Management of complex intertrochanteric fractures of the femur in elderly patients – dynamic hip screws or proximal femoral nails or arthroplasty

Naushad Hussain, Hiren B. Patel, Nirmal D. Patil


Background: Ideal management of intertrochanteric fractures in elderly individuals has been debated for several years. Due to difficulty in obtaining anatomical reduction, management of the complex intertrochanteric fractures in elderly patients is challenging and controversial.

Methods: In the present study prospective comparative evaluation has been done between dynamic hip screws (DHS), proximal femoral nail (PFN) and bipolar hemiarthroplasty for overall clinical outcome of patients with unstable intertrochanteric fractures. The total numbers of patients were 90 with each group consisted of 30 patients.

Results: Complication rate and requirement of revision surgery was more in DHS group but this was not found to be statistically significant. Harris Hip Score & hence the functional outcome was found to be more in PFN group as compared to DHS which was statistically significant. Bipolar hemiarthroplasty provides early full wieght bearing leading to better HHS at 6 weeks evaluation but almost similar score to PFN in long term.

Conclusions: PFN is better choice of fixation if good bone quality present while extremely osteoporotic patients or extreme comminution at fracture site favours bipolar hemiarthroplasty in elderly patients.


DHS, PFN, Bipolar, Intertrochenteric fractures

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Davis TR, Sher JL, Horsman A, Simpson M, Porter BB, Checketts RG. Intertrochanteric femoral fractures. Mechanical failure after internal fixation. J Bone Joint Surg Br. 1990;72(1):26–31

Geiger F, Zimmermann-Stenzel M, Heisel C, Lehner B, Daecke W. Trochanteric fractures in the elderly: the influence of primary hip arthroplasty on 1-year mortality. Arch Orthop Trauma Surg. 2007;127(10):959–66.

Jones HW, Johnston P, Parker M. Are short femoral nails superior to the sliding hip screw? A meta-analysis of 24 studies involving 3,279 fractures. Int Orthop. 2006;30(2):69–78

Chan KC, Gill GS. Cemented hemiarthroplasties for elderly patients with intertrochanteric fractures. Clin Orthop Relat Res. 2000;371:206–15.

Rodop O, Kiral A, Kaplan H, Akmaz I. Primary bipolar hemiprosthesis for unstable intertrochanteric fractures. Int Orthop. 2002;26(4):233–7.

Davis TR, Sher JL, Horsman A, Simpson M, Porter BB, Checketts RG. Intertrochanteric femoral fractures. Mechanical failure after internal fixation. J Bone Joint Surg Br. 1990;72(1):26–31

Bridle SH, Patel AD, Bircher M, Calvert PT. Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg Br. 1991;73(2):330-4.

Adams CI, Robinson CM, Court-Brown CM, McQueen MM. Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur. J Orthop Trauma. 2001;15:394-400.

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.

Boldin C, Seibert FJ, Fankhauser F, Peicha G, Grechenig W, Szyszkowitz R. 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(1):53–8.

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.

Sancheti KH, Sancheti PK, Shyam AK, Patil S, Dhariwal Q, Joshi R. Primary hemiarthroplasty for unstable osteoporotic intertrochanteric fractures in the elderly: A retrospective case series. Indian J Orthop. 2010;44(4):428–34.