A comparative study of Dynamic Hip Screw and Proximal Femoral Nail in the management of Intertrochanteric Fractures of the Femur

Introduction: Intertrochanteric fractures account for approximately half of the hip fractures in the elderly because of the osteoporotic nature of the bone. There are various modalities to treat these fractures. The objective of this study was to compare and evaluate the clinical and radiological outcome of intertrochanteric femur fracture treated with Dynamic hip screw (DHS) and proximal femoral nail (PFN).
Methods: This study was conducted at Nepalgunj medical college, Department of orthopedics Nepalgunj over a time span of two years. A total of 52 patients were included and randomized into Dynamic hip screw (n=26) and Proximal femoral nail (n=26) group. Patient’s demographic details, perioperative findings, radiological findings and follow up findings were recorded. The results were evaluated and compared.
Results: The mean age in our study was 57.63 years. Trivial fall was the most common mode of injury. There was significantly higher intraoperative blood loss in the DHS group. Radiological union and functional outcomes were similar overall, but in case of unstable fracture functional outcome was clinically better in PFN group.
Conclusion: From our study we concluded that PFN has better outcome in case of unstable intertrochanteric fractures, however in stable fracture also it has distinct advantage over DHS.


Introduction
Intertrochanteric fractures account for approximately half of the hip fractures in the elderly because of the osteoporotic nature of the bone.
this study was to compare and evaluate the clinical and radiological outcome of intertrochanteric femur fracture treated with Dynamic hip screw (DHS) and proximal femoral nail (PFN).

Methods
of orthopedics Nepalgunj over a time span of two years. A total of 52 patients were included and randomized into Dynamic hip screw (n=26) and Proximal femoral nail (n=26) group. Patient's demographic details,

Results
blood loss in the DHS group. Radiological union and functional outcomes were similar overall, but in case of unstable fracture functional outcome was clinically better in PFN group.

Introduction
higher life expectancy and rising incidence of motor vehicle accident. Approximately half of the hip fractures in the elderly are intertrochanteric fractures. 1,2 seen in females who are predisposed to osteoporosis. 3 Primary aim of treatment is to provide a stable construct and to restore the patient to pre injury status as early as possible so that complications associated with prolonged recumbency are decreased. 4 For the treatment of intertrochanteric fractures been the standard implant for the treatment of these type of fractures, 5,6 as it allows controlled collapse and compression at the fracture site, initiating fracture union. 7 Proximal femur nail (PFN), a commonly used device in the biomechanically stable construct by shortening the distance between implant and hip joint, which decreases torsional strain across the implant. 8,9 clinical and radiological outcome of patients treated by PFN and DHS in intertrochanteric fractures of the femur.

Methods
College, department of Orthopedic Surgery within the span of two years in between January 2019 and January prospective, observational, hospital based, randomized study.
A total of 59 patients were enrolled in our study. Out of them, seven patients were excluded from the study. A total of 52 patients were evaluated. Inclusion criteria were adults above 18 years of age who were able to walk prior to fracture with intertrochanteric fractures of less than 3weeks old. Pathological fracture or compound fractures to one of the two treatment groups based on a computergenerated randomization table with Group A patients treated with DHS and Group B with PFN. Institutional Ethical Clearance was obtained before patient recruitment. All patients gave written consent.
into stable and unstable fractures. 10 All patients were operated by the same surgeons as soon as possible after relevant investigations, pre anesthesia checkup and table and the fracture was reduced by close manipulation mini open or open reduction technique was done. Postoperative rehabilitation protocol was similar in both groups. Isometric quadriceps exercise, knee bending, abductor strengthening exercise and ankle pump exercise Mobilization with walker or crutches was started as early as possible with non-weightbearing initially. Weight bearing was progressively increased as per the x-ray evaluation of weeks, 16 weeks, 24 weeks and 1 year. End point of our study was fracture union. Demographic details i.e., age, sex, mode of injury and fracture type and perioperative by using gauze visual analogue method, 11 operative time (incision to closure) and postoperative hospital stay were our secondary outcome variables. Whereas fracture union, malunion and functional outcome were our primary outcome variables. Radiologically, the presence of at least three of the four cortices with bridging callus formation and crossing in Antero-Posterior (AP) and lateral radiographs were considered as bony union. Varus angulation of more than 10 degrees was considered as malunion. Functional outcome was assessed with Harris hip score. 12 the two surgical procedures, comparisons were conducted on all study variables. Data were analysed using the IBM SPSS statistics 19. Study variables were analysed and described with means, standard deviations, medians and two surgical procedures were conducted using independent sample t-tests. P-value of less than 0.05 was considered to Results years which ranged from 21 to 87 years; which was not trauma which accounted for 29(55.8%) of the total cases. 10 preoperative comparisons are summarized in Table 1.
Average duration of surgery was more in DHS group compared to PFN group, which was 63.15 min and 59.61 min respectively ( Table 2 (p <0.001) higher mean blood loss in DHS group with four patient requiring blood transfusion postoperatively as compared to none in PFN group (     and Saudan et al. 18,23 Our study has several limitations; smaller sample size and these limitations, results of this study are still encouraging.
enough cohort. As such further new studies are needed over a longer period of time with large enough sample to do a subgroup analysis.

Conclusion
We conclude that in stable intertrochanteric fractures, both the PFN and DHS have similar outcomes; however, PFN has better functional outcome with unstable fracture. As the PFN less blood loss and relatively shorter radiological union intertrochanteric fracture. Hence from our study we have than DHS in the treatment of intertrochanteric fracture.
to DHS in intertrochanteric fractures femur except when trochanteric entry point for the PFN is fractured.