A comparative study of short proximal femoral nail and dynamic hip screw in treatment of intertrochanteric fractures

Abstract

Background: Incidence of intertrochanteric fractures has increased significantly during recent years due to rising age of population and sedentary life style. They are one of the most frequently operated fracture types. Intertrochanteric fractures occur predominantly in elderly patients with osteoporosis. Operative fixation is the treatment of choice. It can be extra medullary implant like dynamic hip screw (DHS) or intramedullary implant like proximal femoral nail (PFN). Objectives • Evaluation of effectiveness of PFN and DHS in the management of intertrochanteric fractures. • The advantages and disadvantages of the PFN and DHS in intertrochanteric fractures Materials and methods: These is a prospective study which was carried out from Feb 2015 to Feb 2016 in Government Medical College Kozhikode. In this study period 48 cases of intertrochanteric fractures were studied, out of which 24 cases were operated with PFN and 24 cases were operated with DHS. The results were evaluated and compared. Results: Most of the patients were between 50 to 80 years of age. Most common mode of injury was domestic fall. The mean time of fracture union was 16 weeks. 54.2% patients operated by PFN were unstable fractures and 58.3% patients operated by DHS were stable fractures. The functional outcome was calculated by Harris hip score during follow up in 2 week, 6 weeks.3 months 6 Months and 1 year. By 1 year follow up of operated patients 96% of patients with PFN had good to excellent results 4% had fair results. 88% patients with DHS had good to excellent results and 12% patient had fair results. Conclusion: There is not much difference in functional outcome of intertrochanteric fractures treated by DHS and PFN in our settings. PFN is used mainly in unstable fracture and DHS in stable intertrochanteric fractures. Surgical exposure is minimal in PFN so minimal blood loss and wound complication. Early mobilization is an advantage with PFN. PFN needed better operative skill than DHS.