Title: A Comparative Study of Short Proximal Femoral Nail and Dynamic Hip Screw in Treatment of Intertrochanteric Fractures

Authors: Dr Manoj Kumar R., Dr Rashid MP,  Dr Sabarisree M.

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i6.224

Abstract

Background: This article is on study of evaluation of effectiveness, advantages and disadvantages of PFN and DHS in the management of intertrochanteric fractures.

Materials and Methods: These is a prospective study which was carried out from February 2015 to February 2016 in government medical college Thiruvanathapuram. In this study period 48 cases of intertrochanteric fractures were studied, out of which 24 cases were operated by PFN and 24 cases were operated by DHS. The results were evaluated and compared.

Results: Harris hip score was used to asses the functional outcome of hip. Calculated at 2 week, 6 week, 3 months, 6 months and 1 year follow up. By 1 year follow up 62.5% cases operated by PFN had excellent score, 33.3% patients had good and 4.2% had fair score. The cases operated by DHS 54.5% had excellent score , 33.3 % cases had good and 12.5% patients had fair score

Conclusion: In our study we concluded that there is no much difference in functional outcome of intertrochanteric fractures treated by DHS and PFN in our settings during one year follow up. PFN is used mainly in unstable fracture and DHS in stable intertrochanteric fractures. Surgical exposure is minimal in PFN so minimal blood loss and wound complication. Early mobilization is better by PFN.

Key Words: Intertrochanteric fractures, short proximal femoral nail, dynamic hip screw, modified Harris hip score.

References

1.      Campbell’s Operative Orthopedics , 11th edition , volume 3 ,  3237- 3308.

2.      Terry S. Canale : Campbell’s operative orthop Vol. 3, pg 218, 9th Ed. 1998

3.      Is the Proximal Femoral Nail a suitable implant for treatment of all trochanteric fractures,Menezes, Daniel F. A MD; Gamulin, Axel MD; Noesberger, Bruno MD clinical orthopaedics and research : October 2005- volume 439-issue-pp 221-2271

4.      Leung KS5 So WS, Sien WY, Hui PW. Gamma nail and dynamic! hip screws for peritrochanteric fractures. J Bone Joint Surg (Br). 1992;

5.      Miedel R, Ponzer S, Tornkvist H, Soderqvist A, TidermarkJ.The standard Gamma nail or the Medoff sliding plate for unstable trochanteric and subtrochanteric fractures: A randomised, controlled trial. J Bone Joint Surg Brit 2005; 87: 68-75. 

6.      O'Brien PJ. The sliding hip screw is better than short femoral nails for extracapsular femoral fracture. J Bone Joint Surg 2004

7.      GallangherJC,MeltonLJ,Riggs BL et al. Epidemiology of fractures of the proximal femur in Rocester,Minnesota. Clinical Orthop 1980; 150:163-171.

8.      Mather Cleveland : A ten year analysis of intertrochanteric fractures, JBJS 63B, 218,1983.

9.      Griffin JB,: The Calcar Femorale Redef-ined. Clin. Orthop 164, 221-214, 1982

10.  Cummings SR, Nevitt MC. Non- skeletal determinants of fractures: the potential importance of mechanics of falls. Osteoporosis Int 1994; supll: S67-70.

11.  Tencer.AF, Johnson KD, Johnson DWC, Gill K. A biomechanical comparison of various methods of stabilisation of subtrochanteric fractures of the femur. J Orthop Res. 1984; 2:297.

12.  Windoff j, Hollander D A , Hakmi M , Linhart w 2005, Pitfalls & complications in the use of proximal femoral nail ,lagenbecks arch surg, feb; 3901(1) Epub 2004 Apr 15.

13.  A Bodoky, U Neff, M. Herberz and F Harder: Antibiotic prophylaxis with two doses of cephalosporin in patients managed with internal fixation for a fracture of hip JBJS Vol. 75, issue- 1,61-65, 1993.

14.  Varley GW, Milner SA : Wound drains in proximal femoral fractures surgery. J.Roy. Soc. Med. 1995 Jan 88(1) : 42P-44P.

15.  B. Mall, SusheelkumarPathak, Vineet Malhotra : Role of dynamic compression hips screw in trochanteric fracture of femour. Indian Journal of Orthopaedics, Vol. 33 No. 3, 226-228, July 1999.

16.  Windoff j, Hollander D A , Hakmi M , Linhart w 2005, Pitfalls & complications in the use of proximal femoral nail ,Lagenbecks arch surg, feb; 3901(1) Epub 2004 Apr 15. 

Corresponding Author

Dr Sabarisree M.

Associate Professor (CAP) in Orthopaedics,

Govt Medical College, Trivandrum