A study of management of trochanteric fracture of femur treated with dynamic sliding hip screw-plate device vs. proximal femoral nail

Abstract

Background:The incidence of intertrochanteric fractures has been increasing significantly due to the rising age of modern human populations. Generally, intramedullary fixation [proximal femoral nail (PFN) and gamma nail] and extra-medullary fixation [dynamic hip screw (DHS)] are the 2 primary options for treatment of such fractures. Objectives: The goal of this study is to compare the clinical and radiographical results of DHS and PFN for the treatment of trochanteric hip fractures. Methods: Patients with trochanteric fractures were treated either with DHS or PFN in the Department of Orthopaedics, M.G.M. Medical College and L.S.K Hospital, Kishanganj, Bihar from October 2010 to October 2012 were included for this study. Results: Forty three patients (24 male and 19 female, ratio of M:F 1.26:1) surgically treated for trochanteric fractures were divided into two groups. Group 1: 25 hips treated with DHS and group 2: 18 hips treated with PFN. The outcome for each group was analyzed, and total operative time, time to union, complications (early and late), and mortality were recorded. The results were statistically compared. Out of 25 cases of DHS, majority cases (13) took between 1 hour 36 minutes to 2 hours. Whereas, out of 18 cases of PFN, majority (8) took 1 hour to 1 hour 30 minutes. The mean time to union for group 1 was 2.09 months and 1.69 months for group 2. Early and late complication rates between treatment groups revealed no statistically significant differences. Total duration of surgery was significantly lower for PFN than it was for DHS. A comparison of time to union and overall mortality demonstrated no statistically significant differences. Conclusions: We detected no differences between the two treatment groups in regard to early versus late complications, time to union, and overall mortality; however, with its shorter operative period, PFN is a good alternative to the DHS.