Retrospectively Comparative Study Of Two Fixations On Intertrochanteric Fracture

BackgroundWith the aging population is increasing, the global number of elderly hip fracture patients increased year by year , according to World Health Organization (WHO) statistics show that the global annual osteoporosis patients with hip fracture in the number of about 166 million people, with the Global population aging is expected by 2050 the incidence of hip fractures will increase fourfold, to about 700 million people each year. According to 2006 statistics of China, above 60 years old people, hip fracture due to osteoporosis incidence rate is about 9.6%, and will increas year by year. Not only for patients with hip fracture caused great suffering, and to the society and the family also brought a heavy financial burden. Before 1970s, the surgical techniques of Intertrochanteric fracture was immature. Conservative treatment had highly complications and mortality rates. With the continuous development of medical technology, surgical treatment on intertrochanteric fracture has become the consensus of orthopedic surgeons.Although there are many fixations now ,the most popular two are PFN and DHS. This study retrospectively compared the clinical indicators of two surgical methods, comprehensive analyze the advantages and disadvantages of them and to provide scientific evidence to choose internal fixation on intertrochanteric fracture.Objective:The purpose of this study is to compare the actual results of clinical treatment between DHS and PFN fixation systems and provide scientific evidence to choose internal fixation on intertrochanteric fracture.Methods :The study included 186 patients who accepted operations in Department of Orthopaedics,First Municipal People's hospital,Affiliated Hospital of Guangzhou Medical university,from January 2005 to October 2009.They were treated with Dynamic Hip Screw (DHS group 96cases) and Proximal Femoral Nail (PFN group 90cases).The data of two groups were collected by medical records,phonecalls,and return visit for the statistical analysis on the following aspects : operative time,length of incision,blood loss, time of fracture healing,preoperative risk assessment ,postoperative complications ,Sander's HIP score and so on. Analyze the efficacy of two fixation methods, and provide scientific evidence on how to select the type of internal fixation on intertrochanteric fracture.Results:The differences of operative time , length of incision , blood loss , time of fracture healing , Screw cutting head and neck, coxa vara deformity, screw back and shortening deformity between DHS Group and PFN Group were of significance (P<0.05). PFN Group were much better than DHS Group. But the differences of hospital stay, perioperative blood transfusion, postoperative function score Sander's excellent rate and other postoperative complications between the two groups were of no statistical significance (p>0.05) Conclusion :By comparison,PFN Group were better than DHS Group on shorter operative time, minor trauma and shorter healing time.PFN allow patients to do early functional exercise. It is an ideal treatment for Intertrochanteric fractures of the elderly.