Objectives: To compare the efficiency of long, locked, trochanteric entry intramedullary nail (Holland nail) against Dynamic Hip Screw in the operative stabilisation of inter-trochanteric femoral fractures.

Study Design: Prospective randomised control study

Method: 190 patients were recruited over 12 months and followed up to fracture union. Patients were randomised into two groups: Holland nail (92) and DHS (98). Variables looked at preoperatively were mini mental test; pre-op mobility; fracture pattern and ASA grading. Operative variables analysed were ease of fracture reduction; surgical time; quality of implant fixation; operative blood loss and radiation time. Post operatively, time to frame; wound problems; time to discharge; rate of fracture union and chronic pain were analysed.

Results: The two study groups were comparable. There was a statistically significant increase in surgical and radiation time with the Holland nail group but this was surgeon dependent. Patients receiving Holland nail had less operative blood loss (p< 0.001). The time to mobility with frame in the Holland nail group was quicker in the fitter patients (ASA 1& 2) (p< 0.005). Holland nail group had lower infection rate (p< 0.01).

Conclusion: Patients with inter-trochanteric fractures who received Holland nail had less blood loss; fewer wound problems; mobilised quicker; had shorter hospital stay and less pain at 6 months compared to patients who had DHS. Fracture union rate was identical in both groups.