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). We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. The neck shaft angle was measured in unaffected side in AP X ray using goniometer. 1 Proximal femoral nailing in such fractures is a challenging task even in the hands of experienced trauma surgeons. Clipping is a handy way to collect important slides you want to go back to later. Faculty of medicine – Al-Azhar university Cairo- Egypt. Reports of serious postoperative complications also exist when used for the elderly Asian population. 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. Biomechanical cadaveric studies demonstrated that PFNA fixation using a helical blade was better compared to the sliding hip screw. See our User Agreement and Privacy Policy. The exact location of the skin incision depends on the type of insertion handle / type of nail used. 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. 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. Proximal femoral fractures proximal femoral nail antirotation (PFNA-long). 1. 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. d) Acts as a buttress to prevent shaft medialisation . BY ALEX BERTINO, COREY VAN DE HAY, ANDREW HNAT Postoperative radiographic union time and modified Harris hip scores were used as major indicators for evaluating the effectiveness of surgery. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. If you continue browsing the site, you agree to the use of cookies on this website. 2003 Jul;85(7):1295-301. doi: 10.2106/00004623-200307000-00016. Compared to PFNA, whether PFNA-II is associated with shorter operative time and lower rates of complications is unknown. The Austofix F1 Hip Nail complements the Austofix Nail Range; for antegrade femoral nailing indications. Do we need a proximal femoral nail ? Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. 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). Malpositioning of the implant should be avoided, as this was the leading cause of failure. Nail 1. 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. Looks like you’ve clipped this slide to already. The same proximal femoral nail anti‐rotation devices and the same surgical procedures were applied to all patients.  acts as a buttress in preventing the medialisation of the shaft. PFN was introduced by AO/ASIF in 1996 for treatment of trochanteric fractures. radiological outcome of subtrochanteric fracture treated with proximal femoral nail. If you continue browsing the site, you agree to the use of cookies on this website. If you continue browsing the site, you agree to the use of cookies on this website. Preoperative planning , decision making , post op rehab, guidelines , evidence based approach. Complex proximal femoral fractures are difficult to treat with all implants demonstrating high complication rates. Evidence based approach Proximal femoral nail [8-10]: Table 3. 2019 Oct 29;20(1):500. doi: 10.1186/s12891-019-2793-8. c) Maintenance of controlled fracture impaction. Proximal Femoral Nail – Standard PFN and long PFN 12 1. Clipping is a handy way to collect important slides you want to go back to later. More than 250,000 femur fracture patients are seen per year in the U.S. on average. 9 Actions. Proximal Femoral Nail Antirotation Technique Guide DePuySynthes 11. Lateral image showing guide wire with fractured femoral neck. 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. a) Provides more efficient load transfer. Once the nail is inserted to appropriate length, the femoral neck fracture must be reduced and held with guide wires. See our Privacy Policy and User Agreement for details. Slight distraction of the femoral neck can still be seen. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime. 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. A femoral nail with proximal cephalomedullary locking options is inserted. entitled “Long proximal femoral nail in ipsilateral fractures of proximal femur and shaft of femur”. 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 proximal femoral nail anti-rotation (PFNA), a modification of proximal femoral nail (PFN), was introduced in 2003, which features a helical blade. The morphological features of the nail are that it has a longer 35 to 40 mm nail and distal locking … 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. 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. Position the C-arm for an AP view of the proximal femur. Operative times can be reduced significantly when using the F1 Hip Nail. 1. APIdays Paris 2019 - Innovation @ scale, APIs as Digital Factories' New Machi... Mammalian Brain Chemistry Explains Everything, No public clipboards found for this slide. Surgical TreatmentSurgical Treatment 23. 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. Complete congruency minimizes normal forces and hence little frictional component to nail’s fixation. ACA ENGINEERING 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. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Mohamed Abulsoud (M.D) b) Shorter lever arm can decrease tensile strain on implant and risk of implant failure. The same proximal femoral nail anti-rotation devices and the same surgical procedures were applied to all patients. 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. 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. Looks like you’ve clipped this slide to already. proximal femoral nail (PFN) and proximal femoral nail antirotation (PFNA). 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. 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. This image shows the first guide wire being inserted through the lateral cortex. 0 From Embeds. The mediolateral angle of the implant amounts to 6º. 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. See our User Agreement and Privacy Policy. If you continue browsing the site, you agree to the use of cookies on this website. available for a proximal femoral nail. Shares. 4.9 mm Locking Bolt Sizes: Length from … proximal femoral nail fixation has been found to prevent such unwanted outcomes [4]. Advantages of proximal femoral nail. If you continue browsing the site, you agree to the use of cookies on this website. 321 ... Use of three- flanged nail 22. You can change your ad preferences anytime. Sir, I have read the article with great interest by Gadegone et al.  Due to its position close to the weight-bearing axis the stress generated on the intramedullary implants is negligible. PFN Nail (Proximal Femoral Nail) Long sizes: Distal diameter 9-12 mm, Angle 130° or 135°, Length from 320 to 420 mm. It includes an Intramedullary nail through which two screws are inserted into the neck of femur. Postoperative radiographic union time and modified Harris hip scores were used as major indicators for evaluating the effectiveness of surgery. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. 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 available for both Left and Right. • ILO • Decision making • Preoperative planning • … 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. Proximal Femoral Radiographic Changes After Lateral Transtrochanteric Intramedullary Nail Placement in Children J Bone Joint Surg Am. Proximal femoral nail anti-rotation versus cementless bipolar hemiarthroplasty for unstable femoral intertrochanteric fracture in the elderly: a retrospective study BMC Musculoskelet Disord. 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). The long gamma nail allowed early weight bearing and was effective in 85% of cases. 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