PFNA-II Presentation

PFNA-II - Proximal Femoral Nail Antirotation PFNA-IIProximal Femoral Nail Antirotation

PFNA-II - Proximal Femoral Nail Antirotation

PFNA-II - Proximal Femoral Nail Antirotation The PFNA system was introduced by AO in 2003 for treating unstable trochanteric fractures. However, it was designed according to the geometric proportions of the White population, and it is known that important differences exist between Asians and Americans with regard to femoral geometry.Geometrical mismatch between PFNA and the femoral of Asians has led the AO to design PFNA-II for Asia with adapted sizes and geometryIntroduction


PFNA-II - Proximal Femoral Nail Antirotation IntroductionPFNA-II is a specified proximal femoral nail for the treatment of Asian patients. The following adaptions were made to better fit to the small trochanteric area and narrow IM canal of the Asian population:- Lateral flat surface to ease insertion, and reduce pressure on the lateral cortex - Higher bending point resulting in a straighter tip part - 5 Medial-Lateral Bending - Smaller proximal diameter ( 16.5 vs 17.0 mm) and smaller blade diameter


PFNA-II - Proximal Femoral Nail Antirotation Introduction

Geometric ParametersPFNAPFNA-IIProximal diameter, mm1716.5Length of helical blade, mm85-12575-120CCD Angle, degree125, 130, 135125, 130Medial lateral angle, degree65


PFNA-II - Proximal Femoral Nail Antirotation IndicationsPFNA-II (Length 170 mm 240 mm)IndicationsPertrochanteric fractures (31-A1 and 31-A2)Intertrochanteric fractures (31-A3)

ContraindicationsLow subtrochanteric fracturesFemoral shaft fracturesIsolated or combined medial femoral neck fractures


PFNA-II - Proximal Femoral Nail Antirotation IndicationsPFNA-II long (Length 260 mm 420 mm)IndicationsLow and extended subtrochanteric fracturesIpsilateral trochanteric fracturesCombination fractures (in the proximal femur)Pathological fracturesContraindicationsIsolated femoral shaft fracturesIsolated or combined medial femoral neck fractures


PFNA-II - Proximal Femoral Nail Antirotation Implant and InstrumentationPFNA-II Extra SmallLength 170 mmDiameter 9, 10, 11, 12 mmProximal diameter 16.5 mmCCD angle 125, 130 PFNA-II SmallLength 200 mmDiameter 9, 10, 11, 12 mmProximal diameter 16.5 mmCCD angle 125, 130 PFNA-II Length 240 mmDiameter 9, 10, 11, 12 mmProximal diameter 16.5 mmCCD angle 125, 130Material TANML bend 5Sterile onlyAll nails are cannulated


PFNA-II - Proximal Femoral Nail Antirotation Implant and InstrumentationPFNA-II LongLength 260 340 mm (nails 9) 260 420 mm (nails 10) 260 340 mm: 20 mm increments 340 420 mm: 40 mm increments Diameter 9, 10 mmCCD angle 125 and 130 Proximal diameter 16.5 mmAntecurvation 1500 mmrights and lefts

Material TANML bend 5Sterile onlyAll nails are cannulated


PFNA-II - Proximal Femoral Nail Antirotation Product ComponentPFNA-II blade Length 75 to 120 mm in steps of 5mm Diameter 12.2 mmSterile packed onlyTAN

Locking bolt Diameter 4.9 mm Length 26 to 76 mm in steps of 2mm 80 to 100 mm in steps of 5mm Drive 3.5mm HexagonalSterile and non-sterileTAN

End caps 0 to 15 mm in steps of 5 mmSterile packed onlyTAN


PFNA-II - Proximal Femoral Nail Antirotation Features and benefits

FeatureBenefitsHelical bladeAntirotation and optimal stability with one single locking element in the femoral head


PFNA-II - Proximal Femoral Nail Antirotation Features and benefitsA=81.3 mm2A=26.7 mm2

FeatureBenefitsBone compaction No predrilling in osteopenic boneExcellent anchorage in the blade in the femoral headNo bone removalStable Fixation


PFNA-II - Proximal Femoral Nail Antirotation 1 mmEdge of helical bladeZone of compactionNo zone of compactionBorderline threadPFNA-II Blade bone compaction


PFNA-II - Proximal Femoral Nail Antirotation PFNA-II Blade bone compactionThe large surface and the increasing core diameter guarantee a maximum of compaction and therefore optimal hold in the bone



FeatureBenefits Aiming device for guide wire insertionFacilitated Guide Wire positioning and insertion


PFNA-II - Proximal Femoral Nail Antirotation Features and benefitsUnlocked PFNA bladeLocked PFNA blade

FeatureBenefitsLocking through lateral incisionFast and reliable procedure



FeatureBenefitsFlexible tip Anatomical design Medio-lateral bend of 5

CannulationOptimal stress distributionOptimal fit in the femurInsertion through tip of greater trochanterEasy insertion over reaming rod


PFNA-II - Proximal Femoral Nail Antirotation Clinical cases94 years, female, 31-A1.1 0 days post-op 14 weeks post-op 11 months post-op 0 days pre-op


PFNA-II - Proximal Femoral Nail Antirotation Clinical cases93 years, female, 31-A3.34 days post-op 4 weeks post-op 5 months post-op 0 days pre-op


PFNA-II - Proximal Femoral Nail Antirotation Clinical Cases27 year old maleAO 31-A3


PFNA-II - Proximal Femoral Nail Antirotation Clinical Cases85 year old maleAO 31 A2


PFNA-II - Proximal Femoral Nail Antirotation Surgical ProcedurePatient Positioning


PFNA-II - Proximal Femoral Nail Antirotation Surgical ProcedurePreparationReduce Fracture

Confirm nail length and diameter309.602 Radiographic Ruler for PFNA


PFNA-II - Proximal Femoral Nail Antirotation Surgical ProcedureOpen Femur1. Determine Entry Point


PFNA-II - Proximal Femoral Nail Antirotation 2. Insert guide wire to open the femurSurgical Procedure


PFNA-II - Proximal Femoral Nail Antirotation Surgical ProcedureOpening w/flexible Drill BitOpening w/curved Awl


PFNA-II - Proximal Femoral Nail Antirotation Surgical ProcedureReam Medulary Canal


PFNA-II - Proximal Femoral Nail Antirotation Surgical ProcedureAssemble of Nail / Insertion HandleInsert Nail


PFNA-II - Proximal Femoral Nail Antirotation Surgical ProcedureInsertion of NailInsertion of Nail


PFNA-II - Proximal Femoral Nail Antirotation Surgical ProcedureInsertion of BladeInsertion of Blade


PFNA-II - Proximal Femoral Nail Antirotation Surgical ProcedurePosition Guide Wire With Aiming Device


PFNA-II - Proximal Femoral Nail Antirotation Surgical Procedure


PFNA-II - Proximal Femoral Nail Antirotation Surgical ProcedureCorrect position of sleeveIncorrect position of sleeveMust be in contact with the bone during the entire blade implantation!


PFNA-II - Proximal Femoral Nail Antirotation Surgical ProcedureInsertion of Guide Wire


PFNA-II - Proximal Femoral Nail Antirotation Surgical ProcedureMeasuring of Blade length


PFNA-II - Proximal Femoral Nail Antirotation Surgical ProcedureProximal LockingDrill bit 11.0 mm for drilling lateral cortexReamer 11.0, for PFNA Blade


PFNA-II - Proximal Femoral Nail Antirotation Surgical ProcedureInsertion of Blade


PFNA-II - Proximal Femoral Nail Antirotation Surgical ProcedureLocking of Blade


PFNA-II - Proximal Femoral Nail Antirotation Surgical ProcedureDistal locking (static oblique)


PFNA-II - Proximal Femoral Nail Antirotation Surgical ProcedureDistal locking (Dynamic / Static 90)


PFNA-II - Proximal Femoral Nail Antirotation Surgical ProcedureDistal locking (Long Nails)




************Position the patient supine on an extension table or a radiolucent operating table. Abduct the unaffected leg as far as possible and place it on a leg support, so that it allows free fluoroscopic examinations. This should be tested preoperatively.For unimpeded access to the medullary cavity, abduct the upper body by about 10 15 to the unaffected side (or adduct the affected leg by 10 15).**

PFNA-II Presentation

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