Proximal Femoral Nailing vs. Dynamic Hip Screw in unstable Intertrochanteric Fracture of Femur – a comparative analysis

Mohammad Faisal,Prithviraj Nistane

doi:10.7439/ijbar.v7i10.3682

Abstract

Inter-trochanteric (IT) fractures account for approximately half of the hip fractures in elderly; out of this, more than 50% fractures are unstable. The Dynamic Hip Screw (DHS) had gained widespread acceptance in previous decades. DHS has been shown to produce good results but complications are frequent, particularly in unstable inter-trochanteric fracture. The advantage of Proximal Femur Nailing (PFN) fixation is that it provides a more biomechanically stable construct by reducing the distance between hip joint and implant. The goal of this study is to compare the clinical and radiological outcomes of DHS and PFN for the treatment of unstable Intertrochanteric hip fractures. In our study we included 100 unstable intertrochanteric fractures, out of which 50 were treated with PFN and 50 were treated with DHS. All surgeries were done on traction table and were followed up at regular intervals at 4 weeks, 8 weeks, 12 weeks, 6 months and annually thereafter. The functional results were assessed with Harris Hip Score. At latest follow up, Patients with excellent results were 33 (66%) in group A and 18 (36%) in group B while patients with good results were 14(28%) in group A and 27(54%) in group B. We observed statistically significant difference between two groups in view of late & early complications and time to union. We observed significantly better outcomes in PFN group for unstable inter-trochanteric fractures and reduction loss was significantly lower. We concluded that PFN may be the better fixation device for most unstable inter-trochanteric fractures.

Highlights

Inter-trochanteric (IT) fractures account for approximately half of the hip fractures in elderly; out of this more than 50% fractures are unstable [1,2]
In 1990 26% of all hip fractures occurred in Asia alone whereas this figure could rise to 37% in 2025 and 45% in 2050 [3]
According to AO/OTA classification 31A1 - fractures are simple, two-part fractures, 31A2 - fractures have multiple fragments 31A3 - fractures includes reverse oblique and transverse fracture patterns 2.1 Inclusion criteria 1)Patients who were in the age group of more than 50 years of either sex 2)Unstable Intertrochanteric fracture type 31-A 1/2/3

Summary

Introduction

Inter-trochanteric (IT) fractures account for approximately half of the hip fractures in elderly; out of this more than 50% fractures are unstable [1,2]. These fractures primarily involve cortical and compact cancellous trochanteric bone. Because of the complex stress configuration and its non-homogeneous osseous structure and geometry, fractures occur along the path of least resistance. The goal of treatment of any IT fracture is to restore mobility efficiently while minimizing the risk of complications and restoring the patient to pre-operative status. Treatment options for intertrochanteric fractures are mostly operative.

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