Comparison of functional outcome following Dynamic Hip Screw versus Proximal Femoral Nail stabilization of stable intertrochanteric fractures

Background: Stable intertrochanteric fractures are commonly treated with either Dynamic Hip Screw (DHS) or Proximal Femoral Nail (PFN). The optimal implant for early functional recovery, complications and reoperation rates remains a matter of debate. This study compared functional outcomes and complication profiles of DHS versus PFN in a 2-year single-center cohort. Methods: 284 consecutive patients with stable intertrochanteric fractures (AO/OTA 31-A1 and selected A2 without extreme comminution) treated at MIHS Janakpur between 01/2023 and 12/2024 were enrolled. Choice of implant (DHS vs PFN) was according to treating orthopedic surgeon preference and fracture configuration; baseline characteristics were recorded. Primary outcome was Harris Hip Score (HHS) at 12 months. Secondary outcomes included operative time, estimated blood loss, time to radiographic union, complications (cut-out, nonunion, infection), and reoperation. Statistical tests: Student’s t-test for continuous variables, chi-square or Fisher’s exact test for categorical variables; p<0.05 considered significant. Results: 148 patients received DHS and 136 received PFN (total n=284). Mean age was 67.2±9.5 years (DHS) vs 66.1±9.0 years (PFN) (p=0.317). Mean operative time was significantly longer for DHS (65±12 min) than PFN (55±10 min), p<0.001. Estimated blood loss was greater for DHS (250±80 ml) vs PFN (120±50 ml), p<0.001. Mean HHS at 12 months was 78.5±10 (DHS) vs 82.3±9.2 (PFN), p=0.001. Overall complication rate was 13.5% (20/148) in DHS vs 8.8% (12/136) in PFN (p=0.289). Reoperation rate was 5.4% (8/148) DHS vs 2.9% (4/136) PFN (p=0.461). Time to radiographic union was similar (14.5±3.0 weeks DHS vs 13.8±2.8 weeks PFN, p=0.06). Conclusions: In this 2-year cohort from MIHS Janakpur, PFN was associated with shorter operative time, less intraoperative blood loss and modestly better functional outcome (HHS at 12 months) compared with DHS for stable intertrochanteric fractures. Rates of complications and reoperations were numerically lower with PFN but did not reach statistical significance. Both implants provide acceptable outcomes; implant choice should consider patient factors and orthopedic surgeon experience.