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. The treatment of proximal femoral fractures in geriatric osteoporotic patients continues to be a challenge in orthopedic trauma. Radiographs were obtained at each followup, and all implant position changes, complications, and fixation failures were recorded. More patients in the recon nail group underwent major or minor reoperation p. Pfna nail product range the pfna is available in 4 sizes pfna small, length 200 mm pfna long, length 300420 mm, with 20 mm increments, bending pfna. In the nail shaft engaged group, a suitable diameter of the nail was chosen and the nail was advanced adequately. Sep 05, 2017 dhs vs pfna for intertrochanteric fractures dr chintan n patel 1. A biomechanical comparison of two intramedullary implants for. Treatment of trochanteric fractures with the pfna proximal. Followup occurred at 1, 3, 6, and 12 months postoperatively and yearly thereafter. The following were the observations made and the available data is analyzed as follows. Efficacy of femoral nail antirotation of helical blade in. A metaanalysis to access the pros and cons of proximal femoral nail antirotation pfna versus intertan nail for intertrochanteric femoral fractures including available evidence extracted from literature.
Objectiveto investigate the effect of anglerassisted proximal femoral nail antirotation pfna spiral blade fixation in treating femoral. The tfna system truly is a global platform that delivers modern innovation. Treatment was applied with pfna in 33 patients and with intertan nail in 36. At 6 weeks postoperatively, ap c and lateral xrays d showed a perforation of the helical blade through the. The nail design has been well proven in over 200 000 cases performed with the pfn. The pfnaii has a mediallateral angle of 5 this allows insertion at the tip of the greater. For patients with a shorter height, we carefully considered whether or not to use the pfnaii. Proximal femoral nail antirotation surgical technique depuy synthes 11 2 confirm nail length and diameter instrument 309.
Standard pfn and long pfn simple, reliable, versatile. In the light of these issues, the pfna device was designed. In this study, 19 patients were less than 60 years of age, 19. Review article comparisons of internal fixation treatments. Pfna and dhs for unstable pertrochanteric fracture table 1. Full list of author information is available at the end of the article. Loo wee lim, department of orthopaedic surgery, changi general hospital. Original article biomechanical evaluation of an improved pfna. Three patients were lost followup and 2 patients died at the end of one year, so 44 cases were available for final study. We conclude that the proximal femoral nail antirotation 2 pfna2 was an ideal implant. Changing the column screw into a helical blade increases the contact surface area between the purchase holding device and the femoral head cancellous bone 4. Pfnaii is designed for asians based on anatomical characteristics of the proximal femur and is better than pfnai in. Proximal femoral nail antirotation pfna is a routine method to deal with.
A proper length spiral blade was selected and placed into femoral neck through an interlocking nail under the guide of a locator. Department of orthopedic surgery, fortis hospitals ltd. Clinical study randomized controlled trials of proximal. Recent clinical studies have shown that pfna is the. Pdf the proximal femur nail antirotation represents a new generation of intramedullary nailing devices for fixation of stable and unstable. Proximal femoral nail antirotation the pfna system was developed by the aoasif in 2004. Original article biomechanical evaluation of an improved. Intertan nail versus 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.
Antirotation proximal femoral nail versus dynamic hip screw for intertrochanteric fractures. Original article proximal femoral nail antirotation. Research article open access clinical evaluation of the. However, the literature regarding treatment of basal fractures with pfnaii is still very sparse and there are few data regarding treatment. A comparison of the intertan nail and proximal femoral. A comparison of proximal femoral nail antirotation and. Ipsilateral femoral neck and shaft fractures fixation with. The proximal femoral nail antirotation pfna device was. Pdf functional and radiological results of proximal femoral. This study sought to compare the effects of proximal femoral nail antirotation pfna and dynamic hip screw dhs helical blade treatments in patients with osteoporotic femoral intertrochanteric fractures.
As implant designs have improved and demonstrated greater longterm success, such helical blade implants have gradually become more popular and have gained acceptance among trauma surgeons. A comparison of the proximal femoral nail antirotation device. Various kinds of cephalomedullary nails, such as gamma nail, intertan and pfna were used clinically. Some clinical studies have previously reported that the shortterm clinical outcomes of pfnaii are satisfactory in most patients, and it provides an anatomy matched with the narrower and shorter femurs of asians and contributes to. Distally there are two slots for static and dynamic locking. Comparison of clinical outcomes with three different. Dhs vs pfna for intertrochanteric fractures dr chintan n patel.
Pdf functional and radiological results of proximal. We searched the embase and pubmed databases in accordance with inclusion and exclusion criteria. The conventional blade removal process is well described in the manual. Pdf treatment of the proximal femoral fractures with. According to sharma and mahajan, pfna has a superior performance over pfn in the setting of osteoporosis, which is attributed. Pfna depuy synthes pdf catalogs technical documentation. The tfna system is designed to advance the treatment of trochanteric fractures by providing surgical options that help to preserve bone in insertion area due to reduced critical width, improve anatomical fit 1 and increase implant strength. Dhs vs pfna for intertrochanteric fractures dr chintan n. A 5 cm incision was made over the greater trochanter.
Pdf the proximal femoral nail antirotation pfna device was recently introduced. Randomized controlled trials of proximal femoral nail. 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. 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. It incorporates the best elements of our highly successful global hip nails tfn, pfna, and pfna ii, optimized through input from hundreds of surgeons around the world. Long proximal femoral nail antirotation pfnalong can. For taller patients, patients with evans type iv fractures and patients whose fracture line extended below the lesser trochanter, a 200 or 240mm nail length was considered to increase the stability of the fixation. Totaly 120 cases enrolled were randomly assigned to a lateral decubitus position group and supine position group. The diameter of nail varies from 9 to 12 millimeters depending on patients medullary diameter. Comparison of proximal femoral nail antirotation pfna core. The proximal diameter of the nail is 15 mm and length is 18cm. Proximal femoral nail antirotation2 pfna2 is the newer design and has been widely used to treat this fracture 5. Proximal femoral nail antirotation surgical technique depuy synthes 3 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. Thus, a comparative study on clinical efficacy of dhs, pflcp, and pfna on intertrochanteric femur fracture was expected to provide reference for increasing the healing rate of clinical treat.
Technique step 1reduction the same procedure as for dhs is followed. Eighty elderly osteoporosis patients with femoral intertrochanteric fracture complications admitted to the hospital between january 20 and. A clinical study to evaluate the effectiveness of proximal. Proximal femoral nail antirotation pfna is a novel intramedullary device with a helical blade that is inserted by impaction, causing. Feb 22, 20 the only intervention was intertan nail or pfnaii fixation of the unstable trochanteric fractures. After establishing a finite element model of an unstable intertrochanteric fracture from the femur with a native ccd angle of 127. Clinicoradiological and functional outcome of unstable. Pdf the pfna proximal femur nail in treatment of unstable.
Introduction proximal femoral nail antirotation pfna is a routine method to deal with. The helical blade avoids bone loss that occurs during the drilling and insertion of. The proximal femoral nail antirotation pfna system is an intramedullary nail implant desi gned by the aoasif foundation 7. Insertion of the blade compacts the cancellous bone. Comparison of clinical outcomes with proximal femoral nail. On postoperative radiographs, the change in the neckshaft angle was 8. Proximal femoral nail antirotation technique guide synthes 3.
Proximal femoral nail antirotation technique guide depuysynthes 11. The pfna blade claims to compact the cancellous bone to provide increased stability and this has been biomechanically proven to retard rotation and varus collapse. Handout english intertrochanteric femoral fractures nlogo. After pfna nail is inserted to adequate depth of the medullary canal. Hospital between january 2015 and december 2017 were enrolled for the study and randomized into the pfna group and the ha group n50 in each group. Patients in the pfna group were applied proximal femoral intramedul lary nail fixation, whereas those in the ha group received ha. Pfna design compacts the cancellous bone to provide increased stability and has been biomechanically proven to retard rotation and varus collapse. Aug 01, 2010 the new proximal femoral nail antirotation pfna in daily practice. Pfnaii nail several distal locking options static or dynamic locking can be performed via the aiming arm with pfnaii standard, small and xs. Original article proximal femoral nail antirotation versus. Proximal femoral nail antirotation ii with antirotation. Pfna2 proximal femoral nail antirotation for asia has been developed especially for asian patients. Femoral intertrochanteric fractures with the 3finger.
Pdf risk factor of breakage after proximal femoral nail. These characteristics provide optimal anchoring and stability when the implant is inserted. The angle of both the distal and the proximal parts is 6. Between 2006 and 2007, 62 consecutive patients with unstable proximal femoral fractures were treated with the pfna. Femoral intertrochanteric fractures with the 3finger method. Dynamic hip screw with trochanterstabilizing plate. Pfna2 nail specification, uses, sizes, surgical techniques. The functional results assessed by harris hip score showed excellent in 41 cases 56. 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. Via the aiming arm, the guide wire for the pfna blade was introduced into the femoral neck in such a way that the pfna blade would be placed into the lower half of the neck on the ap view and centrally on a lateral view. Apr 01, 2009 in 2004, the aoasif group developed the proximal femoral nail antirotation pfna to improve the rotational and angular stability with one single element. Intertan nail versus proximal femoral nail antirotationasia. Pfn system, namely, proximal femoral nail antirotation pfna, is a relatively new type of proximal femoral internal. Original article simulated postoperative weightbearing.
The results obtained with this implant in previous studies had varied outcome. Duration of surgery, intraoperative blood loss, duration. Management of lowenergy basicervical proximal femoral. Important it is recommended that all fractures are treated with the longest nail possible, taking into account patient anatomy or a previous implant. The unique characteristic of this implant is the use of a single blade with a large surface area. There are three different versions of the pfna nail 170, 200 and 240 mm.
Proximal femoral nail standard pfn and long pfn 12 1. Pfna proximal femoral nail antirotation patient positioning and closed reduction were made, as described above. Static bending test after proximal femoral nail pfn removal in vitro analysis. The angle between the nail and screw varies from 0 to 150 0. A retrospective analysis of the intertan nail and proximal femoral.
Comparative study of the proximal femoral nail antirotation. A comparison of the proximal femoral nail antirotation. Postoperative radiograph with the long pfna nail ap a and lateral b. A comparative study of proximal femoral locking compress. Proximal targeting device, for pfna short nail 1 38 chuck with tmoi 0302028 handle 1 39 aiming device, for pfna long nailmoi 0302034 1 instruments information a t l a s p f n a n a i l i n s t r u m e n t s ref description units 40 moi 0302100 pfna nail container. Appropriate pfna main nail was placed into medullary cavity and its location was confirmed by carm xray. Pdf comparative study between intertan and trochanteric. It is an intramedullary device with a helical blade rather than a screw for beer purchase in the femoral head and was tested in a clinical study 5. Analysis of treatment outcome of patients with inter. There are two relationships of the nail and floating trochanteric fragment. The aoasif proximal femoral nail antirotation pfna. Intertan nail for intertrochanteric femoral fractures. The mediolateral angle of the implant amounts to 6.
The surgicaldependent outcome evaluation included the operation time, intraoperative blood loss. Step 2guide wire insertion the entry point is in line with the central axis of the femoral neck. The helical blade avoids bone loss that occurs during the drilling and insertion of the standard sliding hip screw. Functional and radiological results of proximal femoral nail. A succinct technique for the extraction of the proximal femoral nail. We conclude that the proximal femoral nail antirotation 2. Comparison between proximal femur nail pfn and trochanteric femoral nail trochanteric fixation nail tfn. Original article simulated postoperative weightbearing after. Static bending test after proximal femoral nail pfn removal in. Proximal femoral nail antirotation pfna for treatment of. Pdf to analyze the clinical and radiologic results of treatments in proximal femoral fracture with proximal femoral nail antirotation pfna. Functional and radiological results of proximal femoral. Proximal femur nail in intertrochanteric fractures indications and. A proximal femoral nail antirotation for asia pfnaii has been developed especially for asian patients.
Standard pfnaii length 240 mm may be too long for small stature people. Proximal femoral nail antirotation pfna design the pfna is an intramedullary nail with an antirotation lag screwblade in the femoral head. Proximal femoral nail antirotation surgical technique depuy synthes. Nov 22, 2011 patients treated with recon nails experienced a longer operation time p. A guidewire was drilled and the medullary canal was reamed 0. Pfna nail surgical technique animation created by kems.
Pfnaii nail product range the pfnaii is available in 4 sizes pfnaii long, length 260 340 mm with 20 mm increments, length 340 420 mm with 40 mm increments, only 10 mm nails, bending radius 1500 mm pfnaii, length 240 mm pfnaii small, length 200 mm pfnaii xs, length 170 mm pfnaii. 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. Proximal femoral nail antirotation with a helical blade pfna. Department for general, trauma and reconstructive surgery, ludwig. Baseline data on patients before surgery and 3 months and 1 year after implantation of a proximal femoral nail antirotation device pfna or a dynamic hip screw dhs to treat an unstable pertrochanteric fracture before surgery 3 months after surgery 1 year after surgery statistical statistical. Evaluation was made from the radiographs taken on postoperative day 1 and at the final followup examination of changes in the femoral neck and shaft angulation, measurement of telescoping of blade and lag screws and reduction quality. Review of proximal nail antirotation pfna malaysian. The pfnaii long additionally allows for secondary dynamization. Jan 04, 2019 pfna to ameliorate the angular and rotational stability with one single element. In 2004, the proximal femoral nail antirotation pfna, developed by the aoasif group, was introduced as a one of the modern generation intramedullary nails. 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.
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