A comparative study of proximal femoral fracture fixation with proximal femoral nail and dynamic hip screw and plating
Keywords:Inter trochanteric fractures, osteoporosis, dynamic hip screw, Proximal femoral nail
Background: Trochanteric fractures are one of the commonest injuries sustained predominantly in patients over sixty years of age. They are three to four times more common in women. These usually occur through bone affected by osteoporosis; trivial fall being most common mechanism of injury Approximately 10-30% of patients die within one year of an intertrochanteric fracture.
Methods: A prospective study comprising of patients identified for surgical treatment of fracture in the intertrochanteric region of femur admitted to Sri Siddhartha Medical College, Tumkur from 2016 to 2017 where 30 patients with 30 intertrochanteric fractures of femur were selected with equal distribution of 15 dynamic hip screw devices and 15 intramedullary devices.
Results: The purpose of the present study is to verify theoretical advantages of intramedullary device over the dynamic hip screw devices and also whether it actually alters the eventual functional outcome of the patient. Excellent results were seen in 2 patients (13.3%) in the DHS group and in 6 patients (40%) in the PFN group. The overall functional outcome of patients treated with the PFN was significantly better than those treated with DHS (p=0.037). However when we compared the stable and unstable fractures separately, we found that there was no significant difference in the outcomes of the stable fractures in the two groups (p=0.198).
Conclusions: We conclude that in stable intertrochanteric fractures, both the PFN and DHS have similar outcomes. However, in unstable intertrochanteric fractures the PFN has significantly better outcomes in terms of earlier restoration of walking ability as it is an intramedullary implant which can tolerate higher cylindrical loading when compared to DHS type of implants. In addition, as the PFN requires shorter operative time and smaller incision, it has distinct advantages over DHS even in stable intertrochanteric fractures. Hence, in our opinion, PFN may be the better fixation device for most intertrochanteric fractures.
Kaufer H. Mechanics of the Treatment of Hip Injuries. Clin Orthop. 1980;146:53-61.
Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty-two intertrochanteric hip fractures. A retrospective and prospective study. J Bone Joint Surg. 1979;61:216-21.
Kaufer H, Mathews LS, Sonstegard D. Stable Fixation of Intertrochanteric Fractures. J Bone Joint Surg. 1974;56:899-907.
Sahlstrand T. The Richards Compression and Sliding Hip Screw System in the Treatment of Intertrochanteric Fractures. Acta Orthop Scand. 1974;5:213-9.
Ahrengart L, Tornkvist H, Fornander P, Thorngren KG, Pasanen L, Wahlstrom P, et al. A randomized study of the compression hip screw and Gamma nail in 426 fractures. Clin Orthop. 2002;401:209–22.
Jensen JS, Michaelsen M. Trochanteric femoral fractures treated with McLaughlin osteosynthesis. Acta Orthop Scand. 1975;46:795–803.
Baumgaertner MR, Curtin SL, Lindskog DM. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin Orthop. 1998;348:87–94.
Saudan M, Lubbeke 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;16:386–93.
Menezes, Daniel FA, Gamulin A, Bruno. Is the Proximal Femoral Nail a Suitable Implant for Treatment of All Trochanteric Fractures? Clin Orthop. 2005;439:221-7.
Kubaik E, Bong M, Park S, Kummer F, Egol K, Koval K. Intramedullary Fixation of Unstable Intertrochanteric Hip Fractures –One or Two Lag Screws. J Orthop Trauma. 2004;18:12-7.
Boldin C, Seibert FJ, Fankhauser F. The proximal femoral nail (PFN): A minimal invasive treatment of unstable proximal femoral fractures: A prospective study of 55 patients with a follow-up of 15 months. Acta Orthop Scand. 2003;74:53-8.
Fogagnolo F, Kfuri M, Paccola CA. Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail. Arch Orthop Trauma Surg. 2004;124:31-7.
Pajarinen J, Lindahl J, Michelsson O, Savolainen V, Hirvensalo E. Peritrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail - A randomized study comparing post-operative rehabilitation. J Bone Joint Surg. 2005;87:76-81.