Dynamic Hip Screw Devices versus Proximal Femoral Nail in Treatment of Stable Intertrochanteric Femoral Fractures

Intertrochanteric fractures occur in the region between the greater and lesser trochanters of the proximal femur, occasionally extending into the subtrochanteric region. Dynamic Hip Screw (DHS) has been considered the gold standard of fixation for a long time, especially for stable fracture types. The Proximal Femoral Nail (PFN) was designed to overcome implant-related complications of DHS and facilitate the surgical treatment of unstable intertrochanteric fractures. To compare the radiological features and functional outcomes of patients who underwent DHS and PFN in the treatment of stable two-part (31A1:31A2”1) intertrochanteric femur fractures. This prospective study included 30 patients with stable intertrochanteric proximal femoral fractures (31A1:31A2”1) attending the emergency department of Al-Azhar university Al-Hussein hospital) and AlSalam Specialized Hospital starting from December 2020 and January 2022. Among our 30 cases of stable Inter-trochanteric femoral fractures. Of them, 15 were treated by PFN and 15 by DHS have been analyzed. There was no statistically significant difference regarding postoperative complications in both study groups. In the DHS group, the one-month mean hip score was less than that of the PFN group, though not statistically significant however at three months and six months follow up, the DHS group had higher mean scores than the PFN group.  The use of PFN for the fixation of trochanteric fractures against the proven DHS offered better results along with a few advantages. PFN required smaller incisions, shorter duration of surgery, less blood loss, and faster recovery but still, PFN is technically more demanding than the DHS and was found to have longer fluoroscopy exposure. PFN is a better alternative to DHS in the treatment of intertrochanteric fractures, but it is a technically difficult procedure and requires more expertise compared to DHS.