Proximal femoral locking plate versus dynamic hip screw for unstable intertrochanteric femoral fractures (original) (raw)
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International Surgery Journal, 2021
Background: Inter-trochanteric femoral fractures are associated with a high complication rate and mortality. This study aims to compare the proximal femoral locking compression plate (PFLCP) with dynamic hip screws (DHS) for inter-trochanteric femoral fractures in terms of mean bone union time.Methods: It was a prospective randomized study conducted at the department of orthopedics, Benazir Bhutto Hospital, Rawalpindi, Pakistan from June 2015 to December 2015. Sixty patients with a diagnosis of inter-trochanteric fractures, requiring orthopedic surgery, were included in the study. After randomization thirty patients underwent PFLCP fixation and the other thirty patients underwent DHS fixation. Patient information, demographic data, and functional level were assessed. Mean bone union time and implant complications were compared for the two treatment groups.Results: Patients who underwent PFLCP fixation demonstrated shorter bone union time (2.8±0.2 months) than those who underwent DHS...
Outcome of Surgical Fixation of Intertrochanteric Femoral Fractures with Dynamic Hip Screw
International Journal of Science and Research, 2019
Intertrochanteric fracture of the femur is one of the common fractures in the elderly with osteoporosis due to trivial fall. When occurs in the young, intertrochanteric fracture is usually due to high-energy injuries such as motor vehicular accident or fall from height. Dynamic Hip Screw (DHS) fixation has remained the gold standard for the treatment of stable intertrochanteric femoral fractures to which other options are compared.The aim of this study was to assess radiological and functional results in stable intertrochanteric femoral fractures treated with Dynamic Hip Screw fixation.This study was a prospective, interventional study involving 48 consecutive patients with stable intertrochanteric femoral fractures that were treated using internal fixation with DHS between December 2015 and November 2018 at the National Orthopaedic Hospital, Dala - Kano. All patients were followed up for a minimum of 6 months. The mean age of the patients was 56.8 ± 15.0 years. There was a preponderance of males over females in a ratio 4.3:1. At the end of 6 months postoperatively, 45 (93.8%) patients had their fractures united with mean RUSH score of 27.1 ± 3.1. The mean HHS in the preoperative period was 19.2 ± 24.8. At the end of 6th postoperative month, the mean score was 91.7 ± 12.5. It was concluded that DHS is a reliable implant in surgical treatment of stable intertrochanteric fractures
International Journal of Orthopaedics Sciences
Dynamic hip screw has long been a standard implant for intertrochanteric hip fractures. The inception of intramedullary nails has further revolutionized their management. With a constant evolution in the designs of both these implants, there has always been a conflict concerning the superiority of one over the other. In this randomized prospective cohort study, 80 patients with intertrochanteric fracture femur were segregated into two groups based on internal fixation with DHS with locking side plate (DHS) (n=40) or Proximal femoral Nail (PFN) (n=40). Clinical and radiological parameters were studied and functional evaluation was done with Harris hip score. The intraoperative parameters were in favor of PFN with significantly less duration of surgery, length of incision and blood loss but more fluoroscopy time. Postoperatively also, PFN group patients excelled with significantly less postoperative pain, less incidence of deep infection , better range of motion, less mean limb length discrepancy and more patients regaining their pre injury walking capability and also fewer complications. Average union time was comparable between the groups. Functionally, PFN emerged to be superior to DHS in unstable intertrochanteric fractures while in stable fractures, results were same. We deduce that surgical planning and expertise with rigorous regard to the personality of the fracture are pivotal for outstanding results.
Revista Brasileira de Ortopedia (English Edition)
Objective: To evaluate and compare the clinical and radiological outcomes of patients with stable intertrochanteric fractures treated with proximal femoral nail vs. dynamic hip screw. Methods: Sixty patients with stable intertrochanteric fractures, aged over 18 years, were randomly divided into the proximal femoral nail and dynamic hip screw groups. Dynamic hip screw with a three-hole side-plate and an anti-rotation screw were used, as well as a modified ultra-short proximal femoral nail for the smaller Asian population. The intra-operative, early and late complications were recorded, and the functional outcome of each group was assessed using the Harris Hip Score. Results: In the dynamic hip screw group, the one-month mean Harris Hip Score was slightly lower than that of the proximal femoral nail group. However, at the three-and six-month monthly follow-ups, the dynamic hip screw group presented higher mean scores than the proximal femoral nail group; at the one-year follow-up, both the groups attained similar scores. Conclusion: Proximal femoral nail provides a significantly shorter surgery with a smaller incision that leads to less wound-related complications. However, the incidence of technical errors was significantly higher in proximal femoral nail when compared with dynamic hip screw as it is a technically more demanding surgery that leads to more implant failures and the consequent re-operations.
Zenodo (CERN European Organization for Nuclear Research), 2022
Introduction: Although the effects of PFN and DHS in treatment of intertrochanteric fractures have been reported, and many studies have been done to compare both implants but the results and conclusions are not consistent and there is still ongoing controversy whether PFN is a better choice than DHS. Therefore, with the goals of better stable surgical construct of intertrochanteric fractures and early mobilization of patients, this study was planned with rationale to compare the intraoperative complications and functional and radiological outcome of intertrochanteric fractures in patients treated with dynamic hip screw and proximal femoral nail. Materials and Methods: This study was carried out in GMERS Medical College and General Hospital Gotri Vadodara from September 2020 to December 2021, consisting of total 50 patients of intertrochanteric factures of femur. This was a Randomized control prospective study. All the patients were operated by surgeons experienced in handling both implants. For evaluation, personal data, mode of trauma, type of fracture, type of surgery, intra operative & post operative complications, follow up examination and duration of full weight bearing were recorded. Results: Fracture reduction in stable fractures was good and comparable in both DHS (81.25%) And PFN (80%) groups but fracture reduction in unstable fractures was better in PFN group (73%). Mean duration of hospital stay was more in DHS group(7.2 days).Union occurred in all fractures in our study but there were two cases of shortening and varus malunion in unstable type in each DHS and PFN group. Mean duration of fracture union was earlier in PFN group, [15.56 weeks] comparing to DHS group [20.64weeks]. The duration of fracture union was more in unstable type compared to stable type in DHS group but it is nearly same in both type in PFN group. Mean HARRIS hip score was more in PFN group at 6 weeks after surgery. But it became nearly equal in both groups at 20 weeks period. Conclusion: PFN group had advantage of lesser blood loss, incision length, operative time and lesser hospital stay, Early weight bearing and early functional rehabilitation. DHS group had advantage of lesser intraoperative radiation exposure and lesser implant related intraoperative complication. Varus collapse and shortening in unstable fractures were more in DHS than PFN group but statistically insignificant. In stable fractures Both PFN and DHS are equally performing implant. But in unstable fractures PFN had edge over DHS with better functional outcome.
International Journal of Orthopaedics Sciences, 2018
Background: Trochanteric fractures are devastating injuries that most commonly affect the elderly and also in young, have a tremendous impact on both the health care system and society in general. The mainstay of treatment of intertrochanteric fracture is fixation with a screw slide plate device or intramedullary device. The purpose of this retrospective study to review the long term functional outcome of Intertrochanteric femoral fractures treated with dynamic hip screw (DHS) v/s proximal femoral nail (PFN). Methods: This study was conducted on 1000 patients of both sexes with intertrochanteric femoral fractures above 16 years of age group which were operated for intertrochanteric femoral fracture by DHS (500patients) and PFN (500patients) from January 2009 to December 2012. Functional results were assessed by Harris hip scoring system. Results: In our study Mean age-62.66±16.99. The ratio of males to female was 1.23:1. 85.2% of patients were found with domestic fall and both sides were equally involved. In our study 5.2% cases of infection notated in the PFN group and 9.4% in the D.H.S group. Peri-Implant fracture occurred in 8 cases (1.6%) in PFN group and 19 cases (3.8%) in DHS group. Mechanical complications like (Breakage of PFN/ DHS screw and PFN/ DHS plate) occurred in 24 cases (4.8%) in PFN group and in DHS group were found in 16 cases (3.2%). Deformity (varus deformity and external rotation) occurred in 11 cases (2.2%) in PFN group and 44 cases (8.8%) in DHS group. Mean HHS of PFN was 92.064 and of DHS was 91.753(p=0.425). Conclusions: We conclude that long term functional outcome measured by HHS of Intertrochanteric femoral fractures treated with dynamic hip screw v/s proximal femoral nail have no significant difference but complication like peri-implant fracture, Shortening, Screw cutout , varus deformity were more in patient operated by DHS.
International Journal of Orthopaedics Sciences
Intertrochanteric fractures are one of the most common injuries sustained predominantly in patients over 60 years of age. They are 3 or 4 times more common in elderly women who are osteoporotic, in whom trivial trauma is the most common mode of injury. A total of 98 patients of intertrochanteric fractures of the femur were operated during this period in our institute. Among these patients, 26 patients died after surgery and did not follow up and were not included in this study. The rest of the patients were not traceable via telephone, some even by home visitations by us due to difficulty in tracing certain home addresses. Patients who were followed up for upto 6 months to 1 year were included in this study. All patients were in Sahlstrand's Grade 1 walking ability before trauma. Post-op walking ability in this study shows 60%PFN patients walking without support with 33.3% DHS patients walking without support and 66.7% patients of DHS walking with cane and 13.3% patients of PFN needing 2 canes or walker postoperatively measured at 6 months post-op. It was found that proximal femoral nailing had better functional outcome in patients with especially unstable fractures and DHS had better functional outcome among the stable fractures.
International Journal of Research in Orthopaedics, 2020
Background: Intertrochanteric fractures of the femur are difficult to manage because of the complex patterns they present with. A dynamic hip screw (DHS) and a DHS supplemented with a trochanteric stabilisation plate (TSP) are among a variety of fixation methods used in the management of such injuries. We compared the efficacy of DHS with TSP to DHS alone in the treatment of unstable intertrochanteric femur fractures.Methods: 30 patients of intertrochanteric femur fractures (mean age 72 years) were included in the study, 14 were treated using DHS with TSP while 16 were treated using DHS alone, they were followed up till 16 weeks and the progress was recorded according to the parameters in the Salvati and Wilson score.Results: 14 patients were treated using DHS with TSP, 11 of them had excellent Salvati and Wilson scores, 3 patients recorded good scores, 11 patients were able to walk with no pain while 3 needed aids for walking due to pain, normal function was restored in 12 patients...
International Journal of Research in Orthopaedics, 2017
Trochanteric fractures are common in the elderly people. The frequency of these fractures has increased primarily due to the increasing life span and more sedentary life style brought on by urbanization. Trochanteric fractures occur in the younger population due to high velocity trauma, whereas in the elderly population it is most often due to trivial trauma. 1 Dynamic hip screws (DHS) have been considered as the standard fixation for extra-capsular femoral fracture and yielded good results in the patients with stable intertrochanteric fractures. 2,3 However, its value for ABSTRACT Background: Intertrochanteric fractures occur in people with poor bone quality, about half of the intertrochanteric fractures are comminuted and unstable. The purpose of the present study was to compare the outcome of surgical treatment of proximal femoral fracture by dynamic hip screw (DHS), proximal femoral nail (PFN) and proximal femoral locking compression plate (PFLCP). Methods: This prospective comparative observational study had included cases presented with intertrochanteric fractures of femur attended orthopedic OPD and emergency department were treated with dynamic hip screw (DHS), proximal femoral nailing (PFN) or proximal femoral locking compression plate. Post-operative x-rays were done to assess reduction and progress of union (non-union/mal-union), any post-operative complications e.g. operative wound infection, implant failure etc. Results: In our study, we found that PFNs prove to be more useful in difficult fractures with a subtrochanteric extension or reversed obliquity. The rotational stability was higher when proximal femoral nail is used in these fractures. The incidence of wound infection was found to be lower with intramedullary implants which resulted in early ambulation of the patients. Conclusions: In our study, we found that proximal femoral nails prove to be more useful in difficult fractures with a sub-trochanteric extension or reversed obliquity. The rotational stability was higher when PFN is used in these fractures. The incidence of wound infection was found to be lower with intramedullary implants which resulted in early ambulation of the patients. Non-union of trochanteric fracture although is a rare entity.