Functional outcome of intertrochanteric fractures treated with dynamic hip screw and influence of tad over it - 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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A prospective study of treatment of intertrochanteric fractures of femur by fixation with dynamic hip screw or proximal femur nailing

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2019.v5.i1g.61 ◽

2019 ◽

Vol 5 (1.4) ◽

pp. 364-368

Author(s):

Dr. Aditya K Agrawal ◽

Dr. C Sai Sabharish Reddy ◽

Dr. Manish R Shah ◽

Dr. Sarvang Desai ◽

Dr. Paresh Golwala ◽

...

Keyword(s):

Prospective Study ◽

Proximal Femur ◽

Dynamic Hip Screw ◽

Intertrochanteric Fractures ◽

Hip Screw ◽

A Prospective Study

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Dynamic Hip Screw with Trochanteric Stablization Plate Fixation of Unstable InterTrochanteric Fractures: A Prospective Study of Functional and Radiological Outcomes

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2016/20275.8415 ◽

2016 ◽

Cited By ~ 3

Author(s):

Ashwin Shetty

Keyword(s):

Prospective Study ◽

Plate Fixation ◽

Dynamic Hip Screw ◽

Intertrochanteric Fractures ◽

Hip Screw ◽

A Prospective 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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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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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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