Comparative prospective study of proximal femoral nail and dynamic hip screw in treatment of intertrochanteric fracture femur.

Abstract

The aim of this study was to compare the outcome of intertrochanteric fractures treated with Dynamic Hip Screw and Proximal Femoral nail. This study was conducted on 50 cases of Intertrochanteric fractures of femur treated by a dynamic hip screw and proximal femoral nail. Patients were operated on standard fracture table under image intensifier control. The average age of the patient was 62.3 years. Most common mechanism of fracture was domestic fall. Twenty percent four percent had stable, 58% unstable and 18% reverse oblique pattern of fracture. The unstable pattern was more common in old aged patients with higher grade of osteoporosis. The average blood loss was 100 and 250 ml in PFN and DHS group respectively. In PFN there were more no. of radiation exposure intraoperatively. The average operating time for the patients treated with PFN was 55min as compared to 87min in patients treated with DHS. Total complications were 15% with implant failure 6%, infection 4%, nonunion 2% and greater trochanter splintering 4%. In the PFN group the amount of sliding on X-rays was less as compared to DHS. The patients treated with PFN started early ambulation as they had better Harris Hip Score in the early period (at 1 and 3 month). In the long term both the implant had almost similar functional outcomes. The DHS was tolerated better by young patients with stable fracture while PFN had a better outcome with osteoporotic patients and weak bone mass and reverse oblique fractures.