Related Experiment Video
Updated: May 10, 2026
Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
[Trochanteric fixation nail advanced for trochanteric femoral fractures : Central cut-out as a new problem?]
Franz Müller1, Bernd Füchtmeier2, Alexander Hanke2
1Klinik für Unfallchirurgie, Orthopädie und Sportmedizin, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Deutschland. dr.med.franz.mueller@gmail.com.
Introduction:
Trochanteric femoral fractures (TF) are mostly treated with intramedullary nail osteosynthesis. An inherent but rare complication of the system is the central cut-out of the femoral neck helical blade, i.e., the dislocation through the femoral head towards the acetabulum. After switching from proximal femoral nail antirotation (PFNA) to the trochanteric fixation nail advanced (TFNA) by the manufacturer, this rare type of complication has repeatedly been observed.
Material And Method:
The retrospective single center case-control study was based on a database which includes all TFs. Inclusion criteria were TF treated by short PFNA or short TFNA. Exclusion criteria were femoral neck fractures and subtrochanteric femoral fractures. Descriptive and multiple perioperative factors were evaluated for both groups. The primary endpoint was the detection of a central cut-out. Secondary endpoints were any revision, including cranial cut-out failure, infections and the 30-day mortality.
Results:
A total of 400 TFs were consecutively treated with short PFNA between 25 July 2020 and 13 December 2023. From 14 December 2023 until 23 September 2025 a total of 200 TF were stabilized with a short TFNA. Perioperative factors were balanced between the two groups. A total of 3/400 (0.8%) central cut-outs were documented for PFNA. For TFNA, the rate of central cut-outs was 8/200 (4.0%). This difference was statistically different (p = 0.008). The total revision rate, including infections and the 30-day mortality were comparable. In terms of time, central cut-out occurred significantly earlier in TFNA in comparison to PFNA (mean; 64 vs. 135 days).
Conclusion:
The treatment of TF demonstrated no superiority for TFNA in comparison to PFNA with respect to infection rates and total revision rate. However, the rate of central cut-out was significantly higher for the TFNA. The rare complication with PFNA should be recorded for TFNA in a geriatric trauma registry or reported to the manufacturer. The reason for the central cut-out is still unclear.
