A randomized control trial comparing outcomes of proximal femoral nail and reverse distal femoral locking compression plate in management of intertrochanteric fractures with compromised lateral wall
|IJOCP | Volume – 2015| Issue – 2015| Article ID – 2015:108
Conference: Indian Orthopaedic Association Annual Conference IOACON-2013, India [Click for Full details]
Authors: Manhas V, Manhas R, Ul- haq A, Kumar P I, Dhammi
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Background: DHS is considered as gold standard for management of stable intertrochanteric fractures. However consensus is lacking regarding management of unstable intertrochanteric fractures. Aim of present study is to compare proximal femoral nail (PFN) or contralateral reverse distal femoral locking compression plate (DF-LCP) in management of unstable intertrochanteric fractures with compromised lateral wall.
Material and Method: In a randomized controlled study, from November 2011 to April 2013, 40 patients with unstable trochanteric fractures (AO 31 A-2.1-2.2 in 21 and AO 31 A-3 in 19) had osteosynthesis with PFN (n = 20) or DFLCP (n = 20) of which 35 were available for final follow up at 6 months. The average patients age was 54.7years (range 26 to 85). Both the groups were comparable for demographic data except for sex distribution. Main Intraoperative variables compared were duration of surgery, blood loss during surgery, fluoroscopy time. Functional outcome were assessed at 6 months by Harris hip score, parker palmer mobility score and SF-12. Radiologicalassessmentwasdonetolook forfractureunion,neckshaftangle,andimplantfailure.
Results: Duration of surgery, blood loss during surgery and fluoroscopy time was significantly less in PFN group than in DFLCP group. Mean duration of surgery in PFN group was 64.30±2.40 and for DFLCP group was 80.95±22.57 (p=0.022). Mean blood loss for PFN group was 316±143.98 ml and for DFLCP group was 441±131.34 ml (p=0.008). Mean fluoroscopy time for PFN group was 22.75 ±16.02 sec and for DFLCP group was 35.65 ± 8.70 sec (p=0.0001). Functional outcome in PFN group was better than in DFLCP group. HHS for PFN group was 81.53 ±13.21 and for DFLCP group was 68.43±14.36 (p=0.018). SF-12 physical and mental component score in PFN group was significantly better than in DFLCP group. There were six failures in DFLCP group and one in PFN group (p=0.036).
Conclusion: in terms of high complication rate in DFLCP group, we conclude that PFN is better than DFLCP in operative management of intertrochanteric fractures with compromised lateral wall. However, studies with larger study group and longer duration of follow up are required.
|How to Cite this Abstract|
|Manhas V, Manhas R, Ul- haq A, Kumar P I, Dhammi. A randomized control trial comparing outcomes of proximal femoral nail and reverse distal femoral locking compression plate in management of intertrochanteric fractures with compromised lateral wall. International Journal of Conference Proceedings 2015;(2015):108|