Assessment of various fixation options for the treatment of femur fracture: A comparative study

Background: Incidence of intertrochanteric fractures has been found to be significantly increasing in today’s modern human populations. Generally, intramedullary fixation and extramedullary fixation are the 2 primary options for treatment of such fractures. The dynamic hip screw (DHS), commonly used in extramedullary fixation, has become a standard implant in treatment of these fractures. Proximal femoral nail (PFN) and Gamma nail are 2 commonly used devices in the intramedullary fixation. Hence; we prospectively analyzed and compared the DHS and the PFN method of fixation in intertrochanteric fracture of femur in the adults. Materials & Methods: Analysis of a total of 100 patients reporting from 2010 to 2014 with intertrochanteric femur fracture was done in the present analysis. Out of 100 patients 50 patients were treated with P.F.N. and 50 with D.H.S. In this study more than 50 years of age patient were surgically fit who has been diagnosed as having intertrochanteric fractures. The fracture was classified using Orthopaedic Trauma Association classification. Implant either DHS or PFN was randomly selected by operating surgeon. A combination of 3rd generation Cephalosporin and Amino glycoside was administered intravenously 30 min. prior to the skin incision. Patients were encouraged calf and ankle exercises from day one and mobilized non-weight bearing from the second postoperative day depending upon the physical condition of the patient. All drains were removed by 24 h. Follow-up the patients were maintained and results were analyzed. Results: 00 confirmed cases of intertrochanteric femur reporting from 2010 to 2014 were analyzed. Out of 100 cases, 50 were treated by a dynamic hip screw and 50 were treated by proximal femoral nail. The average age was 64.5 years. Out of 100, 40 were males and 60 were females. Accidents were the most common reason for occurrence of fractures in the present study. There were a total of 12 A-1 fractures, 29 A-2 fractures and 9 A-3 fractures. Measurement of blood loss was done by using mop count and collection in suction drain. Blood loss was comparatively less for PFN cases. The average blood loss in the P.F.N group and DHS group were 110 ml and 260 ml respectively. Blood transfusion was required in 10 cases of DHS group. At one month’s follow-up time, hip score in the D.H.S group was less than that of the P.F.N group. Conclusion: Fracture dimensions and quality of bone decides the type of fixation. For the achievement of best post-surgical results, a good quality reduction and proper positioning of the implants favour good prognosis.