PFNA-II Presentation

PFNA-II
Proximal
Femoral Nail
Antirotation
PFNA-II - Proximal Femoral Nail Antirotation
Introduction
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 geometry
Introduction
PFNA-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
Introduction
Geometric Parameters
Proximal diameter, mm
Length of helical blade, mm
CCD Angle, degree
Medial lateral angle, degree
PFNA
PFNA-II
17
16.5
85-125
75-120
125, 130, 135
125, 130
Indications
PFNA-II (Length 170 mm 240 mm)
Indications
Pertrochanteric fractures (31-A1 and 31-A2)
Intertrochanteric fractures (31-A3)
Contraindications
Low subtrochanteric fractures
Femoral shaft fractures
Isolated or combined medial femoral neck fractures
Indications
PFNA-II long (Length 260 mm 420 mm)
Indications
Low and extended subtrochanteric fractures
Ipsilateral trochanteric fractures
Combination fractures (in the proximal femur)
Pathological fractures
Contraindications
Isolated femoral shaft fractures
Isolated or combined medial femoral neck

fractures
Implant and Instrumentation

PFNA-II Extra Small
Length 170 mm
Diameter 9, 10, 11, 12 mm
Proximal diameter 16.5 mm
CCD angle 125, 130
PFNA-II Small
Length 200 mm
CCD angle 125, 130
PFNA-II
Material TAN
Length 240 mm
Sterile only
CCD angle 125, 130
All nails are cannulated
ML bend 5
Implant and Instrumentation

PFNA-II Long
Length
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 mm
CCD angle 125 and 130
Antecurvation 1500 mm
rights and lefts
Material TAN
ML bend 5
Sterile only
All nails are cannulated
Product Component
PFNA-II blade
Length 75 to 120 mm in steps of 5mm

Diameter 12.2 mm
Sterile packed only
TAN
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 Hexagonal
Sterile and non-sterile
TAN
End caps
0 to 15 mm in steps of 5 mm
Sterile packed only
TAN
Features and benefits

Feature
Benefits
Helical blade
Antirotation and optimal stability with

one single locking element in the
femoral head

Feature
Benefits
Bone compaction
No predrilling in osteopenic bone
A=81.3 mm2
Excellent anchorage in the blade in the

femoral head
No bone removal
Stable Fixation
A=26.7 mm2
PFNA-II Blade bone compaction

Edge of helical blade
Zone of compaction
No zone of compaction
Borderline thread
1 mm
PFNA-II Blade bone compaction
The large surface and the increasing

core diameter guarantee a maximum
of compaction and therefore optimal
hold in the bone

Feature
Aiming device for guide wire insertion
Benefits
Facilitated Guide Wire positioning and

insertion

Feature
Benefits
Locking through lateral incision
Unlocked PFNA blade
Fast and reliable procedure
Locked PFNA blade

Feature
Benefits
Flexible tip
Anatomical design
Medio-lateral bend of 5
Cannulation
Optimal stress distribution

Optimal fit in the femur
Insertion through tip of greater
trochanter
Easy insertion over reaming rod
Clinical cases
94 years, female, 31-A1.1
0 days pre-op
0 days post-op
14 weeks post-op
11 months post-op
Clinical cases
93 years, female, 31-A3.3
0 days pre-op
4 days post-op
4 weeks post-op
5 months post-op
Clinical Cases
27 year old male
AO 31-A3
Clinical Cases
85 year old male
AO 31 A2
Surgical Procedure
Patient Positioning
Surgical Procedure
Preparation
Reduce Fracture
Confirm nail length and diameter

309.602 Radiographic Ruler for PFNA
Surgical Procedure
Open Femur
1. Determine Entry Point
Surgical Procedure
2. Insert guide wire to open the femur
Surgical Procedure
Opening w/flexible Drill Bit
Opening w/curved Awl
Surgical Procedure
Ream Medulary Canal
Surgical Procedure
Insert Nail
Assemble of Nail / Insertion Handle
Surgical Procedure
Insertion of Nail
Insertion of Nail
Surgical Procedure
Insertion of Blade
Insertion of Blade
Surgical Procedure
Position Guide Wire With Aiming Device
Surgical Procedure
Surgical Procedure
Incorrect position of sleeve
Correct position of sleeve
Must be in contact with the bone during the entire blade implantation!
Surgical Procedure
Insertion of Guide Wire
Surgical Procedure
Measuring of Blade length
Surgical Procedure
Proximal Locking
1.
Drill bit 11.0 mm for drilling lateral cortex
2.
Reamer 11.0, for PFNA Blade
Surgical Procedure
Insertion of Blade
Surgical Procedure
Locking of Blade
Surgical Procedure
Distal locking (static oblique)
Surgical Procedure
Distal locking (Dynamic / Static 90)
Surgical Procedure
Distal locking (Long Nails)

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PFNA-II

PFNA-II - Proximal Femoral Nail Antirotation

PFNA-II - Proximal Femoral Nail Antirotation

PFNA-II - Proximal Femoral Nail Antirotation

125, 130, 135

Pertrochanteric fractures (31-A1 and 31-A2)

Intertrochanteric fractures (31-A3)

Low subtrochanteric fractures

Femoral shaft fractures

Isolated or combined medial femoral neck fractures

PFNA-II - Proximal Femoral Nail Antirotation

Low and extended subtrochanteric fractures

Ipsilateral trochanteric fractures

Combination fractures (in the proximal femur)

Isolated femoral shaft fractures

Isolated or combined medial femoral neck

PFNA-II - Proximal Femoral Nail Antirotation

Implant and Instrumentation

Diameter 9, 10, 11, 12 mm

Proximal diameter 16.5 mm

CCD angle 125, 130

Diameter 9, 10, 11, 12 mm

Proximal diameter 16.5 mm

CCD angle 125, 130

Diameter 9, 10, 11, 12 mm

Proximal diameter 16.5 mm

CCD angle 125, 130

All nails are cannulated

PFNA-II - Proximal Femoral Nail Antirotation

Implant and Instrumentation

CCD angle 125 and 130

Proximal diameter 16.5 mm

rights and lefts

PFNA-II - Proximal Femoral Nail Antirotation

Length 75 to 120 mm in steps of 5mm

PFNA-II - Proximal Femoral Nail Antirotation

Features and benefits

PFNA-II - Proximal Femoral Nail Antirotation

Antirotation and optimal stability with

Features and benefits

No predrilling in osteopenic bone

PFNA-II - Proximal Femoral Nail Antirotation

Excellent anchorage in the blade in the

PFNA-II Blade bone compaction

PFNA-II Blade bone compaction

The large surface and the increasing

PFNA-II - Proximal Femoral Nail Antirotation

Features and benefits

Aiming device for guide wire insertion

PFNA-II - Proximal Femoral Nail Antirotation

Facilitated Guide Wire positioning and

Features and benefits

Locking through lateral incision

Unlocked PFNA blade

PFNA-II - Proximal Femoral Nail Antirotation

Fast and reliable procedure

Locked PFNA blade

Features and benefits

PFNA-II - Proximal Femoral Nail Antirotation

Optimal stress distribution

PFNA-II - Proximal Femoral Nail Antirotation

PFNA-II - Proximal Femoral Nail Antirotation

PFNA-II - Proximal Femoral Nail Antirotation

PFNA-II - Proximal Femoral Nail Antirotation