Catalog excerpts

A-PFN - 1

Antirotator Proximal Femoral Nail Medical Devices

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A-PFN - 2

Introductions Intertrochanteric femoral fractures constitute 10% of all the bone fractures. They are frequently seen in elderly patients above 65 years. Introductions Indications Features Surgical Technique Set Detail Implants Instruments 1 Instruments 2 Instruments 3 Radiographic Cases Proximal femoral fractures frequently occur as a result of ordinary traumas in elderly patients with osteoporosis. Besides, these kinds of fractures rarely occur in young patients who have high energy trauma. Fractures take place in proximal femur area have an effect on patients' general health and on their...

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A-PFN - 3

This feature of the nail brings too many advantages. As a result of sliding, fracture lines are converged thus provides reinforcement to the bone union process. The length of the moment arm is decreased by telescopic effect which ensures a decrease in bending force over the implant. As a result, fixation failure rate becomes less. Compressive forces that press to medial are equal with tensile forces that press lateral in stable fractures. However; pressure on the lateral cortex increases in unstable fractures. According to these results -made by considering the hip biomechanics-, there is a...

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A-PFN - 4

Features A-PFN nail is developed via making important additions to PFN system. A-PFN nail ensures rotational stability through a special blade which can be sent over the cannulated proximal screw that fronts to the neck with an angle of 125°, allows impaction of fracture by means of sliding compression. Other features of A-PFN are written below. A body which has a 6° of anatomical angle provides an easy insertion to the trochanter major tip with a little incision. The proximal diameter of the nail is 16 mm thus minimizes the bone loss. Cannulated proximal screw that goes to the neck has a...

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A-PFN - 5

lag screw Ø 10 mm antirotator blade collodiaphysial angle cannulated compression screw MEDIOLATERAL SLOPE LENGTH OPTIONS 9, 10, 11, 12 mm NAIL BODY DIAMETER static locking hole dynamic locking hole COMMON DESIGN FOR BOTH LEFT AND RIGHT cortical screw distal slit which enables stretching thus reduces stress focusing *optional 320, 340, 360 mm

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A-PFN - 6

Surgical Technique PATIENT POSITION The patient is placed on the traction table in supine position. Trochanter major is palpated and 5 cm longitudinal incision is made from top to the proximal. Then the reduction is controlled under the fluoroscopy. After achieving the suitable position, it is reached to trochanter major by incision of the skin, subcutaneous and tensor fasciae latae. Gluteus medius is incised parallel to the muscle fibers. NAIL ENTRY POINT A Ø 2.5 x 400 mm K wire is sent via IM from tip of the trochanter major. After conforming that the K-Wire is in the medulla from the...

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A-PFN - 7

NAIL INSERTING After designating proper nail with regard to diameter and length, the nail is fixed to Insertion Handle. The nail is sent under rotational forces through the trochanteric major tip. Hammer should not be used at this stage. If it is not possible to send the nail, one size smaller nail should be sent. If the medullar canal is still tight, the medulla should be widen up to 10 mm. TISSUE PROTECTOR PLACEMENT FOR PROXIMAL SCREW-BLADE If the nail is placed over the guide wire, K-Wire is taken out. After sending the nail, tissue protector system (A-PFN Blade Drill & Proximal Screw...

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A-PFN - 8

To send neck screw and blade, A-PFN Blade K-Wire Guide is placed into the tissue protector, then Ø 2 x 340 mm of K-Wire is sent through it until arriving subchondral part. If the position is convenient, length is measured by Measuring Device over the K-Wire for proximal screw. The Blade K-Wire Guide is taken off. After sending Ø 2 x 340 mm of K-Wire, fluoroscopy control is achieved. The K-Wire should be at the down half part of the femoral head on the AP view and be at the center on the lateral view. Before sending the screw and blade, the anteversion of the nail should be considered. K...

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A-PFN - 9

CARVING OPERATION FOR BLADE CARVING OPERATION FOR PROXIMAL LAG SCREW Guide hole is opened by A-PFN Blade Drill over the Ø 2x340 mm of K-Wire exists at the distal for blade. Tissue protector system is changed. A-PFN Blade Drill & Prox. Screw K-Wire Guide is taken off and A-PFN Proximal Screw-Blade Guide is placed instead. A-PFN Proximal Screw-Reamer Guide is fixed into it then 1. Reamer and 2. Reamer are sent until determined depth thus carving operation is realized.

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A-PFN - 10

2. Reamer is used just for widening lateral cortex. A stopper exists on the drill. TAP OPERATION FOR PROXIMAL SCREW For the Proximal Lag Screw, a threaded guide way is opened by Tap held to the T-Handle. Tapping operation should be done especially on the young patients because of their hard bone structure.

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A-PFN - 11

INSERTING OF THE PROXIMAL SCREW A Proximal Screw in the proper length is fixed to A-PFN Proximal Screw Inserter as in the figure. After pulling out the Proximal Screw Reamer Guide, the Proximal Screw is sent over the K-Wire toward the head. The position of the proximal screw is controlled by the fluoroscopy. Required compression amount (0, 3, 6 mm) is determined by checking window on the tissue protector. For an accurate placement, laser marks on the Inserter and the Tissue Protector should be on the same plane. laser marks should be on the same plane for blade transmission

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A-PFN - 12

A-PFN Antirotator Blade which is in the same length with the proximal screw is assembled to the Blade Inserter as in the figure. Blade is sent after placing to the slide which is in the inferior of Proximal Screw Inserter. It is sent until the sign on the blade inserter that arrives Screw Inserter level with the help of slight Hammer strikes. In this system, the Blade is settled to blade gutter exists in the inferior of Proximal Screw thus provides rotational stability. direction should be placed upwards proximal screw inserter blade inserter

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A-PFN - 13

COMPRESSION SCREW INSERTION A-PFN Blade Inserter and Inner Part of the Proximal Screw Inserter are removed. Cannulated Compression Screw is sent by Ø 4 mm Cannulated Screw Driver inside of the Proximal Screw Inserter to Proximal Screw as providing 3 or 4 threads held. REAMERIZATION FOR DISTAL LOCKING Proximal Tissue Protector is removed. K-Wire is shortened by cutting until 2-3 cm remains outside the skin. Distal locking changes according to condition of the fracture, however locking is made from proximal screw hole for static locking and distal screw hole for dynamic locking. Locking can...

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