Srikar Jakkala, Venkateswarlu Kurukunda, Nagaraju Madiga, Shyamdhar Tirumuru, Mahesh Sagar Athinarapu, Naveen Raj K
BACKGROUND Intertrochanteric fractures are commonest fractures especially in the elderly with osteoporotic bones and due to trivial fall. It occurs commonly in patients above 70 years of age. The most commonly used implant is Dynamic Hip Compression Screw (DHS); it is currently the gold standard for fixation of extracapsular hip fractures. DHS has been shown to produce good results; however, complications are frequent particularly in unstable fractures. These implants had their own problems such as high screw cut out from femoral head due to excess collapse at fracture site which in turn shortened the leg and reduced the lever arm of hip abductors. Proximal Femoral Nail (PFN) has theoretical advantages over other devices in the treatment of trochanteric fractures because Nailing has the advantage of providing rotational as well as axial stability in trochanteric fractures allowing faster postoperative walking ability, compared to DHS. MATERIALS AND METHODS From November 2016 to October 2018, a prospective comparative study was done where 30 alternative cases of type III, IV intertrochanteric fractures of hip which were operated using PFN or DHS. Intraoperative complications were noted. We followed up the patients by assessing their functional ability with Harris Hip Score and fracture union by check x rays at 2, 4, 6 and 12 months postoperatively. RESULTS The age of our patients ranged around 60 years. In our series, we found that patients with DHS had increased intraoperative blood loss (134 ml), longer duration of surgery (97 min), and required longer time for mobilization while patients who underwent PFN had lower intraoperative blood loss (61 ml), shorter duration of surgery (89 min), and allowed early mobilization. The average limb shortening in DHS group was 9.25 mm as compared with PFN group which was only 4.75 mm. Patients who are treated with PFN have early weight bearing compared to DHS but at the end of 12th month there is no significant difference in their functional abilities. CONCLUSION In patients who are treated with PFN for type III and type IV fractures of inter trochanteric region there is less amount of blood loss, short duration of surgery, early ambulation, low chance of infection and short duration of hospital stay.
