Comparison of Proximal Femoral Nail (PFN) and Dynamic Hip Screw (DHS) Fixation for Per Trochanteric Femoral Fractures

Authors: Khan HA, Rehman N, Kamran A, Dawar F and Ahmad I*

DOI: 10.23880/mjccs-16000312

Volume 6, Issue 2

Abstract

Objective: To compare the mean per operative blood loss, operative time, post-operative pain, post-operative mobilization, infection rate and functional outcome between PFN and DHS. Setting: Department of Orthopaedic and Spine Surgery, Hayatabad Medical Complex, Peshawar, Pakistan Introduction: The optimal treatment of per trochanteric and intertrochanteric fractures is internal fixation via intra-medullary or extra-medullary implants. The proximal femoral nail (PFN) and dynamic hip screw (DHS) are used to fix intertrochanteric fractures. Methodology: From July 2019 to December 2020, a total of 60 patients were randomly allocated to PFN group (30 patients) and DHS group (30 patients) using computer generated number. The patients were assessed for operative time, blood loss, post-operative pain, need for transfusion and were followed for 6 months to see the difference in Harris hip score in the two groups. Results: Mean age of the patients was 62.3.3±6.8 in PFN group and 64.1±4.7 in DHS group. There was no significant difference in the co morbidities, ASA status, fracture type and preoperative hemoglobin between the groups. However, there was significant difference in the mean postoperative hemoglobin drop (11.9 ±0.8 vs 11.1±1.0, p= 0.002) and mean operative time (66.1±5.2 vs 88.2±7.5, p= 0.001) between the PFN group and DHS group respectively. Mean pain score at 24 hrs was also significantly lower for PFN group (6.0±0.8 vs 6.5±0.6 p= 0.01). The patients in PFN group did better and were able to mobilise early than the patients in DHS group with a statistical difference (1.6±0.6 vs. 2.4±0.5, p = 0.001). Similarly the mean total hospital stay was shorter for patients in PFN group than those in DHS group (3.7±0.8 vs 4.8±0.9, p= 0.001). At six months follow up the patients in PFN group had better functional outcome as sown by statistical difference in mean Harris Hip score (87.73±4.2 vs 82.8±3.8, p= 0.001). Union was not achieved in 2(6.7%) patients in PFN group and 6(20%) patients in DHS group. Conclusion: PFN provides lesser per operative blood loss, shorter operative time, less post op pain, earlier post-operative recovery and mobilization, lesser infection rate and better functional outcome as compared to DHS.

Keywords: Proximal Femoral Nail; Dynamic Hip Screw; Intertrochanteric Hip Fracture

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