AIMSTo compare the clinical and radiological outcomes of Proximal femoral nail and Dynamic hip screw fixation. SETTINGS AND DESIGNProspective study of forty patients with Intertrochanteric fracture of femur presenting to our hospital from the year 2013 to 2015, who were treated with either proximal femoral nail or dynamic hip screw. METHODS AND MATERIALSThe study material includes data collection, clinical examination and investigations of 40 patients who underwent either Dynamic hip screw or Proximal femoral nail. Out of 40 patients, twenty patients had undergone Proximal femoral nailing and twenty patients had undergone Dynamic hip screw fixation. 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 clinical and functional results were assessed at follow-up. RESULTSThe overall functional outcome of patient treated PFN was significantly better compared to DHS. However, when we compared the stable and unstable fractures separately, we found that there was no significant difference in the outcomes of the stable fractures in the two groups. Patients with proximal femoral nailing had significantly lower pain score at the 6th month follow-up. CONCLUSIONSWe conclude that in stable intertrochanteric fractures, both the PFN and DHS have similar outcomes. However, in unstable intertrochanteric fractures the PFN has significantly better outcomes in terms of earlier restoration of walking ability. In addition, as the PFN requires shorter operative time and a smaller incision, it has distinct advantages over DHS even in stable intertrochanteric fractures. Hence, in our opinion, PFN may be the better fixation device for most intertrochanteric fracture.

BACKGROUNDThe aim of this study is to compare clinical and radiological outcomes of distal metaphyseal tibial fractures using locking compression plates by open reduction technique or minimally invasive percutaneous plate osteosynthesis (MIPPO) technique or closed reduction and IMIL nailing.Settings and Design -This is a prospective study of 23 patients with distal tibial fractures who are presenting to our hospital from July 2013 to September 2015, who are treated with ORIF with locking plate or IMIL. MATERIALS AND METHODSThe study material includes data collection, clinical examination and investigations of 23 patients who underwent either ORIF/MIPPO with distal tibial LCP/IMIL for fractures of lower-third tibia admitted to NRI General Hospital, Chinakakani, attached to NRI Medical College, Chinakakani, had taken for this study after obtaining their informed, valid written consent. Of 23 patients, 14 patients underwent fixation with LCP both ORIF/MIPPO and 9 patients underwent fixation with IMIL. All surgeries done under Carm and followed regularly at 4 weeks, 8 weeks, 12 weeks, 6 months and annually thereafter. Clinical and functional results were assessed at followup. RESULTSBoth these techniques provided adequate and comparable stability, fracture union and allowed early motion in distal tibial fractures. LCP is effective in extra-articular fractures occurring within 5 cm of joint where IMIL nails offend and do not provide adequate stability and where external fixators usually applied for primary stabilisation until soft tissue oedema get subsided, which delays the return to work with fixators. The intramedullary nailing is a safe, feasible and simple method of stabilisation of these fractures. This method is definitely a better alternative to external fixator and plating techniques in the management of open distal tibial fractures. Using fracture table to get satisfactory reduction, which can be maintained till completion of nailing and use of multiple distal locking screws in different plane to give stable fixation for early mobilisation and ambulation can minimise the complications. Impacting the unreamed nail till the subchondral bone of the distal tibia enhances the stabilisation. CONCLUSIONThese techniques had resulted in effective stabilisation of lower-third tibial fractures. Both techniques provided adequate and comparable stability, fracture union and allowed early motion; should be used according to clinical situation and surgeon's experience. Financial or Other, Competing Interest: None. Submission 06-01-2016, Peer Review 29-01-2016, Acceptance 05-02-2016, Published 05-12-2016. Corresponding Author: Dr. Satya Kumar Koduru, Flat 101, Kanchukota N. K. Habitate, Gayatri Nagar, Vijayawada-520008, Andhra Pradesh. E-mail: kodurusk@gmail.com DOI: 10.14260/jemds/2016/1614 BACKGROUND Fractures of the distal third shaft and distal metaphysis of tibia are one of the difficult and challenging problems faced by orthopaedic surgeons. The problems associated with these fractures are due to t...