Key result
Proximal femoral nail fixation resulted in better overall functional outcomes compared to dynamic hip screw fixation in patients with intertrochanteric femur fractures.
Why the study?
Does proximal femoral nail improve functional outcomes compared to dynamic hip screw in adults with intertrochanteric femur fractures?
Cohort (n=30)
No
Does proximal femoral nail improve functional outcomes compared to dynamic hip screw in adults with intertrochanteric femur fractures?
Proximal femoral nail provides significantly better functional outcomes, shorter operative time, and smaller incisions compared to dynamic hip screw in intertrochanteric fractures, particularly in unstable fractures.
Answers are grounded in this paper and cite their sources.
May inform surgical timing decisions in elderly intertrochanteric fracture patients; leaves open need for randomized trials on outcomes.
Background: Trochanteric fractures are one of the commonest injuries sustained predominantly in patients over sixty years of age. They are three to four times more common in women. These usually occur through bone affected by osteoporosis; trivial fall being most common mechanism of injury Approximately 10-30% of patients die within one year of an intertrochanteric fracture. Methods: A prospective study comprising of patients identified for surgical treatment of fracture in the intertrochanteric region of femur admitted to Sri Siddhartha Medical College, Tumkur from 2016 to 2017 where 30 patients with 30 intertrochanteric fractures of femur were selected with equal distribution of 15 dynamic hip screw devices and 15 intramedullary devices. Results: The purpose of the present study is to verify theoretical advantages of intramedullary device over the dynamic hip screw devices and also whether it actually alters the eventual functional outcome of the patient. Excellent results were seen in 2 patients (13.3%) in the DHS group and in 6 patients (40%) in the PFN group. The overall functional outcome of patients treated with the PFN was significantly better than those treated with DHS (p=0.037). However when we compared the stable and unstable fractures separately, we found that there was no significant difference in the outcomes of the stable fractures in the two groups (p=0.198). Conclusions: We conclude that in stable intertrochanteric fractures, both the PFN and DHS have similar outcomes. However, in unstable intertrochanteric fractures the PFN has significantly better outcomes in terms of earlier restoration of walking ability as it is an intramedullary implant which can tolerate higher cylindrical loading when compared to DHS type of implants. In addition, as the PFN requires shorter operative time and smaller incision, it has distinct advantages over DHS even in stable intertrochanteric fractures. Hence, in our opinion, PFN may be the better fixation device for most intertrochanteric fractures.
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Sridhar et al. (2017) conducted a cohort in Intertrochanteric fractures of femur (n=30). Proximal femoral nail (PFN) vs. Dynamic hip screw (DHS) was evaluated on Overall functional outcome (p=0.037). Proximal femoral nail fixation resulted in better overall functional outcomes compared to dynamic hip screw fixation in patients with intertrochanteric femur fractures.
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