Functional and radiological outcome of inter-trochanteric fractures treated with minimally invasive D.H.S or proximal femoral nailing: A comparative study

Introduction: Inter-trochanteric fractures are one of the commonest fractures encountered in orthopaedic practice.Treatment of inter-trochanteric fractures had turned from totally conservative in the pre '70s to totally surgical now.M any surgical methods like Jewet nail, Gamma nail and condylar plates had been tried and given up.The commonest method used now are Dynamic hip screw (D.H.S) system and Proximal Femoral inter-locking nail (P.F.N) system.Materials and Methods: This, prospective study was conducted in Sri Venkateswaraa M edical College, Pondicherry from M ay 2015 to M ay 2017.30 (Thirty) consecutive patients of age over 55 years, with inter-trochanteric fractures were studied.Of these 30 patients alternate patients (15 patients) were treated with minimally invasive D.H.S and the other 15 patients were treated with P.F.N.They were reviewed every 2 weeks.Their functional results were analysed using modified Harris hip score. 37Results: M ales predominated in our study.70% were left sided.M ean time of surgery with incision for D.H.S group was little longer than P.F.N group.P.F.N group bone weight earlier than D.H.S group.Blood loss was more in D.H.S group.There was no difference in mean hospital stay in both groups.P.F.N group patients bore weight earlier in both unstable and stable fracture groups.P.F.N group healed earlier than D.H.S group.The D.H.S group bore weight much later.There was only one complication in both groups.Bony union occurred earlier in P.F.N group than D.H.S group. Conclusion:The P.F.N group required shorter incision and had less blood loss.They were able to bear weight earlier in both stable and unstable groups, whereas D.H.S group with unstable fractures took long time to bear weight.The P.F.N group fractures healed earlier than D.H.S group.At the end of six months, the modified Harris hip score showed no marked difference between two groups.Considering all this, we conclude PFN is a better device to treat inter trochanteric fractures especially in unstable fractures.