A comparative study of three treatments of unstable intertrochanteric fractures

Abstract

Objective To compare the effectiveness of the dynamic hip screw (DHS),the proximal femoral nail anti-rotation (PFNA) and the reversed LISS-DF in treatment of unstable intertrochantetic fractures.Methods From January 2008 to October 2010,42 patients with femoral peritrochanteric fractures were treated respectively with reversed LISS-DF (6 patients),DHS (20 patients) and PFNA (16 patients).There were 23 men and 19 women,aged from 19 to 96 years (average,66.3 years).There was no significant difference between groups in the general data of the patients( P ＞ 0.05).A retrospective study was performed to compare the outcomes of the 3 methods regarding operation time,perioperative blood loss,hospital stay:reduction,time for weight bearing,bone union,Harris score and complications. Results The patients were followed up for 6 to 30 months (average,18.5 months).The perioperative blood loss in 3 groups were respectively 364.5 ± 262.2 mL,176.3 ± 86.3 mL and 205.0 ± 77.1 mL,with significant between-group differences( P ＜ 0.05).The time for full weight bearing in 3 groups were 25.9 ± 6.3 days,16.7 ± 3.5 days and 23.8 ± 4.0 days,with significant between-group differences ( P ＜ 0.05).There were no significant between-group differences in operation time,hospital stay,quality of fracture reduction,time of bone union,postoperative complications or Harris score at 6 months postoperation ( P ＞ 0.05). Conclusion PFNA may be the first choice for treatment of unstable intertrochanteric fractures,with DHS and reversed LISS-DF as alternatives when PFNA management is difficult. Key words: Hip fractures; Fracture fixation, internal; Bone plates; Bone nails; Retrospective studies