Comparison of clinical and radiological outcome of patients with unstable intertrochanteric fracture treated with PFN A2 vs DHS

Background: Intertrochanteric fracture account for a common problem in elderly patients following trivial fall. Intertrochanteric fractures are the extracapsular fracture of the proximal femur at the level of the greater and the lesser trochanter. Unstable intertrochanteric fracture have comminution at the posteromedial cortex, thinner lateral wall thickness of <20mm and reverse oblique fracture.

Materials and method: Around 30 cases of unstable intertrochanteric fracture treated with proximal femoral nail A2 or dynamic hip screw. Around 6 months follow up was done. Both the fractures were treated using lateral approach. For PFN A2 the awl and subsequently the guide wire were put either in the piriformis fossa or medial to the tip of greater trochanter. Then reaming done and PFN A2 nail put. For DHS, hardinge approach is used, derotational screw put and then guide wire put in posteroinferior quadrant or the center of the head of femur. Triple reaming done and Richard screw put and the DHS put. Post op physiotherapy is started on day 2 after surgery in all the patients.

Discussion: A PFN A2 in unstable intertrochanteric fracture has better outcome and lesser postoperative complications compared to DHS. Average time for full weight bearing walking is around 6 weeks.

Conclusion: PFN A2 in Unstable intertrochanteric fracture is better than DHS.