Comparative evaluation of dynamic hip screw and proximal femoral nail for fracture of intertrochanteric femur

Sachin Yadav, D. C. Srivastava, Manish Shukla


Background: The aim of the present study was to compare the result in terms of rate of union, time of ambulation and functional recovery of fracture intertrochanteric femur treated by dynamic hip screw (DHS) and proximal femoral interlocking nail (PFN) and to compare complications in terms of implant failure, infection, blood loss and C arm exposure in both groups.

Methods: This was a prospective study of 92 cases, 38 cases were treated by PFN and 54 cases were treated by DHS. Patients were followed up at 6, 12, 18 and 24 weeks. The results were compared for functional outcome using Palmer and Parker score and also for various complications.

Results: Comparison of mobility score at six month follow up period revealed  the PFN group to be significantly more mobile (5.8 Vs. 4.19 respectively, p <0.001) than the DHS  group. In our study 6 patients managed with DHS (6.52%) developed superficial wound infection which responded to intravenous antibiotics. No patient with PFN had wound infection. Only 2 patients in the PFN group and 12 patients in the DHS group had persistent pain at the incision site.

Conclusions: Dynamic hip screw fixation of these fracture requires less preoperative time,  is associated with less exposure to radiation but the blood loss is much higher. On the contrary PFN allows faster mobilization and greater mobility scores at six months.


DHS, PFN, Intertrochanteric femur fracture

Full Text:



Gadegone Wasudeo M, Salphale Yogesh S. Short proximal femoral nail fixation for trochanteric fractures, J Orthopaed Surg. 2010;18(1):39-44.

Terry Canale S, Beaty JH. Campbell‘s Operative orthopaedics. 11th edition. Elsevier; 2008: 3239.

Harrington KD, Johnston JO. The management of comminuted Unstable Intertrochanteric Fractures. J Bone Joint Surg. 1973;55:1367-76.

Hunter GA. The Results of operative Treatment of trochanteric fractures of the Femur. Injury. 1975;6:202-5.

Kuderna H, Bohler N, Colby AJ. Treatment of Intertrochanteric and Subtrochanteric Fractures of the Hip by Ender method. J Bone Joint surg. 1976;58:604-11.

Zickel Robert E. An Intramedullay Fixation Device for the proximal part of the Femur J. Bone Joint Surg. 1976;58:866.

Cuthbert H, Howat TW. The use of Kuntscher Y-nail in the treatment of intertrochanteric and subtrochanteric fractures of Femur. Injury. 1976;8:135-42.

Poigenfürst J, Schnabl P. Multiple intramedullary nailing of pertrochanteric fractures with elastic nails: operative procedure and results. Injury. 1977;9(2):102-13.

Laskin RS, Gruber MA, Zimmerman AJ. Intertrochanteric fractures of the Hip in the Elderly. Clin Orthop. 1979;101:110-9.

Hall G, Ainscow DAP. Comparison of Nail plate fixation and Enders Nailing for intertrochanteric fractures. JBJS. 1981;63:24-8.

Saudan M, Lübbeke A, Sadowski C, Riand N, Stern R, Hoffmeyer P. Pertrochanteric fractures : is there an advantage to an intramedullary nail?: a randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail. J Orthop Trauma. 2002;16(6):386-93.

Tyllianakis M, Panagopoulos A, Papadopoulos A, Papasimos S, Mousafiris K. Treatment of extracpsular hip fractures with the proximal femoral nail long term results in 45 patients. Acta Orthop Belg. 2004;70(5):444-54.

Heyse-Moore GH, MacEachern AG, Evans DC. Treatment of Intertrochanteric Fractures of the Femur. A comparison of the Richards screw-Plate with the Jewett Nail plate. J Bone Joint surg. 1983;65:262-7.

Hunghston JC. Unstable Intertrochanteric Fractures of the Hip. J Bone joint Surg. 1964;46:1145.

Wilson HJ, Rubin BD, Helbig FE, Fielding JW, Unis GL. Treatment of intertrochanteric fractures with the Jewett nail:experience with 1,015 cases. Clinical Orthopaedics. 1980;148:186–91.

Wolfgang GL, Bryant MH, O’ Neil JP. Treatment of Intertrochanteric Fracture of the Femur Using Sliding Screw Plate Fixation. Clin Orthop. 1982;163:148-58.

Nielsen B, Jelnes R, Rasmussen LB, Ebling A. Trochanteric Fractures Treated by the Mc Laughlin Nail and plate. Injury. 1985;16(5):333-6.

Cummings SR, Phillips SL, Wheat ME, Black D, Goosby E, Wlodarczyk D, et al. Recovery of function aftrr hip fracture. The role ofsocial supports. J Am Geriatr Soc. 1988;36:801-6.

Little NJ, Verma V, Fernando C, Elliott DS, Khaleel A. A prospective trial comparing the Holland nail with the dynamic hip screw in the treatment of intertrochanteric fractures of the hip. J Bone Joint Surg Br. 2008;90(8):1073–8.

Nuber S, Schönweiss T, Rüter A. Stabilisation of unstable trochanteric femoral fractures. DHS with trochanteric stabilization plate vs PFN. Unfallchirurg. 2003;106(1):39-47.

Leung KS, So WS, Shen WY, Hui PW. Gamma nails and dynamic hip screws for peritrochanteric fractures. J Bone Joint Surg. 1992;74:345.