A Prospective Study to evaluate the efficacy of Proximal Femoral Nail vs. Dynamic Hip Screw in Treatment of Intertrochanteric Fracture of Femur

Introduction: An increasing incidence of intertrochanteric fractures with advancing age is more. The dynamic hip screw (DHS), used in extramedullary fixation, is a common treatment of these fractures. Proximal Femoral Nail (PFN), introduced by the AO (Arbeitsgemeinschaft für Osteosynthesefragen),the Association of the Study of Internal Fixation (ASIF) in 1997, has become more common in treatment of intertrochanteric. Although the effects of PFN and DHS in treatment of intertrochanteric fractures have been reported, the results and conclusions are not consistent.Objectives:To investigate a significant difference and to compare the outcome of intertrochanteric fractures treated with Dynamic Hip Screw and Proximal Femoral nail.Material and Methods:This study included 50 cases of intertrochanteric fractures of femur treated by a DHS and PFN. Fracture table was used for all patients under image intensifier.Results:The average age of the patient was 62.3 years. Out of 50 patients 24% had stable, 58% unstable and 18% reverse oblique pattern of fracture. In DHS group average blood loss was 250 ml while in PFN group average blood loss was 100ml. In PFN, there was more number of radiation exposures intra-operatively. The average operating time in DHS group was 87 minutes while in PFN group it was 55 minutes. . The complications were 15%; implant failure 6%,4% infection,2% non-union and 4% greater trochanter splintering. In the PFN group the amount of sliding on X-rays was less as compared to DHS. The patients treated with PFN started early ambulation as they had better Harris Hip Score in the early period at 1 and 3 month. Both the implant had almost similar functional outcomes.Conclusion:Closed and grade-1 open fractures of the tibia shaft, managed with interlocking intramedullary nailing involves minimal surgical trauma and negligible blood loss while provides the advantages of early ambulation, lower rate of infection, delayed union, non union and mal-union.