Comparative Study between Short Proximal Femoral Nail Versus Dynamic Hip Screw with Trochanteric Stabilizing Plate for Unstable Intertrochanteric Fractures.

Document Type : Original Article

Authors

Department of Orthopedic Surgery,, Faculty of Medicine, Beni Suef University, Egypt.

Abstract

Background
Intertrochanteric femoral fractures are one of the most common proximal femoral fractures especially in the elderly. Dynamic hip screws and intramedullary nails are well-documented implants for intertrochanteric fractures; however, there is no consensus regarding which type of implant is better.
Objective
To evaluate the radiological results and the functional outcomes after using dynamic hip screw with trochanteric stabilizing plate (DHS+TSP) versus short proximal femoral nail (PFN) in fixation of unstable trochanteric fractures and to assess related complication.
Patients and Methods
This single center prospective randomized controlled trial (RCT) included eighty eligible subjects with unstable trochanteric fracture; forty patients of them were treated with DHS+TSP and forty patients were treated with short PFN. Patients were recruited and assessed for eligibility from the Orthopedic Department.
Results
In this study, there was no significant difference between the two groups as regard demographic characteristics (P value>0.05). There was a statistically significant increase in the mean operative duration, mean blood loss and mean TAD among patients treated with DHS+TSP compared with short PFN group (P value<0.05). There was a statistically significant increase in the mean time for full weight bearing, union time and the return to the pre-fracture activity among DHS+TSP compared with short PFN group (P value= 0.001). There was no statistically significant differences between both groups regarding each of postoperative complications, mean Harris Hip Score (HHS) and mean Parker Mobility score (PMS) after one year (P value>0.05).
Conclusions
Short Proximal femoral nail is superior to dynamic hip screw with trochanteric stabilizing plate in the fixation of unstable trochanteric fractures in terms of shorter mean operative duration, less mean blood loss, less mean time for full weight bearing, less union time and less time of return to the pre-fracture activity.

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