Key result
Proximal femoral nailing significantly reduced mean total operating time (90.3 vs 107.1 minutes) and estimated blood loss (361 vs 535 ml) compared to dynamic hip screw in patients with stable intertrochanteric femur fractures.
Why the study?
The study aimed to compare the cost-effectivity, clinical, and radiological outcomes of proximal femoral nailing versus dynamic hip screw fixation for stable intertrochanteric femur fractures.
Does proximal femoral nailing improve clinical and radiological outcomes compared to dynamic hip screw in patients with stable intertrochanteric femur fractures?
Cohort (n=122)
No
Does proximal femoral nailing improve clinical and radiological outcomes compared to dynamic hip screw in patients with stable intertrochanteric femur fractures?
Proximal femoral nailing provides similar stability and complication rates to dynamic hip screws for stable intertrochanteric femur fractures, but with significantly less blood loss and shorter operation time.
PFN and DHS yield similar stability and costs in stable intertrochanteric fractures; leaves open whether shorter operative time with PFN improves outcomes in larger trials.
Objective: The aim of this study was to compare the cost-effectivity, clinical and radiological outcomes of the proximal femoral nail (PFN) and Dynamic hip screw (DHS) in the management of stable intertrochanteric femur fractures (SIFFs). Material and Methods: Patients who underwent surgical treatment for a SIFF in our department were retrospectively identified and then divided into two groups according to the treatment modality: Group 1, 57 patients (36 female, 21 male; mean age = 74.5±9.9 years) treated with PFN and Group 2, 65 patients (34 female, 31 male; 72±10.2 years) treated with DHS. Primary outcome measures were: estimated blood loss (EBL), total operating time (TOT), duration of hospital stay (DHS), rate of postoperative complication, rate of mortality, and treatment cost. Radiographic assessment included anteroposterior/lateral tip-apex distance (TAD) and amount of limb length discrepancy (LLD). Results: No significant differences were observed in demographic characteristics between the two treatment groups (p>0.05). The mean follow-up was 44.2±31 months in group 1 and 53.7±38 months in group 2 (p=0.077). The mean TOT and EBL were significantly shorter in group PFN than in group DHS (p<0.001 and p=0.03). No significant difference was observed in the mean duration of hospital stay, rate of postoperative complication, rate of mortality, and treatment cost between the two treatment groups (p>0.05). The post-operative complication rate was 9.5% in group PFN and 8.3% in group DHS, with no significant difference (p=0.83). There were significant differences in neither TAD nor LLD between the two treatment groups (p=0.69 and p=0.87, respectively). Conclusion: The two treatment modalities seem to have similar effect to maintain stability for patients with stable IFFs. However, less EBL and shorter operation time can be expected from PFN compared to DHS in such patients.
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Pehlivanoğlu et al. (2021) conducted a cohort in Stable intertrochanteric femur fractures (n=122). Proximal femoral nail vs. Dynamic hip screw was evaluated on Total operating time (minutes) (p=<0.001). Proximal femoral nailing significantly reduced mean total operating time (90.3 vs 107.1 minutes) and estimated blood loss (361 vs 535 ml) compared to dynamic hip screw in patients with stable intertrochanteric femur fractures.
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