Instruments Set for PFNA-II Nails Antirotation – 63-Piece Proximal Femoral Blade Nail Instrumentation

The Instruments Set for PFNA-II Nails Antirotation from Peak Surgicals (PS-078 Q-Series) is a 63-piece proximal femoral nail antirotation instrumentation set in stainless steel, designed for the complete intraoperative workflow of PFNA-II blade-type cephalomedullary nail fixation — covering entry portal preparation with a dedicated Bone Awl for PFNA-II, proximal femoral canal reaming with a Flexible Reamer Ø9–13mm multi-diameter shaft, guide wire placement, blade channel preparation with a Cannulated Drill Bit Ø17mm and 11mm Reamer, blade introduction with an Impactor, blade compression and seating, anti-rotation wire placement via dedicated Aiming Jig, distal locking with a complete distal targeting system including Distal Guide Bar, Distal Guide Bar Connector, Distal Targeting Device, Distal Aligner, and Ø6mm drill bits, plus a Sliding Hammer, T-Handle Quick Coupling, Radiographic Ruler, and all associated sleeves, wrenches, guide wires, and drivers, all in an empty container. It is used by orthopedic and trauma surgeons performing PFNA-II cephalomedullary blade-nail fixation for intertrochanteric, peritrochanteric, and subtrochanteric hip fractures where the helical blade design is preferred over a lag screw for femoral head fixation.

PFNA-II Helical Blade Design: Clinical Rationale and Distinction from Lag Screw Systems

The PFNA-II (Proximal Femoral Nail Antirotation, Second Generation) uses a helical blade rather than a cylindrical lag screw for proximal femoral head fixation. A helical blade is a flat, screw-like implant that is impacted into the femoral head rather than screwed in — its rotating helical profile compacts the cancellous bone of the femoral head around the blade during insertion, creating a dense bone-blade interface with higher pullout resistance in osteoporotic bone compared to a cylindrical lag screw of equivalent diameter. The blade also occupies a larger cross-sectional area in the femoral head than a same-diameter screw, providing better resistance to rotation and varus collapse. The PFNA-II design was developed specifically for osteoporotic hip fractures — the dominant patient population for intertrochanteric fractures — where the poor cancellous bone density of the femoral head limits the pullout strength achievable with threaded lag screws. The antirotation feature (PFNA-II vs original PFNA) refers to the second-generation modification of the blade locking mechanism that prevents blade rotation within the nail after impaction, eliminating the Z-effect (rotation of the blade relative to the nail) seen in some earlier blade designs. The instrument set for PFNA-II therefore differs substantially from the PS-091 Hip Fracture Nail (lag screw) set in its blade-specific instruments: the Cannulated Drill Bit Ø17mm creates the blade entry channel, the 11mm Reamer (PS-078.70) prepares the blade pathway, the Impactor (PS-078.130) impacts the blade into position without rotation, the Compression Instrument (PS-078.118) applies controlled compression at the blade-nail interface, and the Key for Blade (PS-078.109) and Extraction Screw (PS-078.113) manage blade locking and revision.

Entry Portal and Proximal Canal Preparation: Bone Awl, Flexible Reamer, and Guide Wires

The Bone Awl for PFNA-II (PS-078.37) establishes the proximal femoral entry portal at the tip of the greater trochanter using the medial trochanteric entry approach characteristic of the PFNA-II design — the nail's proximal end is curved to enter at the trochanteric tip without requiring the piriformis fossa entry used in straight cephalomedullary nails. The Guide Wire Ø2.4mm×485mm with Hook (PS-078.142) is placed through the awl entry to guide the subsequent reaming. The Reaming Rod (PS-078.151) provides the stiff guide for the reaming sequence. The Flexible Reamer Ø9/Ø10/Ø11/Ø12/Ø13mm (PS-078.163) is a single multi-diameter flexible reaming shaft that sequentially enlarges the proximal femoral canal from Ø9mm to Ø13mm — the flexible shaft accommodates the curved PFNA-II nail trajectory from the trochanteric entry through the femoral bow without requiring rigid straight reamers. The Protection Sleeves (PS-078.07, Ø11/8mm ×2 green; PS-078.46, Ø20/17mm for PFNA-II), Drill Sleeves (PS-078.10, Ø8/4mm ×2 green; PS-078.49), and Trocars (PS-078.13, Ø4mm ×2 green; PS-078.19, Ø3.2mm for blade; PS-078.94, Ø6mm) protect soft tissue throughout the portal and reaming steps.

Blade Channel Preparation and Blade Impaction: Aiming Arm, Drill Bit, Reamer, Impactor

After the PFNA-II nail is inserted to the correct depth and confirmed fluoroscopically, the proximal femoral head targeting sequence begins using the Insertion Handle for PFNA (PS-078.01) and the Aiming Arm 130° (PS-078.61) — the 130° angle corresponds to the neck-shaft angle of the PFNA-II nail's proximal lag hole and directs the blade guide wire trajectory into the inferior-posterior quadrant of the femoral head at the correct tip-apex distance. The Guide Wire Ø3.2mm ×3 (PS-078.127) is placed through the aiming arm into the femoral head under biplane fluoroscopy. The Direct Measuring Device for Guide Wire Ø3.2mm (PS-078.25) measures the guide wire penetration depth from the lateral cortex to the subchondral bone of the femoral head to confirm correct depth before drilling. The Drill Bit Ø11mm (PS-078.67) creates the initial cortical entry channel through the lateral femoral cortex over the guide wire, guided by the Drill Sleeve Ø11/3.2mm for PFNA Blade (PS-078.139) and Protection Sleeve Ø16/11mm for PFNA Blade (PS-078.136). The Cannulated Drill Bit Ø17mm (PS-078.52) enlarges the proximal channel to the 17mm diameter required for the PFNA-II blade. The Reamer 11mm for PFNA-II Blade (PS-078.70) performs the final channel preparation. The Impactor for PFNA Blade (PS-078.130) drives the blade into the prepared channel without rotation — the blade's helical profile compacts cancellous bone as it is impacted to the correct depth confirmed fluoroscopically. The Compression Nut for PFNA Blade (PS-078.16) locks the blade's sliding and rotation mechanisms. The Compression Instrument for PFNA Blade (PS-078.118) applies controlled fracture compression at the blade-nail interface.

Anti-Rotation Wire and Distal Locking System

The Aiming Jig for Anti-Rotation Wire (PS-078.112) directs the placement of a secondary guide wire into the femoral head alongside the blade to prevent femoral head rotation on the blade axis during the blade impaction step and in the early postoperative period. This anti-rotation wire is the feature that distinguishes PFNA-II from single-element blade systems. The distal locking system consists of a complete mechanically guided targeting assembly: the Distal Guide Bar (PS-078.79) attaches to the insertion handle and provides the mechanical reference for the distal locking hole position; the Distal Guide Bar Connector (PS-078.76) connects the bar to the handle; the Distal Targeting Device (PS-078.82) attaches to the guide bar at the distal locking hole level; and the Distal Aligner (PS-078.185) fine-adjusts the targeting arm position. The Trocar Ø6mm (PS-078.94), Protection Sleeve for Ø6mm Drill Bit (PS-078.97), Drill Bit Ø6mm (PS-078.100), Drill Bit Ø6mm with Handle (PS-078.103), and Drill Sleeve Ø3.2 (PS-078.115) complete the distal locking drilling sequence. The Depth Gauge (PS-078.106) measures the drill depth for distal screw length selection. The Key for Distal Locking System (PS-078.91) and Connection Screws ×3 (PS-078.88) secure the distal targeting assembly to the nail.

CE Mark, ISO 13485, and FDA Certification for PFNA-II Instrumentation Procurement

The Instruments Set for PFNA-II Nails Antirotation is manufactured under CE Mark, ISO 13485, and FDA compliant quality standards. ISO 13485 certification confirms Peak Surgicals operates a documented quality management system covering design control, material traceability, and production consistency for orthopedic surgical instruments. CE Mark confirms conformity with European medical device regulations, and FDA compliance supports procurement for US-based hospitals, trauma centers, and orthopedic departments requiring verified regulatory documentation for cephalomedullary blade-nail instrumentation purchases.

Product Specifications

Frequently Asked Questions

What is the difference between a PFNA-II helical blade and a lag screw in cephalomedullary nailing?
A lag screw is a threaded cylindrical implant screwed into the femoral head — its threads cut into the cancellous bone to generate purchase. A helical blade (PFNA-II) is a flat, non-threaded implant with a helical profile that is impacted into the femoral head without rotation — it compacts the cancellous bone around the blade as it is driven in, creating a denser bone-blade interface that resists pullout better than an equivalent-diameter threaded lag screw in osteoporotic bone. The blade also occupies a larger cross-sectional area in the femoral head than a same-diameter screw, providing greater resistance to rotation and varus collapse under loading. These properties make the PFNA-II blade the preferred implant for intertrochanteric hip fractures in elderly osteoporotic patients, who represent the large majority of the hip fracture population. The corresponding instrument differences are substantial: lag screw systems require a circular drill for the screw channel, while the PFNA-II requires a 17mm cannulated drill and an 11mm reamer specifically matched to the blade profile, followed by an impactor rather than a screwdriver for final blade seating.

Why does this set include a Flexible Reamer rather than the rigid reamers used in other IM nail sets?
The PFNA-II nail has a curved proximal segment designed to enter the femoral medullary canal at the tip of the greater trochanter — the nail bends slightly as it traverses from the entry portal to the femoral shaft. Rigid straight reamers cannot follow this curved trajectory without impacting the lateral femoral cortex proximal to the isthmus, risking cortical fracture or reamer binding. The Flexible Reamer Ø9/10/11/12/13mm (PS-078.163) uses a flexible shaft that bends to follow the curved canal trajectory from the trochanteric entry, allowing sequential progressive reaming from Ø9 to Ø13mm without cortical engagement. The multi-diameter design of this flexible reamer means the surgeon can complete the reaming sequence with a single instrument advancing through five successive diameters, reducing operative time and the risk associated with multiple guide wire exchanges during rigid reamer removal and reinsertion.

What is the Aiming Arm 130° and why is this angle used?
The Aiming Arm 130° (PS-078.61) directs the guide wire trajectory for the PFNA-II blade at 130° to the nail shaft axis — this angle matches the neck-shaft angle of the PFNA-II nail's proximal blade hole. The guide wire placed through the 130° aiming arm follows the femoral neck trajectory at the standard adult caput-collum-diaphysis (CCD) angle of approximately 130°, allowing the guide wire to pass centrally from the lateral femoral cortex through the femoral neck to the inferior-posterior quadrant of the femoral head at the correct tip-apex distance. The Plug for Aiming Device (PS-078.61a) closes the unused aiming arm holes to prevent guide wire placement error. Some PFNA-II nail designs are available in varus configurations (125° or 127.5° neck-shaft angles) for patients with anatomical varus femoral necks; the aiming arm angle must match the specific nail being implanted.

How does this PFNA-II set differ from the Hip Fracture Nail Instrument Set (PS-091) also available from Peak Surgicals?
Both are cephalomedullary nail instrument sets for intertrochanteric hip fractures, but they are configured for fundamentally different nail designs. The PS-091 Hip Fracture Nail Set uses a lag screw system — it includes a Lag Screw Drill, Proximal Locking Lag Screw Tap, and Lag Screw Driver, and the proximal femoral head fixation is achieved by screwing a cylindrical threaded lag screw into the femoral head. The PS-078 PFNA-II set uses a helical blade — it includes a Cannulated Drill Bit Ø17mm, 11mm Blade Reamer, Blade Impactor, Compression Instrument, and Key for Blade, and the proximal fixation is achieved by impacting the helical blade without rotation. The reaming systems also differ: the PS-091 uses a Proximal Reamer for the entry portal, while the PS-078 uses a Flexible Reamer Ø9–13mm for the curved canal. The two sets are not interchangeable and each is specific to its corresponding nail implant design. Centres using both nail types require both sets.

What certifications does this set carry?
The Instruments Set for PFNA-II Nails Antirotation is manufactured under CE Mark, ISO 13485, and FDA compliant quality standards. ISO 13485 certification confirms Peak Surgicals operates a documented quality management system covering design control, material traceability, and manufacturing consistency for orthopedic surgical instruments. CE Mark confirms conformity with European medical device regulations, and FDA compliance supports procurement for US hospitals, trauma centers, and orthopedic departments requiring verified regulatory documentation for PFNA-II blade-nail instrumentation purchases.