Abstract :
Introduction: lntertrochanteric fractures constitute 38-50% of all femoral fractures' and 5-20% of fractures as whole. These fractures are common in elderly population with the incidence of 180/10000. Though dynamic hip screw is considered as a gold standard in the management of intertrochanteric fractures, its role is debatable in the management of unstable intertrochanteric fractures and intramedullary devices such as PFN are considered better implants for these fractures
Materials and Methods: The study was conducted on 100 patients with intertrochanteric fracture femur attending the outpatient and emergency department of M.L.B. Medical College, Jhansi between December 2015 to November 2017. The patients were assessed clinically and radiologically and were divided randomly in two groups A and B, patients of group A were treated by — ORIF with Dynamic hip screw and of group B were treated by closed /open reduction internal fixation with long PFN. Patients personal information, clinical findings, radiological findings and follow-up findings were recorded in the working proforma as below. The results were evaluated and compared.
Results: The mean age in both the groups was 59.88 ± 16.90 years, In DHS group, there were 5(10%) females and 45(90%) males. In PFN group, there were 13(26%) females and 37(74%) males. There was a male preponderance in both the groups in comparison to the females. In PFN group, there were 30(60%) patients who injured because of fall, while 20(40%) were injured due to RTA. In PFN group, higher number of fall patients were there, while in DHS group, higher number of RTA patients were there. The comparison of mean blood loss in both the groups showed a statistically significant difference (P < 0> In DHS group, there were 4(8%) patients who had blood loss between 50-100 ml, in 6(12%) the blood loss was between 101-200 ml, in 16(32%) patients it was between 201-300 ml, in 16(32%) patients it was between 301-40 ml and in 8(16%) patients it was more than 400 ml. In PFN group, there were 44(88%) patients who had blood loss between 50-100 ml, in 6(12%) the blood loss was between 101-200 ml and none of the patients had a blood loss of more than 200 ml. In DHS group, 46(92%) patients had no complications, 1(2%) had DVT and 1(2%) had cut out of screw, 2(4%) had infection. In PFN group, 1(2%) had infection, 49(98%) shows no complication.
Interpretation and conclusion: In intertrochanteric fractures femur.
PFN helps in achieving biological reduction and imparts stability. PFN prevents excessive collapse and limb shortening. Thus it helps in achieving overall good functional outcome.
PFN is a load bearing device and gives stability of fracture area proximally and shaft distally, therefore biomechanically PFN is better choice of implant for fixation of peritrochanteric femoral fractures.
PFN is better choice of implant than DHS in terms of blood loss during surgery and early rehabilitation.
Therefore we advocate the use of PFN in comparison to DHS in intertrochanteric fractures femure except when trochanteric entry point for the PFN is fractured.
Keyword :
It's comparative study.