Dynamic hip screw versus proximal femoral nailing in stable intertrochanteric fractures: a systematic review of efficacy and outcomes.

backgroundStable intertrochanteric fractures of the hip are common injuries, particularly among the elderly population. Effective surgical intervention is crucial for improving patient outcomes and recovery. Two widely used fixation techniques are the Dynamic Hip Screw (DHS) and Proximal Femoral Nailing (PFN). Both methods aim to provide stability and help early mobilization, yet they differ in their biomechanical properties and clinical implications.

objectiveThis review article aims to compare the efficacy and outcomes of DHS and PFN in the treatment of stable intertrochanteric fractures, focusing on key metrics such as the Harris Hip Score (HHS), pain management, functional recovery, and complication rates. By synthesizing findings from recent studies, the review seeks to provide a comprehensive understanding of the advantages and limitations of each technique.

resultsComparative analysis demonstrated that proximal femoral nailing (PFN) was associated with shorter hospital stays (average: 7.8 days compared to 12.4 days), earlier mobilization (7.93 weeks compared to 11.80 weeks to full weight-bearing), and better early postoperative functional results (Harris Hip Scores: 90.33 compared to 89.08 at the 12-month follow-up) compared to dynamic hip screw (DHS). However, PFN was associated with a longer fluoroscopy exposure and higher rates of implant cut-out complications, whereas DHS was associated with higher intraoperative risks of lateral wall fractures (32% rate), higher blood loss, and reoperation rates. Economic evaluation revealed comparable overall costs for both modalities, although the initial implantation costs were greater for PFN. Fracture union timelines were statistically comparable (mean: ~130 days).

conclusionThe diagnosis and management of intertrochanteric fractures remain a subject of considerable debate, both techniques have their distinct sets of benefits and drawbacks, highlighting the necessity for a tailored approach depending on patient-specific factors and surgical settings. Ultimately, these multifaceted findings underscore the need for further comparative studies to better understand these differences and aid in improving surgical approaches for intertrochanteric fractures. This will enable more informed decision-making, potentially improving patient outcomes and optimizing resource use in healthcare settings.