Comparison Between Proximal Femoral Nailing and Dynamic Hip Screw Fixation for the Treatment of Intertrochanteric Fractures

Author(s): Dr. Md. Golam Shaikh Ferdous, Professor Dr. Khandker Md. Nurul Arifeen, Dr. Md. Nazrul Islam, Dr. Debashish Dey, Dr. Aminur Rasul, Dr. Aynun Nahar Rabeya Diba

Background: Intertrochanteric fractures continue to make up a significant portion of everyday orthopedic practice, and their incidence is on the rise with increasing life expectancy. Previously, the dynamic Hip Screw, an extra-medullary device, was used for fixation. However, over the past decade, there has been a growing preference for intramedullary fixation methods such as Proximal Femoral Nailing. Despite this, there is no general consensus on their routine use.

Aim of the study: To evaluate and compare the functional outcomes between Dynamic Hip Screw (DHS) and Proximal Femoral Nail (PFN) for the management of intertrochanteric fractures.

Methods: This prospective comparative study was conducted in the Department of Orthopaedic Surgery, BSMMU, Dhaka, from September 2022 to September 2024, where 36 patients were allocated on the basis of fixation technique into the Dynamic Hip Screw (DHS Group) and Proximal Femoral Nail (PFN Group) groups; after they have met selection criteria. The assessment was done preoperatively and postoperatively on 1, 3, 6 and 12 months by using VAS score and Harris Hip Score. The analyses of different variables were done according to standard statistical analysis using software ‘Statistical Package for Social Science’ (SPSS) version 26, IBM®, Armonk, USA. p-value of <0.05 was considered significant.

Result: The mean age of patients was 67.19 ± 10.01 years, with females comprising 58.3%. Most injuries (80.5%) were from falls, and 41.7% had a Singh Index ≤III. Left-sided fractures (55.6%) and Boyd & Griffin Type I–II (80.5%) were most common. Closed reduction was achieved in 94.4% (DHS) and 88.9% (PFN). Operative time, blood loss, and hospital stay were significantly higher in DHS than PFN. Earlier union was seen with PFN (14.50 ± 1.58 vs 16.78 ± 2.76 weeks). Both groups showed significant VAS and HHS improvements, though differences were insignificant. Excellent outcomes were higher with PFN (44.4% vs 33.3%), and better results were noted in younger males, stable fractures, and TAD ≤25 mm.

Conclusion: DHS and PFN are both safe and effective techniques for the management of intertrochanteric fracture, with relatively better outcomes in the PFN group. Also, peri-operative parameters were in favor of the PFN group.