PFNA Intramedullary Nail System: Proximal Femoral Fracture Fixation
What Is a PFNA Nail?
The PFNA (Proximal Femoral Nail Antirotation) is an intramedullary implant used to stabilize proximal femoral fractures. Developed as a refinement of the earlier PFN design, the PFNA replaces the traditional cephalic lag screw with a single helical blade that is impacted into the femoral head through a small lateral incision.
The blade's expanded cross-section compacts cancellous bone during insertion, creating a larger cancellous footprint than a screw of equivalent diameter. This dramatically increases resistance to cut-out and rotational failure, especially in osteoporotic bone where screws may toggle and back out.
Biomechanics of the Helical Blade
The PFNA helical blade operates on three biomechanical principles:
Bone compaction: the rotating blade displaces cancellous bone radially, increasing local bone density around the implant.
Larger load-bearing area: the rectangular blade cross-section provides more surface contact than a circular screw of equivalent core diameter.
Anti-rotation: the blade's flattened profile resists rotational torque that would otherwise back out a smooth lag screw.
This makes PFNA particularly effective in unstable 31-A2 and 31-A3 (AO/OTA) fracture patterns and in osteoporotic bone where screw purchase is unreliable.
Clinical Indications
| Fracture Type (AO/OTA) | Recommended Nail |
|---|---|
| 31-A1 (stable intertrochanteric) | PFNA short or long |
| 31-A2 (unstable intertrochanteric) | PFNA long preferred |
| 31-A3 (reverse oblique / transverse) | PFNA long mandatory |
| 32 (subtrochanteric) | PFNA long with optional cerclage |
| Pathological fracture prophylaxis | PFNA long |
PFNA is generally not recommended for:
Subcapital (femoral neck) fractures — use cannulated screws or hemiarthroplasty
Active infection at the surgical site
Medullary canal < 9 mm (relative contraindication; consider pediatric or custom nails)
Technical Specifications
| Parameter | AOYE PFNA Specification |
|---|---|
| Material | Ti-6Al-4V ELI titanium alloy (ASTM F136, ISO 5832-3) |
| Proximal diameter | 15.0 mm |
| Distal diameter | 10, 11, 12 mm (sizing dependent) |
| Nail length | Short 170 mm / Standard 200 mm / Long 240-400 mm (20 mm increments) |
| Mediolateral angle (CCD) | 125°, 130°, 135° |
| Cephalic blade diameter | 10.5 mm |
| Cephalic blade length | 75, 80, 85, 90, 95, 100, 105, 110, 115, 120, 125, 130 mm |
| Distal locking | 5.0 mm locking screw (static or dynamic) |
| Anatomical lateral bow | Pre-contoured to match Asian / Western femur geometry |
| Surface | Anodized (gold or blue) |
| Sterilization | Gamma 25-40 kGy, validated per ISO 11137 |
| MRI compatibility | Conditional — titanium |
Surgical Technique Summary
PFNA insertion follows the standard trochanteric entry intramedullary technique:
Position — supine on a fracture table with the unaffected leg flexed and abducted; the affected leg in slight adduction to expose the greater trochanter.
Reduction — closed reduction under fluoroscopy; confirm neck-shaft angle and length.
Approach — 2-3 cm longitudinal incision starting 2 cm proximal to the greater trochanter tip.
Entry point — at the medial tip of the greater trochanter (or slightly lateral in valgus necks); confirmed with guide wire and fluoroscopy AP and lateral.
Reaming — sequential flexible reamers to 0.5-1.0 mm above the chosen nail diameter.
Nail insertion — hand-insert the nail; confirm depth under fluoroscopy so the cephalic blade will sit in the center of the femoral head on AP and center on lateral.
Guide wire for blade — insert a 3.2 mm guide wire under fluoroscopy through the targeting guide; verify tip position 5-10 mm below the subchondral bone.
Reaming for blade — ream to 10.5 mm for the blade path.
Blade insertion — impact the helical blade to the predetermined depth; lock with the set screw.
Distal locking — place one or two distal locking screws using the targeting guide or freehand (long nails).
End cap — insert the end cap to prevent bony ingrowth into the nail driving hole.
Closure — closure in layers; drain optional.
Operative time: 30-90 min. Blood loss: < 100 mL. Hospital stay: 2-5 days.
PFNA vs PFN vs Gamma Nail
| Feature | PFNA | PFN | Gamma Nail |
|---|---|---|---|
| Cephalic fixation | Helical blade | Two screws (lag + anti-rotation) | Single lag screw |
| Cut-out resistance in osteoporotic bone | High | Moderate | Moderate |
| Operative time | Shorter | Longer (two screws) | Short |
| Proximal diameter | Smaller (15 mm) | Larger (17 mm) | Larger (17 mm) |
| Reverse oblique suitability | Yes | Limited | Limited |
| Cost | Moderate | Lower | Moderate |
For most unstable intertrochanteric fractures (31-A2, 31-A3), PFNA has become the preferred choice due to its lower cut-out rates and minimally invasive workflow.
Complications and Risk Mitigation
| Complication | Reported Rate | Mitigation |
|---|---|---|
| Cut-out / blade migration | 1-4% | Proper tip-apex distance < 25 mm, central blade position |
| Peri-implant fracture | 1-3% | Avoid cortical defects; long nails for subtrochanteric |
| Z-effect (cephalic screw migration) | Rare with PFNA (blade) | Blade design eliminates this |
| Non-union | < 5% | Stable reduction, appropriate nail length, dynamic locking option |
| Avascular necrosis | 1-2% | Preserve medial femoral circumflex artery; limit dissection |
| Heterotopic ossification | 5-15% | Limit soft-tissue trauma; NSAIDs post-op |
OEM/ODM Service
AOYE Medical supplies PFNA nails to distributors and OEM partners worldwide. Services include:
Laser logo on nail and blade
Custom tray / case design and IFU
Sterilization packaging (Tyvek / PE)
Regulatory document support (CE MDR 2017/745, 510(k) for FDA)
Low MOQ (50 units per SKU for trial orders)
Lead time: 15-30 days for repeat orders, 30-45 days for new SKUs
Request a quotation at oem@aoyemedical.com.
Frequently Asked Questions
What is a PFNA nail used for?
PFNA (Proximal Femoral Nail Antirotation) is used for internal fixation of proximal femoral fractures, including intertrochanteric, subtrochanteric, reverse oblique, and basicervical fractures. It provides stable fixation with a single helical blade that compacts cancellous bone for enhanced anchorage, especially in osteoporotic patients.
What is the difference between PFNA and PFN?
PFNA uses a single helical blade for femoral head fixation, while PFN (Proximal Femoral Nail) uses two cephalic screws. The PFNA blade compacts cancellous bone and provides greater resistance to cut-out, especially in osteoporotic bone. PFNA also reduces operative time by eliminating one screw step.
What is the difference between PFNA and Gamma nail?
Both are intramedullary devices for proximal femoral fractures. PFNA uses a helical blade; Gamma nail uses a single lag screw. Studies show similar clinical outcomes, but PFNA may have lower cut-out rates in unstable fractures and osteoporotic bone.
What material is the PFNA nail made of?
PFNA nails are manufactured from medical-grade Ti-6Al-4V ELI titanium alloy per ASTM F136 (ISO 5832-3). The titanium provides MRI compatibility, biocompatibility, and fatigue resistance.
What nail lengths are available?
AOYE PFNA nails come in short (170 mm), standard (200 mm), and long versions (240-400 mm in 20 mm increments). The cephalic blade is available in lengths from 75 mm to 130 mm.
Can AOYE OEM PFNA nails with private label?
Yes. AOYE provides OEM/ODM PFNA nail service including laser logo, private label packaging, sterilization packaging (Tyvek/PE), and CE Technical File or 510(k) regulatory document support. Low MOQ (typically 50 units per SKU) is available for trial orders.
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