A comparative study of intramedullary and extramedullary fixation devices in type two unstable trochanteric fractures

Background: For many years, the sliding hip screw and plate had been the gold standard in treating pertrochanteric fractures. Nowadays, there is an increasing interest in intramedullary nailing. Intramedullary devices, although technically difficult seems to have a biomechanical advantage over laterally fixed side plates2.Literature is full of articles categorizing DHS in stable Trochanteric fractures, (31-A1.1, A1.2, A1.3 and 31-A2.1) and use of intramedullary devices PFN as implant of choice in unstable trochanteric, sub trochanteric fractures and particularly in reverse oblique (all A 31.3). But there is always a grey zone of decision of implant to be applied in unstable type A2.2 and A2.3 fractures. This study was designed to compare functional outcome and complications of the PFN device with those of a traditional extramedullary device, the Dynamic hip screw (DHS), inpatients with unstable type 2 trochanteric fracture. (AO/ASIF Classification 31-A2.2 & 31-A2.3) Method: In this Randomised control prospectively, designed study 60 consecutive patients having Fracture according to AO/ASIF classification 31-A2.2 and 31-A2.3 are included and randomized to either PFN or DHS group. The functional outcome and clinical results of the patients was evaluated and graded using HARRIS HIP SCORE system. Results: The average blood loss in PFN was 88.3ml while in DHS it was 318.33ml. Hospital stay after surgery in PFN was average days 4.13 DHS was average days 5.63. Harris hip score in PFN 22 (73.33%) were good, 06 (20%) were fair and 02 (6.66%) while with DHS 12 (40%)were good, 12(40%) were fair and 06 (20%).Average time of union in PFN was 13.4 weeks in DHS was 15.1 weeks. Conclusion: In Type 2 unstable trochanteric fractures PFN gives advantage of lesser blood loss, shorter operating time, faster union, better functional outcome with low complication rate as compared to DHS