The conservative treatment of intertrochanteric (IT) fracture has high complication rate. The operative management of intertrochanteric fractures are sucussful. Commonly used implants for fixation of IT fractures are dynamic hip screw (DHS) and proximal femur nail (PFN). Debate still continues regarding the optimal implant for IT fractures. We aim to compare the results of DHS and PFN in the treatment of IT fractures at our institution.
Materials and Methods: This is a prospective randomized comparative study of 40 patients of IT fractures treated surgically. Patients were divided equally into 2 groups of 20 each, with patients in group-A treated with DHS and those in group-B PFN. The functional outcome was evaluated based on Harris Hip Score (HHS). The radiographic outcomes was based on non-union or mal-union, femoral head necrosis, cut-out, periimplant fracture.
Results: The Harris Hip Score in the D.H.S group at 1 month (Avg. 24.4) was less than that of the P.F.N group (Avg. 33), p<0.05. During follow-up period, Group PFNA improved from 33± 2.99 to 87.62 ± 7.53, and Group DHS improved from 24.4 ± 2.98 to 74.44 ± 7.95. Patients in PFN group had fewer complications as compared to those in DHS group and the difference was statistically significant. DISCUSSION: the most important result is that patients treated with the PFN technique exhibited functional improvement as early as 6 months after surgery, unlike DHS-treated patients. In practice, this means that PFN treatment is associated with faster improvement in quality of life than the DHS technique.
Conclusion: PFN is better than DHS, as indicated by significantly less total complications, less reoperation rate, and higher postoperative HHS.