Analysis of pertrochanteric fractures managed by intramedullary or extramedullary fixation

Abstract

Fractures of the proximal femur are relatively common fractures seen in elderly with trivial trauma. These fractures are associated with substantial morbidity and mortality. There are various forms of internal fixation devices used for peritrochanteric Fractures. The most commonly used device is the Dynamic Hip Screw with Side Plate assemblies. This is a collapsible fixation device, which permits the proximal fragment to collapse or settle on the fixation device, seeking its own position of stability. The latest implant for management of trochanteric fractures is proximal femoral nail, which is also a Centromedullary and collapsible device with added rotational stability. In view of these considerations, the present study of Surgical Management of peritrochanteric fractures was taken up. This prospective comparative present study was carried out in People’s College of Medical Sciences and Research Centre, Bhopal from September 2011 to September 2013. The study consisted a total of 61 patients with pertrochanteric fractures of femur satisfying the inclusion criteria, who are treated with Proximal Femoral nail (30 cases) and Dynamic Hip Screw (31 cases). The advantage with Proximal femoral nail is that a smaller exposure, lesser blood loss, shorter operating time, shorter screening time and less morbidity. (minimizes the jeopardy to the vascularity). It gives a biomechanically sound fixation. In osteoporotic bones Proximal femoral nail fixation carries definitive advantage over Dynamic Hip Screw fixation devices. The incidence of wound infection was found to be lower with PFN which resulted in early ambulation of the patients and lesser duration of antibiotics. The screening time with the help of image intensifier was much lesser in the cases operated by PFN. The implant related complications were much lesser in the patients treated with Dynamic Hip Screw (DHS). However, the rate of union was similar in two groups. (PFN & DHS). Both the implants in their own right are excellent modalities in the management of pertrochanteric fractures of the femur.