A comparative study of treatment of unstable intertrochanteric fractures with PFN and cemented hemiarthroplasty

Abstract

Aim: Aim of the study is to analyse and compare the functional outcomes and radiological results of two different surgical modalities, PFN and cemented hemiarthroplasty in the treatment of unstable intertrochanteric fractures in elderly patients. Background: Elderly patients with intertrochanteric fractures should be mobilized early to reduce the morbidity and mortality. While cemented hemiarthroplasty allows early weight bearing, the prolonged surgical time increase the blood loss and mortality, whereas with PFN once the fracture becomes stable allows early mobilization thus overcoming the problems of recumbency. PFN efficiently preserves the femoral head and the abductor mechanism and thus has the biomechanical advantage of increased range of hip joint movements and better functional outcome. Materials and methods: Sixty patients of age 60 years and above with comminuted intertrochanteric fractures treated by PFN or cemented hemiarthroplasty were taken up for the prospective study in our institute between january2013 and june 2015. 30 patients underwent PFN and 30 patients had hemiarthroplasty. Average period of follow up was 2 years. Post-operative complications and mortality rates were compared between the two groups. Functional results and the hip range of movements were assessed by Harris Hip Score (HHS). In the mean follow up period of 22months radiological examination was done to assess the results & complications. Results:The demographic and background data of the patients in the two groups are statistically similar. At 2 years follow up PFN group patients had a mean HHS of 85.89 and HA group had 78.11. Pain, severity and range of hip movements are better in PFN group than HA group. Radiologicaly 4 patients in HA group had stem loosening and 2 patients had screw cut out in the PFN group with subsequent pain in the final follow up. Conclusion: PFN is a better option for the treatment of elderly intertrochanteric fractures as the operative time is short, easier surgical procedure & has less mortality. PFN also gives a better functional outcome in the late follow up than hemiarthoplasty.

Pre fixation compression screw as a cutting-edge technique for varus correction during proximal femoral nailing for intertrochanteric fractures: A study on 46 cases

“…Proximal femoral nailing has gained popularity as a procedure which can lessen the risk of morbidity and has a biomechanical advantage over DHS [8][9][10] . However, a good pre-reduction is the key for the successful outcome of PFN, hence in this study we evaluate the use of pre-fixation screw for maintaining valgus reduction [4,[8][9][10] .…”

“…The maximum patients in our study were in the age group of 60-70 years with a mean age 66.13 years. In similar studies of comparison between PFN and DHS, PFN was the procedure of choice in this age group [4,[8][9][10] . Jones et al, in his comparative study had a blood loss of 73 ml for PFN and 159 ml for DHS [8] .…”

“…Intertrochanteric fractures (IT) of the femur are common occurrence in the geriatric age group [1] . Internal fixation with minimally invasive approach would be ideal to reduce morbidity at this age group [2,3,4] . Failure to achieve good reduction is one of the important reasons for implant failures and thus compelling the patient to undergo multiple salvage procedures [5] .…”