Comparative analysis between dynamic hip screw and proximal femoral nail the management of intertrochanteric femoral fracture

Abstract

Peritrochanteric fractures are common in the elderly people. The frequency of these fractures has increased primarily due to the increasing life span and more sedentary life style brought on by urbanization. There are various forms of internal fixation devices used for Peritrochanteric Fractures. The most commonly used devices are the Dynamic Hip Screw (DHS) with Side Plate assemblies and proximal femoral nail (PFN). The present study was conducted in 30 cases of stable intertrochantric fractures of femur, classified according to AO classification. All patients were regularly followed up and Harris Hip Score was used for evaluation for the results. All the patients of stable intertrochantric fracture treated with PFN or DHS were allowed partial weight bearing at 4 weeks and full weight bearing at 15 weeks. Most of the patients treated with DHS had excellent outcome (86.66%) as compare to the patient treated with PFN having excellent outcome in 53.33%. Among complications for PFN difficult reduction was seen in 1 patient (6.6%), greater trochanter fracture was seen in 1 patient (6.6%), Hip pain was seen in 1 patient (6.6%) and shortening (> 1cm) was seen in 1 patient (6.6%). In DHS, common complications were superficial infection in 1 patient (6.6%), Hip Pain in 1 patient (6.6%) and shortening (> 1cm) in 3 patients (20%). The range of motion calculated by the Harris Hip Scoring system treated by both the implants i.e. PFN and DHS was good and was almost the same (95% CI:0.83P1.30,P=0.72). Both implants had equal time of union and had few complications in stable fractures but at long term follow up most of patient operated with PFN complained of implant related complications like greater trochanter Pain and anterior thigh pain.