A prospective study of treatment of intertrochanteric fractures of femur by fixation with dynamic hip screw or proximal femur nailing

Abstract

Purpose: Fractures of the proximal femur are more than ever, an important challenge in the field of traumatology. An anatomical reduction obtained at the expense of total devascularisation of the fracture is not a well-planned or well-executed procedure. One must always remember that any form of fixation is at best a splinting device with a definite life span and there is always a race between fracture union and failure of implant. Aims & Objectives: The aim is to study the clinical and radiological outcomes in case of reduction and stabilization of intertrochanteric femur fractures through DHS or PFN. The objectives are to study the advantages and principles of reduction and stabilization methods by DHS or PFN fixation for the treatment of intertrochanteric fractures of femur, to study the range of motion of hip and knee joints and functional outcome, to study complications of the technique. Material &Methods: After ethics committee clearance, subject recruitment procedure was followed. The sample size is total 100 cases with age between 18 to 100 years. The inclusion criteria include 1.Unstable intertrochanteric fractures with posteromedial comminution. 2. Patients with co-morbid conditions like diabetes, hypertension and ischemic heart disease. 3. All patients were ambulatory before the injury. The exclusion criteria include fractures other than intertrochanteric femur and non-ambulatory patients. Standard lateral approach was followed for the fixation of intertrochanteric femur fractures using dynamic hip screw or proximal femur nailing. Results: Out of 100 patients (48 males and 52 females), we have follow up of 67 patients with intertrochanteric femur fracture between July 2013 to May 2016. Majority of the patients in our series were male (53.7%) compared to females (46.3%). The average of male patient was 56 years and that of female patients was 69.9 years. Discussion: The mean Harris Hip Score of DHS is 89.07 and PFN is 89.00. Thus, there was no statistical significance for using DHS or PFN in per-trochanteric femur fractures. Conclusion: Implant selection for the patients must be based on the ability of the implant to withstand long term cyclical loading, the implant should splint the entire femur to bridge other potential areas of unrecognized or future metastatic disease. One must develop mastery over the usage of the implant in a particular fracture and then one can convert that implant as Gold standard for that fracture.