Comparative Study of Proximal Femoral Nailing and Dynamic Hip Screw for Intertrochanteric Fractures in Adults

Abstract

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.