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Learn the Femoral neck fracture : proximal femoral pinpoint ( Synthes short TFNA ) for Pertrochanteric hep fracture ( A3 ) surgical technique with step by step instructions on OrthOracle. Our e-learning chopine contains high solution images and a license CME of the Femoral neck fault : proximal femoral nail ( Synthes short TFNA ) for Pertrochanteric hip fracture ( A3 ) surgical operation .
Fragility fractures of the proximal femur are increasingly coarse injuries with an incidence of over 1.5 million globally. The majority of these injuries are managed surgically, fractures that are extra-capsular and frankincense with a keep rake add to the femoral head are in most cases managed with inner fixation to stabilise the fracture. Extra-capsular fractures are classified according the AO/OTA classification. A1 fractures are simple 2 function per-trochanteric fractures, A2 fractures extend to involve the lesse trochanter and disrupt the median buttress, A3 fractures extend into the lateral pass wall and include the ‘ inverse oblique ’ practice. traditionally extra-capsular fractures were stabilised with a sliding hip screw type implant however it was recognised that this did not provide optimum stability in some fracture patterns and in the by 2 decades there has been an increasing course towards intra-medullary nail of extra-capsular neck of femur fractures.
The current NICE guidelines in the UK recommend that A1 and A2 fractures ( 2 share or involving the lesser trochanter ) are managed with sliding hip screws, fractures with subtrocahanteric extension should be managed with intra-medullary devices according to the road map. The management of A3 fractures, where the lateral wall is insufficient, is not defined in the NICE guidelines reflecting uncertainty in the literature as to the a clear advantage of SHS or intramedullary complete in this fracture blueprint. The SHS however depends on control collapse of the femoral principal controlled by the stave screw in the plate barrel and buttressed by the lateral femoral wall. If the lateral wall is deficient there is nothing to buttress the femoral heading with vector sum medialisation of the shaft with uncontrolled collapse and instability. For this reason many, if not most, surgeons would favour an intramedullary device for A3 fractures .
The Synthes TFNA is an development of the Synthes PFNA. It has many features in coarse with most proximal femoral nails for fragility fractures, the proximal end has a larger diameter than standard nails to increase fit in osteoporotic cram, distally the end of the short collar is tapered and there is equitable a single lock bolt to reduce the stress riser at the nail tap which historically led to peri-implant fractures. The arrested development in the head can be achieved with a traditional lag screw or with a coiling blade. The sword is designed to compress the osteoporotic cancellate bone in the femoral head as it is inserted thereby improving detention in the femoral forefront. additionally the blade is rotationally stable increasing implant stability. Biomechanical data suggests implants using coiling blades confer favorable constancy compared to screws however there is no test clinical benefit .
Readers will besides find of interest the following consociate OrthOracle techniques :
Femoral intramedullary pinpoint : Synthes Expert Lateral Femoral Nail ( LFN ) for impending diseased fault .
Infected femoral nail removal and debridement with Synthes Reamer Irrigator Aspirator ( RIA )
fixation of a diaphyseal femoral fault with a Depuy-Synthes Expert retrograde/antegrade femoral collar ( RAFN )
Intertrochanteric neck of femur fracture treated with a proximal femoral nail ( Synthes hanker TFNA )
Stryker Omega Dynamic Hip Screw for extra-capsular neck of femur fracture
Author: Paul Fenton FRCS ( Tr & Orth )
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Institution: The Queen Elizabeth Hospital, Birmingham, UK .
Clinicians should seek clearing on whether any implant demonstrated is licensed for practice in their own state .
In the USA contact : fda.gov
In the UK reach : gov.uk
In the EU contact : ema.europa.eu