Early functional outcome of proximal femoral nail vs dynamic hip screw in the management of intertrochanteric fractures

Author(s): Dr. Kiran Kalaiah and Dr. Jeffin Abraham Koshy

Abstract: Introduction: Intertochanteric fractures are the most frequently operated fracture type and has the highest postoperative fatality rate. Aim of The Study: To assess the early functional outcome of proximal femoral nail v/s dynamic hip screw in the management of intertrochanteric fractures.
Materials and Methods: All patients admitted in all the Orthopaedic units of Sri Siddhartha Medical College Hospital and Research Centre, Tumkur with a clinical diagnosis of intertrochanteric fractures were included in this study after obtaining their informed and valid written consent. This study was undertaken from October 2015 to March 2017. Fifty cases of intertrochanteric fractures fulfilling the inclusion and exclusion criteria were divided into proximal femoral nail group and Dynamic hip screw group.
Results: Out of 50 patients with intertrochanteric fractures, 25 were treated with proximal femoral nail and 25 were treated with Dynamic hip screw. In Proximal femoral nail group, mean duration of surgery was 82.4+/-14.7 minutes and mean blood loss was 98.4+/-29.1 ml whereas in Dynamic hip screw group, mean duration of surgery was 95.4+/-11.6 minutes and mean blood loss was 204.4+/-61.4 ml. In PFN group, 60% had excellent and 40% had good overall functional outcome. In DHS group, 40% had excellent, 44% had good and 16% had fair overall functional outcome. There were 2 cases of infection and 1 case of implant related complication in the Dynamic hip screw group.
Conclusion: The study concluded that both Dynamic Hip Screw and Proximal Femoral Nail remained the implant of choice for the stable intertrochanteric fractures (31-A1). In the more unstable types of fracture (31-A2 and 31-A3), we observed that the Proximal femoral nail was the best choice of implant for fixation since it had better overall functional outcome, less operative time and less blood loss.

DOI: https://doi.org/10.22271/ortho.2018.v4.i2i.86