Comparative analysis between dynamic hip screw and proximal femoral nail the management of intertrochanteric femoral fracture

Resumo Objetivo Identificar a energia necessária para ocorrência de fratura do fêmur proximal em osso sintético após retirada de três modelos de implantes: parafusos canulados, parafuso dinâmico do quadril (dynamic hip screw-DHS) e haste femoral proximal (proximal femoral nail-PFN). Métodos Foram utilizados 25 modelos de ossos sintéticos da extremidade proximal do fêmur: 10 unidades de grupo controle (GC), 5 unidades após colocação e retirada de 3 parafusos canulados colocados em configuração de triângulo invertido (GPC), 5 unidades após colocação e retirada do parafuso de compressão dinâmico (GDHS), e 5 unidades após colocação e retirada da haste de fêmur proximal (GPFN). Uma análise biomecânica foi realizada em todas as amostras simulando uma queda sobre o grande trocânter utilizando uma máquina servo-hidráulica com o objetivo de verificar a energia (em Joules [J]) necessária até a ocorrência de fratura nos diferentes grupos. Resultados Todos os grupos apresentaram fratura basocervical. Os grupos GC, GPC, GDHS e GPFN apresentaram, respectivamente, valores de 7.1J, 6.6J, 6J e 6.7J de energia até ocorrência da fratura. Não houve diferença estatisticamente significativa (intervalo de confiança de 95%) na energia entre os grupos de estudo (p = 0,34). Conclusão Não houve diferença estatisticamente significativa nos valores de energia necessária para ocorrência de fratura da extremidade proximal do fêmur após a retirada de três tipos de implantes utilizando modelos sintéticos simulando queda sobre o grande trocânter.

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The Treatment of Intertrochanteric Femoral Fracture with Proximal Femoral Nail Antirotation

Journal of the Korean Fracture Society ◽

10.12671/jkfs.2012.25.4.257 ◽

2012 ◽

Vol 25 (4) ◽

pp. 257

Author(s):

Jong Won Kim ◽

Hyun Soo Park ◽

Young Soo Jang ◽

Jae Hyuk Choi ◽

Sung Ju Bae ◽

...

Keyword(s):

Femoral Fracture ◽

Proximal Femoral Nail ◽

Femoral Nail ◽

Intertrochanteric Femoral Fracture ◽

Proximal Femoral Nail Antirotation

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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 comparison study of proximal femoral nail and dynamic hip screw devices in unstable trochanteric fractures

Benha Medical Journal ◽

10.4103/bmfj.bmfj_81_18 ◽

2018 ◽

Vol 35 (3) ◽

pp. 413

Author(s):

MohamedA Mostafa ◽

HassanH Ahmed ◽

HaniA.M Bassiooni ◽

ElsayedM Mohamady

Keyword(s):

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Comparison Study ◽

Trochanteric Fractures ◽

Femoral Nail ◽

Hip Screw

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Effects of Proximal Femoral Nail Anti-Rotation (PFNA-II) and Artificial Total Hip Arthroplasty (THA) on Unstable Intertrochanteric Femoral Fracture Combined with Severe Osteoporosis

Journal of Biomaterials and Tissue Engineering ◽

10.1166/jbt.2020.2255 ◽

2020 ◽

Vol 10 (3) ◽

pp. 413-417

Author(s):

Xiaosong Chen ◽

Xunsheng Cheng ◽

Wuxiu Ma ◽

Congcong Chen ◽

Gan Zhang

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Femoral Fracture ◽

Proximal Femoral Nail ◽

Therapeutic Effects ◽

Severe Osteoporosis ◽

Total Hip ◽

Femoral Nail ◽

Intertrochanteric Femoral Fracture

The current study was conducted to compare the therapeutic effects of proximal femoral nail antirotation (PFNA-II) and artificial total hip arthroplasty (THA) on elderly Chinese patients with unstable intertrochanteric femoral fracture combined with severe osteoporosis. There were 60 people in each group. The duration of surgery, blood loss, and weight-bearing period when standing on the floor were compared between the two groups (P > 0.05). Harries function scores of both groups increased over time. Scores of THA group were significantly higher than those of PFNA-II group during six- and twelve-months follow-up visit (P < 0.05). In addition, excellent and good rates of hip joint function in THA group were higher than those of PFNA-II group during twelve-month follow-up visit (P < 0.05). The occurrence rates of follow-up complications in both groups showed no statistical significance (P > 0.05). Thus, both PFNA-II and THA have good effects on Chinese elderly patients with unstable intertrochanteric femoral fracture combined with severe osteoporosis.

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