Background: DHS fixation has remained a well-established gold standard in intertrochanteric fractures of femur for a long time. 1 However, it has shortcomings and pitfalls. In inter-trochanteric fractures of femur, DHS fixation has shown higher failure rates. PFN is a new fixation device proposed for fixation of unstable intertrochanteric fractures. 1 Being intramedullary, it is a biomechanically advantageous device which should allow better fixation of unstable intertrochanteric translating into lesser failure rates of fixation and also permitting early mobilization and faster rehabilitation especially in elderly patients. We present a study comparing outcomes of managing unstable intertrochanteric fractures with PFN and DHS.

Materials and Methods: We evaluated 30 (PFN: 15; DHS: 15) cases of intertrochanteric fractures of femur out of which 26 were unstable and 4 stable type, from January 2017 to December 2018, with minimum 12 months follow up period. Mean age was 60 years for both PFN and DHS group. We studied the surgical complications in both groups and also compared functional and radiographic results of both groups.

Results: There was significantly more clinical shortening in DHS group than in PFN group (average 1- 1.9 cm versus 0.5-0.9 cm). There were 3 cases of superficial and 2 cases of deep infection in the DHS group while there was one case of infection in PFN group. There was no case of implant failure in the DHS group compared to one case in PFN group (due to screw breakage). Harris hip score at follow up was fair to excellent in PFN as compared to DHS. This difference was statistically significant.

Discussion: DHS despite remaining a gold standard for fixation of intertrochanteric fractures of femur for a long time, it may not be suitable for certain fracture patterns and in older age groups with more medical co-morbidities and osteoporosis. PFN is a biomechanically sound device for fixation of comminuted intertrochanteric fractures of femur2 which has lesser surgical morbidity and should be especially beneficial in elderly, osteoporotic and medically compromised patients. Its load sharing capability provides a more stable fixation allowing early mobilization and rehabilitation.

Conclusion: PFN is unequivocally a better choice of implant for fixation of unstable intertrochanteric fractures of femur, especially in osteoporotic and medically compromised patients as compared to DHS fixation device.