Cephalomedullary Nailings Cephalomedullary Nailings (PFN / TFN)(PFN / TFN)
In Unstable Inter Trochanteric Fractures In Unstable Inter Trochanteric FracturesAnd its Biomechanical ConsiderationsAnd its Biomechanical Considerations
Dr. B. Shivashankar.Dr. B. Shivashankar. SolapurSolapur
ISO 9001:2008Certified Hospital
Stable Easy to treat by any method
Un StableDIffficult to treat
Simpler Classification For Surgeon
If lateral wall is intact and lesser trochanter is intact it is stable, if any one of them is broken it is unstable
Gradual # CollapseGradual # Collapse
Barrel allows the screw to slide gradually during the course of fracture healing
Intact Lateral wall – Key for determining outcome
Pre Operative Day 1
31. A2.1 31. A3. 3
31% of A2 Type Fractures
Day 40 Day 70
IM implant : acts as a buttress to prevent excessive # collapse and shaft medialization
Outcome of Sliding Hip Screw in Un Stable Fractures
Is DHS still the Gold Standard?
Thanks : Dr.Anil Kharkanis for some pictures in this slide
DHS Improvements 1985-1999
To Prevent To Prevent Medialisation – T S PMedialisation – T S P
Slide Courtesy: Indiaorth
Dynamisation along Dynamisation along ShaftShaft
Medoff plate also requires an intact lateral wallOtherwise too much medialisation happens as show here
PFN= DHS+TSP+Medoff Plate Plus Intra Medullary implant!• DHS
• 1. Screw Slides in Barrel
• 2. TSP added can prevent medialisation
• 3. Along with Medoff Plate can have collapse in the shaft useful for ST#s
• 4. Adding Derotational screw increases stability by preventing spinning of head
• PFN
• 1. Screw slides in Nail like DHS
• 2. Expanded proximal portion of nail abuts and works as TSP and prevents medialisation
• 3. Dynamic distal locking done will lead to axial nail subsidence and works as Medoff plate
• 4. Already has a built in derotational screw
Proximal Femoral Proximal Femoral NailNailDHS + TSP + Med Off = PFN
Derotational Screw
Which Appears More Which Appears More Stable ?Stable ?
Cantilever 3rd orderRequires medial intactness to workWill fail if posteromedial comminution+
1st Order lever
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Dr. B. Shivashankar.Dr. B. Shivashankar. SolapurSolapur
ISO 9001:2008Certified Hospital