Eine vergleichende Untersuchung der Versorgung instabiler per- und intertrochantärer Femurfrakturen mittels DHS-Osteosynthese unter Verwendung der Trochanterabstützplatte und dem Proximalen Femurnagel (PFN)

Abstract

The aim of the present paper is to compare the results obtained using two osteosynthesis systems developed for the surgical treatment of unstable fractures of the trochanteric region of the femur: the proximal femoral nail (PFN) and the dynamic hip screw (DHS) with trochanteric butt-press plate (TBPP). From December 1997 to November 2000, 173 patients with instable trochanteric fractures (type 31 A-2 and A-3 according to the AO-classification) had osteosynthesis by PFN (n = 122) or DHS/TBPP (n = 51). The average patient age was 74 years (range 27 to 98). No significant differences between the two study groups were observed with regard to age, sex, and rate of fracture types. At an average follow-up of 17 months the radiological and clinical outcome according to the score of "Merle d'Aubigné" was analysed in 61 % of all patients. All fractures were healed with no difference in functional outcome between the two groups. In the case of PFN 17.2 % revisions were necessary and in the case of DHS with TBPP 21.6 %. A shorter operation time (43 vs. 61 min) and a considerable shorter in-patient stay (20 vs. 24 days) were common with PFN. Full-weight-bearing immediately after the osteosynthesis was possible for 98 % of the PFN patients and 81 % of the DHS/TBPP patients. The DHS/TBPP osteosynthesis in instable trochanteric fractures is associated with a higher incidence of complications. Therefore we recommend to treat instable fractures of the trochanteric region with the PFN.

A Comparative Study of Dynamic Hip Screws and Proximal Femoral Nails in Intertrochanteric Fractures

“…When comparing the union time for unstable fractures individually, it was shown that group 2 had a superior fracture union time (15.11 ± 3.98 weeks) compared to group 1. This study was similar to the studies conducted by Herode et al and Klinger et al [ 20 , 21 ]. The functional result of patients treated with PFN was marginally superior to that of patients treated with DHS; however, this difference was not statistically significant (p = 0.13).…”

Comparison of intra-operative outcomes following internal fixation with trochanteric stabilisation plate or intramedullary nail in intertrochanteric fractures

“…This suggests that even in complex fractures, fixation with DHS/TSP can be a more efficient procedure than fixation with IMN. When comparing this to results in the literature, we found that there were mixed results with some studies obtaining similar results [ 9 ], and others suggesting that IMN had shorter operating times [ 10 , 14 , 15 ], or no significant difference in operating time [ 16 ]. Whilst a small fraction of our patients received the short-stem IMN, their average operation time was marginally longer than the DHS/TSP procedure (89 vs 86 min); however, the cohort size is too small (8 patients) to make adequate assessment of the length of the short-stem IMN operation.…”

“…Therefore, from a surgical perspective, the DHS/TSP seems favourable in these complex, unstable fractures [ 9 ]. However, results in German populations contradict this, without reporting any functional difference between these two groups [ 10 ].…”

Die instabile pertrochantäre Femurfraktur. Komplikationen, Fraktursinterung und Funktion nach extra- und intramedullärer Versorgung (PCCP™, DHS und PFN)

“…PFN A ™ ,G a m m a 3 ™ etc.) zu empfehlen, da die zitierten Studien zu instabilen Frakturen hauptsächlich den PFN oder gar den Standard-Gamma-Nagel mit den bekannt hohen Komplikationsraten verwendeten[1,8,10,20,21,23,24,30,31]. Eine entsprechende Studie ist in unserer Klinik in Arbeit.…”