Comparative study of the clinical and radiological outcome of subtrochanteric fracture femur fixed by dynamic condylar screw (DCS) and long proximal femur nail (PFN)

Abstract

Background: Subtrochanteric fractures are included among those injuries caused by severe high energy trauma in the younger population. However, in the older population, this particular hip injury is caused by trivial fall and osteoporotic bones in the elderly population. It is difficult to treat these kinds of fractures easily. In order to avoid major complication such as mortality, the early surgical treatment regime is required to be followed. Aim: To compare and study the clinical and radiological outcome of subtrochanteric fracture femur fixed by Dynamic Condylar Screw (DCS) and Long Proximal Femur Nail (PFN) Materials and Methods: Total of 30 patients was included in the study. Simple randomization technique was employed to categorized patients for either PFN treatment or DCS treatment. Fifteen patients out of 30 were treated using PFN, and the remaining 15 were treated using DCS using close reduction. The study period was from July 2017 to June 2019. All the patients with subtrochanteric femur fractures within two weeks of injury were included for the study. Patients' follow-up was done at 6-weeks, 3-months, and 6 months. Results: The highest number of patients, i.e. 40%, was aged between 51 and 60 years with the mean age of 58.23±1.26 years. The number of male patients (66.66%) was higher as compared to female patients. The mode of treatment for 50% of patients was PFN while it was DCS for the remaining 50% of the patients. The highest number of patients, i.e., 50% had Type III femur fracture. The patients treated using PFN showed improved functional outcome as compared to the patients treated using DCS. The patients were able to bear full weight within five weeks of surgery. The mean union time for patients treated with PFN was 16 weeks, while the mean union time in patients treated with DCS was 19 weeks. Also, the mean Harris Hip Score for patients treated with PFN was 90 and for the patients treated with DCS was 85. Conclusion: In light of the above results and literature, it was clear that PFN was a better surgical intervention as compared to DCS. It required a shorter operation duration and rehabilitation time. The patients treated with PFN showed improved functional outcomes as compared to the patients treated with DCS.

Comparative study between effectiveness of proximal femoral nail and dynamic condylar screw in fixation of subtrochanteric femur fracture

“…PFN and DCS fixation are the most often used systems for the fixation of subtrochanteric femur fractures. In our study of 80 patients, the mean age was 56 years most common age group being 41-60 years, which was similar to studies conducted by Fuse et al, 4 Kachewar et al, 5 Nayak et al, 6 and Bhasme et al 7 However, studies conducted by Islam et al,8 and Mishra et al,9 showed most common age group for subtrochanteric femur fracture being 21-40. In our study, 80% of the patients were male with only 20% females.…”

“…The average blood loss in PFN group was 178 mL, there was a significant lower amount of blood loss in PFN groups compared to DCS group. Fuse et al, 4 Kachewar et al, 5 Nayak et al, 6 and Bhasme et al, 7 also had similar findings.…”

“…In our study, 80% of the patients were male with only 20% females. Kachewar et al, 5 Nayak et al, 6 Bhasme et al, 7 Islam et al, 8 and Mishra et al, 9 all have showed significant higher incidence among men. The higher male incidence may be due to increased outdoor activity.…”

“…However, Islam et al,8 showed the mean time to fracture union, 24.5 weeks for DCS which was lower than 26.25 weeks for PFN.In our study, we observed that 80% of cases in PFN group had good to excellent Harris hip score, whereas, for DCS group, 55% of cases had good to excellent Harris hip score. Fuse et al,4 Kachewar et al,5 and Mishra et al,9 also suggested better functional result in patient operated with PFN than DCS. Similarly, Bhasme et al,7 showed 9 excellent, 9 good, 2 fair, and 2 poor functional outcome in 22 cases of PFN and 2 excellent, 5 good, 5 fair, and 1 poor outcome in 13 cases of DCS group.…”

“…That signfies PFN to be better than DCS with significantly shorter mean time to fracture union.Fuse et al,4 had a mean union time of PFN of 24.6 weeks and 26.4 weeks for DCS. Kachewar et al,5 and Nayak et al,6 both had 16 weeks of mean union time for PFN and 19 weeks for DCS. Mishra et al,9 had 20.4 weeks mean union time among those treated with DCS and 17.04 weeks in those treated by PFN.…”