Key result
Proximal femoral nailing resulted in a significantly longer mean duration of surgery compared to dynamic hip screw (120.25 vs 83.73 minutes, p<0.001), with no significant differences in functional or radiological outcomes.
Why the study?
While the efficacy of DHS versus PFN has been extensively explored in unstable intertrochanteric fractures, comparative data are sparsely available for stable fractures.
Does Proximal Femoral Nailing improve functional and radiological outcomes compared to Dynamic Hip Screw in patients with stable intertrochanteric fractures?
Cohort (n=62)
No
Does Proximal Femoral Nailing improve functional and radiological outcomes compared to Dynamic Hip Screw in patients with stable intertrochanteric fractures?
Absolute Event Rate: 120.25% vs 83.73%
p-value: p=<0.001
In stable intertrochanteric fractures, Proximal Femoral Nailing showed promising but statistically non-significant improvements in functional and radiological outcomes compared to Dynamic Hip Screw, albeit with longer surgical times.
Should not yet change DHS preference in stable intertrochanteric fractures; leaves open PFN advantages pending randomized confirmation.
Introduction Dynamic Hip Screw (DHS) and Proximal Femoral Nail (PFN) are two well-accepted modes of surgical treatments for intertrochanteric (IT) hip fractures. While studies have extensively explored the efficacy of one over the other in unstable fractures, the comparison is sparsely available for stable fractures. The main aim of this study is to compare DHS or PFN corrective surgeries in cases of stable IT fractures operated at the Hamad General Hospital, Doha, Qatar, between 2016 and 2018. Methods We conducted a retrospective data review of all stable IT fractures operated at the Hamad General Hospital, Doha, Qatar, between 2016 and 2018. Data were extracted from electronic medical CERNER records, including demographics, clinical notes, operative reports, radiographs, and imaging reports. Data review was followed by prospective data collection via phone about the current post-operative functional status of all cases. Data analysis was done on SPSS v.23. Study was approved by Medical Research Center (MRC) and Institutional Review Board (IRB) at Hamad Medical Corporation (HMC). Study Protocol ID: MRC-01-19-108 Results Out of 62 stable IT fractures operated at our center during the study period, 42 underwent DHS correction, while 20 had PFN. The mean age of the studied cohort was 66.56 years (± 15.95). Males were twice more than females. The mean duration of surgery was 83.73 minutes for DHS and 120.25 minutes for PFN. This difference was statistically significant (p < 0.001). Differences in intraoperative blood loss, duration between fracture and surgery, and length of hospital stay were all statistically insignificant. Patients who underwent PFN showed a higher frequency of return to ambulation (assisted and unassisted), while the number of patients with DHS was less for the functional outcome. Similarly, more post-PFN radiographs displayed union than post-DHS radiographs (55% and 38%, respectively). This difference was statistically insignificant. Conclusion Our study showed promising results for stable IT fractures treated with PFN. However, more data and prospective observational studies are required to establish more statistically significant results.
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Shiraz et al. (2023) conducted a cohort in Stable intertrochanteric hip fractures (n=62). Proximal Femoral Nailing (PFN) vs. Dynamic Hip Screw (DHS) was evaluated on Mean duration of surgery (minutes) (p=<0.001). Proximal femoral nailing resulted in a significantly longer mean duration of surgery compared to dynamic hip screw (120.25 vs 83.73 minutes, p<0.001), with no significant differences in functional or radiological outcomes.
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