2017, Vol. 1 Issue 3, Part A
Intertrochantric fractures are common in elderly osteoporotic patients due to trivial trauma and in young due to high energy trauma. The ultimate goal in the management of intertrochanteric fracture is early mobilization of patient to prevent morbidity. Early mobilization primarily depends on the implant used & stability of the surgical construct. Dynamic Hip Screw (DHS) has been considered as the gold standard device in treating these fractures but has short comings & pit falls. Trochanteric Fixation Nail (TFN) is a relatively newer device which is biomechanically sound & allows early weight bearing with much better results compared to DHS.
Aims and Objectives: This study aimed to compare the results regarding functional outcome, the rate of union and complications in intertrochanteric fractures treated with DHS (DYNAMIC HIP SCREW) and TFN (Trochanteric Fixation Nail) in patients with trochanteric fractures among south Indian rural people
Methodology: In this prospective study, total of 40 patients were randomized to the tfn group [group a (n = 20)] and the dhs group [group b (n = 20)]. All relevant perioperative information and complications were recorded and assessments of functional outcome were made.
Results: In the present series - 40 cases of Intertrochanteric fractures were treated by trochanteric fixation nail and dynamic hip screw, 20 cases in each. Out of 40 there were 26 male and 14 female cases. Minimum age was 33 years, maximum age 85 years. Slip and fall accounted for 80% of cases. BOYD and GRIFFIN type II fracture accounted for majority of cases. Mean duration of hospital stay was 15.2 days in TFN & 16.6 days in DHS group. Length of incision was small 5-6cm in TFN group compared to 10-12cm in TFN. Mean time for full weight bearing was 12.6 weeks for TFN group and 15.8 weeks for DHS group. Radiological union was 12-14 weeks in TFN group and 15-16 weeks in DHS group. Good to excellent results were seen in 90 % of cases in TFN group and 80% of cases in DHS group.
Conclusion: From this study, we consider TFN as better alternative to DHS in the treatment of intertrochanteric fractures but technically difficult procedure which requires more expertise compared to DHS. As a learning curve the TFN procedure is steep but with experience gained from each case operative time, radiation exposure and intraoperative complications can be reduced in each case of TFN.