A Comparative study of the Dynamic Hip Screw, the Cemented Bipolar Hemiarthroplasty and the Proximal Femoral Nail for the Treatment of Unstable Intertrochanteric Fractures RC14-RC19
Dr. Sameer Ajit Mansukhani,
8 Ginza, 4th Floor, Junction of 23/29 Road, Bandra, West Mumbai-400050, Maharashtra, India.
Introduction: Fractures of the Intertrochanteric (IT) region are some of the most common fractures encountered by an orthopedic surgeon in his lifetime. With increase in life expectancy, the incidence of these fractures is also increasing. By 2040, the incidence of these fractures is expected to double. Unstable IT fractures are a major cause of concern in the elderly due to the associated increase in morbidity and mortality.
Aim: The purpose of this study was to compare the intraoperative and postoperative parameters using the Dynamic Hip Screw (DHS), the Cemented Bipolar Hemiarthroplasty (BH) and the Proximal Femoral Nail (PFN) for the management of unstable IT fractures.
Materials and Methods: Fifty patients, having unstable IT fractures with age more than 60 years were randomly selected and were followed up averagely for 19 months (12– 30 months). The type of implant for a particular patient and a particular type of fracture was randomly selected and the same surgical team treated all patients. Total number of 19 patients were operated using the DHS (Group-1), 13 using the BH (Group-2) and 18 using the PFN (Group-3). All patients in the three groups were compared in terms of preoperative, intraoperative and postoperative parameters and functionally assessed using the Harris hip score and the mobility score of Parker and Palmer.
Results: Patients operated using the PFN had significantly lower mean blood loss as compared to the other two groups. The mean days to unaided Full Weight Bearing (FWB) was significantly higher in patients treated by the DHS as compared to the other two groups. All three groups were comparable in terms of functional assessment.
Conclusion: Treatment of unstable IT fracture of femur is a matter open to debate. IT fractures of elderly must be treated with considering the age of the patient, mental status, bone quality, and the type of fracture. Level of Evidence according to OCEBM Levels of Evidence Working Group - Level 2.