PFNA-II.

Proximal Femoral Nail

Antirotation.

Surgical Technique

This publication is not intended for

distribution in the USA.

Instruments and implants

approved by the AO Foundation.
Image intensifier control

This description alone does not provide sufficient background for direct use
of DePuy Synthes products. Instruction by a surgeon experienced in handling
these products is highly recommended.

Processing, Reprocessing, Care and Maintenance

For general guidelines, function control and dismantling of m ­ ulti-part
instruments, as well as processing guidelines for i­mplants, please contact your
local sales representative or refer to:
http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance
For general information about reprocessing, care and maintenance of
Synthes reusable devices, instrument trays and cases, as well as processing of
Synthes non-sterile implants, please consult the Important Information leaflet
(SE_023827) or refer to:
http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance
Table of Contents

Introduction Introduction2

AO Principles  5

Indications and Contraindications  6

Clinical Cases  7

Surgical Technique Preoperative Planning  8

Patient Positioning 9

Preparation  10

Open Femur 14

Insert Nail 19

Proximal Locking 22

Distal Locking 40
– For PFNA-II Short 42
– For PFNA-II Long 48

Insert End Cap 51

Implant Removal 53

Correction of Insertion Depth of PFNA-II Blade 56

Cleaning57

Product Information Implants58

Alternative Implants 64

Instruments66

Cases75

MRI Information  79

PFNA-II Surgical Technique DePuy Synthes 1

PFNA-II. Proximal Femoral Nail
Antirotation II.

PFNA-II Nail

The PFNA-II has a medial-lateral angle of 5°

This allows insertion at the tip of the greater
trochanter.

Several distal locking options

Static or dynamic locking can be per­ PFNA-II PFNA-II

formed via the aiming arm with PFNA-II short long
standard, small and xs. The PFNA-II
long additionally allows for secondary
dynamization.

Static Static (90°) Dynamic Static Dynamic

2 DePuy Synthes PFNA-II Surgical Technique

PFNA-II Nail
Product range

The PFNA-II is available in 4 sizes

PFNA-II xs, length 170 mm

PFNA-II small, length 200 mm

PFNA-II, length 240 mm

PFNA-II long, length 260 – 340 mm

(with 20 mm increments), length 340 – 420 mm
(with 40 mm increments, only B 10 mm nails),
bending radius 1500 mm

PFNA-II Surgical Technique DePuy Synthes 3

PFNA-II. Proximal Femoral Nail
Antirotation.

PFNA-II Blade

Rotational and angular stability achieved with one

single element

Compaction of cancellous bone

Inserting the PFNA-II blade compacts the cancellous bone
providing additional anchoring, which is especially important
in osteoporotic bone.1

Bone structure before insertion of the Bone structure after PFNA-II blade
PFNA-II blade. inser­tion – cancellous bone is
compacted providing additional
anchoring to the PFNA-II blade.

Large surface and increasing core diameter for

maximum compaction and optimal hold in bone
Increased stability caused by bone compaction around the
PFNA-II blade has been biomechanically proven to retard
­rotation and varus collapse. Biomechanical tests have
­demonstrated that the PFNA-II blade had a significantly
­higher cut-out resistance in comparison with commonly-used
screw systems.2

Lateral locking of the PFNA-II blade

–– All surgical steps required to insert the PFNA-II blade are
performed through lateral incision
–– The PFNA-II blade is automatically locked to prevent
­rotation of the blade and femoral head

PFNA-II blade unlocked PFNA-II blade locked

1
 Amir A. Al-Munajjed, Joachim Hammer, Edgar Mayr, Michael Nerlich and Andreas
Lenich. Biomechanical characterization of osteosyntheses for proximal fractures:
helical blade versus screw. Medicine Meets Engineering. 2008
2
 Data on file.

4 DePuy Synthes PFNA-II Surgical Technique

 AO Principles

AO PRINCIPLES

In 1958, the AO formulated four basic principles, which have

In 1958, the guidelines
become AO formulated four basic
for internal principles,
fixation1,2
. which
have become the guidelines for internal fixation1, 2.

4_Priciples_03.pdf 1 05.07.12 12:08

Anatomic
Anatomic reduction fixation
Stable fixation
Fracture reduction
Fracture reduction and
and fixation
fixation to Fracture
Fracture fixation
fixationproviding
providingabsolute
abso-
to restore
restore anatomical
anatomical relationships.
relationships. or relative
lute stability,
or relative as required
stability, as by the
­prequired
atient, theby injury, and thethe
the patient, personality
injury,
1 2 of
andthethe
fracture.
personality of the
fracture.

Early,
Early, active mobilization
mobilization Preservationof
Preservation of blood
blood supply
supply
Early and
Early and safe mobilization
mobilizationand
and 4 3 Preservation
Preservationof ofthe
theblood
bloodsupply
supply
rehabilitation the injured partand
rehabilitation of the injured part to
to soft tissues and bone bygentle
soft tissues and bone by
the patient
and as a whole.
the patient as a whole. reduction techniques
gentle reduction and careful
techniques and
handling.
careful handling.

1
Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal
Fixation. 3rd ed. Berlin Heidelberg New York: Springer. 1991.
2
Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management.
2nd ed. Stuttgart, New York: Thieme. 2007.

1
 Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation.
3rd ed. Berlin, Heidelberg, New York: Springer. 1991.
2
 Rüedi TP, Buckley RE, Moran CG. AO Principles of Fracture Management. 2nd ed.
Stuttgart, New York: Thieme. 2007.

4 DePuy Synthes Expert Lateral Femoral Nail Surgical Technique

PFNA-II Surgical Technique DePuy Synthes 5
Indications and Contraindications

PFNA-II short (Length 170 mm – 240 mm)

Indications
–– Pertrochanteric fractures (31-A1 and 31-A2)
–– Intertrochanteric fractures (31-A3)
–– High subtrochanteric fractures (32-A1)

Contraindications
–– Low subtrochanteric fractures
–– Femoral shaft fractures
–– Isolated or combined medial femoral neck fractures

PFNA-II long (Length 260 mm – 420 mm)

Indications
–– Low and extended subtrochanteric fractures
–– Ipsilateral trochanteric fractures
–– Combination fractures (in the proximal femur)
–– Pathological fractures

Contraindications
–– Isolated or combined medial femoral neck fractures

Note: ASLS, the Angular Stable Locking System, is indicated

in cases where increased stability is needed in fractures
closer to the metaphyseal area or in poor quality bone.
For more details regarding the intramedullary fixator
­principle, please consult the ASLS surgical technique
(DSEM/TRM/0115/0284) and concept flyer (036.001.017).

6 DePuy Synthes PFNA-II Surgical Technique

Clinical Cases

94 years, female 31-A1.1 0 days post-op 14 weeks post-op 11 months post-op

93 years, female, 31-A3.3 4 days post-op 4 weeks post-op 5 months post-op

PFNA-II Surgical Technique DePuy Synthes 7

Preoperative Planning

Use the preoperative planner template for the PFNA-II to

­estimate the CCD angle, nail diameter and length.

Take a preoperative AP radiography of the unaffected leg.

Determine the CCD angle using a goniometer or the
­preoperative planning template.

To estimate the CCD angle, place the template on the AP ­

x-ray of the uninjured femur and determine the CCD angle.

To estimate the nail diameter, place the template on the

AP x-ray of the uninjured femur and measure the ­diameter of
the medullary canal at the narrowest part that will contain
the nail.

To estimate the nail length, place the template on the

AP x-ray of the uninjured femur and select the appropriate
nail length based on patient anatomy.

Note: When selecting the nail size, consider canal diameter,

fracture pattern, patient anatomy and post-operative
­protocol.

8 DePuy Synthes PFNA-II Surgical Technique

Patient Positioning

Position the patient supine on an extension table or a

­radiolucent operating table. Abduct the unaffected leg as far
as possible and place it on a leg support, so that it allows
free fluoroscopic examinations. This should be tested preop-
eratively.

For unimpeded access to the medullary cavity, abduct the up­

per body by about 10 –15° to the unaffected side (or adduct
the affected leg by 10 –15°).

PFNA-II Surgical Technique DePuy Synthes 9

Preparation

1
Reduce fracture

Perform closed reduction of the fracture under image

­intensifier control. If the result is not satisfactory, perform
open reduction.

Note: Exact anatomical reduction and secure fixation of the

patient to the operating table are essential for easy handling
and a good surgical result.

Precautions:
–– Instruments and screws may have sharp edges or moving
joints that may pinch or tear user’s glove or skin.
–– Handle devices with care and dispose worn bone cutting
instruments in an approved sharps container.

11 DePuy Synthes PFNA-II Surgical Technique

2
Confirm nail length and diameter

Instrument

309.602 Radiographic Ruler for PFNA

The required nail length must be determined after reduction

of the femoral fracture.

Position the C-arm for an AP view of the proximal femur.

With long forceps, hold the ruler alongside the lateral thigh,
parallel to and at the same level as the femur. Adjust the
ruler until the proximal end is at the desired nail insertion po-
sition. Mark the skin at the proximal end of the ruler.

Move the C-arm distally. Align the proximal end of the radio­
graphic ruler to the skin mark, and take an AP image of
the distal part. Verify fracture reduction going from proximal
to the fracture to distal.

Read the nail length directly from the ruler image. For long
nails, select the measurement at or just proximal to the
­epiphyseal scar, or at the chosen insertion position.

Note: When selecting the nail size, consider canal diameter,

fracture pattern, patient anatomy and post-operative protocol.

PFNA-II Surgical Technique DePuy Synthes 11

Preparation

Alternatives

Determine the nail length by the procedure above on the

­uninjured leg before draping (unsterile) or compare
the length of two identical SynReam reaming rods B 2.5 mm
(352.032) or use the depth gauge (351.717 and 351.719)
in combination with the SynReam reaming rod B 2.5 mm,
length 950 mm (352.032) before inserting the PFNA-II nail.

Place the Radiographic Ruler for PFNA (309.602) perpendicu-

lar to the femur axis so that the diameter gauge is located
over the isthmus. Select the nail diameter with which the
­intramedullary canal-to-cortex transition is still visible on
both sides of the diameter gauge.

The ruler provides only an estimate of the canal diameter as

it is not at the same level as the femur.

If the reamed technique is used, the diameter of the ­largest

medullary reamer applied must be 0.5 mm to 1.5 mm larger
than the nail diameter.

Always choose the largest diameter nail that fits into the in-
tramedullary canal (B 9 mm nails should only be used for an
intramedullary canal smaller than 11 mm).

11 DePuy Synthes PFNA-II Surgical Technique

3
Approach

Palpate the trochanter major.

Make a 5 cm incision proximal from the tip of the greater

trochanter. Make a parallel incision of the fasciae of the
­gluteus medius and split the gluteus medius in line with the
fibers.

PFNA-II Surgical Technique DePuy Synthes 11

Open Femur

1 5°
Determine entry point

In AP view, the PFNA-II entry point is on the tip or slightly

­lateral to the tip of the greater trochanter in the curved
­extension of the medullary cavity, as the ML angle of the
­PFNA-II is 5°.

In lateral view the entry point is in line with the axis of the
­intramedullary canal.

2
Insert guide wire

Instruments

356.830 Guide Wire B 3.2 mm, for PFNA Blade

393.100 Universal Chuck with T-Handle

03.023.002 Protection Sleeve 20.0/17.0, for PFNA-II

03.023.006 Drill Sleeve, for PFNA-II

Secure the guide wire in the power tool. Alternatively, the

universal chuck with T-handle can be used to insert the guide
wire manually.

Position both the protection sleeve and the drill sleeve at

the insertion point. Insert the guide wire through the protec-
tion sleeve and the drill sleeve. Remove the power tool and
the drill sleeve.

11 DePuy Synthes PFNA-II Surgical Technique

To correct the placement of the guide wire, leave the first
guide wire in place and insert a second guide wire through
one of the multiple holes of the drill sleeve.

Note: The correct entry point and angle are essential for a
successful result. To ensure the correct position of the
guide wire, position a guide wire ventrally on the femur and
check under image intensifier control.

Alternative

Instruments

356.830 Guide Wire B 3.2 mm, for PFNA Blade

393.100 Universal Chuck with T-Handle

357.001 Protection Sleeve 20.0/17.0,

for No. 357.005

309.603 Drill Sleeve 17.0/3.2, for No. 357.001

Note: Use drill bit 309.600 only together with protection

sleeve 357.001.

Secure the guide wire in the power tool. Alternatively, the

universal chuck with T-handle can be used to insert the guide
wire manually.

Position both protection sleeve and drill sleeve at the inser-

tion point. Insert the guide wire through the protection
sleeve and the drill sleeve. Remove the power tool and the
drill sleeve.

PFNA-II Surgical Technique DePuy Synthes 11

Open Femur

3
Open femur with flexible drill bit

Instruments

03.023.010 Drill Bit B 16.5 mm, cannulated, flexible,

for PFNA-II

03.023.002 Protection Sleeve 20.0/17.0, for PFNA-II

393.100 Universal Chuck with T-Handle

Guide the flexible cannulated drill bit through the protection

sleeve over the guide wire and drill the cavity for the proxi-
mal part of the PFNA-II nail with the power tool. Remove the
drill bit, the protection sleeve and the guide wire.

Precaution: It is recommended to open the femur by using

a power tool at high speed or carefully by hand. To prevent
dislocating the fracture fragments, avoid lateral movements
or excessive compression forces.

Alternative: Open femur with awl

Instrument

03.023.003 Awl for PFNA-II

Guide the awl over the guide wire and prepare with bi-direc-
tional turns the cavity for the proximal part of the PFNA-II
nail. Remove the awl and the guide wire.

11 DePuy Synthes PFNA-II Surgical Technique

Alternative: Open femur with drill bit

Instruments

309.600 Drill Bit B 17.0 mm, cannulated, for PFNA

357.001 Protection Sleeve 20.0/17.0,

for No. 357.005

393.100 Universal Chuck with T-Handle

Note: Use drill bit 309.600 only together with protection

sleeve 357.001.

Guide the drill bit through the protection sleeve over the
guide wire and drill as far as the stop on the protection
sleeve. Remove the drill bit, the protection sleeve and the
guide wire.

Precaution: It is recommended to open the femur by using

a power tool at high speed or carefully by hand. To prevent
dislocating the fracture fragments, avoid lateral movements
or excessive compression forces.

PFNA-II Surgical Technique DePuy Synthes 11

Open Femur

4
Option: Ream medullary canal

Instruments

189.060/ SynReam Intramedullary Reaming System

175.500

351.782 Holding Forceps for SynReam Reaming

Rod B 2.5 mm

If necessary, enlarge the femoral canal to the desired

diameter using the medullary reamer and the corresponding
surgical technique (DSEM/TRM/0614/0103).

Check fracture reduction under image intensifier control.

Insert reaming rod

Insert the reaming rod into the medullary canal to the
­desired insertion depth. The tip must be correctly positioned
in the medullary canal since it determines the final distal
­position of the long PFNA-II.

Reaming
Starting with the 8.5 mm diameter reaming head, ream to a
diameter of 0.5 to 1.5 mm greater than the nail d­ iameter.
Ream in 0.5 mm increments and advance the reamer with
steady, moderate pressure. Do not force the reamer. Partially
retract the reamer repeatedly to clear debris from the
­medullary canal.

Use the holding forceps to retain the reaming rod while

reaming and to prevent it from rotating. Remove the ream-
ing rod before locking the intramedullary nail.

11 DePuy Synthes PFNA-II Surgical Technique

Insert Nail

1
Assemble PFNA-II instruments

Instruments

03.010.405 Insertion Handle, radiolucent, for PFNA

357.029 Connecting Screw, cannulated, for PFNA

03.023.011 Screwdriver, hexagonal with spherical

head B 10.0 mm, cannulated

Guide the connecting screw through the insertion handle

and secure the desired PFNA-II to the insertion handle using
the hexagonal screwdriver with spherical head.

Precaution: Ensure that the connection between PFNA-II

and insertion handle is tight (retighten, if necessary) to avoid
deviations when inserting the PFNA-II blade through the
­aiming arm. Do not attach the aiming arm yet.

PFNA-II Surgical Technique DePuy Synthes 11

Insert Nail

2
Insert PFNA-II

Use image intensifier control to insert the PFNA-II.

Carefully insert the PFNA-II manually using slight bidirectional

turns of the insertion handle as far as possible into the
­femoral opening. If the PFNA-II cannot be inserted, select a
smaller size PFNA-II diameter or ream the medullary cavity to
a diameter that is at least 1 mm larger than that of the
­selected nail.

The correct PFNA-II insertion depth is reached as soon as

the projected PFNA-II blade is positioned in the center of the
femoral head. A too cranial or too caudal PFNA-II position
should be avoided as it can lead to malposition of the
PFNA-II blade.

The anteversion can be determined by inserting a guide

wire ventral to the femoral neck in the femoral head.
In the mediolateral view, place the insertion handle parallel
to the guide wire to align the correct rotation of the PFNA-II.

Remove all guide wires.

Precautions:
–– Guide wires are single-use items, do not re-use.
–– Always ensure that the PFNA-II is firmly attached to the
insertion handle.

22 DePuy Synthes PFNA-II Surgical Technique

Optional instruments

03.010.424 Connector for Insertion Handle for PFNA

03.010.124 Combined Hammer 500 g, can be

mounted, for No. 357.117

357.071 Hammer Guide, for No. 357.026

Attach the connector on the insertion handle and use light

hammer blows on the connector to insert the nail.

Remove the connector.

Optionally, instead of the connector, the hammer guide can

be threaded into the insertion handle and the hammer
can be used as a slide hammer.

Remove the hammer guide.

Precaution: Use only light blows on the con­nector for

­insertion handle. Avoid unnecessary use of force to prevent
loss of reduction or an iatrogenic fracture.

PFNA-II Surgical Technique DePuy Synthes 22

Proximal Locking

1
Choose aiming arm for PFNA-II blade insertion

Instruments

03.010.406 Aiming Arm 125° for PFNA Blade

03.010.407 Aiming Arm 130° for PFNA Blade

03.010.470 Plug for Aiming Arm

Using the hexagonal screwdriver with spherical head,

­confirm that the connecting screw between the insertion
handle and the PFNA-II is sufficiently tightened.

Mount the appropriate aiming arm based on the chosen

CCD angle of the PFNA-II and fix it firmly to the insertion
­handle.

Insert the plug for aiming arm into the locking hole of the
nail length that is NOT used in this case.

22 DePuy Synthes PFNA-II Surgical Technique

2
Prepare guide wire insertion

Instruments

356.817 Buttress/Compression Nut, for PFNA Blade

356.818 Protection Sleeve 16.0/11.0,

for PFNA Blade

356.819 Drill Sleeve 11.0/3.2, for PFNA Blade

356.820 Trocar B 3.2 mm, for PFNA Blade, gold

Screw the buttress nut on the protection sleeve for PFNA

blade. Make sure the «lateral side» marking points ­towards
the head of the sleeve. Screw the buttress nut up to the
marking on the protection sleeve.

Insert the drill sleeve and the trocar through the protection
sleeve.

Advance the entire sleeve assembly for PFNA blade through

the aiming arm to the skin until it clicks into the aiming
arm. Adjust the position of the buttress nut if necessary.

Precaution: Ensure that the sleeve assembly clicks into

the aiming arm, otherwise it will not guarantee the exact
­position of the ­PFNA-II blade.

Verify nail insertion depth and position for the helical blade/
screw. Place a guide wire on the yellow marking of the aim-
ing arm and radiographically check the guide wire position in
AP.

PFNA-II Surgical Technique DePuy Synthes 22

Proximal Locking

3
Option: Position guide wire with aiming device

Instruments

03.010.412 Aiming Device for Guide Wire,

for PFNA and TFN, for AP Orientation

03.010.414 Connecting Screw for PFNA,

for No. 03.010.412

Attach the guide wire aiming device for AP orientation to the

aiming arm using the connecting screw for PFNA.

Position the C-arm for the AP view. Rotate the C-Arm until
any two orientation lines are symmetric to the protection
sleeve.

The midline in between these two orientation lines predicts

the location of the guide wire and PFNA-II Blade.

Adapt the insertion depth of the nail until the midline is

­centered in the femoral head.

The C-arm may be readjusted to make sure that two lines

are symmetric to the sleeve.

Note: The outer lines can be used to determine the center

of the femoral head.

22 DePuy Synthes PFNA-II Surgical Technique

Position the C-arm in the true lateral view (alignment of
the axis of the femoral neck congruent with the axis of the
­femoral shaft1).

Adjust nail rotation until the two lines on the insertion

handle are symmetric to the PFNA nail.

Note: A 3.2 mm guide wire can be inserted in the corre-

sponding hole in the insertion handle to predict the location
of the guide wire and PFNA blade.

1
T. Nishiura, 1077–1083

PFNA-II Surgical Technique DePuy Synthes 22

Proximal Locking

4
Insert guide wire

Instrument

356.830 Guide Wire B 3.2 mm, for PFNA Blade

Make a stab incision in the area of the trocar tip. Advance

the sleeve assembly through the soft tissues in direction
of the lateral cortex.

Insert the sleeve assembly as far as the lateral cortex.

­Advance the protection sleeve to the lateral cortex using
slight clockwise turns of the buttress nut. Prepare the
­passage of the protection sleeve by turning the internal
drill sleeve.

Note: The sleeve assembly must be in contact with the bone

during the entire blade implantation. Do not tighten the but-
tress nut too firmly as this could impair the precision of the
insertion handle and sleeve assembly.

Incorrect position Correct position

Mark the femur and remove the trocar. Insert a new guide
wire through the drill sleeve into the bone. Verify both direc-
tion and position under image intensifier control in both AP
and l­ateral view.

22 DePuy Synthes PFNA-II Surgical Technique

In the AP and lateral view, the optimal position of the guide
wire is the exact center of the femoral head. Insert the guide
wire subchondrally into the femoral head at a distance of
10 mm below the joint level. Minimal distance to the joint is
5 mm. The tip of the guide wire is positioned at the intended
blade tip position.

Note: If the PFNA-II or the guide wire requires repositioning;

remove the guide wire, release the sleeve assembly with but- 10 mm
tress nut from the aiming arm by pressing the button on the
clamp device, and remove it. The PFNA-II can be reposi-
tioned only by rotation, deeper insertion or partial r­ etraction.
Reinsert the sleeve assembly and turn the buttress nut clock-
wise to position the assembly on the bone. Introduce a new
guide wire.

Precaution: Insert the guide wire for the PFNA blade care­
fully to avoid penetration into the joint. Penetration of the
articular surface might lead to a contraindication for the aug­
mentation of the PFNA blade.

PFNA-II Surgical Technique DePuy Synthes 22

Proximal Locking

Optional technique for antirotation wires

Instruments

356.826 Aiming Jig for Anti-rotation Wire

356.827 Drill Sleeve 5.6/3.2, for No. 356.826

356.830 Guide Wire B 3.2 mm, for PFNA Blade

In very unstable fractures, insert an additional guide wire to

prevent rotation. Leave the drill sleeve in place in the protec-
tion sleeve when applying this technique.

After having inserted the guide wire into the femoral head,
secure the aiming jig for anti-rotation wire either anterior
or posterior to the aiming arm. Secure the position of the
anti­-rotation wire by tightening the hexagonal nut.

Insert the drill sleeve into the aiming jig for anti-rotation wire.
Make a stab incision and insert the drill sleeve to the bone.

22 DePuy Synthes PFNA-II Surgical Technique

Use image intensifier control to insert a guide wire into the
femoral head. If a second anti-rotation wire is necessary,
use the same procedure to insert it into the femoral head.

Note: In axial view, the anti-rotation wire will approach,

but not touch the blade tip. This anti-rotation wire fixes the
femoral head only temporarily and will be removed after
the insertion of the blade.

PFNA-II Surgical Technique DePuy Synthes 22

Proximal Locking

5
Measure the PFNA-II blade length

Instrument

356.829 Direct Measuring Device

for Guide Wire B 3.2 mm

Verify the position of the guide wire in AP and lateral view

before measuring the length.

Guide the measuring device over the guide wire. Advance

the measuring device to the protection sleeve and determine
the length of the required blade. The measuring device indi-
cates the exact length of the guide wire in the bone.

In the AP and lateral view, the correct position of the PFNA-II

blade is 10 mm below the joint level. Minimal distance to the
joint is 5 mm. If the guide wire’s position is subchondral, sub­
tract 10 mm to measure the PFNA-II blade length correctly.

Remove the measuring device.

Carefully remove the drill sleeve without changing the posi-

tion of the guide wire.

10 mm

33 DePuy Synthes PFNA-II Surgical Technique

6
Open lateral cortex for PFNA-II blade insertion

Instrument

356.822 Drill Bit B 11.0 mm, for PFNA Blade

Push the cannulated drill bit over the 3.2 mm guide wire. Drill
to the stop. This opens the lateral cortex.

Precaution: If the guide wire has been bent slightly during

insertion, guide the drill bit over the wire using carefully
­forward and backward movements. However, if the wire has
been bent to a greater extent, reinsert it or replace it by a
new guide wire (see step 4). Otherwise, the guide wire may
be advanced through the joint.

PFNA-II Surgical Technique DePuy Synthes 33

Proximal Locking

7
Drill hole for PFNA-II blade

Instruments

356.821 Reamer B 11.0 mm, for PFNA Blade

357.046 Fixation Sleeve, for No. 357.045

Note: Use reamer only in a situation with good bone quality.

Set the chosen blade length on the cannulated reamer by

­fixing the fixation sleeve in the corresponding position.
Read off the correct length on the side of the fixation sleeve
pointing towards the tip of the reamer.

Push the reamer over the guide wire. Monitor drilling under
image intensifier control. Drill to the stop. The fixation sleeve
prevents further drilling.

Precaution: Use the reamer only after opening the lateral

cortex. If the guide wire has been bent slightly during inser-
tion, guide the reamer over the wire using carefully forward
and backward movements. However, if the wire has been
bent to a greater extent, reinsert it or replace it with a new
guide wire (see step 4). Otherwise, the guide wire may
be advanced through the joint.

33 DePuy Synthes PFNA-II Surgical Technique

8
Assemble PFNA-II blade on the impactor

Instrument

03.010.410 Impactor for PFNA Blade

The PFNA-II blade is supplied in a locked state.

While attaching the PFNA-II blade on the impactor, screw

the impactor counterclockwise (note the mark “attach” on
the impactor) into the end of the PFNA-II blade to unlock
the blade. Push the PFNA-II blade gently towards the im­
pactor while attaching the PFNA-II blade. Do not overtighten.

Precaution: The tip of the PFNA-II blade must rotate freely

­after attaching it to the impactor. This is essential for the
­implantation of the PFNA-II blade. Otherwise remove and
dispose of the blade. Do not over tighten the connection
­between the impactor and the PFNA-II blade.

PFNA-II Surgical Technique DePuy Synthes 33

Proximal Locking

9
Insert PFNA-II blade

Instrument

03.010.124 Combined Hammer 500 g,

can be mounted, for No. 357.117

Insert the blade-impactor assembly over the guide wire.

Push the button on the protection sleeve, align the blade
(note marking on the protection sleeve) and advance
the blade impactor assembly further through the protection
sleeve.

Manually insert the blade over the guide wire advancing as

far as possible into the femoral head.

33 DePuy Synthes PFNA-II Surgical Technique

Use monitoring during insertion of the PFNA-II blade.

Insert the PFNA-II blade to the stop by applying gentle blows

with the hammer.

Precaution: Inserting the blade to the stop is important,

as the impactor must click into the protection sleeve. Do not
use unnecessary force when inserting the PFNA-II blade.

PFNA-II Surgical Technique DePuy Synthes 33

Proximal Locking

10
Lock PFNA-II blade

To lock the PFNA-II blade, turn the impactor clockwise

(note «lock» marking on the handle) and tighten the blade.

Verify PFNA-II blade locking intraoperatively. The PFNA-II

blade is locked if all gaps are closed.

Note: The gliding of the PFNA-II blade is guaranteed. If the

PFNA-II blade cannot be locked, remove it and replace it
with a new PFNA-II blade (see implant removal, step 1).

PFNA-II blade unlocked PFNA-II blade locked

33 DePuy Synthes PFNA-II Surgical Technique

Press the button on the protection sleeve to remove the
­impactor. Remove and dispose of the guide wire.

When proximal locking is complete, release and remove the

protection sleeve and the buttress nut by pressing the button
on the clamp device of the aiming arm in order to continue
with distal locking or leave it in place to continue with intra-
operative compression.

PFNA-II Surgical Technique DePuy Synthes 33

Proximal Locking

11
Option: Intraoperative compression

Instrument

03.010.423 Compression Instrument for PFNA Blade

Precaution: Do not use intraoperative compression in

­osteoporotic bone.

Screw the compression instrument into the blade through

the protection sleeve.

Turn the buttress nut counterclockwise to move the

­protection sleeve backwards until it is pushing towards the
compression instrument.

33 DePuy Synthes PFNA-II Surgical Technique

Under image intensifier control, further turn the buttress nut
counterclockwise to achieve intraoperative compression and
close the fracture gap.

Precautions:
–– The blade must be locked to apply intraoperative
­compression.
–– Control compression under image intensifier control.
–– Do not use excessive force in order to avoid pulling out
the blade from the femoral head.
–– The blade may be slightly overinserted before applying in-
traoperative compression (see correction of insertion
depth of PFNA-II blade, page 56) to prevent it from stick-
ing out laterally.

Release strain by turning the buttress nut clockwise.

Remove the compression instrument. Verify PFNA-II blade

locking under image intensifier control. The PFNA-II blade is
locked if all gaps are closed. If necessary, relock the blade us-
ing the extraction screw.

Release and remove the protection sleeve and the buttress

nut by p
­ ressing the button on the clamp device of the aim-
ing arm to continue with distal locking.

PFNA-II Surgical Technique DePuy Synthes 33

Distal Locking

Distal Locking for PFNA-II Short PFNA short

(Length 170 mm – 240 mm)

Static or dynamic locking can be performed via the aiming

arm with PFNA-II short (Length 170 mm – 240 mm).

Static Static (90°) Dynamic

Distal Locking for PFNA-II Long PFNA long

(Length 260 mm – 420 mm)

The PFNA-II long (Length 260 mm – 420 mm) additionally

­allows for secondary dynamization.

Distal locking of PFNA-II long is performed with the freehand

technique. Alternatively distal locking can be performed
­using the SureLock System and the corresponding surgical Static Dynamic
technique (DSEM/TRM/0816/0728).

44 DePuy Synthes PFNA-II Surgical Technique

Locking implants for distal locking

Distal locking for PFNA-II described in this surgical technique

is using the 4.9 mm locking bolts and the corresponding
­instruments (68.027.002.02: Insert 1, for B 4.9 mm locking
bolts, from instrument set 01.027.101).

Alternatively, the 5.0 mm locking screws from the Expert

Nailing Systems can be used with the corresponding instru-
ments (68.027.002.03: Insert 1, for B 5.0 mm locking
screws, from instrument set 01.027.102) for distal locking
of the PFNA-II.

See table below for corresponding instruments.

Short PFNA-II Nails (170 mm – 240 mm)

Locking Bolts B 4.9 mm Locking Screws B 5.0 mm
Part No. Description Part No. Description
356.834 Drill Bit B 4.0 mm, for PFNA 03.010.061 Drill Bit B 4.2 mm, calibrated,
length 340 mm, 3-flute, for Quick Coupling
356.831 Protection Sleeve 11.0/8.0, green 03.025.040 Protection Sleeve 11.0/8.0, lenght 188 mm
356.828 Drill Sleeve 8.0/4.0, green 03.010.065 Drill Sleeve 8.0/4.2
356.833 Trocar B 4.0 mm, green 03.010.070 Trocar B 4.2 mm
356.835 Measuring Device for Locking Bolt 03.010.428 Depth Gauge for Locking Screws,
measuring range to 110 mm
314.260 Screwdriver, hexagonal, large, B 3.5 mm, 03.010.107 Screwdriver Stardrive, SD25, length 330 mm
with Groove, length 300 mm

Long PFNA-II Nails (260 mm – 420 mm)

Locking Bolts B 4.9 mm Locking Screws B 5.0 mm
Part No. Description Part No. Description
356.834 Drill Bit B 4.0 mm, for PFNA 03.010.101 Drill Bit B 4.2 mm, calibrated,
length 145 mm, 3-flute,
with Coupling for RDL
03.010.104 Drill Bit B 4.2 mm, calibrated,
length 145 mm, 3-flute,
for Quick Coupling
356.835 Measuring Device for Locking Bolt 03.010.019 Depth Gauge for Locking Screws,
measuring range up to 110 mm
for No. 03.010.009
03.010.429 Direct Measuring Device for Drill Bits,
length 145 mm
314.260 Screwdriver, hexagonal, large, B 3.5 mm, 03.010.362 Screwdriver Stardrive, SD25, length 275 mm
with Groove, length 300 mm
314.280 Holding Sleeve, large 03.010.112 Holding Sleeve, with Locking Device

PFNA-II Surgical Technique DePuy Synthes 44

Distal Locking
For PFNA-II Short

Distal Locking for PFNA-II Short

(Length 170 mm – 240 mm)

1
Choose aiming arm for distal locking

Distal locking of PFNA-II short is performed through the aim-

ing arm (see steps 2 and 3). Choose an appropriate aiming
arm according to the table below. Make sure the plug for
aiming arm is inserted into the locking hole of the nail length
that is NOT used in this case.

Nail length Locking Aiming arm

170 – 240 mm Static 03.010.406 Aiming Arm 125° for PFNA Blade

170 – 240 mm Static 03.010.407 Aiming Arm 130° for PFNA Blade

170 – 240 mm Static (90°) 03.023.004 Aiming Arm for static locking, for PFNA-II

170 – 240 mm Dynamic 03.010.409 Aiming Arm, for dynamic locking of PFNA

2
Option A: Static distal locking of PFNA-II short

Instruments

356.831 Protection Sleeve 11.0/8.0, green

356.828 Drill Sleeve 8.0/4.0, green

356.833 Trocar B 4.0 mm, green

Using the hexagonal screwdriver with spherical head, con-

firm that the connecting screw between the insertion handle
and the PFNA-II is sufficiently tightened.

Insert the three-part trocar combination (protection sleeve,

drill sleeve and trocar) through the hole in the aiming arm
that corresponds with the nail length, make a stab incision
and insert the trocar to the bone. Mark the femur and re-
move the trocar.

44 DePuy Synthes PFNA-II Surgical Technique

Option B: Static distal locking (90°) of PFNA-II short

Instruments

03.023.004 Aiming Arm for static locking, for PFNA-II

356.831 Protection Sleeve 11.0/8.0, green

356.828 Drill Sleeve 8.0/4.0, green

536.833 Trocar B 4.0 mm, green

Using the hexagonal screwdriver with spherical head, con-

firm that the connecting screw between the insertion handle
and the PFNA-II is well tightened.

Remove the aiming arm for PFNA-II blade. Mount the aiming
arm for static locking 90° and fix it firmly to the insertion
handle.

Insert the three-part trocar combination (protection sleeve,

drill sleeve and trocar) through the hole in the aiming arm
that corresponds with the nail length, make a stab incision
and insert the trocar to the bone. Mark the femur and re-
move the trocar.

PFNA-II Surgical Technique DePuy Synthes 44

Distal Locking
For PFNA-II Short

Option C: Dynamic distal locking of PFNA-II short

Instruments

03.010.409 PFNA Aiming Arm for dynamic locking

356.831 Protection Sleeve 11.0/8.0, green

356.828 Drill Sleeve 8.0/4.0, green

356.833 Trocar B 4.0 mm, green

Using the hexagonal screwdriver with spherical head, con-

firm that the connecting screw between the insertion handle
and the PFNA-II is well tightened.

Remove the aiming arm for PFNA-II blade. Mount the aiming
arm for dynamic locking and fix it firmly to the insertion
­handle.

Insert the three-part trocar combination (protection sleeve,

drill sleeve and trocar) through the hole in the aiming arm
that corresponds with the nail length, make a stab incision
and insert the trocar to the bone. Mark the femur and re-
move the trocar.

44 DePuy Synthes PFNA-II Surgical Technique

3
Drill

Instrument

356.834 Drill Bit B 4.0 mm, for PFNA

Use the drill bit to drill through both cortices. The tip of the
drill bit should protrude by 2 to 4 mm.

Just after drilling both cortices, confirm the drill bit position.

Ensure that the drill sleeve is pressed firmly to the near cortex
and read the measurement from the calibrated drill bit at
the back of the drill sleeve. This measurement corresponds to
the appropriate length of the locking bolt. Remove the drill
bit and the drill sleeve.

Precaution: Always make sure that no diastasis has oc-

curred intraoperatively before beginning distal locking.
­Diastasis can cause delayed healing. Always ensure that the
connection between PFNA-II, insertion handle and aiming
arm is good, otherwise drilling for distal locking may damage
the PFNA-II.

PFNA-II Surgical Technique DePuy Synthes 44

Distal Locking
For PFNA-II Short

4
Option: Determine length of the locking bolt

Instrument

356.835 Measuring Device for Locking Bolt

After drilling both cortices, remove the drill bit and the drill
sleeve.

Insert the depth gauge through the protection sleeve to the

near cortex and advance the hook through both cortices.
Draw back the hook until it engages in the opposite cortex.
Read the measurement from the depth gauge. Add 2 to
4 mm to the measured length to ­ensure good engagement
of the locking bolt in the opposite cortex.

44 DePuy Synthes PFNA-II Surgical Technique

5
Insert locking bolt

Instrument

314.260 Screwdriver, hexagonal, large, B 3.5 mm,

with Groove, length 300 mm

Insert a locking bolt of the measured length with the hexag-

onal screwdriver through the protection sleeve until the
­locking bolt head lies against the near cortex. The tip of the
locking bolt should not project more than 1–2 mm beyond
the far cortex.

Remove the screwdriver and the protection sleeve.

PFNA-II Surgical Technique DePuy Synthes 44

Distal Locking
For PFNA-II Long

Distal Locking for PFNA-II Long

(Length 260 mm – 420 mm)

1
Align C-arm

Check reduction, then correct alignment of the fragments

and leg length before locking the nail.

Align the C-arm with the hole in the nail until a perfect circle
is visible in the center of the screen.

2
Determine incision point

Place a guide wire on the skin over the center of the hole to
mark the incision point and make a stab incision.

44 DePuy Synthes PFNA-II Surgical Technique

3
Drill

Option: Locking with ASLS

ASLS, the Angular Stable Locking System, can be used as an
alternative to standard locking screws in any round hole of a
Synthes cannulated titanium nail. For more details regarding
the intramedullary fixator principle please consult the ASLS
surgical technique (DSEM/TRM/0115/0284) and concept flyer
(036.001.017). Please note that for the use of ASLS special
instruments are required.

Instrument

511.417 Drill Bit B 4.0 mm with centering tip,

length 148/122 mm, 3-flute,
with Coupling for RDL

Using the radiolucent drive, under image intensification,

­insert the tip of the drill bit through the incision down to the
bone.

Incline the drive in order that the tip of the drill bit is cen-
tered over the locking hole. The drill bit should almost
­completely fill the circle of the locking hole. Hold the drill
bit in this position and drill through both cortices until the
tip of the drill bit penetrates the medial far cortex.

Note: For greater drill bit control, discontinue drill power af-
ter perforating the near cortex. Manually guide the drill bit
through the nail before drilling the far cortex.

PFNA-II Surgical Technique DePuy Synthes 44

Distal Locking
For PFNA-II Long

4
Determine length of the locking bolt and
insert locking bolt

Instruments

356.835 Measuring Device for Locking Bolt

314.260 Screwdriver, hexagonal, large, B 3.5 mm,

with Groove, length 300 mm

314.280 Holding Sleeve, large, for Nos. 314.190,

314.240, 314.260, 314.270 and 314.750

Measure the locking bolt length using the measuring device.

Ensure that the outer sleeve is in contact with the bone
and the hook grasps the far cortex. Add 2 to 4 mm to the
measured length in order to ensure that the locking bolt
is well engaged in the opposite cortex.

Insert the locking bolt with the appropriate length using the
hexagonal screwdriver and the holding sleeve, if required.

Verify the bolt length under image intensification. The bolt

tip should be about 1–2 mm outside of the cortex. Exchange
the locking bolt with the appropriate length if necessary.

55 DePuy Synthes PFNA-II Surgical Technique

Insert End Cap

1
Remove PFNA-II instruments

Instrument

03.023.011 Screwdriver, hexagonal with spherical

head B 10.0 mm, cannulated

Remove the aiming arm. Loosen the connection screw

with the hexagonal screwdriver with spherical head. Remove
the connecting screw and the insertion handle.

Note: The end cap with 0 mm extension can be inserted

through the insertion handle barrel. Only remove the
­connecting screw and leave the insertion handle in place.

PFNA-II Surgical Technique DePuy Synthes 55

Insert End Cap

2
Insert end cap

Instruments

356.717 Guide Wire B 2.8 mm, length 460 mm,

with Hook

03.023.001 Screwdriver Stardrive with spherical head,

SD40, cannulated, length 300 mm

If the proximal end of the nail is flush with the upper edge of
the trochanter major use the end cap with 0 mm extension.
Use the end cap with 5 to 15 mm extension to lengthen the
nail end.

Insert the hook of the guide wire through the selected end
cap. Guide the cannulated screwdriver over the guide wire
to the end cap. The end cap is retained automatically as soon
as this connection is established.

Screw the end cap into the proximal end of the nail and
tighten it firmly.

Remove the screwdriver and the guide wire.

55 DePuy Synthes PFNA-II Surgical Technique

Implant Removal

1
Remove PFNA-II blade

Instruments

356.830 Guide Wire B 3.2 mm, for PFNA Blade

03.010.411 Extraction Screw for PFNA Blade

03.010.124 Combined Hammer 500 g,

can be mounted

356.832 Key for PFNA Blade

Note: Implant removal is an elective procedure.

After an incision through the old scars, locate the PFNA-II

blade by palpation or under image intensifier control. Insert
the guide wire trough the cannulated PFNA-II blade. Push
the extraction screw over the guide wire and use gentle pres­
sure to screw it counterclockwise into the PFNA-II blade (note
”attach” marking on the extraction screw shaft).

Extract the PFNA-II blade by applying gentle blows with the

hammer.

Notes:
–– If the extraction of the PFNA-II blade is difficult, remove
the locking bolt and the end cap, screw the hammer
guide into the PFNA-II and mobilize the nail to loosen the
nail-blade connection.
–– To detach the blade from the bone use light hammer
blows to slightly drive in the blade before removal of the
blade.

PFNA-II Surgical Technique DePuy Synthes 55

Implant Removal

Use the key for PFNA blade to detach the blade from the
­extraction screw if necessary.

Note: If the removal of the PFNA-II blade is not possible with

the standard instruments use the special instruments from
the PFNA/PFNA-II Blade Extraction Set and the correspond-
ing surgical technique (DSEM/TRM/0816/0727).

2
Remove end cap

Instruments

356.717 Guide Wire B 2.8 mm, length 460 mm,

with Hook

356.715 Socket, hexagonal, B 11.0/11.0 mm,

cannulated, for AFN

321.160 Combination Wrench B 11.0 mm

Insert the hook of the guide wire with hook through the end
cap. Guide the cannulated hexagonal socket over the guide
wire to the end cap. Remove the end cap with the combina-
tion wrench.

55 DePuy Synthes PFNA-II Surgical Technique

3
Remove locking bolt and nail

Instruments

357.071 Hammer Guide, for No. 357.026

314.260 Screwdriver, hexagonal, large, B 3.5 mm,

with Groove, length 300 mm

314.280 Holding Sleeve, large, for Nos. 314.190,

314.240, 314.260, 314.270 and 314.750

03.010.124 Combined Hammer 500 g,

can be mounted

Before removing the locking bolt, screw the hammer guide

into the PFNA-II and tighten it.

Remove the locking bolt with the hexagonal screwdriver.

Mount the large holding sleeve onto the hexagonal screw-
driver to facilitate removal of the locking bolt.

Note: If removal of the locking bolt is not possible

and/or in case of broken locking bolts, the Screw
Extraction Set and the corresponding surgical technique
(DSEM/TRM/0614/0727) is ­recommended.

Extract the nail by applying gentle blows with the hammer.

Notes:
–– Remove the locking bolt after screwing the hammer guide
into the PFNA/PFNA-II.Thereby a rotation of the
PFNA/PFNA-II in the bone will be avoided.
–– If the removal of the nail is not possible with the standard
instruments use the special instruments from the Proximal
Femoral Nail Removal Set for PFN, TFN and PFNA/PFNA-II
(01.010.180) and the corresponding surgical technique
(DSEM/TRM/1214/0253).

PFNA-II Surgical Technique DePuy Synthes 55

Correction of Insertion Depth
of PFNA-II Blade

Instruments

03.010.411 Extraction Screw for PFNA-II Blade

03.010.124 Combined Hammer 500 g,

can be mounted

Remove the impactor if it is still in place. Insert the extraction

screw over the guide wire and through the sleeve assembly
using gentle counterclockwise pressure to attach the extrac­
tion screw to the PFNA-II blade (note “attach” marking).

Advance the now unlocked PFNA-II blade to the desired

­insertion depth by applying gentle blows with the combined
hammer. In the AP and lateral view, the correct position of
the PFNA-II blade is 10 mm below the joint level. Minimal
distance to the joint is 5 mm. Turning the extraction screw
clockwise to the stop (note “lock” marking) allows for
­relocking of the PFNA-II blade and removing the extraction
screw.

Verify PFNA-II blade locking intraoperatively.

Note: The PFNA-II blade is locked if all gaps are closed.

55 DePuy Synthes PFNA-II Surgical Technique

Cleaning

Intra- and postoperative cleaning

Instruments

319.460 Cleaning Stylet B 2.8 mm,

for Cannulated Instruments

357.009 Cleaning Stylet B 2.8 mm,

length 450 mm, for Cannulated
Instruments

Use the 2.8 mm stylet or the long 2.8 mm cleaning stylet

(length 450 mm) for intraoperative cleaning of the
­instrument cannulations.

PFNA-II Surgical Technique DePuy Synthes 55

Implants

PFNA-II Nails

Material: Titanium alloy* (TAN)

Color: Aqua

Diameters: 
B 9 to B 12 mm (short nails, 1 mm
increments)
B 9 and B 10 mm (long nails)
All nails have a proximal diameter of
16.5 mm with a lateral flattened surface

Lengths short Nails:

170 mm XS
200 mm Small
240 mm
(one nail for left and right)

Lengths long Nails:

260 mm – 340 mm
(with 20 mm increments)
340 mm – 420 mm
(with 40 mm ­increments,
only B 10 mm nails)
(left and right nails)

CCD-Angle: 125° and 130°

Cannulation: All nails are cannulated

*Ti-6Al-7Nb

55 DePuy Synthes PFNA-II Surgical Technique

PFNA-II XS, Length 170 mm, Titanium Alloy (TAN)
Distal Diameter Angle Length
(mm) 170 mm
9 125° 472.100S
10 125° 472.101S
11 125° 472.102S
12 125° 472.103S

9 130° 472.104S
10 130° 472.105S
11 130° 472.106S
12 130° 472.107S

PFNA-II Small, Length 200 mm, Titanium Alloy (TAN)

Distal Diameter Angle Length
(mm) 200 mm
9 125° 472.110S
10 125° 472.111S
11 125° 472.112S
12 125° 472.113S

9 130° 472.114S
10 130° 472.115S
11 130° 472.116S
12 130° 472.117S

PFNA-II, Length 240 mm, Titanium Alloy (TAN)

Distal Diameter Angle Length
(mm) 240 mm
9 125° 473.800S
10 125° 473.801S
11 125° 473.802S
12 125° 473.803S

9 130° 473.804S
10 130° 473.805S
11 130° 473.806S
12 130° 473.807S

PFNA-II Surgical Technique DePuy Synthes 55

Implants

PFNA-II Nail Long, Titanium alloy (TAN)

Length (mm) Angle B 9 mm right B 9 mm left
260 125° 473.060S 473.070S
280 125° 473.062S 473.072S
300 125° 473.035S 473.031S
320 125° 473.064S 473.074S
340 125° 473.037S 473.033S

Length (mm) Angle B 9 mm right B 9 mm left

260 130° 473.061S 473.071S
280 130° 473.063S 473.073S
300 130° 473.036S 473.032S
320 130° 473.065S 473.075S
340 130° 473.038S 473.034S

Length (mm) Angle B 10 mm right B 10 mm left

260 125° 473.040S 473.050S
280 125° 473.042S 473.052S
300 125° 473.015S 473.023S
320 125° 473.044S 473.054S
340 125° 473.017S 473.025S
380 125° 473.019S 473.027S
420 125° 473.021S 473.029S

Length (mm) Angle B 10 mm right B 10 mm left

260 130° 473.041S 473.051S
280 130° 473.043S 473.053S
300 130° 473.016S 473.024S
320 130° 473.045S 473.055S
340 130° 473.018S 473.026S
380 130° 473.020S 473.028S
420 130° 473.022S 473.030S

66 DePuy Synthes PFNA-II Surgical Technique

PFNA-II Blades

Material: Titanium Alloy* (TAN), color: aqua

Lengths: 75 –120 mm (5 mm increments)

Cannulation: All blades are cannulated

PFNA-II Blades
Length (mm) TAN
75 04.027.050S
80 04.027.051S
85 04.027.052S
90 04.027.053S
95 04.027.054S
100 04.027.055S
105 04.027.056S
110 04.027.057S
115 04.027.058S
120 04.027.059S

*Ti-6Al-7Nb

PFNA-II Surgical Technique DePuy Synthes 66

Implants

PFNA-II End Caps

Used to protect nail threads from tissue ingrowth

Material: Titanium Alloy* (TAN), color: aqua

Lengths: 0 mm – sits flush with end of nail

5, 10 and 15 mm extensions – extend nail
height if nail is overinserted

Cannulation: All end caps are cannulated

Design: Stardrive SD40 / hexagonal recess

B 11 mm

PFNA-II End Caps

Extension (mm) TAN
0 04.027.005S
5 04.027.006S
10 04.027.007S
15 04.027.008S

*Ti-6Al-7Nb

66 DePuy Synthes PFNA-II Surgical Technique

Locking Bolts

Material: Titanium alloy* (TAN), color: light green

Drill: B 4 mm

Lengths: 16 – 60 mm (2 mm increments)
60 – 80 mm (4 mm increments)
80 –100 mm (5 mm increments)

Design: Hexagonal recess B 3.5 mm

Locking Bolts B 4.9 mm, self-tapping

Length (mm) TAN** Length (mm) TAN**
26 459.260 54 459.540
28 459.280 56 459.560
30 459.300 58 459.580
32 459.320 60 459.600
34 459.340 64 459.640
36 459.360 68 459.680
38 459.380 72 459.720
40 459.400 76 459.760
42 459.420 80 459.800
44 459.440 85 459.850
46 459.460 90 459.900
48 459.480 95 459.950
50 459.500 100 459.960
52 459.520

*Ti-6Al-7Nb
**Available non-sterile or sterile packed. Add “S” to the article number to
order sterile products.

PFNA-II Surgical Technique DePuy Synthes 66

Alternative Implants

PFNA-II End Caps

Used to protect nail threads from tissue ingrowth

Material: Titanium Alloy* (TAN), color: aqua

Lengths: 0 mm – sits flush with end of nail

5, 10 and 15 mm extensions – extend
nail height if nail is overinserted

Cannulation: All end caps are cannulated

Design: Hexagonal recess B 4.0 mm / B 11.0 mm

PFNA-II End Caps

Extension (mm) TAN
0 473.170S
5 473.171S
10 473.172S
15 473.173S

*Ti-6Al-7Nb

66 DePuy Synthes PFNA-II Surgical Technique

Locking Screws

Material: Titanium Alloy* (TAN), color: light green

Drill: B 4.2 mm

Lengths: 26 mm – 80 mm (2 mm increments)
85 mm –100 mm (5 mm increments)

Design: Stardrive SD25 recess

Locking Screws Stardrive B 5.0 mm, for Medullary Nails

Length (mm) TAN** Length (mm) TAN**
26 04.005.516 58 04.005.548
28 04.005.518 60 04.005.550
30 04.005.520 62 04.005.552
32 04.005.522 64 04.005.554
34 04.005.524 66 04.005.556
36 04.005.526 68 04.005.558
38 04.005.528 70 04.005.560
40 04.005.530 72 04.005.562
42 04.005.532 74 04.005.564
44 04.005.534 76 04.005.566
46 04.005.536 78 04.005.568
48 04.005.538 80 04.005.570
50 04.005.540 85 04.005.575
52 04.005.542 90 04.005.580
54 04.005.544 95 04.005.585
56 04.005.546 100 04.005.590

*Ti-6Al-7Nb
**Available non-sterile or sterile packed. Add “S” to the article number to
order sterile products.

PFNA-II Surgical Technique DePuy Synthes 66

Instruments

309.602 Radiographic Ruler for PFNA

314.050 Screwdriver, hexagonal, cannulated,

for Cannulated Screws B 6.5 and 7.3 mm

314.260 Screwdriver, hexagonal, large, B 3.5 mm,

with Groove, length 300 mm

314.280 Holding Sleeve, large, for Nos. 314.190,

314.240, 314.260, 314.270 and 314.750

321.160 Combination Wrench B 11.0 mm

321.170 Pin Wrench B 4.5 mm, length 120 mm

356.715 Socket, hexagonal, B 11.0/11.0 mm,

cannulated, for AFN

356.717 Guide Wire B 2.8 mm, length 460 mm,

with Hook

356.817 Buttress/Compression Nut, for PFNA Blade

66 DePuy Synthes PFNA-II Surgical Technique

356.818 Protection Sleeve 16.0/11.0 for PFNA Blade

356.819 Drill Sleeve 11.0/3.2, for PFNA Blade

356.820 Trocar B 3.2 mm, for PFNA Blade, gold

356.821 Reamer B 11 mm, for PFNA Blade

356.822 Drill Bit B 11 mm, for PFNA Blade

356.826 Aiming Jig for Anti-rotation Wire

356.827 Drill Sleeve 5.6/3.2, for No. 356.826

356.828 Drill Sleeve 8.0/4.0, green

356.829 Direct Measuring Device for Guide Wire

B 3.2 mm

356.830 Guide Wire B 3.2 mm, for PFNA Blade

356.831 Protection Sleeve 11.0/8.0, green

PFNA-II Surgical Technique DePuy Synthes 66

Instruments

356.832 Key for PFNA Blade

356.833 Trocar B 4.0 mm, green

356.834 Drill Bit B 4.0 mm, for PFNA

356.835 Measuring Device for Locking Bolt

357.029 Connecting Screw, cannulated,

for PFN and PFNA

357.046 Fixation Sleeve, for No. 357.045

357.071 Hammer Guide, for No. 357.026

393.100 Universal Chuck with T-Handle

03.010.124 Combined Hammer 500 g,

can be mounted, for No. 357.117

03.010.405 Insertion Handle, radiolucent, for PFNA

66 DePuy Synthes PFNA-II Surgical Technique

03.010.407 Aiming Arm 130° for PFNA Blade

03.010.410 Impactor for PFNA Blade

03.010.411 Extraction Screw for PFNA Blade

03.010.423 Compression Instrument for PFNA Blade

03.010.424 Connector for Insertion Handle for PFNA

03.010.470 Plug for Aiming Arm

03.023.001 Screwdriver Stardrive with spherical head,

SD40, cannulated, length 300 mm

03.023.002 Protection Sleeve 20.0/17.0, for PFNA-II

03.023.006 Drill Sleeve, for PFNA-II

03.023.010 Drill Bit B 16.5 mm, cannulated, flexible,

for PFNA-II

03.023.011 Screwdriver, hexagonal with spherical

head B 10.0 mm, cannulated

PFNA-II Surgical Technique DePuy Synthes 66

Instruments

Optional instruments

309.600 Drill Bit B 17.0 mm, cannulated, for PFNA

309.603 Drill Sleeve 17.0/3.2, for No. 357.001

319.970 Screw Forceps, self-holding, length 85 mm

351.050 Tissue Protector

356.830S Guide Wire B 3.2 mm, for PFNA Blade,

sterile

357.001 Protection Sleeve 20.0/17.0,

for No. 357.005

357.009 Cleaning Stylet B 2.8 mm,

length 450 mm, for Cannulated
­Instruments

03.010.019 Depth Gauge for Locking Screws,

measuring range up to 110 mm,
for No. 03.010.009

03.010.362 Screwdriver Stardrive, SD25,

length 275 mm

77 DePuy Synthes PFNA-II Surgical Technique

03.010.406 Aiming Arm 125° for PFNA Blade

03.010.408 Aiming Arm 135° for PFNA Blade

03.010.409 PFNA Aiming Arm for dynamic locking

03.010.412 Aiming Device for Guide Wire,

for PFNA and TFN, for AP Orientation

03.010.414 Connecting Screw for PFNA,

for No. 03.010.412

03.023.003 Awl for PFNA-II

03.023.004 Aiming Arm for static locking,

for PFNA-II small and extra-small

PFNA-II Surgical Technique DePuy Synthes 77

Instruments

Alternative instruments

321.200 Ratchet Wrench for Nut, hexagonal,

11.0 mm

357.012 Insertion Handle for PFN

357.013 Thread Gland for Hammer Guide,

for No. 357.012

357.020 Insertion Handle for PFN and PFNA

357.021 Connecting Screw for PFN,

for no. 357.012

357.023 Wrench, hexagonal, with T-Handle,

for No. 357.021

357.026 Slotted Hammer 400 g, can be mounted

77 DePuy Synthes PFNA-II Surgical Technique

357.027 Socket, hexagonal, with T-Handle, short

357.028 Connector for PFN, for No. 357.020

399.420 Hammer 500 g

03.025.040 Protection Sleeve 11.0/8.0, lenght 188 mm

03.010.061 Drill Bit B 4.2 mm, calibrated,

length 340 mm, 3-flute,
for Quick Coupling

03.010.065 Drill Sleeve 8.0/4.2, for No. 03.010.063

03.010.070 Trocar B 4.2 mm, for No. 03.010.065

03.010.101 Drill Bit B 4.2 mm, calibrated,

length 145 mm, 3-flute,
with Coupling for RDL

03.010.104 Drill Bit B 4.2 mm, calibrated,

length 145 mm, 3-flute,
for Quick Coupling

PFNA-II Surgical Technique DePuy Synthes 77

Instruments

03.010.107 Screwdriver Stardrive, SD25,

length 330 mm

03.010.112 Holding Sleeve, with Locking Device

03.010.126 Wrench, hexagonal with T-handle

03.010.428 Depth Gauge for Locking Screws,

measuring range to 110 mm

03.010.429 Direct Measuring Device for Drill Bits,

length 145 mm

77 DePuy Synthes PFNA-II Surgical Technique

Cases

SynCases

01.027.110 Instrument Set for PFNA-II Locking

Bolts B 4.9 mm, in SynCase

68.027.013 Lid for SynCase No. 68.027.010

68.027.012 Insert 2 for Instruments for PFNA/PFNA-II

(part 1), for SynCase No. 68.027.010

68.027.011 Insert 1 for Instruments for PFNA/PFNA-II

(part 1), for SynCase No. 68.027.010

68.027.023 Lid for SynCase No. 68.027.020

68.027.022 Insert 2 for Instruments for PFNA/PFNA-II

(part 2), for SynCase No. 68.027.020

68.027.021 Insert 1 for Instruments for PFNA/PFNA-II

(part 2), for SynCase No. 68.027.020

PFNA-II Surgical Technique DePuy Synthes 77

Cases

01.027.120 Instrument Set for PFNA-II Locking

Screws B 5.0 mm, in SynCase

68.027.013 Lid for SynCase No. 68.027.010

68.027.012 Insert 2 for Instruments for PFNA/PFNA-II

(part 1), for SynCase No. 68.027.010

68.027.011 Insert 1 for Instruments for PFNA/PFNA-II

(part 1), for SynCase No. 68.027.010

68.027.023 Lid for SynCase No. 68.027.020

68.027.022 Insert 2 for Instruments for PFNA/PFNA-II

(part 2), for SynCase No. 68.027.020

68.027.021 Insert 1 for Instruments for PFNA/PFNA-II

(part 2), for SynCase No. 68.027.020

77 DePuy Synthes PFNA-II Surgical Technique

Vario Cases

01.027.101 Instrument Set for PFNA Locking Bolts

B 4.9  mm, in Vario Case

68.027.001 Vario Case for PFNA Instrument Set

(part 1), without Lid, without Contents

68.027.002 Vario Case for PFNA Instrument Set

(part 2), without Lid, without Contents

68.027.002.02 Insert 1, for B 4.9 mm Locking Bolts,

for PFNA Instrument Set (part 2),
for Vario Case No. 68.027.002

PFNA-II Surgical Technique DePuy Synthes 77

Cases

01.027.102 Instrument Set for PFNA Locking

Screws B 5.0 mm, in Vario Case

68.027.001 Vario Case for PFNA Instrument Set

(part 1), without Lid, without Contents

68.027.002 Vario Case for PFNA Instrument Set

(part 2), without Lid, without Content

68.027.002.03 Insert 1, for B 5.0 mm Locking Screws,

for PFNA Instrument Set (part 2),
for Vario Case No. 68.027.002

Optional

68.027.003 Rack for Locking Implants B 4.9 mm or

B 5.0 mm, for Vario Case

689.507 Lid (Stainless Steel), size 1/1, for Vario Case

77 DePuy Synthes PFNA-II Surgical Technique

MRI Information

Torque, Displacement and Image Artifacts according

to ASTM F 2213-06, ASTM F 2052-06e1 and
ASTM F 2119-07
Non-clinical testing of worst case scenario in a 3 T MRI
­system did not reveal any relevant torque or displacement
of the construct for an experimentally measured local spatial
gradient of the magnetic field of 3.69 T/m. The largest image
artifact extended approximately 169 mm from the construct
when scanned using the Gradient Echo (GE). Testing was
conducted on a 3 T MRI system.

Radio-Frequency-(RF-)induced heating according to

ASTM F 2182-11a
Non-clinical electromagnetic and thermal testing of worst
case scenario lead to peak temperature rise of 9.5 °C
with an average temperature rise of 6.6 °C (1.5 T) and a
peak temperature rise of 5.9 °C (3 T) under MRI Conditions
using RF Coils (whole body averaged specific absorption rate
[SAR] of 2 W/kg for 6 minutes [1.5 T] and for 15 minutes
[3 T]).

Precautions: The above mentioned test relies on non-clini-

cal testing. The actual temperature rise in the patient will
­depend on a variety of factors beyond the SAR and time of
RF application. Thus, it is recommended to pay particular
­attention to the following points:
–– It is recommended to thoroughly monitor patients under-
going MR scanning for perceived temperature and/or pain
sensations.
–– Patients with impaired thermoregulation or temperature
sensation should be excluded from MR scanning proce-
dures.
–– Generally, it is recommended to use a MR system with
low field strength in the presence of conductive implants.
The employed specific absorption rate (SAR) should be
­reduced as far as possible.
–– Using the ventilation system may further contribute to
­reduce temperature increase in the body.

PFNA-II Surgical Technique DePuy Synthes 77

 09/16
All rights reserved. 036.000.035 DSEM/TRM/0714/0109(4)
© DePuy Synthes Trauma, a division of Synthes GmbH. 2016.

Synthes GmbH
Eimattstrasse 3 Not all products are currently available in all markets.
4436 Oberdorf
Switzerland This publication is not intended for distribution in the USA.
Tel: +41 61 965 61 11
Fax: +41 61 965 66 00 All surgical techniques are available as PDF files at
www.depuysynthes.com www.depuysynthes.com/ifu 0123