Proximal femoral nail antirotation in management of intertrochanteric. Oct 17, 20 unstable proximal femoral fractures are common and challenging for the orthopaedic surgeon. Best survival books 7 titles handpicked by a us marine. Because the implantation technique does not differ except for the perforated blade from the established nonaugmented pfna, it is implemented easily. Search the worlds most comprehensive index of fulltext books. Therefore, a surgical technique allowing anatomic alignment and a stable. The external femoral 94 alignment system appendix iii. Pfna ii proximal femoral nail antirotation introduction. But in certain cases, especially in younger patients with good bone quality, the pfna pfna ii blade may not be removable with the standard surgical technique and instrumentation. Sep 17, 2011 a81 first experience with a new fixation implant. Pfna depuy synthes pdf catalogs technical documentation. Introduction pfna system overview 2 surgical technique preoperative planning 14 option. Ao surgery reference is a resource for the management of fractures, based on current clinical principles, practices and available evidence. Mar 05, 2015 pfna nail surgical technique animation created by kems studio.
Surgical technique definition of surgical technique by the. Jul 11, 2014 the pfna augmented is a safe implant, which can be used in revision surgery in proximal femur fractures as a salvage procedure to avoid prosthetic replacement. Step 2 insert pfna carefully insert the pfna manually using slight bidirectional turns of the insertion handle as far as possible into the femoral opening if it is difficult to insert the nail manually, attach the connector on the insertion handle and use light hammer blows on the connector to insert the nail. Before giving the evaluation form to the surgical technologist fill in the following. The pfnaii long additionally allows for secondary dynamization. Proximal femoral nail antirotation in treatment of intertrochanteric. However, adequate knowledge and experience of operative technique is imperative.
Anatomic reduction before inserting the nail, the reduction can be achieved manually or using a reduction table. Proximal femoral nail antirotation function figures 1 to 3. Pfna augmentation 45 correction of insertion depth of pfna. The usual technique of insertion of 2 ball tip wires into the broken nail was not used as the inner diameter of the newer pfna nail was too small to accommodate the 2 ball tip wires. Pfna abbreviation stands for proximal femoral nail antirotation. Osteosynthese international 2011 annula meeting programme. If youre a hobbyist or trying to learn serious skills, this belongs on your shelf. The corresponding operative stabilization techniques for such fractures are still somewhat con troversial.
In 5 patients, closed fracture reduction could not be done and open fracture reduction with use of cerclage became necessary. A longitudinal incision was made over the previous incision site, and the iliotibial band was split. All surgeries were performed in the same institution. Migration of the lag screw after intramedullary treatment. Computerassisted preoperative planning improves the learning. The learning curve of the surgical procedure in group a was steeper than. Clinicoradiological and functional outcome of unstable. 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. Pfna has shared an excellent implant for a wide variety of indications. If a second antirotation wire is necessary, use the same procedure to insert it into the femoral head. Technical tips from the clinical application of proximal femoral naila ii pfna ii d.
The alignment support frame on the shell inserter will not be vertical to the floor and should not be used as a positioning guide. Objectives to compare the longterm functional and radiographic outcomes of the proximal femoral nail antirotationasia pfna ii and intertan nail it in the management of intertrochanteric. A too cranial or too caudal pfna position should be avoided as it can lead to malposition of the pfna blade. However, four studies reported that the it group required a significantly longer surgical time than the gn or pfna or pfna ii groups 4, 5, 18, 19, which indicates that intertan intramedullary nail may increase operative time after we had mastered the technique, although it has some potential clinical advantages, such as increasing harris hip. In axial view, the antirotation wire will approach, but not touch the blade tip. Aorn is committed to promoting excellence in perioperative nursing practice, advancing the profession, and supporting the professional perioperative registered nurse rn. Does pfna ii avoid lateral cortex impingement for unstable. However, it is unclear whether the new design in fact avoids lateral cortex impingement. Nov 15, 2012 the pfna asia also known as pfna ii fig 1 has a proximal diameter of 16. We recommend pfna ii for fixation of unstable intertrochanteric fractures with less operative time and low complication rate. Cai 1department of orthopedic surgery, shanghai tenth peoples hospital, tongji university, school of medicine, shanghai, china. In this preliminary series, no negative biological side effects of the cement i.
Review of proximal nail antirotation pfna and pfna2our. Abduct the unaffected leg as far as possible and place it on a leg support, so that it does allow free. Surgical technique synonyms, surgical technique pronunciation, surgical technique translation, english dictionary definition of surgical technique. Surgical technique the profemurz is a femoral implant designed with a rectangular cross section and a conical profile characterised by a constant increase in volume from the distal tip to the proximal area. Pfna ii surgical technique depuy synthes 3 pfna ii nail product range the pfna ii is available in 4 sizes pfna ii long, length 260 340 mm with 20 mm increments, length 340 420 mm with 40 mm increments, only b 10 mm nails, bending radius 1500 mm pfna ii, length 240 mm pfna ii small, length 200 mm pfna ii xs, length 170 mm.
The aim of the present study was to analyze the results of treatment with pfna in 50 patients with trochanteric fractures. Unstable proximal femoral fractures are common and challenging for the orthopaedic surgeon. The epub format uses ebook readers, which have several ease of reading. The augmentation improves implant anchorage in the impaired bone stock. Pfna nail surgical technique animation created by kems studio. Step by step instructions to achieve a perfect proximal femur. Proximal femoral nail antirotation in treatment of. Intertan nail versus proximal femoral nail antirotation. 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. Proximal femoral nail antirotation devices pfnas are considered biomechanically superior to dynamic hip screws for treating unstable peritrochanteric fractures and reportedly have a lower complication rate. Pfnaii nail excellent fit the design is adapted to the anatomical situation in small statured patients. Jun 24, 2017 variable pfna 58 patients pfna2 50 patients impingement on the lateral cortex and lateral fragment loss of reduction at insertion fracture union occurred in all patients treated with pfna ii. Instruments f16bbpa00010 connector f16bbpa00011 connector, shaft f16bbpa00042 hammer guide m101.
See other formats 232 the open orthopaedics journal, 2014, 8, 232236 open access the pfna augmented in revision surgery of proximal femur fractures alexander scola, florian gebhard, christoph dehner and gotz roderer ulm university, department of orthopaedic trauma, ulm, germany abstract. Evolution of intramedullary nails linkedin slideshare. Do you want to use the redesigned ao sr like an app. However, it 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. Extramedullary tibial 100 alignment device with proximal fixation spike appendix v. Pfna ii nail several distal locking options static or dynamic locking can be performed via the aiming arm with pfna ii standard, small and xs. Expert consult online and print, 1e provides beautiful handdrawn anatomic images along with clear instructions on the performance of each operation. Proximal femoral nail antirotation asian version pfnaii is widely used.
The correct pfna insertion depth is reached as soon as the projected pfna blade is positioned in the center of the femoral head. An intramedullary rod, also known as an intramedullary nail im nail or interlocking nail or kuntscher nail without proximal or distal fixation, is a metal rod forced into the medullary cavity of a bone. Proximal femoral nailing in communited intertrochanteric fractures is increasingly becoming popular in view of superior biomechanics and prevention of varus collapse associated with dynamic hip screw. Other techniques such as a knee arthrotomy and removal of the nail from the knee joint was deemed as too aggressive. Pfna ii cases were associated with a slightly shorter surgical time than pfna cases 23 minutes versus 27 minutes, respectively. Pfna, designed by ao in 2004, is an intramedullary device with a helical. Impacted cages made of titanium, carbonfiber reinforced or plain peek polymer polyetheretheketone. What is the abbreviation for proximal femoral nail antirotation. Variable pfna 58 patients pfna2 50 patients impingement on the lateral cortex and lateral fragment loss of reduction at insertion fracture union occurred in all patients treated with pfna ii. 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. The proximal femoral nail pfna minimal invasive treatment. Trochanteric buttress plate combined with proximal femoral. Results of the proximal femoral nail antirotation pfna in elderly.
Proximal femoral nail antirotation pfnatm fixation of. An orthopedic implant is a medical device manufactured to replace a missing joint or bone or to support a damaged bone. We offer one of the worlds most comprehensive portfolios of orthopaedic products and services in the areas of joint reconstruction, trauma, spine, sports medicine, craniomaxillofacial, power tools and biomaterials. Reason and treatment of failure of proximal femoral nail antirotation internal fixation for femoral intertrochanteric fractures of senile patients j. Many studies investigated novel preoperative planning methods in order. Internal fixation is an operation in orthopedics that involves the surgical implementation of implants. I like to think of it as the joy of cooking of survival technique books. Jul 26, 2015 newer pfn designs pfna ii is the modified pfn design meant to match the asian proximal femoral morphometry. Chaaban editor crush otolaryngology boards volume 1 edition pdf. Pfnaii presentation hip musculoskeletal system scribd. Dissection was done down to the fibrous nonunion fracture site. Discussion intertrochanteric fractures are emerging as a major healthcare problem in the elderly. A novel modified trochanteric entry portal and percutaneous.
Treatment of trochanteric fractures with the pfna proximal femoral nail antirotation nail system. Pfna ii proximal femoral nail antirotation introduction the pfna system was introduced by ao in 2003 for treating unstable trochanteric fractures. The pfna ii was introduced to eliminate lateral cortex impingement encountered with the pfna. Im nails have long been used to treat fractures of long bones of the body. A total of 237 patients 45 male, 192 female were eligible for the. When compared to a column screw, use of the helical blade results in increased contact surface area between the device and the femoral head.
Here youll find current best sellers in books, new releases in books, deals in books, kindle ebooks, audible audiobooks, and so much more. Should the tipapex distance tad rule be modified for the. Does pfna ii avoid lateral cortex impingement for unstable peritrochanteric fractures. Pfna is listed in the worlds largest and most authoritative dictionary database of abbreviations and acronyms. In conclusion, the pfn is a good minimal invasive implant of unstable proximal femoral fractures, if closed reduction is possible. The pfna ii exhibits some improvements in the design. Highly readable, accurate, and comprehensive, it clearly covers the nuts and bolts of surgical techniques. D oes pfna ii avoid l ateral c ortex i mpingement for u nsta. Proximal femoral nail antirotation in treatment of fractures. Pfna nail surgical technique animation created by kems. Pfnaii surgical technique depuy synthes 5 ao principles in 1958, the ao formulated four basic principles1, 2, which have become the guidelines for internal.
The pfna augmented in revision surgery of proximal femur. Discussion the pfna augmented is a potential implant for jointpreserving revision surgery in proximal femur fractures. Learning curve and clinical outcomes of performing surgery. Clinical report by bulletin of the nyu hospital for joint diseases. There were 11 hematomas 5 pfna, 6 gn3 of the surgical wound, which resolved satisfactorily in all cases. Femoral and tibial 103 insert compatibility charts appendix iv, surgical technique, edited by william l. May 01, 2015 pfna nail surgical technique animation created by kems studio. Is pfnaii a better implant for stable intertrochanteric.
Type of procedures performed give the surgical technologist the filled in. Treatment of unstable intertrochanteric fractureswith. Treatment of trochanteric fractures with the pfna proximal. Poor bone quality and neck screw instability can adversely affect the results with currently available fixation devices, which predominantly consist in dynamic hip screwplates and proximal reconstruction nails. Expandable pfn was designed to retain the mechanical characteristics of a largediameter nail, to provide the good torsional stability between the femoral neck and shaft obtained by an expendable peg inserted in the femoral head. Pfnaii nail several distal locking options static or dynamic locking can be performed via the aiming arm with pfnaii standard, small and xs. Reduction aids should be placed so as not to interfere with final plate placement. Accolade surgical protocol previously lasst adm x3 mobile bearing hip system surgical protocol for us previously lsp64 hiprestoration adm. The functional results assessed by harris hip score showed excellent in 41 cases 56.
Proximal femoral nail antirotation versus hemiarthroplasty. Proximal femoral nail antirotation in treatment of fractures of. What is the optimal salvage procedure for cutout after surgical fixation of. Aotk system innovations 2015 by ao foundation issuu. Accolade ii femoral hip system surgical technique previously lsp76 hipaccolade ii. Threaded cylindrical cages made of titanium, cortical allograft donor bone or synthetic bone. Nov 02, 2018 pfna ii could avoid lateral cortex impingement while providing fast and stable fixation of unstable pertrochanteric fractures. Often, these are treated with intramedullary nails. Pfna proximal femoral nail antirotation in medical. Health, general fracture fixation equipment and supplies methods fracture repair hip fractures care and treatment hip joint fractures orthopedic fixation devices usage. Surgical technique is an important factor in the out. Pfna ii could avoid lateral cortex impingement while providing fast and stable fixation of unstable pertrochanteric fractures. Loo wee lim, department of orthopaedic surgery, changi general hospital, 2 simei street 3, singapore 529889. However, proper operative technique is important for achieving fracture stability and to avoid major complications.
Should the tipapex distance tad rule be modified for. Full text of the pfnar augmented in revision surgery of. The books homepage helps you explore earths biggest bookstore without ever leaving the comfort of your couch. Surgical technique is an important factor in the outcome of treatment for intertrochanteric hip fracture, and that it can be influenced by education and improved methods of assessment. The best intramedullary nail for the treatment of unstable aoota 31. The pfna blade, proximal aspect of the broken nail, and screw at the proximal femur was removed in standard. Pfna ii has been improved for the asian patient with a flattened lateral surface, and. However, technical difficulties and implant related complications have been described with this technique, thus we need more studies to address these issues. Conclusion pfna ii avoided lateral cortex impingement experienced with pfna, providing fast and stable fixation of the unstable peritrochanteric fractures. The synthes proximal femoral nail antirotation pfna is unique because it is the only proximal femoral intramedullary nail which employs a helical blade in lieu of a.
Analysis of treatment outcome of patients with intertrochanteric femoral fractures undergoing surgical management by proximal femoral nail antirotation pfna. Standard surgical technique was used for both pfna ii and dhs. Aorn promotes safe care for patients undergoing operative and other invasive procedures by creating this collection of evidencebased and evidencerated perioperative guidelines. Step by step instructions to achieve a perfect proximal. The treatment of this type of fracture remains a challenge for surgeons. The proximal femoral nail antirotation pfna, 11 a modification of the proximal femoral nail, uses helical neck blade fixation to obtain high stability to prevent rotation and collapse. The medical implant is mainly fabricated using stainless steel and titanium alloys for strength and the plastic coating that is done on it acts as an artificial cartilage. Gerhard kuntscher is credited with the first use of this. Features of the proximal femoral nail antirotation pfna asia the proximal femoral nail antirotation pfna, with its helical blade concept, is a stateoftheart treatment method for proximal. Review of proximal nail antirotation pfna and pfna2 our local experience wl loo, m med orth, syj loh, frcs edin, hc lee, frcs edin department of orthopaedic surgery, changi general hospital, singapore corresponding author. Careful surgical technique and modification of the pfn can reduce the high complication rate. The current main techniques of posterior lumbar interbody fusion plif surgery all incorporate a supplementary intervertebral implant. Radiographic and functional results of osteosynthesis using the proximal femoral nail antirotation pfna in the treatment of unstable intertrochanteric femoral fractures acta orthop traumatol turc 2010.
Proximal femoral nail antirotation2 pfna 2 is the newer design and has been widely used to treat this fracture 5. Request a surgical technologist evaluation daily unless told differently by the program director. 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. Full text of the pfnar augmented in revision surgery of proximal femur fractures. The envelope was opened prior to surgery by the operating surgeon. This site is published by the depuy synthes companies, which are solely responsible for its content.
Both groups were similar with regard to general and local wound complications. Pdf proximal femoral nail antirotation in treatment of. Geometric parameters proximal diameter, mm length of helical blade, mm ccd angle, degree medial lateral angle, degree pfna ii proximal femoral nail antirotation. The proximal femoral nail antirotation, known as the pfna, is an intramedullary implant for the treatment of unstable trochanteric femoral fractures. In the present study, 73 unstable intertrochanteric fractures underwent surgical fixation with proximal femoral nail antirotation 2 pfna2. Reason and treatment of failure of proximal femoral nail.