Hip fractures often require surgical intervention with an internal fixation device to restore stability and allow for successful healing. These injuries, affecting the upper part of the femur (thigh bone), are common orthopedic traumas, especially in older patients. Trochanteric Fixation Nail (TFN) surgery is a modern and highly effective approach to managing these injuries. The TFN is a specialized metal rod, also known as a cephalomedullary nail, used to stabilize broken bone fragments from the inside. This procedure provides immediate structural support to the hip area, which bears the body’s weight.
Fractures Treated by TFN Surgery
The Trochanteric Fixation Nail is designed to address fractures in the proximal femur, the region closest to the hip joint. These injuries typically result from low-energy falls in patients with weakened bone structure, such as osteoporosis, but high-impact trauma can also cause them. The TFN is particularly suited for unstable fractures where bone fragments are displaced or severely fragmented, making traditional fixation methods less reliable.
Two primary types of fractures benefit from TFN stabilization: intertrochanteric and subtrochanteric fractures. Intertrochanteric fractures occur between the greater and lesser trochanters, the large bony prominences on the upper femur. Subtrochanteric fractures occur just below the lesser trochanter, extending down the shaft.
These fracture locations are subject to immense biomechanical stress during walking and standing. The TFN provides a biomechanical advantage over older plate-and-screw systems by operating within the bone’s central canal. This allows the device and the bone to share the load, promoting earlier mobilization and reducing the risk of fixation failure in these weight-bearing areas.
How the Trochanteric Fixation Nail Works
The TFN is an intramedullary nail, inserted directly into the medullary canal, the hollow center of the femur. This method provides stability by splinting the bone from the inside, offering a mechanical advantage over implants placed externally. The nail is a hollow, cannulated rod that comes in various lengths and diameters.
The main part of the nail stabilizes the long shaft, while the top accepts specialized hardware to anchor the fracture fragments. This anchoring is achieved through the insertion of a cephalomedullary component, such as a lag screw or a helical blade. This component is driven through the nail into the head and neck of the femur, grasping the dense trabecular bone near the joint surface.
A set screw or locking mechanism prevents the main screw or blade from backing out or rotating, ensuring secure fixation. The TFN’s design allows for controlled collapse or “sliding” of the component, which compresses the fracture fragments together as the patient bears weight. This dynamic compression encourages the bone fragments to heal and consolidate, leading to a robust final repair.
The Surgical Process
The TFN procedure is performed under general or regional anesthesia, such as a spinal block. The patient is positioned on a specialized fracture table that uses gentle traction and manipulation to align the broken bone fragments, a process known as reduction. Achieving the best possible alignment before inserting the implant is a primary goal for a successful long-term outcome.
The surgery is considered minimally invasive compared to older, more open techniques, utilizing small incisions for hardware insertion. A small incision is made at the hip, above the greater trochanter, to establish the entry point for the nail. The surgeon uses a guide wire and then reams, or slightly widens, the medullary canal to accommodate the TFN.
The nail is inserted down the femur’s canal under precise guidance using fluoroscopy, a real-time X-ray imaging system. Once positioned, the lag screw or helical blade is inserted through the nail, across the fracture site, and securely into the femoral head. Distal locking screws are sometimes placed at the lower end of the nail to prevent rotation of the construct. Fluoroscopy confirms the accurate placement and position of the implant, ensuring optimal stability for healing.
Recovery and Rehabilitation Timeline
Recovery begins immediately after the operation, and the patient is typically monitored in the hospital for a few days. The stable internal fixation allows for early mobilization, with the goal of getting the patient out of bed shortly after the procedure. Early movement is important for preventing complications like blood clots and pneumonia, especially in elderly patients.
Physical therapy is a fundamental component of recovery, often beginning on the first or second day post-surgery. The initial focus is on performing range-of-motion exercises and safely transferring from the bed to a chair. Effective pain management during the hospital stay allows the patient to participate in these activities comfortably.
The timeline for weight-bearing progression is determined by the surgeon based on the fracture pattern, bone quality, and surgical stability. Some patients may be cleared for immediate weight-bearing as tolerated. Others may be restricted to “touch-down” weight-bearing, which means only placing the foot on the ground for balance. Full functional recovery, including regaining the ability to walk without assistance, typically takes between three to six months.