Management of intertrochanteric hip fractures by proximal femoral nail and dynamic hip screw fixation: A comparative study

Abstract

Intertrochanteric fractures are significantly increasing in older adults. Treatment choices for trochanteric fractures include intramedullary nail and extra medullary fixation, even though the appropriate treatment choices for such fractures remain controversial. The present study was aimed to assess optimal treatment option for intertrochanteric fractures to determine which method i.e. proximal femoral nailing (PFN) and dynamic hip screw fixation (DHS) gives minimal post-operative complications, minimal blood loss and minimal duration surgery. A total of 46 cases with intertrochanteric fractures attending Department of Orthopedics were recruited. Cases were randomly allocated to PFN (Group 1) and DHS (Group 2). The intra-operative, early and late complications were recorded, and the functional outcome of each group was assessed. Road traffic accidents were most common cause of fractures in both groups. In group 1, the mean length of incision (9.56 cm), duration of surgery (71.45 min), fluoroscopy time (72.66) and total intraoperative blood loss (138 ml). In group 2, the mean length of incision (15.89 cm), duration of surgery (89.18 min), fluoroscopy time (59.38) and total intraoperative blood loss (322 ml). Cases treated with PFN had excellent outcome in 21.7%, good in 69.56%, fair in 8.69% and none of the case had poor outcome. Whereas in DHS group, excellent outcome in 21.7%, good in 43.47%, fair in 21.7% and poor in 13.04%. Both PFN and DHS had similar functional outcome. However, PFN had significantly more desirable functional outcome. PFN requires a smaller incision, shorter surgical duration, less intraoperative blood loss and post-operative complication than DHS group.