A COMPARATIVE STUDY OF FIXATION OF PERTROCHANTERIC FRACTURES WITH DYNAMIC HIP SCREW AND PROXIMAL FEMORAL NAIL

Nadir Shah , Ayush Kumar Singh , Arohi Sharma

Abstract


Trochanteric femoral fractures are among the most common injuries necessitating hospital admission. Regardless the type of fracture, trochanteric fractures can lead to substantial morbidity and mortality , especially in elderly patients.[1,2] Surgery is the mainstay of the treatment for both displaced and non displaced trochanteric fractures, to allow early mobilization of the patient, depending on the stability of the reduction and fixation achieved.[4]Dynamic Hip Screw  [DHS] as extramedullary and Proximal Femoral Nail [PFN] as intramedullary  systems are established and standard in treatment of trochanteric femoral fractures.[5,6]

 

Aim: To compare the results of Dynamic Hip Screw and Proximal Femoral Nail in the treatment of intertrochanteric fractures.

 

Materials & Methods: In our study we compared DHS with PFN in a group of 60 patients admitted in a tertiary care hospital between August 2013 – December 2016 . Patients  with intertrochanteric fractures  without having concomitant shaft femur or neck femur fractures  were included. The preoperative morbidity was evaluated using Parker’s mobility scale. Salvati and Wilson’s scoring helped in measuring overall functional outcome at 16 & 24 weeks between the two study groups.

 

Results: The preoperative Parker’s mobility scale was comparable between two study groups. Salvati and Wilson’s score at 16 & 24 weeks was significantly better with PFN group.

The functional outcome based on SWS score was Fair in 39% of patients operated with DHS at 16 weeks while for PFN it was Fair to Good in 79 % of patients . At 24 weeks it was Fair to Good in 84% patients operated with DHS while in case of PFN the score was Fair to Good in 59% of the patients & Excellent in 38% of the patients.

 

Conclusion: Our conclusion from this study supported the use of PFN for both stable and unstable peritrochanteric fractures over DHS due to its lesser operation time, lesser blood loss, early weight bearing, limited open reduction & better functional outcome.


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References


Zuckerman JD .Hip Fracture.N Engl J Med 1996;334 :1519-25.

Koval KJ ,Zuckerman JD .Hip Fracture : Evaluation and treatment of intertrochanteric fractures. J Am Acad Orthop Surg 1994 ;2: 150-6.

Friedl W and Ruf W .Experimental studies of the effectiveness of the sliding principle in dynamic hip screw osteosynthesis and its value in managing unstable pertrochanteric femoral fractures .Chirurg 1987 Feb; 58 (2):106-12.

Dosa G ,Tausch F, Wahler G and Vecsei V. Management of Hip fractures using a dynamic hip screw. Magy Traumatol Orthop Helyreallito Seb 1989 ; 32(1) :24-34.

Simmermacher RK , Bosch AM and Van der Werken C. The AO/ASIF –Proximal Femoral nail : a new device for the treatment of unstable proximal femoral fractures .Injury 1999 Jun ; 30 (5) :327-32.

Taeger G ,Schmid C, Zetttl R , Schweiberer L and Nast- Kold D. Stable and unstable pertrochanteric femoral fractures .Differentiated indications for the dynamic hip screw. Unfallchirurg 2000 Sep; 103(9) : 741-8.

Nuber S, Schonweiss T and Ruter A. Stabilisation of unstable trochanteric femoral fractures. Dynamic Hip screw with Trochanteric stabiisation plate vs Proximal Femoral Nail .Unfallchirurg 2003 Jan ; 106 (1) : 39-47.

Pajarinen J ,Lindahl J, Michelsson O, Savolainen V and Hirvensalo E. Pertrochanteric femoral fractures trated with a dynamic hip screw or a proximal femoral nail.A randomized study comparing post –operative rehabilitation. J Bone J Joint Surg Br 2005 Jan ; 87(1) :76-81.

Simmermacher RK ,Bosch AM and Van der Werken C. The AO /ASIF –proximal femoral nail: a new device for the treatment of unstable proximal femoral fractures . Injury 1999 Jun ; 30 (5) :327-32

Klinger HM ,Baums MH ,Eckert M and Neugebauer R. A comparative study of unstable per and intertrochanteric femoral fractures treated with Dynamic hip screw and Trochanteric buttress plate vs Proximal femoral nail. Zentralbl Chir 2005 Aug; 130(4) :301-6

Ahrengart L ,Tbrnqvist H, Fornander P. et al .A randomized study of the compression hip screw and Gamma Nail in 426 fractures. Clin Orthop 2002;401:209-22.

Domingo LJ ,Cecilia D, Herrera A and Resines C. Trochanteric fractures treated with a proximal femoral nail. Int Orthop 2001;25(5):298-301.


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