The aoasif proximal femoral nail pfn is a new device designed for the treatment of the unstable trochanteric femoral fracture. Pfna nail surgical technique animation created by kems studio. Surgical technique page 3 post op care nail removal page 8 implants required page 9. Dissection was done down to the fibrous nonunion fracture site. This was a prospective study of 50 patients with sub trochanteric fractures of femur who were treated with long pfn at a tertiary care center from july 2012 to june 2016.
Study of clinical and functional outcome of unstable. Reported avn rates are 2% for piriformis entry and 1. Titanium trochanteric fixation nail system quick reference chart. Splitting of the proximal femur with a new femoral nail. Sub trochanteric fractures in adults are included, fractures. Surgical technique implant selection the trigen intertan nail preoperative template set 71674200 may be used to assist with preoperative implant selection. Careful preoperative evaluation and planning, proper surgical technique, and extended postoperative care are essential for success of limb lengthening procedures. Such complications are induced by the migration of screws in opposite directions, which may lead to failure of the osteosynthesis. This brochure presents a surgical technique available for use with the depuy. Through the development of a common, streamlined and intuitive surgical approach the t2 gtn system offers the potential for more efficient. Proximal femoral nail antirotation against dynamic hip screw for unstable trochanteric fractures. Tfnadvanced proximal femoral nailing system is intended for treatment of fractures in adults and adolescents 1221 in which the growth plates have fused.
Titanium trochanteric fixation nail system surgical technique depuy synthes companies 5 biomechanical features in 1958, the ao formulated four basic principles, which have. The initial results in biomechanical and clinical studies have shown promise. The report indicates that the degree aiming arm and insertion handle are tools routinely used with the titanium trochanteric fixation nail system for intramedullary fixation of proximal femur fractures technique guide j3900i. Instructions for use intramedullary nailing implants. Preoperatively radiographs must be measured to ensure the canal is wide enough to accept the nail. The proximal femur nail antirotation pfna is the recent addition to the growing list of intramedullary implants for trochanteric fracture fixation. The tfnadvanced proximal femoral nailing system tfna is designed to advance hip fracture treatment with. Proximal femur nail in intertrochanteric fractures indications and tipstricks.
We followed prospectively 295 patients with trochanteric fractures treated with the proximal femoral nail. This is similar to the proximal bend in the original gamma nail, which was subsequently revised to a 4degree bend. Trochanteric fractures treated with a proximal femoral nail. Comparative study of proximal femoral nailing and dynamic hip screw for intertrochanteric fractures in adults.
This study aims to evaluate use of the russelltaylor reconstruction nail rtrn in this group with regard to mortality risk, complication rates and final outcome. Hip fracture fixation with nails thoughts, techniques and tips coi disclosure zimmerbiomet. Zimmer itst intertrochanteric subtrochanteric fixation system. Jul 22, 2016 trochanteric entry nailing for pediatric femoral shaft fractures j. Subtrochanteric femoral fracture during trochanteric nailing. When positioning the drapes, bear in mind that the incision. Gamma3 trochanteric nail 180 cambridge orthopaedics. Step by step instructions to achieve a perfect proximal femur pfna ii surgery.
Tfnadvanced proximal femoral nailing system tfna with augmentation. Piriformis fossa nail if using the piriformis fossa nail, the entry point is between the top of the femoral neck and bottom. Comparative study of proximal femoral nailing and dynamic hip. Femoral nail synthes pfn in trochanteric fractures. The short proximal femoral nail is a superior implant for stable and unstable intertrochanteric fractures in terms of operating time, surgical exposure, blood loss, and complications, especially for patients with relatively small femora. Femoral recon nail frn features animation depuy synthes. Pdf of adolescent lateral entry femoral nail surgical technique guide. It may be helpful to preliminarily insert the trochanteric nail utilizing its bow to. Smith definition fractures of the femoral shaft are characterized by acute, nonpathologic fractures of the femur in which the primary portion of the fracture is at least 5 cm distal to the lesser trochanter and at least as far proximal to the. The operative technique followed the manufacturers instructions, the implant used being the proximal femoral nail antirotation system pfna, synthes, solothurn, switzerland. The aoasif proximal femoral nail pfn for the treatment. Other common nails in the us market advocated for trochanteric entry are within 46 degrees4,5,7 to. Intraoperative and postoperative complications, surgical details, and outcome.
The following surgical procedures should be considered for the trochanteric nailing of femoral shaft fractures to prevent implantderived complications. We report our results of low velocity trochanteric fractures internally fixed by proximal femur nail antirotation. Treatment of recent trochanteric fracture in adults. A longitudinal incision was made over the previous incision site, and the iliotibial band was split. Trochanteric buttress plate combined with proximal femoral. Gamma3 s trochanteric nail 170 hip fracture operative technique. The nail design has been well proven in over 200 000 cases performed with the pfn. The t2 supracondylar nailing system offers the advantages of a unique locking configuration and. Tfnadvanced proximal femoral nailing system tfna surgical technique depuy synthes. This study reports the outcome in such fractures treated using the. Proximal femoral nail is a better choice of implant for the treatment of an unstable trochanteric fracture, however it is associated with screw migration and cutout because of greater trochanteric comminution and coronal split. This study evaluated the feasibility of a helixshaped femoral nail that would facilitate ease of nail insertion through the trochanter and save implant removal along a helical pathway.
Study of clinical and functional outcome of unstable trochanteric and subtrochanteric fractures managed with proximal femoral nail in elderly. Failure of fixation of trochanteric femur fractures. Titanium trochanteric fixation nail system instrument assembly blade guide sleeve, for trochanteric fixation nails 357. A comparative study of unstable per and intertrochanteric femoral fractures treated with dynamic hip screw dhs and trochanteric buttpress plate vs. In this study, we aimed to report the results of a retrospective study carried out at our institute regarding cases of patients who had suffered proximal femoral fractures between january 2002 and february 2007, and who were treated with a proximal femoral nail. Aug 20, 20 the trochanteric im nail is a useful implant for treating femoral shaft fractures. Report by journal of evolution of medical and dental sciences. Trochanteric femoral nail trochanteric fixation nail. We have used selflengthening telescopic nails with a proximal herzog bend and standard trochanteric entry for femoral lengthening in children. First, the proper starting point for trochanteric nailing is just lateral to the long axis of the femur. Trochanteric entry for femoral lengthening nails in children. Short proximal femoral nail fixation for trochanteric fractures. Consultant, inventor, trauma, etex, knee creations.
Management of subtrochanteric fractures of femur with. Depuy synthes covering the specialized field of orthopedic. The titanium trochanteric fixation nail tfn is intended to treat stable and unstable fractures of the proximal femur including pertrochanteric fractures, intertrochanteric fractures, basal neck fractures, and combinations thereof. None had fractures of the femoral shaft or trochanter or experienced nail breakage. If it is to be done, it should be before the greater trochanter grows well above the top of the nail. Femoral nailing is a surgical technique used to treat a fractured or broken femur, or thighbone. Insert blade guide sleeve assembly through the aiming arm. Titanium trochanteric fixation nail system tfn titanium trochanteric fixation nail system tfn the tfn permits an intramedullary approach for fixation of proximal femur fractures. Results of proximal femur nail antirotation for low. Synthes expert lateral femoral nail lfn for impending pathological fracture surgical procedure.
Attach the helical blade to the helical blade inserter. Proximal femoral nail versus dynamic hip screw fixation for. The average age of the patients was 80 years and three out of four were female. Proximal femoral nail antirotation pfnatm fixation of extra.
This website uses cookies to help you get the most out of your experience during your visit, and we can improve the content served to you by collecting statistical information. Oct 31, 2014 proximal femoral nail antirotation technique offers better recovery than dynamic hip screw, whereas both techniques possess the same risk of postoperative complications. Arthroplasty for proximal femur fracture intechopen. Entry point trochanteric nail if using the trochanteric nail, the entry point is at the tip of the greater trochanter, in line with the femur on the lateral radiograph. Trochanteric and long gamma nails as well as the small stature versions. Zeffect and reverse zeffect are complications that arise from the surgical treatment of pertrochanteric fractures of the femur with proximal femoral nails pfn comprising two interlocking head screws.
Open reduction internal fixation orif with intra or extramedullary implants is the most frequent attitude in these fractures, which usually heal easily. Trochanteric entry nailing for pediatric femoral shaft fractures. The design of the lateral entry femoral nail synthes usa includes a greater lateral proximal valgus bend of 10 degrees. The paper describes three cases of pertrochanteric fractures. Tfn advanced proximal femoral nailing system tfna surgical technique depuy synthes. Nail or plate fixation for a3 trochanteric hip fractures. If trochanteric nonunion is encountered, fibrous tissue is debrided from the cancellous surface of the fragments, and a highspeed burr can be used to expose bleeding cancellous bone. Surgical treatment of basicervical intertrochanteric. Complications of trochanteric fractures musculoskeletal key.
Treatment of complex proximal femoral fractures with the. Note as template magnification levels are set at 117%, all measurements are estimates of true size. Measure with the measuring device under image intensification position the image intensi. With the tip of the ball nose guide wire at the level of the desired depth of nail insertion, slide or snap the nail length gauge cat. Our elearning platform contains high resolution images and a certified cme of the femoral intramedullary nail. The aoasif proximal femoral nail pfn for the treatment of. The affixus hip fracture nail combines the principles of a compression hip screw with the biomechanical advantages of an. The aim of the present study was to analyze the results of treatment with pfna in 50 patients with trochanteric fractures. Trochanteric intramedullary nails, which have a proximal lateral bend, are specifically designed for trochanteric insertion. Tfna proximal femoral nailing system surgical technique depuy synthes 11 5 determine nail diameter instrument 03. The excised femoral head is often a useful source of autograft, and applying an acetabular reamer to the femoral head will rapidly morselise the fragment. With augmentation option pfn proximal femoral nail pfn proximal femoral nail set screw for trochanteric fixation nail.
Hold the radiographic ruler perpendicular to the femur. Moreover, the credo pronounced craydough appears in book form a compilation. The purpose of this study is to evaluate the results of augmented pfn in terms of prevention of postoperative. Depuy synthes industry partners ota online trauma access. Surgical technique for the afn antegrade femoral nail afn surgical technique 11 p a 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 femoral antegrade nail fan technique changes with respect to nail entry point and insertion technique. Biomechanically proximal femoral nail pfn is a better choice of implant, still it is associated with screw breakage, cut out of screw through femoral head, z effect, reverse z effect, and lateral migration of screws. Comparison of the functional and radiological outcomes of. Jan 28, 2016 complications after hip nailing for fractures. A report from the norwegian hip fracture register of 2716. Treatment of trochanteric fractures with the pfna proximal. This study is to evaluate the results of trochanteric buttress plate tbp combined with pfn in an unstable it fractures for buttressing lateral wall and.
Hip fracture fixation with nails thoughts, techniques and tips. Pdf implant fracture analysis of the tfna proximal femoral nail. Ao surgery reference is a resource for the management of fractures, based on current clinical principles, practices and available evidence. Comparative functional analysis between titanium and stainless. Electronic instructions for use depuy synthes companies. The purpose of this study is to determine whether trochanteric entry im lengthening nails can be used safely no avn or proximal femoral deformity in the skeletally immature. T2 femoral nailing system operative technique contents 1. Femoral universal femoral universal nailing system. Gadegone1, bhaskaran shivashankar2, vijayanad lokhande3, and yogesh salphale3 1 department of orthopaedic and traumatology, associate professor of orthopaedics, gmc, 442402 chandrapur, maharashtra, india. Unstable proximal femoral fractures and pathological lesions involving the trochanteric region in the elderly comprise an increasing workload for the trauma surgeon as the ageing population increases. Surgical technique new directions classic supine position leg positioning. The pfna blade, proximal aspect of the broken nail, and screw at the proximal femur was removed in standard.
The procedure involves inserting a metal rod called an intramedullary nail, or femoral nail, into the femur and positioning it so that it runs vertically along the length of the shaft. Ensure that you are familiar with the appropriate surgical technique. Furthermore, the development of the t2 femoral nailing system offers the competitive advantages of. Itst intramedullary nail surgical technique 3 surgical technique preoperative planning the itst femoral fixation system implants are designed to place the lag screw at, with 15 of anteversion on the long nails, to accommodate the most common anatomic femoral neck angle, while minimizing inventory requirements. An animation describing the features and benefits of the greater trochanter and piriformis entry femoral recon nail frn. Outcomes of trochanteric femoral fractures treated with. This article reports on the surgical technique of the recently introduced 4.
Suprapatellar instrumentation for expert tibial nail. Some of the randomised trials that have comparing an intramedullary nail with the shs have suggested a tendency to slightly better regain of mobility for the nail 17,36,48,49,56. Ufn unreamed femoral nail cfn cannulated femoral nail uhnphn humeral nailing system utnctn solidcannulated tibial nail please read these instructions for use, the synthes important information and the corresponding surgical technique guide carefully before use. Step by step instructions to achieve a perfect proximal. Achieving proper rotation of the femur with the patella in a horizontal position was crucial. Nail size, screw length and femoral neck angle may be determined. The purpose of this metaanalysis was to find out whether the proximal femoral nail was better than the dynamic hip screw in the treatment of trochanteric fractures with respect to operation time, blood transfusion, hospital stay, wound complications, number of reoperation, and mortality rate. Femur t2 gtn knifelight greater trochanter entry carpal. Phoenix antegrade femoral nail system featuring corelock.
Gamma3 long nail is intended for fixation of stable and unstable femoral fractures occurring from the base of the femoral neck extending distally to a point approximately 10cm proximal to the intracondylar notch including fractures of the basilar neck, intertrochanteric fractures, peritrochanteric fractures, subtrochanteric fractures and femoral shaft fractures. Place the contralateral leg on a leg support, and orient it intraoperatively. Augmentation of proximal femoral nail in unstable trochanteric fractures wasudeo m. However, even though the pfna has produced good clinical outcomes, a poor introduction technique with an inappropriate entry point can cause surgical complications. I believe the depuy synthes femoral nail system offers the most. Some researchers suggest improving clinical outcomes by modifying the entry point, but no. The companys honest, transparent approach to the ordeal is considered the. Further analysis cannot be conducted until the return of the manufactured product. Recent trochanteric fracture is frequent in adults, and mainly affects elderly patients who risk loss of independence. Femoral universal nails are available in 1 mm increments from 9 mm to 15 mm diameters. This site is published by depuy synthes companies which is solely responsible for its content. Short proximal femoral nail fixation for trochanteric. None of previous reports described im lengthening nails for limb lengthening procedures.
The company also is developing a digital surgery platform through its. Subtrochanteric femoral fracture during trochanteric. The affected leg was abducted, adducted and rotated to reduce the fracture. Several techniques and devices have evolved for nailing through or lateral to the greater trochanteric apophysis.
In addition to the t2 femoral nailing system, stryker developed the t2 supracondylar nail scn for the treatment of complex distal femoral fractures. Femoral universal femoral universal nailing system options. Influence of different great trochanteric entry points on the. The guide pin was then removed and the actual synthes trochanteric fixation nail with degree angle x 11 mm diameter was placed down into canal on the insertion device. Trochanteric entry for femoral lengthening nails in.
Piriformis fossa nail if using the piriformis fossa nail, the entry point is between the top of the femoral. We report on three cases of subtrochanteric femoral fractures during trochanteric intramedullary nailing for the treatment of femoral shaft fractures. Some devices listed in this surgical technique may not have been licensed in accordance with canadian law and may not be. Mar 14, 2017 the proximal femoral nail antirotation pfna system for treatment of intertrochanteric fractures is currently widely applied worldwide. Titanium trochanteric fixation nail system synthes. The technique of placement of a lateral entry nail is a useful development in the spectrum of surgical treatment for femoral shaft fractures in the immature. The guide pin was drilled up into the center of the femoral head on ap. Implant failures in proximal femoral nails retrieved in wa. A laboratory model to evaluate cutout resistance of implants for pertrochanteric fracture fixation, somers et al, 2004. Success, recently published by ao trauma, is the first book of its kind to give. Trigen metatan trochanteric antegrade nail provides both stability and versatility for high proximal fractures, midshaft fractures, distal fractures. The nail also has an anterior bow, which mimics normal pediatric anatomy for children ages 816, as well as a distal lateral bend to ease insertion lateral to the greater trochanter, minimizing medial cortex interference.
Solid and cannulated nails technique guide synthes synthes on. Femoral universal surgical technique femoral universal nailing system options made easy. All these 30 patients are subjected to surgical profile and cardiac evaluation, plain xrays of pelvis including both hips taken, the nail diameter is. Comparative analysis of the results of trochanteric femoral nail and dynamic hip screw in treatment of comminuted unstable trochanteric fractures a prospective randomised controlled trial on indian population. Gamma3 nail 180 all nails use the same lag screws, set. Proximal femur nail in intertrochanteric fractures. Synthes expert lateral femoral nail lfn for impending pathological fracture surgical technique with step by step instructions on orthoracle. Antegrade and retrograde femur operative technique. Clinical and radiographic controls were performed at 1, 3 and 6 months.
A new device designed by aoasif, the pfna proximal femoral nail antirotation, represents a unique intramedullary nail system for improved management, particularly in the elderly. The best surgical strategy for extracapsular proximal femoral fractures pffs is. This surgical technique is written from the trochanteric antegrade nail tan perspective. Tfn titanium trochanteric fixation nail system surgical technique depuy synthes.
A prospective study to evaluate the management of sub. Complex proximal femoral fractures in the elderly managed by. Introduction the biomet pediatric locking nail pln was designed to provide stable subrigid fixation of femur fractures in children. Health, general femur analysis fractures care and treatment risk factors fractures injuries internal fixation usage internal fixation in fractures.
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