Comparative study of functional outcome of the intertrochanteric fracture of femur managed by Dynamic hip screw and proximal femoral nail

Abstract

Introduction: Intertrochanteric (IT) femur fractures comprise approximately half of all hip fractures. These fragility hip fractures occur in a characteristic population with risk factors including increasing age, female gender, osteoporosis, a history of falls, and gait abnormalities. Although the effects of PFN and DHS in treatment of intertrochanteric fractures have been reported, the results and conclusions are not consistent. Materials and Methods: This Comparative Prospective study was conducted in a tertiary care institute ELMCH for a period of 18 months from January 2017 to June 2018. Every case with intertrochanteric fracture was treated randomly (computer generated number table) either by Dynamic hip screw(DHS) or Proximal femoral nail(PFN). A total of 80 cases were included. The patients were further divided into two groups, each of 40 cases, 40 were treated by Dynamic Hip Screw & 40 were treated with proximal femoral nail (P.F.N). All patients were followed up for nine months. Results: In our study the mean age in the PFN group was 62.5 while in the DHS group it was 64 years. In present study the intergroup comparison of Harris Hip score between PFN and DHS group revealed that post operatively after 1 month the Harris hip score in PFN group had mean value 32.95±2.65, while the HH score in DHS group had mean 22.30±0.65. Post operatively after 3 month the Harris hip score in PFN group had mean value 57.33±2.10, while the HH score in DHS group had mean 51.90±0.96. Post operatively after 6 month the Harris hip score in PFN group had mean value 83.50±0.96, while the HH score in DHS group had mean 73.73±3.30. Conclusion: Therefore, the study showed that PFN is better method of fixation in intertrochanteric fracture of femur.

A Comparative Study of Functional Outcome Following Dynamic Hip Screw and Proximal Femoral Nailing for Intertrochanteric Fractures of the Femur

“…In his study of 80 cases, Gill et al [12] found that males comprised only 32% of the study group. Our study has findings similar to that of Gill et al and Zhao et al with female preponderance [11].…”

“…In a study of 40 patients conducted by Amandeep et al [16], the mean HHS in the DHS group was 83.75, and that in the PFN group was 84.4. In his study of 80 cases, Shakeel et al [11] found that the mean HHS in the DHS group was 73.73 while in the PFN group, it was 83.5. In a study of 60 patients conducted by Sharma et al [17], the mean HHS in the DHS group was 88.7, and that in the PFN group was 82.2 (Table 5).…”

“…In the present study in both groups, two cases with superficial surgical site infection in the DHS group might have been because of the longer incision exposure to open pathogens during surgery. Shakeel et al [11] and Gill et al [12] noted a high incidence of superficial infection in the DHS group which they attributed to the lengthier incision associated with DHS. This is similar to the findings of our study.…”

“…In his study of 80 cases, Shakeel et al [10] found that 66% of the study group was males. Zhao et al [11] describe the male incidence at 40%. In his study of 80 cases, Gill et al [12] found that males comprised only 32% of the study group.…”

AO/OTA 31A2 and 31A3 Intertrochanteric Fractures Managed by Proximal Femoral Nail Antirotation (PFNA)

“…19 This magic device is not only indicated for intertrochanteric fractures but has been recommended as implant of choice in subtrochanteric fractures as described in study of 33 patients at civil hospital Karachi by Kumar. 13 Qidwai 20 has done recent study of 18 months with 9 month follow-up in Lucknow India; comparative study between DHS and PFN in terms of functional outcome, they suggest PFN as better device to get required outcome. Saleem 21 has done the same comparative study in Karachi in 108 patients in two different groups and he concludes the PFN predominance over DHS; with average time taken for union with mentioned device PFN was 13.67±1.72 weeks, while we observed the same in18.5±3.5 weeks.…”