Type II Intertrochanteric Fractures: Proximal Femoral Nailing (PFN) Versus Dynamic Hip Screw(DHS)

Abstract

<br/><strong><span style="font-size: xx-small;">Background: </span></strong><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Intertrochanteric fracture is one of the most common fractures of the hip especially in the elderly with osteoporotic bones, usually due to low-energy trauma like simple falls. Dynamic Hip Screw (DHS) is still considered the gold standard for treating intertrochanteric fractures by many. Not many studies compare the DHS with Proximal femoral </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">nail (PFN), in Type II intertrochanteric fractures (Boyd and Griffin classification). This study was done to compare the </span></span><br/><span style="font-size: xx-small; font-family: Arial,Arial;">functional and radiological outcome of PFN with DHS in treatment of Type II intertrochanteric fractures. </span><br/> <br/>Methods: <br/><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">From October 2012 to March 2015, a prospective comparative study was done where 30 alternative cases of type II intertrochanteric fractures of hip were operated using PFN or DHS. Intraoperative complications were noted. </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">Functional outcome was assessed using Harris Hip Score and radiological findings were compared at 3, 6, and 12 </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">months postoperatively. </span></span></span></strong><br/>Results: <br/><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">The average age of the patients was 60 years. In our series we found that patients with DHS had increased </span></span><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">intraoperative blood loss (159ml), longer duration of surgery (105min), and required longer time for mobilization while patients who underwent PFN had lower intraoperative blood loss (73ml), shorter duration of surgery (91min), and allowed early mobilization. The average limb shortening in DHS group was 9.33 mm as compared with PFN group which was only 4.72 mm. The patients treated with PFN started early ambulation as they had better Harris Hip Score in the early post-op period. At the end of 12th month, there was not much difference in the functional outcome between the two groups. </span></span></span></strong><br/>Conclusion: <br/><strong><span style="font-size: xx-small;"><span style="font-size: xx-small; font-family: Arial,Arial;"><span style="font-size: xx-small; font-family: Arial,Arial;">PFN is better than DHS in type II inter-trochanteric fractures in terms of decreased blood loss, reduced duration of surgery, early weight bearing and mobilization, reduced hospital stay, decreased risk of infection and decreased complications. </span></span></span></strong>