Dynamic Hip Screw Versus Proximal Femoral Nail in Treatment of Unstable Intertrochanteric Fracture of Femur AO/OTA Types 31 A2 and 31A3 in Patients above Sixty Years Old. A Comparative Study

Abstract

Background and objectives: Intertrochanteric fracture of the femur is one of the common and challenging fractures in the orthopedic field, which mostly affect old osteoporotic patients. Different method of fixation used to treat inter- trochanteric fracture of femur, including dynamic hip screws and proximal femoral nail .We compared the dynamic hip screw and proximal femoral nail methods of fixation in unstable intertrochanteric fracture of femur (AO Types A2 and A3) with respect to duration of surgery, blood loss, intraoperative complications, union rate and functional return. Methods:A prospective randomized and comparative study was conducted on forty two patients, 26 males (61.9%), 16 females (38.1%), from March 2015 to March 2017. Out of 42 cases, 20 patients (47.6%) treated with dynamic hip screw (group A) and 22 patients (52.4%) with proximal femoral nail (group B). In this study, maximum age was 80 years and minimum was 60 years old with a mean age of 70.9 years. Results: Our study found that proximal femoral nail fixation had relatively lesser operative time (74.5+2.6 minutes in dynamic hip screw group and 57+2.3 minutes in proximal femoral nail group), less blood loss observed (150±10.7 ml in dynamic hip screw group and 90±6.7 ml in proximal femoral nail group) and the patients were capable of early mobilization and lesser rates of implant failures (2 cases in dynamic hip screw group with no case in proximal femoral nail group), however, dynamic hip screw patients showed faster fracture healing (12-16 weeks in dynamic hip screw group and 16-24 weeks in proximal femoral nail group). Conclusions:Proximal femoral nail provides more stable fixation for unstable intertrochanteric fractures spe- cially AO type 31A3 and has more favorable short-term outcomes with a shorter procedure duration, less blood loss and no implant failures.