Comparative study of the management of inter-trochanteric fractures in the elderly: Trochantric femoral nail vs dynamic hip screw

Abstract

Introduction: Trochanteric fractures are among the most common injuries necessitating hospital admission. Regardless the type of fracture, trochanteric fractures can lead to substantial morbidity and mortality, especially in elderly patients. Surgery has been the mainstay of the treatment for these fractures to allow early mobilization of the patient. Among the surgical treatment, dynamic hip screw (DHS) as extramedullary power transmission system and trochanteric fixation nail (TFN) as the means of intramedullary stabilization are the established and standard in the treatment of trochanteric femoral fractures, particulary in elderly patients. AIM: The present study was designed to compare the results of TFN and DHS in treatment of intertrochanteric fracture femur. Material and methods: After fulfilling the mentioned criteria, patients were screened for medical fitness and then further randomized in group I and II. Group I-Patients treated with TFN (n=30). Group II-Patients treated with DHS (n=30). The clinical assessment was done according to the “Salvati and Wilson Function Score (SWS Score)”. Blood loss measurement and complications were also studied and compared. Results: Thirty patients were included in the study in each group. Salvati and Wilson Function Score (SWS) Score was used to evaluate the results at follow up. Mean ± SD of SWS at 16 weeks & 24 weeks was 18.93±3.34 & 28.80±5.33 respectively in group I whereas in group II, the value was 15.13±2.18 & 21.67±5.14 respectively. P-value was significant (< .01) Complications were observed in follow ups and the most frequent was varus displacement. It was observed that out of 30 subjects of Group 2, maximum i.e. 8 (26.67%) subjects had varus deformity whereas out of 30 subjects of group 1, only 1 (3.33%) subject had varus deformity Other complications include Non Union and Implant failure. Conclusion: We conclude that the advantage with Trochanteric fixation nail is that a smaller exposure is required than for a sliding screw, it may therefore be associated with lesser blood loss, shorter operating time and less morbidity.