Complex proximal femoral fractures in the elderly managed. Pdf trochanteric buttress plate combined with proximal. Osteosynthesis with the proximal femoral nail pfn features the advantages of high rotational stability of the headneck fragment, an unreamed implantation technique and the possibility of static or dynamic distal locking. Proximal femoral nail versus dynamic hip screw fixation. Complicated multiple trauma injuries, associated pelvic and acetabular frac tures. Sixteen patients had proximal femoral fractures and 23 patients had femoral metastases. Besides the t2 femoral nail with a 3m radius of curvature, stryker offers also a 1. Reason and treatment of failure of proximal femoral nail antirotation internal fixation for femoral intertrochanteric fractures of senile patients j. As the nail passes through the middle of the bone, it serves to. Current techniques of femoral lengthening rely on gradual distraction with use of external fixation to form new bone in the distraction gap.
Apr 18, 2020 femoral nailing is a surgical technique used to treat a fractured or broken femur, or thighbone. Benefits of early intramedullary nailing in femoral metastases. Some recommend that all such nails be removed after fracture healing,1,2 whereas others prefer to remove only those that cause symptoms. This study aims to evaluate use of the russelltaylor reconstruction nail rtrn in this group with regard to mortality risk, complication rates and final outcome. However, the use of the nail is technically ambitious and is accompanied by some risks of error, which can lead to failure of the osteosynthesis. Nail combines the principles of a compression hip screw with. Feb 04, 2017 in this presentation intramedullary nailing of the femur will be demonstrated using the expert a2fn. Then you can start reading kindle books on your smartphone, tablet, or computer no kindle device required.
This serves not only to reduce the fracture, but also permits free access to the greater trochanter. Mechanical failures after fixation with proximal femoral. A secondary highvelocity trauma to a previously stabilized femoral fracture with intramedullary nailing is rare. The nails have been designed for specific applications to help restore the shape of the fractured bone to its natural, preinjured state. If the nail cannot be inserted, select a smaller size nail diameter. Phoenix antegrade femoral nail system featuring corelock. Proximal femoral nail versus dynamic hip screw fixation for. These techniques of distraction osteogenesis have two distinct phases of.
Oct 15, 20 we made a retrospective study of 65 patients with femoral metastases treated with intramedullary nails between 1995 and 2011 at the department of traumatology in hospital clinico san carlos in madrid. Proximal femoral nails antirotation, gamma nails, and. Proximal femoral nail pfn are used to fix pertrochanteric, intertrochanteric, high subtrochanteric and transcervical fractures of the femur. Canal preparation nail selection figure 10 figure 11 surgical technique proximal end color pink darkgolden nail type left right neogen femoral nail. Intramedullary nails used for fixation of femoral fractures may require removal for a variety of reasons. Innovative technique article pdf available in open journal of orthopedics 0806. The procedure is performed using a lateral trochanteric entry point to facilitate a simplified procedure, and reduces the danger to blood. Treatment of the intertrochanteric femoral fracture with proximal femoral nail. Nail sizing using telescoping gauge the telescoping nail measuring gauge is placed over the 98cm ball tip guide wire until it rests on the trochanter figure 11. All randomized controlled trials comparing proximal femoral nail and dynamic. Safe, rapid, and effortless femoral nail removal using a.
Long nail achei ve proper aigl nment of the inuj red lmi b pori r to reamni g. Pedinail intramedullary nail the pedinail intramedullary nail is anatomically designed to meet the unique needs of pediatric and adolescent patients, and is available in diameters of 7, 8, 9, and 10mm with lengths ranging from 2038cm. Operative treatment fixedangle nailplate devices the first successful implants were fixedangle nailplate devices e. Kukla c, pichl w, prokesch r, jacyniak w, heinze g, gatterer r, et al. If advancement of the nail is difficult remove the nail and ream up another. Ufn unreamed femoral nail cfn cannulated femoral nail. Short nail confirm that the femoral diaphysis is wide enough and long enough to allow the selected nail diameter to pass. The unreamed femoral nail ufn and the cannulated femoral nail cfn are used to stabilize diaphyseal and metaphyseal fractures of the femur. Pdf short proximal femoral nail fixation for trochanteric. Intramedullary nailing for femur fracture management. Unfollow femoral nail to stop getting updates on your ebay feed. Pitfalls and complications in the use of the proximal femoral. The treatment of stable and unstable proximal femoral fractures with a new trochanteric nail.
W grechenig, r szyszkowitzthe proximal femoral nail pfn a minimal invasive treatment of unstable proximal femoral fractures. Since its introduction as a treatment for femoral and tibial shaft fractures, indications for use of intramedullary. Trigen im nail system femoral tibial intertan short and long lengths metanail retrograde femoral fan femoral antegrade nail standard and recon locking options tan metanail tibial trochanteric antegrade nail standard and recon locking options. Proximal femoral nails antirotation, gamma nails, and dynamic. To estimate the nail diameter, place the template on the lateral xray of the uninjured femur and measure the dia.
Your child will be able to move his hip, knee and ankle on the operated side. The zimmer natural nail system is a system of intramedullary im nails, screws, instruments and other associated implants that are designed to provide stable internal fixation for fractured long bones. Enter your mobile number or email address below and well send you a link to download the free kindle app. The purpose of this metaanalysis was to find out whether the proximal femoral nail was better than the dynamic hip screw in the treatment of trochanteric fractures with respect to operation time, blood transfusion, hospital stay, wound complications, number of reoperation, and mortality rate.
Using controlled blows with the mallet, drive the nail into the distal femur. Proximal femoral nail standard pfn and long pfn 12 1. Femoral universal femoral universal nailing system options. At postmortem, bony metastases have been found in 70% of patients dying from breast and prostate cancer. These devices have been found to suffer from cutout, implant breakage, femoral shaft fractures, and subsequent loss of reduction in clinical practice domingo et al. Pdf the treatment of trochanteric femoral fracture with. We propose to improve the use of proximal femoral nail antirotation in korea by reporting anatomical measurements of the normal korean. Plan the diameter of the nail on the basis of a measurement of the medullary canal on a calibrated radiograph. The ufn is preferably used with the unreamed technique while, since it is cannulated, the cfn is primarily used with the reamed technique using a guide wire. Femoral lengthening over nail video journal of orthopaedics.
This material is intended for the sole use and benefit of the biomet sales force and health care. Solid and cannulated nails technique guide synthes synthes on. Cai 1department of orthopedic surgery, shanghai tenth peoples hospital, tongji university, school of medicine, shanghai, china. With the ball tip end resting at the desired level, distal end of nail the telescoping tube is extended to the end of the guide wire. Orthopaedic advances motorized intramedullary nail for management of limblength discrepancy and deformity abstract distraction osteogenesis has been used for more than 50 years to address limblength discrepancy and deformity. Prep the hip limb free, circumferentially from the hemi pelvis to the toes, to ensure access to the lesser trochanter. Utilizing the trigen sureshot distal targeting system. A new design for the treatment of unstable proximal femoral fractures. In this presentation intramedullary nailing of the femur will be demonstrated using the expert a2fn. Orthopaedic advances motorized intramedullary nail for. The pedinail intramedullary nail is anatomically designed to meet the unique needs of pediatric and adolescent patients, and is available in diameters of 7, 8, 9, and 10mm with lengths ranging from 2038cm. Be sure that the nail slides free over the guide wire to prevent advancement of the guide wire distally. It has been estimated that intertrochanteric fractures occur in more than 200,000 people each year in the united states, with reported mortality rates ranging from 15% to 30% there is a considerable debate regarding which is the optimal implant for fixing intertrochanteric fractures. Proximal femoral nail antirotation versus gamma3 nail for intramedullary.
Reason and treatment of failure of proximal femoral nail. The procedure involves inserting a metal rod called an intramedullary nail, or femoral nail, into the femur and positioning it so that it runs vertically along the length of the shaft. Proximal femoral nail in reverse trochanteric femoral fractures. Retrograde femoral trigen metanail tibial trigen fan femoral antegrade nails. Femoral shaft fracture intramedullary nailing femur fracture.
The trigen tan and fan intramedullary nails are indicated for. Medial migration into the pelvis of the femoral head lag screw, similar to the reverse zeffect, may occur with hip nails comprising a single femoral head lag screw. Lavini f, renzi brivio l, aulisa r, cherubino f, di seglio pl, galante n, leonardi w, manca m. Pdf treatment of the proximal femoral fractures with. Unstable proximal femoral fractures and pathological lesions involving the trochanteric region in the elderly comprise an increasing workload for the trauma surgeon as the ageing population increases.
Ream as necessary to enlarge the diaphysis to accept the selected nail. Femoral neck fracture after removal of the standard gamma interlocking nail. This is an example of a surgery to fix a femur thigh bone fracture utilizing an intramedullary nail. A cadaveric study to determine factors influencing the biomechanical properties of the proximal femur. Affixus hip fracture nail surgical technique zimmer biomet. The joints will remain flexible and muscle strength. Standard pfn and long pfn simple, reliable, versatile. Treatment of the proximal femoral fractures with proximal femoral nail antirotation pfna.
Retrograde femoral nailing has expanded the use of intramedullary nails 1, 2. All nail insertions in acute cases should be performed using a traction table or a reduction device. In most cases, neither a cast nor brace will be required postsurgery. The patient is positioned supine on the traction table. This is a minimally invasive way of fixing this surgical problem and allows for immediate range of motion and full weightbearing.
We made a retrospective study of 65 patients with femoral metastases treated with intramedullary nails between 1995 and 2011 at the department of traumatology in hospital clinico san carlos in madrid. 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. Dec 01, 2016 the most common site for cancer to spread is bone. Surgical technique for the afn antegrade femoral nail afn surgical technique 11 p a 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. Femoral shaft fracture intramedullary nailing femur. Complex proximal femoral fractures in the elderly managed by. Find details of companies offering proximal femoral nail at best price. Volume 43, supplement 2, december 2012, pages s47s54. Mechanical failures after fixation with proximal femoral nail and risk factors semmi koyuncu,1 task. Apr 15, 2004 osteosynthesis with the proximal femoral nail pfn features the advantages of high rotational stability of the headneck fragment, an unreamed implantation technique and the possibility of static or dynamic distal locking.
The remotecontrolled magnetic intramedullary nail is a telescopic implant that contains a magnet that turns a gear box to induce controlled elongation of the nail. The centronail titanium universal femoral nailing system. Femoral universal femoral universal nailing system. In this paper, we present the management of a 40yearold man presented with a bent intramedullary nail due to secondary trauma. Access is improved by inclining the trunk towards the uninjured side by about 25. Intramedullary nailing using the expert antegrade femoral. Trochanteric buttress plate combined with proximal femoral nail for unstable intertrochanteric fractures. Due to the prevalence of cancer, bone metastasis and the associated management represents a huge. Randomised comparison of the gamma nail and the pfn. A lateral longitudinal femoral osteotomy was used for the resection of the distorted nail. Lengthening of the femur with a remotecontrolled magnetic. Solid and cannulated nails technique guide synthes paperback 1996. Failure of intramedullary femoral nail with segmental.
Phoenix antegrade femoral nail system featuring corelock technology 20 biomet orthopedics form no. The short proximal femoral nail is a superior implant for stable and unstable intertrochanteric. Finite element analysis of proximal femur nail for. Femoral nailing is a surgical technique used to treat a fractured or broken femur, or thighbone. Proximal femoral nails antirotation, gamma nails, and dynamic hip screws for fixation of intertrochanteric fractures of femur. Femoral shaft fractures proximal or midshaft femoral nonunions and malunions pathologic fractures in osteoporotic bone of the diaphyseal area revision procedures retrograde locking option antegrade locking options the universal femoral nail hole configurations provide a number. The current status of prophylactic femoral intramedullary.
For the freehand distal locking screws, follow the proce dure described in section retrograde approach free hand locking, steps 2 to 6. Common 5mm cortical screws simplify the surgical procedure and promote a minimally invasive approach. A wide variety of proximal femur nail options are available to you. Treatment of trochanteric fractures with proximal femoral nail. The rod is fixed by screws at both ends and will keep the bone stable in order to ensure proper healing. Zimmer natural nail system retrograde femoral nail surgical. Pdf treatment of the intertrochanteric femoral fracture. With a growing aging population, the incidence of intertrochanteric fractures is rising.
The femur was reconstructed with a new nail, and the fixation. Short proximal femoral nail fixation for trochanteric fractures. Proximal femoral nail antirotation versus gamma3 nail for. Retograde nail antegrade femoral nail distal femoral nail supra condylar nail 6. The aoasif proximal femoral nail antirotation pfna.
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