A comparative, prospective study of proximal femoral nail and dynamic hip screw in the treatment of stable intertrochanteric fractures in adult Indian patients
Journal Title: Medpulse International Journal of Orthopedics - Year 2018, Vol 7, Issue 2
Abstract
Background: Conservative treatment for intertrochanteric fractures (ITF) have shown higher mortality and have largely been abandoned. Rigid internal fixation and early mobilization is the current standard treatment. Methodology: In this prospective study, we compared efficacy, rate of union, complications, operative risks and functional outcomes in ITF, treated with dynamic hip screw (DHS) and proximal femoral nail (PFN). Results: We included 30 eligible patients (females=19). Fall from the height (n=12) was most common and 53.33% had Boyd and Griffin Type II fracture. Mean radiographic exposure (70 Vs 40) and duration of surgery (100min Vs 80 mins) was greater, but blood loss was less (240mL s 320 mL) with PFN. Failure to achieve closed reduction, fracture of lateral cortex, fracture displacement by nail insertion, failure to put de-rotation screw and drill bit breakage, improper positioning of Richard screw, varus angulation were seen with PFN and DHS, respectively. Stiffness of hip and knee were seen with PFN; occurrence of shortening of >1cm, varus malunion was double with PFN. Mean duration of hospital stay and time for full weight bearing was 26 daysand 12.7 weeks (PFN-10.6weeks, DHS-14.8weeks), respectively. Restriction of hip rotation was more with DHS. Good to excellent results were seen in 81.8% and 63.33%in PFN and DHS, respectively. There were two deaths (myocardial infacrction and liver disorder) in DHS group. Conclusion: PFN is a better alternative to DHS but is technically difficult procedure requiring greater precision and expertise. Proper patient selection and good preoperative planning helps to minimize complications.
Authors and Affiliations
Anil Kumar DN, Gowda B
Keywords
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