title: What is the optimal salvage procedure for cut-out after surgical fixation of trochanteric fractures with the PFNA or TFN?: A multicentre study.
abstract: OBJECTIVE
  To evaluate the outcome after different types of revision operations for blade 'cut-out' and 'cut-through' after fixation of trochanteric fractures with proximal femoral nail antirotation (PFNA) or a trochanter fixation nail (TFN).
  
  
  METHODS
  Twenty hospitals participated in this multicentre study. A total of 4109 patients were retrospectively screened for cut-out or cut-through complications after nailing of trochanteric fractures using PFNA or TFN. Fifty-seven patients (28 with 'cut-through' and 29 with 'cut-out') were included in the study. In the 'cut-through' group, 16 patients underwent a blade exchange, six patients had a blade exchange with bone cement augmentation, and six received total hip arthroplasty (THA). In the 'cut-out' group, three patients had a blade exchange, one had a blade exchange with augmentation, three underwent re-nailing of the fracture with a new PFNA, one had a girdlestone procedure and 21 had THA procedures.
  
  
  RESULTS
  In the 'cut-through' group, eight patients who had a blade exchanges (50%) and two patients with blade exchange and augmentation (33%) required further revision operations. THA was the definite treatment in all 6 cases. In the 'cut-out' group, two patients (66%) who had blade exchanges and two (66%) who underwent re-nailing required additional revision operations during the subsequent course. One patient (4%) who had total hip arthroplasty needed revision surgery for acetabular replacement. Overall, a total of 81 revision procedures were performed.
  
  
  CONCLUSIONS
  Based on the data from this study, we recommend THA as the only valid salvage procedure for 'cut-out' and 'cut-through' of helical blades after fixation of trochanteric fractures with the PFNA and TFN.
authors.affiliation: Medical University Innsbruck, Department of Trauma Surgery, Anichstrasse 35, 6020 Innsbruck, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Brunner
authors.affiliation: DePuy Synthes, Luzernstrasse 21, 4528 Zuchwil, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Büttler
authors.affiliation: Clinic Forchheim, Trauma Surgery Department, Krankenhausstraße 10, 91301 Forchheim, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Lehmann
authors.affiliation: Davos Hospital, Department of Trauma and Orthopaedic Surgery, Promenade 4, 7270 Davos Platz, Switzerland.
authors.forename: Hans Curd
authors.initials: HC
authors.lastname: Frei
authors.affiliation: Lachen Hospital, Department of Trauma Surgery, Oberdorfstrasse 41, 8853 Lachen, Switzerland.
authors.forename: Renato
authors.initials: R
authors.lastname: Kratter
authors.affiliation: Männedorf Hospital, Asylstrasse 10, 8708 Männedorf, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Di Lazzaro
authors.affiliation: Ulm University, Department of Orthopaedic Trauma, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Scola
authors.affiliation: University Hospitals Gasthuisberg, Department of Traumatology, Herestraat 49, 3000 Leuven, Belgium.
authors.forename: An
authors.initials: A
authors.lastname: Sermon
authors.affiliation: Medical University Innsbruck, Department of Trauma Surgery, Anichstrasse 35, 6020 Innsbruck, Austria. Electronic address: rene.attal@tirol-kliniken.at.
authors.forename: Rene
authors.initials: R
authors.lastname: Attal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation; D006620:Hip Fractures / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D010027:Osteotomy; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D017410:Practice Guidelines as Topic; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016879:Salvage Therapy
keywords: Cut-out; Cut-through; PFNA; Revision; TFN