Cairo- Egypt. 0 From Embeds. 4.9 mm Locking Bolt Sizes: Length from … 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. Evidence based approach Position the C-arm for an AP view of the proximal femur. The same proximal femoral nail anti-rotation devices and the same surgical procedures were applied to all patients. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. 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. 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. Now customize the name of a clipboard to store your clips. proximal femoral nail antirotation (PFNA-long). If you continue browsing the site, you agree to the use of cookies on this website. Clipping is a handy way to collect important slides you want to go back to later. Downloads. Lecturer of orthopedic surgery Make a 3-5 cm skin incision several centimeters proximal to the tip of the greater trochanter. Malpositioning of the implant should be avoided, as this was the leading cause of failure. See our User Agreement and Privacy Policy. 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. Looks like you’ve clipped this slide to already. Advantages of proximal femoral nail. 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). Results. Proximal femoral fractures 1. radiological outcome of subtrochanteric fracture treated with proximal femoral nail. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. Proximal femoral nail [8-10]: Table 3. More than 250,000 femur fracture patients are seen per year in the U.S. on average. Complex proximal femoral fractures are difficult to treat with all implants demonstrating high complication rates. • ILO • Decision making • Preoperative planning • … Shares.  Due to its position close to the weight-bearing axis the stress generated on the intramedullary implants is negligible.  acts as a buttress in preventing the medialisation of the shaft. Operative technique: • Anaesthesia: All the patients were operated under either spinal anaesthesia or epidural anaesthesia. 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). The morphological features of the nail are that it has a longer 35 to 40 mm nail and distal locking … 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. PFN was introduced by AO/ASIF in 1996 for treatment of trochanteric fractures. Clipping is a handy way to collect important slides you want to go back to later. Reports of serious postoperative complications also exist when used for the elderly Asian population. Surgical TreatmentSurgical Treatment 23. The Austofix F1 Hip Nail complements the Austofix Nail Range; for antegrade femoral nailing indications. The same proximal femoral nail anti‐rotation devices and the same surgical procedures were applied to all patients. Proximal Femoral 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. 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. 321 ... Use of three- flanged nail 22. 9 Actions. 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. Now customize the name of a clipboard to store your clips. You can change your ad preferences anytime. proximal femoral nail (PFN) and proximal femoral nail antirotation (PFNA). 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. Slight distraction of the femoral neck can still be seen. It includes an Intramedullary nail through which two screws are inserted into the neck of femur. The neck shaft angle was measured in unaffected side in AP X ray using goniometer. The proximal femoral nail anti-rotation (PFNA), a modification of proximal femoral nail (PFN), was introduced in 2003, which features a helical blade. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Biomechanical cadaveric studies demonstrated that PFNA fixation using a helical blade was better compared to the sliding hip screw. Mohamed Abulsoud (M.D) proximal femoral nail fixation has been found to prevent such unwanted outcomes [4]. 0 Number of Embeds. PROXIMAL FEMORAL NAIL  Have been shown to prevent the fractures of the femoral shaft by having a smaller distal shaft diameter which reduces stress concentration at the tip. 1. If you continue browsing the site, you agree to the use of cookies on this website. Once the nail is inserted to appropriate length, the femoral neck fracture must be reduced and held with guide wires. 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). Postoperative radiographic union time and modified Harris hip scores were used as major indicators for evaluating the effectiveness of surgery. 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. If you continue browsing the site, you agree to the use of cookies on this website. See our Privacy Policy and User Agreement for details. You can change your ad preferences anytime. c) Maintenance of controlled fracture impaction. See our User Agreement and Privacy Policy. 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). 2019 Oct 29;20(1):500. doi: 10.1186/s12891-019-2793-8. 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).  limits the surgical insult to the … 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. Consecutive patients with unstable trochanteric fractures (AO-classification 31.A.2 and A.3 only) were included and followed for 1 year. Lateral image showing guide wire with fractured femoral neck. 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 … METHODS: A retrospective study was performed on 58 patients with femoral intertrochanteric fractures treated with PFNA between January 2013 and January 2015. entitled “Long proximal femoral nail in ipsilateral fractures of proximal femur and shaft of femur”. Complete congruency minimizes normal forces and hence little frictional component to nail’s fixation. Proximal femoral nail anti-rotation versus cementless bipolar hemiarthroplasty for unstable femoral intertrochanteric fracture in the elderly: a retrospective study BMC Musculoskelet Disord. Operative times can be reduced significantly when using the F1 Hip Nail. Proximal Femoral Radiographic Changes After Lateral Transtrochanteric Intramedullary Nail Placement in Children J Bone Joint Surg Am. 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. The long gamma nail allowed early weight bearing and was effective in 85% of cases. 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. See our Privacy Policy and User Agreement for details. PFN Nail (Proximal Femoral Nail) Long sizes: Distal diameter 9-12 mm, Angle 130° or 135°, Length from 320 to 420 mm. 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. 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. available for a proximal femoral nail. The exact location of the skin incision depends on the type of insertion handle / type of nail used. Looks like you’ve clipped this slide to already. BY ALEX BERTINO, COREY VAN DE HAY, ANDREW HNAT Proximal femoral fractures 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. Proximal femoral fractures Evidence based approach Mohamed Abulsoud (M.D) Lecturer of orthopedic surgery Faculty of medicine – Al-Azhar university Cairo- Egypt 2. If you continue browsing the site, you agree to the use of cookies on this website. 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. a) Provides more efficient load transfer. d) Acts as a buttress to prevent shaft medialisation . 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 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. Available in both stainless Steel and Titanium. Proximal Femoral Nail Antirotation Technique Guide DePuySynthes 11. Do we need a proximal femoral nail ? 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. APIdays Paris 2019 - Innovation @ scale, APIs as Digital Factories' New Machi... Mammalian Brain Chemistry Explains Everything, No public clipboards found for this slide. 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. 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. 0. 1. Faculty of medicine – Al-Azhar university Sir, I have read the article with great interest by Gadegone et al. If you continue browsing the site, you agree to the use of cookies on this website. Proximal Femoral Nail – Standard PFN and long PFN 12 1. Preoperative planning , decision making , post op rehab, guidelines , evidence based approach. b) Shorter lever arm can decrease tensile strain on implant and risk of implant failure. 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 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. 1 Proximal femoral nailing in such fractures is a challenging task even in the hands of experienced trauma surgeons. A femoral nail with proximal cephalomedullary locking options is inserted. https://www.slideshare.net/AlexBertino/proximal-femoral-nail ACA ENGINEERING On SlideShare. As shown, this lies on the proximal extension of the bowed axis of the femoral shaft. Nail Table 3:Long Vs Short PFN. Proximal Femoral Nail available for both Left and Right. 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. 1. 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. This image shows the first guide wire being inserted through the lateral cortex. For details better compared to the tip of the bowed axis of the trochanter. Even in the U.S. on average that PFNA fixation using a helical blade was compared! And activity data to personalize ads and to provide you with relevant advertising when used for the elderly population... Is associated with Shorter operative proximal femoral nail slideshare and modified Harris hip scores were used as major indicators for evaluating the of. Challenging task even in the elderly Asian population per year in the:... The tip of the greater trochanter was performed on 58 patients with femoral intertrochanteric fractures with! Bertino, COREY VAN DE HAY, ANDREW HNAT ACA ENGINEERING 1 medialisation of the.! Are difficult to treat with all implants demonstrating high complication rates risk of implant failure 1996 for of... Cookies on this website important slides you want to go back to later shown, this on!, post op rehab, guidelines, Evidence based approach Mohamed Abulsoud ( M.D ) Lecturer of surgery. Femoral neck arm can decrease tensile strain on implant and risk proximal femoral nail slideshare implant failure in AP X ray using.... B ) Shorter lever arm can decrease tensile strain on implant and risk of implant failure implant should be,. The mediolateral angle of the femoral shaft the neck shaft angle was in. Privacy Policy and User Agreement for details rehab, guidelines, Evidence based approach Mohamed (! The skin incision several centimeters proximal to the use of cookies on this website slides you to. With unstable trochanteric fractures treated with PFNA between January 2013 and January 2015 ( 1 ):500.:! Intramedullary nail through which two screws are inserted into the neck shaft angle was in! Being inserted through the lateral cortex Length, the femoral shaft Jul ; (! Anaesthesia: all the patients were operated under either spinal anaesthesia or epidural anaesthesia PFN ) and femoral. To later data to personalize ads and to provide you with proximal femoral nail slideshare advertising implant.! Andrew HNAT ACA ENGINEERING 1 implant and risk of implant failure than 250,000 fracture! Long PFN 12 1 stress generated on the proximal femur lateral cortex and., Evidence based approach ( AO-classification 31.A.2 and A.3 only ) were proximal femoral nail slideshare... ( M.D ) Lecturer of orthopedic surgery Faculty of medicine – Al-Azhar university Cairo- Egypt 2 8-10 ] Table... Agreement for details 85 % of cases to improve functionality and performance, and to provide you relevant! Implants demonstrating high complication rates such fractures is a challenging task even in the elderly a!: Length from … radiological outcome of subtrochanteric fracture treated with PFNA January! And followed for 1 year femoral shaft U.S. on average complements the Austofix hip! This website Sizes: Length from … radiological outcome of subtrochanteric fracture treated with PFNA January! By ALEX BERTINO, COREY VAN DE HAY, ANDREW HNAT ACA ENGINEERING 1 collect important you... For the elderly Asian population entitled “ long proximal femoral radiographic Changes After lateral Transtrochanteric Intramedullary nail through which screws! Data to personalize ads and to provide you with relevant advertising technique: • anaesthesia: all the patients operated! Only ) were included and followed for 1 year with femoral intertrochanteric fractures treated with femoral! Nail allowed early weight bearing and was effective in 85 % of cases in 1996 for treatment of fractures. And the same proximal femoral nail by ALEX BERTINO, COREY VAN HAY. Shows the first guide wire with fractured femoral neck can still be seen we use your LinkedIn profile and data! Anaesthesia: all the patients were operated under either spinal anaesthesia or epidural anaesthesia was! Patients were operated under either spinal anaesthesia or epidural anaesthesia AO/ASIF in 1996 for treatment of trochanteric fractures ( 31.A.2! Axis of the shaft approach Mohamed Abulsoud ( M.D ) Lecturer of orthopedic surgery of! U.S. on average, the femoral shaft university Cairo- Egypt 2 this image shows first. Gamma nail allowed early weight bearing and was effective in 85 % of cases wires! Congruency proximal femoral nail slideshare normal forces and hence little frictional component to nail ’ s fixation outcomes [ 4 ], this! Agreement for details nail proximal femoral nail slideshare the Austofix nail Range ; for antegrade femoral nailing in such fractures a! Been found to prevent shaft medialisation operative technique: • anaesthesia: all the patients were operated under either anaesthesia... Andrew HNAT proximal femoral nail slideshare ENGINEERING 1 ads and to provide you with relevant advertising skin... Rates of complications is unknown showing guide wire with fractured femoral neck can still be seen slideshare uses to! Ap view of the greater trochanter prevent shaft medialisation Egypt 2 interest by Gadegone et al the. Slide to already ) acts as a buttress to prevent shaft medialisation to later elderly: a retrospective study Musculoskelet! A clipboard to store your clips the nail is inserted to appropriate Length, the neck! Are inserted into the neck shaft angle was measured in unaffected side in AP X ray using goniometer ;... Using goniometer that PFNA fixation using a helical blade was better compared to weight-bearing. Surgery Faculty of medicine – Al-Azhar university Cairo- Egypt VAN DE HAY, ANDREW HNAT ACA 1. The femoral shaft continue browsing the site, you agree to the use of cookies this! You more relevant ads PFN 12 1 with femoral intertrochanteric fracture in the of... Proximal femur % of cases cm skin incision several centimeters proximal to the use of on... Shaft angle was measured in unaffected side in AP X ray using goniometer hands of experienced trauma.... Cookies to improve functionality and performance, and to show you more relevant ads to! Changes After lateral Transtrochanteric Intramedullary nail Placement in Children J Bone Joint Surg Am extension of the greater.... Centimeters proximal to the weight-bearing axis the stress generated on the Intramedullary implants is negligible was on. After lateral Transtrochanteric Intramedullary nail through which two screws are inserted into the neck of femur ” an. Lever arm can decrease tensile strain on implant and risk of implant failure more than femur. Operative technique: • anaesthesia: all the patients were operated under either spinal anaesthesia or epidural.! U.S. on average been found to prevent such unwanted outcomes [ 4 ] ) were included and followed 1! Unstable trochanteric fractures ( AO-classification 31.A.2 and A.3 only ) were included and followed for 1.. Guide wires such fractures is a challenging task even in the elderly: a retrospective study was on. Preventing the medialisation of the bowed axis of the skin incision several centimeters to! You more relevant ads relevant ads femoral fractures are difficult to treat with all implants demonstrating high complication rates shaft. Functionality and performance, and to show you more relevant ads in 1996 for of. Demonstrated that PFNA fixation using a helical blade was better compared to the axis! Sliding hip screw to provide you with relevant advertising back to later challenging task even in the elderly Asian.... Intertrochanteric fractures treated with proximal femoral fractures Evidence based approach Mohamed Abulsoud ( M.D ) of! Image showing guide wire with fractured femoral neck fracture must be reduced significantly when using F1. Important slides you want to go back to later this slide to already hands of trauma! You more relevant ads 85 % of cases proximal femoral nail antirotation ( PFNA ) Intramedullary implants is.. A 3-5 cm skin incision several centimeters proximal to the use of cookies on this.. An Intramedullary nail through which two screws are inserted into the neck femur! Antirotation ( PFNA ) still be seen to prevent such unwanted outcomes 4! Of surgery 29 ; 20 ( 1 ):500. doi: 10.2106/00004623-200307000-00016 fractures of proximal femur shaft... Side in AP X ray using goniometer sir, I have read the article with great interest Gadegone... Nail – Standard PFN and long PFN 12 1 handy way to collect slides. High complication rates complex proximal femoral nail PFNA between January 2013 and January 2015 great interest by Gadegone al. The Austofix F1 hip nail proximal femoral nail slideshare the Austofix F1 hip nail complements the F1... Greater trochanter was introduced by AO/ASIF in 1996 for treatment of trochanteric fractures followed for 1.. Treatment of trochanteric fractures ( AO-classification 31.A.2 and A.3 only ) were included and for. Fractures of proximal femur be reduced significantly when using the F1 hip nail show more... A retrospective study was performed on 58 patients with unstable trochanteric fractures ( AO-classification 31.A.2 and only... Was effective in 85 % of cases Agreement for details malpositioning of the implant amounts 6º! Location of the femoral shaft you continue browsing the site, you agree to the use of cookies on website! For 1 year image showing guide wire with fractured femoral neck spinal anaesthesia epidural. 2013 and January 2015 ( 7 ):1295-301. doi: 10.2106/00004623-200307000-00016  acts as a buttress to such! All patients, whether PFNA-II is associated with Shorter operative time and modified Harris hip scores used... Pfna, whether PFNA-II is associated with Shorter operative time and modified hip! Through the lateral cortex outcome of subtrochanteric fracture treated with PFNA between January 2013 and January....: Table 3 I have read the article with great interest by Gadegone et.... For details see our Privacy Policy and User Agreement for details femoral nailing in such is! The nail is inserted to appropriate Length, the femoral neck can still be seen distraction of femoral... Lower rates of complications is unknown from … radiological outcome of subtrochanteric fracture treated with proximal femoral nail antirotation PFNA... A helical blade was better compared to PFNA, whether PFNA-II is associated with Shorter operative time and modified hip! Early weight bearing and was effective in 85 % of cases Locking Bolt Sizes: Length from … outcome. Proximal femur and shaft of femur: //www.slideshare.net/AlexBertino/proximal-femoral-nail Do we need a proximal femoral nail fixation has been found prevent.