Dynamic Hip Screw with Trochanter-Stabilizing Plate Compared with Proximal Femoral Nail Antirotation as a Treatment for Unstable AO/OTA 31-A2 and 31-A3 Intertrochanteric Fractures

Abstract

Background. The dynamic hip screw (DHS) with the addition of an angular stable trochanter-stabilizing plate (TSP) has been considered the ideal treatment for the unstable intertrochanteric fracture type. However, there have been few comparisons between DHS+TSP augmentation with intramedullary (IM) nailing. The aim of this retrospectively registered study was to compare the clinical outcomes of patients with the unstable type of intertrochanteric fractures treated with DHS+TSP or IM nailing (proximal femoral nail antirotation (PFNA)). Methods. From June 2013 to April 2018, 358 patients with proximal femur fracture AO/OTA type 31A2 and 31A3 treated with PFNA or DHS+TSP and followed for ≥10 months postoperatively were included. The surgical-dependent outcome evaluation included the operation time, intraoperative blood loss, postoperative decrease in hemoglobin, and blood transfusion amount. Functional status was also measured. Radiographic findings and postoperative complications were recorded and analyzed. Result. The operation time was significantly shorter in the DHS+TSP group than that in the PFNA group for both A2 and A3 fractures (A2 type: 84.0 vs.96.4 min; p<0.05; A3 type: 102.4 vs.116.1 min; p<0.05). Postoperative decrease in hemoglobin was more significant in the PFNA group than that in the DHS+TSP group for both fracture types (A2 type: −1.88 vs. −1.29 (mg/dL); p<0.05; A3 type: −1.63 vs. −1.04 (mg/dL); p<0.05). However, the patients treated with DHS+TSP had significantly more residual pain than those treated with PFNA during the final follow-up (Visual Analog Scale score, A2 type: 28.4 vs.23.2; p<0.05; A3 type: 27.5 vs.23.6; p<0.05) and complained of greater implant irritation. Conclusion. We found that DHS+TSP was associated with less operation time and less postoperative decrease in hemoglobin but more residual pain and implant irritation than those of PFNA. As a treatment for unstable intertrochanteric fracture, DHS+TSP provided ideal surgical outcomes which were not inferior to the PFNA.

Comparative Bony Union Time Analysis of Dynamic Hip Screw and Proximal Femoral Plate Implants

“…19 For the recovery of A2 and A3 fractures, the DHS-TSP devices exploited lessening of post-operative reduction of haemoglobin for unstable intertrochanteric fractures, however, accompanied by an increase of residual pain and implant irritation. 20 This perhaps is linked to the additional treatment of trochanteric stabilizing plate that may offer steadier healing in elderly unstable per trochanteric fractures. Hence, the solitary use of sliding hip screws is presumably discouraging due to several reported postoperative complications, including femoral head screw cut out, 21 avascular necrosis of the femoral head, cracking of screws, femoral fracture below the plate, and the development of coxarthrosis and pseudoarthrosis.…”

Biomechanical comparison of screw vs. cerclage refixation in orthogeriatric lesser trochanteric fractures: a cadaveric study

“…Although nowadays many surgeons prefer intramedullary devices due to its minimally invasive, time-sparing approach as well as theoretically better biomechanical intramedullary load distribution [21], the dynamic hip screw globally is still the most used implant for the treatment of proximal femur fractures. Until now, no superiority of one implant over the other has been clearly demonstrated [30].…”

A Retrospective Study of 98 Elderly Patients with High-Risk Lateral Femoral Wall Intertrochanteric Hip Fractures to Compare Outcomes Following Surgery with Proximal Femoral Nail Antirotation (PFNA) Versus Dynamic Hip Screw (DHS)

“…It has been confirmed that the lateral wall of the femur plays an important mechanical stabilization role in the treatment of femoral fractures, and that the integrity of the lateral wall can provide rotational stability for the femur, support the bone of the head and neck, and effectively resist its varus, rotation, and diaphyseal displacement, which can avoid the cut-out of screws [ 16 , 18 ]. The helical blade must be implanted in the femoral head neck through the lateral wall for FIF, whether treated with extramedullary fixation or intramedullary nailing, and maintaining the integrity of the lateral wall is critical to the stability of FIF internal fixation [ 19 , 20 ]. However, Palm et al [ 21 ] found that 74% of lateral wall fractures were due to intraoperative manipulation, while patients with lateral wall fractures had a 22% re-operation revision rate.…”