A comparative study of proximal femoral nailing versus dynamic hip screw device in the surgical management of intertrochanteric fractures

Introduction: Trochanteric fractures are one of the most common injuries sustained predominantly in patients over sixty years of age. Studies have shown that when compared to the dynamic hip screw, proximal femoral nailing had certain advantages over the former. Aim: To compare the surgical treatment of intertrochanteric fractures of the femur with the proximal femoral nail and dynamic hip screw device, with respect to fluoroscopic time, duration of surgery, post-operative shortening and functional outcome. Materials and Methods: The study was conducted in Father Muller Hospital, Mangalore from July 2015 to July 2016 where 60 patients with 60 intertrochanteric fractures of femur were selected. The fractures were fixed with either dynamic hip screw device (DHS) or a proximal femoral nail (PFN). Of the 60 patients in the study, 30 were treated with DHS and 30 with PFN. Fluoroscopy time was recorded intraoperatively. Results and Discussion: The difference in the operative times in both the groups was found to be highly significant and we attributed this difference to the smaller incisions in the PFN group. The fluoroscopy time in the PFN group (average 72.60secs) was significantly higher as compared to that of the DHS group (average 48.60secs). In this study the average limb length shortening of patients in the DHS group was 1.25cm as compared to 0.63cm in the PFN group which was highly significant (p=0.009). The overall functional outcome of patients treated with the PFN was significantly better than those treated with DHS (p=0.037). This is in accordance to a study by Kukla and co-workers8 and also Ahrengart and associates. Conclusion: We conclude that in stable intertrochanteric fractures, both the PFN and DHS have similar outcomes. However, in unstable intertrochanteric fractures the PFN has significantly better outcomes in terms of earlier restoration of walking ability. In addition, as the PFN requires shorter operative time and a smaller incision, it has distinct advantages over DHS even in stable intertrochanteric fractures. Hence, in our opinion, PFN may be the better fixation device for most intertrochanteric fractures.