Gajanand Shriram Dhaked1, Abhishek Komalsingh Jaroli2, Khushboo Parmanand Malav3, Harish Narayan Singh Rajpurohit4
BACKGROUND
Current management of Intertrochanteric (IT) fractures has evolved with the
introduction of dynamic hip screw (DHS) and proximal femoral nail (PFN). The
purpose of this study was to compare the functional outcomes between the DHS
and PFN for IT fracture fixation.
METHODS
This study is a retrospective comparative analysis of 455 patients with IT fractures;
DHS (292) and PFN (163), who were treated from June 2012 to June 2015. The
patients were reviewed postoperatively for a minimum of 12 months to evaluate
functional outcome using Salvati-Wilson score. Categorical data was present as
absolute number or percentages, and parametric variables were presented as
Mean ± SD, while non parametric data were presented as median. Statistical
significance was defined as P < 0.05.
RESULTS
Intramedullary nails offer no advantage over extramedullary devices to treat IT
fractures caused by low-energy trauma (AO 31 - A1). However, clinically significant
outcomes were established for PFN group in terms of duration of surgery, x- ray
exposure and SW Score for AO / OTA 31 - A2 and 31 - A3. Reoperations
encountered for local pain due to implant prominence were significantly higher in
the PFN group (4.90 % versus 1.02 %). Kaplan Meier survival probability of 69.3
% and 79.5 % predicted for DHS and PFN respectively, 3 years postoperatively.
CONCLUSIONS
Our conclusion reinforces indication for PFN in unstable IT fractures (31 - A2 and
31 - A3), owing to its better functional outcome and biomechanical properties.
Functional outcomes for stable IT fracture (AO 31 - A1) were comparable between
DHS and PFN, therefore final decision for implant choice depends on implant cost,
surgeon’s preference for specific technique. However, understanding the
morphology of proximal femur, peritrochanteric region is crucial to analyse the
anatomical variations in Indian population which will provide the basis for
intramedullary nail design modifications.
