Comparison between cephalomedullary device and dynamic hip screw in the management of stable intertrochanteric fractures

الملخص EN

Objective : To evaluate and compare the clinical and radiological outcomes of patients with stable intertrochanteric fractures treated with proximal femoral nail vs.

dynamic hip screw.MSixty patients with stable intertrochanteric fractures, aged over 18 years, were randomly divided into the proximal femoral nail and dynamic hip screw groups.

Dynamic hip screw with a three-hole side-plate and an anti-rotation screw were used, as well as a modified ultra-short proximal femoral nail for the smaller Asian population.

The intra-operative, early and late complications were recorded, and the functional outcome of each group was assessed using the Harris HiResulIn the dynamic hip screw group, the one-month mean Harris Hip Score was slightly lower than that of the proximal femoral nail group.

However, at the three- and six-month monthly follow-ups, the dynamic hip screw group presented higher mean scores than the proximal femoral nail group; at the one-year follow-up, both the groups attaConclusiProximal femoral nail provides a significantly shorter surgery with a smaller incision that leads to less wound-related complications.

However, the incidence of technical errors was significantly higher in proximal femoral nail when compared with dynamic hip screw as it is a technically more demanding surgery that leads to more implant failures and the consequent re-opeKeywords: Bone nails, Bone screws, Fracture fixation, intramedullary/instrumentation, Hip Treatment of stable intertrochanteric fractures of the femur with proximal femoral nail versus dynamic hip screw: a comparative study.

Background : The frequency of Intertrochanteric fractures increased because of increased life span and increased road traffic accidents.

Intramedullary (cephalomedullary device) and extramedullary( dynamic hip screw )fixations are the two initial choices for management of intertrochanteric fractures.

Aim: To assess the postoperative results of femur stable intertrochanteric fractures managed using cephalomedullary device or dynamic hip screw.

Methods: Our prospective, observational and randomized investigation included 112 patients, aged 63-79 yr, of both sexes and with femur stable intertrochanteric fractures.

Patients were grouped according to type of management used into the cephalomedullary device group (GI, n=57) and dynamic hip screw group (GII, n=55) at Royal Rehabilitation Center, Amman, JORDAN, during the period June 2016- June 2018.

Reduction was performed using Closed or indirect methods.

Follow up intervals were achieved at 14days after surgery, then at 60,120 and 240 days for the first year and then once per year.

The postoperative profile, including early with late complications and function (using the Harris Hip Score) was followed up.

The data was evaluated statistically using student's t-test.

P-value was considered statistically significant if it was less than 0.05.

Results : 14 days postoperatively, the median Harris Hip Score was better in group II than that of group I(not statistically significant).

At the postoperative 60 and 120 days intervals, group II had more median scores than group I.

At the postoperative 240days interval, both groups experienced comparable scores.

Conclusion: Cephalomedullary device caused remarkably less non-significant incision-induced hazards, but there were more non-significant prosthesis failures and re-surgery.