OJO  Vol.3 No.7 , November 2013
Comparitive Study between Proximal Femoral Nailing and Dynamic Hip Screw in Intertrochanteric Fracture of Femur
Abstract: Background: Internal fixation is appropriate for most intertrochanteric fractures. Optimal fixation is based on the stability of fracture. The mainstay of treatment of intertrochanteric fracture is fixation with a screw slide plate device or intramedullary device. So it is a matter of debate that which one is the best treatment, dynamic hip screw or proximal femoral nailing. Method: A prospective randomized and comparative study of 2 years duration was conducted on 60 patients admitted in the Department of Orthopedics in our hospital with intertrochanteric femur fracture. They were treated by a dynamic hip screw and proximal femoral nail. Patients were operated under image intensifier control. The parameters studied were functional outcome of Harris hip score, total duration of operation, rate of union, amount of collapse. These values were statistically evaluated and two tailed p-values were calculated and both groups were statistically compared. Result: The average age of our patient is 67.8 years. Among the fracture, 31% were stable, 58% were unstable, 11% were reverse oblique fracture. The average blood loss was 100 and 250 ml in PFN and DHS group, respectively. In PFN there was more no. of radiation exposure intraoperatively. The average operating time for the patients treated with PFN was 45 min as compared to 70 min in patients treated with DHS. The patients treated with PFN started early ambulation as they had better Harris Hip Score in the early period (at 1 and 3 months). In the long term both the implants had almost similar functional outcomes. Conclusion: In our study we have found that the unstable pattern was more common in old aged patients with higher grade of osteoporosis and PFN group has a better outcome in this unstable and osteoporotic fracture. PFN group has less blood loss and less operating time compared to DHS group. In PFN group patients have started early ambulation compared to DHS group.
Cite this paper: U. Bhakat and R. Bandyopadhayay, "Comparitive Study between Proximal Femoral Nailing and Dynamic Hip Screw in Intertrochanteric Fracture of Femur," Open Journal of Orthopedics, Vol. 3 No. 7, 2013, pp. 291-295. doi: 10.4236/ojo.2013.37053.

[1]   D. Carter and W. Hayes, “The Compressive Behavior of Bone as a Two-Phase Porous Structure,” The Journal of Bone & Joint Surgery, Vol. 59A, No. 7, 1977, pp. 954-962.

[2]   B. Gullberg, O. Johnell and J. A. Kanis, “World Wide Projection for Hip Fracture,” Osteoporosis International, Vol. 7, No. 5, 1997, pp. 407-413.

[3]   L. J. Melton, A. E. Kearns, E. J. Atkinson, et al., “Secular Trends in Hip Fracture Incidence and Recurrence,” Osteoporosis International, Vol. 20, No. 5, 2009, pp. 687-694.

[4]   D. Hardy, P. Descamps, P. Krallis, et al., “Use of an Intramedullary Hip Screw Compared with a Compression Hip Screw with a Plate for Intertrochanteric Femoral Fractures. A Prospective Randomized Study of One Hundred Patients,” The Journal of Bone & Joint Surgery, Vol. 80, 1998, pp. 618-630.

[5]   J. M. Spivak, J. D. Zuckerman and F. J. Kumme, “Fatigue Failure of Sliding Hip Screw in Hip Fractures. A Report of Three Cases,” Journal of Orthopaedic Trauma, 1991, Vol. 3, pp. 325-331.

[6]   K. S. Leung, W. S. So, W. Y. Shen and P. W. Hui, “Gamma Nails and Dynamic Hip Screws for Pertrochanteric Fractures. A Randomized Prospective Study in Elderly Patients,” The Bone & Joint Journal, Vol. 74, 1992, pp. 345-351.