DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20214067

Comparative study between proximal femoral nailing versus dynamic hip screw in unstable inter-trochanteric fractures of the femur in adults

Manoj Kumar, Zubair A. Lone, M. Farooq Bhatt, Abdul Basit

Abstract


Background: Hip fractures are more common in elderly among them intertrochanteric fractures are most common, more than 50% fractures are unstable. The proximal femoral nailing (PFN) and dynamic hip screw (DHS) are frequently used modalities from last two decades in both stable and unstable fractures. The DHS has been shown to produce good results but complications are frequent, particularly in unstable inter-trochanteric fracture. The advantage of PFN fixation is that it provides a more biomechanically stable construct with good collapse control. The goal of this study was to compare the clinical and radiographical results of the DHS and PFN for the treatment of inter-trochanteric hip fractures as one is load bearing another is load shearing.

Methods: In our study we included 70 inter-trochanteric fractures, out of which 40 were treated with DHS fixation and 30 were treated with PFN, and were followed up at regular intervals of 2 weeks, 8 weeks, 12 weeks, 6 months and annually thereafter.

Results: The functional results were assessed with Harris hip score and observed 35% excellent results in DHS group and 63.3% excellent results in PFN group. We observed no statistically significant difference between two groups in view of late and early complications and time to union. We observed significantly better outcomes in PFN group for unstable inter-trochanteric fractures and in unstable fractures reduction loss was significantly lower in PFN group. We observed total duration of surgery was significantly lower in PFN group.

Conclusions: We concluded that PFN may be the better fixation device for most unstable inter-trochanteric fractures. 


Keywords


Inter-trochanteric fractures, DHS, PFN

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References


Robert BW, James Heckman D, Brown MCC. In Rockwood and Green’s Fractures in Adults, 8th edi, Philadelphia: Wolters Kluwer Health. 2015;1827-44.

David Lavelle G. Fractures and dislocations of the hip chapter-52 in Cambell’s Operative Orthopaedics, 11th edit, Philadelphia, PA: Mosby/Elsevier. 2008;3237-3308.

Kish B, Sapir O, Carmel A, Regev A, Masrawa S. Full weight bearing after unstable per and subtrochanteric fracture using proximal femur nail. J Bone Joint Surg (Br). 2001;83-B:289.

Christian B. The proximal femoral nail-a minimal invasive treatment of unstable proximal femoral fractures, Acta Orthop Scand. 2003;74(1):53-8.

Nuber S, Schoweiss T, Ruter A. Stabilization of unstable trochanteric femoral fractures: dynamic hip screw with trochanteric stabilization plate vs Proximal femoral nail. J orthop trauma. 2003;17(4):316-7.

Ramakrishnan M, Prasad SS, Parkinson RW, Kaye JC. Management of subtrochanteric femoral fractures and metastases using long proximal femoral nail. Injury. 2004;35:184-90.

Ely Steinberg L, Blumberg N, Deke S. The fixion proximal femur nailing system: biomechanical properties of the nail and a cadaveric study. J biomechanics. 2005;38:63-8.

Pajarinen J. pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail. A randomized study comparing post operative rehabilitation. JBJS (Br). 2005;87(1):76-81.

Kenneth KJ, Joseph ZD. In Hip fractures-A practical guide to management, 1st edi, Springer-Verlag New York. 2000;191-252.

Jacobs RR, McClain O, Armstrong HJ. Internal fixation of intertrochanteric hip fractures: a clinical and biomechanical study. Clin Orthop. 1980;146:62.

Rha JD, Kim YH, Yoon SI. Factors affecting sliding of the lag screw in intertrochanteric fractures. Int Orthop. 1993;17(5):320-4.

Gross RH. Leg length discrepancy in marathon runners. Am J Sports Med. 1983;11:121-4.

Baumgaertner MR. Intertrochanteric hip fracture. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, eds. Skeletal Trauma. Philadelphia, PA: Saunders. 2003;1776-16.