The new trochanteric nail TFN-A has a higher complication rate in the treatment of proximal femoral fractures than the predecessor model PFN-A

AIMS: Trochanteric fractures (TF) are among the most frequent fractures and have major impact on the affected patients and the healthcare system. Cephalomedullary nails (CMN) are widely used for these fractures. Complications remain frequent, either due to comorbidities or concerning the implant. The goal of this retrospective, single-centre study was to compare the complication rates of two CMN from one manufacturer. MATERIALS AND METHODS: All internal fixations TF performed between 01/2017 and 07/2021 in our institution were analysed retrospectively. Follow-up was at least two years. The CMN were the PFN-A or the TFN-A. Demographic data, all reoperations and revisions were recorded. Reoperations and revisions were estimated using the Kaplan-Meier method, with subgrouping as minor reoperation, minor revision or major revision, including conversion to total hip arthroplasty. RESULTS: A total of 492 CMN, used in 475 patients, could be included. Among these, 248 were PFN-A and 244 were TFN-A. The overall reoperation rate was 15%, 12.9% for the PFN-A and 17.2% for the TFN-A, respectively. The TFN-A group had significantly more major revisions (hazard ratio 3.57 (95% confidence interval 1.42-9.94; p = 0.004). No relevant differences were found regarding demographic data or the quality of reduction and internal fixation. DISCUSSION: The TFN-A had a significantly higher rate of complications leading to major revision than the former PFN-A. This may have been missed when considering only the reoperation rate for all causes due to a camouflage effect by minor complications.