Comparative Study Of Dynamic Hip Screw And Trochanteric Nail For Management Of Stable Intertrochanteric Fracture
A Comparative Evaluation On Mandibular Movements
Keywords:
DHS, TN, Intertrochanteric fractureAbstract
Background& objectives : Intertrochanteric fractures of hip are relatively one of the common fractures and
it is imposing a huge burden on patients in terms of medical expenses and morbidity .A sliding hip screw (DHS) and
trochanteric nail (TN) both are described for fixation of these fractures. The discussion about the selection of ideal
implant is controversial in terms of outcomes in various studies. Methods: Ninety patients with intertrochanteric
fracture were treated in our hospital from Jan 2009 to Dec 2011. All AO 31-A1 patients who were between 40-80
years old were included to compare Dynamic hip screw and Trochanteric nail in the management of intertrochanteric
fractures by analyzing operative time, duration of hospital stay, complications, time taken to union and post
operative mobility. 63 patients were enrolled in DHS group and 27 were enrolled in intertrochanteric nail group.
Results: Patients treated with DHS had shorter operative time ,less radiological exposure ,easy reduction and fewer
intraoperative and postoperative complications .Implant failure and non union was noted in one out of twenty seven
patients treated with trochanteric nail group. Interpretation & Conclusions : The analysis of our study supports the
use of DHS rather than trochanteric nail for the treatment of stable intertrochanteric fractures in elderly patients
[Jesan M NJIRM 2016; 7(4):61-67]
References
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2. Parker MJ, Myles JW, Anand JK, Drewett R. Cost-benefit analysis of hip fracture treatment. J Bone Joint Surg Br. 1992 Mar;74(2):261–4.
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4. Wolfgang GL, Bryant MH, O’Neill JP. Treatment of intertrochanteric fracture of the femur using sliding screw plate fixation. Clin Orthop. 1982 Mar;(163):148–58.
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6. Rosenblum SF, Zuckerman JD, Kummer FJ, Tam BS. A biomechanical evaluation of the Gamma nail. J Bone Joint Surg Br. 1992 May;74(3):352–7.
7. Alvarez DB, Aparicio JP, Fernández EL-A, Múgica IG-B, Batalla DN, Jiménez JP. Implant breakage, a rare complication with the Gamma nail. A review of 843 fractures of the proximal femur treated with a Gamma nail. Acta Orthop Belg. 2004 Oct;70(5):435–43.
8. Leung KS, So WS, Shen WY, Hui PW. Gamma nails and dynamic hip screws for peritrochanteric fractures. A randomised prospective study in elderly patients. J Bone Joint Surg Br. 1992 May;74(3):345–51.
9. Radford PJ, Needoff M, Webb JK. A prospective randomised comparison of the dynamic hip screw and the gamma locking nail. J Bone Joint Surg Br. 1993 Sep;75(5):789–93.
10. Halder SC. The Gamma nail for peritrochanteric fractures. J Bone Joint Surg Br. 1992 May;74(3):340–4.
11. Setiobudi T, Ng YH, Lim CT, Liang S, Lee K, Das De S. Clinical outcome following treatment of stable and unstable intertrochanteric fractures with dynamic hip screw. Ann Acad Med Singapore. 2011 Nov;40(11):482–7.
12. Adams CI, Robinson CM, Court-Brown CM, McQueen MM. Prospective randomized controlled
trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur. J Orthop Trauma. 2001 Aug;15(6):394–400.
13. Varela-Egocheaga JR, Iglesias-Colao R, Suárez-Suárez MA, Fernández-Villán M, González-Sastre V, Murcia-Mazón A. Minimally invasive osteosynthesis in stable trochanteric fractures: a comparative study between Gotfried percutaneous compression plate and Gamma 3 intramedullary nail. Arch Orthop Trauma Surg. 2009 Oct;129(10):1401–7.
14. Kudłacik K, Jesse L, Gagaczowski T. Intramedullary osteosynthesis with gamma nail in treatment of peritrochanteric fractures of the femur. Ortop Traumatol Rehabil. 2008 Dec;10(6):566–75.
15. Dumville JC, Hahn S, Miles JNV, Torgerson DJ. The use of unequal randomisation ratios in clinical trials: a review. Contemp Clin Trials. 2006 Feb;27(1):1–12.
16. Barton TM, Gleeson R, Topliss C, Greenwood R, Harries WJ, Chesser TJS. A comparison of the long gamma nail with the sliding hip screw for the treatment of AO/OTA 31-A2 fractures of the proximal part of the femur: a prospective randomized trial. J Bone Joint Surg Am. 2010 Apr;92(4):792–8.
17. Simmermacher RK, Bosch AM, Van der Werken C. The AO/ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures. Injury. 1999 Jun;30(5):327–32.
18. Daabiss M. American Society of Anaesthesiologists physical status classification. Indian J Anaesth. 2011 Mar;55(2):111–5.
19. Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br. 1993 Sep;75(5):797–8.
20. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969 Jun;51(4):737–55.
21. Mohanty S, Chacko V. A Comparative Analysis Of Operative And Non-Operative Management Of Trochanteric Fractures. Indian J Ortopaedtcs 1984;18:19–4. Indian J Orthopaedics. 1984;18:19–4.
22. Baumgaertner MR, Curtin SL, Lindskog DM. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin Orthop. 1998 Mar;(348):87–94.
23. O’Brien PJ, Meek RN, Blachut PA, Broekhuyse HM, Sabharwal S. Fixation of intertrochanteric hip fractures: gamma nail versus dynamic hip screw. A randomized, prospective study. Can J Surg J Can Chir. 1995 Dec;38(6):516–20.
24. Goldhagen PR, O’Connor DR, Schwarze D, Schwartz E. A prospective comparative study of the compression hip screw and the gamma nail. J Orthop Trauma. 1994 Oct;8(5):367–72.
25. Habernek H, Schmid L, Frauenschuh E. Sport related proximal femoral fractures: a retrospective review of 31 cases treated in an eight year period. Br J Sports Med. 2000 Feb;34(1):54–8.
26. Bridle SH, Patel AD, Bircher M, Calvert PT. Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg Br. 1991 Mar;73(2):330–4.
27. Sharma V, Babhulkar S, Babhulkar S. Role of gamma nail in management of pertrochanteric fractures of femur. Indian J Orthop. 2008 Apr;42(2):212–6.
28. Jones HW, Johnston P, Parker M. Are short femoral nails superior to the sliding hip screw? A meta-analysis of 24 studies involving 3,279 fractures. Int Orthop. 2006 Apr;30(2):69–78.
29. Matre K, Vinje T, Havelin LI, Gjertsen J-E, Furnes O, Espehaug B, et al. TRIGEN INTERTAN intramedullary nail versus sliding hip screw: a prospective, randomized multicenter study on pain, function, and complications in 684 patients with an intertrochanteric or subtrochanteric fracture and one year of follow-up. J Bone Joint Surg Am. 2013 Feb 6;95(3):200–8.
30. Silva P, Coelho D, Curi Júnior C, Oliveira LA de, Moraes FB de, Amaral RA do, et al. Proximal femural valgus subtrochanteric osteotomy for non union of trochanteric fractures. Rev Bras Ortop. 2012;47:37–2.
31. Aros B, Tosteson ANA, Gottlieb DJ, Koval KJ. Is a sliding hip screw or im nail the preferred implant for intertrochanteric fracture fixation? Clin Orthop. 2008 Nov;466(11):2827–32.
32. Cheng Q, Huang W, Gong X, Wang C, Liang X, Hu N. Minimally invasive percutaneous compression plating versus dynamic hip screw for intertrochanteric fractures: a randomized control trial. Chin J Traumatol Zhonghua Chuang Shang Za Zhi Chin Med Assoc. 2014;17: 249–5.
33. Wang J-P, Yang T-F, Kong Q-Q, Liu S-J, Xiao H, Liu Y, et al. Minimally invasive technique versus
conventional technique of dynamic hip screws for intertrochanteric femoral fractures. Arch Orthop Trauma Surg. 2010 May;130(5):613–20.
34. Yao C, Zhang C, Jin D, Chen Y. Early results of reverse less invasive stabilization system plating in treating elderly intertrochanteric fractures: a prospective study compared to proximal femoral nail. Chin Med J (Engl). 2011 Jul;124(14):2150–7.
35. Liu Y, Tao R, Liu F, Wang Y, Zhou Z, Cao Y, et al. Mid-term outcomes after intramedullary fixation of peritrochanteric femoral fractures using the new proximal femoral nail antirotation (PFNA). Injury. 2010 Aug;41(8):810–7.
36. Sadowski C, Lübbeke A, Saudan M, Riand N, Stern R, Hoffmeyer P. Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95 degrees screw-plate: a prospective, randomized study. J Bone Joint Surg Am. 2002 Mar;84-A(3):372–81.
37. Parker MJ, Handoll HHG. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures. Cochrane Database Syst Rev. 2004;(1):CD000093.
2. Parker MJ, Myles JW, Anand JK, Drewett R. Cost-benefit analysis of hip fracture treatment. J Bone Joint Surg Br. 1992 Mar;74(2):261–4.
3. Davis TR, Sher JL, Horsman A, Simpson M, Porter BB, Checketts RG. Intertrochanteric femoral fractures. Mechanical failure after internal fixation. J Bone Joint Surg Br. 1990 Jan;72(1):26–31.
4. Wolfgang GL, Bryant MH, O’Neill JP. Treatment of intertrochanteric fracture of the femur using sliding screw plate fixation. Clin Orthop. 1982 Mar;(163):148–58.
5. Hardy DC, Descamps PY, Krallis P, Fabeck L, Smets P, Bertens CL, et al. Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients. J Bone Joint Surg Am. 1998 May;80(5):618–30.
6. Rosenblum SF, Zuckerman JD, Kummer FJ, Tam BS. A biomechanical evaluation of the Gamma nail. J Bone Joint Surg Br. 1992 May;74(3):352–7.
7. Alvarez DB, Aparicio JP, Fernández EL-A, Múgica IG-B, Batalla DN, Jiménez JP. Implant breakage, a rare complication with the Gamma nail. A review of 843 fractures of the proximal femur treated with a Gamma nail. Acta Orthop Belg. 2004 Oct;70(5):435–43.
8. Leung KS, So WS, Shen WY, Hui PW. Gamma nails and dynamic hip screws for peritrochanteric fractures. A randomised prospective study in elderly patients. J Bone Joint Surg Br. 1992 May;74(3):345–51.
9. Radford PJ, Needoff M, Webb JK. A prospective randomised comparison of the dynamic hip screw and the gamma locking nail. J Bone Joint Surg Br. 1993 Sep;75(5):789–93.
10. Halder SC. The Gamma nail for peritrochanteric fractures. J Bone Joint Surg Br. 1992 May;74(3):340–4.
11. Setiobudi T, Ng YH, Lim CT, Liang S, Lee K, Das De S. Clinical outcome following treatment of stable and unstable intertrochanteric fractures with dynamic hip screw. Ann Acad Med Singapore. 2011 Nov;40(11):482–7.
12. Adams CI, Robinson CM, Court-Brown CM, McQueen MM. Prospective randomized controlled
trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur. J Orthop Trauma. 2001 Aug;15(6):394–400.
13. Varela-Egocheaga JR, Iglesias-Colao R, Suárez-Suárez MA, Fernández-Villán M, González-Sastre V, Murcia-Mazón A. Minimally invasive osteosynthesis in stable trochanteric fractures: a comparative study between Gotfried percutaneous compression plate and Gamma 3 intramedullary nail. Arch Orthop Trauma Surg. 2009 Oct;129(10):1401–7.
14. Kudłacik K, Jesse L, Gagaczowski T. Intramedullary osteosynthesis with gamma nail in treatment of peritrochanteric fractures of the femur. Ortop Traumatol Rehabil. 2008 Dec;10(6):566–75.
15. Dumville JC, Hahn S, Miles JNV, Torgerson DJ. The use of unequal randomisation ratios in clinical trials: a review. Contemp Clin Trials. 2006 Feb;27(1):1–12.
16. Barton TM, Gleeson R, Topliss C, Greenwood R, Harries WJ, Chesser TJS. A comparison of the long gamma nail with the sliding hip screw for the treatment of AO/OTA 31-A2 fractures of the proximal part of the femur: a prospective randomized trial. J Bone Joint Surg Am. 2010 Apr;92(4):792–8.
17. Simmermacher RK, Bosch AM, Van der Werken C. The AO/ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures. Injury. 1999 Jun;30(5):327–32.
18. Daabiss M. American Society of Anaesthesiologists physical status classification. Indian J Anaesth. 2011 Mar;55(2):111–5.
19. Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br. 1993 Sep;75(5):797–8.
20. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969 Jun;51(4):737–55.
21. Mohanty S, Chacko V. A Comparative Analysis Of Operative And Non-Operative Management Of Trochanteric Fractures. Indian J Ortopaedtcs 1984;18:19–4. Indian J Orthopaedics. 1984;18:19–4.
22. Baumgaertner MR, Curtin SL, Lindskog DM. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin Orthop. 1998 Mar;(348):87–94.
23. O’Brien PJ, Meek RN, Blachut PA, Broekhuyse HM, Sabharwal S. Fixation of intertrochanteric hip fractures: gamma nail versus dynamic hip screw. A randomized, prospective study. Can J Surg J Can Chir. 1995 Dec;38(6):516–20.
24. Goldhagen PR, O’Connor DR, Schwarze D, Schwartz E. A prospective comparative study of the compression hip screw and the gamma nail. J Orthop Trauma. 1994 Oct;8(5):367–72.
25. Habernek H, Schmid L, Frauenschuh E. Sport related proximal femoral fractures: a retrospective review of 31 cases treated in an eight year period. Br J Sports Med. 2000 Feb;34(1):54–8.
26. Bridle SH, Patel AD, Bircher M, Calvert PT. Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg Br. 1991 Mar;73(2):330–4.
27. Sharma V, Babhulkar S, Babhulkar S. Role of gamma nail in management of pertrochanteric fractures of femur. Indian J Orthop. 2008 Apr;42(2):212–6.
28. Jones HW, Johnston P, Parker M. Are short femoral nails superior to the sliding hip screw? A meta-analysis of 24 studies involving 3,279 fractures. Int Orthop. 2006 Apr;30(2):69–78.
29. Matre K, Vinje T, Havelin LI, Gjertsen J-E, Furnes O, Espehaug B, et al. TRIGEN INTERTAN intramedullary nail versus sliding hip screw: a prospective, randomized multicenter study on pain, function, and complications in 684 patients with an intertrochanteric or subtrochanteric fracture and one year of follow-up. J Bone Joint Surg Am. 2013 Feb 6;95(3):200–8.
30. Silva P, Coelho D, Curi Júnior C, Oliveira LA de, Moraes FB de, Amaral RA do, et al. Proximal femural valgus subtrochanteric osteotomy for non union of trochanteric fractures. Rev Bras Ortop. 2012;47:37–2.
31. Aros B, Tosteson ANA, Gottlieb DJ, Koval KJ. Is a sliding hip screw or im nail the preferred implant for intertrochanteric fracture fixation? Clin Orthop. 2008 Nov;466(11):2827–32.
32. Cheng Q, Huang W, Gong X, Wang C, Liang X, Hu N. Minimally invasive percutaneous compression plating versus dynamic hip screw for intertrochanteric fractures: a randomized control trial. Chin J Traumatol Zhonghua Chuang Shang Za Zhi Chin Med Assoc. 2014;17: 249–5.
33. Wang J-P, Yang T-F, Kong Q-Q, Liu S-J, Xiao H, Liu Y, et al. Minimally invasive technique versus
conventional technique of dynamic hip screws for intertrochanteric femoral fractures. Arch Orthop Trauma Surg. 2010 May;130(5):613–20.
34. Yao C, Zhang C, Jin D, Chen Y. Early results of reverse less invasive stabilization system plating in treating elderly intertrochanteric fractures: a prospective study compared to proximal femoral nail. Chin Med J (Engl). 2011 Jul;124(14):2150–7.
35. Liu Y, Tao R, Liu F, Wang Y, Zhou Z, Cao Y, et al. Mid-term outcomes after intramedullary fixation of peritrochanteric femoral fractures using the new proximal femoral nail antirotation (PFNA). Injury. 2010 Aug;41(8):810–7.
36. Sadowski C, Lübbeke A, Saudan M, Riand N, Stern R, Hoffmeyer P. Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95 degrees screw-plate: a prospective, randomized study. J Bone Joint Surg Am. 2002 Mar;84-A(3):372–81.
37. Parker MJ, Handoll HHG. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures. Cochrane Database Syst Rev. 2004;(1):CD000093.
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Published
2018-01-23
How to Cite
Khan, M. J., Venkat Rao, M. V., Khan, A. Q., Sherwani, M. K. A., Azharuddin, M. M., & Ahmad, M. (2018). Comparative Study Of Dynamic Hip Screw And Trochanteric Nail For Management Of Stable Intertrochanteric Fracture: A Comparative Evaluation On Mandibular Movements. National Journal of Integrated Research in Medicine, 7(4), 61–67. Retrieved from http://www.nicpd.ac.in/ojs-/index.php/njirm/article/view/1106
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