Stable Intertrochanteric Fracture in the Elderly. Is an Anti-Rotation Short Proximal Femoral Nail Better than a Dynamic Hip Screw

Ejaz Ashraf  Mallhi

doi:10.51253/pafmj.v75i2.9261

Authors

Ejaz Ashraf Mallhi Department of Orthopeadic Surgery, CMH Multan/Institute of Medical Sciences Multan/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75i2.9261

Keywords:

Dynamic Hip Screw, Femoral Fracture, Fracture Healing, Geriatrics, Time to Union

Abstract

Objective: To compare a dynamic hip screw with an anti-rotation proximal femoral nail antirotation in a stable intertrochanteric fracture in the elderly, in terms of functional outcome, time to union, complications operating time and blood loss.

Study Design: Quasi-experimental study.

Place and Duration of Study: Orthopedic Department at Combined Military Hospital Multan, Pakistan from Oct 2019 to Jul 2021.

Methodology: We enrolled one hundred cases of stable intertrochanteric fractures in the elderly. Patients were randomly allocated to two groups: into Group-A (PFNA) and Group-B (DHS). Three patients were eliminated from the analysis, two possessing multiple lower limb fractures and one having a pathological fracture. We lost three patients in follow-up. Ninety-four patients were left. We evaluated them for operating time, intraoperative blood loss, time to union, complications and reoperation. Our team gauged functional outcomes using modified Harris hip scores at 3, 6 and 12 months.

Results: We established no significant discrepancy between time to union and complications and reoperation rate between Group-A (PFNA) and Group-B (DHA). Functional outcomes evaluated at 3,6 and 12 months have identical findings in both groups. However, operating time was considerably longer in Group-B, with extra blood loss compared to group-A.

Conclusion: We inferred that both DHS and PFNA could be used in stable intertrochanteric fractures in the elderly with proportional effectiveness. However, in the elderly with comorbidities and employing shorter anesthesia time and blood loss, PFNA should be given preference.

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