Sreekumar K1, Dinesh Mitra R. P2
Ninety percent of the hip fractures in the elderly result from a simple fall. More than fifty percent of the hip fractures in the elderly are intertrochanteric fractures. The goal of treatment of any intertrochanteric fracture in elderly is to restore mobility at the earliest and minimise the complications of prolonged bed rest. The Dynamic Hip Screw (DHS) has been shown to produce good results, but complications are frequent, particularly in unstable intertrochanteric fractures. Intramedullary fixation is considered to provide a more biomechanically stable construct by reducing the distance between the hip joint and implant.
MATERIALS AND METHODS
The goal of this study is to compare the functional outcome of intertrochanteric fractures in elderly patients treated with Proximal Femoral Nail (PFN) and Dynamic Hip Screw (DHS) by analysing the clinical and radiological results to evaluate the advantages and disadvantages and possible complications associated with fixation of intertrochanteric fractures with PFN and DHS.1 In our study, we included 106 intertrochanteric fractures, out of which 46 were treated with PFN and 60 with DHS. Ordinary fracture table was used in all cases and were followed up at regular intervals of 4, 8 and 12 weeks, 6 months and one year.
Functional results were assessed with modified Harris hip score. We observed significantly higher excellent results and less poor results in PFN compared to DHS.
Unstable intertrochanteric fractures treated with PFN have significantly better outcome than DHS. In unstable fractures, reduction loss, union in varus and limb shortening are significantly higher in DHS. Hence, the advantages of PFN are less surgical trauma, less blood loss and the possibility of early weightbearing even after very complex fractures.