Comparative study of the management of inter-trochanteric fractures in the elderly: short proximal femoral nail vs dynamic hip screw

Agrawal Nargesh, Tiwari Ashok, Shahid Muhammad, AK Mehra

Abstract

Introduction: Unstable intertrochanteric fractures of the femur are still a great challenge to surgeons with a dilemma of which implant is better. The objective of this study was to compare the results of the new generation short proximal femoral nails (PFN) with the dynamic hip screw (DHS) in intertrochanteric fractures in the elderly.

Method: This is a randomized prospective comparative study of 96 patients over the age of fifty years in two study groups; the first group of 48 patients operated with short proximal femoral nail (Group 1, n=48) and the second group of 48 patients operated with dynamic hip screw and a side plate (group 2, n=48). Patients were followed for at least one year or until union.

Results: Mean time of union in PFN was 9.8 weeks and DHS was 13.5 weeks; p<0.05. Duration of surgery was less with PFN (mean time 42 minutes vs. 65 minutes with DHS; p<0.05). Blood loss was less with PFN with mean 95 ml vs. 162 ml in DHS; p<0.05. Length of incision was small in PFN 8.5+/-1.2 cm while in DHS, the length of incision was 16.5 +/- 2.3 cm.; p<0.05 Post-operative complications were less with the PFN group as compared to DHS.

Conclusion: PFN, being a load sharing implant, provided a good biomechanically stable construct for intertrochanteric fractures of the femur allowing early fracture union and early weight bearing. It is an implant of choice for both stable and unstable types of intertrochanteric fractures.

The Sri Lanka Journal of Surgery 2012; 30(2):13-17

http://dx.doi.org/10.4038/sljs.v30i2.5176

Keywords

Hip fracture; Dynamic hip screw; Proximal femoral nail
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