Surgical Treatment of Type 31-A1 Two-part Intertrochanteric Femur Fractures: Is Proximal Femoral Nail Superior to Dynamic Hip Screw Fixation?

Mohan, Hariharan; Kumar, Prakash

doi:10.7759/cureus.4110

Cited by 7 publications

(6 citation statements)

References 16 publications

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“…II) This meta-analysis showed significantly shorter operative times, smaller incisions, and less intraoperative blood loss in PFN than in DHS. These were exactly our findings [23][24] . According to Zhang et al A higher (but not significant) infection rate was observed in the group of DHS.…”

Section: Resultssupporting

confidence: 91%

A Comparative Study of Proximal Femoral Nail and Dynamic Hip Screw in the Treatment of Intertrochanteric Fractures of Femur

Sarfraz¹,

Ahmad²,

Raza³

et al. 2022

PJMHS

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Aim: The aim of this analysis is the comparison of the functional and radiological results of stable intertrochanteric femoral fractures managed with the dynamic hip screw (DHS) and proximal femoral nail (PFN). Study Design: A Randomized, controlled study. Place and Duration: In the Orthopaedics department of Capital Hospital (CDA), Islamabad for two years duration from January 2020 to December 2021. Methods: All patients with stable intertrochanteric fractures who met the criteria of selection were randomly allocated to group A (DHS) and B (PFN). There were 80 total patients alienated into group A and B. Patients were x-rayed for union evaluation and functional evaluation was done with Harris Hip Score (HHS) was performed, rated as poor (score <70), good (80 to 90), fair (70 to 80) and excellent (90 to 100). The comparison of the results in the two groups was made at the third, sixth and twelfth months, and the P value was calculated using the chi-square test and the independent sample t-test. P <0.05 was measured significant. Results: There were 80 total patients. They were divided equally and randomly into groups A and B of 40 patients each. The PFN group had a shorter operative time, smaller incision and minimum blood loss intraoperatively than the DHS group (p <0.05). The group A mean age was 60.10±4.48 years, and of group B was 59.20±5.71 years. There were 25 men (62.5%) in A group and 23 (57.5%) in B group. Women were 15 (37.5%) in A group and 17 (42.5%) in B group. Mean time of radiological union was 14.2±4 weeks in group A and 12.8±6 weeks in group B (P> 0.05). During the 3-month follow-up period, the Harris Hip Score (HHS) was 54.20 ± 4.20 (poor) and 35.03 ± 4.11 (poor) in Groups A and B, correspondingly (P <0.05). HHS in group A was 90.27 ± 3.80 (good) and in B group, it was 82.27 ± 3.65 (good) (P <0.05) at 6 months and HHS 94.61 ± 2.08 (excellent) and 93.27 ± 2.18 (excellent) 1 year in the group A and B (P> 0.05). Conclusions: Both DHS and PFN gave similar results in terms of radiological union in stable intertrochanteric fractures. The short-term functional score was poor and good for both DHS and PFN at 3 and 6 months, although DHS scored statistically better than PFN. After one year of follow-up, both DHS and PFN had similar excellent functional scores, but had no statistically significant difference in score. Keywords: Harris hip Score, Proximal femoral nail, Dynamic hip screw and Intertrochanteric fracture.

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Section: Resultssupporting

confidence: 91%

A Comparative Study of Proximal Femoral Nail and Dynamic Hip Screw in the Treatment of Intertrochanteric Fractures of Femur

Sarfraz¹,

Ahmad²,

Raza³

et al. 2022

PJMHS

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“…After carefully reviewing entire manuscripts, 41 studies were excluded. Finally, 30 studies were included 11‐40 . The included studies were published between 2002 and 2022, with sample sizes ranging from 46 to 222 patients.…”

Section: Resultsmentioning

confidence: 99%

Proximal femoral nail anti‐rotation vs dynamic hip screws decrease the incidence of surgical site infections in patients with intertrochanteric fractures: A meta‐analysis

Dai

Zhou

Mao

et al. 2023

International Wound Journal

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In this study, a meta‐analysis was conducted to comprehensively analyse the effectiveness of using proximal femoral nail anti‐rotation (PFNA) and dynamic hip screws (DHS) to treat intertrochanteric fractures on postoperative surgical site infections (SSI). PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang databases were searched from their inception until December 2022 to identify studies that compared PFNA and DHS in the treatment of intertrochanteric fractures. Two investigators independently screened the retrieved studies to assess their quality and verify their eligibility for inclusion. Meta‐analyses were performed with RevMan 5.4 software. Thirty studies, including 3158 patients, met the inclusion criteria. These studies included 1574 patients treated with PFNA, and 1584 were treated with DHS. The findings of the meta‐analysis revealed a significant reduction in the incidence of SSI in patients treated with PFNA compared with those treated with DHS (2.64% vs 6.76%, odds ratio [OR]: 0.40, 95% confidence intervals [CIs]: 0.28–0.57, P < .001), superficial SSI (2.58% vs 5.01%, OR: 0.53, 95% CIs: 0.33–0.85, P = .008) and deep SSI (1.26% vs 3.43%, OR: 0.41, 95% CIs: 0.19–0.92, P = .03). PFNA was more effective than DHS in reducing the incidence of SSI. Even so, significant variations in sample sizes among the included studies meant that the methodology for some studies had qualitative deficiencies. Therefore, additional studies with large sample sizes are needed to validate these results.

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“…21,22 In stable ITFs, DHS and PFN have proven not to be superior to each other. 30 DHS was preferred in our study because compression in DHS was more pronounced than PFN and it was a cheaper implant for the treatment.…”

Section: Discussionmentioning

confidence: 99%

Treatment strategy for elderly patients with the isolated greater trochanteric fracture

et al. 2020

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Background: The objective of this study was to evaluate the risk of femur intertrochanteric fracture associated with femur trochanter major fractures in patients over 65 years of age with magnetic resonance examination for better diagnosis and treatment. Methods: Thirty-one patients who had incomplete femur intertrochanteric fracture diagnosed were included in the study. Patients were classified according to the length of the fracture line crossing the intertrochanteric border. Fracture patterns were described on magnetic resonance imaging coronal views. Group A, pattern 1, greater trochanteric fracture extends to intertrochanteric region with both cortices; Group B, pattern 2, fracture has characteristics of pattern 1 fracture including diametaphysis fracture line; Group C, pattern 3, greater trochanteric fracture only has extending superolateral cortex fracture line of intertrochanteric region; and Group D, pattern 4, fracture has characteristics of pattern 1 fracture and including superior extension to the baso-cervical line. Surgical treatment with dynamic hip screw was applied to all patients with intertrochanteric extension after magnetic resonance examination. Results: This study included 16 women (80.3 ± 6.7 years) and 15 men (76.9 ± 10.94 years). Group A had 11 patients, group B had 8 patients, group C had 6 patients, and group D had 6 patients. Ambulation was initially prescribed for these patients 1 day after the surgery. The average surgery durations of the A, B, C, and D patterns were 44.54 ± 7.56, 49.37 ± 12.65, 49.16 ± 3.76, and 44.16 ± 5.84 min, respectively. No statistically significant differences were observed among the four patterns (P = 0.404). Conclusion: Surgical treatment of the greater trochanteric fracture which is considered an indicator of occult intertrochanteric fracture is a good choice for the treatment because of the procedure safety and early mobilization after the surgery

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Surgical Treatment of Type 31-A1 Two-part Intertrochanteric Femur Fractures: Is Proximal Femoral Nail Superior to Dynamic Hip Screw Fixation?

Cited by 7 publications

References 16 publications

A Comparative Study of Proximal Femoral Nail and Dynamic Hip Screw in the Treatment of Intertrochanteric Fractures of Femur

A Comparative Study of Proximal Femoral Nail and Dynamic Hip Screw in the Treatment of Intertrochanteric Fractures of Femur

Proximal femoral nail anti‐rotation vs dynamic hip screws decrease the incidence of surgical site infections in patients with intertrochanteric fractures: A meta‐analysis

Treatment strategy for elderly patients with the isolated greater trochanteric fracture

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