A Comparative Study of Proximal Femoral Nail and Dynamic Hip Screw in Treatment of Inter-Trochanteric Fracture in a Tertiary Care Hospital of Eastern India

Introduction:An intertrochanteric fracture is one of the most common hip fractures, especially in elderly adults with osteoporotic bones.The most common cause of these fractures is low-energy trauma, like small falls.The recommended treatment for intertrochanteric femur fractures is internal fixation.There are various kinds of internal fixation devices for intertrochanteric fractures, including the DHS (dynamic hip screw) and PFN (proximal femoral nail).Aims/ objective: To compare the effectiveness of DHS and PFN using Harris Hip Score and compare any potential shortcomings of these methods for management of inter-trochanteric fractures. Materials and Method:Within two weeks of enrollment, 50 patients with close intertrochanteric fractures were added to our research.PFN (proximal femoral nail) was used for internal fixation in 25 patients, while DHS (dynamic hip screw) was used in another 25 patients.Each patient had three months of monitoring, following which their clinical and radiological states were assessed.For a year, this process was carried out every three months.The results at 1, 3, 6 and 12 months were analyzed using the Harris hip scoring methodology.Results: There were 50 patients in our study out of which 28 (26%) were male and 22 (44%) were female.Mean age of the patients was 59.73 ± 5.14.More patients in PFN group (52%) were stable as compared to DHS group (32%) but the difference was not significant (p>0.05).There was significantly better improvement with respect to Harris hip score in patients receiving PFN internal fixation as compared to DHS at 3 and 6 months of follow-up (p<0.0001)however at 12 months of follow-up, DHS and PFN group were similar with respect to Harris hip score (p>0.05). Conclusion:PFN provides earlier rehabilitation, a quicker union, reduced mechanical failure rates, shorter surgical times, and more rotation stability than DHS.DHS requires less surgical expertise and is cheaper for implants.PFN shows promise as a DHS alternative in some challenging fragmented unstable osteoporotic inter-trochanteric fractures.