Umair Nadeem, Muhammad Farrukh Bashir, Saeed Ahmad, Ashfaq Ahmad, Rizwan Akram, Shahzad Javed, Amer Aziz.
Outcome of proximal femoral nail versus dynamic hip screw fixation in unstable intertrochanteric fractures.
Pak J Surg Jan ;35(2):142-6.

Introduction: Intertrochanteric fractures of the hip are very common and are a cause of significant morbidity and mortality, particularly in elderly osteoporotic patients. Unstable fractures are challenging to treat. Goal of the treatment is early stable fixation and quick return of hip function. Surgical treatment of these fractures is still an evolving science. Over the decade`s several implant designs have been developed and evaluated. Dynamic Hip Screw (DHS) is time-tested and is still very popular. However, recently introduced Proximal Femoral Nail (PFN) has been reported to have improved biomechanics. Objectives: To compare the outcome of fixation of unstable intertrochanteric fractures with DHS and PFN in terms of mean Harris Hip Score. Design: Randomized Controlled Trial Setting: The study was conducted in the Department of Orthopedics and Spine Surgery, Ghurki Trust Teaching Hospital/Lahore Medical & Dental College, Lahore. Duration of study with dates: Six months (15th July, 2015 to 15th January, 2016) Material and Methods: Sixty cases of unstable intertrochanteric fractures were included in the study and internal fixation was done randomly with DHS and PFN under fluoroscopic guidance. Patients were followed and Harris Hip Score was determined for each at 6 weeks. Means were compared using independent samples t-test. Results: There were 37 males and 23 females with male to female ratio of 1.6:1. Th e mean+-SD of the age distribution was 66+-9.4 years. All patients were admitted through emergency. There were 40 AO type 31A2 and 20 AO type 31A3 intertrochanteric fractures. Mean Harris Hip Score at 6 weeks was 32.8+-4.5 for the DHS group and 43.8+-6.1 for the PFN group which was found to be statistically significant. Conclusion: In unstable intertrochanteric fractures, internal fixation with PFN provides more rapid improvement in hip function which facilitates quicker ambulation and early return to normal activity.

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