TFN with Screw
The trochanteric fixation nail (TFN) is intended for the treatment of stable and unstable pertrochanteric, intertrochanteric, basal neck fractures, and combinations thereof. The long TFN is additionally indicated for subtrochanteric fractures, pertrochanteric fractures associated with shaft fractures, pathological fractures of osteoporotic bone (including prophylactic use) in both trochanteric and diaphyseal regions, long subtrochanteric fractures, proximal or distal nonunions, malunions, and revisions.
The TFN has been available with a spiral blade only, but will be offered with a screw as an optional femoral head element for those surgeons who are concerned about distraction of the fracture while impacting the TFN blade. This occurs very rarely in patients with dense, healthy bones.
AO has favored in the past, and will continue to favor, the spiral blade, since biomechanical research has demonstrated the advantages of the spiral blade compared to a screw, which includes preventing cutout and providing rotational stability.
The screw is self-tapping and will be available in a diameter of 11.0 mm in lengths of 70130 mm. Two flats allow an adjustability of 180. A slot aids control of rotation and the amount of screw travel.
Using the TFN with a screw instead of a blade requires these additional instruments: inserter/extractor, compression nut, and tap/reamer.
Case provided by Cliff Turen, Macon, USA
The patient was involved in a road traffic accident.
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