Treatment of recent trochanteric fracture in adults. Oneyear mortality ranges between 15% and 36%, intramedullary, nailing is widely used to fix trochanteric fracture, incurring fewer. Comparison of two methods of locating proximal femoral. 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. Earlier results with gamma nail did not produce any sig. The short proximal femoral nail is a superior implant for stable and unstable intertrochanteric. The proximal femoral nail pfn introduced by the aoasif group in 1998 has become prevalent in treating trochanteric fractures in recent years 1215.
Proximal femoral nail to reduce the risk of implant related complications. Gamma nail in the treatment of closed trochanteric fractures. Trochanteric femoral fractures treated by proximal femoral. Apr 21, 2020 treatment of complex proximal femoral fractures with the proximal femur locking compression plate. Help with complete thesis work available for download in all subjects. Reason and treatment of failure of proximal femoral nail.
Two of those sustained a fracture just distal to the tip of the nail one patient was treated conservatively and one patient was treated with an open reduction and internal fixation and one patient sustained a neck of femur fracture which treated with a hemiarthroplasty after removal of nail. Besides the t2 femoral nail with a 3m radius of curvature, stryker offers also a 1. Case 2 radiographic images showing the intertrochanteric fracture that was fixed with a proximal femoral nail a preoperative and b postoperative. Randomised comparison of the gamma nail and the proximal femoral nail. Reduction is usually achieved by positioning the patient on a fracture table with the foot secured to a boot to aid in traction and rotation. Surgical technique implant selection the trigen intertan nail preoperative template set 71674200 may be used to assist with preoperative implant selection. The new fluted sub trochanteric nail system or rod disclosed herein is designed to provide an entirely intramedullary device for the fixation of sub trochanteric fractures which can be inserted via a closed or blind procedure, or via an open procedure without the necessity of xray surveillance, with only a minimal surgical exposure and not. A pfn is useful for the treatment of trochanteric femoral fractures. In our study we have used intramedullary method of fixation for trochanteric fracture using proximal femoral nail.
Select a guide wire and insert the guide wire in line. Femoral fracture occurred postoperatively in 3 patients of group b, following a fall. Oct 31, 2014 we sought to determine whether intramedullary fixation with proximal femoral nail antirotation produces comparable outcomes to dynamic hip screw in the treatment of unstable trochanteric fractures. 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. Check the magnification on the specific preoperative planner ruler. The sliding hip screw is the most widely used implant for stabilization of both stable and unstable intertrochanteric fractures. A selfadjusting nail plate for fractures about the hip joint. Aos antegrade femoral nails, aos humeral nails, aos modular femoral nails, aos retrograde femoral nails, aos tibial nails, aos trochanteric nails, aos small bone nails, aos clavicle intramedullary devices download pdf. The trochanteric femoral nail tfn is a recently introduced intramedullary system, designed to improve treatment of intertrochanteric fractures of the hip. The helical blade should be centered in the ap and lateral views of the femoral head. Proximal femoral nailing in communited intertrochanteric fractures is increasingly becoming popular in view of superior biomechanics and prevention of varus collapse associated with dynamic hip screw. The trochanteric fixation nail and axial migration.
The use of the tipapex distance tad has previously been studied as a means to predict varus collapse and eventual cutout in systems utilizing a lag screw design. It is highly beneficial for patients with poor quality bone e. A comparison of proximal femoral nail antirotation and. Get a printable copy pdf file of the complete article 1. The trochanteric im nail used in all cases was the sirus nail intramedullary.
The proximal fragment was short and varus angulated before surgery. Or trochanteric fractures and pfna or proximal femoral nail antirotation or proximal femoral nail or dhs or dynamic hip screw or gamma nail or trochanter fixation nail or intramedullary nail. Regardless of the preference of using a short nail or a long nail, a large percentage of the hip fractures encompass basilar neck, intertrochanteric or subtrochanteric with minimal shaft extension. Proximal femur nail in intertrochanteric fractures indications and. Gamma nail, were associated with high intraoperative technical and mechanical difficulties due to their short length 20 cm, large diameter 17 mm proximal and 12, 14 and 16mm distal and 10 degree of valgus curvature which created stress at the tip of the nail on lateral cortex of femur. Comparative study of the treatment of pertrochanteric fractures trochanteric gamma nail vs. Trochanteric femoral nail surgical technique depuy synthes trauma 7 preparation 5 determine nail diameter instrument 03. Hip nailing is a surgical procedure that involves reconnecting the loose bone fragments of the femur, close to the hip joint. Download procedure basics pdf on hip fractures curvo labs. Outcomes of trochanteric femoral fractures treated with. A comparative study of unstable per and intertrochanteric femoral fractures treated with dynamic hip screw dhs and trochanteric buttpress plate vs. The treatment of stable and unstable proximal femoral fractures with a new trochanteric nail.
Note as template magnification levels are set at 117%, all measurements are estimates of true size. Use of enders nails in unstable trochanteric femoral. Insert blade guide sleeve assembly through the aiming arm. Also with limited access approach, one can reduce the blood loss, soft tissue trauma and infection. Treatment of trochanteric fractures with the pfna proximal femoral nail antirotation nail system. Intramedullary nailing allows for endochondral repair at the fracture site, whereas compression plating precludes this. We followed prospectively 295 patients with trochanteric fractures treated with the proximal femoral nail.
The tfna system is designed to solve a wide range of unmet needs for surgeons, or staff, and administrators. We present the results of proximal femoral nailing surgery performed for reverse obliquity. Study of clinical and functional outcome of unstable. The es trochanteric nail is intended for the treatment of basilar neck, inter and high subtrochanteric femoral fractures. Short proximal femoral nail fixation for trochanteric. Internal fixation can be performed with multiple pins, intramedullary hip screw ihmscrossed screwnails or compression with a dynamic screw and plate frztura. Open the medullary canal using the curved cannulated trocar se202. Failure of fixation of trochanteric femur fractures. The trochanteric nail was developed to overcome the problems encountered with the use of the standard gamma nail.
Pdf proximal femoral nail in reverse trochanteric femoral. Proximal femoral nail in reverse trochanteric femoral. D the lag screw was cutting through at 3 months after surgery. Cephalomedullary nailing of fractures of the proximal. Recent trochanteric fracture in adults overwhelming affects elderly subjects.
Trochanteric also inter and per trochanteric fractures are fractures in which the section between the greater and lesser trochanter is broken. Cai 1department of orthopedic surgery, shanghai tenth peoples hospital, tongji university, school of medicine, shanghai, china. To compare the longterm functional and radiographic outcomes of the proximal femoral nail antirotationasia pfnaii and. Trochanteric entry nailing for pediatric femoral shaft fractures. Femur t2 gtn knifelight greater trochanter entry carpal. Galileo trochanteric nail system advanced orthopaedic solutions. First, the proper starting point for trochanteric nailing is just lateral to the long axis of the femur. Insert the nail on the guide wire and continue until the correct position is reached. Pdf treatment of intertrochanteric fracture of the femur. Treatment of complex proximal femoral fractures with the proximal femur locking compression plate. Reason and treatment of failure of proximal femoral nail antirotation internal fixation for femoral intertrochanteric fractures of senile patients j. However, the management of massive bone defects constitutes a surgical challenge, requiring the use of different nails, expensive long stems, or cementcoated tumor prostheses for preparing the spacer. Tfnadvanced proximal femoral nailing system tfna 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. Download full thesis topics for ms dnb orthopaedics degree.
Closed reduction and proximal femoral nailing in the management. Regardless of the preference of using a short nail or a long nail, a large percentage of the hip fractures encompass basilar neck, intertrochanteric or. Management of subtrochanteric fractures of femur with. The hip joint is a ball the head of a thigh bone femur and socket called acetabulum joint that is covered by a soft tissue envelope called capsule. The aoasif proximal femoral nail pfn is a new device designed for the treatment of the unstable trochanteric femoral fracture. These are most often caused by a fall on the side of the hip. A study of management of trochanteric fracture of femur treated with dynamic sliding hip screwplate device vs. Clinical report by bulletin of the nyu hospital for joint diseases.
Proximal femoral nail antirotation versus gamma3 nail for. Original article is proximal femoral nail antirotation. However, even though the pfna has produced good clinical outcomes, a poor introduction technique with an inappropriate entry point can cause surgical complications. Bone cement spacers loaded with antibiotic are the gold standard in septic revision. Aug 20, 20 the trochanteric im nail is a useful implant for treating femoral shaft fractures. Trochanteric fractures treated with a proximal femoral nail. Pdf treatment of reverse oblique trochanteric femoral fractures poses a lot of challenges. Biarticular total femur spacer for massive femoral bone. Trochanteric buttress plate, lateral wall comminution of greater trochanter, unstable trochanteric fracture, screw migration, cut out of screw 1. Complex proximal femoral fractures in the elderly managed. This study reports the outcome in such fractures treated using the pfn at a district general hospital. Pdf short proximal femoral nail fixation for trochanteric.
The average age of the patients was 80 years and three out of four were female. 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. As a general rule, internal fixation is fratuta for young, otherwise, fit patients with small risk for avn. Attach the helical blade to the helical blade inserter. We usually use short femoral nails for the treatment of trochanteric fracture of the femur. Proximal femoral fracture is frequent in the elderly. The following surgical procedures should be considered for the trochanteric nailing of femoral shaft fractures to prevent implantderived complications. Pdf to report outcomes of 87 consecutive patients treated with a proximal femoral nail pfn for trochanteric femoral fractures. Any fracture to the socket is not considered a hip fracture. Mar 14, 2017 the proximal femoral nail antirotation pfna system for treatment of intertrochanteric fractures is currently widely applied worldwide. Gadegone 1, bhaskaran shivashankar 2, vijayanad lokhande 3 and yogesh salphale 3 1 department of orthopaedic and traumatology, associate professor of orthopaedics, gmc, 442402 chandrapur, maharashtra, india.
Preventive measures based on antishock trousers have failed to demonstrate efficacy, due to poor compliance, in elderly subjects, fracture entails a serious risk of loss of independence best. Jul 22, 2016 trochanteric entry nailing for pediatric femoral shaft fractures j. More than five years in the making, this system offers advancement in hip. Twenty five patients suffering from unstable trochanteric and subtrochanteric fractures for 30 months from july 2012 to december 2014. Pdf proximal femoral nail for treatment of trochanteric femoral. Trochanteric femoral nail how is trochanteric femoral nail. Early fixation failure was seen in 18% of patients. During this period, modifications of design and instrumentation have occurred to combat the intra and postoperative complications that were associated with the use of early designs. Trochanteric femoral nail can be abbreviated as tfn. Titanium trochanteric fixation nail system instrument assembly blade guide sleeve, for trochanteric fixation nails 357. Between july 2000 and january 2001, 88 consecutive proximal femoral extracapsular fractures were treated with a trochanteric nail, seventyfive patients 76 fractures were observed clinically and radiographically for 2 years. Hold the radiographic ruler perpendicular to the femur. Trochanteric fractures treated with a proximal femoral nail article pdf available in international orthopaedics 255. Inter trochanteric fractures have traditionally been treated by closed reduction and internal fixation with a dynamic hip screw or an intramedullary device gamma nail, reconstruction nail, proximal femoral nail or intramedullary hip screw 14.
Fides trochanteric nail system trochanteric nail 120 125 5 universal anatomical shape distal dynamization is possible greater strength and stability compared with the side plate lag screw to transfer the load of the femoral head into the nail shaft by bridging the fracture line. Trigen intertan intramedullary nail versus sliding hip screw. Influence of different great trochanteric entry points on the. Introduction in an unstable trochanteric fractures intact lateral wall plays a key role instabilization of fracture by proximal femoral nail. Augmentation of proximal femoral nail in unstable trochanteric fractures wasudeo m. Proximal femoral nail versus dynamic hip screw fixation for. Therefore in addition to the 8 mm load bearing femoral neck screw, the pfn has a 6.
The intramedullary proximal femoral nail was devised by the aoasif group in 1996 with two proximal screws including an antirotation screw with the aim of. Clinical and radiographic controls were performed at 1, 3 and 6 months. From january 2010 to june 20, 90 patients with intertrochanteric fractures were surgically treated, including 48 males and 42 females with an average age of 70. Trochanteric femoral nail surgical technique depuy synthes trauma 5 3 determine ccd angle instruments 03. Nail size, screw length and femoral neck angle may be determined. Sliding hip screw fixation of trochanteric hip fractures. C and d the lateral migration of the superior screw and perforation of the femoral head by the inferior screw reverse zeffect. The es trochanteric nail is intended for the treatment of basilar neck, inter and. We analyzed the clinical and radiological results after treatment of intertrochanteric fracture of the femur using a dyna locking trochanteric dlt nail.
The gamma nail is the latest advance in the treatment of trochanteric fractures based on intramedullary nailing principles during closed procedures. Two of the more significant complications that are seen with cephalomedullary nailing are iatrogenic femur fractures and proximal lag screw cutout. Treatment for trochanteric fracture of the femur with. Trochanteric femoral fractures treated by proximal femoral nail. Trigen intertan intertrochanteric antegrade nail, or. There were no abnormal bowing of the contralateral femurs in the preoperative radiographs. The trigen intertan nail was designed as a trochanteric portal intramedullary nail especially shaped for fractures of the proximal femur. Galileo trochanteric nail system surgical technique download pdf.
This prospective, randomized study compared the functional outcome and complications associated with a proximal femoral nail antirotation pfna device with those of a traditional extramedullary device, the dynamic hip screw dhs, in patients with trochanteric fracture. All fractures were unstable, 22 of them of the type 31a2 prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur. Subtrochanteric femoral fracture during trochanteric. Trochanteric buttress plate combined with proximal femoral. Short proximal femoral nail fixation for trochanteric fractures. Functional impact is very severe, with significant loss of autonomy. Percutaneous compression plate versus proximal femoral nail anti. The trochanteric femoral fracture is common in elderly patients. Health, general fracture fixation equipment and supplies methods fracture repair hip fractures care and treatment hip joint fractures orthopedic fixation devices usage. In this study, we aimed to report the results of a retrospective study carried. However, technical difficulties and implant related complications have been described with this technique, thus we need more studies to address these issues.
Introduction intertrochanteric fractures are one of the most common fractures encountered in an any. The treatment of stable and unstable proximal femoral. The neck shaft angle of 5 degrees was used in the forty eight patients whereas the rest needed a degree nail. Treatment is more likely to be an internal fixation device such as a compression hip screw, or femoral nail. Various intramedullary devices such as gamma nail, proximal femoral nail, proximal femoral nail antirotation, and intertan integrated nail have been used for fixation of these fractures. Treatment of trochanteric fractures with the pfna proximal. Trochanteric fixation nail how is trochanteric fixation.
Gamma nail is a cephalomedullary implant that was developed for the treatment of pertrochanteric hip fractures and has been successfully used for over 20 years. In this retrospective study, we investigated and compared the clinical results of the conventional intramedullary hip screw imhs and the asian imhs, which is a redesigned version of the former. E the incorrect positioning of the interlocking screws in the lateral incidence, together with poor bone. Trochanteric gamma nail and compression hip screw for trochanteric fractures. To compare the efficacy of threepoint locating versus routine locating techniques for implanting helical blades for proximal femoral nail antirotationii in the treatment of trochanteric fractures. Pdf trochanteric fractures treated with a proximal femoral nail. B the threedimensional computed tomographic scan shows the otaa21 fracture. Tfn is defined as trochanteric femoral nail rarely. The meaning of tfn abbreviation is trochanteric femoral nail. The t2 gtn system is one of the first femoral nailing systems to offer an option for tip of greater trochanteric entry point insertion with the option to apply compression either by an external compression device or by an internal compression screw. Pdf trochanteric gamma nail and compression hip screw. This study evaluated the feasibility of a helixshaped femoral nail that would facilitate ease of nail insertion through the trochanter and save implant removal along a helical pathway. Gamma3 nail with ublade rc lag screw is effective with. Subtrochanteric femoral fracture during trochanteric nailing.
The aoasif proximal femoral nail pfn for the treatment of. Download thesis pdf files, complete thesis dissertation work. The objective of this retrospective study was to investigate the surgical outcomes of aoota 31 a trochanteric fractures treated with the newgeneration gamma3 nail with ublade rc lag screw. Incidence of 143,000 was predicted in france for 2050. Titanium trochanteric fixation nail system quick reference chart. Complications following treatment of trochanteric fractures. Prospective assessment of trochanteric fracture managed by. All cases of unstable trochanteric and subtrochanteric fractures operated by proximal femoral nail during this time period were taken up for study, which were studied prospectively after taking due consent. Although there were several reports showing benefits of proximal femoral nail 1618, it was still associated with technical failures 19, 20. Some researchers suggest improving clinical outcomes by modifying the entry point, but no. Intertrochanteric fracture treated with tfn trochanteric femoral nail. From march 2008 to february 2009, 36 patients 10 males and 26 females who had at least 6 months followup among 43 patients were included in our study. The proximal femoral nail of 250 mm used in this study was made of 316l stainless steel and the diameters used were 9 mm, 10 mm and 11 mm. Assemble the guide se208a on the nail introducer se206a.
This article is from clinical interventions in aging, volume 9. For intramedullary fixation of femoral shaft fractures. Pdf a study of management of trochanteric fracture of. Frequency is increasing with population aging despite the development of treatments for osteoporosis.278 223 429 70 270 1541 176 905 9 15 137 1001 719 604 1164 506 380 1215 30 1021 1102 634 687 468 745 510 1085 42 442 706 1192