Comparative study of extramedullary versus intramedullary fixation for unstable Intertrochanteric femur fracture

Abstract

Context: Most frequent fractures of proximal femur are intertrochanteric fractures which involve upper end of femur between both trochanters with or without extending into the upper femoral shaft occuring commonly in geriatric patients. Unstable contribute to about 50%-60% of all intertrochanteric fractures. Aims: Though intertrochanteric fractures unite without surgical intervention, malunion with coxa vara deformity occur with conservative management. The aim of fixation of intertrochanteric fractures is to prevent morbidity and mortality. With this aim of stable surgical reconstruct of intertrochanteric fracture this study was done to evaluate functional, clinical and radiological outcome of unstable intertrochanteric fracture operated with dynamic hip screw with trochanteric stabilization plate (extra meduary fixation) and proximal femoral nailing (intramedullary fixation) and study epidemiology and demographics of intertrochanteric femur fractures in Indian scenario. Settings and Design: Methods and Material: The study was conducted at New Civil Hospital Surat. 50 patients with unstable intertrochanteric femur fractures admitted between february 2018 to march 2019. Conclusions: In this study we found that both-extra-medullary or intramedullary fixation were able to provide good clinical result for unstable Intertrochanteric femur fracture. We conclude that there is statistically significant difference between patients operated with DHS with TSP (Extra medullary implant) and Proximal Femoral Nail (Intramedullary implant) in terms of Blood loss, Mean operative time and functional outcome. Harris hip score in patients treated with PFN had better Harris hip score at final follow up which was statistically significant. All patients in both groups had bony union at final follow up. Blood loss and duration of surgery was significantly less with intramedullary Implant.