Evaluation of dynamic hip screw plate v/s proximal femoral nail for unstable inter-trochanteric fracture femur

Abstract

Background: Intertrochantric fracture is most common fracture around hip joint in elderly patients. Dynamic Hip Screw (DHS) plate is gold standard treatment for stable Intertronchantric fracture but it has its own complication in unstable intertronchantric fracture. So newer implant was introduced “Proximal Femoral Nail (PFN)” but it has its own complication. We studied 100 cases of unstable intertrochantric fracture to know which implant is better and was clinically assessed by Kyles criteria. Aims and objectives: To compare the short term result in DHS and PFN in all type of IT fracture and to set guidelines for managements of these fracture Methodology: This was Prospective randomized study comprised of unstable Fracture Intertronchantric treated by DHS and PFN. The cases were selected by envelop method for fixation unstable IT Fracture. The series consist of 100 cases were divided into 2 groups of patient treated by DHS and PFN . These cases where followed up for 6 months. Fracture stability was assessed by according to EVANS classification. Results: The mean time needed for the two procedures was 56.6 minutes (range 45-65 min) in Group A (DHS) and 40.8 minutes (range 35-51 min) in Group B (PFN). The period of hospitalization in Group A (DHS) was 9-12 days mean of days while in Group B (PFN) was 5-7 days with mean of days. Conclusion: Any modality of treatment done with proper expertise maintaining ideal surgical steps and principle, PFN carries slightly better result than DHS but which was not statically significant. Keywords: Intertronchantric Unstable Fracture, Proximal Femoral Nail (PFN), Dynamic Hip Screw Plate (DHS)