Proximal femoral nailing versus dynamic hip screw device for trochanteric fractures - A comparative study

Abstract

Background: The incidence of femoral neck fractures, one of the most common traumatic injuries in the elderly increases continuously due to the ageing of population on the planet and urbanization. Aims and Objective of the Study: To study the incidence of intracapsular femoral neck fractures in the elderly population with respect to age, sex, occupation, fracture type and laterality of injury. Materials and Methods: The prospective study included 30 patients with intracapsular femoral neck fractures referred to the Department of Orthopaedics, Ashwini Hospital, Gulbarga were selected for this study. Patients with intracapsular femoral neck fractures and aged above 55 years were considered. Patients were briefed about the nature of the study, the interventions used and written, informed consent was obtained. Further, descriptive data of the participants like name, age, sex, detailed history, were obtained by interviewing the participants and clinical examination and necessary investigations were recorded on predesigned and pretested proforma. Results: Majority of the patients (seven patients, 23.33%) were in the age group between 71 to 75 years and five patients, (16.67%) each were in the age groups of 55 to 60 years, 76 to 80 years and above 80 years. In the present study, out of the 30 patients there 18 were female accounting to 60% and 12 male patients making up the remaining 40%. The average interval between admission to the hospital and surgery was 3.6 days with a range of 01 to 17days. The average duration of hospital stay was 13.3 days with a range of 7 to 26 days. The duration of hospital stay is less in our series as the patients were mobilized early. Out of 18 female patients 14 females were house wives. Three were retired from job, and one was self-employed. Among the males, seven were retired from their jobs, four males were businessman and one male patient was self-employed. Majority of the fractures occurred due to fall in bathroom (56.67%) and fall in living room (30%). Right side involvement was more commonly seen than the Left in this study group. Right side was involved in twenty patients making up for 66.67% of the fractures and the left was involved in ten patients accounting for 33.33% of the fractures. Out of the 30 fractures, majority were type IV fractures (23 patients) accounting for 76.7%. Remaining 23.3% (07 patients) were type III fractures. Conclusion: In conclusion, hip fractures are a serious injury in the elderly population. There is a very mortality rate and morbidity rate following hip fractures in the elderly. Once diagnosis has been made, appropriate stabilization of the patient from a medical standpoint and rapid operative fixation of the fracture or prosthetic replacement helps patients obtain a better functional result. Adequate rehabilitation in an inpatient setting, as well as at the patient's home with home health is an important adjunct to an overall successful outcome.

Functional and radiological outcome of inter-trochanteric fractures treated with minimally invasive D.H.S or proximal femoral nailing: A comparative study

“…in trochanteric fractures. 7,13,20,21,23,27,28,33 We conclude both D.H.S and P.F.N are good. But with shorter surgical time, less blood, quicker union time, the P.F.N is a better device to treat inter-trochanteric fractures, especially in unstable fractures.…”

Inter-Trochanteric Fractures;

“…1 Healing with conservative treatment usually resulted in malunion with varus, external rotation deformity and shortening of limb. 3 Now a day's these fractures are treated by surgery(internal fixation) however poor bone quality and neck screw instability can adversely affect the results with currently available fixation devices. 4 The dynamic hip screw (DHS) may be a better option in elderly patients.…”

“…6 The goal of surgical treatment is the restoration of the patient to his pre-injury status as soon as possible. 3 For union of these fractures, maintenance of stable reduction is the most important factor.…”