A comparative study of fixation of pertrochanteric fractures with dynamic hip screw and proximal femoral nail

Abstract

Trochanteric femoral fractures are among the most common injuries necessitating hospital admission. Regardless the type of fracture, trochanteric fractures can lead to substantial morbidity and mortality, especially in elderly patients [1, 2]. Surgery is the mainstay of the treatment for both displaced and non displaced trochanteric fractures, to allow early mobilization of the patient, depending on the stability of the reduction and fixation achieved [4]. Dynamic Hip Screw [DHS] as extramedullary and Proximal Femoral Nail [PFN] as intramedullary systems are established and standard in treatment of trochanteric femoral fractures [5, 6]. Aim: To compare the results of Dynamic Hip Screw and Proximal Femoral Nail in the treatment of intertrochanteric fractures. Materials & Methods: In our study we compared DHS with PFN in a group of 60 patients admitted in a tertiary care hospital between August 2013 – December 2016. Patients with intertrochanteric fractures without having concomitant shaft femur or neck femur fractures were included. The preoperative morbidity was evaluated using Parker’s mobility scale. Salvati and Wilson’s scoring helped in measuring overall functional outcome at 16 & 24 weeks between the two study groups. Results: The preoperative Parker’s mobility scale was comparable between two study groups. Salvati and Wilson’s score at 16 & 24 weeks was significantly better with PFN group. The functional outcome based on SWS score was Fair in 39% of patients operated with DHS at 16 weeks while for PFN it was Fair to Good in 79% of patients. At 24 weeks it was Fair to Good in 84% patients operated with DHS while in case of PFN the score was Fair to Good in 59% of the patients & Excellent in 38% of the patients. Conclusion: Our conclusion from this study supported the use of PFN for both stable and unstable pertrochanteric fractures over DHS due to its lesser operation time, lesser blood loss, early weight bearing, limited open reduction & better functional outcome.