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Femoral intramedullary nail: Synthes Expert Lateral Femoral Nail (LFN) for impending pathological fracture. surgical technique

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The Synthes Expert Lateral Femoral is a trochanteric entry proximal femoral nail. It can be used to treat fractures involving the femoral shaft using its standard locking options. It is a fairly versatile implant and can equally be used to treat fractures involving the femoral neck or sub-trochanteric region with its recon locking options.

Proposed advantages of this nail include an easier to access entry point (it is more lateral than the commoner entry point at the tip of the greater trochanter). This is also an advantage in the obese patient where it is difficult to obtain the correct trajectory for nail insertion. The lateral entry point is intended to avoid damage to the ascending branch of the lateral femoral circumflex artery, which if damaged may lead to avascular necrosis of the femoral head. The nail has a  more anatomic radius of curvature compared to the Synthes Proximal Femoral Nail Alpha (PFNa). It also has multi-planar distal locking, with an option to insert a third locking bolt through an oblique hole, thus providing increased stability in distal third femoral fractures. Its end caps are also cannulated which makes them easier to insert.

Author: Mr Ross Fawdington FRCS Ed (Tr & Orth).

Institution: Queen Elizabeth Hospital, Birmingham,  UK.

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