We treated 108 patients with a pertrochanteric femoral fracture using either the dynamic hip screw or the proximal femoral nail in this prospective, randomised series. We compared walking ability before fracture, intra-operative variables and return to their residence. Patients treated with the proximal femoral nail (n = 42) had regained their pre-operative walking ability significantly (p = 0.04) more often by the four-month review than those treated with the dynamic hip screw (n = 41). Peri-operative or immediate post-operative measures of outcome did not differ between the groups, with the exception of operation time. The dynamic hip screw allowed a significantly greater compression of the fracture during the four-month follow-up, but consolidation of the fracture was comparable between the two groups. Two major losses of reduction were observed in each group, resulting in a total of four revision operations.

Our results suggest that the use of the proximal femoral nail may allow a faster postoperative restoration of walking ability, when compared with the dynamic hip screw.

Aims: In the present study we evaluated short-term outcome of complex proximal tibial fractures treated with hybrid external þxation. Methods: A retrospective evaluation of 33 tibiae in 31 patients treated with hybrid external þxation; 9 (27.2%) AO type A metaphyseal and 24 (72.8%) type C bicondylar intraarticular proximal tibial fractures. Majority of the fractures (58.1%) were due to high-energy trauma and open fractures constituted 18.2% of all fractures. Percutaneous pinning combined with indirect reduction techniques was used in 14 (42.4%) cases. Mini-open clamp reduction and screw þxation was applied in 12 (36.4%) operations. Open reduction, reconstruction of articular surface, bone-grafting and screw þxation combined with the hybrid frame was used in 7 (21.2%) patients. Results: Uneventful consolidation without complications occurred in 13 (39.4%) patients. The mean time to bony fusion was 18 ± 6.6 weeks. However, in 21.2% of the patients the fracture had not consolidated by 24 weeks. There were 5 (20.8%) primary re-operations due to malreduction of a type C fracture. In addition 3 (33.3%) type A metaphyseal fractures were re-operated upon due to non-union by 24 weeks. Two (6.1%) fractures united in axial malalignment and required an osteotomy. Conclusions: Our þndings suggest that due to high rate of unsatisfactory reductions, hybrid external þxation may not be the method-of-choice in þxation of displaced intra-articular proximal tibial fractures. It may be indicated in þxation of high energy metaphyseal fractures, but includes a signiþcant risk of delayed consolidation.