Comparison of Clinical Outcomes Between Cephalomedullary Nails and Dynamic Hip Screws for Basicervical Proximal Femoral Fractures

Abstract Background Basicervical proximal femoral fractures have greater biomechanical instability and higher incidence of implant-related complications than other types of proximal femoral fractures. The present retrospective study was performed to find a proper fixation treating basicervical proximal femoral fractures by a comparation of clinical outcomes between cephalomedullary nails and dynamic hip screws, and introduce our experience in surgical tricks and perioperative management. Methods Between January 2015 and December 2018, 821 patients aged 60 years or older suffering from a proximal femoral fracture and receive internal fixation surgery were reviewed. 25 patients of basicervical femoral fractures were included in the study according to inclusion and exclusion criteria. 7 patients were treated with a DHS, 18 with the CMN. Relevant operational data and clinical evaluation were collected. Results Reduction qualities of 6 patients were good (85.7%), 1 were acceptable (14.3%) in DHS Group and 14 of the 18 patients were good (77.8%), 4 were acceptable (22.2%) in CMN Group. The mean TAD in DHS Group of was 17.4 mm while 20.3 mm in CMN Group. Bone union had been achieved 19.9 weeks in DHS Group and 17.8 weeks in CMN Group. The mean Harris score at the final follow up was 83.9, 84.4 respectively in DHS and CMN Group with no significant difference. Conclusions DHS was not inferior for the treatment of basicervical proximal femoral fractures compared to CMNs with blade type or two integrated screw type. When applied properly, both CMNs with blade type or two integrated screw type and DHS can achieve satisfied prognosis. Our unique experiences included anatomic reduction during surgery, anti-osteoporosis treatment and prolonged weight-bearing time.