Intertrochanteric Femur Fractures: A Comparison of the Proximal Femoral Nail and the Dynamic Hip Screw

Abstract

Objective: Determination and comparison of the radiological as well as the functional outcomes of Proximal Femoral Nail (PFN) and Dynamic Hip Screw (DHS) in the treatment of intertrochanteric fractures (ITF) of the femur Study design: A randomized controlled trial Place and Duration: This study was conducted in Ghulam Muhammad Mahar Medical College Sukkur from February 2022 to February 2023. Methodology: According to the inclusion criteria, the patients added to the study had stable intertrochanteric fractures and they were divided into two groups. One group was treated using PNS and called group A. The other group was treated by DHS and called group B.  After the treatment course was completed, the patients were reviewed functionally and radiologically. The assessment was done for functional outcomes by Harris Hip Score (HHS). The grading was done in such a way that a <70 score was considered poor, a 70-80 score was considered fair, 81-90 was considered good and a 91-100 score was considered to be excellent. The comparison of both treatments was done three months after the treatment, then on the sixth and twelfth months. Results: The study was done on 110 patients, out of which 62 (56.36%) were male and 48 (43.63%) were female. The patients were randomly split into Group A and Group B. Group A and B had 55 patients each. The mean age of the patients in group A (PFN) was 58.64±6.35 years and in group B (DHS) was 58.96±5.96 years. The number of male patients in group A was 35 (63.63%) and in group B was 27 (49%). The number of female patients in Group A was 20 (36.36%) and in Group B was 28 (50.9%). The mean time of reunion of the bone seen radiologically in group A was 13.6±6 weeks and in group B was 13.3±4 weeks. In group A, the mean HHS score in the third month was 35.65±3.55 (poor) and it was 53.79±4.65 (poor) in group B (p <0.05). In the sixth month of the treatment, it was 82.75±4.64 (good) in group A and 88.65±4.86 (good) in group B (p <0.05). After one year of the treatment, the HHS score of the patients in group A was 92.87± 2.97 (excellent) and in group B was 93.18±2.19 (excellent) (p<0.05). Conclusion: The outcomes of PFN and DHS-treated patients for intertrochanteric femur fractures are similar. The outcomes were not excellent in the beginning, however, the reunion on radiology and HHS scores were excellent after one year of the treatment.