Rebar Muhammad Noori Khaffaf*

* Department of Surgery, School of Medicine, Faculty of Medical Sciences, University of Sulaimani.

Submitted: 21/6/2015; Accepted: 10/1/2016; Published: 1/6/2016

DOI Link: https://doi.org/10.17656/jsmc.10087 



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.


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.


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.


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.


Proximal Femoral Nail, Hip Screw, Intertrochenteric Fracture.


1. Saudan, A. Lubbeke, C. Sadowski, N. Riand, R. Stern, and P. Hoffmeyer. Petrochanteric fractures: is there an advantage to an intramedullary nail? A randomized, prospective study . Journal of Orthopaedic Trauma.2002 vol. 16 ( 6),.386–393

2. Huang ZY,  Liu XW, and  Su JC. Dynamic hip screw vs. proximal femur nail in treatment of intertrochanteric fractures in patients aged over 70 years old. Shanghai Medical Journal,2010 vol. 33, no. 11, 1042 pages

3. Huang X, Leung F, Xiang Z, Tan PY, Yang J, Wei DQ, Yu X. Proximal femoral nail versus dynamic hip screw fixation for trochanteric fractures: a meta-analysis of randomized controlled trials. ScientificWorldJournal. 2013;vol 2013:ID805805,8 pages

4.Nayagam.S. injuries of the hip and femur . In:Solomon L,Warwick D,Nayagam S(eds).Apley’s System of Orthopedics and Fractures. Ninth Edition.London:Hodder Arnold;2010. Chapter 29, P 859.

5. John W. fractures and dislocation of the hip .In: Terry canal S ,James H(eds) .CAMPBELL’S OPERATIVE ORTHOPAEDICS. Twelfth edition.Philadilphia :Mosby ;2013 chapter 55:P 2965—2966.

6. John C. We6.Pan X, . Xiao D,  Lin B, and HuangG, Dynamic hip screws (DHS) and proximal femoral nails (PFN) in treatment of intertrochanteric fractures of femur in elderly patients. Chinese Journal of Orthopedic Trauma, 2004 vol. 6, (7), pp. 785–789.

7. Papasimos S,  Koutsojannis CM,  Panagopoulos A, Megas P, and  Lambiris E. A randomised comparison of AMBI, TGN and PFN for treatment of unstable trochanteric fractures. Archives of Orthopaedic and Trauma Surgery,2005 vol. 125, no. 7, pp. 462–468

8.Liu M, Yang Z, Pei F, Huang F, Chen S, Xiang Z. A meta-analysis of the Gamma nail and dynamic hip screw in treating peritrochanteric fractures. Int Orthop. 2010;34:323-28.

9. Kumar R., Singh R.N., Singh B.N. Comparative prospective study of proximal femoral nail and dynamic hip screw in treatment of intertrochant. Journal of Clinical Orthopaedics and Trauma,2012 vol. 3 (1), pp. 28-36. 

10. Parker, M. J. and Handoll, H. H. G.  Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. The Cochrane Database of Systematic Reviews;2008 vol 3( No. CD000093

11. Giraud B , Dehoux E, Jovenin N, Madi K, Harisboure A, Usandizaga G, Segal P.. Pertrochanteric fractures: a randomized prospective study comparying dynamic screw plate and intramedullary fixation. Revue de Chirurgie Orthopedique et Reparatrice de l’Appareil Moteur.2005 vol. 91, no. 8, pp. 732–736, 2005.

12. Herman A, Landau Y, Tenenbaum S, Remu E, Chechick A, Shazar N. A Comparison of Two Proximal Femoral Nail Devices For Fixation of Unstable Intertrochanteric Femur Fractures. The Internet Journal of Orthopedic Surgery. 2011 Volume 19 Number 1. DOI: 10.5580/150.  

13 . Morihara T,  Arai Y,  Tokugawa S,  Fujita S,  ChataniK , Kubo K. Proximal femoral nail for treatment of trochanteric femoral fractures. Journal of Orthopaedic Surgery;2007,vol15(3):273-7

14. de Landevoisin E, Bertani A, Candoni P, Charpail C, Demortiere E.. Proximal femoral nail antirotation (PFN-ATM) fixation of extra-capsular proximal femoral fractures in the elderly: Retrospective study in 102 patients. Journal of Orthopaedics & Traumatology: 2012, vol. 98( 3), pp. 251-366

Full Text

 © The Authors, published by University of Sulaimani, College of Medicine

This work is licensed under a Creative Commons Attribution 4.0 International License.