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Forum: OWL Lists: Orthopod:
PFN - LONG or SHORT

 



drtigeorge at gmail
New User

Sep 26, 2006, 11:13 PM

Post #1 of 5 (4629 views)
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PFN - LONG or SHORT Can't Post

We have recently started using PFN(Indian) for our pertrochanteric
fractures. Can I ask the more experienced surgeons on their preference of
nail? LONG OR SHORT PFN? What is the reported incidence of shaft fractures
following short PFN?

Can my Indian colleagues tell us the names of manufacturers with acceptable
instrumentation.

Thanks in advance.


Dr. T. I. George,
Senior Orthopaedic Surgeon
And
Head of Orthopaedics Unit-III,
Little Flower Hospital and research Centre,
Angamaly, Kerala State,
India.


n.vora at virgin
New User

Sep 26, 2006, 11:34 PM

Post #2 of 5 (4629 views)
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Re: PFN - LONG or SHORT [In reply to] Can't Post

Dear George,

I have moved to using the long PFN for all these kind of fractures, mainly because of the fear of a more distal fracture if a short nail is used.

This distal fracture might even occur as a result of the frequent falls that some of the elderly population are prone to.

Having said that, my preference for an Intertrochanteric fracture still remains the DHS/CHS as it is a time tested procedure and is (usually) a lot quicker to do than a nail.

For reverse IT and subtrochs, the PFN is the way to go.

Niraj

Niraj L Vora
Orthopaedic Surgeon
Prescot, UK


hselhi at gmail
New User

Sep 27, 2006, 4:42 AM

Post #3 of 5 (4629 views)
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RE: PFN - LONG or SHORT [In reply to] Can't Post

I fully agree with you on this account



Harpal



_____

From: Niraj L Vora [mailto:n.vora@virgin.net]
Sent: Wednesday, September 27, 2006 12:04 PM
To: orthopod@orthogate.com
Subject: Re: PFN - LONG or SHORT



Dear George,



I have moved to using the long PFN for all these kind of fractures, mainly
because of the fear of a more distal fracture if a short nail is used.



This distal fracture might even occur as a result of the frequent falls that
some of the elderly population are prone to.



Having said that, my preference for an Intertrochanteric fracture still
remains the DHS/CHS as it is a time tested procedure and is (usually) a lot
quicker to do than a nail.



For reverse IT and subtrochs, the PFN is the way to go.



Niraj



Niraj L Vora

Orthopaedic Surgeon

Prescot, UK



ggcortho at comcast
New User

Sep 27, 2006, 12:32 PM

Post #4 of 5 (4624 views)
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RE: PFN - LONG or SHORT [In reply to] Can't Post

In our area the Synthes short trochanteric femoral nail is especially
popular for intertrochanteric fractures. An intermediate nail is available
for those people with some small amount of subtrochanteric extension.
Complex subtrochanteric fractures are addressed nicely handled by their long
nail.



G. Caronis, MD

Libertyville, IL



-----Original Message-----
From: george therthanath [mailto:drtigeorge@gmail.com]
Sent: Wednesday, September 27, 2006 1:14 AM
To: Indiaorth@indiaorthmail.com; orthopod@orthogate.com
Subject: PFN - LONG or SHORT



We have recently started using PFN(Indian) for our pertrochanteric
fractures. Can I ask the more experienced surgeons on their preference of
nail? LONG OR SHORT PFN? What is the reported incidence of shaft fractures
following short PFN?



Can my Indian colleagues tell us the names of manufacturers with acceptable
instrumentation.



Thanks in advance.


Dr. T. I. George,
Senior Orthopaedic Surgeon
And
Head of Orthopaedics Unit-III,
Little Flower Hospital and research Centre,
Angamaly, Kerala State,
India.



theo at asumu
New User

Sep 30, 2006, 2:16 AM

Post #5 of 5 (4611 views)
Shortcut
RE: PFN - LONG or SHORT [In reply to] Can't Post

The main advantage of a short nail is the ability to carry our distal
locking through the jig.

Short proximal femoral nails (as a generic group regardless of
manufacturer) tend to be straight on the lateral view. There is no
antecurvature to match the femur. Patients with excessive bowing of the
femur often end up with the tip of the nail abutting against the
anterior cortex. This stress riser can lead to peri-implant fractures.
The true incidence of this complication is difficult to estimate. A
study in 1993 (1) reported an 11% incidence with the gamma nail.
Changes in design have lead to a reduced rate of shaft fractures but the
rate still exceeds that seen following a dynamic hip screw.

The long nail with an antecurvature was designed to avoid this
complication. There remains an incidence of fracture at the tip of the
long nail. Robinson's group in Edinburgh (2) had 5 such fractures
occurring within 8 weeks of surgery in 302 patients (1.6% incidence).

Other disadvantages of the short nail, in my opinion include the
limitation of the short nail in dealing with fractures extending low in
the subtrochanteric region.

My preference is to use the long nail for all such fractures. In purely
trochanteric fractures, I do not lock distally.



1) Bridle SH, Patel AD, Bircher M, Calvert PT. Fixation of
intertrochanteric fractures of the femur. A randomised prospective
comparison of the gamma nail and the dynamic hip screw. J Bone Joint
Surg Br. 1991;73:330 -4.


2) C. Michael Robinson, S. Houshian, and L.A.K. Khan
Trochanteric-Entry Long Cephalomedullary Nailing of Subtrochanteric
Fractures Caused by Low-Energy Trauma
J. Bone Joint Surg. Am., Oct 2005; 87: 2217 - 2226.

Mr Theophilus Asumu FRCS (Tr & Orth)
Consultant in Trauma and Orthopaedic Surgery
Oldham
United Kingdom

-----Original Message-----
From: george therthanath [mailto:drtigeorge@gmail.com]
Sent: 27 September 2006 07:14
To: Indiaorth@indiaorthmail.com; orthopod@orthogate.com
Subject: PFN - LONG or SHORT

We have recently started using PFN(Indian) for our pertrochanteric
fractures. Can I ask the more experienced surgeons on their preference
of nail? LONG OR SHORT PFN? What is the reported incidence of shaft
fractures following short PFN?

Can my Indian colleagues tell us the names of manufacturers with
acceptable instrumentation.

Thanks in advance.


Dr. T. I. George,
Senior Orthopaedic Surgeon
And
Head of Orthopaedics Unit-III,
Little Flower Hospital and research Centre,
Angamaly, Kerala State,
India.

 
 


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