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

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

<p><strong>Background:</strong> 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.          </p><p><strong>Methods:</strong> 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.</p><p><strong>Results:</strong> 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.                                                                                         </p><p><strong>Conclusions:</strong> 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.</p>

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

2021 ◽  
Author(s):  
Manoj Kumar ◽  
Zubair A. Lone ◽  
M. Farooq Bhatt ◽  
Abdul Basit
Keyword(s):  
Hip Fractures ◽  
Dynamic Hip Screw ◽  
Harris Hip Score ◽  
Trochanteric Fractures ◽  
Femoral Nailing ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Hip Screw ◽  
Proximal Femoral Nailing ◽  
Unstable Fractures

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. 

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

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

<p class="abstract"><strong>Background:</strong> 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.  </p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.  </p><p class="abstract"><strong>Conclusions:</strong> 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.  </p>

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

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

<p class="abstract"><strong>Background:</strong> 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).</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> We observed no statistically significant difference between two groups in view of late &amp; 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.</p><p><strong>Conclusions:</strong> We concluded that PFN may be the better fixation device for most unstable inter-trochanteric fractures. </p>

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

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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).</p><strong>Conclusions:</strong>The proximal femoral nail has better functional outcome in terms of Harris hip score and early radiologic union in unstable intertrochanteric fractures of femur. <p> </p>

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

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

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Incidence of intertrochanteric fractures has increased significantly during recent years and<strong> </strong>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 &amp; 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)</span><span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This is a randomized prospective study of 102 cases of intertrochanteric fractures,<strong> </strong>admitted to Mysore Medical College &amp; Hospital, Mysore and ESIC medical college and hospital Kalaburagi and Kamareddy Ortho &amp; 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 &amp; 51 were treated with proximal femoral nail (PFN).All patients were followed up for one year</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">In our series of 102 patients of Intertrochanteric fractures, 51 were treated with sliding hip screw with<strong> </strong>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</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">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 &amp; proper positioning of the implant are important to achieve the best post-operative outcome</span><span lang="EN-IN">.</span></p>

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

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> The functional outcomes and complications between DHS and locking plate DHS were not significantly different.</p>

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

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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).</p><p><strong>Conclusions:</strong> 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.</p>

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