Compound and simple shaft fractures proximal, metaphyseal, and distal shaft fractures segmental fractures closed supracondylar fractures. This universal retrograde femoral nail is composed of titanium alloy that. Risk of septic knee following retrograde intramedullary. Phieffer ronald lakatos definition retrograde femoral nailing can be defined as any femoral nailing technique with a distal entry from the condyles or through an intercondylar, intraarticular starting point. A longer nail can be used, but one must realize that the proximal femoral sagittal bow can be an obstacle. Indications discuss indications and more general concerns. Intramedullary nail for treating femoral shaft as well as distal femur fractures. Once impacted, the nail is secured with proximal and distal locking screws to stabilize the femur. Retrograde removal of broken intra medullary femoral nail an. Retrograde femoral nailing is an effective method of femoral shaft fracture fixation in polytrauma patients. By orthopaedic trauma institute at ucsf featuring eric meinberg.
The femoral components of the tkrs were implanted onto left sided femoral sawbones using the manufacturers guides and cutting blocks and positioned appropriately. We now report on our experience with the retrograde femoral nailing as a treatment option in these situations. Surgical technique for the afn antegrade femoral nail afn surgical technique 11 p a determine nail insertion point and insert guide wire in the ap view, the nail insertion point is normally found on the tip or slightly lateral to the tip of the greater trochanter in the curved extension of the medullary cavity. Here 74 patients were men and 29 were women with a mean age of 54 years range 1789 years. Retrograde intramedullary fixation with the supracondylar femoral nail is commonly used in the treatment of fractures of the distal femur. Modular instrumentation for oic nail line is intuitive and flattens learning curve. After making a distal and anterior incision, a guide wire is drilled into place to allow reaming of the femoral canal. In distal femoral fractures aoasif type 33 the use of retrograde imn was free to the estimation of the treating surgeon. The objective of this retrospective study was to describe healing and complication rates of 31 patients who underwent. Retrograde im nailing of the femur orthopaedicsone.
A tibial nail for insertion into the medullary canal of the tibia in a retrograde manner comprising. Apr 01, 2012 retrograde locked intramedullary nailing is widely used to treat femoral supracondylar fractures. Radial head replacement tejwani repair of a femoral nonunion with plate compression and autogenous iliac graft. The patent pending phoenix retrograde femoral nail system features corelock technology, a preassembled, embedded locking mechanism that allows the four distal screws 2 transverse and 2oblique to be mechanically locked to provide enhanced distal femoral fixation. The trigen metanail retrograde femoral nail is the latest addition to the trigen family of intramedullary nails. Enhanced fixation via threaded screw holes and polyethylene bushings offer better solutions for the fixation.
Complicated multiple trauma injuries, associated pelvic. Austin fragomen shares an animation depicting the surgical procedure used to correct a shortened and deformed femur using the precice nail retrograde technique. Reason and treatment of failure of proximal femoral nail antirotation internal fixation for femoral intertrochanteric fractures of senile patients j. The exclusion criterion to use a retrograde im nail was a type c2 or c3 fracture. Retrograde femoral nailing of periprosthetic fractures around. The exhibit illustrates the fixation of a distal femoral fracture with a retrograde nail. Femur lengthening with a retrograde entry precice nail. Zimmer natural nail system retrograde femoral nail surgical. Retrograde locked intramedullary nailing is widely used to treat femoral supracondylar fractures. This video demonstrates retrograde nailing of a midshaft femur fracture. This video demonstrates retrograde nailing of a diaphyseal femoral shaft fracture utilizing minimally invasive techniques. Pdf antegrade versus retrograde locked intramedullary. The phoenix retrograde femoral nail system features corelock. Retrograde versus antegrade intramedullary nailing of gunshot.
The centronail titanium universal femoral nailing system. Nail is indicated for fractures of the femur including stable and unstable distal metaphyseal fractures, diaphyseal. Pdf prospective comparison of retrograde and antegrade. Retrograde nailing for supracondylar fracture around total. Retrograde femoral nailing utilizing percutaneous reduction. Retrograde femoral nailing of periprosthetic fractures.
We had difficulty achieving closed reduction to facilitate passing the balltipped guidewire, thus utilize percutaneously placed schanz pins as joysticks to facilitate reduction. Retrograde removal of broken intra medullary femoral nail. Retrograde intramedullary nailing with a blocking pin. The phoenix retrograde femoral nail system features corelock technology, a preassembled, embedded locking mechanism that allows the four distal screws 2 transverse and 2oblique to be mechanically locked to provide enhanced distal femoral fixation. Antegrade femoral nailing there were more complications related to the knee after retrogradenailing retrograde. One potential complication of retrograde femoral nailing in the treatment of femur fractures is the risk of septic knee. A comparison of the outcomes after antegrade and retrograde nailing of the femur. Finally, use of a blocking drill bit helps to correct coronal plane malalignment.
Tenmillimeter antegrade or retrograde nail inserted for a femoral shaft fracture after reaming. Retrograde removal of broken intra medullary femoral nail an innovative technique. All patients with a femoral shaft fracture admitted at an urban level 1 trauma center from december 1995 to december 1996 were treated with a retrograde femoral intramedullary nail. Femur lengthening with a retrograde entry precice nail youtube. The objective of this retrospective study was to describe healing and complication rates of 31 patients who underwent retrograde femoral. Indications for use of the retrograde femur nails in the femur including. Ota video library retrograde femoral nailing utilizing. This universal retrograde femoral nail is composed. Studies have reported varying incidences of complications associated with retrograde femoral nailing such as knee pain, nonunion, and arthrofibrosis. Complicated multiple trauma injuries, associated pelvic and acetabular fractures, ipsilateral femoral shaft fractures, supracondylar and intercondylar fractures, may be better managed by utilizing retrograde femoral nailing techniques. The retrograde femur nail is designed to help treat various fractures of the femur. In femoral shaft fractures aoasif type 32 the use was restricted to cases where the fracture line extended into the distal dia metaphyseal area or where distal nail insertion seemed favorable due to the. Femoral shaft fractures proximal or midshaft femoral nonunions and malunions pathologic fractures in osteoporotic bone of the diaphyseal area revision procedures retrograde locking option antegrade locking options the universal femoral nail hole configurations provide a number.
Retrograde intramedullary nail techniques generally require an open box femoral prosthesis. Retrograde femoral nailing is a common method to repair femoral shaft fractures in polytrauma patients. The distance from the osteotomy site to the nail insertion site at the knee is then added to render the minimum total nail length. Outcome of retrograde intramedullary nailing and locking. Thats why the oic intramedullary femur nail supports indications for both retro and antegrade approaches.
Implant length is read from the exposed calibrations at the end of. Femoral universal femoral universal nailing system. According to occams razor, the simplest answer is the correct one. For this chapter, retrograde femoral nailing will refer to nails with an intercondylar starting point that extend through. The retrograde im nails were inserted using the conventional entry point and a nail was deemed compatible if this was possible through the femoral prosthesis. Retrograde versus antegrade intramedullary nailing of. Easier maintenance of length and rotation, esp if skeletal traction is used antegrade con. Retrograde im nailing of the femur orthopaedicsone articles. Orthopedics functional outcome after retrograde femoral intramedullary nailing was investigated in 35 patients older than 60 years mean, 86 years with 36 fractures, comprising 15 41. May 21, 20 the use of retrograde nailing for gunshot wound femur fractures is controversial due to concerns of knee sepsis after this procedure since the knee is entered to introduce the nail into the canal. Lengthening of the femur with a remotecontrolled magnetic. Femoral universal femoral universal nailing system options. Newer nail designs have allowed the orthopaedic surgeon to use a more implant specific approach to. Antegrade femoral nailing there were more complications related to the knee after retrogradenailing.
Expert retrogradeantegrade femoral nail surgical technique depuy synthes 9 indications for retrograde approach in retrograde approach, the expert retrogradeantegrade femoral nail is indicated for fractures in the distal femur. Advanced nail design 4 synthes expert retrogradeantegrade femoral nail technique guide retrograde rfn, 160200mm straight retrograde rfn, 220280mm antecurvature 1500mm retrograde rafn, 300480mm antecurvature 1500mm. Nail is indicated for fractures of the femur including stable and unstable distal metaphyseal fractures. The surgeon must check that the package has not been damaged and has not expired. Prevention of tip of nail lying into the knee and early physical therapy are. Please check the sterility of each device on the product label. Reason and treatment of failure of proximal femoral nail. Cai 1department of orthopedic surgery, shanghai tenth peoples hospital, tongji university, school of medicine, shanghai, china. This risk theoretically increases in open fractures as a contaminated fracture site has the potential to seed the instrumentation being passed in and out of the sterile intraarticular starting point.
Figure 3 and table 1 give a summary of the notch designs of various femoral components, including intercondylar width and distance from the anterior femoral osteotomy. Nmpreps new mexico high school sports coverage 101,289 views. Nail entry sites for pediatric long bone fractures 17. We compared retrograde and antegrade nailing for gunshot femur fractures to determine whether 1 knee sepsis or other adverse events were more likely to complicate procedures using retrograde nails. Antegrade femoral nail afn surgical technique depuy synthes 9 determine nail diameter determine the distal nail diameter by placing the aoasif planning template on an ap image over the isthmus. Push down on the top of ruler until contact is made with the 3. The first report of a supracondylar femoral fracture with an ipsilateral total knee replacement tkr was by hirsh et al. There are few studies examining this potential complication in a relatively. The healing rate of femoral shaft fractures fixed with a retrograde nail is the same regardless of location of fracture, age, sex, or comminution. Newer nail designs have allowed the orthopaedic surgeon to use a more implant specific approach to treating these fractures. Fixation of right distal femoral fracture with retrograde nail.
Anatomy of the medial femoral circumflex artery and its surgical implications. The use of retrograde nailing for gunshot wound femur fractures is controversial due to concerns of knee sepsis after this procedure since the knee is entered to introduce the nail into the canal. Furthermore, its anteriorposterior proximal screws promote easeofuse with desired patient positioning and intraoperative imaging. Between 488 and 1090, 29 retrograde femoral nailing in 24 patients were attempted. Orthofix supplies the centronail titanium universal femoral nail, locking screws and end caps in a sterile package, while the instruments are supplied nonsterile. The trigen meta nail retrograde femoral nail is indicated for fractures of the femur including stable and unstable distal metaphyseal fractures, diaphyseal fractures, intraarticular fractures, periprosthetic fractures, nonunions, malunions, and for the prophylactic nailing of impending pathological fractures. Screws are placed through the nail to secure the implant in place and maintain.
Fracture location was isthmal in 14 and infraisthmal in 15. Ostrum, md intramedullary nailing is the treatment of choice for fractures of the femoral shaft. Originally developed for the treatment of supracondylar femur fractures in the elderly, the success of the technique, has led to an expansion of its applications. Include any exams preformed under anesthesia positioning describe and provide or photos to illustrate p.
The zimmer natural nail system is intended for temporary fracture fixation and stabilization of the bone. Retrograde intramedullary fixation with the supracondylar. Confirm guide rod position in the window at the opposite end of the ruler as shown in order to ensure accurate implant measurement. Ao type b distal femoral fractures, compound grade iiib and c gustilo andersons fractures and pathological fractures were excluded from the study. Phoenix retrograde femoral nail system featuring corelocktm. New versatile system for treatment of diaphyseal and metaphyseal fractures. Technology, a preassembled, embedded locking mechanism that allows the four distal screws. With a full range of sizes, the retrograde femoral nail is a comprehensive approach to the treatment of femoral fractures. Retrograde intramedullary nailing of the femur laura s.
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