Does metaphyseal cement augmentation in fracture management. The best intramedullary nail for the treatment of unstable aoota 31. A biomechanical comparison of two intramedullary implants. Introduction e absolute number of pertrochanteric fractures may increase in the years to come, along with the increase of population sagingandosteoporosis,withabsoluteindication for surgery. Implants all intramedullary implants for the femur cfn cannulated femoral nail standard locking tan titaniumaluminiumniobium alloy, cannulated, for procedures with or without reaming. Editorials, letters to the editor, and publications in languages other than english, german, and french were excluded. This site is published by the depuy synthes companies, which are solely. In this study, we aimed to assess the results of osteosynthesis using the pfna system, synthes, switzerland, in the treatment fractures of the. Jcm free fulltext functional and radiological results of.
The aoasif proximal femoral nail antirotation pfna. Pdf the nailshaftaxis of the of proximal femoral nail antirotation. Should the tipapex distance tad rule be modified for the. The best surgical strategy for extracapsular proximal femoral fractures pffs is controversial in the elderly. Proximal femoral nail antirotation technique guide pfna.
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. Oct 17, 20 unstable proximal femoral fractures are common and challenging for the orthopaedic surgeon. The pfna synthes, hertfordshire, uk is available in four sizes standard, small, xs and long and has right and left options for the long nail. Mechanical failures after fixation with proximal femoral nail and risk factors semmi koyuncu,1 task. Several distal locking options static or dynamic locking can. A comparative study of trigen intertan nail intertan. Synthes oberdorf, switzerland, was developed by the aoasif group. The mediallateral angle of 6 allows insertion at the tip of the greater trochanter. Unstable trochanteric fractures have been an enigma for the orthopedic surgeon in the community because of unpredictable results. 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. Helical blade compression failure occurred during pfna implantation. The details concerning the classification of fractures are based on the ao fracture classification.
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 lag screw. The analysis of biomechanical properties of proximal femur after implant removal jaehyukyang, 1 taegonjung, 2 arjunrupanagudihonnurappa, 1 jaemincha, 3 changhwaham, 1 taeyoonkim, 4 andseungwoosuh 1 scoliosis research institute, department of orthopedics, kor ea university medical college, guro hospital, guro dong, gurogu, seoul, republic of. Each of these nails allow compression over the nail\blade with the intramedullary stability. In the synthes pfna technique guide, it underlines removing and replacing the blade if it cannot be locked intraoperatively. Proximal femoral nail antirotation pfnatm fixation of extra. A biomechanical comparison of two intramedullary implants for. Two pfna blade cutout and one pfna blade cutthrough. We assessed the cutout rate, the tad and caltad tip apex distance of three different implants. Bipolar hemiarthroplasty should not be selected as the. Three patients were died within 6 months of follow up. Biomechanical effect of bone cement augmentation on rotational stability and pullout strength of the proximal femur nail antirotationtm. A 3d finite element model of an intact femur was constructed and validated.
Between march 20 and december 2015, fifty patients 28 male and 22 females with a mean age of 72. Does pfna ii avoid lateral cortex impingement for unstable. Followups of 2 4 animals and 4 6 animals months were chosen to investigate possible cartilage damage and subchondral plate alterations in the knee. The optimal tipapex distance is 25 mm or less for a dynamic hip screw. Due to the worlds aging population, intertrochanteric fractures are frequent. Sites at highest risk of fracture include the hipfemur and pelvis in females, and vertebrae in males with anorexia nervosa. Request pdf the new proximal femoral nail antirotationasia. The literature search resulted in numerous reports regarding intraoperative and postoperative complications and technical errors with intramedullary hip nailing for fractures.
The most common mode of failure of any device to treat these fractures is cutout. Aug 17, 2017 depuy synthes impactor for pfna proximal femoral nail antirotation blade. Free fulltext pdf articles from hundreds of disciplines, all in one place reply to letter to the editor. All of failure cases were later converted into bipolar hemiarthroplasty. The following experimental study investigates whether subchondral pmma injection compromises the homeostasis of the subchondral bone andor the joint cartilage. Carefully insert the pfna manually as far as possible into the femoral opening. Pfna nail optimal fit the anatomical design guarantees an optimal fit in the femur. Cephalic intramedullary nails with proximal antirotation device are the treatment of choice for such patients. Nov 17, 2011 proximal femoral nail antirotation pfna versus pfna augmentation the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Proximal femoral nail antirotation in treatment of fractures of.
Comparison of proximal femoral nail antirotation pfna with. Proximal femoral nail antirotation pfna versus pfna. The nail design has been well proven in over 450 000 cases performed with the pfn and pfna. Intertrochanteric fracture with lowenergy trauma in a young. We evaluated radiographic and functional outcomes of patients with unstable pertrochanteric fractures treated with the proximal femur nail antirotation pfna. Migration of the lag screw after intramedullary treatment of. Pfna blades have been biomechanically proven to compact cancellous bone and achieve increased stability and. Synthes long proximal femoral nails pfn, pfnapfnaii and. Does pfna ii avoid lateral cortex impingement for unstable peritrochanteric fractures. Comparing weight bearing after intramedullary fixation. Proximal femoral nail antirotation in treatment of fractures. Mechanical failures after fixation with proximal femoral nail. Article pdf available in clinical orthopaedics and related research 4714. Proximal femoral nail antirotation technique guide synthes 1.
A 29yearold woman known to have suffered from anorexia nervosa 15 years ago visited the emergency department due to right hip pain after. 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. If the pfna cannot be inserted, select a smaller size pfna diameter or ream the medullary cavity to a. On the contrary, none of all patients in cement augmented pfna group were assessed as having mechanical failure caused by pfna blade cutoutcutthrough and having venous thromboembolism in our case series as shown in. To compare the biomechanical stability of the femur following the removal of proximal femoral nail antirotation pfna ii and dynamic hip screw dhs. Ufn unreamed femoral nail cfn cannulated femoral nail. The decreased mediolateral angle of the pfna ii 5 compared with 6 for the pfna and its. Proximal femoral nail antirotation pfna proximal femoral nail antirotation pfna proximal femoral nail antirotation pfna is an intramedullary implant for the treatment of unstable trochanteric femoral fractures, with the additional option of augmentation. Proximal femoral nail antirotation in treatment of. Proximal femoral nail antirotation with cement augmentation. In our practice, we always try to use the recommended entry point for the pfna ii according to the manufacturers suggested surgical technique. The pfna augmented in revision surgery of proximal femur. Research article the analysis of biomechanical properties of.
There were 26 men and 16 women with mean age of 61 years range, 35 90. Oberdorf, switzerland is a recently developed intramedullary fixation device which. After locating a sufficient number of individual complications, the literature search was restricted, combining the term hip nailing with each individual complica tion identified. Research article a study of inflammatorynecrosis biomarkers. Furthermore, the results ofthe primary treatment of osteoporotic proximal femur fractures are promising. May 31, 2014 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. Pfna depuy synthes pdf catalogs technical documentation. Often, these are treated with intramedullary nails. Comparison of proximal femoral nail antirotation pfna.
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. Ten mature sheep were used to simulate subchondral pmma injection. A comparative study of trigen intertan nail intertan and. In five cases revision surgery was performed because of a loosening of the femoral neck implant, in two cases because of a pseudarthrosis, in two cases because of an implant failure and in one case because of a new fracture with the implant being in situ summarized. In the pfnaii group, the pfnaii device synthes, geneva, switzerland, which is composed of a nail and helical blade, was inserted and removed after fixation. The analysis of biomechanical properties of proximal femur. Clavofemoralproximaldeantirrotacion tecnicaquirurgica pfna. Age 75 years and older closed unstable trochanteric fracture. Biomechanical effect of bone cement augmentation on rotational stability and pullout strength of the proximal femur nail. Free fulltext pdf articles from hundreds of disciplines, all in one place comparison of proximal femoral nail antirotation pfna with ao dynamic condylar screws dcs for the treatment for unstable peritrochanteric femoral fractures pdf paperity. The proximal femoral nail antirotation pfna ii is commonly used for treating. A total of 237 patients 45 male, 192 female were eligible for the assessment with an average age of 81. Feb 27, 20 to achieve rotational and angular stability, in 2004, the proximal femoral nail antirotation pfna device, one of the thirdgeneration intramedullary implants pfna.
New advanced nailing system from depuy synthes companies. In the experimental group, pfna ii and dhs were randomly inserted into femurs on both sides and then removed. The nail is 170 mm long, and the proximal and distal diameters are 16. Depuy synthes impactor for pfna proximal femoral nail anti. The pfna augmented proximal femoral nail antirotation, synthes inc. Early results the proximal femoral nail antirotation system was introduced by the arbeitsgemeinschaft fur osteosynthesfragen. The surgery was prolonged due to the jamming of the implants. Proximal femoral nail antirotation surgical technique pfna. 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. The full text of this article is available in pdf format. 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. Pfna nail optimal fit the anatomical design guarantees an optimal. From a biomechanical perspective, these results are.
Proximal femoral nail antirotation pfnatm fixation of. Although proximal femoral nail antirotation pfna and bipolar hemiarthroplasty bph are selected. Listing a study does not mean it has been evaluated by the u. To report outcomes of 36 consecutive patients treated with a proximal femoral nail pfna for osteoporotic trochanteric femoral fractures. Treatment of unstable intertrochanteric fractureswith. Mar 16, 2020 intertrochanteric fractures itfs in the elderly are still a big challenge for clinical doctors. Intraoperative failures of the pfna ii spiral blade oatext. Pertrochanteric femur fractures are considered amongst the most commonly encountered fractures in the geriatric age group. Proximal femoral nail pfna nail the anatomical design guarantees an optimal fit in the femur. Pdf proximal femoral nail antirotation in treatment of. The fractured and postoperative models were accordingly produced. The blade and nail were eventually removed and replaced with an alternative product.