Abstract: Background: Internal fixation is appropriate for most intertrochanteric fractures. Optimal fixation is based on the stability of fracture. The mainstay of treatment of intertrochanteric fracture is fixation with a screw slide plate device or intramedullary device. So, it is a matter of debate that which one is the best treatment, dynamic hip screw or proximal femoral nailing.
Method: A prospective randomized and comparative study of 2 years duration was conducted on 60 patients admitted in the Department of Orthopedics in MGM Medical College and Hospital, Navi Mumbai with intertrochanteric femur fracture. They were treated by a dynamic hip screw and proximal femoral nail antirotation Asia. Patients were operated under image intensifier control. The parameters studied were functional outcome of Harris hip score, total duration of operation, rate of union, amount of collapse. These values were statistically evaluated and two tailed p-values were calculated and both groups were statistically compared.
Result: The average age of our patient is 67.8 years. Among the fracture, 31% were stable, 58% were unstable, 11% were reverse oblique fracture. The average blood loss was 100 and 250 ml in PFNA2 and DHS group, respectively. In PFNA2 there was more no. of radiation exposure intra-operatively. The average operating time for the patients treated with PFNA2 was 45 min as compared to 70 min in patients treated with DHS. The patients treated with PFNA2 started early ambulation as they had better Harris Hip Score in the early period (at 1 and 3 months). In the long term both the implants had almost similar functional outcomes.
Conclusion: In our study we have found that the unstable pattern was more common in old aged patients with higher grade of osteoporosis and PFN group has a better outcome in this unstable and osteoporotic fracture. PFNA2 group has less blood loss and less operating time compared to DHS group. In PFNA2 group patients have started early ambulation compared to DHS group.
