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Re: PFN
V. M. Iyer 14 Апрель 2004, 22:19
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Dear Alex,
The curve in the frontal plane is obviously to be able to introduce the nail
thro the tip of the trochanter. Though you may find it easy to enter the pyriformis fossa, for others entry thro the troch is easier. That is the reason. Regards
V M Iyer
. Iyer Orthopaedic Centre,
103,Railway lines Solapur India.
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Re: PFN
Alexander Chelnokov 14 Апрель 2004, 22:32
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t seems to me there is no difference, both approaches are equal -
either through the troch or the piriformis fossa. Do you think this is
the only reason? Maybe insertion through the trochanter provides any
more benefits comparatively to the fossa?
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Re: PFN
Отправитель: George Thomas 15 Апрель 2004, 21:13
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Dear Alex,
According to recent AO literature, the entry through the pyriformis fossa risks damage to the blood supply of the femoral neck and head. Personally, I am not convinced that this is the real reason for the change of entry point in the new AO nails (example cannulated femur nail). Many surgeons (including me), prefer the trochanter as an entry point for the ease of getting it right, ease of doing a small incision procedure.
Cannulated nails also give one the comfort of using a guide wire, and many nails with cannulation can be used reamed or unreamed, thereby fulfilling the needs of the other great controversy in nailing! Therefore, perhaps, the entry point has been changed due to the preference of the surgeons! If the trochanter is the entry point an antecurvature is definitely helpful to ease insertion. Also perhaps a lateralisation curve, that is from medial to lateral.
Dr. George Thomas,
Chennai (Madras),
India
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Re: PFN
Отправитель: Alexander Chelnokov 15 Апрель 2004, 23:29
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GT> the pyriformis fossa risks damage to the blood supply
GT> of the femoral neck and head. Personally, I am not
GT> convinced that this is the real reason for the change
AFAIK this is mostly related to children/adolescents?
GT> trochanter as an entry point for the ease of getting
GT> it right, ease of doing a small incision procedure.
How does it depend on the point of insertion?
GT> Cannulated nails also give one the comfort of using a
GT> guide wire, and many nails with cannulation can be
Either way allows to use the guide wire and cannulated nails, doesn't it?
GT> Also perhaps a lateralisation curve, that is from medial to
GT> lateral.
This is what i asked initially - i see that the curve intended for insertion through the trochanter, and try to realize why change the point from the piriformis to the troch...
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Re: PFN
Отправитель: George Thomas 18 Апрель 2004, 22:47
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AC> AFAIK this is mostly related to children/adolescents?
According to recent AO literature this is true also for adults.
GT>> it right, ease of doing a small incision procedure.
AC> How does it depend on the point of insertion?
Some surgeons (me included) feel it is easier because the trochanter is so easy to palpate, also the insertion device is away from the bulk of the gluteus (very large sometimes in fat people!).
GT>> Cannulated nails also give one the comfort of using a
GT>> guide wire, and many nails with cannulation can be
AC> Either way allows to use the guide wire and cannulated nails, doesn't
it?
This sentence was in relation to the AO unreamed nail which is solid, not cannulated.
GT>> Also perhaps a lateralisation curve, that is from medial to
GT>> lateral.
AC> This is what i asked initially - i see that the curve intended for insertion through the trochanter, and try to realize why change the point from the piriformis to the troch...
I thought I gave the AO's reasons for this at first. The rest of the mail was some random thoughts on nail design.
Warmest regards (40 degrees centigrade in Chennai!)
Dr. George Thomas,
Chennai, India
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