Comparative study of fixation of intertrochanteric fracture of the femur by proximal femur nail versus dynamic hip screw

Background: Intertrochanteric fractures are common in old age group, but uncommon in younger age group. The goal of treatment of intertrochanteric fractures is restoration to pre-injury status at the earliest. The purpose of this study is to compare the functional outcome of the two fixation devices proximal femur nail (PFN) and dynamic hip screw available for intertrochanteric fractures in terms of the eventual functional outcome of the patient.Methods: Prospective study of 30 cases of Intertrochanteric fractures admitted and operated in KIMS hospital from November 2017 to May 2019. Follow-up of these patients was done at 6 weeks, 12 weeks and 24 weeks with functional evaluation was done using Harris hip score at the 24th week.Results: The results at the end of 24 weeks follow-up were calculated by the Harris hip score were better with the PFN. 66.7% of the patients operated with PFN gave excellent results as compared to 60% of patients operated with dynamic hip screw (DHS).Conclusions: We conclude that the use of PFN for the fixation of trochanteric fractures against the proven DHS offered better results along with a few advantages. PFN required smaller incision, shorter duration of surgery, less blood loss and faster recovery and better functional outcome at the end of 24 weeks. But still PFN is technically more demanding than the DHS and was found to have longer fluoroscopy exposure.

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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.

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Cannulated cancellous screws versus dynamic hip screw in femoral neck fractures: a comparison in productive age group at tertiary care hospital of North India

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20205398 ◽

2020 ◽

Vol 7 (1) ◽

pp. 44

Author(s):

Sakib Arfee ◽

Akib Arfee ◽

Adnan Aadil Arfee

Keyword(s):

Femoral Neck ◽

Femoral Neck Fractures ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Age Group ◽

Fracture Neck Femur ◽

Hip Screw ◽

Cancellous Screws ◽

Lost To Follow Up

Background: Since intracapsular fracture neck femur was recognized by Ambrose Pare almost 4 centuries back, the management of intracapsular neck femur fracture has undergone many changes. The multitude of various implants designed and techniques available for its treatment themselves indicate the inadequacy of the various methods of treatment. Objective was to compare cannulated cancellous screws (CCS) versus dynamic hip screw (DHS) in femoral neck fractures in productive age group.Methods: This observational study with both prospective and retrospective data analysis of patients operated by different surgeons in same hospital setup has been conducted from March, 2018 to February, 2020 at the department of Orthopedics, Government Medical College (GMC), Jammu. 105 cases satisfying the inclusion criteria admitted in GMC Jammu were included clinically and radiologically. Total number of patients included in the study was 97 patients as 8 patients were lost to follow-up. Functional outcome was evaluated by using Harris hip scoring.Results: In our study 8 CCS cases were lost to follow up. Total 97 of cases were followed up till one year both radiologically and clinically after a given time intervals and final assessment done on the basis of Harris hip score. Among 97 cases 71 were males most of them in age group of 41-45 years and 26 were females with 46-50 years age group predominance. 47.42% fractures were classified as type III in garden’s staging. Conclusions: DHS is a better implant than CCS in hands of doctors who lack of expertise and precision i.e. required for CCS in fracture neck femur in young adult patients.

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Prospective randomised control study of role of proximal femur nail and dynamic hip screw and plate in unstable intertrochanteric fractures of the femur in elderly

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2018.v4.i2l.117 ◽

2018 ◽

Vol 4 (2l) ◽

pp. 812-815

Author(s):

Naveen PR ◽

Kiran Kumar HG ◽

Chaitanya PR ◽

Ramachandra N Badami

Keyword(s):

Proximal Femur ◽

Dynamic Hip Screw ◽

Intertrochanteric Fractures ◽

Hip Screw ◽

Proximal Femur Nail ◽

Fractures Of The Femur ◽

Control Study

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

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20201090 ◽

2020 ◽

Vol 6 (3) ◽

pp. 525

Author(s):

Kiran Ramachandran ◽

Dileep Sasidharan ◽

Oommen Mathew

Keyword(s):

Functional Outcomes ◽

Locking Plate ◽

Dynamic Hip Screw ◽

Research Centre ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Neck Shaft Angle ◽

Operative Care ◽

Significant Difference ◽

Hip Screw

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.

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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.

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