Q.Y.YEO1, M.TAN2, K.PILLAY1, I.T.H.CHUA2, E.B.K.KWEK3
MOH Holdings Pte Ltd (MOHH)1, Tan Tock Seng Hospital2, Woodlands Health3
Intertrochanteric (IT) hip fractures are the second most common fractures of the hip, associated with significant morbidity and mortality. There is little evidence guiding the optimal implant choice for fixation of stable Intertrochanteric (IT) fractures.
This is a single blinded prospective, randomized controlled trial comparing the use of the Proximal Femoral Nail Antirotation II (PFNA) and the Dynamic Hip Screw (DHS) for the treatment of stable IT femur fractures in a single tertiary centre with an established ortho-geriatric co-managed hip fracture care pathway.
A total of 33 patients were enrolled into the study. 18 patients were treated with the DHS and 15 patients treated with the PFNA II. The 2 groups had similar demographic profiles and radiological parameters. There was no statistical difference between the two groups in terms of intraoperative bleeding, post-operative pain score and total surgical time. The median scores for Harris Hip Score and Parker Mobility Score for the DHS group were non-inferior compared to the PFNA II group.
With all results (surgical time, blood loss, radiological parameters and functional outcome) being equivalent, a cheaper DHS implant is in fact superior to a more expensive, newer PFNA II implant. In conclusion, we recommend the use of the DHS for this fracture type in view of its cost savings and equivalent outcomes.