A Comparative Study of Dynamic Hip Screw Versus Proximal Femoral Nailing in Surgical Management of Trochanteric Fractures in a Tertiary Care Centre, Thrissur District, Kerala

Abstract

BACKGROUND Intertrochanteric fractures account for approximately half of the hip fractures in the elderly. Safe and efficient restoration of mobility is the goal of the treatment of intertrochanteric fractures. At the same time, we need to reduce the medical complications, and finally restore the patient to the pre-operative status. Dynamic hip screw gives good results but is sometimes not suitable particularly in unstable intertrochanteric fractures. The objective of this study was to compare dynamic hip screw and proximal femoral nail with respect to their functional and radiological outcomes during surgical management of the trochanteric fracture. METHODS A prospective study was conducted among 100 patients admitted with trochanteric fracture, in Government medical college, Thrissur, out of which 50 patients underwent fixation with proximal femoral nail and 50 with dynamic hip screw. Using proforma, socio-demographic details, details of admission, mode of trauma, details of fracture and surgery, complications and Harris hip score were assessed, minimum follow up was 6 months following surgery and longest follow up was 12 months. RESULTS Functional outcome was assessed with Harris hip score, and of the patients treated with dynamic hip screw, 28 % had a good score, whereas in patients treated with proximal femoral nail 42 % had good score (P-value 0.019), a significant difference was found between duration of non-weight bearing and type of fixation, also there was a significant difference in Harris Hip Score (P-value of 0.0001) CONCLUSIONS The proximal femoral nail (PFN) group had better functional outcomes both radiologically and clinically. KEY WORDS Intertrochanteric Fractures, Proximal Femoral Nail, Dynamic Hip Screw.