Type II Intertrochanteric Fractures: Proximal Femoral Nailing (PFN) Versus Dynamic Hip Screw(DHS)

  Background: Intertrochanteric fracture is one of the most common fractures of the hip especially in the elderly with osteoporotic bones, usually due to low-energy trauma like simple falls. Dynamic Hip Screw (DHS) is still considered the gold standard for treating intertrochanteric fractures by many. Not many studies compare the DHS with Proximal femoral nail (PFN), in Type II intertrochanteric fractures (Boyd and Griffin classification). This study was done to compare the functional and radiological outcome of PFN with DHS in treatment of Type II intertrochanteric fractures.   Methods: From October ۲۰۱۲ to March ۲۰۱۵, a prospective comparative study was done where ۳۰ alternative cases of type II intertrochanteric fractures of hip were operated using PFN or DHS. Intraoperative complications were noted. Functional outcome was assessed using Harris Hip Score and radiological findings were compared at ۳, ۶, and ۱۲ months postoperatively. Results: The average age of the patients was ۶۰ years. In our series we found that patients with DHS had increased intraoperative blood loss (۱۵۹ml), longer duration of surgery (۱۰۵min), and required longer time for mobilization while patients who underwent PFN had lower intraoperative blood loss (۷۳ml), shorter duration of surgery (۹۱min), and allowed early mobilization. The average limb shortening in DHS group was ۹.۳۳ mm as compared with PFN group which was only ۴.۷۲ mm. The patients treated with PFN started early ambulation as they had better Harris Hip Score in the early post-op period. At the end of ۱۲th month, there was not much difference in the functional outcome between the two groups. Conclusion: PFN is better than DHS in type II inter-trochanteric fractures in terms of decreased blood loss, reduced duration of surgery, early weight bearing and mobilization, reduced hospital stay, decreased risk of infection and decreased complications.

Keywords:

Dynamic Hip Screw (DHS) , Inter-trochanteric fractures , Harris Hip Score , Proximal Femoral Nail (PFN)