Comparison of Dynamic Hip Screw and Proximal Femoral Nail in Intertrochanteric Femur Fractures.
Keywords:Dynamic hip screw, Harris hip Score, Intertrochanteric fracture, Proximal femoral nail.
Objective: To compare the radiological and functional outcome of stable intertrochanteric femur fractures treated with Dynamic Hip Screw(DHS) and Proximal Femoral Nail(PFN).
Methods: This randomized controlled trial was conducted in Department of Orthopaedics Pakistan Railway General Hospital Rawalpindi from 20th March 2018 and 19th March 2020. All patients with stable intertrochanteric fractures fulfilling the inclusion criteria were randomly allocated to group A(DHS) and B(PFN). Patients were reviewed radiologically for healing and functional assessment was done with Harris Hip Score(HHS) and graded as poor(score <70),fair( 70 to 80),good( 80 to 90) and excellent(90 to 100). Comparison of outcomes in both groups were done at 3rd,6th and 12th month and P value was calculated with independent sample t test and Chi-square test. P<0.05 was considered significant.
Results: The total number of patients were 60.They were equally and randomly divided into group A and B with 30 patients in each. The mean age of group A was 59.20±5.94 years and group B was 58.80±6.67 years. Male patients were 19( 63.33% ) in group A and 17( 56.66%) in group B. Female patients were 11(36.66%) in group A and 13(43.33% ) in group B. The mean radiological union time in group A was 13.4±3 weeks while in group B 13.5±5 weeks(P>0.05). The Harris Hip Score(HHS) at 3 months follow up was 53.50±3.91(poor) and 34.93±3.98(poor) in group A and B respectively.(P< 0.05) At 6 months group A had HHS 89.37±4.03(good) and B 81.87±4.10.( P< 0.05)At one year HHS was 93.73±1.99(excellent) and 92.57±2.30(excellent) in group A and B.( P>0.05).
Conclusion: For stable intertrochanteric fractures both DHS and PFN yielded similar outcome in terms of radiological union. The short term functional outcome of both DHS and PFN at 3rd and 6th was poor and good but DHS had statistically better score than PFN.At one year follow up both DHS and PFN had similar excellent functional outcome but without any statistically significant difference in the score.
Chang SM, Hou ZY, Hu SJ, Du SC. Intertrochanteric Femur Fracture Treatment in Asia: What We Know and What the World Can Learn. Orthop Clin North Am.2020;51(2):189?205.
Kanters TA, van de Ree CLP, de Jongh MAC, Gosens T, Hakkaart-van Roijen L. Burden of illness of hip fractures in elderly Dutch patients. Arch Osteoporos 2020;15(1):11-17.
Cheung CL, Ang SB, Chadha M, Chow ES, Chung YS, Hew FL, et al. An updated hip fracture projection in Asia: The Asian Federation of Osteoporosis Societies study. Osteoporos Sarcopenia 2018;4(1):16-21.
Tay E. Hip fractures in the elderly: operative versus nonoperative management. Singapore Med J 2016;57(4):178-81.
Li J, Zhang L, Tang P. Evolving concept in treatment of intertrochanteric fractures and development of internal fixation devices. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019;33(1):1-7.
Zhang WQ, Sun J, Liu CY, Zhao HY, Sun YF. Comparing the Intramedullary Nail and Extra medullary Fixation in Treatment of Unstable Intertrochanteric Fractures. Sci Rep 2018;8(1):23-29.
Jonnes C, Sm S, Najimudeen S. Type II Intertrochanteric Fractures: Proximal Femoral Nailing (PFN) Versus Dynamic Hip Screw (DHS). Arch Bone Jt Surg 2016;4(1):23-8.
Gadegone WM, Shivashankar B, Lokhande V, Salphale Y. Augmentation of proximal femoral nail in unstable trochanteric fractures. SICOT J 2017;3:12-18.
Pires RES, Santana EO, Santos LEN, Giordano V, Balbachevsky D, dos Reis FB. Failure of fixation of trochanteric femur fractures: clinical recommendations for avoiding Z-effect and reverse Z-effect type complications. Patient Safety in Surgery 2011; 5(1):1-6.
Pavelka T, Matejka H, Cervenkova H. Complications of internal fixation by a short proximal nail. Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca 2005;72(6):344-354.
Kamboj P, Sharma PK, Jesadia B, Arora S, Siwach RC. A comparative prospective study of osteosynthesis in intertrochanteric fractures, using dynamic hip screw (DHS) and proximal femoral nailing (PFN). Int J Orthop Sci 2019;5(2):954-960.
Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, et al. Fracture and dislocation classification compendium-2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 2007; 21:S1–S133.
Lee MH, Ingvertsen BT, Kirpensteijn J, Jensen AL, Kristensen AT. Quantification of surgical blood loss Vet Surg 2006;35(4):388-93.
Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969;51(4):737-755.
Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ, et al. CONSORT 2010 Explanation and Elaboration: updated guidelines for reporting parallel group randomised trials. BMJ 2010;340:c869.doi: 10.1136/bmj.c869.
Sharma A, Sethi A, Sharma S. Treatment of stable intertrochanteric fractures of the femur with proximal femoral nail versus dynamic hip screw: a comparative study. Rev Bras Ortop 2017;53(4):477-481.
Harish K, Paleti ST, Kumar RN. A comparative study between DHS and PFN for the treatment of IT fractures. Nat J Clin Orthop 2019;3(3):01-07.
Karanam V, Kumar UA, Teja SP, Teja CB. PFN v/s DHS in stabilization of intertrochanteric fractures: A comparative study. Int J Orthop Sci 2019;5(2):750-754.
Bhakat U, Bandyopadhayay R. Comparative Study between Proximal Femoral Nailing and Dynamic Hip Screw in Intertrochanteric Fracture of Femur. Open Journal of Orthopedics 2013;3:291-295.
Kumar R, Singh RN, Singh BN. Comparative prospective study of proximal femoral nail and dynamic hip screw in treatment of intertrochanteric fracture femur. J Clin Orthop Trauma 2012;3(1):28-36.
Chandy G,Saju S. A comparative study on the functional outcome of intertrochanteric fractures treated by proximal femoral nailing or dynamic hip screw fixation. Int J Res Orthop. 2021;7(1):51-55.
Zhao C, Liu DY, Guo JJ, LP L, Zheng YF, Yang HB, et al.Comparison of proximal femoral nail and dynamic hip screw for treating intertrochanteric fractures. Zhongguo Gu Shang 2009;22(7):535-537.
Zhang K, Zhang S, Yang J, Dong W, Wang S, Cheng Y, et al. Proximal Femoral Nail vs. Dynamic Hip Screw in Treatment of Intertrochanteric Fractures: A Meta-Analysis. Med Sci Monit 2014;20:1628-1633.
Parker M, Bowers T, Pryor G. Sliding hip screw versus the targon PF nail in the treatment of trochanteric fractures of the hip: A randomised trial of 600 fractures.J Bone Joint Surg Br 2012;94(3): 391–397.
Huang ZY, Liu XW, Su CJ. Dynamic hip screw vs. proximal femur nail in treatment of intertrochanteric fractures in patients aged over 70 years old. Shanghai Medical Journal 2010; 33(11):1042-1947.
Liu XW, Zhang CC, Su JC, Fu QG, Yu BQ, Xu SG. Treatment of trochanteric fractures of elderly with dynamic hip screw and proximal femoral nail (single center, randomized and prospective research). Chinese Journal of Bone and Joint Injury 2009;24(9):796–797.
Pajarinen JJ, Lindahl, O, Michelsson O, Savolainen V,Hirvensalo E, Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail: A randomised study comparing post-operative rehabilitation .J Bone Joint Surg Br.2005;87(1):76–81.
Giraud B, Dehoux E, Jovenin N, Madi K, Harisbou A, Usandizaga G, et al. “Pertrochanteric fractures: a randomized prospective study comparying dynamic screw plate and intramedullary fixation. Rev Chir Orthop Reparatrice Appar Mot 2005;91(8):732-736.
Papasimos S, Koutsojannis CM, Panagopoulos A, Megas P, Lambiris E.A randomised comparison of AMBI, TGN and PFN for treatment of unstable trochanteric fractures. Arch Orthop Trauma Surg 2005;125(7):462-768.
Pan X, Xiao D, Lin B,Huang G, Dynamic hip screws (DHS) and proximal femoral nails (PFN) in treatment of intertrochanteric fractures of femur in elderly patients.Chinese Journal of Orthopaedic Trauma 2004;6(7):785-789.
Saudan M, Lubbeke MA, Sadowski C, Riand N, Stern R, Hoffmeyer P. Petrochanteric fractures: Is there an advantage to an intramedullary nail? A randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nai.2002 J Orthop Trauma 2002;16(6): 386-393.