gms | German Medical Science

Objectives: We aimed to evaluate and compare the clinical and functional outcomes of Dynamic Hip Screw (DHS) and Proximal Femoral Nail Antirotation (PFNA) treatment of type A1 intertrochanteric fractures in elderly patients.

Methods: We retrospectively reviewed 194 consecutive patients with AO type 1 intertrochanteric femoral fractures who were treated with DHS(n=113) or PFNA(n=81). We evaluated operation time, intra-operative blood loss, and functional outcomes in terms of pain on the Hardy-Wolff-Goodell scale, walking ability, and the Barthel activities of daily living index. Fracture union, sliding of hip screw, proximal femur shortening, and presence of complications

Results and Conclusion: The mean operation time and blood loss were significantly lower for the PFNA group (67.8±12.7 min and 249.5±146.2 ml, respectively) than for the DHS group (96.2±26.5 min and 376.1±258.7 ml, respectively), but walking ability and Barthel index decreased to a similar extent for both groups. However, patients in the DHS group complained of significantly more pain (p = 0.049), as evaluated on the Hardy-Wolff-Goodell scale. Although there were no significant differences between the two groups with respect to the time until fracture union was achieved, patients in the DHS group exhibited a higher extent of proximal femoral shortening and sliding of the hip screw. Compared to DHS treatment, PFNA treatment of type A1 intertrochanteric fractures is associated with reduced blood loss, shorter operation time, and less severe pain after surgery. Additionally, sliding of the hip screw and proximal femur shortening are expected to occur more frequently after DHS.