ASSESSMENT OF THE OUTCOME OF PROXIMAL FEMORAL NAIL VERSUS DYNAMIC HIP SCREW IN THE TREATMENT OF UNSTABLE INTERTROCHANTERIC FRACTURE IN ELDERLY PATIENTS

Abstract

Background 

Intertrochanteric fractures are common problems in elderly and need surgical intervention to prevent bed ridden problems and decrease comorbidities among the elderly population. Globally there is an increase in the incidence of femoral neck fracture and the surgical management with better outcome is challenging for surgeons and for hospitals.

Objective

To assess the outcome of proximal femoral nail versus dynamic hip screw in the treatment of unstable Intertrochanteric fracture in elderly patient.

Patients and Methods

This prospective study was carried out at orthopedic departments in Shar Hospital, teaching hospital,Tuymalik and Roonaki private hospitals between 26th July 2013 to 15th October 2014. The study included 88 patients with intertrachanteric fracture of the femur, 48 were male, and 40 were female they were divided in two groups; 44 patients were treated by proximal femoral nail (PFN) and the other 44 patients by dynamic hip screw (DHS). For both groups data regarding age, sex, side of fracture were recorded, then we compared both group intraoperatively and postoperatively with respect to operation time,hospital stay, varus deformity of the neck, misplacement of hip screw, mobilization after operation, implant failure, screw cut out, hip pain, bed sore, deep vein thrombosis, and union duration.

Results

The mean age was 64±19, 48% were above 70 year and 52% were below 70 years age, male 48 (54.5%) and female 40(45.5), fracture side was 40.9% right and 59.1% left, 50% fixed by PFN and 50% fixed by DHS, operation duration mean for PFN was 63.8±11.5 min and 88.5±13.3 min for DHS with significance P value (<0.001), mean hospitalization time was 4.3±1.2 day for PFN and 6.3±1.7 day for DHS with significance P value (<0.001), mean mobilization time was 1.6± 0.7 day for PFN and 2.5±1.2 day for DHS with significance P value (0.007), mean union duration was 3.3 ±0.9 months for PFN and 4.8±1.6 months for DHS with significance P value (0.001), Intra and postoperative complication was 6 (13%)screw of hip screw misplacement happen in 4 cases of DHS and 2(3.7%) cases of PFN, implant failure 1 (2%) case of PFN ,screw cut out 2(3.7%) cases for PFN, bed sore 8(18%) cases for DHS, hip pain was 8(13%) cases for DHS, varus collapse 6 (13%) in which 2 cases (3.7%) for PFN and 4(8%) for DHS.

Conclusion

Proximal femoral nail which is an intramedulary devices for the fixation is more stable devices for the patients with fracture of Intertrochanteric (kyle 3 or Ao31-A2) than DHS which is extramedulary devices (plate and screws) in term of shorter time of surgery. Early mobilization of the patient, early callus formation and earlier union, with less complication regarding bed sore and hip pain.