Dynamic Hip Screw in Comparison with Proximal Femoral Nail Technique in Intertrochanteric Femur Fracture Patients

Background: Hip bone fractures are the main cause of concern on a worldwide level. The main two operative techniques involve dynamic hip screw and proximal femoral nail technique. Aim: To compare the dynamic hip screw with proximal femoral nail technique in intertrochanteric femur fracture patients. Study design: Retrospective study Place and duration of study: Department of Orthopaedics, Khyber Teaching Hospital, Peshawar from 1-7-2019 to 30-12- 2021. Methodology: Seventy patients were enrolled and they were divided in two groups; Group 1 patients were operated with dynamic hip screw (DHS) while group 2 patients were operated by proximal femoral nail (PFN) technique. The detailed pre and post-operative clinical information including blood loss, incision size, Harris hip score and rate of complication was documented. Results: The mean age of patients was 58.62±6.71 year with more male patients than females. The Harris hip score of proximal femoral nail technique was better than distal hip screw. The incision length of distal hip screw cases was 7.61±0.89 in comparison to 4.72±0.73 in proximal femoral nail technique cases with a longer duration of surgery and inter-operative blood loss in case of distal hip screw cases. Conclusion: Proximal femoral nail technique is comparatively better than the distal hip screw procedure. Keywords: Proximal femoral nail technique, distal hip screw, Hip fracture

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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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Outcome of proximal femur fracture treated with long proximal femoral nail and dynamic hip screw

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2017.v3.i3i.95 ◽

2017 ◽

Vol 3 (3i) ◽

pp. 600-606

Author(s):

Dr. Arvind Kumar ◽

Dr. Anurag Jain ◽

Dr. Aditya Agrawal ◽

Dr. Malkesh Sah ◽

Dr. Anirudh Bansal ◽

...

Keyword(s):

Proximal Femur ◽

Femur Fracture ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Proximal Femur Fracture ◽

Femoral Nail ◽

Hip Screw

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Randomized comparative study to evaluate the role of proximal femoral nail and dynamic hip screw in unstable trochanteric fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20162618 ◽

2016 ◽

Vol 2 (3) ◽

pp. 75

Author(s):

Shivanand C Mayi ◽

Sachin Shah ◽

Sadashiv R Jidgekar ◽

Arunkumar Kulkarni

Keyword(s):

Comparative Study ◽

Functional Outcome ◽

Trochanteric Fracture ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Trochanteric Fractures ◽

Stable Fixation ◽

Femoral Nail ◽

Duration Of Surgery ◽

Hip Screw

Background: Treatment of unstable trochanteric fracture is much more challenging than stable fracture. These fractures require stable fixation to minimize the fracture and implant related complications. Need of this study is to assess the suitable implant for stable fixation of unstable trochanteric fracture with less intra and postoperative complications and good functional outcome.Methods: In this prospective randomized comparative study, 64 patients were distributed into two groups. Group A consisted of patients treated by proximal femoral nail (PFN) (n=32) and group B treated by dynamic hip screw (DHS) (n=32). All the patients were evaluated preoperatively and surgery was done according to the group they were allotted. Post-operative follow up was done at 6 weeks, 3, 6 and 12 months.Results: Average age of the patients in this study was 51.26±10.24 year. In this study patients were followed up for an average of 10.87±2.61 month. The duration of surgery was shorter in PFN group. Weight bearing was earlier in PFN group than DHS group. Mean functional ability score was better in PFN group with significant gain in function earlier as compared to DHS group.Conclusions: PFN is a better implant for internal fixation of unstable trochanteric fractures which allows early mobilization and has got better functional outcome score in early postoperative period than DHS

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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.

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Treatment of Trochanteric Fractures with Proximal Femoral Nail Antirotation or Dynamic Hip Screw Systems: A Meta-Analysis

Journal of International Medical Research ◽

10.1177/147323001204000302 ◽

2012 ◽

Vol 40 (3) ◽

pp. 839-851 ◽

Cited By ~ 16

Author(s):

C Zeng ◽

Y-R Wang ◽

J Wei ◽

S-G Gao ◽

F-J Zhang ◽

...

Keyword(s):

Blood Loss ◽

Meta Analysis ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Intraoperative Blood Loss ◽

Trochanteric Fractures ◽

Fixation Failure ◽

Duration Of Surgery ◽

Hip Screw ◽

Proximal Femoral Nail Antirotation

OBJECTIVE: A meta-analysis to compare the intraoperative and postoperative outcome data for the proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS) implant systems for the treatment of patients with trochanteric fractures. METHODS: A detailed search of several electronic databases was undertaken to identify randomized controlled trials published before 5 December 2011 that compared PFNA with DHS in patients with trochanteric fractures. RESULTS: A quantitative meta-analysis of 11 studies including 798 patients was performed. PFNA was associated with significant reductions in duration of surgery (weighted mean difference [WMD] −21.38 min; 95% confidence interval [CI] −33.50, −9.26 min), intraoperative blood loss (WMD −176.36 ml; 95% CI −232.20, −120.52 ml), rate of fixation failure (relative risk [RR] 0.27, 95% CI 0.11, 0.62) and rate of postoperative complications (RR 0.46; 95% CI 0.31, 0.70) compared with DHS. CONCLUSION: The use of PFNA for treatment of trochanteric fractures was found to be superior to DHS in terms of the duration of surgery, intraoperative blood loss, and rates of fixation failure and overall complications.

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Comparative study between proximal femoral nail and dynamic hip screw with trochanteric stabilizing plate in unstable intertrochantric femur fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20173198 ◽

2017 ◽

Vol 3 (5) ◽

pp. 936

Author(s):

Siddaram N. Patil ◽

Pandurangaiah Srinivas

Keyword(s):

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Unstable Fracture ◽

Intertrochanteric Fractures ◽

Femoral Nail ◽

Hip Screw ◽

Mobility Score ◽

Unstable Fractures ◽

Parker Mobility Score

Background: Unstable fractures accounts for approximately 50 to 60% of all intertrochanteric fractures. Failure rates of (DHS) dynamic hip screw for unstable fracture patterns are as high as 50%. Proximal femoral nail is technically more demanding surgery and also associated with complications like implant failure, femoral shaft fracture, improper reduction, screw cut-out and non-union. This study was done to compare the results of using Trochanteric stabilization plate in addition to dynamic hip screw versus proximal femoral nail which is considered as a better implant for unstable fractures.Methods: A prospective study was conducted comparing outcomes of proximal femoral nailing versus trochanteric stabilization plate with dynamic hip screw for 44 patients with unstable intertrochanteric fractures (22 each). Harris hip scoring system and Parker mobility score was used for evaluation.Results: In our study, Average time of union in all 22 patients of PFN group was about 12 weeks while average time of union in all 22 patients of DHS with TSP group was about 14 weeks. The Harris hip score was 85.45 in DHS with TSP group while it was 84.72 in the PFN group (p=0.846). The Parker mobility score was 7.81 in the DHS with TSP group while it was 7.95 in the PFN group (p=0.728). Conclusions: Use of TSP with DHS can give good results in unstable IT fractures. Addition of TSP to DHS gives good lateral wall buttress which prevent excessive medialisation of shaft and gives comparable result to PFN.

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Functional outcome and revision rate of proximal femoral nail antirotation versus dynamic hip screw for osteoporotic intertrochanteric femur fracture: A systematic review and meta-analysis

Journal of Orthopedics Traumatology and Rehabilitation ◽

10.4103/jotr.jotr_17_20 ◽

2020 ◽

Vol 12 (1) ◽

pp. 31

Author(s):

SherlyDesnita Savio ◽

IMade Arya Susila ◽

CokordaGde Oka Dharmayuda

Keyword(s):

Systematic Review ◽

Functional Outcome ◽

Femur Fracture ◽

Revision Rate ◽

Meta Analysis ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Hip Screw ◽

Proximal Femoral Nail Antirotation ◽

Intertrochanteric Femur Fracture

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A comparative study of Dynamic Hip Screw and Proximal Femoral Nail in the management of Intertrochanteric Fractures of the Femur

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v24i1.41031 ◽

2021 ◽

Vol 24 (1) ◽

pp. 14-18

Author(s):

Sandeep Gurung ◽

Gopalsagar DC

Keyword(s):

The Elderly ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Distinct Advantage ◽

Unstable Fracture ◽

Intertrochanteric Fractures ◽

Femoral Nail ◽

Clinical And Radiological Outcome ◽

Hip Screw ◽

Intertrochanteric Femur Fracture

Introduction: Intertrochanteric fractures account for approximately half of the hip fractures in the elderly because of the osteoporotic nature of the bone. There are various modalities to treat these fractures. The objective of this study was to compare and evaluate the clinical and radiological outcome of intertrochanteric femur fracture treated with Dynamic hip screw (DHS) and proximal femoral nail (PFN). Methods: This study was conducted at Nepalgunj medical college, Department of orthopedics Nepalgunj over a time span of two years. A total of 52 patients were included and randomized into Dynamic hip screw (n=26) and Proximal femoral nail (n=26) group. Patient’s demographic details, perioperative findings, radiological findings and follow up findings were recorded. The results were evaluated and compared. Results: The mean age in our study was 57.63 years. Trivial fall was the most common mode of injury. There was significantly higher intraoperative blood loss in the DHS group. Radiological union and functional outcomes were similar overall, but in case of unstable fracture functional outcome was clinically better in PFN group. Conclusion: From our study we concluded that PFN has better outcome in case of unstable intertrochanteric fractures, however in stable fracture also it has distinct advantage over DHS.

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Proximal femoral nail antirotation versus dynamic hip screw fixation for treatment of osteoporotic type 31-A1 intertrochanteric femoral fractures in elderly patients

Journal of International Medical Research ◽

10.1177/0300060517703277 ◽

2017 ◽

Vol 45 (3) ◽

pp. 1109-1123 ◽

Cited By ~ 9

Author(s):

Xianshang Zeng ◽

Nan Zhang ◽

Dan Zeng ◽

Lili Zhang ◽

Ping Xu ◽

...

Keyword(s):

Elderly Patients ◽

Femoral Fractures ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Secondary Outcome ◽

Femoral Nail ◽

Hip Screw ◽

Proximal Femoral Nail Antirotation

Objective To evaluate long-term radiographic and functional outcomes between dynamic hip screw (DHS) and proximal femoral nail antirotation (PFNA) fixation for treatment of osteoporotic type 31-A1 intertrochanteric femoral fractures (IFFs) among elderly patients Methods A retrospective comparative study was carried out. Follow-up was performed at 1, 3, 6, 9, and 12 months postoperatively and yearly thereafter. The primary outcome was the radiographic outcome, and the secondary outcome was the functional outcome. Results A significant difference in radiographic complications was observed between the DHS group (n = 45, 40.2%) and PFNA group (n = 15, 13.6%). The risk of femoral shaft fracture after implant removal at the 1-year follow-up was increased by 0.9% (n = 1) and 6.3% (n = 7) in the PFNA and DHS groups, respectively. This difference persisted with rates of 3.6% (n = 4) and 12.5% (n = 14) at the final follow-up. Additionally, significant differences were present in the Harris hip score at each visit. Conclusion Our results indicate that PFNA yields better outcomes than DHS fixation among elderly patients with osteoporotic type 31-A1 IFFs.

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A prospective comparative study between proximal femoral nail and dynamic hip screw treatment in trochanteric fractures of femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20175562 ◽

2017 ◽

Vol 4 (1) ◽

pp. 58

Author(s):

Mahendra Kumar Reddy Mundla ◽

Mohammad Rafi Shaik ◽

Someswara Reddy Buchupalli ◽

Chandranna B.

Keyword(s):

Blood Loss ◽

Comparative Study ◽

Operating Time ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Intertrochanteric Fractures ◽

Type Ii ◽

Femoral Nail ◽

Prospective Comparative Study ◽

Hip Screw

Background: Intertrochanteric (IT) fracture is one of the most common fractures of the femur in the female and elderly with osteoporotic bones, usually due to simple falls. Not many studies compared the treatment of dynamic hip screw (DHS) and proximal femoral nail (PFN), in type II intertrochanteric fractures. Hence, this study was done to compare the management, complications, functional and radiological outcome of PFN with DHS in management of type II intertrochanteric fractures.Methods: This prospective comparative study was conducted on 60 patients of IT fractures at Santhiram General Hospital, Nandyal, Kurnool (Dist.) during the period May 2016 to September 2017. 30 cases were operated with proximal femoral nail (PFN) and 30 by using dynamic hip screw (DHS). Intraoperative details, complications and outcome of the procedures were noted, compared and analysed statistically.Results: The mean age in DHS group was 57.5 and PFN group was 56.5 yrs. Female preponderance was observed in the study. Most of the injuries were on right side due to slip and fall in both the groups. Mean radiographic exposure (60 sec) and duration of operation (90 min) were more in PFN group compared to DHS group. Mean blood loss was 230 ml in PFN group and 320 ml in DHS group. Better anatomical and functional results were observed in PFN group compared to DHS group. Conclusions: PFN is the better surgical procedure for elderly patients with IT fractures in terms of reduced blood loss, shorter operating time, rotational stability, good fixation, less morbidity and good outcome (anatomical and functional).

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