Comparison between Dynamic Hip Screw and Proximal Femoral Nail in Patients with Pertrochanteric Fractures

Abstract

Objective: To compare dynamic hip screw and proximal femoral nail in patients with pertrochanteric fractures in terms of frequency of infection and union. Study Design: It was a randomized controlled trial. Settings: This study was carried at Department of Orthopedic Surgery, DHQ Teaching Hospital Faisalabad-Pakistan. Duration: 1 year from March 2017 to March 2018. Methodology: This study involved 60 patients belonging both genders having age between 20-70 years undergoing pertrochanteric fracture surgery. By random division of these patients, two treatment groups were made; Group-A (n=30) patients underwent fracture fixation with DHS while those in Group-B (n=30) were treated with proximal femoral nailing. Outcome variable was frequency of infection (diagnosed clinically upon appearance of any two of the following signs within 4 weeks after operation; redness around the wound, serosangious discharge and fever >100^oF) and union (clinical and radiological) at 12 weeks follow-up that was noted for making comparison between the two groups. A written informed consent was taken from all the participating patients. Results: The mean age of the patients was 54.80±8.57 years. There was a female predominance with male to female ratio of 1:1.4. The frequency of union was significantly higher (86.7% vs. 46.7%; p=0.001) while the frequency of infection was significantly lower (0.0% vs. 30.0%; p<0.001) in patients managed with PFN as compared to conventional practice of DHS regardless of patient’s age and gender. Conclusion: Proximal femoral nail was found superior to DHS in terms of significantly higher frequency of union and decreased risk of infection in patients with pertrochanteric fractures regardless of patient’s age and gender which advocates preferred use of proximal femoral nail in future practice provided the necessary hardware and surgical skills are available.