O1013 TO NAIL OR TO SCREW?

Abstract

A prospective trial of proximal femoral nail versus dynamic hip screw for unstable intertrochanteric fractures of the femur. Introduction: The proximal formal nail (PFN) is purposed to have superior bio-mechanical properties to the dynamic hip screwwhen use in the treatment of unstable intertrochantric fractures of the femur. Objective: To compare the outcome of PFN and DHS fixation of unstable proximal femoral fractures. Methods: The authors conducted a prospective study of 70 consecutive patients presenting to the orthopaedic department with acute AO/ASIF 31 -A2 and A3 fractures. Patient underwent either PFN or DHS fracture fixation depending on surgeon experience and preference. Patients were all followed up for 6 months. The main outcome measures were operative blood loss, length of hospital stay, radiographic fracture union, com-plication rates, independent mobility and residual hip pain at 6 months. Result: The two groups exhibited similar demographic characteristics, premorbid mobility and fracture severity. Operation duration was similar in the two groups although blood loss was significantly less in the PFN groups (PFN 200mls; DHS 375mls). There was a significant difference in length of hospital stay (PFN 8 days; DHS 14 days). Radiographic signs of fracture healing at 3 months were 88% PFN and 83% DHS. Three patients in the DHS groups suffered failure of fixation with screw cut out There were no implant failures or failure of fixation in the PFN groups. At 3 month PFN follow up mobility was greater in the PFN group (Wheelchair bound/walking frame/stick/no aide: group = 0%/20%/49%/14%). At 6 months both groups showed similar mobility. Persistent sever hip pain at 6 months was PFN 3% and DHS 9%. Conclusion: The proximal femoral nail may be used successfully in the fixation of unstable femoral fractures with similar result to the DHS for mobility at 6 months. There may be advantages over the DHS in term of reduced blood loss and shorter hospital stay.