Functional and radiological outcome of proximal femoral nailing versus dynamic hip screw in unstable intertrochanteric femur fractures


  • Kushal Nikhil Parikh Department of Orthopaedics, Surat Municipal Institute of Medical Education and Research, Surat, Gujarat
  • Chintan Parmar Consultant Orthopaedic Surgeon, Tricolour Hospital, Vadodara, Gujarat
  • Mitesh Patel Department of Orthopaedics, Surat Municipal Institute of Medical Education and Research, Surat, Gujarat
  • Shalin Bharat Shah Department of Orthopaedics, Surat Municipal Institute of Medical Education and Research, Surat, Gujarat



DHS, PFN, Unstable IT, Harris hip score


Background: Intertrochanteric femur fractures account half of the hip fractures in elderly, the other majority being neck of femur fracture. 35-40% of intertrochanteric are unstable (Tronzo’s classification type 3, 4 and 5). The dynamic hip screw (DHS) has achieved widespread acclaim in the last few years and is currently considered to be the standard device for outcome assessment. Though, the DHS has been shown to produce good results, but complications are frequent, particularly in unstable inter-trochanteric fracture. 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 assess the clinical and radiographical outcomes of the DHS (load bearing implant) and PFN (load sharing implant) for the treatment of Intertrochanteric hip fractures.

Methods: We assessed the same in 52 cases of unstable femur fracture 26 operated with DHS and 26 with PFN and followed up with sequential radiographs for radiological union and sequential interview with Harris hip score calculation for functional outcome assessment.

Results: Patients operated for unstable intertrochanteric femur fracture with Proximal femoral nailing had better Harris hip scores (excellent 4, good 14) compared to dynamic hip screw group (Excellent 6, good 5) and earlier weight bearing (At 18 weeks, 100% in PFN compared to 65.5% in DHS). PFN has lesser incidence of postoperative complications (15% in PFN compared to 38% in DHS).

Conclusions:The proximal femoral nail has better functional outcome in terms of Harris hip score and early radiologic union in unstable intertrochanteric fractures of femur. 


Author Biography

Kushal Nikhil Parikh, Department of Orthopaedics, Surat Municipal Institute of Medical Education and Research, Surat, Gujarat

Assistant Professor in Orthopaedics


Tronzo RG. Symposium on fractures of the hip. Special considerations in management. Orthop Clin North Am. 1974;5(3):571–83.

Sidhu AS, Singh AP, Singh S. Total hip replacement as primary treatment of unstable intertrochanteric fractures in elderly patients. Int Orthop. 2010;34(6):789–92.

Grimsrud C, Monzon RJ, Richman J, Ries MD. Cemented hip arthroplasty with a novel cerclage cable technique for unstable intertrochanteric hip fractures. J Arthroplasty. 2005;20(3):337–43.

Kim WY, Han CH, Park JI, Kim JY. Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis. Int Orthop. 2001;25(6):360–2.

Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures:treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51(4):737-55.

Pan XH, Xiao DM, Lin B, Huang G. Dynamic hip screws (DHS) and proximal femoral nails (PFN) in treatment of intertrochanteric fractures of femur in elderly patients. Chinese J Orthop Trauma. 2004;6(7):785-9.

Saudan M, Lübbeke 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(6):386-93.

Pajarinen J, Lindahl J, Michelsson O, Savolainen V, Hirvensalo E. Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail:a randomised study comparing post-operative rehabilitation. J Bone Joint Surg. British volume. 2005;87(1):76-81.

Cleveland M, Bosworth DM, Thompson FR, Wilson HJ, Ishizuka T. A ten-year analysis of intertrochanteric fractures of the femur. J Bone Joint Surg. 1959;41(8):1399-408.

Cummings SR, Nevitt MC. Non- skeletal determinants of fractures:the potential importance of mechanics of falls. Osteoporosis Int. 1994;4(l):67-70.

Giraud B, Dehoux E, Jovenin N, Madi K, Harisboure A, Usandizaga G, et al. Pertrochanteric fractures:a randomized prospective study comparing dynamic screw plate and intramedullary fixation. Revue de Chirurgie Orthop Et Reparatrice De L'appareil Moteur. 2005;91(8):732-6.

Liu XW, Zhang CC, Su JC, Fu QG, Yu BQ, Xu SG. Treatment of trochanteric fractures of eldly with dynamic hip screwand proximal femoral nail (single center, randomized and prospective research). Chinese J Bone Joint Injury Chinese. 2009;24(9):796-7.

Kulkarni GS. Treatment of trochanteric fractures of the hip by modified Richard’s compressing and collapsing screw. Indian J Orthop. 1984;18(1):30-4.

Harrington KD, Johnston JO. The management of comminuted Unstable Intertrochanteric Fractures. J Bone Joint Surg. 1973;55:1367-76.

Rao JP, Banzon MT, Wiess AB. Treatment of unstable intertrochanteric fracture with anatomic reduction and compression hip screw. Clin Orthop Rel Res. 1983;(175):65-71.

Venkatesh Gupta SK, Valisetti VS. Comparative study between dynamic hip screw vs proximal femoral nailing in inter-trochanteric fractures of the femur in adults. Int J Orthop Sci. 2015;1(1):7-11.






Original Research Articles