“FUNCTIONAL OUTCOMES OF PROXIMAL FEMORAL NAIL VERSUS DYNAMIC HIP SCREW IN INTERTROCHANTERIC FRACTURE OF FEMUR”

Abstract

Intertrochanteric fractures of the femur represent a significant proportion of hip fractures in the elderly and are associated with considerable morbidity, prolonged rehabilitation, and high healthcare costs. Surgical fixation remains the standard of care, with the aim of achieving early mobilization, stable fixation, and optimal functional recovery. Among the commonly used implants, the Dynamic Hip Screw (DHS) has been a traditional choice for stable fracture patterns, whereas the Proximal Femoral Nail (PFN), an intramedullary device, has gained popularity due to its biomechanical advantages in unstable and osteoporotic fractures. This study compares the functional recovery, complication rates, and radiological results between PFN and DHS in patients with intertrochanteric fractures.

Objective: To compare the functional outcomes, operative characteristics, and postoperative complications between patients treated with Proximal Femoral Nail (PFN) and Dynamic Hip Screw (DHS) for intertrochanteric femur fractures.

Methodology: A prospective comparative clinical study was conducted on n = 60 patients presenting with intertrochanteric fractures at a Sughra Shafi Medical Complex Hospital Narowal. Patients were randomly allocated into two groups: Group A (PFN, n = 30) and Group B (DHS, n = 30). Inclusion criteria were patients aged ≥50 years with stable or unstable intertrochanteric fractures. Exclusion criteria included pathological fractures, polytrauma, open fractures, and previous ipsilateral hip surgery. Data collected included operative time, intraoperative blood loss, duration of hospital stay, radiographic union time, and postoperative complications. Functional outcomes were assessed at 6 weeks, 3 months, and 6 months using the Harris Hip Score (HHS). Statistical analysis was performed using SPSS 26, with p < 0.05 considered significant.

Results: PFN demonstrated significantly lower intraoperative blood loss, shorter surgical duration, and reduced hospital stay compared to DHS (p < 0.05). The mean radiological union time was earlier in the PFN group (13.8 ± 2.1 weeks) compared to the DHS group (16.4 ± 2.7 weeks). Functional evaluation at 6 months revealed a higher mean Harris Hip Score in the PFN group (82.6 ± 8.4) than in the DHS group (76.3 ± 9.1), indicating superior functional outcomes (p = 0.03). Complication rates including screw cut-out and varus collapse were lower in the PFN group.

Conclusion: Proximal Femoral Nail provides better biomechanical stability, earlier mobilization, faster fracture union, and superior functional outcomes compared to Dynamic Hip Screw in the management of intertrochanteric femur fractures. PFN should be preferred, especially in unstable fracture patterns.