Nail Proximal Femoral Radiographic Changes After Lateral Transtrochanteric Intramedullary Nail Placement in Children J Bone Joint Surg Am. Once the nail is inserted to appropriate length, the femoral neck fracture must be reduced and held with guide wires. Available in both stainless Steel and Titanium. Proximal femoral fractures 1. Postoperative radiographic union time and modified Harris hip scores were used as major indicators for evaluating the effectiveness of surgery. 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). Evidence based approach PFN was introduced by AO/ASIF in 1996 for treatment of trochanteric fractures. proximal femoral nail (PFN) and proximal femoral nail antirotation (PFNA). 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. available for a proximal femoral nail. Postoperative radiographic union time and modified Harris hip scores were used as major indicators for evaluating the effectiveness of surgery. Make a 3-5 cm skin incision several centimeters proximal to the tip of the greater trochanter. b) Shorter lever arm can decrease tensile strain on implant and risk of implant failure. More than 250,000 femur fracture patients are seen per year in the U.S. on average. 2019 Oct 29;20(1):500. doi: 10.1186/s12891-019-2793-8. 1. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. 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. On SlideShare. The exact location of the skin incision depends on the type of insertion handle / type of nail used. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Clipping is a handy way to collect important slides you want to go back to later. Operative technique: • Anaesthesia: All the patients were operated under either spinal anaesthesia or epidural anaesthesia. 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. Biomechanical cadaveric studies demonstrated that PFNA fixation using a helical blade was better compared to the sliding hip screw. Surgical TreatmentSurgical Treatment 23. Now customize the name of a clipboard to store your clips. Sir, I have read the article with great interest by Gadegone et al. Proximal Femoral Nail – Standard PFN and long PFN 12 1. 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. See our User Agreement and Privacy Policy. The same proximal femoral nail anti-rotation devices and the same surgical procedures were applied to all patients. Clipping is a handy way to collect important slides you want to go back to later. The same proximal femoral nail anti‐rotation devices and the same surgical procedures were applied to all patients. 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 … It includes an Intramedullary nail through which two screws are inserted into the neck of femur. 0 Number of Embeds. Malpositioning of the implant should be avoided, as this was the leading cause of failure. If you continue browsing the site, you agree to the use of cookies on this website. Consecutive patients with unstable trochanteric fractures (AO-classification 31.A.2 and A.3 only) were included and followed for 1 year. This image shows the first guide wire being inserted through the lateral cortex. Reports of serious postoperative complications also exist when used for the elderly Asian population. 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. METHODS: A retrospective study was performed on 58 patients with femoral intertrochanteric fractures treated with PFNA between January 2013 and January 2015. Position the C-arm for an AP view of the proximal femur. Proximal femoral fractures Evidence based approach Mohamed Abulsoud (M.D) Lecturer of orthopedic surgery Faculty of medicine – Al-Azhar university Cairo- Egypt 2. 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. If you continue browsing the site, you agree to the use of cookies on this website. 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. PFN Nail (Proximal Femoral Nail) Long sizes: Distal diameter 9-12 mm, Angle 130° or 135°, Length from 320 to 420 mm. 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. The long gamma nail allowed early weight bearing and was effective in 85% of cases. Looks like you’ve clipped this slide to already. The neck shaft angle was measured in unaffected side in AP X ray using goniometer. 1. 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. Operative times can be reduced significantly when using the F1 Hip Nail. Due to its position close to the weight-bearing axis the stress generated on the intramedullary implants is negligible. 1. The morphological features of the nail are that it has a longer 35 to 40 mm nail and distal locking … Complete congruency minimizes normal forces and hence little frictional component to nail’s fixation. https://www.slideshare.net/AlexBertino/proximal-femoral-nail 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). Proximal femoral fractures 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. Complex proximal femoral fractures are difficult to treat with all implants demonstrating high complication rates. 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). 4.9 mm Locking Bolt Sizes: Length from … The Austofix nail Range ; for antegrade femoral nailing in such fractures is a handy to! Lateral image showing guide wire with fractured femoral neck indicators for evaluating the effectiveness of surgery cadaveric. / type of insertion handle / type of insertion proximal femoral nail slideshare / type of used... 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