Management of complex intertrochanteric fractures of the femur in elderly patients – dynamic hip screws or proximal femoral nails or arthroplasty

Abstract

Background: Ideal management of intertrochanteric fractures in elderly individuals has been debated for several years. Due to difficulty in obtaining anatomical reduction, management of the complex intertrochanteric fractures in elderly patients is challenging and controversial. Methods: In the present study prospective comparative evaluation has been done between dynamic hip screws ( DHS), proximal femoral nail (PFN) and bipolar hemiarthroplasty for overall clinical outcome of patients with unstable intertrochanteric fractures. The total numbers of patients were 90 with each group consisted of 30 patients. Results: Complication rate and requirement of revision surgery was more in DHS group but this was not found to be statistically significant. Harris Hip Score & hence the functional outcome was found to be more in PFN group as compared to DHS which was statistically significant. Bipolar hemiarthroplasty provides early full wieght bearing leading to better HHS at 6 weeks evaluation but almost similar score to PFN in long term. Conclusions: PFN is better choice of fixation if good bone quality present while extremely osteoporotic patients or extreme comminution at fracture site favours bipolar hemiarthroplasty in elderly patients.