Comparative study of management of intertrochanteric fracture by dynamic hip screw and proximal femoral nailing
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20211436Keywords:
Intertrochanteric fracture, Dynamic hip screw, Proximal femoral nail, Harris hip scoreAbstract
Background: The purpose of the present study is to verify the theoretical advantages of the intramedullary device over the dynamic hip screw devices and also whether it actually alters the eventual functional outcome of the patient.
Methods: The study is comparative prospective study in which 40 patients were taken and treated either with dynamic hip screw or proximal femoral nailing. The clinical data will be collected and compared with pre-injury activity and present functional level with modified Harris hip score.
Results: We found that there is no significant difference between Harris hip score in stable fracture (p value=0.222) fixed either with DHS or PFN. But there is statistically significant difference of score in unstable fracture (p value 0.040) treated by DHS and PFN. Functionally, utilizing the Harris hip scoring system, at the final follow-up, our study affirms PFN to be superior to DHS in unstable intertrochanteric fractures while in stable fractures, functional results are same.
Conclusions: PFN is also found better in unstable fractures, because a greater number of patients having excellent Harris hip score. In stable fracture, functional result is same in both groups.
References
Russel TA, Brown CM, Heckman JD, McQueen MM, Ricci WM, Tornetta P. Rockwood and Green’s Fracture in Adults, Intertrochanteric Fractures, 8th ed. Philadelphia: Wolters Kluwer Health; 2015:2075-129.
Cummings SR, Rubin SM, Black D. The future of hip fractures in the United States. Numbers, costs, and potential effects of postmenopausal estrogen. Clin Orthop Relat Res. 1990;252:163-6.
Egol KA, Koval KJ, Zuckerman JD. Handbook of fracture, 4th ed. Philadelphia: Lippincott Williams and Wilkins, Wolters Kluwer Health; 2010:388-98.
Cummings SR, Nevitt MC. A hypothesis: the causes of hip fractures. J Gerontol. 1989;44(4):107-11.
Kulkarni GS, Limaye R, Kulkarni S. Intertrochanteric fractures. Indian J Orthop 2006;40:16-23.
Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg Br. 1949 May;31B(2):190-203.
Lustosa LP, Bastos EO. Proximal femoral fracture on the elderly: what is the best treatment? Actaortop Bras. 2009;17(5) 309-12.
Pajarinen J, Lindahl J, Savolainen V, Michelsson O, Hirvensalo E. Femoral shaft medialization and neck- shaft angle in unstable pertrochanteric fractures. Int Orthop. 2004;28:347-53.
Saarenpaa I, Heikkinen T, Jalovaara P. Functional comparison of the Dynamic Hip Screw and Gamma locking nail in unstable trochanteric hip fracture: a matched- pair study of 268 patients. IntOrthop. 2009;33(1):255-60.
Valverde JA, Alonso MG, Porro JG. Use of Gamma Nail in treatment of fractures of the proximal femur. ClinOrtop. 1998;350:56-61.
Windoff J, Hollander DA, Hakimi M, Linhart W. Pitfall and complications in the use of proximal femoral nail. Langenbeck Arch Surg. 2005;390(1):59-65.
Schipper IB, Bresina S, Wahl D, LinkeB, Vugt AB, Schneider E, et al. Biomechanical evaluation of the proximal femoral nail. ClinOrthop Related Res. 2002;405:277-86.
Rosenblum SF, Zuckerman JD, Kummer FJ, Tam BS. A biomechanical evaluation of the Gamma nail. J Bone Joint Surg Br. 1992;74(3):352-7.
Dousa P, Bartonícek J, Jehlicka D, Skála-Rosenbaum J. Osteosynthesis of trochanteric fractures using proximal femoral nails. Acta Chir Orthop Traumatol Cech. 2002;69(1):22-30.
Bhakat U, Bandyopadhayay R, Bankura Sammilani Medical College, Bankura, India. Open J Orthop. 2013;3:291-5.
Kumar MNB, Ullas Mahesh, Kumar SG. A comparative study of proximal femoral fracture fixation with proximal femoral nail and Dynamic hip screw & plating. Int J Orthop Sci. 2017;3(1):499-505.
