DAKSH Proximal Femoral Nail with Helical Blade

Proximal Femoral Nail with Helical Blade Specification, uses, Sizes, Surgical Techniques and Clinical Evaluation.

Proximal Femoral Nail with helical blade is an intramedullary implant for the treatment of unstable trochanteric femoral fractures, with the additional option of augmentation. Proximal femoral nail with helical blade represents a unique intramedullary nail system for improved management, particularly in the elderly. Proximal Femoral Nail with Helical Blade is an excellent device for osteosynthesis as it can be easily inserted, it provides angular and rotational stability and allows early weight bearing on the affected limb.

Proximal Femoral Nail with Helical Blade Specification.

The Proximal Femoral Nail with Helical blade has a medial-lateral angle of 6°. This allows insertion at the tip of the greater trochanter.

Several distal locking options: Static or dynamic locking can be performed via the aiming arm with Proximal femoral nail with helical blade small and medium. The Proximal femoral nail with helical blade long additionally allows for secondary dynamization.

The Proximal femoral Nail with helical blade is available in 4 sizes

1. Small, length 180 mm
2. Small, length 200 mm
3. Medium, length 240 mm
4. Large, length 300-420 mm

Inserting the Proximal femoral nail blade compacts the cancellous bone providing additional anchoring, which is especially important in osteoporotic bone.

Increased stability caused by bone compaction around the Proximal femoral nail blade has been biomechanically proven to retard rotation and varus collapse. Biomechanical tests have demonstrated that the Proximal femoral nail blade had a significantly higher cut-out resistance in comparison with commonly-used
screw systems.

All surgical steps required to insert the Proximal femoral nail blade are performed through lateral incision. The Proximal femoral nail blade is automatically locked to prevent rotation of the blade and femoral head.

Proximal femoral Nail with helical blade Contraindications

The physician’s education, training and professional judgement must be relied upon to choose the most appropriate device and treatment. Conditions presenting an increased risk of failure include:

• Any active or suspected latent infection or marked local inflammation in or about the affected area.
• Compromised vascularity that would inhibit adequate blood supply to the fracture or the operative site.
• Bone stock compromised by disease, infection or prior implantation that cannot provide adequate support and/or fixation of the devices.
• Material sensitivity, documented or suspected.
• An overweight or obese patient can produce loads on the implant that can lead to failure of the fixation of the device or tofailure of the device itself.
• Patients having inadequate tissue coverage over the operative site.
• Implant utilization that would interfere with anatomical structures or physiological performance.
• Any mental or neuromuscular disorder which would create an unacceptable risk of fixation failure or complications in postoperative care.
• Other medical or surgical conditions which would preclude the potential benefit of surgery.

Clinical Evaluation of Proximal femoral Nail with helical blade for treatment of intertrochanteric fractures.

Background

Primary hemiarthroplasty was recommended by some surgeons as the preferred choice in treating unstable senile intertrochanteric fractures with osteoporosis. However, many studies reported that proximal femoral nail antirotation (Proximal femoral nail with helical blade) currently was as an optimal implant for the treatment of different type of intertrochanteric fractures. Which method is better for treating senile intertrochanteric fractures remains controversial due to the insufficient clinical evidences.

Methods

We reviewed all consecutive senile intertrochanteric fractures treated with Proximal femoral nail with helical blade or cemented hemiarthroplasty at our institution between July 2010 and March 2015. The primary outcome measures were postoperative complications, reoperation rate and hip function. The secondary outcome measures were intraoperative blood loss, transfusion rate, surgical time, postoperative hemoglobin, hospital stay and 1- year mortality.

Results

Seventy-one patients in Proximal femoral nail with helical blade group and 52 patients in hemiarthroplasty group were included for analysis. There were no significant differences between the two groups regarding to the orthopaedic complications, reoperation rate, surgical time and Harris Hip Score at 1 year follow-up. Significant differences were found between Proximal femoral nail with helical blade and hemiarthroplasty group in comparison of intraoperative blood loss (P < 0.001), transfusion rate, medical complications (P = 0.037) and hospital stay (P = 0.001). Patients treated with hemiarthroplasty had a trend of higher postoperative 1- year mortality compared to those underwent Proximal femoral nail with helical blade but this was statistically not significant (P = 0.134).

Conclusion

These findings indicate that Proximal femoral nail with helical blade has obvious advantages over hemiarthroplasty in the treatment of senile intertrochanteric fractures. Hemiarthroplasty in treating these fractures is associated with greater surgical trauma and higher incidence of postoperative medical complications.