Comparative Study on Evaluation of Results of DHS/PFN in Management of Intertrochanteric Fracture of Femur

Introduction:  38–50% of all femur fractures and 5–20% of fractures in their entirety are intertrochanteric fractures. The prevalence of these fractures is 180/10000, making them prevalent in the senior population. While intramedullary devices like PFN are thought to be superior implants for unstable intertrochanteric fractures, dynamic hip screws are still the gold standard for managing intertrochanteric fractures. Their function in treating these fractures remains questionable. Materials and Methods: The study was conducted on 100 patients with intertrochanteric fracture of femur attending the outpatient and emergency department of National Institute of Traumatology & Orthopedic Rehabilitation (NITOR), Dhaka between May 2019 to April 2020. Following a clinical and radiological evaluation, the patients were split into two groups at random, A and B. Patients in group A received treatment by ORIF using a dynamic hip screw, whereas patients in group B received treatment via closed/open reduction and internal fixation with PFN. The working proforma below contains the following information of the patient: personal information, clinical findings, radiological findings, and follow-up findings. The outcomes were assessed and contrasted. Results: The mean age in both the groups was 58.88 ± 15.76 years, In DHS group, there were 8(16%) females and 42(84%) males. In PFN group, there were 15(30%) females and 35(70%) males. There was a male preponderance in both the groups in comparison to the females. In PFN group, there were 24(48%) patients who injured because of fall, while 26(52%) were injured due to RTA. In PFN group, higher number of fall patients were there, while in DHS group, higher number of RTA patients were there. The comparison of mean blood loss in both the groups showed a statistically significant difference (P < 0.0001), with a higher mean blood loss in DHS group in comparison to PFN group. In DHS group, 48(96%) patients had no complications, 2(4%) had DVT and 1(2%) had cut out of screw, 3(6%) had infection. In PFN group, 2(4%) had infection, 48(96%) shows no complication. The difference in mean union time was significant (P < 0.0001) with a higher union time in DHS group in comparison to PFN group. DHS group functional outcome assessment by Harris Hip score, there were 22(44%) patients had Excellent and the PFN group functional outcome assessment by Harris Hip score, there were 26(52%) patients had Excellent. Conclusion: PFN provides stability and aids in biological reduction. Excessive collapse and limb shortening are avoided by PFN. As a result, it aids in obtaining a positive functional outcome overall. PFN is a load-bearing implant that provides stability to the fracture area both proximally and distally. As such, it is a more biomechanically sound implant option for fixing peri-trochanteric femoral fractures. When it comes to bleeding during surgery and the early stages of recovery, PFN is a superior implant option than DHS. Consequently, we support the use of PFN rather than DHS in intertrochanteric fractures, with the exception of fractured trochanteric entry points for the PFN