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

Author(s): S.K. Venkatesh Gupta, Veera Shekar Valisetti

Abstract: Inter-trochanteric 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) has gained widespread acceptance in the last two decade and is currently considered as the standard device for comparison of outcomes. The DHS has been shown to produce good results but complications are frequent, particularly in unstable inter-trochanteric fracture. The advantage of Proximal Femur Nailing 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 radiographical results of the DHS and PFN for the treatment of Inter-trochanteric hip fractures (Load bearing vs Load shearing). In our study we included 400 inter-trochanteric fractures, out of which 240 are treated with DHS fixation and 160 are treated with PFN. All surgeries done on traction table and are followed up at regular intervals of 4 weeks, 8 weeks, 12 weeks, 6 months and annually thereafter. The functional results are assessed with Harris Hip Score and observed 37.5% excellent results in DHS group and 66.2% excellent results in PFN group. We observed no 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 in unstable fractures reduction loss is significantly lower in PFN group. We observed total duration of surgery is significantly lower in PFN group. We concluded that PFN may be the better fixation device for most unstable inter-trochanteric fractures.