A comparative analysis between the proximal femoral nail and dynamic hip screw in the management of unstable trochanter fracture of the femur

Background: Trochanteric fractures are a growing public health concern, particularly as the population ages. This study aims to assess recovery and functional outcomes following treatment of trochanteric femoral fractures using either PFN or DHS. The aim of this study was to compare the effectiveness of proximal femoral nail (PFN) and dynamic hip screw (DHS) in managing unstable trochanteric fractures of the femur. Methods: This quasi-experimental study at the emergency and outpatient department of the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka (July 2005-June 2007), included 30 patients with unstable trochanteric fractures, treated with proximal femoral nail (n=14) or dynamic hip screw (n=16). Surgeries were performed under spinal anesthesia, and outcomes, including union rate, complications, and functional results, were assessed and analyzed using SPSS (p<0.05). Results: Out of the 33 patients initially included, 2 died and 1 were lost to follow-up, leaving 14 patients in the PFN group and 16 in the DHS group. The mean operation time was significantly longer for PFN (117.4 minutes) compared to DHS (72.3 minutes). A higher percentage of DHS patients required blood transfusions. Follow-up results showed that PFN patients experienced less pain, better hip movement, and higher Harris hip scores, with statistical significance in pain relief and functional outcomes. Conclusions: The proximal femoral nail (PFN) is an effective treatment for unstable trochanteric femoral fractures, offering biomechanical stability, early weight-bearing, and a lower risk of wound infection compared to traditional methods.