Type II Intertrochanteric Fractures: Proximal Femoral Nailing (PFN) Versus Dynamic Hip Screw(DHS)

Document Type : RESEARCH PAPER


Department of Orthopaedics, Pondicherry Institute of Medical Sciences, Pondicherry, India


Background: Intertrochanteric fracture is one of the most common fractures of the hip especially in the elderly with osteoporotic bones, usually due to low-energy trauma like simple falls. Dynamic Hip Screw (DHS) is still considered the gold standard for treating intertrochanteric fractures by many. Not many studies compare the DHS with Proximal femoral nail (PFN), in Type II intertrochanteric fractures (Boyd and Griffin classification). This study was done to compare the
functional and radiological outcome of PFN with DHS in treatment of Type II intertrochanteric fractures.
From October 2012 to March 2015, a prospective comparative study was done where 30 alternative cases of type II intertrochanteric fractures of hip were operated using PFN or DHS. Intraoperative complications were noted. Functional outcome was assessed using Harris Hip Score and radiological findings were compared at 3, 6, and 12 months postoperatively.
The average age of the patients was 60 years. In our series we found that patients with DHS had increased intraoperative blood loss (159ml), longer duration of surgery (105min), and required longer time for mobilization while patients who underwent PFN had lower intraoperative blood loss (73ml), shorter duration of surgery (91min), and allowed early mobilization. The average limb shortening in DHS group was 9.33 mm as compared with PFN group which was only 4.72 mm. The patients treated with PFN started early ambulation as they had better Harris Hip Score in the early post-op period. At the end of 12th month, there was not much difference in the functional outcome between the two groups.
PFN is better than DHS in type II inter-trochanteric fractures in terms of decreased blood loss, reduced duration of surgery, early weight bearing and mobilization, reduced hospital stay, decreased risk of infection and decreased complications.


  1. Dimon JH, Hughston JC. Unstable intertrochanteric fractures of the hip. J Bone Joint Surg Am. 1967; 49(3):440–50.
  2. Gulberg B, Johnell O, Kanis JA. World-wide projection for hip fractures. Osteoporos Int. 1997; 7(5):407-13.3.
  3. Melton LJ 3rd, Kearns AE, Atkinson EJ, Bolander ME, Achenbach SJ, Huddleston JM, et al. Secular trends in hip fracture incidence and recurrence. Osteoporos Int. 2009; 20(5):687-94.
  4. Kulkarni GS, Limaye R, Kulkarni M, Kulkarni S. Intertrochanteric fractures. Indian J Orthop. 2006; 40(1):16-23
  5. Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg Br. 1949; 31B(2):190-203.
  6. Bridle SH, Patel AD, Bircher M. Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg Br. 1991; 73(2):330-4.
  7. Radford PJ, Needoff M, Webb JK. A prospective randomised comparison of the dynamic hip screw and the gamma locking nail. J Bone Joint Surg Br. 1993; 75(5):789–93.
  8. O’Brien PJ, Meek RN, Blachut PA, Broekhuyse HM, Sabharwal S. Fixation of intertrochanteric hip fractures: gamma nail versus dynamic hip screw: A randomized, prospective study. Can J Surg. 1995; 38(6):516-20.
  9. Lee MH, Ingvertsen BT, Kirpensteijn J, Jensen AL, Kristensen AT. Quantification of surgical blood loss. Vet Surg. 2006; 35(4):388-93.
  10. Hardy DC, Descamps PY, Krallis P, Fabeck L, Smets P, Bertens CL, et al. Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients. J Bone Joint Surg Am. 1998; 80(5):618–30.
  11. Kuntscher G. A new method of treatment of pertrochanteric fractures. Proc R Soc Med. 1970; 63(11 Part 1):1120–1.
  12. Grosse A, Kempf I, Lafforgue D. Treatment of fragments, loss of bony substance and pseudarthrosis of femur and tibia using screw fixation (40 cases)in French. Rev Chir Orthop Reparatrice Appar Mot. 1978; 64(2):33-5.
  13. Russell TA. Fractures of hip and pelvis. In: Crenshaw AH, Wenger Dr, editors. Campbell’s Operative Orthopaedics. 8th ed. St Louis: CV Mosby; 1992. P. 895-7.
  14. Spivak JM, Zuckerman JD, Kumme FJ. Fatigue failure of sliding hip screw in hip fracture fixation: a report of three cases. J Orthop Trauma. 1991; 5(3):325-31.
  15. Leung KS, So WS, Shen WY, Hui PW. Gamma nails and dynamic hip screws for peritrochanteric fractures. A randomized prospective study in elderly patients. J Bone Joint Surg Br. 1992; 74(3):345-51.
  16. Kyle RF, Wright TM, Burstein AH. Biomechanical analysis of the sliding characteristics of compression hip screws. J Bone Joint Surg Am. 1980; 62(8):1308-14.
  17. Pajarinen J, Lindahl J, Michelsson O, Savolainen V, Hirvensalo E. Pertrochanteric femoral fractures treated with dynamic hip screws or a proximal femoral nail: A randomized study comparing post-operative rehabilitation. J Bone Joint Surg Br. 2005; 87(1):76–81.
  18. Boldin C, Seibert FJ, Fankhauser F, Peicha G, Grechenig W, Szyszkowitz R. The proximal femoral nail (PFN)--a minimal invasive treatment of unstable proximal femoral fractures: a study of 55 patients with a follow-up of 15 months. Acta Orthop Scand. 2003; 74(1):53-8.
  19. Nuber S, Schoweiss T, Ruter A. Stabilization of unstable trochanteric femoral fractures. Dynamic hip screw (DHS) with trochanteric stabilisation plate vs. proximal femur nail (PFN). Unfallchirurg. 2003; 106(1):39-47.
  20. Peivandi MT, Kachooei AR, Nazemian Z. New method to remove a broken guide pin in the hip joint. Orthopedics. 2011;34(10):e685-7.