A Comparative Study of Functional Outcome Following Dynamic Hip Screw and Proximal Femoral Nailing for Intertrochanteric Fractures of the Femur

Abstract

Introduction Intertrochanteric fractures are common in the old age group. The goal/aim of the treatment for intertrochanteric fractures will be to nearly restore pre-injury condition as early as it is possible. Dynamic hip screw (DHS) and proximal femoral nailing (PFN) have been the two standard treatment methods used for treating these kinds of fractures. The main goal of this proposed study was to compare functional outcomes of two available fixation devices for inter-trochanteric fracture using Harris hip scoring. The aim of this study is to compare the functional outcome of the DHS and PFN for the treatment of Intertrochanteric hip fractures achieved by the patient based on Harris hip score. Methods and materials The clinical methodology for the study consists of 46 cases of Inter-trochanteric fractures of femur that meet the inclusion criteria of patients aged above 45 years diagnosed with closed intertrochanteric fractures that are less than three weeks duration who were able to walk prior to fracture and exclusion criteria, admitted to R L Jalappa Hospital, Tamaka, Kolar between November 2019 and November 2021. The patients were divided into two groups, group A treated with DHS and group B treated with PFN and followed up at six weeks, 12 weeks, and 24 weeks based on the functional outcome on the 24^th week using Harris hip score. Results A total of 46 patients were included in the study. The mean age in Group DHS was 61.09 ± 11.69 and in Group PFN was 65 ± 14.98. In the group of DHS, nine out of 23 patients were male and 14 out of 23 patients were female patients. In a group of PFN, 12 out of 23 patients were male and 11 out of 23 patients were female. The mean six weeks score in Group DHS was 34.43 ± 3.23 out of 100 and in Group PFN was 34.35 ± 2.5 out of 100. The mean Harris hip score in Group DHS was 84.3 ± 7.68 out of 100. The mean Harris hip score in Group PFN was 89.26 ± 6.53 out of 100. In Group DHS, 52.17% had injuries on the left side and 47.83% had on the right side. In Group PFN, 39.13% had Injury on the left side and 60.87% had on the right side. In Group DHS, results were excellent in 34.78% (eight patients), good in 43.48% (10 patients), fair in 17.39% (four patients out of 23 patients), and poor in 4.35% (one patient). In Group PFN, results were excellent in 56.52% (13 patients), good in 34.78% (eight patients), and fair in 8.70% (two patients). Conclusion From the study, it can be concluded that PFN had a better outcome in intertrochanteric fractures compared to DHS. The highest percentage of subjects in the PFN group had excellent to a good outcome and none of them had poor outcomes when compared to the DHS group. PFN group had higher scores of Harris hip score at 12 weeks, 24 weeks, and at the end of follow-up.

Keywords: dynamic hip screw; functional outcome; harris hip score; intertrochanteric fractures; proximal femoral nailing.

Figure 1. Bar diagram showing the functional outcome of the DHS and the PFN group based on Harris hip score

DHS = dynamic hip screw; PFN = proximal femoral nail

Figure 2. Pre-operative and post-operative follow-up radiographs of an intertrochanteric fracture treated with DHS fixation

(A) Pre-operative radiograph. (B) Immediate post-operative radiograph. (C) 12-week follow-up radiograph. (D) 24-week follow-up radiograph. DHS = Dynamic hip screw

Figure 3. Pre-operative and post-operative follow-up radiographs of an intertrochanteric fracture treated with PFN fixation

(A) Pre-operative radiograph. (B) Immediate post-operative radiograph. (C) 12-week follow-up radiograph. (D) 24-week follow-up radiograph. PFN = Proximal femoral nail