Comparative study between proximal femoral nailing versus dynamic hip screw in unstable inter-trochanteric fractures of the femur in adults

Background: Hip fractures are more common in elderly among them intertrochanteric fractures are most common, more than 50% fractures are unstable. The proximal femoral nailing (PFN) and dynamic hip screw (DHS) are frequently used modalities from last two decades in both stable and unstable fractures. The DHS has been shown to produce good results but complications are frequent, particularly in unstable inter-trochanteric fracture. The advantage of PFN fixation is that it provides a more biomechanically stable construct with good collapse control. The goal of this study was to compare the clinical and radiographical results of the DHS and PFN for the treatment of inter-trochanteric hip fractures as one is load bearing another is load shearing.Methods: In our study we included 70 inter-trochanteric fractures, out of which 40 were treated with DHS fixation and 30 were treated with PFN, and were followed up at regular intervals of 2 weeks, 8 weeks, 12 weeks, 6 months and annually thereafter.Results: The functional results were assessed with Harris hip score and observed 35% excellent results in DHS group and 63.3% excellent results in PFN group. We observed no statistically significant difference between two groups in view of late and early complications and time to union. We observed significantly better outcomes in PFN group for unstable inter-trochanteric fractures and in unstable fractures reduction loss was significantly lower in PFN group. We observed total duration of surgery was significantly lower in PFN group.Conclusions: We concluded that PFN may be the better fixation device for most unstable inter-trochanteric fractures.

Download Full-text

A comparative study of 70 cases of inter-trochanteric fracture femur treated with dynamic hip screw and proximal femoral nailing

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20170788 ◽

2017 ◽

Vol 3 (2) ◽

pp. 293

Author(s):

Gaurav Singla

Keyword(s):

Hip Fractures ◽

Standard Procedure ◽

Trochanteric Fracture ◽

Dynamic Hip Screw ◽

Trochanteric Fractures ◽

Fracture Femur ◽

Femoral Nailing ◽

Significant Difference ◽

Hip Screw ◽

Proximal Femoral Nailing

Background: Inter-trochanteric fracture femur is a common and grievous injury, mostly suffered in elderly people. It accounts for approximately half of hip fractures in elderly and out of this, more than 50% of fractures are unstable. In old age, it occurs mostly due to trivial trauma. Various procedures of internal fixation had been proposed as a treatment. DHS considered to be the standard procedure for comparison of outcomes. 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 compare the clinical and radio-graphical results of the DHS and PFN for the treatment of Intertrochanteric hip fractures (load bearing vs. load sharing).Methods: Seventy patients (more than 55 years old) presented to Adesh Hospital from March 2015 to November 2015 with trochanteric fracture femur. Patients were treated with osteosynthesis with dynamic hip screw (DHS) and proximal femoral nailing (PFN). The clinical results were compared between the dynamic hip screw and proximal femoral nailing groups of 35 patients each. All surgeries done on traction table and were followed up at regular intervals of 4 weeks, 6 weeks, 8 weeks, 10 weeks, 12 weeks, 6 months and at 1 year.Results: We observed no statistically significant difference between two groups in view of late & early complications and time to union. We observed significantly better outcomes in PFN group for unstable inter-trochanteric fractures and in unstable fractures reduction loss is significantly lower in PFN group.Conclusions: We concluded that PFN may be the better fixation device for most unstable inter-trochanteric fractures.

Download Full-text

A comparative study on the functional outcome of intertrochanteric fractures treated by proximal femoral nailing or dynamic hip screw fixation

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20205559 ◽

2020 ◽

Vol 7 (1) ◽

pp. 51

Author(s):

Gineshmon Chandy ◽

Saju S.

Keyword(s):

Functional Outcome ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Femoral Nailing ◽

Hip Screw ◽

Group 2 ◽

Proximal Femoral Nailing ◽

Radiological Union ◽

Unstable Fractures

Background: Intertrochanteric fractures are one of the commonly occurring injuries in elderly patients and are high among females and those with osteoporosis. They were treated with either dynamic hip screw (DHS) fixation or proximal femoral nailing (PFNA2) here at our institution. The study was conducted in order to find which method of surgical fixation has better functional outcome. Methods: Total 96 patients of intertrochanteric fractures admitted during the study period of November 2017 to April 2019 were included for the study. These patients were randomly divided into two groups; DHS was used as implant in group1 and PFNA2 in group 2. Postoperatively patients were followed up after 1 month, 3months and 6 months of the surgery and were assessed using Harris hip score.Results: Harris hip score was higher with PFNA2 group compared to DHS group in all follow-ups. In unstable fractures DHS group had poor outcome compared to PFNA2. Radiological union occurred in 27.1 % cases by 3 months and 72.9% cases by 6 months with DHS whereas 70.8% and 97.9% respectively with PFNA2. Conclusions: PFNA2 gives a better functional outcome when compared to DHS. Even though DHS gives good functional outcome in stable fractures it is not so in the case of unstable fractures. The radiological union also is faster with proximal femoral nailing. Hence in our opinion PFNA2 can be the better fixation device compared to DHS especially in unstable fractures.

Download Full-text

Comparative study of management of intertrochanteric fracture by dynamic hip screw and proximal femoral nailing

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20211436 ◽

2021 ◽

Vol 7 (3) ◽

pp. 487

Author(s):

Vivek Kumar Parsurampuriya ◽

M. Shahbaz Siddiqui ◽

Ritesh Kumar ◽

Rejo Varghese Jacob

Keyword(s):

Dynamic Hip Screw ◽

Harris Hip Score ◽

P Value ◽

Unstable Fracture ◽

Femoral Nailing ◽

Intramedullary Device ◽

Number Of Patients ◽

Significant Difference ◽

Hip Screw ◽

Proximal Femoral Nailing

Background: The purpose of the present study is to verify the theoretical advantages of the intramedullary device over the dynamic hip screw devices and also whether it actually alters the eventual functional outcome of the patient. Methods: The study is comparative prospective study in which 40 patients were taken and treated either with dynamic hip screw or proximal femoral nailing. The clinical data will be collected and compared with pre-injury activity and present functional level with modified Harris hip score.Results: We found that there is no significant difference between Harris hip score in stable fracture (p value=0.222) fixed either with DHS or PFN. But there is statistically significant difference of score in unstable fracture (p value 0.040) treated by DHS and PFN. Functionally, utilizing the Harris hip scoring system, at the final follow-up, our study affirms PFN to be superior to DHS in unstable intertrochanteric fractures while in stable fractures, functional results are same. Conclusions: PFN is also found better in unstable fractures, because a greater number of patients having excellent Harris hip score. In stable fracture, functional result is same in both groups.

Download Full-text

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

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20184376 ◽

2018 ◽

Vol 4 (6) ◽

pp. 861

Author(s):

Kushal Nikhil Parikh ◽

Chintan Parmar ◽

Mitesh Patel ◽

Shalin Bharat Shah

Keyword(s):

Functional Outcome ◽

Outcome Assessment ◽

Hip Fractures ◽

Femur Fracture ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Femoral Nailing ◽

Femur Fractures ◽

Hip Screw ◽

Proximal Femoral Nailing

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.

Download Full-text

A comparative study between dynamic hip screw and intramedullary nail fixation in trochanteric fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20212424 ◽

2021 ◽

Vol 7 (4) ◽

pp. 794

Author(s):

Krishan Kumar ◽

Anurag Chhabra ◽

Ashok Kumar ◽

Sourabh Jain ◽

Ankush Berwal

Keyword(s):

Blood Loss ◽

Traffic Accidents ◽

Road Traffic ◽

Common Type ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Trochanteric Fractures ◽

Surgical Time ◽

Significant Difference ◽

Hip Screw

Background: The trochanteric fractures are one of the commonest fractures in elderly population. Incidence of these fractures is increasing due to better life expectancy, growing number of population, industrialization and the road traffic accidents. Variety of implants are available but still there is no consensus for single implant.Methods: A prospective randomized control study was conducted on total 60 patients of intertrochanteric fractures which were randomized into 2 groups of 30 each, treated with dynamic hip screw (DHS) and proximal femoral nail (PFN). All the patients were followed up for a maximum of 6 months. Outcomes were reviewed and compared such as mode of injury, complications, functional and radiological outcomes.Results: There was no significant difference between two groups of patients as regards to mean age and sex. The mode of injury by slip and fall was main cause. The most common type of fracture as per AO-orthopaedic trauma association (OTA) classification was 31-A2 (65%) and 31-A3 (5%) being the least common type. Mean surgical time of DHS group and PFN group was 125.17 minutes and 89.93 minutes respectively. Mean blood loss in DHS group and PFN group was 251.67 ml and 158.67 ml respectively. Mean radiological union time of fracture in DHS group and PFN group was 12.3 and 9.5weeks respectively. Mean Harris hip score at six month in DHS group and PFN group was 80.77 and 85.47 respectively.Conclusions: We conclude that though both the implants can achieve comparable union rates but PFN are better than DHS as of better Harris hip score, shorter surgical time and less intra operative blood loss.

Download Full-text

Proximal femoral nailing versus dynamic hip screw device for trochanteric fractures - A comparative study

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2017.v3.i2h.78 ◽

2017 ◽

Vol 3 (2h) ◽

pp. 738-740

Author(s):

Shashi Kant Suman ◽

Shashi Kant Kumar Singh ◽

LB Manjhi

Keyword(s):

Comparative Study ◽

Dynamic Hip Screw ◽

Trochanteric Fractures ◽

Femoral Nailing ◽

Hip Screw ◽

Proximal Femoral Nailing

Download Full-text

Can proximal femoral nailing of unstable trochanteric fractures help to regain pre-injury functional status in Indian rural patients? A prospective study of functional outcome of unstable intertrochanteric fractures with proximal femoral nailing

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20172079 ◽

2017 ◽

Vol 3 (4) ◽

pp. 728

Author(s):

Shankar Linga S. ◽

Janardhana Aithala P. ◽

Amarnath Savur

Keyword(s):

Functional Outcome ◽

Harris Hip Score ◽

Walking Ability ◽

Trochanteric Fractures ◽

Femoral Nailing ◽

Femur Fractures ◽

Time Period ◽

Hip Screw ◽

A Prospective Study ◽

Proximal Femoral Nailing

Background: In view of the high incidence of implant failure and varus collapse seen in unstable inter trochanteric femur fractures treated with dynamic hip screw (DHS), proximal femoral nailing (PFN) has gained popularity.1,2 However there is limited literature regarding functional outcome following PFN especially in Indian patients. In this study, our aim was to assess functional outcome following PFN of unstable inter trochanteric femur fractures which includes the ability to sit cross leg and squat.Methods: This prospective observational study was done at the associated hospitals of KMC Mangalore, spanning a time period of around 2 years, from October 2014 to July 2016. All patients who presented with isolated closed unstable inter-trochanteric fractures were included in the study. Patients were treated with proximal femoral nailing and followed up for a minimum period of 6 months. Outcome measures included Harris hip score, walking status and ability to sit cross leg and squat.Results: 40 consecutive patients (Mean age 61 years, range 25-95) were included in the study, all fractures united within 6 months. As per Harris hip score, 25 patients (62.5%) had excellent or good results, 8 patients (20%) had fair and 7 patients (17.5%) had poor results. 74% (20 out of 27) regained their gainful working status. 80% (24 out of 30) were able to squat easily or with some difficulty and 74% (20 out of 27) patients were able to sit crossed leg with or without difficulty. 82% (23 out of 28) regained their unassisted walking status.Conclusions: For unstable inter trochanteric femur fracture PFN gives good results in terms of union, walking ability and majority of the patients regained their pre injury activity status including squatting and cross leg sitting.

Download Full-text

Comparative functional analysis of intertrochanteric fractures of femur treated with dynamic hip screw with that of proximal femoral nailing

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2017.v3.i4f.58 ◽

2017 ◽

Vol 3 (4f) ◽

pp. 418-421

Author(s):

Dr. Makesh Ram S ◽

Dr. Anand A ◽

Dr. Kathir Azhagan S

Keyword(s):

Functional Analysis ◽

Dynamic Hip Screw ◽

Intertrochanteric Fractures ◽

Femoral Nailing ◽

Hip Screw ◽

Proximal Femoral Nailing

Download Full-text

Proximal Femoral Nailing vs. Dynamic Hip Screw in unstable Intertrochanteric Fracture of Femur – a comparative analysis

International Journal of Biomedical and Advance Research ◽

10.7439/ijbar.v7i10.3682 ◽

2016 ◽

Vol 7 (10) ◽

pp. 489

Author(s):

Mohammad Faisal ◽

Prithviraj Nistane

Keyword(s):

Comparative Analysis ◽

Intertrochanteric Fracture ◽

Dynamic Hip Screw ◽

Femoral Nailing ◽

Unstable Intertrochanteric Fracture ◽

Hip Screw ◽

Proximal Femoral Nailing

Download Full-text

Comparative study between dynamic hip screw and plate with proximal femoral nailing in trochanteric fractures of femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171909 ◽

2017 ◽

Vol 3 (3) ◽

pp. 602

Author(s):

M. K. Nizamoddin Khateeb ◽

Satish Babu D. G.

Keyword(s):

Early Mobilization ◽

Dynamic Hip Screw ◽

Care Hospital ◽

Intertrochanteric Fractures ◽

Sliding Hip Screw ◽

Medical College ◽

Femoral Nailing ◽

Hip Screw ◽

One Year ◽

Proximal Femoral Nailing

Background: Incidence of intertrochanteric fractures has increased significantly during recent years and it will probably continue to rise in near future due to increased longevity of life. Closed methods of treatment for intertrochanteric fractures have increased mortality rates & have largely been abandoned. Rigid internal fixation and early mobilization has been the standard protocol of treatment nowadays. This study was intended to compare the results of Intertrochanteric fractures treated by dynamic hip screw (DHS) over proximal femoral nailing (PFN).Methods: This is a randomized prospective study of 102 cases of intertrochanteric fractures, admitted to Mysore Medical College & Hospital, Mysore and ESIC medical college and hospital Kalaburagi and Kamareddy Ortho & Trauma care Hospital Kalaburagi; treated with proximal femoral nailing and DHS. The patients were divided randomly into two groups, each of 51 patients, 51 were treated by Dynamic Hip Screw & 51 were treated with proximal femoral nail (PFN).All patients were followed up for one year.Results: In our series of 102 patients of Intertrochanteric fractures, 51 were treated with sliding hip screw with plate and 51 were treated by an intra-medullary hip screw. Most of the patients were between 51 to 80 years. Slip and trivial fall accounted for 70% cases. Right side was more common accounted for 58.34% of cases. Conclusions: From our study, we consider PFN as better alternative to DHS in more unstable fractures with technically difficulty and require more experience. Sliding hip screw remains the implant of choice for stable type fractures. We noticed less operative time, less blood loss, fewer intra-op complications in PFN group. The quality of the reduction achieved & proper positioning of the implant are important to achieve the best post-operative outcome.

Download Full-text