How PFN scores over DHS for inter trochanteric fractures.

1. ISO 9001:2008
Certified
Hospital
Cephalomedullary Nailings
(PFN / TFN)
In Unstable Inter Trochanteric Fractures
Dr. B. Shivashankar.
And its Biomechanical Considerations
Solapur

2. Simpler Classification For Surgeon
Stable
E asy to treat by any method
Un Stable
DIffficult
to treat
If lateral wall is intact and lesser trochanter is intact it is stable,
if any one of them is broken it is unstable

3. Gradual # Collapse
Barrel allows the screw to slide gradually during the course of fracture healing

4. Intact Lateral wall – Key for determining outcome

5. 31% of A2 Type Fractures
31. A2.1
Pre Operative
31. A3. 3
Day 1

6. Day 40
Day 70

7. IM implant : acts as a buttress to
prevent excessive # collapse and
shaft medialization

8. 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

9. DHS Improvements 1985-1999
To Prevent
Medialisation – T S P

10. Slide Courtesy: Indiaorth

11. Dynamisation along Shaft
Medoff plate also requires an intact lateral wall
Otherwise too much medialisation happens as show here

12. PFN= DHS+TSP+Medoff Plate
Plus Intra Medullary implant!
• DHS
• PFN
• 1. Screw Slides in Barrel
• 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
• 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

13. Proximal Femoral Nail
DHS + TSP + Med Off =
Derotational
Screw
PFN

14. Which Appears More Stable ?
1st Order lever
Cantilever 3rd order
Requires medial intactness to work
Will fail if posteromedial comminution+

15. ISO 9001:2008
Certified
Hospital
THANK YOU
drbshivashankar@gmail.com
Dr. B. Shivashankar.
Solapur