E.KWEK1, D. HAP2
Woodlands Health1, MOH Holdings Pte Ltd (MOHH)2
The surgical fixation of intertrochanteric fractures can be performed using devices such as the dynamic hip screw (DHS) and the proximal femoral nail antirotation (PFNA). The purpose of this study is to determine if osteoporosis is a significant predictor of femoral neck collapse in intertrochanteric fractures treated with either the DHS or the PFNA .
A total of 237 patients with unilateral intertrochanteric fractures who underwent surgical fixation between January 2008 and June 2012 were included in the study. 121 (51%) patients had undergone DHS insertion, and 116 (49%) had undergone PFNA insertion.The amount of implant sliding in the DHS screw and the PFNA helical blade was measured at various time intervals and used as a surrogate measure for femoral neck shortening. This was then correlated with the fracture type and the degree of osteoporosis.
The unstable fracture types had a greater amount of implant collapse compared to the stable fracture types.
In stable fracture types treated with PFNA, the osteoporotic patients had consistently higher mean collapse at all post-operative time intervals. However, in the unstable fractures treated with PFNA, those with osteoporosis had a significantly higher amount of mean implant collapse when compared to those without osteoporosis.
Osteoporosis is a significant predictor of collapse of the femoral head-neck element in elderly patients with intertrochanteric fractures treated with either the DHS or the PFNA. Unexpectedly, osteoporosis led to significantly greater implant collapse in the DHS when used in stable intertrochanteric fractures when compared to unstable fracture types.