If you continue browsing the site, you agree to the use of cookies on this website. 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. a) Provides more efficient load transfer. Proximal femoral nail [8-10]: Table 3. Advantages of proximal femoral nail. 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. 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. The proximal femoral nail anti-rotation (PFNA), a modification of proximal femoral nail (PFN), was introduced in 2003, which features a helical blade. Complex proximal femoral fractures are difficult to treat with all implants demonstrating high complication rates. Lateral image showing guide wire with fractured femoral neck. 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. 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. Nail 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. radiological outcome of subtrochanteric fracture treated with proximal femoral nail. 9 Actions. Shares. 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). PFN was introduced by AO/ASIF in 1996 for treatment of trochanteric fractures. Biomechanical cadaveric studies demonstrated that PFNA fixation using a helical blade was better compared to the sliding hip screw. d) Acts as a buttress to prevent shaft medialisation . 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. 2003 Jul;85(7):1295-301. doi: 10.2106/00004623-200307000-00016. See our User Agreement and Privacy Policy. 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. 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 nail fixation has been found to prevent such unwanted outcomes [4]. 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. 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. Looks like you’ve clipped this slide to already. The mediolateral angle of the implant amounts to 6º. 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). Now customize the name of a clipboard to store your clips. 1. If you continue browsing the site, you agree to the use of cookies on this website. 4.9 mm Locking Bolt Sizes: Length from … Do we need a proximal femoral nail ? Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Proximal Femoral Nail Antirotation Technique Guide DePuySynthes 11. Faculty of medicine – Al-Azhar university Looks like you’ve clipped this slide to already. Cairo- Egypt. Proximal femoral fractures 1. 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. https://www.slideshare.net/AlexBertino/proximal-femoral-nail Mohamed Abulsoud (M.D) Complete congruency minimizes normal forces and hence little frictional component to nail’s fixation. Reports of serious postoperative complications also exist when used for the elderly Asian population. Postoperative radiographic union time and modified Harris hip scores were used as major indicators for evaluating the effectiveness of surgery. 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. The same proximal femoral nail anti‐rotation devices and the same surgical procedures were applied to all patients. 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. Consecutive patients with unstable trochanteric fractures (AO-classification 31.A.2 and A.3 only) were included and followed for 1 year. Preoperative planning , decision making , post op rehab, guidelines , evidence based approach. Results. PFN Nail (Proximal Femoral Nail) Long sizes: Distal diameter 9-12 mm, Angle 130° or 135°, Length from 320 to 420 mm. 2019 Oct 29;20(1):500. doi: 10.1186/s12891-019-2793-8. On SlideShare. The morphological features of the nail are that it has a longer 35 to 40 mm nail and distal locking … 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. 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 … A femoral nail with proximal cephalomedullary locking options is inserted. More than 250,000 femur fracture patients are seen per year in the U.S. on average. It includes an Intramedullary nail through which two screws are inserted into the neck of femur. Now customize the name of a clipboard to store your clips. entitled “Long proximal femoral nail in ipsilateral fractures of proximal femur and shaft of femur”. 1. c) Maintenance of controlled fracture impaction. This image shows the first guide wire being inserted through the lateral cortex. 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. 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. Table 3:Long Vs Short PFN. The neck shaft angle was measured in unaffected side in AP X ray using goniometer. The Austofix F1 Hip Nail complements the Austofix Nail Range; for antegrade femoral nailing indications. Once the nail is inserted to appropriate length, the femoral neck fracture must be reduced and held with guide wires. You can change your ad preferences anytime. 0. Position the C-arm for an AP view of the proximal femur. METHODS: A retrospective study was performed on 58 patients with femoral intertrochanteric fractures treated with PFNA between January 2013 and January 2015. b) Shorter lever arm can decrease tensile strain on implant and risk of implant failure. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Proximal Femoral 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. Downloads. Evidence based approach 1 Proximal femoral nailing in such fractures is a challenging task even in the hands of experienced trauma surgeons. Operative technique: • Anaesthesia: All the patients were operated under either spinal anaesthesia or epidural anaesthesia. Make a 3-5 cm skin incision several centimeters proximal to the tip of the greater trochanter. The exact location of the skin incision depends on the type of insertion handle / type of nail used. Proximal femoral nail anti-rotation versus cementless bipolar hemiarthroplasty for unstable femoral intertrochanteric fracture in the elderly: a retrospective study BMC Musculoskelet Disord. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. proximal femoral nail antirotation (PFNA-long). 0 Number of Embeds. Lecturer of orthopedic surgery You can change your ad preferences anytime. Slight distraction of the femoral neck can still be seen. 1. 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. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. 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. 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. 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. 0 From Embeds.  Due to its position close to the weight-bearing axis the stress generated on the intramedullary implants is negligible. Compared to PFNA, whether PFNA-II is associated with shorter operative time and lower rates of complications is unknown. Available in both stainless Steel and Titanium. 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). 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. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. 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). APIdays Paris 2019 - Innovation @ scale, APIs as Digital Factories' New Machi... Mammalian Brain Chemistry Explains Everything, No public clipboards found for this slide. • ILO • Decision making • Preoperative planning • … Surgical TreatmentSurgical Treatment 23. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. The long gamma nail allowed early weight bearing and was effective in 85% of cases. 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). 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.  acts as a buttress in preventing the medialisation of the shaft. ACA ENGINEERING BY ALEX BERTINO, COREY VAN DE HAY, ANDREW HNAT Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Postoperative radiographic union time and modified Harris hip scores were used as major indicators for evaluating the effectiveness of surgery. Proximal femoral fractures Evidence based approach Mohamed Abulsoud (M.D) Lecturer of orthopedic surgery Faculty of medicine – Al-Azhar university Cairo- Egypt 2. Proximal Femoral Nail – Standard PFN and long PFN 12 1. The same proximal femoral nail anti-rotation devices and the same surgical procedures were applied to all patients. See our User Agreement and Privacy Policy. As shown, this lies on the proximal extension of the bowed axis of the femoral shaft. Proximal femoral fractures Operative times can be reduced significantly when using the F1 Hip Nail. Clipping is a handy way to collect important slides you want to go back to later. 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. proximal femoral nail (PFN) and proximal femoral nail antirotation (PFNA). available for a proximal femoral nail.  limits the surgical insult to the … Clipping is a handy way to collect important slides you want to go back to later. Pre-operative planning proximal femoral nail: The nail diameter was determined the level of isthmus by measuring the diameter of the femur on an AP X ray. 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