Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail

Abstract

We treated 108 patients with a pertrochanteric femoral fracture using either the dynamic hip screw or the proximal femoral nail in this prospective, randomised series. We compared walking ability before fracture, intra-operative variables and return to their residence. Patients treated with the proximal femoral nail (n = 42) had regained their pre-operative walking ability significantly (p = 0.04) more often by the four-month review than those treated with the dynamic hip screw (n = 41). Peri-operative or immediate post-operative measures of outcome did not differ between the groups, with the exception of operation time. The dynamic hip screw allowed a significantly greater compression of the fracture during the four-month follow-up, but consolidation of the fracture was comparable between the two groups. Two major losses of reduction were observed in each group, resulting in a total of four revision operations.Our results suggest that the use of the proximal femoral nail may allow a faster postoperative restoration of walking ability, when compared with the dynamic hip screw.The incidence of pertrochanteric femoral fractures has increased significantly during recent decades, and this tendency will probably continue in the near future due to the rising age of the population.

Is a Sliding Hip Screw or IM Nail the Preferred Implant for Intertrochanteric Fracture Fixation?

“…Using American Board of Orthopaedic Surgery (ABOS) Part II data, Anglen and Weinstein reported that use of IM fixation increased from 3% in 1999 to 67% of cases in 2006 [3]. Numerous studies have been published comparing sliding compression hip screw and side plate with IM fixation [2,12,16,17,29,31,32]. However, results have been contradictory in terms of outcomes [2,12,16,17,29,31,32] with the only consistent differences reported between the two fixation techniques being increased complications (particularly intraoperative and postoperative fractures) and a higher reoperation rate with IMN [4,10,16,29].…”

“…Historically, a sliding hip screw (SHS) has been the preferred implant to stabilize these fractures [5,13,18,21,24,25,35]. However, intramedullary hip screw devices have gained popularity for stabilizing this fracture type [2,4,7,8,10,12,16,17,29,31,32].…”

“…Many of the published studies comparing SHS and IMN for stabilization of intertrochanteric fractures have involved a small number of patients and looked at a limited number of outcomes such as mortality and need for revision surgery [2,4,7,8,10,12,16,17,29,31,32]. Our study, using a large cohort of Medicare beneficiaries, was performed to determine whether patients who sustain an intertrochanteric fracture have better outcomes when stabilized with a SHS or an IMN.…”

Avaliação do emprego da haste femoral curta na fratura trocantérica instável do fêmur

“…Autores são de opinião que a haste PFN ® possibilita a obtenção de excelentes resultados no tratamento da fratura trocantérica instável do fêmur, principalmente quanto à estabilidade propiciada pelo implante, que permite deambulação precoce com melhor reabilitação funcional do paciente idoso e alto índice de consolidação decorrente da preservação do envelope de partes moles em torno da fratura (37)(38)(39)(40) .…”

Comparative Study of Proximal Femoral Nailing and Dynamic Hip Screw for Intertrochanteric Fractures in Adults

“…The PFN group consistently required shorter incisions (p=0.0001), had less blood loss and shorter operative times (p=0.0001) when compared to the DHS group. Baumgaertner et al 6 had comparable results regarding length of incision and blood loss similar to Pajarinen et al 7 and Ishrat A Khan et al 8 The operative times on the other hand were reported to be comparable in the studies of Ishrat A Khan et al 8 and Saudan et al 9 Pan et al 10 and Giraud et al 11 reported significantly less surgery times for the PFN group compared to the DHS group. Papasimos et al 12 had reported shorted surgery times for the DHS group compared to the PFN group.…”