BY ALEX BERTINO, COREY VAN DE HAY, ANDREW HNAT 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). 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. Malpositioning of the implant should be avoided, as this was the leading cause of failure. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. Proximal femoral nail anti-rotation versus cementless bipolar hemiarthroplasty for unstable femoral intertrochanteric fracture in the elderly: a retrospective study BMC Musculoskelet Disord. Now customize the name of a clipboard to store your clips. Proximal Femoral Radiographic Changes After Lateral Transtrochanteric Intramedullary Nail Placement in Children J Bone Joint Surg Am. PFN was introduced by AO/ASIF in 1996 for treatment of trochanteric fractures. As shown, this lies on the proximal extension of the bowed axis of the femoral shaft. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. 0 Number of Embeds. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. The long gamma nail allowed early weight bearing and was effective in 85% of cases. Make a 3-5 cm skin incision several centimeters proximal to the tip of the greater trochanter. Table 3:Long Vs Short PFN. Faculty of medicine – Al-Azhar university Consecutive patients with unstable trochanteric fractures (AO-classification 31.A.2 and A.3 only) were included and followed for 1 year. 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. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. 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. 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. 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. 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. Do we need a proximal femoral nail ? 1. Operative technique: • Anaesthesia: All the patients were operated under either spinal anaesthesia or epidural anaesthesia. It includes an Intramedullary nail through which two screws are inserted into the neck of femur. APIdays Paris 2019 - Innovation @ scale, APIs as Digital Factories' New Machi... Mammalian Brain Chemistry Explains Everything, No public clipboards found for this slide. Looks like you’ve clipped this slide to already. b) Shorter lever arm can decrease tensile strain on implant and risk of implant failure. proximal femoral nail (PFN) and proximal femoral nail antirotation (PFNA). 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 Nail available for both Left and Right. Available in both stainless Steel and Titanium. Now customize the name of a clipboard to store your clips. Biomechanical cadaveric studies demonstrated that PFNA fixation using a helical blade was better compared to the sliding hip screw. A femoral nail with proximal cephalomedullary locking options is inserted. 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. 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. 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. The same proximal femoral nail anti‐rotation devices and the same surgical procedures were applied to all patients. The morphological features of the nail are that it has a longer 35 to 40 mm nail and distal locking … Proximal femoral fractures Evidence based approach Mohamed Abulsoud (M.D) Lecturer of orthopedic surgery Faculty of medicine – Al-Azhar university Cairo- Egypt 2.  limits the surgical insult to the … 2003 Jul;85(7):1295-301. doi: 10.2106/00004623-200307000-00016. 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. 321 ... Use of three- flanged nail 22. Proximal femoral fractures 1. Lateral image showing guide wire with fractured femoral neck.  Due to its position close to the weight-bearing axis the stress generated on the intramedullary implants is negligible. Postoperative radiographic union time and modified Harris hip scores were used as major indicators for evaluating the effectiveness of surgery. Clipping is a handy way to collect important slides you want to go back to later. 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. Compared to PFNA, whether PFNA-II is associated with shorter operative time and lower rates of complications is unknown. 2019 Oct 29;20(1):500. doi: 10.1186/s12891-019-2793-8. METHODS: A retrospective study was performed on 58 patients with femoral intertrochanteric fractures treated with PFNA between January 2013 and January 2015. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. Postoperative radiographic union time and modified Harris hip scores were used as major indicators for evaluating the effectiveness of surgery. The same proximal femoral nail anti-rotation devices and the same surgical procedures were applied to all patients. radiological outcome of subtrochanteric fracture treated with proximal femoral nail. The mediolateral angle of the implant amounts to 6º. 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 … Evidence based approach 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. If you continue browsing the site, you agree to the use of cookies on this website. Complex proximal femoral fractures are difficult to treat with all implants demonstrating high complication rates. More than 250,000 femur fracture patients are seen per year in the U.S. on average. 1. d) Acts as a buttress to prevent shaft medialisation . The neck shaft angle was measured in unaffected side in AP X ray using goniometer. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. 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. 1. Surgical TreatmentSurgical Treatment 23. Mohamed Abulsoud (M.D) Complete congruency minimizes normal forces and hence little frictional component to nail’s fixation. 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. Once the nail is inserted to appropriate length, the femoral neck fracture must be reduced and held with guide wires. Cairo- Egypt. See our User Agreement and Privacy Policy. proximal femoral nail fixation has been found to prevent such unwanted outcomes [4]. Proximal Femoral Nail – Standard PFN and long PFN 12 1. The exact location of the skin incision depends on the type of insertion handle / type of nail used. Proximal Femoral Nail Antirotation Technique Guide DePuySynthes 11. 9 Actions. Operative times can be reduced significantly when using the F1 Hip Nail. • ILO • Decision making • Preoperative planning • … proximal femoral nail antirotation (PFNA-long). 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. See our User Agreement and Privacy Policy. If you continue browsing the site, you agree to the use of cookies on this website. a) Provides more efficient load transfer. 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. Sir, I have read the article with great interest by Gadegone et al. c) Maintenance of controlled fracture impaction. 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. Such fractures is a handy way to collect important slides you want to back. Devices and the same proximal femoral nail in ipsilateral fractures of proximal femur 31.A.2. Experienced trauma surgeons the sliding hip screw this was the leading cause of failure buttress to prevent unwanted. Fracture in the U.S. on average early weight bearing and was effective in 85 % of cases nail is to! 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