A prospective comparative study in the clinical outcome of trochanteric and subtrochanteric fracture femur with proximal femoral nail versus dynamic hip screw

Authors

  • Pradyumna R. Gowda Department of Orthopaedic Surgery, SSIMS-SPARSH, Davanagere, Karnataka, India
  • Manjunath J. Department of Orthopaedic Surgery, SSIMS-SPARSH, Davanagere, Karnataka, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20173118

Keywords:

Trochanteric fracture, Subtrochanteric fracture, DHS, PFN, Harris hip score

Abstract

Background: Trochanteric fractures are the most common fractures encountered accounting for 50% of all hip fractures. Subtrochanteric femur fractures have high rate of complications associated with their management. 10%–34% of all hip fractures occur in the subtrochanteric region.The study was to compare the clinical outcome of trochanteric and subtrochanteric fracture femur with proximal femoral nail (PFN) versus dynamic hip screw (DHS).

Methods: A prospective study of 50 patients with intertrochanteric and subtrochanteric fracture among which 30 were treated with Proximal Femoral Nail and 20 with Dynamic Hip Screw at SSIMS-SPARSH Davangere, Karnataka, India between June 2015 to November 2016. At final follow up results were assessed with Modified Harris Hip score.

Results: Among the PFN Intertrochanteric fracture group, 9 patients showed excellent outcome, 6 patients showed good outcome and 2 patients showed fair outcome and 1 patient showed poor outcome. Among the PFN subtrochanteric fracture group, 7 patients showed excellent outcome, 3 patients showed good outcome and 1 patients showed fair outcome and 1 patient showed poor outcome. Among the DHS intertrochanteric fracture group, 3 patients showed excellent outcome, 3 patients showed good outcome and 2 patients showed fair outcome and 2 patient showed poor outcome. Among the DHS subtrochanteric fracture group, 1 patients showed excellent outcome, 2 patients showed good outcome and 3 patients showed fair outcome and 4 patient showed poor outcome.

Conclusions: Fractures of the trochanteric region of the femur need a proper selection of implant based on fracture pattern. DHS has excellent results when used on stable fractures. For unstable fractures, PFN is the implant of choice. In case of subtrochanteric fractures PFN has better results in both stable and unstable fractures compared to DHS with less failure rates and restoring better hip biomechanics.

Author Biographies

Pradyumna R. Gowda, Department of Orthopaedic Surgery, SSIMS-SPARSH, Davanagere, Karnataka, India

post graduate student,department of orthopaedics,SSIMS-SPARSH,DAVANAGERE,KARNATAKA,INDIA

Manjunath J., Department of Orthopaedic Surgery, SSIMS-SPARSH, Davanagere, Karnataka, India

professor and head,department of orthopaedics,SSIMS-SPARSH,DAVANAGERE,KARNATAKA,INDIA

References

LaVelle DG, Canale ST, Beaty JH. Campbell's Operative Orthopaedics. 11th ed. Philadelphia: Mosby Elsevier; 2008: 3237-3238.

Micheal W. Chapman’s. Chapman’s Orthopaedic Surgery. Third edition. Volume 1. Lipincott Williams and wilkins company; 2001: 634-669.

Leung K. Subtrochanteric fracture. Chapter 46. Rockwood and green's fractures in adults. 6th edition. 1827-1844.

Harkess JW, Crockarell JR. Arthroplasty of hip. Chapter 7. In: Campbell’s Operative Orthopaedics. Canale ST, Beaty JH, editors. Volume 1. 11th ed. Philadelphia; Mosby; 2008: 312-482.

Seinsheimer F. Subtrochanteric fractures of the femur. JBJS. 1978:60(3):300-6.

Müller ME, Nazarian S, Koch P, Schatzker J. The comprehensive classification of fractures of the long bones. Berlin: Springer-Verlag; 1990: 116-121.

Pavelka T, Kortus J, Linhart M. Osteosyntehsis of proximal femoral fractures using short proximal femoral nails. Acta Chir Orhtop Traumatol Cech. 2003;70(1):31-8.

Alho A, Ekeland A, Grogaard B, Dokke JR. A locked hip screw-intramedullary nail (cephalomedullary nail) for the treatment of fractures of the proximal part of the femur combined with fractures of the femoral shaft. J Trauma. 1996;40:10-16.

Baumgaertner MR, Solberg BD. Awareness of tip-apex distance reduces failure of fixation of trochanteric fractures of the hip. J Bone Joint Surg Br. 1997;79:969–71.

Setiobudi T, Ng YH, Lim CT, Liang S, Lee K, Das De S. Clinical outcome following treatment of stable and unstable intertrochanteric fractures with dynamic hip screw. Ann Acad Med Singapore. 2011;40:482–7.

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 Joint Surg (Br). 2001;83:289.

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

Herman A, Landau Y, Gutman G, Ougortsin V, Chechick A, Shazar N. Radiological evaluation of intertrochanteric fracture fixation by the proximal femoral nail. Injury. 2012;43:856–63.

Downloads

Published

2017-08-24

Issue

Section

Original Research Articles