Background: Osteoporosis being an age related disease is showing a yearly growth especially among the elderly population. Osteoporosis causes decrease in the bone mass and strength and therefore increased risk of fractures. Osteoporotic hip fracture is one of the most common and serious fracture and is associated with high morbidity, mortality, and disability rates. Both intramedullary treatment options like Proximal Femoral Nail (PFN) and extramedullary treatment options like Dynamic Hip Screw (DHS) have been used for the treatment. The objective of this study was to compare the functional outcomes of PFN and DHS for treatment of unstable intertrochantric fractures. Material and Methods: This prospective study was conducted in the department of Orthopaedics at Adesh Institute of Medical Sciences and Research Bathinda from August 2017 to March 2020. We included 50 patients aged between 42- 89 years with unstable intertrochantric fractures of Type II, Type III and Type IV (Boyd and Griffin classification). Out of these patients, 25 patients were treated with PFN and 25 patients were treated with DHS. All patients were followed at least for a minimum period of 6 months and were evaluated radiologically and clinically by Kyle’s Criteria. Results: Out of the 50 patients, 23 (46%) were males and 27 (54%) were females. Male to female ratio was 11:14 in PFN group and 12:13 in DHS group. The age of the patients ranged from 42 years to 89 years. Mean age of the patients in the PFN and DHS group was 64.3±14.42 years and 62.5±12.85 years respectively. Average operative time was 54.2 minutes for PFN group and 65.3 minutes for DHS group and the difference was statistically significant (p<0.05). Average amount of blood loss during the surgery was150.45±48.216 ml in PFN group and 265.91±78.156 ml in the DHS group and the difference was statistically significant (p<0.05). Time for toe touch weight bearing was significantly shorter in the PFN group (15.56±6.15 days) as compared to the DHS group (40.23±11.27 days) (p<0.05). Average limb length shortening was 4.46 mm in PFN group and 8.63 mm in DHS group and the difference was statistically significant (p<0.05). Conclusion: PFN is a better treatment option as compared to DHS for unstable intertrochantric fractures in terms of reduced duration of surgery, blood loss, early weight bearing and mobilization. Functional outcome was found to be better in PFN group as compared to the DHS group.
Keywords: Proximal Femoral nail, Dynamic Hip Screw, unstable intertrochantric fractures, Kyle’s Criteria, outcome