657 Comparison of the Intramedullary Nail and Dynamic Hip Screw in the Treatment of Subtrochanteric Femoral Fractures

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
Z Arshad ◽  
A Thahir ◽  
J Rawal ◽  
P Hull ◽  
A Carrothers ◽  
...  
Keyword(s):  
Blood Loss ◽  
Statistical Significance ◽  
Femoral Fractures ◽  
Subtrochanteric Fracture ◽  
Dynamic Hip Screw ◽  
Dose Area Product ◽  
Subtrochanteric Fractures ◽  
Operative Outcomes ◽  
Operation Rate ◽  
Hip Screw

Abstract Introduction A subtrochanteric femoral fracture occurs in the 5cm of bone distal to the lesser trochanter. This study aims to compare peri-operative outcomes of patients with such fractures treated with either an IMN or a dynamic hip screw (DHS). Method We retrospectively reviewed subtrochanteric fractures presenting to our institution between October 2014 -May 2019, classifying them into two treatment groups: IMN and DHS. These groups were compared using outcomes including surgical time, blood loss, radiation dose area product (DAP), stay length, re-operation rate and mortality. Results During the study period, 86 patients presented with a subtrochanteric fracture, 74 (86%) receiving an IMN and 12 (14%) receiving a DHS. The DHS group showed a significantly lower blood loss (776.19 ml) and DAP (150.30 mGy.cm2) compared to the IMN group (1028.74 ml and 288.86 mGy.cm2 respectively). All other outcome measures failed to reach statistical significance. Conclusions Although National Institute for Health and Care Excellence guidelines recommend treating all subtrochanteric fractures with an IMN; the outcomes assessed did not show use of an IMN to be superior. This, along with the reduced financial cost associated with a DHS; may support the use of DHS over IMN for certain subtrochanteric fractures.

scholarly journals Dynamic hip screw fixation of subtrochanteric femoral fractures

2021 ◽  
Author(s):  
Zaki Arshad ◽  
Azeem Thahir ◽  
Jaikirty Rawal ◽  
Peter D. Hull ◽  
Andrew D. Carrothers ◽  
...  
Keyword(s):  
Blood Loss ◽  
Outcome Measures ◽  
Statistical Significance ◽  
Dynamic Hip Screw ◽  
Economic Research ◽  
National Guidelines ◽  
Subtrochanteric Fractures ◽  
Estimated Blood Loss ◽  
Operation Rate ◽  
Hip Screw

Abstract Introduction A subtrochanteric proximal femur fracture occurs in the 5 cm of bone immediately distal to the lesser trochanter. UK national guidelines advise that adults with subtrochanteric fractures should be treated with an intramedullary nail (IMN). This study aims to compare peri-operative outcome measures of patients with subtrochanteric fractures treated with either an IMN or a dynamic hip screw (DHS) construct. Materials and Methods We retrospectively reviewed subtrochanteric fractures presenting at our institution over 4.5 years (October 2014–May 2019), classifying them into two treatment groups; IMN and DHS. These groups were compared on outcome measures including surgical time, blood loss, radiation dose area product (DAP), length of stay, re-operation rate and mortality. Results During the time period studied, 86 patients presented with a subtrochanteric fracture of the femur; with 74 patients (86%) receiving an IMN and 12 (14%) receiving a DHS. The comparative outcome measures reaching statistical significance were blood loss and radiation DAP. The DHS group showed a significantly lower mean blood loss of 776 ml compared to 1029 ml in the IMN group. Also, the DHS group showed a significantly lower mean DAP of 150.30 mGy cm2 compared to 288.86 mGy cm2 in the IMN group. Conclusion Although UK national guidelines recommend treating all subtrochanteric fractures with an IMN; the outcome measures assessed in our study did not show use of an IMN to be superior to a DHS. The DHS group showed a lower estimated blood loss and a reduced DAP. This, along with the reduced financial cost associated with a DHS, may support the use of DHS over IMN for certain subtrochanteric fractures of the femur. There may not be a single favourable implant for the treatment of subtrochanteric fractures as a whole; instead different subtypes of fracture may be amenable to a number of fixation devices. Choice of implant should be determined locally and based on existing and future clinical and health economic research.

scholarly journals 1260 Comparison of the Intramedullary Nail and Dynamic Hip Screw in the Management of Subtrochanteric Femoral Fractures

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
Z Arshad ◽  
A Thahir ◽  
J Rawal ◽  
P Hull ◽  
A Carrothers ◽  
...  
Keyword(s):  
Blood Loss ◽  
Outcome Measures ◽  
Statistical Significance ◽  
Femoral Fractures ◽  
Dynamic Hip Screw ◽  
National Guidelines ◽  
Subtrochanteric Fractures ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Hip Screw

Abstract Aim Subtrochanteric femoral fractures are said to occur in the 5cm of bone immediately distal to the lesser trochanter. This study aims to compare peri-operative outcome measures in patients with subtrochanteric fractures treated with either an IMN, or an alternative construct, the dynamic hip screw (DHS). Method A retrospective review of all subtrochanteric fractures presenting to our institution between October 2014 and May 2019 was performed. All patients were classified into two treatment groups, IMN or DHS. These groups were compared on outcome measures including radiation dose area product (DAP), length of hospital stay, estimated blood loss, mortality, and re-operation/complication rate. Results A total of 86 patients presented to our institution with a subtrochanteric femoral fracture during the study time period. Of these, 74 (86%) received an IMN and the remaining 12 (14%) received a DHS. The only comparative outcome measures showing a statistically significant difference between the two groups were radiation DAP and blood loss., both of which were significantly lower in the DHS group. All other comparative outcome measures failed to reach statistical significance. Conclusions Although current United Kingdom national guidelines advise all subtrochanteric femoral fractures should be treated with an IMN, the outcome measures used in this study suggest that the DHS, which also has a reduced implant cost compared to an IMN, may be the better option in some cases. There may not be one optimal implant for all subtrochanteric fractures. Recent biomechanical research suggests that the DHS is able to provide adequate fixation in more stable fracture subtypes, whereas an IMN may be required for unstable subtrochanteric fractures.

Gotfried percutaneous compression plating (PCCP) versus dynamic hip screw (DHS) in hip fractures: blood loss and 1-year mortality

2014 ◽  
Vol 26 (5) ◽  
pp. 497-503 ◽  
Author(s):  
Diego Gaddi ◽  
Giorgio Piarulli ◽  
Andrea Angeloni ◽  
Marta Gandolla ◽  
Daniele Munegato ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hip Fractures ◽  
Dynamic Hip Screw ◽  
Hip Screw ◽  
Compression Plating

Dynamic Hip Screw versus Proximal Femoral Nail in the Management of Intertrochanteric Fractures - A Retrospective Analysis from Rajasthan

2021 ◽  
Vol 8 (26) ◽  
pp. 2271-2277
Author(s):  
Gajanand Shriram Dhaked ◽  
Abhishek Komalsingh Jaroli ◽  
Khushboo Parmanand Malav ◽  
Harish Narayan Singh Rajpurohit
Keyword(s):  
Functional Outcome ◽  
Functional Outcomes ◽  
Statistical Significance ◽  
Dynamic Hip Screw ◽  
Proximal Femoral Nail ◽  
Final Decision ◽  
Intertrochanteric Fractures ◽  
Femoral Nail ◽  
Duration Of Surgery ◽  
Hip Screw

BACKGROUND Current management of Intertrochanteric (IT) fractures has evolved with the introduction of dynamic hip screw (DHS) and proximal femoral nail (PFN). The purpose of this study was to compare the functional outcomes between the DHS and PFN for IT fracture fixation. METHODS This study is a retrospective comparative analysis of 455 patients with IT fractures; DHS (292) and PFN (163), who were treated from June 2012 to June 2015. The patients were reviewed postoperatively for a minimum of 12 months to evaluate functional outcome using Salvati-Wilson score. Categorical data was present as absolute number or percentages, and parametric variables were presented as Mean ± SD, while non parametric data were presented as median. Statistical significance was defined as P < 0.05. RESULTS Intramedullary nails offer no advantage over extramedullary devices to treat IT fractures caused by low-energy trauma (AO 31 - A1). However, clinically significant outcomes were established for PFN group in terms of duration of surgery, x- ray exposure and SW Score for AO / OTA 31 - A2 and 31 - A3. Reoperations encountered for local pain due to implant prominence were significantly higher in the PFN group (4.90 % versus 1.02 %). Kaplan Meier survival probability of 69.3 % and 79.5 % predicted for DHS and PFN respectively, 3 years postoperatively. CONCLUSIONS Our conclusion reinforces indication for PFN in unstable IT fractures (31 - A2 and 31 - A3), owing to its better functional outcome and biomechanical properties. Functional outcomes for stable IT fracture (AO 31 - A1) were comparable between DHS and PFN, therefore final decision for implant choice depends on implant cost, surgeon’s preference for specific technique. However, understanding the morphology of proximal femur, peritrochanteric region is crucial to analyse the anatomical variations in Indian population which will provide the basis for intramedullary nail design modifications. KEYWORDS Intertrochanteric Fractures, DHS Fixation, PFN Fixation

scholarly journals Comparison of the Outcome between Conventional Open Technique and Minimally Invasive Technique Using Dynamic Hip Screw for Fixation of Inter-Trochanteric Fracture of Femur

2018 ◽  
Vol 1 (2) ◽  
pp. 7-20
Author(s):  
Rajiv Maharjan ◽  
S.R. Paneru ◽  
R. Rijal ◽  
P. Chaudhary ◽  
G.P. Khanal
Keyword(s):  
Blood Loss ◽  
Trochanteric Fracture ◽  
Dynamic Hip Screw ◽  
Harris Hip Score ◽  
Invasive Technique ◽  
Open Technique ◽  
Minimal Incision ◽  
Hip Screw ◽  
Incision Technique ◽  
Operative Recovery

Background: Inter-trochanteric fracture of femur causes significant morbidity and mortality in elderly. Dynamic Hip Screw (DHS) fixation is the most effective and safe method of treatment. Conventional open technique (CDHS) is the popular and familiar one; however, minimal incision technique (MIDHS) has many advantages like: smaller incision, lesser dissection/blood loss, less requirement of transfusion, less painful, faster recovery etc. Objectives: To Compare CDHS and MIDHS technique of DHS fixation for inter-trochanteric fracture femur in terms of functional outcome, safety and associated complications (if any). Methods: Eligible patients presenting within study period were randomized into CDHS group (n= 33) and MIDHS group (n= 32). Success of randomization was tested by analyzing demographics, injury characteristics and pre-op. clinical data (p> 0.05). They were followed up at 2, 6, 12, 24 and 52 weeks post-op. for clinico-radiological and functional assessment. Results: The duration of surgery, lag screw positioning, post-operative hospital stay and surgical site infection were not significantly different between the groups. However, need for blood transfusion, length of incision and post-operative VAS score for pain were significantly lesser for MIDHS group than CDHS group (p< 0.05). Patients in MIDHS group started walking with aids significantly earlier in post-operative recovery period. The Harris Hip Score at final follow-up and grading of the results and surgical complications were not significantly different between the groups. Conclusion: The minimal incision technique had various immediate / short term advantages over conventional technique; like: minimal scar, minimal soft tissue dissection / less blood loss requiring less transfusion, lesser pain in post-operative period and ability to ambulate early.

A BIOMECHANICAL VALIDATION OF A NEW FEMORAL NECK FIXATION DYNAMIC HIP SCREW FOR PROXIMAL FEMORAL FRACTURE

2010 ◽  
Vol 22 (01) ◽  
pp. 53-59 ◽  
Author(s):  
Shih-Wei Lin ◽  
Jaw-Lin Wang
Keyword(s):  
Femoral Neck ◽  
Mechanical Test ◽  
Femoral Fractures ◽  
Vertical Displacement ◽  
Proximal Femoral Fracture ◽  
Dynamic Hip Screw ◽  
Fixation Strength ◽  
Proximal Femoral Fractures ◽  
Suitable Site ◽  
Hip Screw

High failure rates are expected in the treatment of osteoporotic proximal femoral fractures. A newly designed femoral neck locking dynamic hip screw has been developed to increase the fixation strength; a biomechanical examination was performed to prove its efficacy. Femoral surrogate specimens were used for the test. Unstable intertrochanteric fractures were created on specimens. Then these specimens were divided into two groups to test two different methods of fixation: (1) the conventional dynamic hip screw and (2) the new designed femoral neck fixation dynamic hip screw. For each specimen, the peak cyclic loading was 800 N, and a total of 20,000 cycles were applied. The vertical displacement, rotation around the long axis of lag screw, and the varus rotation around the center of femoral head between the two groups were compared at specific intervals. All the conventional dynamic hip screw constructs failed within 1000 cycles, while no gross mechanical failure was recorded for the femoral neck fixation dynamic hip construct even after 20,000 loading cycles. The mechanical test comparing the two constructs at the end of each 1000 loading cycles demonstrated that the femoral neck fixation dynamic hip screw construct is stronger than that of the conventional dynamic hip screw. For the fixation of proximal femoral fractures, the femoral neck fixation dynamic hip screw can provide a stronger support than what a conventional dynamic hip screw can do. At the same time, femoral neck can be a suitable site for the application of proximal locking screws.

Blood loss in trochanteric fractures: multivariate analysis comparing dynamic hip screw and Gamma nail

Injury ◽  
2017 ◽  
Vol 48 ◽  
pp. S44-S47 ◽  
Author(s):  
Mario Ronga ◽  
Daniele Bonzini ◽  
Marco Valoroso ◽  
Giuseppe La Barbera ◽  
Jacopo Tamini ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Blood Loss ◽  
Gamma Nail ◽  
Dynamic Hip Screw ◽  
Trochanteric Fractures ◽  
Hip Screw

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

2017 ◽  
Vol 3 (5) ◽  
pp. 986
Author(s):  
Pradyumna R. Gowda ◽  
Manjunath J.
Keyword(s):  
Intertrochanteric Fracture ◽  
Subtrochanteric Fracture ◽  
Dynamic Hip Screw ◽  
Proximal Femoral Nail ◽  
Fracture Group ◽  
Excellent Outcome ◽  
Good Outcome ◽  
Poor Outcome ◽  
Femoral Nail ◽  
Hip Screw

<p class="abstract"><strong>Background:</strong> <span lang="EN-AU">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</span><span lang="EN-IN">.</span>The study was <span lang="EN-AU">to compare the </span><span lang="EN-IN">clinical outcome of trochanteric and subtrochanteric fracture femur with proximal femoral nail (PFN) versus dynamic hip screw (DHS).</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">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.</span><span lang="EN-AU"> At final follow up results were assessed with Modified Harris Hip score</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">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</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">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</span><span lang="EN-IN">.</span></p>

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