1. Best PFNA/TFN-specific salvage study
   Brunner et al. (2016), What is the optimal salvage procedure for cut-out after surgical fixation of trochanteric fractures with the PFNA or TFN? A multicentre study. Injury. PMID: 26748415.
   Retrospective multicentre study of 57 blade failures. It reported high re-revision rates after blade exchange or re-nailing, whereas THA was definitive in their series. The authors recommend THA as the reliable salvage procedure for both classical cut-out and cut-through. Read the PubMed abstract.
2. Broad, practical review of failed intertrochanteric fixation
   Liu et al. (2020), Revision surgery due to failed internal fixation of intertrochanteric femoral fracture: current state-of-the-art. BMC Musculoskeletal Disorders. PMID: 32828132.
   Useful decision framework: evaluate physiologic age, preinjury function, life expectancy, fracture/nonunion pattern, remaining bone stock, bone quality, and hip-joint damage. It generally supports head-preserving revision fixation for selected younger patients and conversion arthroplasty for frail elderly patients or when early mobilization is needed. Open-access full review.
3. Blade exchange + cement augmentation, with femoral-head cement plug
   Hanke et al. (2020), Revision of a blade cut-out in PFN-A fixation: Blade exchange, cement augmentation and a cement plug as a successful salvage option. Trauma Case Reports. PMID: 32322652.
   A technical case report relevant when the patient is not a good arthroplasty candidate, the hip joint is reasonably preserved, and a less invasive salvage is sought. It describes closing the blade tract with a cement plug to reduce risk of intra-articular cement leakage before blade exchange and augmentation. Open-access full article.
4. PFNA augmentation in revision surgery
   Scola et al. (2014), The PFNA Augmented in Revision Surgery of Proximal Femur Fractures. Open Orthopaedics Journal. PMID: 25136390.
   Small series of 10 revision cases using an augmented PFNA blade. It supports cement augmentation as a potential joint-preserving option where there is impaired proximal bone stock, but it emphasizes that cut-out/cut-through with joint destruction is a contraindication to this approach. Open-access full article.
5. Revision fixation and bone grafting for selected patients
   Haidukewych and Berry (2003), Salvage of failed internal fixation of intertrochanteric hip fractures. Clinical Orthopaedics and Related Research. PMID: 12838070.
   In selected patients with failed fixation/nonunion, revision ORIF plus grafting achieved union in 19/20 cases. Although not blade-specific and older, it is useful when planning head-preserving reconstruction in younger or physiologically fit patients. See the PubMed abstract.
6. InterTAN revision after PFNA blade cut-through
   Zhang et al. (2023), Successful Revision with INTERTAN for a Blade Cut Through in PFNA Fixation: A Case Report. Orthopaedic Surgery. PMID: 36710303.
   Case report of nail exchange to INTERTAN with preservation of the native femoral head after blade cut-through. It is useful as a technical precedent but should not outweigh the multicentre data favoring arthroplasty in many elderly patients. Open-access full article.

Practical interpretation from this literature

• Classical cut-out: superior/anterior blade escape with varus collapse and loss of reduction. In older, low-demand patients or where cartilage/acetabulum is damaged, conversion THA or hemiarthroplasty is usually the more dependable salvage route.
• Cut-through: medial blade penetration into the femoral head or joint, sometimes with reduction maintained. If there is no major acetabular damage, fracture is still potentially salvageable, and the patient is unsuitable for arthroplasty, selected options include blade exchange with cement augmentation or revision fixation. Evidence for these is mainly small series/case reports.
• Before choosing revision fixation, assess infection, union status, reduction/varus, femoral-head and acetabular destruction, blade track/bone loss, proximal femoral bone stock, and patient fitness. In one revision-fixation series, catastrophic proximal femoral failure, substantial acetabular erosion, or suspected infection directed patients toward arthroplasty rather than cement-augmented revision.