Proximal femoral nailing significantly reduced operative time (48.73 vs 69.03 minutes) and blood loss compared to dynamic hip screw, while providing better early functional outcomes and similar long-term results.
RCT (n=60)
Randomized
No
Does proximal femoral nailing improve functional outcomes and reduce operative time compared to dynamic hip screw in patients with intertrochanteric femur fractures?
Proximal femoral nailing offers advantages over dynamic hip screw in terms of reduced operative time, less blood loss, and earlier ambulation for intertrochanteric femur fractures, particularly in unstable and osteoporotic patterns.
Absolute Event Rate: 48.73% vs 69.03%
p-value: p=<0.0001
Background: Internal fixation is appropriate for most intertrochanteric fractures. Optimal fixation is based on the stability of fracture. The mainstay of treatment of intertrochanteric fracture is fixation with a screw slide plate device or intramedullary device. So it is a matter of debate that which one is the best treatment, dynamic hip screw or proximal femoral nailing. Method: A prospective randomized and comparative study of 2 years duration was conducted on 60 patients admitted in the Department of Orthopedics in our hospital with intertrochanteric femur fracture. They were treated by a dynamic hip screw and proximal femoral nail. Patients were operated under image intensifier control. The parameters studied were functional outcome of Harris hip score, total duration of operation, rate of union, amount of collapse. These values were statistically evaluated and two tailed p-values were calculated and both groups were statistically compared. Result: The average age of our patient is 67.8 years. Among the fracture, 31% were stable, 58% were unstable, 11% were reverse oblique fracture. The average blood loss was 100 and 250 ml in PFN and DHS group, respectively. In PFN there was more no. of radiation exposure intraoperatively. The average operating time for the patients treated with PFN was 45 min as compared to 70 min in patients treated with DHS. The patients treated with PFN started early ambulation as they had better Harris Hip Score in the early period (at 1 and 3 months). In the long term both the implants had almost similar functional outcomes. Conclusion: In our study we have found that the unstable pattern was more common in old aged patients with higher grade of osteoporosis and PFN group has a better outcome in this unstable and osteoporotic fracture. PFN group has less blood loss and less operating time compared to DHS group. In PFN group patients have started early ambulation compared to DHS group.
Bhakat et al. (Tue,) conducted a rct in Intertrochanteric femur fracture (n=60). Proximal Femoral Nailing (PFN) vs. Dynamic Hip Screw (DHS) was evaluated on Duration of surgery (minutes) (p=<0.0001). Proximal femoral nailing significantly reduced operative time (48.73 vs 69.03 minutes) and blood loss compared to dynamic hip screw, while providing better early functional outcomes and similar long-term results.
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