Mechanical failures after fixation with proximal femoral nail. Proximal femoral nail antirotation technique guide depuysynthes 11. Clinicoradiological and functional outcome of unstable. Helical blade compression failure occurred during pfna implantation. Proximal femoral nail antirotation2 pfna 2 has been widely used to treat intertrochanteric fractures with varied outcomes in the previous studies.
Jan 18, 20 we read the article entitled does pfna ii avoid lateral cortex impingement for unstable peritrochanteric fractures. Jan 15, 2016 the purpose of this study was to compare the clinical outcomes of elderly patients undergoing surgery for treatment of unstable trochanteric fractures receiving either proximal femoral nails antirotationasia pfna iis or intertan nails its. The mean surgical time for patients treated with pfna was 57 min range 3296 min and was significantly lower than in those treated with dcs, in which the mean time was 87 range 64178 min p editor, since the clinical introduction of proximal femoral nail antirotation pfna by ao group in 2004 and pfnaii asian version in 2008, this type of cephalomedullary nail with single headneck helical blade were commonly used in unstable pertrochanteric and intertrochanteric fractures in geriatric patients. Previous studies comparing proximal femoral nail antirotation pfna with dynamic hip screw dhs for peritrochanteric fractures reported conflicting findings. Of the many complications following anorexia nervosa, low bone mineral density bmd is a significant risk factor for fractures. Conventional intramedullary nails including gamma 3 locking nail and proximal femoral nail antirotation pfna were designed for.
In addition, there will be no gapped region and no concerned stress riser in a single nailing construct. Totaly 120 cases enrolled were randomly assigned to a lateral decubitus position group and supine position group. Comparison between proximal femur nail pfn and trochanteric femoral nail trochanteric fixation nail tfn. The nailshaftaxis of the of proximal femoral nail antirotation pfna is an important prognostic factor in the operative treatment of intertrochanteric fractures. Sep 29, 2015 pfna nail surgical technique animation created by kems studio. Does pfna ii avoid lateral cortex impingement for unstable peritrochanteric fractures. Pfna blade bone structure after pfna blade insertion cancellous bone is compacted providing additional anchoring to the pfna blade. Pfnaii nail several distal locking options static or dynamic locking can be performed via the aiming arm with pfnaii standard, small and xs. Proximal femoral nail antirotation with cement augmentation. The proximal femoral nail antirotation pfna in the. Proximal femoral nail antirotation in treatment of. In 2007, the aoasif developed the pfna ii also known as pfna asia with sizes and geometry adapted to the femoral geometric proportions of asians. Take a preoperative ap radiography of the unaffected leg. We compared nail positioning, major and minor complication rates, operative and fluoroscopy time, blood transfused, time to mobilization, hospital stay, fracture union, and harris hip score.
Pdf the nailshaftaxis of the of proximal femoral nail antirotation. 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. The pfna is an excellent implant for stabilisation of both trochanteric and complex combination fractures as well as an exceptional device for reosteosynthesis. Antirotation proximal femoral nail versus dynamic hip screw. Proximal femoral nail antirotation2 pfna2 is the newer design and has been widely used to treat this fracture 5. A comparative study of trigen intertan nail intertan and. Comparison of proximal femoral nail antirotation pfna with. Treatment of unstable intertrochanteric fractureswith. The sizes of pfna ii nail used are depicted in table 1. Comparative analysis of three internal fixation methods. Pdf clinicoradiological and functional outcome of unstable. Between january 1, 2012, and june 31, 2015, 168 elderly patients with unstable intertrochanteric femur fractures enrolled in this study.
Mechanical failures after fixation with proximal femoral. The aim of this study was to compare the outcomes of intertrochanteric femur fractures treated with proximal femoral plate pfp and cephalomedullary nail pfna in sardjito general hospital. The aaos 2014 suggested cephalomedullary nail for unstable type of intertrochanteric fracture with a moderate strength of recommendation. Fractures of the proximal femur and hip are relatively common injuries in adults and. Pfnaii protrusion over the greater trochanter in the asian. The objective of this metaanalysis was to compare the efficacy and safety of pfna and dhs for pertrochanteric fractures. A 29yearold woman known to have suffered from anorexia nervosa 15 years ago visited the emergency department due to right hip pain after.
We agree with the importance of keeping the instrument insertion line guide wire, reamer, and the nail coaxial to the femoral canal. Between february 2007 and august 2009, 76 patients underwent the pfna fixation for proximal femoral fractures 15. Comparison of clinical outcomes with intertan vs gamma nail. Recently, severe complications of helical blade perforation through the. This study was proposed to determine the optimal greater trochanteric entry. Clinical evaluation of the asian proximal femur intramedullary nail antirotation system pfnaii for treatment of intertrochanteric fractures. 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. The pfnaii has a mediallateral angle of 5 this allows insertion at the tip of the greater. Antirotation proximal femoral nail versus dynamic hip. Should the tipapex distance tad rule be modified for. The pfna augmented in revision surgery of proximal femur. Intertrochanteric fracture with lowenergy trauma in a young. Intertrochanteric fractures are common injuries in the elderly. Between march 20 and december 2015, fifty patients 28 male and 22 females with a mean age of 72.
The most common mode of failure of any device to treat these fractures is cutout. A comparison of proximal femoral nail antirotation and. The trial 1 participants comparing the intertan nail versus the pfna ii nail found very low quality evidence that more pfna ii group participants experienced thigh pain 347 versus 1246. Clinical evaluation of the asian proximal femur intramedullary nail antirotation system pfna ii for treatment of intertrochanteric fractures should the tipapex distance tad rule be modified for the proximal femoral. Proximal femoral nail antirotation pfna versus gamma. We compared nail positioning, major and minor complication rates, operative and fluoroscopy time, blood transfused, time to.
A comparison of proximal femoral nail antirotation and dynamic hip screw devices in trochanteric fractures. Treatment options for unstable intertrochanteric fractures include intramedullary nail and extramedullary fixation, although evidence regarding the most appropriate treatment for such fractures. Jcm free fulltext functional and radiological results. However, there was some mechanical failure from proximal femoral nail antirotation pfna blade cutout in clinical practice after osteoporotic hip fracture fixation. Aug 18, 2008 proximal femoral nail antirotation pfna versus gamma nail 3 gamma3 for intramedullary nailing of unstable trochanteric fractures progaintes the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Functional and radiological results of proximal femoral nail. The objective of this study was to compare the clinical results and complications of proximal femoral nail antirotation pfna on treatment of intertrochanteric fractures in 120 elderly chinese patients using randomized controlled trials rcts. Pfna nail product range the pfna is available in 4 sizes pfna long, length 300 420 mm, with 20 mm increments, bending radius 1500 mm pfna, length 240 mm pfna small, length 200 mm pfna xs, length 170 mm pfna.
In our study, we highlighted the fact that surgical technique is the key to achieve ideal nail positioning, ensure stable fixation, and prevent major complications. Mechanical failures after fixation with proximal femoral nail and risk factors semmi koyuncu,1 task. Comparative study of the proximal femoral nail antirotation. The aim of the present study was to compare the efficacy and complications of two fixation techniques, namely dynamic hip screw dhs and proximal femoral nail antirotation pfna, in the treatment of osteoporotic femoral intertrochanteric fracture in elderly patients, and to detect changes in transforming growth factor. Research article a study of inflammatorynecrosis biomarkers in the fracture of the femur treated with proximal femoral nail antirotation mariapaolamarino, 1 giuseppepalmieri, 2 marcoperuzzi, 2 flaviascuderi, 3 andemanuelabartoccioni 1,2,3 institute of general pathology, catholic university, rome, italy. Pfna interlocking nail new gam interlocking naillong. Unstable proximal femoral fractures are common and challenging for the orthopaedic surgeon. The pfna augmented proximal femoral nail antirotation, synthes inc. Sites at highest risk of fracture include the hipfemur and pelvis in females, and vertebrae in males with anorexia nervosa. We commend the authors for confirming that the proximal femoral nail antirotation pfnaii could avoid lateral cortex impingement. Comparison of proximal femoral nail antirotation pfna. Intramedullary nails for extracapsular hip fractures in. Pdf proximal femoral nail antirotation in treatment of fractures.
Comparison of the curative effects of pfna and dhs. Commonly used nail diameter was 10 mm, which was used in 33 patients. Reason and treatment of failure of proximal femoral nail. Comparison of efficacy, complications and tgf2 expression. Intertrochanteric fracture with lowenergy trauma in a. From january 2011 to december 2016, 7 elderly patients with intertrochanteric fractures were treated with 3 mehhods, including locking plate, proximal femoral nail pfna and artificial femoral head replacement. Position the carm for an ap view of the proximal femur. The incidence of this disorder has increased markedly in recent years owing to continuously aging populations bonnaire et al. Comparison of the curative effects of pfna and dhs fixation in treating intertrochanteric fractures in elderly patients. Apolymer pink this is a transparent pink powder and used to apply on the pink part of the nail plate. Jul 01, 2012 to the editor, since the clinical introduction of proximal femoral nail antirotation pfna by ao group in 2004 and pfnaii asian version in 2008, this type of cephalomedullary nail with single headneck helical blade were commonly used in unstable pertrochanteric and intertrochanteric fractures in geriatric patients.
We evaluated radiographic and functional outcomes of patients with unstable pertrochanteric fractures treated with the proximal femur nail antirotation pfna. Often, these are treated with intramedullary nails. Anorexia nervosa is associated with higher risk of incident fracture in females across all age groups, and in males. Unstable intertrochanteric fractures were one of the most common fractures of the hip especially in the elderly with osteoporotic bones, usually due to lowenergy trauma and in young adults due to high velocity trauma. Proximal femoral nail antirotation technique guide synthes 3. Galanakos md, phd, konstantinos kateros md, phd, stamatios a.
A retrospective analysis of 127 patients 32 men and 95 women, with mean age 78. The incidence of these fractures was rising because of increasing number of senior citizens with osteoporosis. Article pdf available in clinical orthopaedics and related research 4714. Pfna nail surgical technique animation created by kems studio. Does pfna ii avoid lateral cortex impingement for unstable. Loo wee lim, department of orthopaedic surgery, changi general hospital, 2 simei street 3, singapore 529889. Furthermore, the results ofthe primary treatment of osteoporotic proximal femur fractures are promising.
The results obtained with this implant in previous studies had varied outcome. Pfn nails ask price proximal femoral nail pfn are used to fix pertrochanteric, intertrochanteric, high subtrochanteric and transcervical fractures of the femur. Cephalomedullary nails, including gamma nail, intertan, proximal femoral nail pfn and pfna, are now favoured in the treatment of unstable proximal femur. The pfnaii long additionally allows for secondary dynamization. A retrospective analysis of the intertan nail and proximal. Pfna, designed by ao in 2004, is an intramedullary device with a helical blade rather than a screw for better purchase in the femoral head 2, 3. Proximal femur nail in intertrochanteric fractures indications and. We read the article entitled does pfna ii avoid lateral cortex impingement for unstable peritrochanteric fractures.
Despite the biomechanically proved advantages of the pfna in the treatment of unstable. Synthes, oberdorf, switzerland is an intramedullary device with a helical blade that was developed by aoasif davos, switzerland in 2004. Clinical evaluation of the asian proximal femur intramedullary nail. Comparing the intramedullary nail and extramedullary fixation. The entry point of the nail plays an important role in achieving acceptable reduction, stable fixation, and avoiding implant related complications. The study aimed to investigate the effect of ratios of marrow cavity diameter to intramedullary nail diameter from different layers on hidden blood loss hbl, overt blood loss obl and total blood loss tbl during using proximal femoral nail antirotationasian version pfnaii for femoral intertrochanteric fractures we retrospectively studied 70 patients treated in our hospital recently. Comparison of the curative effects of pfna and dhs fixation.
Nov 21, 2017 intertrochanteric fractures are common injuries in the elderly. Jan 01, 2012 previously, the recon nail was used to stabilize comminuted subtrochanter fractures. A total of fifty one patients with intertrochanteric femur fractures treated surgically with either pfp or pfna in our hospital. Treatment of proximal femur osteomyelitis occurred after. Proximal femoral nail antirotation technique guide use the preoperative planner template for the pfna to estimate the ccd angle, nail diameter and length. In the synthes pfna technique guide, it underlines removing and.
Comparison of clinical outcomes with intertan vs gamma. Examples include the gamma nail strykerhowmedica, the intramedullary hip screw smith and nephew richards, the proximal femoral nail synthes and the ace trochanteric nail depuy orthopaedics. Pertrochanteric femur fractures are considered amongst the most commonly encountered fractures in the geriatric age group. Ipsilateral femoral neck and shaft fractures fixation with proximal. A twostage surgery, including removal of the existing pfna to treat the infection and stable fixation to treat the nonunion, is generally performed but requires a prolonged hospitalization period. The results of unstable intertrochanteric femur fracture. Apolymer clear this is a 100% transparent powder and very suitable to create a natural effect on a beautiful nail plate. Effects of the ratios of marrow cavity diameter to.
Wenjiang duan, yu wu, guoyin liu, jianmin chen department of orthopaedics, bayi hospital affiliated nanjing university of chinese medicine, nanjing, pr china abstract. In our experience, proximal femoral nail antirotation pfna is an excellent device for osteosynthesis as it can be easily inserted, it provides angular and rotational stability and allows early weight bearing on the affected limb. Comparison of the curative effects of pfna and dhs fixation in treating intertrochanteric fractures in elderly patients biomed res india 2017 volume 28 issue 6 2719. Randomized controlled trials of proximal femoral nail. Poinformatie en complicaties werden geregistreerd, en beoordelingen van het functioneel resultaat werden gemaakt.
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. Review of proximal nail antirotation pfna and pfna2our. Large surface and increasing core diameter guarantee maximum compaction and optimal hold in bone increased stability caused by bone compaction around the. Proximal femoral nail antirotation surgical technique depuy synthes 11 2 confirm nail length and diameter instrument 309. Anorexia nervosa is a chronic psychiatric disease defined by severe weight loss, due to fear of obesity, and selfimposed semistarvation. Comparison of outcome between proximal femoral plate and. It is easily inserted with few intra and postoperative complications and allows early weight bearing on the affected limb as well as quicker rehabilitation of patients. Determine the ccd angle using a goniometer or the preoperative planning template. Proximal femoral nail antirotation pfna versus gamma nail. Jan 18, 20 a retrospective analysis of 127 patients 32 men and 95 women, with mean age 78. Proximal femoral nail antirotation pfna versus gamma nail 3 gamma3 for intramedullary nailing of unstable trochanteric fractures progaintes the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. A comparison of proximal femoral nail antirotation and dynamic hip screw.
Jan 01, 2016 the incidence of proximal femur fractures is increasing proportionally with the aging of the population, since it is a lesion typically found in the elderly. All patients received prophylactic antibiotic cefazolin within 1 hour of skin incision. Listing a study does not mean it has been evaluated by the u. The nail design has been well proven in over 200 000 cases performed with the pfn.