[Pertrochanteric fractures: a randomized prospective study comparing dynamic screw plate and intramedullary fixation]

Area of Science:

• Orthopedic surgery
• Traumatology
• Biomaterials and implants

Background:

• Pertrochanteric fractures are common, particularly in elderly patients with osteoporosis.
• Intramedullary nailing is often favored for its mechanical advantages in treating these fractures.
• Dynamic hip screw (DHS) fixation remains a widely used alternative.

Purpose of the Study:

• To compare the dynamic hip screw (DHS) and intramedullary fixation (Targon PF) for pertrochanteric fractures.
• To evaluate stability, complication rates, and cost-effectiveness of each fixation method.

Main Methods:

• Prospective randomized study of 60 patients with pertrochanteric fractures.
• Comparison between Targon PF intramedullary nail (34 patients) and Synthes Synthes dynamic hip screw (26 patients).
• Outcomes assessed included operative time, blood loss, complications, Harris hip score, time to walking, and mortality at three months.

Main Results:

• Mean operative time was shorter for intramedullary nailing (35 min) vs. DHS (42 min).
• Mean blood loss was lower for DHS (325 ml) vs. intramedullary nailing (410 ml), though not statistically significant (p=0.07).
• Mechanical complications (screw migration) occurred in 3 Targon PF and 2 DHS cases; favored by instability and osteoporosis. Similar functional outcomes (Harris score) and time to walking were observed.

Conclusions:

• While literature suggests mechanical advantages for intramedullary nailing, DHS fixation provides good results.
• The Synthes DHS fixation demonstrated less blood loss and was more cost-effective.
• DHS fixation is a viable and potentially advantageous option for pertrochanteric fractures, especially considering cost and blood loss.