A comparative prospective study of osteosynthesis in intertrochanteric fractures, using dynamic hip screw (DHS) and proximal femoral nailing (PFN)

Abstract

Background: Intertrochanteric fractures (IT) are fragility fractures of hip and mostly associated with senile osteoporosis with trivial trauma or low velocity injuries. Traditionally extramedullary osteosynthesis in form of dynamic hip screw (DHS) was treatment of choice for these fractures in past but recent trends are more in favors of intramedullary osteosynthesis as proximal femoral intramedullary nailing (PFN). Here we studied and compared the radiological and functional evaluation of treatment parameters of these fractures managed with both modalities of treatment. Methods: This prospective randomized study was conducted on 42 patients (21 patients in each group, group A, DHS; group B, PFN) with intertrochanteric fracture managed in two years of duration (July 2014 to June 2016). All the per-operative findings and complications were compared, while radiological assessment with radiographs and functional evaluation with Harris hip score was done at 1, 3 and 6 months post-operative follow-ups. Results: Mean age of patients were 56.14 years (range 25-84), and 56.19 years (range 28-80), in group A and B respectively. We observed that PFN had less mean blood loss (144 ml), less mean limb length shortening (0.5 cm) and gained better mean functional results at 6 months (Harris hip score, 86.9) due to early mobilization while patients managed with DHS had more blood loss (155 ml), more shortening (1.07 cm) and less functional outcomes at 6 months follow-up (scores, 77.2). Intra-operative radiation exposure was more in PFN group, while there was no significant difference in radiological union, neck-shaft angle and implant sliding in both groups. Conclusion: PFN was better than DHS in management of intertrochanteric fractures in terms of per-operative parameters (decreased blood loss, less complications), and as well as in functional outcomes (early weight bearing and mobilization, better Harris hip scores), while other parameters are not significantly different.