DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20203730

Comparative evaluation of management of intertrochanteric fracture femur with proximal femoral nailing versus dynamic hip screw

Navneet Adhikari, Chandra Shekhar, Ganesh Singh, Hardev Singh

Abstract


Background: Fractures involving trochanteric region of femur are one of the common fractures affecting elderly population. Presently surgical treatment is the treatment of choice with early mobilisation as primary goal. The two most common implants that are used are Dynamic hip screw (DHS) and Proximal femoral nail (PFN).

Methods: This was a prospective study with 50 patients divided randomly into two groups of 25 each. One group operated by PFN and other with DHS. Patients were evaluated periodically and final comparison between two group was done at six months for analysing results on the basis of Harris hip score.

Results: At final follow up in patients in PFN group 9 (36%), 7 (28%), 5 (20%), 4 (16%) patients had functional grade in excellent, good, fair and poor category respectively. In DHS group patients, 7 (28%), 10 (40%), 6 (24%), 2 (8%) patients had functional grade in excellent, good, fair and poor functional grade. Harris hip score was insignificantly (p>0.05) lower in patients of PFN (82.68±12.28) than DHS (84.60±10.39).

Conclusion: At final follow up we found that pain, limp, use of support while walking and hospital stay was less in PFN group. However, range of motion and hip functions were better in patients treated with DHS. Complications like Varus malunion and infection were common in DHS group while hip joint stiffness was seen more commonly in PFN group. So, both PFN and DHS in are comparable in respect to most of functional criteria for treatment of intertrochanteric fracture femur.


Keywords


DHS, PFN, Intertrochanteric fracture, Harris hip score

Full Text:

PDF

References


Cooper A. A treatise on dislocations and on fractures of the joints. London: Published for the author, by Longman, Hurst, Rees, Orme, Brown, and Green; S. Highley; T. and G. Underwood; Burgess & Hill; & Cox & Son; 1824-1906.

Hagino H, Furukawa K, Fujiwara S, Okano T, Katagiri H, Yamamoto K, et al. Recent trends in the incidence and lifetime risk of hip fracture in Tottori, Japan. Osteoporos Int. 2009;20(4):543-8.

Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int. 1997;7(5):407-13.

Boyd HB, Griffin LL. Classification and treatment of trochanteric fractures. Arch Surg. 1949;58(6):853-66.

Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. J Bone Joint Surg Am. 1969;51:737-55.

Dahl E. Mortality and life expectancy after hip fractures. Acta Orthop Scand. 1980;51(1):163-70.

Domingo LJ, Cecilia D, Herrera A, Resines C. Trochanteric fractures treated with a proximal femoral nail. Int Orthop. 2001;25(5):298-301.

Ahrengart L, Törnkvist H, Fornander P, Thorngren KG, Pasanen L, Wahlström P et al. A randomized study of the compression hip screw and Gamma nail in 426 fractures. Clin Orthop Relat Res. 2002;(401):209-22.

Wang J, Zhang W, Yu C, Zhang X, Zhang H, Guan Q, et al. Follicle-stimulating hormone increases the risk of postmenopausal osteoporosis by stimulating osteoclast differentiation. PLoS One. 2015;10(8):e0134986.

Anil M. The use of an intramedullary nail vs. dynamic hip screw in the treatment of intertrochanteric fractures; a case cohort study. Kerala J Orthop. 2011;25(1):6-13.

Simmermacher RK, Bosch AM, Van der Werken C. The AO/ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures. Injury. 1999;30(5):327-32.

Boldin C, Seibert FJ, Fankhauser F, Peicha G, Grechenig W, Szyszkowitz R. The proximal femoral nail (PFN) - a minimal invasive treatment of unstable proximal femoral fractures: A prospective study of 55 patients with a follow-up of 15 months. Acta Orthopaedica Scandinavica. 2003;74(1):53-8.

Jonnes C, Sm S, Najimudeen S. Type II intertrochanteric fractures: proximal femoral nailing (PFN) versus dynamic hip screw (DHS). Arch Bone Jt Surg. 2016;4(1):23-8.

Saudan M, Lübbeke A, Sadowski C, Riand N, Stern R, Hoffmeyer P. Pertrochanteric fractures: is there an advantage to an intramedullary nail?: a randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail. J Orthop Trauma. 2002;16(6):386-93.

Giraud B, Dehoux E, Jovenin N, Madi K, Harisboure A, Usandizaga G et al. Pertrochanteric fractures: a randomized prospective study comparing dynamic screw plate and intramedullary fixation. Rev Chir Orthop Reparatrice Appar Mot. 2005;91(8):732-6.

Matre K, Havelin LI, Gjertsen JE, Espehaug B, Fevang JM. Intramedullary nails result in more reoperations than sliding hip screws in two-part intertrochanteric fractures. Clin Orthop Relat Res. 2013;471(4):1379-86.

Parker MJ, Bowers TR, Pryor GA. Sliding hip screw versus the targon pf nail in the treatment of trochanteric fractures of the hip: a randomised trial of 600 fractures. J Bone Joint Surg Br. 2012;94(3):39-7.

Kumar R, Singh RN, Singh BN. Comparative prospective study of proximal femoral nail and dynamic hip screw in treatment of intertrochanteric fracture femur. J Clin Orthop Trauma. 2012;3(1):28-36.

Mahesh Kumar NB, Mahesh U, Santosh Kumar G. A comparative study of proximal femoral fracture fixation with proximal femoral nail and dynamic hip screw & plating. International J Orthop Sci. 2017;3(1):499-505.

Gupta SKV, Valisetti VS. Comparative study between dynamic hip screw vs proximal femoral nailing in intertrochanteric fractures of the femur in adults.International Journal of Orthopaedics Sciences. 2015;1(1):07-11.