Comparative study on evaluation of results of DHS versus PFN in management of intertrochanteric fractures femur

Abstract

Introduction: Inter-trochanteric fractures constitute 38-50% of all femoral fractures' and 5-20% of fractures as whole. The treatments for trochanteric fractures try to regain early mobility and limit morbidity and risk of reoperations. The most currently used dynamic hip screw (DHS) and the proximal femoral nail (PFN) are both with pros and cons. The aim of this study was to compare operative management and functional outcome of femoral intertrochanteric fractures by dynamic hip screw v/s proximal femoral nail implants. Materials and Methods: This prospective study was carried on 60 consecutive patients with intertrochanteric fractures of femur to compare our results of treatment by dynamic hip screw v/s proximal femoral nail. The patients were divided randomly in two groups A (DHS) and B (PFN) with equal number of patients (n=30) in each group. Comparison was done in terms of: duration of surgery, total amount of blood loss during surgery, timing of early mobilization and full weight bearing, radiological assessment for callus formation and bony union, complications with technical and implant failure and Harris hip score for clinical and radiological assessment at end of 12 months. Clinical assessment was done at 3, 6 and 12 months follow-up using Harris Hip Score. Results: The mean duration of surgery was 53.24±8.67 and 69.62±12.82 minutes in group A (DHS group) and group B (PFN group) respectively. In group A (DHS group) mean blood loss was 161.80±21.84 ml and in group B (PFN group) mean blood loss was 91.90±14.98 ml, with a significant difference. In this study post-operative weight bearing and full weight bearing was seen to be significantly quicker in group B (PFN group) patients. The mean time for union in DHS group and PFN group was 4.40±0.53 months and 2.10±0.70 months respectively. The mean Harris Hip Score at 12 months follow-up was 84.18±4.68 and 88.28±3.96 in DHS and PFN groups respectively. Conclusion: We conclude that proximal femoral nail (PFN) is a preferable form of osteosynthesis when treating intertrochanteric fractures compared to dynamic hip screw (DHS).