A comparison of walking ability between the dynamic hip screw and cephalomedullary nailing fixations in intertrochanteric femur fracture

Karya Triko Biakto; Idrus Andi Paturusi; Harry Supratama Azis; Luky Tandio Putra; Jorvin Kurniawan

doi:10.15562/bmj.v11i1.3207

A comparison of walking ability between the dynamic hip screw and cephalomedullary nailing fixations in intertrochanteric femur fracture

Karya Triko Biakto ,

Idrus Andi Paturusi ,

Harry Supratama Azis ,

Luky Tandio Putra ,

Jorvin Kurniawan ,

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DOI: https://doi.org/10.15562/bmj.v11i1.3207 |
Published: 2022-04-30

Abstract

Introduction: Fractures of the hip are common injuries; approximately 50% of fractures occur in the intertrochanteric region. The treatment is to restore patients to their pre-injury level of mobility. Secure fixation is required to allow immediate return to unrestricted weight-bearing. The common fixation methods are dynamic hip screw (DHS) and proximal femoral nail anti-rotation (PFNA). This study compared postoperative walking ability in femoral intertrochanter fractures treated with DHS and PFNA and evaluated the confounding factors.

Methods: We conducted a retrospective cross-sectional conducted at Wahidin Sudirohusodo General Hospital and Universitas Hasanuddin Hospital for patients from 2018 to 2021. The sample was patients with intertrochanteric femoral fracture based on x-ray treated with DHS and PFNA using the purposive sampling method. A total of 107 patients with complete medical record data were included in this research, consisting of 81 DHS cases and 26 PFNA cases. Obtained data from these patients were then statistically analyzed by Chi-square and Fischer exact test. The p-value <0.05 was significant.

Results: In bivariate analysis, the percentage of weight-bearing subjects was higher in DHS (61.7%) than in PFNA (46.2%), although not statistically significant (p>0.05). By controlling for confounding factors such as age, gender, type of fracture, and length of stay, it turns out that there is no significant difference in the results of the postoperative walking ability comparison.

Conclusion: It was concluded that there was no difference in weight-bearing walking ability (full and partial) at discharge between PFNA and DHS.

References

Lu Y, Wang Q, Sun L, Hu B, Xue H, Li M, et al. Comparisons of internal fixation treatments for femoral intertrochanteric fractures: a network meta-analysis. Int J Clin Exp Med. 2018;11(11):11465–80.
Huang X, Yu B, Gu Y, Li Z. Biomechanical comparison of dynamic hip screw and Gamma nail for the treatment of unstable trochanteric fractures: a finite element study. Int J Clin Exp Med. 2017;10(5):7867–74.
Carulli C. A comparison of two fixation methods for femoral trochanteric fractures: a new generation intramedullary system vs sliding hip screw. Clin Cases Miner Bone Metab. 2017;14(1):41. Available from: http://dx.doi.org/10.11138/ccmbm/2017.14.1.041
Cho HM, Lee K. Clinical and Functional Outcomes of Treatment for Type A1 Intertrochanteric Femoral Fracture in Elderly Patients: Comparison of Dynamic Hip Screw and Proximal Femoral Nail Antirotation. Hip pelvis. 2016/12/28. 2016;28(4):232–42. Available from: https://pubmed.ncbi.nlm.nih.gov/28097113
Li H, Wang Q, Dai GG, Peng H. PFNA vs. DHS helical blade for elderly patients with osteoporotic femoral intertrochanteric fractures. Eur Rev Med Pharmacol Sci. 2018;22(1 Suppl):1–7.
Kristensen MT, Öztürk B, Röck ND, Ingeman A, Palm H, Pedersen AB. Regaining pre-fracture basic mobility status after hip fracture and association with post-discharge mortality and readmission—a nationwide register study in Denmark. Age Ageing. 2019;48(2):278–84. Available from: http://dx.doi.org/10.1093/ageing/afy185
Kandel M, Shrestha R, Poudel KP, Thapa S, Thapa S, Panta S. Dynamic Hip Screw (DHS) versus Proximal Femoral Nail Anti-rotation (PFNA) Fixation for Unstable (Evans-Jensen II and III) Inter-trochanteric Fractures of Femur in Elderly. J Coll Med Sci. 2019;15(3):222–5. Available from: http://dx.doi.org/10.3126/jcmsn.v15i3.25554

[1] Lu Y, Wang Q, Sun L, Hu B, Xue H, Li M, et al. Comparisons of internal fixation treatments for femoral intertrochanteric fractures: a network meta-analysis. Int J Clin Exp Med. 2018;11(11):11465–80.

[2] Huang X, Yu B, Gu Y, Li Z. Biomechanical comparison of dynamic hip screw and Gamma nail for the treatment of unstable trochanteric fractures: a finite element study. Int J Clin Exp Med. 2017;10(5):7867–74.

[3] Carulli C. A comparison of two fixation methods for femoral trochanteric fractures: a new generation intramedullary system vs sliding hip screw. Clin Cases Miner Bone Metab. 2017;14(1):41. Available from: http://dx.doi.org/10.11138/ccmbm/2017.14.1.041

[4] Cho HM, Lee K. Clinical and Functional Outcomes of Treatment for Type A1 Intertrochanteric Femoral Fracture in Elderly Patients: Comparison of Dynamic Hip Screw and Proximal Femoral Nail Antirotation. Hip pelvis. 2016/12/28. 2016;28(4):232–42. Available from: https://pubmed.ncbi.nlm.nih.gov/28097113

[5] Li H, Wang Q, Dai GG, Peng H. PFNA vs. DHS helical blade for elderly patients with osteoporotic femoral intertrochanteric fractures. Eur Rev Med Pharmacol Sci. 2018;22(1 Suppl):1–7.

[6] Kristensen MT, Öztürk B, Röck ND, Ingeman A, Palm H, Pedersen AB. Regaining pre-fracture basic mobility status after hip fracture and association with post-discharge mortality and readmission—a nationwide register study in Denmark. Age Ageing. 2019;48(2):278–84. Available from: http://dx.doi.org/10.1093/ageing/afy185

[7] Kandel M, Shrestha R, Poudel KP, Thapa S, Thapa S, Panta S. Dynamic Hip Screw (DHS) versus Proximal Femoral Nail Anti-rotation (PFNA) Fixation for Unstable (Evans-Jensen II and III) Inter-trochanteric Fractures of Femur in Elderly. J Coll Med Sci. 2019;15(3):222–5. Available from: http://dx.doi.org/10.3126/jcmsn.v15i3.25554

A comparison of walking ability between the dynamic hip screw and cephalomedullary nailing fixations in intertrochanteric femur fracture

Abstract

References

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