A Comparative Study of Intertrochanteric Fracture Femur Treated with Proximal Femoral Nailing and Dynamic Hip Screw

Introduction: Although the effects of PFN and DHS in treatment of intertrochanteric fractures have been reported, and many studies have been done to compare both implants but the results and conclusions are not consistent and there is still ongoing controversy whether PFN is a better choice than DHS. Therefore, with the goals of better stable surgical construct of intertrochanteric fractures and early mobilization of patients, this study was planned with rationale to compare the intraoperative complications and functional and radiological outcome of intertrochanteric fractures in patients treated with dynamic hip screw and proximal femoral nail.

Materials and Methods: This study was carried out in GMERS Medical College and General Hospital Gotri Vadodara from September 2020 to December 2021, consisting of total 50 patients of intertrochanteric factures of femur. This was a Randomized control prospective study. All the patients were operated by surgeons experienced in handling both implants. For evaluation, personal data, mode of trauma, type of fracture, type of surgery, intra operative & post operative complications, follow up examination and duration of full weight bearing were recorded.

Results: Fracture reduction in stable fractures was good and comparable in both DHS (81.25%) And PFN (80%) groups but fracture reduction in unstable fractures was better in PFN group (73%). Mean duration of hospital stay was more in DHS group(7.2 days).Union occurred in all fractures in our study but there were two cases of shortening and varus malunion in unstable type in each DHS and PFN group. Mean duration of fracture union was earlier in PFN group, [15.56 weeks] comparing to DHS group [20.64weeks]. The duration of fracture union was more in unstable type compared to stable type in DHS group but it is nearly same in both type in PFN group. Mean HARRIS hip score was more in PFN group at 6 weeks after surgery. But it became nearly equal in both groups at 20 weeks period.

Conclusion: PFN group had advantage of lesser blood loss, incision length, operative time and lesser hospital stay, Early weight bearing and early functional rehabilitation. DHS group had advantage of lesser intraoperative radiation exposure and lesser implant related intraoperative complication. Varus collapse and shortening in unstable fractures were  more in DHS than PFN group but statistically insignificant. In stable fractures Both PFN and DHS are equally performing implant. But in unstable fractures PFN had edge over DHS with better functional outcome.