Comparative evaluation of dynamic hip screw and proximal femoral nail for fracture of intertrochanteric femur

Background: The aim of the present study was to compare the result in terms of rate of union, time of ambulation and functional recovery of fracture intertrochanteric femur treated by dynamic hip screw (DHS) and proximal femoral interlocking nail (PFN) and to compare complications in terms of implant failure, infection, blood loss and C arm exposure in both groups.Methods: This was a prospective study of 92 cases, 38 cases were treated by PFN and 54 cases were treated by DHS. Patients were followed up at 6, 12, 18 and 24 weeks. The results were compared for functional outcome using Palmer and Parker score and also for various complications.Results: Comparison of mobility score at six month follow up period revealed the PFN group to be significantly more mobile (5.8 Vs. 4.19 respectively, p <0.001) than the DHS group. In our study 6 patients managed with DHS (6.52%) developed superficial wound infection which responded to intravenous antibiotics. No patient with PFN had wound infection. Only 2 patients in the PFN group and 12 patients in the DHS group had persistent pain at the incision site.Conclusions: Dynamic hip screw fixation of these fracture requires less preoperative time, is associated with less exposure to radiation but the blood loss is much higher. On the contrary PFN allows faster mobilization and greater mobility scores at six months.

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Comparative evaluation of management of intertrochanteric fracture femur with proximal femoral nailing versus dynamic hip screw

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20203730 ◽

2020 ◽

Vol 6 (5) ◽

pp. 1050

Author(s):

Navneet Adhikari ◽

Chandra Shekhar ◽

Ganesh Singh ◽

Hardev Singh

Keyword(s):

Intertrochanteric Fracture ◽

Joint Stiffness ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Functional Grade ◽

Fracture Femur ◽

Trochanteric Region ◽

Hip Screw ◽

A Prospective Study

Background: Fractures involving trochanteric region of femur are one of the common fractures affecting elderly population. Presently surgical treatment is the treatment of choice with early mobilisation as primary goal. The two most common implants that are used are Dynamic hip screw (DHS) and Proximal femoral nail (PFN).Methods: This was a prospective study with 50 patients divided randomly into two groups of 25 each. One group operated by PFN and other with DHS. Patients were evaluated periodically and final comparison between two group was done at six months for analysing results on the basis of Harris hip score.Results: At final follow up in patients in PFN group 9 (36%), 7 (28%), 5 (20%), 4 (16%) patients had functional grade in excellent, good, fair and poor category respectively. In DHS group patients, 7 (28%), 10 (40%), 6 (24%), 2 (8%) patients had functional grade in excellent, good, fair and poor functional grade. Harris hip score was insignificantly (p>0.05) lower in patients of PFN (82.68±12.28) than DHS (84.60±10.39).Conclusion: At final follow up we found that pain, limp, use of support while walking and hospital stay was less in PFN group. However, range of motion and hip functions were better in patients treated with DHS. Complications like Varus malunion and infection were common in DHS group while hip joint stiffness was seen more commonly in PFN group. So, both PFN and DHS in are comparable in respect to most of functional criteria for treatment of intertrochanteric fracture femur.

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To analyze and use the parameters in post-operative unstable intertrochanteric fractures treated using dynamic hip screw fixation as guidelines for re-operation

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164004 ◽

2016 ◽

Vol 2 (4) ◽

pp. 273

Author(s):

K. Thirusenthil Aathipan ◽

T. R. Ashok ◽

Ganesan G. Ram

Keyword(s):

Prospective Study ◽

Screw Fixation ◽

Dynamic Hip Screw ◽

Intertrochanteric Fractures ◽

Anatomical Reduction ◽

Pull Out ◽

Hip Screw ◽

Tip Apex Distance ◽

Definite Indicator ◽

A Prospective Study

Background: The treatment of unstable intertrochanteric fractures is challenging due to the difficulty in obtaining anatomical reduction. The purpose of this study was to analyse and use the parameters (lateral femoral wall integrity and tip-apex distance) in post-operative unstable intertrochanteric fractures treated using dynamic hip screw (DHS) fixation as guidelines for re-operation.Methods: This was a prospective study and included 40 patients with unstable intertrochanteric fractures treated using DHS fixation from December 2014 to September 2016. The AO/OTA classification was used to classify each of the patients and their lateral femoral wall integrity and tip-apex distance was assessed in the post-operative radiographs.Results: In this study, 3 patients out of 40 (7.5%) had screw pull out within 5 months of surgery. 2 pull outs occurred when the screw was in the antero-superior zone and 1 when it was in the centre to centre zone. Thus, the rate of screw pull out was higher in the antero-superior zone. The 3 patients with screw pull out had a mean tip-apex distance (TAD) of 36.01 mm as compared to 32.96 mm of those who did not have screw pull out. We further found that pre-operatively 6 patients out of 40 (15%) had lost lateral femoral wall integrity whereas post-operatively 26 patients out of 40 (65%) had lost it. In summary, there is a 5 times higher risk of losing lateral femoral wall integrity if DHS is the implant of choice. Conclusions: On conclusion, unacceptable TAD limit with loss of lateral femoral wall integrity was found to be a definite indicator of DHS implant pull out. And also found that by using the DHS as an implant of choice, there is a 5 times higher risk of losing lateral femoral wall integrity intra-operatively and that its use for the treatment of unstable intertrochanteric fractures must be guarded.

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PERTROCHANTERIC FRACTURE FEMUR;

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.03.916 ◽

2013 ◽

Vol 20 (03) ◽

pp. 462-471

Author(s):

NOOR AKBAR SIAL, ◽

NASIR MAHMOOD,

Keyword(s):

Image Intensifier ◽

Standard Technique ◽

Dynamic Hip Screw ◽

Pertrochanteric Fracture ◽

Walking Ability ◽

X Rays ◽

Fracture Femur ◽

Hip Screw ◽

A Prospective Study

Background: Pertrochanteric fracture is common in elderly population. The dynamic hip screw is widely accepted in thetreatment of P/T fractures of the proximal femur. Objective: The purpose of this study was to assess radiological and clinical union inelderly patients after operative treatment of a pertrochanteric femoral fracture with DHS. Design: A prospective study. Setting:Orthopaedic surgery department of Independent Medical College Faisalabad. Study Period: Between July 2009 and June 2012. Method:The study group included 22 males and 51 females aged 50-95 years following pertrochanteric fracture femur either stable or unstable.Relevant history and x-rays were taken. We followed the inclusion and exclusion criteria. All patients were operated on routine operationlist under image intensifier after necessary investigations and fitness for anaesthesia. All the cases were treated by closed/openreduction and a dynamic hip screw (DHS) was inserted by a standard technique. An outpatient follow-up with x-ray check-ups wascarried out at one-month, 3months, 6 months and after 1year intervals to assess union and walking ability as outcome measures.Results: 73 cases were included in study 22 males and 51 females.66 fractures (90%) healed at an average of 12 weeks postoperatively(range 8-28 weeks). There were 4 patients (5.47%) requiring further surgical intervention. No obvious shortening of more than 1.6 cmwas noted compared to the contra lateral normal limb. Our results suggest that fixation with DHS may allow a faster post-operativerestoration of walking ability. Mortality upto1 year 11(15.06%).Further 6(8.22%) patients were lost to follow up. Conclusion: It isconcluded that the Dynamic Hip Screw is safe, suitable and reliable fixation.

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