TFN-ADVANCED Proximal Femoral Nailing System (TFNA)

Introduction

• Designed for intramedullary fixation of proximal femoral fractures.
• Promotes excellence in patient care and outcomes.

AO Principles of Fracture Management

1. Fracture reduction and fixation to restore anatomical relationships.
2. Fixation providing absolute/relative stability based on fracture type, patient, and injury.
3. Preservation of blood supply through gentle reduction.
4. Early mobilization and rehabilitation.

Clinical Cases

Case 1

• 72-year-old female with AO 31A3 fracture.
• Unstable transverse intertrochanteric fracture.
• Long nail chosen to protect entire femur.

Case 2

• 85-year-old with 31A3 fracture and subtrochanteric extension.
• Highly unstable, quick, closed procedure needed.

Indications, Contraindications, and Precautions

Indications

• Treats stable/unstable pertrochanteric, intertrochanteric, basal neck, and subtrochanteric fractures.
• Used with PMMA bone cement for patients at risk of cut-out/device instability.

Contraindications

• Intra-articular cement leakage risk.
• Cases with active infections.
• Not for intracapsular hip fractures.

TRAUMACEM V+ Augmentation System

• Injectable bone cement for augmentation in patients with poor bone quality.

Surgical Technique Overview

Preparation

1. Position patient for fracture visualization.
2. Perform closed fracture reduction.
3. Determine femoral neck angle using radiographic ruler.
4. Determine nail length and diameter.

Open Proximal Femur

1. Identify nail entry point.
2. Insert guide wire.
3. Open canal with the drill.

Insert Nail

1. Assemble insertion instruments.
2. Insert nail manually or with light hammer blows.

Proximal Locking

1. Choose aiming arm matching nail angle.
2. Verify nail depth and insert guide wire.
3. Insert helical blade or screw.
4. Engage locking mechanism.

Augmentation

• Use 3 mL of cement for augmentation.
• Avoid injecting more than 6 mL.
• Ensure minimum distance of 6 mm from joint surface.

Distal Locking

• Use freehand technique for long nails.
• Confirm reduction with imaging.

Insert End Cap

• Use to prevent bone ingrowth and adjust nail length.

Implant Removal

1. Disengage locking mechanism.
2. Remove helical blade/screw and distal locking screw.
3. Extract nail.

Product Information

• Various implant sizes and configurations for both short and long nails.
• Instruments and augmentation system components detailed.

Additional Notes

• Keep MR compatibility in mind, as not evaluated for safety.
• Regular tool maintenance and calibration recommended.