Randomized comparative study to evaluate the role of proximal femoral nail and dynamic hip screw in unstable trochanteric fractures

Abstract

INTRODUCTIONThe stability of the trochanteric fracture depends on the amount of contact between the proximal and distal main fragments. Trochanteric fractures with comminution of posteromedial buttress exceeding simple lesser trochanteric fragment or with subtrochanteric extension are termed as unstable. In 3-part fractures stability is inversely proportional to the size of the lesser trochanteric fragment. Instability occurs when more than 50% of the calcar is affected allowing the proximal fragment to collapse into varus with shortening. Reverse obliquity fracture is unstable fracture in which major fracture line extends outward and downward from the lesser trochanter.Unstable trochanteric fractures are technically much more challenging than stable fractures. Stable reduction of an intertrochanteric fracture requires providing medial and posterior cortical contact between the major proximal and distal fragment to resist varus and posterior displacing forces. For unstable fractures intramedullary implants are (biomechanically) superior.1 Lag screw cut-out failure following fixation of unstable intertrochanteric fractures in osteoporotic bone remains an unsolved challenge. 2 ABSTRACTBackground: Treatment of unstable trochanteric fracture is much more challenging than stable fracture. These fractures require stable fixation to minimize the fracture and implant related complications. Need of this study is to assess the suitable implant for stable fixation of unstable trochanteric fracture with less intra and postoperative complications and good functional outcome. Methods: In this prospective randomized comparative study, 64 patients were distributed into two groups. Group A consisted of patients treated by proximal femoral nail (PFN) (n=32) and group B treated by dynamic hip screw (DHS) (n=32). All the patients were evaluated preoperatively and surgery was done according to the group they were allotted. Post-operative follow up was done at 6 weeks, 3, 6 and 12 months. Results: Average age of the patients in this study was 51.26±10.24 year. In this study patients were followed up for an average of 10.87±2.61 month. The duration of surgery was shorter in PFN group. Weight bearing was earlier in PFN group than DHS group. Mean functional ability score was better in PFN group with significant gain in function earlier as compared to DHS group. Conclusions: PFN is a better implant for internal fixation of unstable trochanteric fractures which allows early mobilization and has got better functional outcome score in early postoperative period than DHS.

Barriers and facilitators of weight bearing after hip fracture surgery among older adults. A scoping review

“…No association was reported between extramedullary DHS and derotation screw alone or with trochanteric wiring [81], Minimally invasive DHS and conventional DHS [62], and weight bearing. The studies that compare different types of extramedullary and intramedullary implants report facilitators of weight bearing favouring PFNA-II (compared with dynamic hip locking plates (DHLP)) [95], PFNA (compared with DHS) [52,65,72,94,96], PFN (compared with DHS) [68,76,77], short PFN (compared with DHS) [78], Mini-invasive static nail (compared with conventional DHS) [56], and gamma nail (compared with DHS) [71]. No difference between extramedullary and intramedullary implants was reported in two studies [54,85].…”

“…Okkaoğlu 2020 [79] − Tao 2013 [97] ✓ (B) Shu 2020 [84] ✓ (A) Peyser 2007 [80] ✓ (B) Torres 2014 [92] ✓ (B) Lunsjo 1999 [73] ✓ (D) Xie, 2017 [95] ✓ (B) Leung 1992 [71] ✓ (B) Duymus 2019 [58] ✓ (B) Kamboj 2019 [68] ✓ (B) Mayi 2016 [76] ✓ (B) Meesala 2018 [77] ✓ (B) Huang 2017 [65] ✓ (B) Chen 2018 [52] ✓ (B) Li 2018 [72] ✓ (B) Wang 2019 [94] ✓ (B) Xu 2018 [96] ✓ (B) Nargesh 2013 [78] ✓ (B) Singh 2021 [85] − Darbandi 2022 [54] − Dujardin 2001 [56] ✓ (B) Sandhu 2019 [82] ✓ (B) Jianbo 2019 [66] ✓ (A) Kaneko 2004 [69] ✓ (A) Karaali and Ciloglu 2021 [70] ✓ (B)…”

Comparison between Dynamic Hip Screw and Proximal Femoral Nail in Patients with Pertrochanteric Fractures

“…Author Population Union (%) PFNA DHS Kumar et al [9] Indian 100.0% 96.00% Gourishankar et al [10] Indian 100.0% 98.00% Gill et al [11] Indian 100.0% 100.0% Karn et al [12] Nepalese 100.0% 100.0% Mulay et al [13] Indian 100.0% 98.00% Yadav et al [14] Indian 100.0% 100.0% Walia et al [15] Indian 100.0% 100.0% Naikwade et al [16] Indian 99.03% 94.24% Gupta et al [17] Indian 98.75% 99.17% Khateeb et al [18] Indian 98.04% 98.04% Naushad et al [19] Indian 97.10% 82.90% Basavaraj et al [20] Indian 97.06% 94.11% Yeganeh et al [21] Iranian 96.66% 85.19% Pundkar et al [22] Indian 92.00% 100.0% Jonnes et al [23] Indian 86.70% 80.00% Kregor et al [8] American 83.00% 44.00% Suranigi et al [24] Indian 40.00% [26] Indian 6.66% 33.33% Mulay et al [13] Indian 6.00% 14.00% Harisudhan et al [27] Indian 0.00% 13.33% Walia et al [16] Indian 0.00% 11.10% Sridhar et al [28] Indian 8.33% 10.53% Mittal et al [29] Indian 0.00% 6.66% Mallikarjun et al [30] Indian 0.00% 6.66% Ujjal et al [31] Indian 0.00% 6.60% Naikwade et al [16] Indian 0.97% 5.77% Kumar et al [9] Indian 2.50% 4.35% Ranjeetesh et al [32] Indian 0.00% 4.00% Mayi et al [33] Indian 0.00% 3.13% Sharma et al [34] Indian 1.00% 2.00% Gupta et al [35] Indian 0.00% 1.25% Rohra et al [36] Indian 0.00% 1.25% Sahin et al [37] Turkey 0.00% 1.16% Matre et al [38] Norway 0.40% 0.80% Present Study Pakistan 0.0% 30.0%…”