Proximal Femur Fracture: DHS Vs PFNA

AIM: The aim of this clinical analysis is to compare two osteosynthesis systems developed for surgical treatment of intertrochanteric fracture of femur: The proximal femur nail anti-rotation and dynamic hip screw.This study was conducted from august 2006 to January 2008 at First affiliated hospital of DMU. PFNA is a intramedullary fixation system and DHS is a extramedullary fixation system.MATERIALS AND METHODS: 50 patients were included 25 in each group. Age ranging from 30 to 85 years. 30 females and 20 men. According to Toronzo-Evans classification 5 were type-2, 25 type-3, 19 type-4 . one with pathological fracture. One patient in group B died three weeks after surgery at home ? PTE. All patients were followed up for 18 months clinically and radiologically. Surgical incision length, operation duration, intra-op bleeding, post-op drainage, blood transfusion requirement are used in analysis. Time of bony union on an x-ray, post-op rehabilitation, range of motion of hip joint and regaining pr- hospitalisation walking status were evaluated.RESULTS: All the patients were available for follow up 18 months. All achieved bony union and no infection was found in both the groups. We found statistically difference in operation duration, incision length and blood loss with in the both groups, PFNA (p<0.05). Post-operative pain was well tolerated in patients treated with PFNA. Bony union was found on a radiograph with a PFNA by 2.5 months and DHS at 4 months. Migration of compression screw was less then 3mm with PFNA and less than 5mm with DHS.CONCLUSION: PFNA is choice of implant in treatment of proximal femoral fractures particularly comminuted and with underlying osteoporotic bone. It is also a choice of treatment of ipsilateral femur neck and shaft fracture.