanteric femoral fractures. The Trochanteric Fixation Nail-Advanced (TFN-A) system is designed with the fenestrated spiral blade/screw for cement augmentation to reduce the risks of cut-out and fixation failure. This comparative study aimed to compare the outcomes of pertrochanteric femoral fracture fixation with TFN-A with and without cement augmentation. Methods: A retrospective study of patients who sustained pertrochanteric femoral fractures from low-energy trauma and underwent surgical fixation using TFN-A from January 2018 to August 2021 was conducted. The patients were categorised into cement augmentation (CA) and non-cement augmentation (NCA) groups. Baseline demographics, ambulatory status, fracture classification, and reduction and fixation quality were noted. Primary outcomes analysed included rates of fixation failure and revision surgery. Results: A total of 194 patients (39 cemented and 155 non-cemented) were included. The mean age was 78.6 years, and patients were predominantly female (63.9%). Fracture reduction quality (good; CA 25.6% vs. NCA 59.4%, P < 0.001) and the calcar-referenced tip–apex distance (CA 25.2° ± 5.16° vs. NCA 23.3° ± 5.41°, P = 0.048) were significantly better in the NCA group. However, the fixation failure rate was higher in the NCA group (three cut-outs, one implant breakage and two loss of reduction) compared to the CA group, which had no failure. No cement-related complications were observed in the CA group. Conclusion: The TFN-A with cement augmentation had a lower rate of fixation failures, despite having poorer reduction quality compared to the NCA group, with minimal adverse effects. These results justify its use, especially in patients with higher risk of fixation failure.