Vijaya Bhushanam Meesala Ashok Padala Sivananda Pathriq
BACKGROUND Inter trochanteric fracture is the extra capsular fracture of the proximal femur, involving the two trochanters. It is most commonly seen in the older age group due to trivial injury, resulting in hip fracture owing to osteoporosis and in the youth due to high velocity road traffic accident. The ultimate aim of treatment of IT fracture in older people is early mobilization, early weight bearing and to prevent the complications of prolonged recumbency. Surgical treatment of intertrochanteric fractures of femur by Dynamic Hip Screw or by Proximal Femoral Nail provides better results. This study aims to compare the radiological union and functional results of DHS and PFN in the fixation of intertrochanteric fracture of femur. MATERIALS AND METHODS This was a prospective multicentre study of 40 cases, from June 2016 to June 2017 admitted in the Department of Orthopaedics, at Maharajah’s Institute of Medical Sciences, Nellimarla, Vizianagaram and Rajiv Gandhi Institute of Medical Sciences; Srikakulam. 18 cases were treated by PFN and 22 cases were treated by DHS. Patients were followed up at 6, 12, 18 and 24 weeks, then 3 monthly till 1 yr. The results were compared for union rate, time for weight bearing, functional outcome using Harris hip score and also for various complications. RESULTS In our study mean perioperative blood loss was 70.52 ml in PFN and 154.03 ml in DHS group. Mean duration of surgery is 94.6 min. for PFN and 67.2 min. for DHS. C arm exposure was greater for PFN compared to DHS. PFN group showed significant early mobilization and early weight bearing than DHS group. PFN had better Harris Hip Score in the early post-op period but at the end of 12th month, there was not much difference in the functional outcome between the two groups. CONCLUSION Surgical treatment of IT fractures of femur requires proper implant selection based on the pattern of the fracture. Dynamic hip screw fixation with attached barrelled plate and proximal femoral nail are the two surgical options available. DHS fixation takes less time for surgery, less radiation exposure with ‘C Arm’ and has moderate risk of infection, but has much higher blood loss than PFN. Whereas, PFN surgery has the advantages of early mobilization, early weight bearing, minimal blood loss and with minimal risk of infection. When compared to the results of DHS surgery, PFN has got better surgical outcome with paramount results both in stable and unstable IT fractures, with few failure rates and with successful restoration of hip bio mechanics.
