Slovenská chirurgia 2/2022

Improvement of guide wire position in PFNA implant

Introduction: Many fixation systems for the treatment of proximal femoral fracture use a guide wire before inserting the screw, screws or blade in the proximal femur. Even though the guide wire is commonly inserted through a guiding device, malposition of the wire is a common technical problem with many devices. Various explanations for this issue exist, including anatomical variations, technical errors and design of the guiding device. Methods/Description of technique: We describe an innovative technique for inserting the guide wire in its optimal position in cases where multiple unsuccessful insertion attempts have been made. In this case, after optimal insertion of the PFNA and sliding of the assembly device onto the femoral bone, we recommend drilling through the lateral femoral cortex with a 11 mm drill bit for blade and subsequently reinserting the guide wire. Conclusion: Proposed technique can help to easily achieve optimal positioning of the guide wire in PFNA, it is easy to perform, it is not time-consuming, and moreover it does not interfere with implant placement.

Keywords: PFNA, innovative technique, guide wire malposition