Randomized control trial comparing the functional outcomes of dynamic hip screw and locking plate dynamic hip screw in intertrochanteric fractures of femur

Background: The objective of the study was to compare the functional outcomes of intertrochanteric fractures of the femur treated with dynamic hip screw (DHS) and locking plate DHS in elderly.Methods: 48 participants (23 in DHS and 25 in locking plate DHS) aged ≥ 50 years with intertrochanteric fracture of femur were enrolled in the present randomized open label parallel group trial conducted at Pushpagiri Institute of Medical Sciences and Research Centre during a period of 1 year. Open, pathological, other fractures in the same limb and participants with neurological involvement were excluded. Standard of care (pre and post-operative care) was given to all participants. Sociodemographic, radiological findings, fracture type and Singh’s index were recorded at baseline, 6 weeks, 3 and 6 months. Study commenced after approval from Institutional Ethics Committee and written informed consent was obtained from all study participants. Participants were randomized in 1:1 ratio using coin flip method. Quantitative variables were expressed means and medians and qualitative variables were expressed as proportions. Tests of significance were independent sample t test, Mann Whitney U test, Friedman test and Chi square test.Results: Between DHS and locking plate DHS, no significant difference in baseline parameters, neck shaft angle, tip apex distance, shortening, Harris hip score, range of motion score and length of hospital stay were observed.Conclusions: The functional outcomes and complications between DHS and locking plate DHS were not significantly different.

Download Full-text

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

Download Full-text

Analysis of the Effect of Dynamic Hip Screw and Anatomical Locking Plate

Advanced Emergency Medicine ◽

10.18686/aem.v4i4.4 ◽

2015 ◽

Vol 4 (4) ◽

pp. 11

Author(s):

Rong Ren ◽

Ying Ren ◽

Junhua Ji

Keyword(s):

Locking Plate ◽

Operation Time ◽

The Elderly ◽

Healing Time ◽

Dynamic Hip Screw ◽

Intertrochanteric Fractures ◽

Successful Operation ◽

Postoperative Drainage ◽

Hip Screw ◽

Intertrochanteric Femur Fracture

Objective: To analyze the effects of dynamic hip screw (DHS) and anatomical locking plate in the treatment of intertrochanteric fractures in elderly patients. Method: 56 cases of intertrochanteric femur fracture from March 2009 to October 2011 were treated by surgical treatment. The cases were divided into A and B groups with A group treated with DHS and B group with anatomical locking plates. Results: Treatments of the two groups were successful. Operation time, bleeding volume, postoperative drainage, hospitalization time and fracture healing time of B group were significantly less than that of A group (p < 0.05). The incidence of postoperative complications in B group was significantly less than that in the A group (p < 0.05). The excellent and good ratings of B group was 93.1% and 66.7% for the A group. The fine rating of B group was higher than that of A group (p < 0.05). Conclusion: Anatomical locking plate internal fixation for the treatment of intertrochanteric fractures in the elderly has certain advantages.

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

A comparative study of proximal femoral fracture fixation with proximal femoral nail and dynamic hip screw and plating

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20172889 ◽

2017 ◽

Vol 3 (4) ◽

pp. 871

Author(s):

Sridhar D. K. ◽

Veeranna H. D. ◽

Madhusudan H.

Keyword(s):

Functional Outcome ◽

Proximal Femoral Fracture ◽

Dynamic Hip Screw ◽

Common Mechanism ◽

Walking Ability ◽

Intertrochanteric Fractures ◽

Equal Distribution ◽

Intramedullary Device ◽

Significant Difference ◽

Hip Screw

Background: Trochanteric fractures are one of the commonest injuries sustained predominantly in patients over sixty years of age. They are three to four times more common in women. These usually occur through bone affected by osteoporosis; trivial fall being most common mechanism of injury Approximately 10-30% of patients die within one year of an intertrochanteric fracture.Methods: A prospective study comprising of patients identified for surgical treatment of fracture in the intertrochanteric region of femur admitted to Sri Siddhartha Medical College, Tumkur from 2016 to 2017 where 30 patients with 30 intertrochanteric fractures of femur were selected with equal distribution of 15 dynamic hip screw devices and 15 intramedullary devices.Results: The purpose of the present study is to verify theoretical advantages of intramedullary device over the dynamic hip screw devices and also whether it actually alters the eventual functional outcome of the patient. Excellent results were seen in 2 patients (13.3%) in the DHS group and in 6 patients (40%) in the PFN group. The overall functional outcome of patients treated with the PFN was significantly better than those treated with DHS (p=0.037). However when we compared the stable and unstable fractures separately, we found that there was no significant difference in the outcomes of the stable fractures in the two groups (p=0.198).Conclusions: We conclude that in stable intertrochanteric fractures, both the PFN and DHS have similar outcomes. However, in unstable intertrochanteric fractures the PFN has significantly better outcomes in terms of earlier restoration of walking ability as it is an intramedullary implant which can tolerate higher cylindrical loading when compared to DHS type of implants. In addition, as the PFN requires shorter operative time and smaller incision, it has distinct advantages over DHS even in stable intertrochanteric fractures. Hence, in our opinion, PFN may be the better fixation device for most intertrochanteric fractures.

Download Full-text

A comparative study between proximal femur locking compression plate and dynamic hip screw fixation in management of intertrochantric femur fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164163 ◽

2016 ◽

Vol 2 (4) ◽

pp. 327

Author(s):

Mithlesh Kumar Meena ◽

Vinay Joshi

Keyword(s):

Locking Plate ◽

Locking Compression Plate ◽

Dynamic Hip Screw ◽

Intertrochanteric Fractures ◽

Trochanteric Fractures ◽

Superficial Infection ◽

Femur Fractures ◽

Compression Plate ◽

Hip Screw ◽

The Mean

Background: Proximal femur fractures are one of the commonest fracture encountered in orthopaedic trauma practice. Dynamic hip screw (DHS) is the gold standard procedure for treatment for stable intertrochanteric fractures, however problem arises with unstable fractures in maintenance of neck shaft angle and proper reduction. Here we are giving results of trochanteric fractures treated with proximal femoral locking compression plate (PFLCP) as compared with dynamic hip screw (DHS).Methods: This study was a prospective study. Two groups of trochanteric fractures of 25 patients operated with DHS and LCP were taken. Each patient was followed-up from July 2011 to October 2012 for minimum of 12 month or till the bony union. Every fracture was classified according to AO classification. Functional results will be assessed as per modified Harris hip evaluation score.Results: Among 25 patient treated with PFLCP, length discrepancy was .857 cm while that for DHS was 1.2 cm. The mean time of unaided walking with LCP Was 14.20 weeks while for DHS it was 16.20 weeks. The mean varus angulation for LCP 8 degree while for DHS 10.2 degree. In LCP in 1 case screw cut out from head and neck of femur while in DHS, same is seen in 2 cases and in addition loss of position of lag screw seen in 5 cases.one case was found with superficial infection in LCP while in case of DHS 3 cases with deep infection for that implant was removed and 6 cases were found with superficial infection.Conclusions: Proximal femoral locking plate (PFLCP) is simple, stable for fixation with fewer complications, and is an effective method for unstable intertrochanteric fractures. Comparing with DHS group, the locking plate has shorter operative time, fewer blood loss and drainage.

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

386 Proximal Femoral Nail (PFN) Versus Dynamic Hip Screw (DHS) In Unstable Intertrochanteric Fractures of Femur -A Comparative Clinical Study

British Journal of Surgery ◽

10.1093/bjs/znab134.267 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

V Dubey ◽

B Spiegelberg ◽

S Shahane ◽

A Samant

Keyword(s):

Blood Loss ◽

Randomized Study ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Leg Length ◽

Femur Fractures ◽

Intertrochanteric Femoral Fracture ◽

Duration Of Surgery ◽

Hip Screw

Abstract Introduction The goal of treatment of an intertrochanteric femoral fracture is restoration of patient's mobility as early as possible. The dynamic hip screw (DHS) has been used for several decades to treat these fractures. Proximal femoral nails (PFN) are reported to have an advantage in such fractures. This study aims at comparing the results of unstable intertrochanteric fractures femur treated with PFN and DHS. Method This was a prospective, randomized study which includes sixty patients. All patients were available for follow up with 30 patients in each group. The data about intraoperative blood loss, time to union, leg length shortening was collected. The functional outcome at the end of one year was evaluated using Harris Hip Score. Results Blood loss, duration of surgery, time to union and leg length shortening was significantly less in the patients treated with PFN (p < 0.05). The mean harris hip score for patients managed with PFN was significantly more than in DHS group, 12 months after surgery (p = 0.05). Conclusions PFN requires a smaller incision, lesser operative time, less blood loss and has improved functional results. In our opinion PFN may be a better fixation device for most of the unstable intertrochanteric femur fractures.

Download Full-text

Reduction in Blood Loss with Tranexamic Acid use in Dynamic Hip Screw Surgery for Intertrochanteric Fractures

10.53350/pjmhs211571657 ◽

2021 ◽

Vol 15 (7) ◽

pp. 1657-1760

Author(s):

Muhammad Akram ◽

Ali Muqadas ◽

Arif Mahmood ◽

Faheem Mubashir Farooqi ◽

Shumaila Jabbar

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Dynamic Hip Screw ◽

Control Group ◽

P Value ◽

Intertrochanteric Fractures ◽

Significant Difference ◽

Group A ◽

Hip Screw ◽

Group B

Aim: To compare the mean decrease in hemoglobin levels in fixation of intertrochanteric fractures with or without use of Tranexamic acid. Methods: This study was conducted at Orthopedics Unit II, Mayo Hospital Lahore, Pakistan. Total 78 patients were included in the study. Duration of study was from 15-07-2017 till 15-01-2018.Study was approved by hospital ethical committee. A written informed consent was taken. Diagnosis was made clinically and with help of radiology. Patients were randomly divided into two groups. Patients in intervention Tranexamic acid (TXA) group received 15 mg/kg of Tranexamic acid at the time of induction of anesthesia and repeated after three hours, while those in the control group received placebo which is normal saline, intravenously. Results: There were 16(41%) males and 23(59%) females in group-A. There were 15(38.5%) males and 24(61.5%) females in group-B. Mean age in group A (control) with standard deviation was 44.2051±9.64141. Mean age in group B (TXA) was 45.9744±9.03061. p value 0.0046. Mean BMI in group A was 25.65±5.136. Mean BMI in group B was 24.307±2.153. p value 0.233. In group A 13(33.3%) patients had hypertension and 26(66.67%) did not have hypertension in group-A. In group B 16 (46.2%) patients had hypertension and 21 (53.8%) did not have hypertension in group-B. Mean fall in Hb in Group A was 9.47±1.054. Mean fall in Hb in group B was 9.547±0.9402. p value 0.001. Statistically significant difference was present in Group B (TXA) in term of mean fall in Hb ( p value 0.001). Conclusion: We in our study concluded that the patients in TXA group who were given tranexamic acid 1g intravenously before start of surgery had a lesser fall in mean Hb for the operative treatment of per trochanteric fractures with dynamic hip screw. Hence injecting tranexamic acid intravenously can effectively reduce the blood loss during DHS surgery for the intertrochanteric fractures. Keywords: Interochanteric fracture, tanexamic acid, blood loss

Download Full-text

Poor outcomes for osteoporotic patients undergoing conversion total hip arthroplasty following prior failed dynamic hip screw fixation: a nationwide retrospective cohort study

Journal of International Medical Research ◽

10.1177/0300060518823410 ◽

2019 ◽

Vol 47 (4) ◽

pp. 1544-1554 ◽

Cited By ~ 3

Author(s):

Qian Xu ◽

Jiajie Lai ◽

Fan Zhang ◽

Yangkai Xu ◽

Fugui Zhu ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Insurance Company ◽

Total Hip ◽

Asian Patients ◽

Significant Difference ◽

Hip Screw

Objectives This study was performed to compare the long-term clinical and radiological outcomes of conversion total hip arthroplasty (CTHA) following prior failed InterTan nail (IT) fixation or dynamic hip screw (DHS) fixation in Asian patients with osteoporotic intertrochanteric hip fractures (IHFs) and to clarify which implant tends to be more favourable for CTHA. Methods Records of consecutive Asian patients with osteoporosis who underwent conversion of failed primary unilateral IT or DHS fixation to THA from 2010 to 2013 were extracted from the comprehensive database of the China Pacific Insurance Company Ltd. All consecutive procedures were managed by high-volume surgeons. The primary endpoint was the clinical outcome. The secondary endpoint was the radiological outcome. Results In total, 447 Asian patients with osteoporotic IHFs (DHS, n = 223; IT, n = 224) were assessed during a median follow-up of 46 months (range, 39–53 months). The two groups showed a significant difference in the Harris hip score at final follow-up and in the orthopaedic complication rate (DHS, 20.2%; IT, 9.8%). Conclusion Conversion to THA following prior failed DHS fixation tends to be associated with poorer clinical and radiological outcomes in Asian patients with osteoporotic IHFs than that following prior failed IT fixation.

Download Full-text

Evaluation of Outcome of Treatment of Intertrochanteric Fracture with Dynamic Hip Screw (DHS)

Ibrahim Cardiac Medical Journal ◽

10.3329/icmj.v9i1-2.53986 ◽

2020 ◽

Vol 9 (1-2) ◽

pp. 36-41

Author(s):

Jonaed Hakim ◽

Afrina Jahan ◽

Mahbubur Rahman Khan ◽

Md Humayun Reza ◽

Rasel Al Zilani ◽

...

Keyword(s):

Intertrochanteric Fracture ◽

Treatment Strategies ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

College Hospital ◽

Female Ratio ◽

Femur Fractures ◽

Fixation Techniques ◽

Hip Screw

Background & Objective: Intertrochanteric femur fractures are becoming increasingly common as our population ages. Effective treatment strategies that result in high rates of union of these fractures and low rates of complication are important. This study was designed to evaluate the clinical outcome of intertrochanteric fracture treated with dynamic hip screw, among many other fixation techniques available to fix intertrochanteric fractures. Methods: This prospective interventional study was done in the Department of Orthopaedics & Traumatology Department of Dhaka Medical College Hospital, Dhaka between June 2013 to November 2014. A total of 30 patients having intertrochanteric femur fracture were treated with Dynamic Hip Screw (DHS) after doing all necessary investigations for anesthetic fitness. Regular follow up was done up to six months after each operation and was observed for fracture healing, stability, complications and functional outcome by the prescribed scoring system (Harris Hip Score). Result: Nearly one third (30.0%) of the patients belonged to 7th decade and male to female ratio was 1:1.3. According to Harris Hip Score, 13(44.82%) patients were rated as excellent, 9 (31.03%) good, 5(17.24%) fair and 2(6.89%) poor. Conclusion: Dynamic hip screw (DHS) is a reliable method of fixing the stable intertrochanteric femur fractures. The reliability and long-term effect of dynamic hip screw used to treat intertrochanteric fractures of unstable variety are unsatisfactory and not up to the mark. Ibrahim Card Med J 2019; 9 (1&2): 36-41

Download Full-text