Proximal Femoral Nail Group Research Articles

Functional outcomes of proximal femoral nail versus dynamic hip screw in intertrochanteric fracture.

Objective: To compare the functional and radiological outcomes of Dynamic Hip Screw (DHS) and Proximal Femoral Nail (PFN) treatments for patients with unstable intertrochanteric fractures. Study Design: Comparative study. Setting: Trauma Centre, Hayatabad Medical Complex Peshawar. Period: May 2020 to June 2022. Methods: The study comprised 150 patients aged over 40 years old and had Type 2 intertrochanteric fractures, as classified by Boyd and Griffin. Radiographs, functional assessments, and demographic information were collected and patients were followed for up to two years at regular intervals. Results: The mean age of patients was 70 years. The PFN group had significantly shorter surgery duration (57.47 minutes) compared to the DHS group (85.30 minutes), less blood loss (74 ml vs. 195 ml), and a shorter hospital stay (6.5 days vs. 11.8 days). Early weight bearing was achieved faster in the PFN group, with mean times to partial and full weight bearing of 3.12 and 8.45 weeks, respectively, compared to 5.52 and 12.32 weeks in the DHS group. Radiological union at three months was significantly better in the PFN group. Complications were fewer in the PFN group, with notable differences in screw cutout, migration, and backout rates. Pain levels were lower in the PFN group at three and six months post-operatively. Conclusion: PFN demonstrated superior outcomes in terms of reduced surgical time, blood loss, hospital stay, and faster weight-bearing capabilities compared to DHS. Radiological and functional outcomes also favoured PFN, making it a preferable option for treating unstable intertrochanteric fractures.

Prospective Research Comparing Different Trochanteric Fracture Fixation Techniques.

Aim Evaluation and comparison of various methods of trochanteric fracture fixation. Methods This study was conducted prospectively at the Orthopaedics Department of Dr. D Y Patil Medical College and Research Centre. The study spanned 18 months and involved 100 patientstreated in the outpatient and the emergency department. Patients who fulfilled that specific criteria were selected for this study and the appropriate surgical intervention for each group was determined through radiological examination. Results Of the 100 patients, 55 (55%) were male and 45 (45%) females. Patients in our collection ranged from 20 to 90 years old. Proximal Femoral Nail (PFN), Dynamic Hip Screw (DHS ), and Proximal Femoral Locking Compression Plate (PFLCP ) groups averaged 56, 58, and 64 years old, respectively. The most common cause of intertrochanteric fracture was domestic falls (60%), followed by road traffic accidents (35%). The Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification rated 40 individuals (40%) as stable and 60 as unstable. Most patients in our study had unstable A3 fractures. PFN patients had 16 A3 fractures. In DHS, 32 patients suffered A3 fractures. Twelve PFLCP patients suffered A3 fractures. The smallest group had A1 fractures. Six PFN patients suffered A1 fractures. Two DHS patients had A1 fractures. Two PFLCP patients suffered A1 fractures. PFN group mean scores improved significantly after one and three months in this study. At six months, the PFN group had a significant mean score improvement. Conclusion PFN results ranged from satisfactory to excellent, offering numerous advantages over other methods such as DHS and PFLCP. The benefits of PFN include a shorter lever arm, fracture site compression, and enhanced rotational stability, which contribute to a lower chance of mechanical failure. Additionally, patients treated with PFN typically experience shorter hospital stays, earlier mobilization, less blood loss, shorter surgery times, faster rehabilitation, and quicker bone healing, making PFN a highly effective treatment option for certain fractures.

A comparative study of proximal femoral nail and dynamic hip screw for intertrochanteric fractures of the femur

Introduction: Intertrochanteric fracture is one of the most common fractures of the hip. However, the implant of choice for type II intertrochanteric fracture is still under debate. The aim of this study was to compare the functional outcomes of proximal femoral nail (PFN) and dynamic hip screw (DHS) in treatment of intertrochanteric fractures. Material and Methods: We did a prospective comparative study on 60 patients of type II intertrochanteric fractures operated with closed/open reduction and internal fixation with either DHS or PFN between October 2018 and March 2023. During each follow-up, the functional outcome of patients was calculated using the Harris hip score. Results: There was a statistically significant difference present in average functional scores between the two groups at 1 month, 3 months and 6 months; however, no difference was seen at the end of 12th month follow-up. Functional outcomes in the DHS group were excellent in 34.78%, fair in 17.39%, good in 43.48% and poor in 4.35%. In the PFN group, results were excellent in 56.52%, fair in 8.70% and good in 34.78% and no poor results were seen. Conclusion: In stable two-part intertrochanteric femur fractures, both PFN and DHS are equally effective but due to minimal invasiveness. PFN is a better implant of choice than DHS in the treatment of elderly patients with intertrochanteric fractures.

Comparison of Twin Screw Derotation Type Versus Single Helical Blade Type Cephalomedullary Nail in the Management of Unstable Intertrochanteric Fractures.

The intertrochanteric fracture is a frequently occurring fracture, often attributed to osteoporosis in older populations. Recently, there has been a proposal to perform early surgical fixation on elderly patients to facilitate early rehabilitation. This approach has been shown to have a beneficial effect in lowering comorbidities. The study aims to compare the efficacy of the twin screw derotation type cephalomedullary nail with that of the single helical blade type cephalomedullary nail in the management of unstable intertrochanteric fractures. The research sample included patients from the orthopedic outpatient and emergency departments of Adesh Medical College and Hospital,Ambala Cantt, India, who were scheduled for surgery for unstable intertrochanteric femur fractures. The patients were categorized into two groups according to the kind of implant they were given: either a twin screw derotation cephalomedullary nail or a single helical blade cephalomedullary nail. The functional result was evaluated by comparing the modified Harris hip score (HHS). Patients with unstable intertrochanteric fractures, including reverse oblique fractures and fractures with posteromedial comminution, as well as patients who provided consent, were included in this study. Thirteen individuals received treatment with proximal femoral nail antirotation (PFNA2), whereas 19 individuals received treatment with proximal femoral nail (PFN). The mean age in the PFNA2 group was 69.51, whereas the mean age in the PFN group was 70.804. There were three patients in the PFNA2 group and five patients in the PFN group who had a tip apex distance of more than 25 mm. According to the Cleveland index, nine patients in the PFNA2 group and eight patients in the PFN group had an implant location that was not optimum. Four patients in the PFNA2 group and seven patients in the PFN group had a neck shaft angle difference of more than 10° between their undamaged and operated sides. The mean HHS was 74.55 for the PFNA2 group and 69.88 for the PFN group. The PFNA2 group exhibited four problems, whereas the PFN group had five issues. The study found that both implants offer similar functional outcomes, with adherence to specific radiological parameters optimizing results. While both face similar challenges with osteoporosis, there was no notable distinction between them. Notably, the PFNA2 group showed superior outcomes in perioperative morbidity.

Efficacy and Outcomes of Gamma Nail Versus Proximal Femoral Nail in the Treatment of Stable Extracapsular Fractures of the Proximal Femur: A Comparative Study

Background: Stable extracapsular fractures of the proximal femur are a common and challenging injury in the elderly, with Gamma Nail and Proximal Femoral Nail (PFN) being the primary surgical options. This study aims to compare the efficacy and outcomes of these two methods.
 Methods: A prospective study was conducted on 50 patients with stable extracapsular fractures, randomly assigned to undergo CRIF with either Gamma Nail or PFN. Parameters such as operation time, blood loss, radiological outcomes, and postoperative recovery were analyzed.
 Results: The Gamma Nail group experienced shorter operation times (33±6.5 min) and less blood loss (28.08±32.80 ml) compared to the PFN group. Radiological outcomes showed no significant difference between the groups, with high success rates in achieving stable fixation. Both methods demonstrated effectiveness in managing these fractures, but Gamma Nail offered some technical advantages.
 Conclusion: Gamma Nail and PFN are both effective for treating stable extracapsular fractures of the proximal femur, with the choice of technique depending on various patient-specific factors.
 Keywords: Extracapsular fractures, proximal femur, Gamma Nail, Proximal Femoral Nail, orthopedic surgery, elderly.

Postoperative Recovery and Rehabilitation: A Comparative Analysis of Mobility and Social Dependency After Gamma Nail Vs. Proximal Femoral Nail Surgery

Background: The management of stable extracapsular fractures of the proximal femur challenges orthopedic practice, with postoperative recovery and rehabilitation outcomes being crucial for patient independence and quality of life. This study compares Gamma Nail and Proximal Femoral Nail (PFN) regarding mobility and social dependency post-surgery.
 Methods: Fifty patients were retrospectively analyzed, divided into two groups based on the surgical intervention received. Mobility scores, social dependency scales, and pain levels were assessed at various postoperative intervals.
 Results: The PFN group showed quicker improvements in mobility and reductions in social dependency, with notably less pain reported in the early postoperative period. Both interventions were effective, but PFN presented some advantages in facilitating rehabilitation.
 Conclusion: While both Gamma Nail and PFN effectively manage stable extracapsular fractures, PFN may offer benefits in early postoperative recovery. Tailoring surgical choices to individual patient needs is essential for optimizing rehabilitation outcomes.
 Keywords: Proximal femur fractures, Gamma Nail, Proximal Femoral Nail, postoperative recovery, mobility, social dependency.

Which factor is more associated with survival of patients with hip fracture over 90 years: Type of fracture or treatment modality?

We aimed to analyze prognostic factors affecting the mortality and to evaluate whether the fracture type (collum femoris or intertrochanteric fracture) or treatment method (proximal femoral nail or hemiarthroplasty) affects the mortality in patients with hip fractures and older than 90 years old. In our study, we retrospectively reviewed the patients aged >90 years and operatively treated hip fractures. Patients were categorized according to fracture type and treatment method. Finally, three groups were created. Demographic values, laboratory values were analyzed for prognostic factors and determining independent factors associated with survival for each group. A total of 193 patients were included with an average age of 92.5±2.4 (range, 90-104) years. There were 144 women and 49 men. There were 126 (65.2%) patients with intertrochanteric fracture and 67 (34.8%) patients with collum femoris fracture. At the time of this study, 142 (73.5%) patients had deceased. Staying in intensive care unit for collum femoris group, general anesthesia for intertrochanteric fracture treated with hemiarthroplasty group and delay to surgery and preoperative albumin level for intertrochanteric fracture treated with proximal femoral nail group were associated with poor survival. Staying intensive care unit, general anesthesia, delay to surgery and preoperative albumin levels should be carefully evaluated for patients aged over 90 years with hip fractures. Our study showed that both fracture type and treatment modality were not associated with poor overall survival of the patients aged >90 years following hip fracture surgery.

Intertrochanteric Femoral Fractures: A Comparative Analysis of Clinical and Radiographic Outcomes Between Talon Intramedullary Nail and Intertan Nail.

Introduction Hip fractures in the elderly constitute a significant health concern, and their incidence is on the rise. It has been reported that intertrochanteric femoral fractures comprisea large portion of hip fractures, and they are especially prevalent among women. Over 75% of these types of fractures in the elderly occur as a result of simple falls.Surgical intervention must be performed for these fractures to expedite the healing process in patients. The application of a proximal femoral nail (PFN) is conducted using a minimally invasive technique after the fracture has been reduced using closed techniques. This technique maintains the fracture hematoma while minimizing the occurrence of consequences such as surgical trauma, hemorrhaging, infection, and issues with the wound site.This study aimed to assess the radiologic and functional outcomes among the groups following surgical procedures utilizing two distinct PFNs. Methods Between November 2021 and June 2023, a total of 96 individuals (38 males and 58 females) who underwent surgery for ITF using PFN were included in the study.Our surgical team utilized the Talon™ DistalFix™ PFN system (Orthopedic Designs North America Inc., FL, USA) and the Trigen InterTAN® nail (Smith & Nephew). Results The surgery time (number of scopes) for the Talon PFN was recorded as 25 (25-30), while it was 30 (30-35) in the InterTAN group (p<0.001). No nail protrusion was observed in the InterTAN group, whereas nail protrusion was observed in 12 patients (31.6%) in the Talon PFN group (p<0.001). Nail jamming was observed in two (5.3%) patients in the Talon PFN group, while none was observed in the InterTAN group (p<0.07). Conclusion In ITF fractures, the InterTAN nail is a more reliable implant. The shorter surgery time, reduced radiation exposure, and more minimally invasive nature of the Talon PFN might be preferred for geriatric patient populations with comorbidities where prolonged anesthesia could elevate mortality risks or for fractures of two or three pieces (Evans-Jansen Type 1 and Type 2). However, for more unstable fractures (Evans-Jensen Type 3) and in the active elderly patient group, we recommend the use of the InterTAN nail.

Comparative Outcome of Short Proximal Femoral Nail Versus Proximal Femoral Locking Compression Plate in the Management of Unstable Trochanteric Fractures

Introduction: Trochanteric fractures are mostly due to RTA and falls. Unstable trochanteric fractures include those with a reverse oblique fracture line, intertrochanteric comminution, big posteromedial fragment, subtrochanteric extension, a broken greater trochanter and lateral cortex breach. As per the AO Classification of intertrochanteric fractures, AO31-2.2, AO31-2.3, AO31-3.1, AO31-3.2 and AO31-3.3 fall under the category of unstable trochanteric fractures. Internal fixation is mandatory to provide early mobilization of patients with partial weight-bearing and prevent further compli&amp;cations. Materials and Methods: 43 patients more than 18 years old with unstable trochanteric fractures, less than 3 weeks old trauma were included in the prospective study for 1 year period (1st June 2020 to 31st May 2021). 22 cases were treated with short Proximal Femoral Nail (PFN) and 21 cases were treated with Proximal Femoral Locking Compression Plate (PFLCP). Results: (P&lt;0.05), mean duration of surgery, blood loss was less in the PFN group (67minutes; 80mL) than PFLCP group (99 minutes; 152 ml). Union and partial weight-bearing was seen earlier in PFN group (14.1weeks; 10.6weeks) than in PFLCP group (18.7 weeks; 15.8weeks) (P&lt;0.05). Good-excellent outcome was seen in 100% cases in PFN group and 85.71% cases in PFLCP group. There were 3 cases of delayed union in PFLCP group and 1 in PFN group. 1 PFLCP case had malunion in varus deformity. Conclusion: Short PFN is the optimum implant in treatment of unstable trochanteric fractures as it is an intramedullary, load sharing device with short lever arm and hastens biological healing with early ambulation and minimal complications.

Comparison of Unstable Per-Trochanteric Fractures Fixed with Proximal Femoral Nail Versus Dynamic Hip Screw Using Harris Hip Score

Objective: To compare the frequency of a good functional outcome in unstable per-trochanteric fractures fixed with a dynamic hip screw and proximal femoral nail using the Harris Hip Score. Methodology: A comparative study was conducted at the Department of Orthopaedic Surgery, Pakistan Institute of Medical Sciences, Islamabad, from June to December 2021. A total of 80 patients with per-trochanteric femur fractures were selected and divided into two groups based on the surgical procedure performed: dynamic hip screw or proximal femoral nail. A comprehensive history and thorough examination were performed for all patients during scheduled follow-up visits. Patients were called in for follow-up assessments at 1 month and 3 months to evaluate the functional outcomes using the Harris Hip Score. Results: The mean age of all patients was 58.73±6.78 years. At the 3-month follow-up, the mean Harris Hip Score was significantly higher in the proximal femoral nail group compared to the dynamic hip screw group (84.64±7.05 vs. 73.9±12.53; p = 0.005). The proportion of patients with good functional outcomes (Harris Hip Score ≥ 70 points) was significantly higher in the proximal femoral nail group compared to the dynamic hip screw group (97.5% vs. 72.5%, p = 0.002). Conclusion: In this study, the proximal femoral nail group demonstrated superior functional outcomes compared to the dynamic hip screw group. The use of proximal femoral nail fixation can provide better outcomes and facilitate an earlier return to pre-injury status for patients.

Comparison of functional outcomes of pertrochanteric fractures of the femur managed with dynamic hip screw with a locking side plate versus proximal femoral nail

Background: In current practice, proximal femoral nail (PFN) and dynamic hip screw (DHS) with locking side plate are the implant of choice in stable trochanteric fractures. Most of the deficiencies of the standard DHS have been addressed by the introduction of the Locking side plate. There are plenty of studies comparing standard DHS and PFN. But studies comparing locking DHS and PFN are scarce in current literature. This study aimed to compare the outcomes of both implants in stable pertrochanteric fractures. Methods: The objective of this study was to assess and compare the clinical outcomes of using locking DHS and PFN for fixation in 40 patients who were admitted to SUT Academy of Medical Sciences between October 2017 and April 2019. The modified Harris hip score was used to evaluate the patients' progress, and regular follow-up was conducted to compare their outcomes. Results: Among the DHS group, the mean Harris hip score was 83.05, with excellent results observed in 2 patients (10%), good results in 12 patients (60%), fair results in 5 patients (25%), and poor results in 1 patient (5%). In comparison, the PFN group had a mean Harris hip score of 85.50, with excellent results seen in 6 patients (30%), good results in 10 patients (50%), fair results in 3 patients (5%), and poor results in 1 patient (5%). Conclusions: The DHS group had more patients with good and fair outcomes, while the PFN group had more patients with excellent and good outcomes. Based on these findings, we can conclude that both the PFN and DHS with locking side plate are similarly effective in treating stable intertrochanteric fractures.

Comparative Study of Functional and Radiological Outcome of Pertrochanteric Fracture Fixation by Proximal Femoral Nail Antirotation 2 and Old Proximal Femoral Nail

Abstract Context: Pertrochanteric fractures include the fractures in the region which extend from the extracapsular basilar neck region to the region along the lesser trochanter of femur. Pertrochanteric femur fracture accounts for the most common hip fracture. Most of pertrochanteric fractures, in younger as well as in the elderly patients, are unstable and slightly or partially displaced and require operative intervention. There are different types of fixation for pertrochanteric femur fracture such as proximal femoral nail (PFN), proximal femoral nail antirotation-2 (PFNA-2), Dynamic hip screw (DHS), Dynamic condylar screw (DCS), and angled blade plate. The PFNA-2 has been introduced to reduce implant-related complications, operative time, and intraoperative blood loss, especially in elderly osteoporotic individuals. This study was done with the belief that unstable pertrochanteric fractures can be better reconstructed with PFNA-2 designed specifically for the Asian population than with PFN and thereby enhance the functional outcome. Materials and Methods: A total of 40 patients were selected randomly. The fracture pattern included for the study was pertrochanteric fracture of the femur. The selection was based on performed inclusion and exclusion criteria. The functional outcomes and clinical results of the patients were evaluated and graded using the Harris hip score. Statistical Analysis Used: Statistical package for the social sciences software version 22.0 (IBM software package) was used for statistical analysis. Results: In our study, there were 20 (50%) patients who were treated with PFN and 20 (50%) were treated PFN-A2. The mean age in the PFN group was 43.90 ± 16.88 years and in the PFNA-2 group was 47.80 ± 17.25 years. In the PFNA-2 group, the average time of surgery was 67.00 min, and with PFN, the average time of surgery was 90.25 min. Mean intraoperative blood loss, in the PFNA-2 group was 68.25 ± 5.20 mL and in the PFN Group, it was 86.50 ± 10.37 mL. The group with PFN-A2 had a better hip score when compared with the PFN group. The complication rates were significantly lower in the PFN-A2 group. Conclusions: The newer alternative PFNA-2 was found to be much better than PFN in terms of lesser surgical time, small incision resulting in lesser blood loss, lesser number of image intensifier shoots, lesser duration of surgery, and advantage of compression mechanism at fracture site and lesser chances of biomechanical failure compared to PFN.

Proximal Femoral Nail Causes Lower Systemic Immunoinflammatory Response Compared to Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fractures

Introduction: This study aimed to compare the surgical stress and immunoinflammatory response caused by proximal femoral nail and hemiarthroplasty in patients with unstable intertrochanteric fractures. Materials and Methods: We retrospectively evaluated 344 patients who had undergone surgery for intertrochanteric fractures. Inclusion criteria were defined as being between the ages of 65 and 80, having an American Society of Anesthesiology physical status classification system score of 3, and the time between fracture formation and surgery being less than 72 hours. Proximal femoral nail was performed in 42 of the patients whereas hemiarthroplasty was performed in 40 patients. Data of age, gender, pre-operative waiting and operation times, length of hospital stay, change in haemoglobin levels, and erythrocyte suspension need were recorded. Venous blood samples were collected from all the patients at the first admission to the emergency department, 6 hours after the operation, and 3 days after the operation. Neutrophil-lymphocyte ratio and systemic immune-inflammation index were compared between the two procedures at three different time. Results: The operation and hospitalisation duration, erythrocyte suspension use were significantly higher (p&lt;0.05) in the hemiarthroplasty group than in the proximal femoral nail group. In both groups, neutrophil-lymphocyte ratio and systemic immune-inflamation index values increased significantly (p&lt;0.05) between the day 0 and the 3rd postoperative day. The postoperative day 0 neutrophil-lymphocyte ratio and systemic immune-inflammation index values in the hemiarthroplasty group were significantly higher than in the proximal femoral nail group (p&lt;0.05). Conclusions: We conclude that the proximal femoral nail procedure causes less surgical stress than hemiarthroplasty; therefore, it is a safer procedure.

Functional results of patients with femoral intertrochanteric fractures who underwent surgery of proximal femoral nail or bipolar hemiarthroplasty – a comparative study

ABSTRACT Purpose: In this study, the functional results of patients with femoral intertrochanteric fractures who underwent surgery were compared with their clinical features in terms of proximal femoral nail ( PFN ) and bipolar hemiarthroplasty ( BPH ). Methods: PFN (Group 1) was implanted in 40 of 89 patients (44 female, 45 male) aged between 51-80 (mean 68,16 ± 6,78) whereas BPH (Group 2) was used with 49 patients. Age, gender, fracture mechanism, additional disease, Body mass index (BMI), Albumin level, Hemoglobin (Hb) decrease level, T-score, American Society of Anesthesiologists (ASA) classification, type of anesthesia, surgery type, operation time, hospital stay and full weight-bearing time, the scores of Harris Hip Function (HHS), the social function of Jensen (JSF), Parker-Palmer mobility (PPMS) in preoperative and postoperative periods, and postoperative complications were all recorded. Results: In group 1; patients were younger, operation time was 46.78 ± 5.29 minutes and hospital stay was 2.48±0.75 days, which were shorter compared with group 2. For group 1, most surgery types were closed, T-score was -2.49±0.59 and better, the time of full weight-bearing was 3.48±0.78 months, Hb decrease was 1.17±0.37 and less, and Albumin level was 3.11±0.4 g/dL and higher compared to group 2 (p&lt;0.05). HHS was better in the BPH group at the sixth month (p&lt;0.05). In group 1, the 12th, and 24th months scores of JSF were better, PPMS was higher in all evaluations (p&lt;0.05). Operation time, ASA, T-score, albumin correlate with functional scores, while BMI and Hb did not. Conclusion: Many factors are important for progressing patients with intertrochanteric femur fractures toward a functional level. Considering these parameters in patients with femoral intertrochanteric fracture , PFN or BPH can both be used for treatment according to the surgeon's preference.

Prognostic factors between the proximal femoral nail and bipolar hemiarthroplasty in femoral intertrochanteric fractures

Aim: In the treatment of intertrochanteric femur fractures, proximal femoral nail (PFN), and bipolar hemiarthroplasty (BPH) are widely used. This study aimed to compare these two types of implants depending on risk factors regarding patients. &#x0D; Material and Method: PFN (Group 1) was applied to 40 of the 89 patients (44 female, 45 male) aged between 51-80 (mean 68.16±6.78) and BPH (Group 2) was applied to 49 of them. Age, gender, fracture side, fracture mechanism, additional disease, Body mass index (BMI), Albumin level, Hemoglobin (Hb) decrease level, T-score, American Society of Anesthesiologists (ASA) classification, type of anesthesia, surgery type, operation time, hospital stay and full weight-bearing time, Harris Hip Score (HHS) in preoperative and postoperative periods, classification of intertrochanter fracture according to the AO Foundation and Orthopedic Trauma Association (AO/OTA), postoperative complications were recorded.&#x0D; Results: Group 1 was younger with a mean age of 64.55±6.23 years compared to Group 2 (p 0.05). In group 1, operation time was 46.78±5.29 minutes and hospital stay was 2.48±0.75 days, which was shorter, most surgery types were closed, T-score was -2.49±0.59 and better, the time of full weight-bearing was 3.48±0.78 months, Hb decrease was 1.17±0.37 g/dL and less, Albumin level was 3.11±0.4 g/dL and higher (p

Effect of Treatment Modality on Mobility and Quality of Life in Unstable Intertrochanteric Fractures

Purpose: The aim of the study was to investigate mobility and quality of life in patients who underwent osteosynthesis with proximal femoral nail (PFN), or arthroplasty for unstable intertrochanteric fractures.&#x0D; Methods: Treatment outcomes of 117 patients (76 Female/41 Male) who were treated with PFN (Group 1, n=66), hemiarthroplasty (Group 2, n=42), or total hip arthroplasty (Group 3, n=9) between 2008 and 2014 were retrospectively evaluated. The mobility of the patients was evaluated with the Palmer and Parker mobility score, and the quality of life was evaluated with the Barthel quality of life index.&#x0D; Results: The mean ages in the groups were 83.51 (range, 75-97) years, 84.72 (range, 75-109) years, and 83.37 (range, 75-94) years; respectively. The mean follow-up periods were 23.26 (range, 3-43.9) months, 19.24 (range, 3-38) months, and 20.1 (range, 3-40) months; respectively. There was no statistical difference between the 3 groups in terms of age and follow-up time (p&gt;0.05). Palmer-Parker mobility scores were 6.23 for Group 1, 3.68 for Group 2, and 4.22 for Group 3. Barthel Indexes were 68.73 for Group 1, 37.75 for Group 2, and 52.77 for Group 3. Group 1 had a statistically significantly higher Palmer-Parker mobility and Barthel Index score than Group 2 and Group 3 (p

Comparison of the dynamic HIP screw to PFN (proximal femoral nail) for unstable peri trochanteric femur fracture

Introduction: One of the most common fractures in the elderly is inter-trochanteric fractures where surgical management allows better functional and rehabilitation outcomes making it a treatment of choice. Aim: To compare radiological, functional, and clinical outcomes following treatment of unstable intertrochanteric femur fractures using dynamic hip screw (DHS) or proximal femur nail (PFN). Methods: The study assessed 120 subjects with unstable intertrochanteric femur fractures where 60 were treated with DHS and the other 60 with PFN. For assessment of the outcomes, Harris hip scores were used. Results: Most surgeries were done in 56-70 minutes in 30% (n=18) subjects and 37% (n=22) subjects in DHS and PFN group respectively which was statistically non-significant with p=0.86. Most common complication was lateral cortex shattering in 16.6% (n=10) study subjects followed by ill-fitting jig in 13.3% (n=8) study subjects and distal locking difficulty in 10% (n=6) study subjects respectively. Mean Harris hip score was higher in PFN group (83.5±2.38) compared to DHS group (82.1±2.32).

Comparative Study of Hemireplacement Arthroplasty with Bipolar Prosthetic and Proximal Femoral Nail (PFN) in Unstable Intertrochanteric Fracture of Femure

Background: To study of hemireplacement arthroplasty with bipolar prosthetic and proximal femoral nail (PFN) in unstable intertrochanteric fracture of femure&#x0D; Methods: The present study was prospectively carried out in 60 consecutive patients of Fracture Intertrochanter Femur and treated with Hemiarthroplasty with Cemented Bipolar Prosthesis and Proximal Femoral Nail.&#x0D; Results: The average harris hip score in PFN group is 88.12±4.01 and in Bipolar group is 85.21±7.17. Final functional outcome were better in PFN group (P value 0.01) than by Bipolar group and significant.&#x0D; Conclusion: Unstable comminuted fractures treated with Bipolar showed significantly better outcomes with all patients having good results.&#x0D; Keywods: Hip arthroplasty, PFN, Complication

A Comparative Study of Proximal Femoral Nail and Dynamic Hip Screw in the Treatment of Intertrochanteric Fractures of Femur

Aim: The aim of this analysis is the comparison of the functional and radiological results of stable intertrochanteric femoral fractures managed with the dynamic hip screw (DHS) and proximal femoral nail (PFN). Study Design: A Randomized, controlled study. Place and Duration: In the Orthopaedics department of Capital Hospital (CDA), Islamabad for two years duration from January 2020 to December 2021. Methods: All patients with stable intertrochanteric fractures who met the criteria of selection were randomly allocated to group A (DHS) and B (PFN). There were 80 total patients alienated into group A and B. Patients were x-rayed for union evaluation and functional evaluation was done with Harris Hip Score (HHS) was performed, rated as poor (score &lt;70), good (80 to 90), fair (70 to 80) and excellent (90 to 100). The comparison of the results in the two groups was made at the third, sixth and twelfth months, and the P value was calculated using the chi-square test and the independent sample t-test. P &lt;0.05 was measured significant. Results: There were 80 total patients. They were divided equally and randomly into groups A and B of 40 patients each. The PFN group had a shorter operative time, smaller incision and minimum blood loss intraoperatively than the DHS group (p &lt;0.05). The group A mean age was 60.10±4.48 years, and of group B was 59.20±5.71 years. There were 25 men (62.5%) in A group and 23 (57.5%) in B group. Women were 15 (37.5%) in A group and 17 (42.5%) in B group. Mean time of radiological union was 14.2±4 weeks in group A and 12.8±6 weeks in group B (P&gt; 0.05). During the 3-month follow-up period, the Harris Hip Score (HHS) was 54.20 ± 4.20 (poor) and 35.03 ± 4.11 (poor) in Groups A and B, correspondingly (P &lt;0.05). HHS in group A was 90.27 ± 3.80 (good) and in B group, it was 82.27 ± 3.65 (good) (P &lt;0.05) at 6 months and HHS 94.61 ± 2.08 (excellent) and 93.27 ± 2.18 (excellent) 1 year in the group A and B (P&gt; 0.05). Conclusions: Both DHS and PFN gave similar results in terms of radiological union in stable intertrochanteric fractures. The short-term functional score was poor and good for both DHS and PFN at 3 and 6 months, although DHS scored statistically better than PFN. After one year of follow-up, both DHS and PFN had similar excellent functional scores, but had no statistically significant difference in score. Keywords: Harris hip Score, Proximal femoral nail, Dynamic hip screw and Intertrochanteric fracture.

“SURGICAL MANAGEMENT OF SUBTROCHANTERIC FEMORAL FRACTURES BY PFN AND DCS - A COMPARATIVE STUDY”

Background: The treatment of Subtrochanteric fractures continues to be a challenge in orthopaedic trauma, especially in geriatric population. Among the various surgical technique- Proximal Femoral Nail (PFN) and Dynamic Condylar Screw (DCS) are the ideally sought implants for xation. Aims and objectives: This study was designed to assess the clinical, functional and radiological outcomes and complications of femoral subtrochanteric fractures treated with PFN and DCS Methodology: This is a prospective observational study of 35 cases of subtrochanteric femoral fractures admitted to KIMS hospital, Hubballi, Karnataka. These 35 cases then randomized into two groups of PFN and DCS. All patients were followed up with radiographs for every 4 weeks th for 3 months and on 6 month and outcome was assessed using modied Harris Hip Score. Results: In our study, mean duration of hospital stay was found to be 11.23 ± 3.038 days in PFN group and 14.08 ± 2.178 days in DCS group and mean time for union was 14.91 ± 3.006 weeks in PFN group and 17.33 ± 2.871 in DCS group. Good to excellent results were seen in 81.82% of subtrochanteric fractures in PFN group and 53.85% in DCS group. Conclusion: From this study, we conclude that, functionally there were no signicant difference between DCS and PFN but, PFN has advantages in terms of faster surgical procedure, less blood loss, shorter hospital stays and less time for union. However, in complex subtrochanteric fractures DCS denitely a reliable and a backup implant.