Published: 2021-06-23

A comparative study between dynamic hip screw and intramedullary nail fixation in trochanteric fractures

Krishan Kumar, Anurag Chhabra, Ashok Kumar, Sourabh Jain, Ankush Berwal


Background: The trochanteric fractures are one of the commonest fractures in elderly population. Incidence of these fractures is increasing due to better life expectancy, growing number of population, industrialization and the road traffic accidents. Variety of implants are available but still there is no consensus for single implant.

Methods: A prospective randomized control study was conducted on total 60 patients of intertrochanteric fractures which were randomized into 2 groups of 30 each, treated with dynamic hip screw (DHS) and proximal femoral nail (PFN). All the patients were followed up for a maximum of 6 months. Outcomes were reviewed and compared such as mode of injury, complications, functional and radiological outcomes.

Results: There was no significant difference between two groups of patients as regards to mean age and sex. The mode of injury by slip and fall was main cause. The most common type of fracture as per AO-orthopaedic trauma association (OTA) classification was 31-A2 (65%) and 31-A3 (5%) being the least common type. Mean surgical time of DHS group and PFN group was 125.17 minutes and 89.93 minutes respectively. Mean blood loss in DHS group and PFN group was 251.67 ml and 158.67 ml respectively. Mean radiological union time of fracture in DHS group and PFN group was 12.3 and 9.5weeks respectively. Mean Harris hip score at six month in DHS group and PFN group was 80.77 and 85.47 respectively.

Conclusions: We conclude that though both the implants can achieve comparable union rates but PFN are better than DHS as of better Harris hip score, shorter surgical time and less intra operative blood loss.


Intertrochanteric, Proximal femoral nail, Dynamic hip screw, Functional and radiological outcome

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Saarenpaa I, Heikkinen T, Ristiniemi J, Hyvönen P. Functional comparison of the dynamic hip screw and the Gamma locking nail in trochanteric hip fractures: a matched-pair study of 268 patients. Int Orthop. 2009;33:255-60.

Mathew A. The use of an Intramedullary Nail vs. Dynamic Hip Screw in the treatment of Intertrochantric fractures; a case cohort study. Kerala J Orthop. 2012;25:6-13.

Walia JPS, Tailor H, Mann HS, Gupta AS, Rehncy JS, Singh S. A comparative study of 30 cases of trochanteric fracture femur treated with dynamic hip screw and proximal femoral nail. Pb J Orthop. 2013;16:6-10.

Zhang K, Zhang S, Yang J, Dong W, Wang S, Cheng Y et al. Proximal Femoral Nail vs. Dynamic Hip Screw in Treatment of Intertrochanteric Fractures: A Meta-Analysis. Med Sci Monit. 2014;20:1628-33.

Kumar V, Singh A, Bharti A, Dalmia D, Ali S. A Comparison of Intramedullary and Extramedullary Fixation Devices in Unstable Trochanteric Fractures. Int J of Biomed Adv Res. 2014;5(7):335-9.

Gupta SKV, Valisetti VS. Comparative study between dynamic hip screw vsproximal femoral nailing in inter-trochanteric fractures of the femur in adults. Int J Orthop. 2015;1:7-11.

Faisal M, Nistane P. Proximal Femoral Nailing vs. Dynamic Hip Screw in unstable Intertrochanteric Fracture of Femur - A comparative analysis. Int J of Biomed Res. 2016;7:489-92.

Yadav S, Srivastava DC, Shukla M. Comparative evaluation of dynamic hip screw and proximal femoral nail for fracture of intertrochanteric femur. Int J Res Orthop. 2016;2:286-90.

Myderrizi N. Proximal femoral nailing is better choice in treatment of intertrochanteric fracture in elderly people. Int Surg J. 2016;3:781-5.

Gill SPS, Mittal A, Raj M, Singh P, Kumar S, Kumar D. Dynamic hip screw with locked plate versus Proximal Femoral Nail for the management of intertrochanteric fracture: A comparative study. Int J Orthop. 2017;3:173-80.

Kumar A, Jain A, Agrawal A, Sah M, Bansal A, Desai S. Outcome of proximal femur fracture treated with long proximal femoral nail and dynamic hip screw. Int J Orthop. 2017;3:600-6.

Neikar S, Sajjan NY, Telkar NB, Nasequddin S. Clinical research on dynamic hip screw and proximal femoral nail in the treatment of intertrochanteric fractures. J Evid Based Med Healthc. 2017;4(90):5350-4.

Sharma A, Sethi A, Sharma S. Treatment of stable intertrochanteric fractures of the femur with proximal femoral nail versus dynamic hip screw: a comparative study. Revistabrasileira de ortopedia. 2018;53(4):477-81.

Kameshwar I, Rao SV, Haranadh K, Damera Y, Ashwani N. PFN-Future in Intertrochanteric Fracture Treatment. Galore Int J Health Sci Res. 2018;3(4):9-15.

Müller ME, Nazarian S, Koch P, Schatzker J. The comprehensive classification of fractures of long bones. Springer Berlin. 1990;8:116-27.

Meesala VB, Padala A, Pathri S. DHS Versus PFN in Stabilization of Intertrochanteric Fractures-A Comparative Study. J Evid Based Med Healthc. 2018;5(46):3183-6.