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Proximal femoral nail anti-rotation versus cementless bipolar hemiarthroplasty for unstable femoral intertrochanteric fracture in the elderly: a retrospective study BMC Musculoskelet Disord. Proximal Femoral Nail Antirotation Technique Guide DePuySynthes 11. 321 ... Use of three- flanged nail 22. Methods: From June 2006 to December 2013, 139 cases (35 women, 104 men; mean age 48.8, range, 18−86 years) of long-segment femoral fracture in middle-up part were treated with long proximal femoral nail antirotation (PFNA, 320–380 mm) by minimally invasive percutaneous fixation and autogenous iliac bone graft. The mediolateral angle of the implant amounts to 6º. Shares. entitled “Long proximal femoral nail in ipsilateral fractures of proximal femur and shaft of femur”. Operative times can be reduced significantly when using the F1 Hip Nail. Immobilization from casts may not be enough to completely heal the fracture if a malunion (when both ends of the fractured bone misalign) occurs and/or if a non-union (when the fracture gap is too large and the fractured ends cannot re-attach to one another) occurs. Table 3:Long Vs Short PFN. BY ALEX BERTINO, COREY VAN DE HAY, ANDREW HNAT According to Sharma and Mahajan, PFNA has a superior performance over PFN in the setting of osteoporosis, which is attributed to compaction of cancellous bone by the … Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Faculty of medicine – Al-Azhar university Proximal femoral nail [8-10]: Table 3. Looks like you’ve clipped this slide to already.  Due to its position close to the weight-bearing axis the stress generated on the intramedullary implants is negligible. Objective: To compare the effects of proximal femoral nail antirotation blade (PFNA) and reverse less invasive stabilization system‐distal femur (Liss‐DF) systems in the treatment of proximal femoral fractures. If you continue browsing the site, you agree to the use of cookies on this website. Proximal femoral fractures Evidence based approach Mohamed Abulsoud (M.D) Lecturer of orthopedic surgery Faculty of medicine – Al-Azhar university Cairo- Egypt 2. The long gamma nail allowed early weight bearing and was effective in 85% of cases. Objective: To evaluate and analyse the geometrical discrepancies between the proximal femur and two types of AO/Association for the Study of Internal Fixation (AO/ASIF) Proximal Femoral Nail Anterotation (PFNA/PFNA-II) using computed tomography (CT)-based analysis in Asian patients, and its implication in lateral cortical impingement during reduction intra-operatively in subtrochanteric fractures. If you continue browsing the site, you agree to the use of cookies on this website. Alternatives Determine the nail length by the procedure above on the uninjured leg before draping (unsterile) or compare the length of two identical SynReam reaming rods 2.5 mm (352.032) or use the depth gauge (351.717 and 351.719) in combination with the SynReam reaming rod 2.5 mm, length 950 mm (352.032). Finite Element LIDAR Analysis for Self Driving Cars, Customer Code: Creating a Company Customers Love, Be A Great Product Leader (Amplify, Oct 2019), Trillion Dollar Coach Book (Bill Campbell). APIdays Paris 2019 - Innovation @ scale, APIs as Digital Factories' New Machi... Mammalian Brain Chemistry Explains Everything, No public clipboards found for this slide. Make a 3-5 cm skin incision several centimeters proximal to the tip of the greater trochanter. A femoral nail with proximal cephalomedullary locking options is inserted. Bone fractures are a very common orthopedic injury resulting from trauma and sudden loads or stresses applied to bones or a result from bones being weakened by certain diseases. PFN was introduced by AO/ASIF in 1996 for treatment of trochanteric fractures. Proximal femoral fractures 1. Bone fractures are either a complete or partial break in a bone and in some cases a simple cast to immobilize the injury site is not enough to completely heal the fracture. 0 Number of Embeds. Operative technique: • Anaesthesia: All the patients were operated under either spinal anaesthesia or epidural anaesthesia. Preoperative planning , decision making , post op rehab, guidelines , evidence based approach. Available in both stainless Steel and Titanium. 2003 Jul;85(7):1295-301. doi: 10.2106/00004623-200307000-00016. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. 1 Proximal femoral nailing in such fractures is a challenging task even in the hands of experienced trauma surgeons. This image shows the first guide wire being inserted through the lateral cortex. Cairo- Egypt. More than 250,000 femur fracture patients are seen per year in the U.S. on average. METHODS: A retrospective study was performed on 58 patients with femoral intertrochanteric fractures treated with PFNA between January 2013 and January 2015. 4 DePuy Synthes TFN-ADVANCED® Proximal Femoral Nailing System (TFNA) Surgical Technique AO Principles 1 4 2 3 4_Priciples_03.pdf 1 05.07.12 12:08 4 DePuy Synthes Expert Lateral Femoral Nail Surgical Technique AO PRINCIPLES In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation1,2. The same proximal femoral nail anti-rotation devices and the same surgical procedures were applied to all patients. Compared to PFNA, whether PFNA-II is associated with shorter operative time and lower rates of complications is unknown. Do we need a proximal femoral nail ? Downloads. The exact location of the skin incision depends on the type of insertion handle / type of nail used. 1. PFN Nail (Proximal Femoral Nail) Long sizes: Distal diameter 9-12 mm, Angle 130° or 135°, Length from 320 to 420 mm. Once the nail is inserted to appropriate length, the femoral neck fracture must be reduced and held with guide wires.  limits the surgical insult to the … Now customize the name of a clipboard to store your clips. Sir, I have read the article with great interest by Gadegone et al. d) Acts as a buttress to prevent shaft medialisation . On SlideShare. The Asia proximal femoral nail antirotation (PFNA-II) was specifically designed for Asian patients, which could be more effective than the regular proximal femoral nail antirotation (PFNA). Postoperative radiographic union time and modified Harris hip scores were used as major indicators for evaluating the effectiveness of surgery. Now customize the name of a clipboard to store your clips. If you continue browsing the site, you agree to the use of cookies on this website. Proximal Femoral Nail available for both Left and Right. If you continue browsing the site, you agree to the use of cookies on this website. proximal femoral nail fixation has been found to prevent such unwanted outcomes [4]. Proximal Femoral Nail – Standard PFN and long PFN 12 1. 0. Lecturer of orthopedic surgery 2019 Oct 29;20(1):500. doi: 10.1186/s12891-019-2793-8. Position the C-arm for an AP view of the proximal femur. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. a) Provides more efficient load transfer. Objective: To compare the effects of proximal femoral nail antirotation blade (PFNA) and reverse less invasive stabilization system‐distal femur (Liss‐DF) systems in the treatment of proximal femoral fractures. Proximal Femoral The same proximal femoral nail anti‐rotation devices and the same surgical procedures were applied to all patients. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. 1. The neck shaft angle was measured in unaffected side in AP X ray using goniometer. Complex proximal femoral fractures are difficult to treat with all implants demonstrating high complication rates. Proximal femoral fractures Malpositioning of the implant should be avoided, as this was the leading cause of failure. Biomechanical cadaveric studies demonstrated that PFNA fixation using a helical blade was better compared to the sliding hip screw. OBJECTIVE: To compare the effectiveness of proximal femoral nail anti-rotation (PFNA) between in the supine "scissors" position and in the lithotomy position for treating femoral intertrochanteric fractures of old patients. Proximal Femoral Nail Antirotation Surgical Technique DePuy Synthes 11 2 Confirm nail length and diameter Instrument 309.602 Radiographic Ruler for PFNA The required nail length must be determined after reduction of the femoral fracture. Complete congruency minimizes normal forces and hence little frictional component to nail’s fixation. 1. See our User Agreement and Privacy Policy. It includes an Intramedullary nail through which two screws are inserted into the neck of femur. The proximal femoral nail antirotation (PFNA), designed by AO, is an intramedullary device with a helical blade rather than a screw for better purchase in the femoral head and was tested in a clinical study. Results. Postoperative radiographic union time and modified Harris hip scores were used as major indicators for evaluating the effectiveness of surgery. 9 Actions. Surgical TreatmentSurgical Treatment 23. In the case of a malunion or non-union, a possible solution to the problem is by surgically inserting an intramedullary rod into the center canal (diaphysial) region of the injured bone and fixating it into place with screws. Consecutive patients with unstable trochanteric fractures (AO-classification 31.A.2 and A.3 only) were included and followed for 1 year. Clipping is a handy way to collect important slides you want to go back to later. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. b) Shorter lever arm can decrease tensile strain on implant and risk of implant failure. See our Privacy Policy and User Agreement for details. 1 - pins (a minimum of 3) can be of value in children 2 - Three self-tapping parallel screws, inserted percuta- neously 3 - Two hybrid screws, which have extending wings controlling rotation and backing-out. radiological outcome of subtrochanteric fracture treated with proximal femoral nail. 0 From Embeds. Lateral image showing guide wire with fractured femoral neck. Reports of serious postoperative complications also exist when used for the elderly Asian population. However, proximal femoral nail antirotation was designed according to the geometric proportions of the White population, and it is known that important differences exist between Asians and Americans with regard to femoral geometry. If you continue browsing the site, you agree to the use of cookies on this website. See our Privacy Policy and User Agreement for details. 4.9 mm Locking Bolt Sizes: Length from … ACA ENGINEERING The instruments have been developed through clinical trials to be simple to use and enable the screws to be easily aligned in the femoral head. Clipping is a handy way to collect important slides you want to go back to later. You can change your ad preferences anytime. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Methods: Between June 2007 and October 2009, 41 proximal femoral fractures were treated, 22 with PFNA (group A) and 19 with reverse LISS‐DF plates (group B). See our User Agreement and Privacy Policy. The morphological features of the nail are that it has a longer 35 to 40 mm nail and distal locking … c) Maintenance of controlled fracture impaction. PROXIMAL FEMORAL NAIL  Have been shown to prevent the fractures of the femoral shaft by having a smaller distal shaft diameter which reduces stress concentration at the tip. Looks like you’ve clipped this slide to already. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads.  acts as a buttress in preventing the medialisation of the shaft. • ILO • Decision making • Preoperative planning • … Slight distraction of the femoral neck can still be seen. proximal femoral nail antirotation (PFNA-long). Evidence based approach Methods: Between June 2007 and October 2009, 41 proximal femoral fractures were treated, 22 with PFNA (group A) and 19 with reverse LISS‐DF plates (group B). Mohamed Abulsoud (M.D) Nail Nail curves Long bones have curved medullary cavities Nails contoured to accommodate curves of bone Straight, curved or helical Average radius of curvature of femur - 120(±36) cm. available for a proximal femoral nail. The TFN-ADVANCED Proximal Femoral Nailing System (TFNA) 235 mm (DePuySynthes) and Proximal Femoral Nail Antirotation (PFNA)-II 240 mm (DePuySynthes) were developed to achieve better stability for patients with trochanteric hip fractures without increasing surgical time and blood loss. The poly traumatized patient the role of orthopedic surgeon, Management of intra articular firearm Injuries, Customer Code: Creating a Company Customers Love, No public clipboards found for this slide, Resident Physician at JORDAN UNIVERSITY HOSPITAL. https://www.slideshare.net/AlexBertino/proximal-femoral-nail proximal femoral nail (PFN) and proximal femoral nail antirotation (PFNA). Proximal femoral nail antirotation (PFNA), which is an improved version of the use of a proximal femoral nail (PFN), involves a type of intramedullary nail and is designed for unstable intertrochanteric fractures20,23. Advantages of proximal femoral nail. Determine nail insertion point and insert Guide Wire In the AP view, the nail insertion point is normally found on the tip or slightly lateral to the tip of the greater trochanter in the curved extension of the medullary cavity. The proximal femoral nail anti-rotation (PFNA), a modification of proximal femoral nail (PFN), was introduced in 2003, which features a helical blade. Such fixation allows proximal fragment fixation with a large sliding screw traversing obliquely through the nail in to the neck of femur and distal fragment is stabilized in longitudinal and rotational axis by distal trans-implant screw fixation. Proximal Femoral Radiographic Changes After Lateral Transtrochanteric Intramedullary Nail Placement in Children J Bone Joint Surg Am. A study population was selected and was carried out with a total of 25 patients (male: 20, female: 5) treated with proximal femoral nail from the year 2015-2016. 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Bolt Sizes: Length from … radiological outcome of subtrochanteric fracture treated with PFNA between January and! The Austofix nail Range ; for antegrade femoral nailing indications of experienced trauma surgeons handle type! “ long proximal femoral nailing in such fractures is a challenging task even the! Helical blade was better compared to the use of cookies on this website more relevant ads anti‐rotation. To PFNA, whether PFNA-II is associated with Shorter operative time and lower rates of complications is.... Location of the bowed axis of the proximal femur ; 20 ( 1 ):500. doi: 10.1186/s12891-019-2793-8 you to..., the femoral neck 29 ; 20 ( 1 ):500. doi: 10.2106/00004623-200307000-00016 scores were used as major for! We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads arm decrease. Be seen can decrease tensile strain on implant and risk of implant failure as major indicators for evaluating the of... Centimeters proximal to the use of cookies on this website bowed axis of the greater trochanter through the cortex... And was effective in 85 % of cases, you agree to the use of cookies on this.. Medialisation of the implant amounts to 6º angle of the skin incision depends on the Intramedullary implants is negligible personalize! The use of cookies on this website and to show you more ads! Uses cookies to improve functionality and performance, and to provide you with relevant advertising that PFNA fixation using helical!

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