Comparative analysis of proximal femoral nail and dynamic hip screw devices for the treatment of unstable trochanteric fractures AO31A2.

purposeWe hypnoses that the DHS with adequate reduction is comparable to PFN as regard functional outcome and offers low cost especially in developing and low-income countries. However PFN has a faster radiological union. Does the DHS and PFN provide comparable clinical and functional outcome for unstable trochanteric fractures? This is the research question.

methodsThis was a retrospective study of unstable trochanteric fractures (AO-classification: 31-A2) that were managed surgically at a university hospital between 2020 and 2023. All patients were scheduled for a follow-up review for at least 18 months after the operation. The data collected included age, sex, medical history, injury mechanism, and plain radiographs. We excluded patients who had pathological fractures other than osteoporosis and excluded also unstable trochanteric fractures type AO31A3.

resultsA total of 240 individuals with unstable trochanteric fractures, including 82 patients who underwent DHS and 158 who underwent PFN, were included. There were 76 (31%) males and 82 (69%) females, with mean ages of 71.56 ± 10.93 in the PFN group, while the DHS group had 40 (48%) males and 42 (52%) females, with mean ages of 71.73 ± 11.13. In most patients (210 patients, 87.5%), closed reductions were used, whereas only 30 patients (12.5%) had open reductions. The PFN group had significantly less external blood loss during surgery (150 ± 24 ml) than did the other group (350 ± 65 ml) (P < 0.05). The average length of hospital-stay did not differ significantly between the two groups. The DHS group had a significantly longer operative time (65.8 ± 16.2) than did the PFN group (49.8 ± 12.5), (P > 0.05), while the PFN group had a significantly longer fluoroscopy time (7 ± 1.4 min) than did the DHS group (4.1 ± 1 min) (P < 0.05). The incision length was significantly shorter in the PFN group (7.5 ± 1.5 cm) than in the DHS group (12.8 ± 2.5) (p < 0.001).

conclusionIn the management of unstable trochanteric fractures (AO 31-A2), both DHS and PFN are effective fixation devices that can provide satisfactory functional outcomes when proper surgical technique and accurate reduction are achieved. While PFN offers advantages such as reduced blood loss, shorter operative time, and earlier radiological union, DHS remains a viable option in appropriately selected cases, particularly in settings where resource limitations necessitate lower-cost alternatives. However, the success of DHS is highly dependent on achieving and maintaining an accurate anatomical reduction. Therefore, surgical decision-making should prioritize fracture pattern, surgeon expertise, and intraoperative reduction quality, rather than the cost or the type of the implant alone.