Dynamic hip screw with locked plate VRS Proximal Femoral Nail for the management of intertrochanteric fracture: A comparative study

Abstract

Dynamic hip screw has long been a standard implant for intertrochanteric hip fractures. The inception of intramedullary nails has further revolutionized their management. With a constant evolution in the designs of both these implants, there has always been a conflict concerning the superiority of one over the other. In this randomized prospective cohort study, 80 patients with intertrochanteric fracture femur were segregated into two groups based on internal fixation with DHS with locking side plate (DHS) (n=40) or Proximal femoral Nail (PFN) (n=40). Clinical and radiological parameters were studied and functional evaluation was done with Harris hip score. The intraoperative parameters were in favor of PFN with significantly less duration of surgery, length of incision and blood loss but more fluoroscopy time. Postoperatively also, PFN group patients excelled with significantly less postoperative pain, less incidence of deep infection , better range of motion, less mean limb length discrepancy and more patients regaining their pre injury walking capability and also fewer complications. Average union time was comparable between the groups. Functionally, PFN emerged to be superior to DHS in unstable intertrochanteric fractures while in stable fractures, results were same. We deduce that surgical planning and expertise with rigorous regard to the personality of the fracture are pivotal for outstanding results.