Comparative study between proximal femoral nail and dynamic hip screw with trochanteric stabilizing plate in unstable intertrochantric femur fractures

Background: Unstable fractures accounts for approximately 50 to 60% of all intertrochanteric fractures. Failure rates of (DHS) dynamic hip screw for unstable fracture patterns are as high as 50%. Proximal femoral nail is technically more demanding surgery and also associated with complications like implant failure, femoral shaft fracture, improper reduction, screw cut-out and non-union. This study was done to compare the results of using Trochanteric stabilization plate in addition to dynamic hip screw versus proximal femoral nail which is considered as a better implant for unstable fractures. Methods: A prospective study was conducted comparing outcomes of proximal femoral nailing versus trochanteric stabilization plate with dynamic hip screw for 44 patients with unstable intertrochanteric fractures (22 each). Harris hip scoring system and Parker mobility score was used for evaluation. Results: In our study, Average time of union in all 22 patients of PFN group was about 12 weeks while average time of union in all 22 patients of DHS with TSP group was about 14 weeks. The Harris hip score was 85.45 in DHS with TSP group while it was 84.72 in the PFN group (p=0.846). The Parker mobility score was 7.81 in the DHS with TSP group while it was 7.95 in the PFN group (p=0.728). Conclusions: Use of TSP with DHS can give good results in unstable IT fractures. Addition of TSP to DHS gives good lateral wall buttress which prevent excessive medialisation of shaft and gives comparable result to PFN.