COMPARISON OF CLINICAL AND RADIOLOGICAL OUTCOMES OF INTERTROCHANTERIC FRACTURES TREATED WITH PROXIMAL FEMORAL NAIL VERSUS DYNAMIC HIP SCREW: A RETROSPECTIVE COHORT STUDY
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Keywords
Intertrochanteric fractures, Proximal Femoral Nail, Dynamic Hip Screw, Harris Hip Score, fracture fixation, geriatric trauma
Abstract
Background: Intertrochanteric fractures represent a significant public health burden in India, particularly among the elderly population. The choice between Proximal Femoral Nail (PFN) and Dynamic Hip Screw (DHS) remains controversial, with varying outcomes reported across different settings. This study aimed to compare the clinical and radiological outcomes of these two fixation methods in the Indian healthcare context.
Objectives: To compare operative time, blood loss, fracture union rates, functional outcomes, and complication rates between PFN and DHS for intertrochanteric fractures in patients treated at Sharda Hospital, Greater Noida, between January 2024 and August 2024.
Methodology: A retrospective cohort study was conducted on 124 patients with intertrochanteric fractures. Patients were divided into two groups: PFN (n=64) and DHS (n=60). Data on demographics, fracture characteristics (AO/OTA classification), operative parameters, radiological union, Harris Hip Score, and complications were collected from medical records. Statistical analysis was performed using SPSS version 26.0, with chi-square test and independent t-test for comparison, considering p<0.05 as significant.
Results: The PFN group demonstrated significantly shorter operative time (48.3±8.2 vs 62.7±9.4 minutes, p<0.001) and reduced intraoperative blood loss (142.5±32.6 vs 218.4±45.3 ml, p<0.001). Fracture union was achieved earlier in the PFN group (13.2±2.1 vs 15.8±2.9 weeks, p<0.001). At six-month follow-up, mean Harris Hip Score was comparable (82.4±6.8 vs 80.2±7.3, p=0.087). The PFN group showed lower rates of lag screw cut-out (3.1% vs 11.7%, p=0.049) and varus collapse (4.7% vs 13.3%, p=0.046).
Conclusion: PFN offers superior outcomes in terms of operative parameters, earlier fracture union, and lower mechanical complication rates compared to DHS for intertrochanteric fractures in this regional population. These findings support PFN as the preferred treatment modality, particularly for unstable fracture patterns commonly observed in the North Indian demographic.
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Dr. Dhamsania Hardik Jagdishbhai
Assistant Professor, Department of Orthopaedics, School of Medical Sciences and Research, Greater Noida, Uttar Pradesh, India
Dr. Arunkumar R Varun
Professor, Department of Community Medicine, M M Institute of Medical Sciences & Research, Mullana, Ambala, Haryana, India
Mr. Alok Pritam
Statistician Cum Tutor, Department of Community Medicine, Lord Buddha Koshi Medical College & Hospital, Saharsa, Bihar, India
