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Fixation of a diaphyseal femoral fracture with a Depuy-Synthes Expert retrograde/antegrade femoral nail (RAFN) surgical technique

Overview

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Learn the Fixation of a diaphyseal femoral fracture with a Depuy-Synthes Expert retrograde/antegrade femoral nail (RAFN) surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Fixation of a diaphyseal femoral fracture with a Depuy-Synthes Expert retrograde/antegrade femoral nail (RAFN) surgical procedure.

 

The retrograde/antegrade femoral nail (RAFN) is a versatile system whose benefits include:

  • One system of instrumentation for retrograde and antegrade insertion.
  • One system / implant for left and right femurs.
  • An anatomic anterior bow that allows easier nail insertion.
  • All nails are cannulated and can be inserted with either a reamed or unreamed technique.
  • There is a large range of nail diameters available 9.0 mm to 15.0 mm
  • There are multiple locking options including; static, dynamic, standard and blade options for osteoporotic bone.

It should be noted that a distal femoral nail is inserted with a retrograde technique and in some literature the words are often used to mean the same thing. However, this shouldn’t be confused with an antegrade nail (e.g. Lateral Femoral Nail – LFN) that is used to treat a distal third femoral fracture.

In a retrospective series by Kim et al., sixty patients undergoing femoral nailing for infra-isthmal fractures were reviewed. Thirty-eight patients were treated with an antegrade nail and twenty-two patients with a retrograde nail. They report no statistical difference in time to union, no difference in malalignment > 10 degrees and no difference in Knee Society scores. They did however find that the IM nail with the shorter working length distal to the fracture showed a strong relationship with nonunion.

In a systematic review and meta-analysis by Koso et al., they report that femoral shaft fractures developed nonunion in 6.6% of unreamed nails and 2.1% of reamed nails (p = 0.002). Therefore if the patient’s physiology will permit reaming of the femoral canal, this lowers the risk of developing a nonunion.

Kim JW et al. Treatment of infra-isthmal femoral fracture with an intramedullary nail: Is retrograde nailing a better option than antegrade nailing? Arch Orthop Trauma Surg 2018;138(9):1241-1247. 

Koso RE et al. Healing, nonunion, and re-operation after internal fixation of diaphyseal and distal femoral fractures: a systematic review and meta-analysis. Int Orthop 2018;42(11):2675-2683.

Readers will may also find of use the following OrthOracle techniques:

Open reduction and internal fixation of an open intra-articular distal femoral fracture with Synthes LCP distal femoral plate

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

Tibial intramedullary nailing (suprapatella approach): Synthes Expert Tibial Nail.

Author: Mr Ross Fawdington FRCS (Tr & Orth)

Institution: The Queen Elisabeth Hospital, Birmingham, UK.

Surgical Steps

Welcome to the surgical steps quiz.

This tests your ability to recall the correct order in which the key steps of an operation should be performed.

There will be various legitimate variations in this order but the quiz doesn’t reflect this.
Your reference point for the steps quiz is just our operative technique.
It’s one starting point in helping you to learn the technique.

  • You simply “drag & drop” the boxes containing the descriptions of the steps into the order you think fits and submit for marking.
  • If you get it correct first time you will be presented your certificate at the end of the quiz.
  • If you need to do more work on the steps you access your marked version by clicking the“re-sit the quiz” button.
  • This will show the steps you ordered correctly highlighted in green and the incorrect ones in red.
  • The correct green steps are fixed and won’t move.
  • The red steps move differently after your initial attempt and swap locations with the step they are dragged and dropped onto .
  • Finally resubmit the quiz once again.
  • The quiz will let you keep going until you get all the steps in the right order.
  • The correct green steps are fixed and won’t move.
  • The red steps move differently after your initial attempt and swap locations with the step they are dragged and dropped onto .
  • Finally resubmit the quiz once again.
  • The quiz will let you keep going until you get all the steps in the right order.

COURSE PROGRESS

Surgical Steps

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