Randomised controlled trial of the dynamic hip screw (DHS) versus the proximal femoral nail (PFN) for unstable hip fractures

Resumo Objetivo Identificar a energia necessária para ocorrência de fratura do fêmur proximal em osso sintético após retirada de três modelos de implantes: parafusos canulados, parafuso dinâmico do quadril (dynamic hip screw-DHS) e haste femoral proximal (proximal femoral nail-PFN). Métodos Foram utilizados 25 modelos de ossos sintéticos da extremidade proximal do fêmur: 10 unidades de grupo controle (GC), 5 unidades após colocação e retirada de 3 parafusos canulados colocados em configuração de triângulo invertido (GPC), 5 unidades após colocação e retirada do parafuso de compressão dinâmico (GDHS), e 5 unidades após colocação e retirada da haste de fêmur proximal (GPFN). Uma análise biomecânica foi realizada em todas as amostras simulando uma queda sobre o grande trocânter utilizando uma máquina servo-hidráulica com o objetivo de verificar a energia (em Joules [J]) necessária até a ocorrência de fratura nos diferentes grupos. Resultados Todos os grupos apresentaram fratura basocervical. Os grupos GC, GPC, GDHS e GPFN apresentaram, respectivamente, valores de 7.1J, 6.6J, 6J e 6.7J de energia até ocorrência da fratura. Não houve diferença estatisticamente significativa (intervalo de confiança de 95%) na energia entre os grupos de estudo (p = 0,34). Conclusão Não houve diferença estatisticamente significativa nos valores de energia necessária para ocorrência de fratura da extremidade proximal do fêmur após a retirada de três tipos de implantes utilizando modelos sintéticos simulando queda sobre o grande trocânter.

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A study to assess proximal femoral nailing versus dynamic hip screw device in surgical management of intertrochanteric fractures: a comparative study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20184719 ◽

2018 ◽

Vol 5 (1) ◽

pp. 23

Author(s):

E. S. Radhe Shyam ◽

K. Ashwin

Keyword(s):

Functional Outcome ◽

Intertrochanteric Fracture ◽

Trochanteric Fracture ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Technical Failure ◽

Intertrochanteric Fractures ◽

Femoral Nail ◽

Fracture Management ◽

Hip Screw

Background: The incidence of inter trochanteric fracture is expected to have doubled by 2040. Inter trochanteric fractures account for about 45% to 50% of all hip fractures in the elderly populationand out of these, near about 50% to 60% are classified as unstable intertrochanteric fractures. The goal of treatment is restoring mobility safely and efficiently, while minimizing the risk of medical complications and technical failure. This study as performed to assess functional outcome with dynamic hip screw and proximal femoral nail in intertrochanteric fracture management.Methods: It was prospective observational study done for a period of 1year from January 2016-January 2017 among patients who attended OPD or emergency department with intertrochanteric fracture. Two different implants were used dynamic hip screw (DHS) and proximal femoral nail (PFN).Results: Excellent results in functional outcome was more in case of PFN (66.6%) compared to DHS (50%). The type of trauma in DHS group was road traffic accident in 38.8%, domestic fall in 50% and others such as assault was in 11.1% while in PFN group intertrochanteric fracture was seen in 61.1% due to domestic fall.Conclusions: The functional outcome was more better with proximal femoral nail (PFN) compared to dynamic hip screw (DHS). Therefore, proximal femoral nail (PFN) should be preferred for management of intertrochanteric fractures.

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

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/424 ◽

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

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A comparison study of proximal femoral nail and dynamic hip screw devices in unstable trochanteric fractures

Benha Medical Journal ◽

10.4103/bmfj.bmfj_81_18 ◽

2018 ◽

Vol 35 (3) ◽

pp. 413

Author(s):

MohamedA Mostafa ◽

HassanH Ahmed ◽

HaniA.M Bassiooni ◽

ElsayedM Mohamady

Keyword(s):

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Comparison Study ◽

Trochanteric Fractures ◽

Femoral Nail ◽

Hip Screw

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Proximal Femoral Nail Antirotation versus Compression Hip Screw with Trochanter Stabilizing Plate for Unstable Intertrochanteric Hip Fractures

Journal of the Korean Fracture Society ◽

10.12671/jkfs.2010.23.2.161 ◽

2010 ◽

Vol 23 (2) ◽

pp. 161 ◽

Cited By ~ 3

Author(s):

Jae-Young Rho ◽

Sang-Bum Kim ◽

Youn-Moo Heo ◽

Seong-Jin Cho ◽

Dong-Sik Chae ◽

...

Keyword(s):

Hip Fractures ◽

Proximal Femoral Nail ◽

Femoral Nail ◽

Hip Screw ◽

Proximal Femoral Nail Antirotation

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A Prospective Randomized Control Trial Comparing Proximal Femoral Nail and Sliding Hip Screw in The Management of Trochanteric Fracture of The Femur

Health Renaissance ◽

10.3126/hren.v9i1.4354 ◽

1970 ◽

Vol 9 (1) ◽

pp. 7-11

Author(s):

NK Kam ◽

Ashis Jain ◽

P Nepal ◽

Mahi Pal Singh ◽

N Das

Keyword(s):

Controlled Trial ◽

Trochanteric Fracture ◽

Proximal Femoral Nail ◽

Joint Disease ◽

Harris Hip Score ◽

Sliding Hip Screw ◽

Femoral Nail ◽

Number Of Patients ◽

Hip Screw ◽

Screw Group

Introduction: There are various implants designed for fixation of trochanteric fracture which can be extramedullary (Sliding hip screw) and intramedullary (Proximal Femoral Nail). A randomized controlled trial comparing these techniques was conducted at BP Koirala Institute of Health Sciences. Objective: To compare efficacy of proximal femoral nail and sliding hip screw in the management of trochanteric fractures. Methods: Patients in both groups were matched for age (mean 67 years, 50 to 100) and gender. We excluded all pathological fractures, patients presenting at more than one week, multiple fractures or any bone and joint disease interfering with rehabilitation. Results: The amount of blood loss and length of incision were significantly higher in the sliding hip screw group (p < 0.05). The time of union, range of movement and Western Ontario and McMasterUniversity knee scores were comparable at two years. The mean Harris hip score was better in proximal femoral group. Conclusion: The number of patients showing shortening, external malrotation and varus angulation was more in sliding hip screw group. There was one case of wound infection and a single case of breakage of implant in sliding hip screw group. Keywords: fracture trochanter; proximal femoral nail; sliding hip screw DOI: 10.3126/hren.v9i1.4354Health Renaissance, 2011: Vol.9 No.1:7-11

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Proximal Femoral Nail Unlocked versus Locked (ProFNUL): a protocol for a multicentre, parallel-armed randomised controlled trial for the effect of femoral nail mode of lag screw locking and screw configuration in the treatment of intertrochanteric femur fractures

BMJ Open ◽

10.1136/bmjopen-2019-032640 ◽

2020 ◽

Vol 10 (2) ◽

pp. e032640 ◽

Cited By ~ 1

Author(s):

Arjun Sivakumar ◽

Dominic Thewlis ◽

Andreas Ladurner ◽

Suzanne Edwards ◽

Mark Rickman

Keyword(s):

Randomised Controlled Trial ◽

Controlled Trial ◽

Functional Independence ◽

Local Health ◽

Intertrochanteric Fractures ◽

Management Options ◽

Lag Screw ◽

Femoral Nail ◽

Surgical Data ◽

Randomised Controlled

IntroductionIntertrochanteric fractures are common fragility injuries in the elderly. Surgical fixation using intramedullary devices are one of the widely used management options. To date, evidence demonstrating the effects of lag screw configuration and the mode of lag screw locking in these devices is lacking. The purpose of this study is to investigate whether the lag screw configuration (single vs integrated dual interlocking screw) and the mode of lag screw locking (static vs dynamic) of a femoral nail device result in differences in clinical and functional outcomes.Methods and analysisA multicentre, pragmatic, single-blinded randomised controlled trial (RCT) with a three-arm parallel group design is proposed. Nine-hundred patients with intertrochanteric fractures (A1 and A2 AO/OTA) will be randomised to fracture treatment using a Gamma3 nail (Stryker; proximally dynamic) or a Trigen Intertan nail (Smith & Nephew) in a dynamic or static lag screw configuration. The primary outcome measure consists of radiological evidence of construct failure within 6 months following surgery, with failure being defined as breakage of the femoral nail or distal locking screw, a change in tip-apex distance of more than 10 mm or lag screw cut-out through the femoral head. Secondary outcomes include surgical data (operation time, fluoroscopy time), complications (surgical site infection, reoperation, patient death), return to mobility and home circumstances, functional independence, function and pain. Patients who are able to walk independently with or without a mobility aid and are able to answer simple questions and follow instructions will be asked to participate in three dimensional gait analysis at 6 weeks and 6 months to assess hip biomechanics from this cohort. Additional secondary measures of gait speed, hip range of motion, joint contact and muscle forces and gross activity monitoring patterns will be obtained in this subgroup.Ethics and disseminationThe Central Adelaide Local Health Network Human Research Ethics Committee has approved the protocol for this RCT (HREC/17/RAH/433). The results will be disseminated via peer-reviewed publications and presentations at relevant conferences.Trial registration numberACTRN12618001431213.

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