Is trochanteric fixation nail a better implant in the management of intertrochanteric fracture in elderly compared to dynamic hip screw

Abstract

Background: Intertrochanteric fractures are the most common fractures in elderly and have devastating sequence if not managed properly. The ultimate goal in the management of Intertrochanteric fracture is early mobilization of patients to prevent morbidity and mortality. Early mobilization primarily depends on the implant used & stability of the surgical construct. The purpose of this study is to compare the functional and radiological outcome of intertrochanteric fractures in elderly & osteoporotic patients managed with Dynamic Hip Screw (DHS) & Trochanteric Fixation Nail (TFN). Materials and Methods: The present study was carried out at Rajah Muthiah Medical College & Hospital from June 2016 to May 2017. 20 patients of age more than 60 years with intertrochanteric factures of femur were treated with Trochanteric Fixation nail (10 cases) and Dynamic Hip Screw (10 cases). Discussion: Individual cases were followed up for at least 24 weeks to one year and during each & every follow up visit clinical, radiological, functional outcomes were documented, analyzed, evaluated and compared. In our study of 10 patients, we had 8 patients (40%) with stable type of fracture pattern and 12 patients (60%) cases were of unstable fracture pattern. 5 patients underwent DHS and 3 patients underwent TFN in the stable category of 8.Whereas 5 patients underwent DHS and 7 patients underwent TFN in unstable Intertrochanteric fracture group of 12 patients. Results: The Average time taken for union was about 16 weeks (Range: 12 to 20 weeks) and full weight bearing correlated well with the time of fracture union. Conclusion: We conclude that the fracture pattern& experience of the surgeon are the primary determinants of implants choice & primary fixation of intertrochanteric fractures aid early rehabilitation and return back to activities of daily living.