A comparative study of 70 cases of inter-trochanteric fracture femur treated with dynamic hip screw and proximal femoral nailing


  • Gaurav Singla Department of Orthopaedics, Adesh Hospital, Ambala Cantt, Haryana, India




Inter-trochanteric fracture femur, Dynamic hip screw, Proximal femoral nailing


Background: Inter-trochanteric fracture femur is a common and grievous injury, mostly suffered in elderly people. It accounts for approximately half of hip fractures in elderly and out of this, more than 50% of fractures are unstable. In old age, it occurs mostly due to trivial trauma. Various procedures of internal fixation had been proposed as a treatment. DHS considered to be the standard procedure for comparison of outcomes. The advantage of proximal femur nailing fixation is that it provides a more biomechanically stable construct by reducing the distance between hip joint and implant. The goal of this study is to compare the clinical and radio-graphical results of the DHS and PFN for the treatment of Intertrochanteric hip fractures (load bearing vs. load sharing).

Methods: Seventy patients (more than 55 years old) presented to Adesh Hospital from March 2015 to November 2015 with trochanteric fracture femur. Patients were treated with osteosynthesis with dynamic hip screw (DHS) and proximal femoral nailing (PFN). The clinical results were compared between the dynamic hip screw and proximal femoral nailing groups of 35 patients each. All surgeries done on traction table and were followed up at regular intervals of 4 weeks, 6 weeks, 8 weeks, 10 weeks, 12 weeks, 6 months and at 1 year.

Results: We observed no statistically significant difference between two groups in view of late & early complications and time to union. We observed significantly better outcomes in PFN group for unstable inter-trochanteric fractures and in unstable fractures reduction loss is significantly lower in PFN group.

Conclusions: We concluded that PFN may be the better fixation device for most unstable inter-trochanteric fractures. 


Carter D, Hayes W. The Compressive Behavior of Bone as a Two-Phase Porous Structure. J Bone & Joint Surg. 1977;59(7):954-62.

Rockwood Charles A, Green David P, Bucholz, Robert W. In: Robert BW, James Heckman D, Charles Court Brown M, editors. Rockwood and Green’s Fractures in Adults. Volume 2. 6th ed. Philadelphia : Lippincott Williams & Wilkins; 2006: 1827-1844.

David Lavelle G. Fractures and dislocations of the hip. In: Canale ST, editor. Campbell’s Operative Orthopaedics. Chapter 52. Volume 3. 11th edition. 2008: 3237-3308.

Kish B, Sapir O, Carmel A, Regev A, Masrawa S. Full weight bearing after unstable per and subtrochanteric fracture using proximal femur nail. J Bone and Joint Surg (Br). 2001;83:289.

Sermon A, Broos PLO. The use of PFNA in treatment of intertrochanteric fractures. Folia Traumatologica. 2007:48-52.

Babhulkar SS. Management of trochanteric fracture. Indian J Orthop. 2006;40:210-8.

Christian B. The proximal femoral nail - a minimal invasive treatment of unstable proximal femoral fractures. Acta Orthop Scand. 2003;74(1):53-8.

Ely Steinberg L, Blumberg N, Deke S. The fixion proximal femur nailing system: biomechanical properties of the nail and a cadaveric study. J Biomechanics. 2005;38:63-8.

Pajarinen J. Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail. A randomized study comparing postoperative rehabilitation. JBJS (Br). 2005;87(1):76-81.

Nuber S, Schoweiss T, Ruter A. Stabilization of unstable trochanteric femoral fractures: dynamic hip screw with trochanteric stabilization plate vs Proximal femoral nail. J Orthopaedic Trauma. 2003;17(4):316-7.

Ramakrishnan M, Prasad SS, Parkinson RW, Kaye JC. Management of subtrochanteric femoral fractures and metastases using long proximal femoral nail. Injury. 2004;35:184-90.

Cummings SR, Rubin SM, Black D. The future of hip fractures in united States: Number, costs and potential effects of postmenopausal estrogen. Clin Orthop. 1990;252:163-6.

Ishrat AK. O1013 To nail or to screw? J Bone Joint Surg. 2004;86:225-6.

Khaled I, Khalil A, Mossa W. Trochanteric Fractures. The best method of treatment. Tanta Med Sc J. 2008;3(2):204-14.

Lunsjo K. Extramedullary fixation of 569 unstable intertrochanteric fractures. A randomized multicentre trial of the Medoff sliding plate versus three other screw plate systems. Acta Orthop Scand. 2001;72(2):133-40.






Original Research Articles