Treatment of stable intertrochanteric fractures of the femur with proximal femoral nail versus dynamic hip screw: a comparative study

Abstract

ObjectiveTo evaluate and compare the clinical and radiological outcomes of patients with stable intertrochanteric fractures treated with proximal femoral nail vs. dynamic hip screw.MethodsSixty patients with stable intertrochanteric fractures, aged over 18 years, were randomly divided into the proximal femoral nail and dynamic hip screw groups. Dynamic hip screw with a three-hole side-plate and an anti-rotation screw were used, as well as a modified ultra-short proximal femoral nail for the smaller Asian population. The intra-operative, early and late complications were recorded, and the functional outcome of each group was assessed using the Harris Hip Score.ResultsIn the dynamic hip screw group, the one-month mean Harris Hip Score was slightly lower than that of the proximal femoral nail group. However, at the three- and six-month monthly follow-ups, the dynamic hip screw group presented higher mean scores than the proximal femoral nail group; at the one-year follow-up, both the groups attained similar scores.ConclusionProximal femoral nail provides a significantly shorter surgery with a smaller incision that leads to less wound-related complications. However, the incidence of technical errors was significantly higher in proximal femoral nail when compared with dynamic hip screw as it is a technically more demanding surgery that leads to more implant failures and the consequent re-operations.

Dynamic Hip Screw with Trochanter-Stabilizing Plate Compared with Proximal Femoral Nail Antirotation as a Treatment for Unstable AO/OTA 31-A2 and 31-A3 Intertrochanteric Fractures

“…The change in the surgical plan may have elongated the surgical time, especially when closed nailing was initially planned. In other words, IM nailing in unstable type fractures requires greater surgical technique skill [17]. Second, for unstable fracture fixation, a long nail was chosen sometimes to achieve adequate implant working length, which often increased the operation time for nail and distal screw application [18,19].…”

Clinical Efficacy of Intramedullary Fixation vs. Plate Fixation for Femoral Intertrochanteric Fractures

“…Compared with extramedullary xation, intramedullary xation holds the following advantages: the intramedullary xation system belongs to central xation, which is more in line with the biomechanics of the proximal femur and can better perform femoral anatomical reduction, improving the stability of internal xation; the operation is simple and convenient with a short operation time, and the injury of blood vessels and nerves may be greatly avoided [7] [8] [9] ; the surgical incision is small, which protects the blood supply of the fracture end to the greatest extent and is conducive to fracture healing. The postoperative incision healing time is shorter, and the postoperative recovery is faster [10] [11] [12] ; early mobility can greatly reduce the occurrence of postoperative complications, and hip joint functional exercises may be performed more quickly [13] [14] ; effects in long-term operation is reliable, and the failure rate is relatively low with the passage of time [15] [16] [17] .…”

Clinical Efficacy of Intramedullary Fixation vs. Plate Fixation for Femoral Intertrochanteric Fractures

“…Compared with extramedullary xation, intramedullary xation holds the following advantages: the intramedullary xation system belongs to central xation, which is more in line with the biomechanics of the proximal femur and can better perform femoral anatomical reduction, improving the stability of internal xation; the operation is simple and convenient with a short operation time, and the injury of blood vessels and nerves may be greatly avoided [7] [8] [9] ; the surgical incision is small, which protects the blood supply of the fracture end to the greatest extent and is conducive to fracture healing. The postoperative incision healing time is shorter, and the postoperative recovery is faster [10] [11] [12] ; early mobility can greatly reduce the occurrence of postoperative complications, and hip joint functional exercises may be performed more quickly [13] [14] ; effects in long-term operation is reliable, and the failure rate is relatively low with the passage of time [15] [16] [17] .…”