Cao, LH; Liu, XW; Su, JC; Zhang, CC
OBJECTIVE: To evaluate and compare the biocompatibility and curative effect of dynamic hip screw (DHS), Gamma nail (GN) and proximal femoral nail (PFN) in the treatment of intertrochanteric fractures in the elderly. METHODS: A total of 95 cases of intertrochanteric fracture, 26 males, 69 females, aged 70-88 years, were selected from Department of Orthopaedics, Changhai Hospital of Second Military Medical University of Chinese PLA between June 2006 and March 2008. According to Evans classification system, the patients were randomly divided into 3 groups: DHS (n=30), GN (n=30) and PFN groups (n=35). Postoperative bleeding, hospitalization, surgery duration, postoperative complications, fracture healing, and biocompatibility were recorded. The hip evaluation was evaluated 9 months after surgery using Harris scores. RESULTS: All patients were followed-up. (1)The blood loss o f GN and PFN groups was significantly less than DHS group (P < 0.05); no significant difference was found between any two groups (P > 0.05), but DHS group was the longest while PFN was the shortest. In addition, there was no significant difference in length of stay among groups (P > 0.05). (2) One case of DHS group developed coax vara, and one developed injured extremity crispation. In GN group, one case had fracture of shaft of femur. No complications were found in PFN group, all fracture healed at the primary stage. Wound epidermal infection was found in 4 cases treated with Gamma nail (2 wound liquification, 2 superficial infection), and 6 case treated with dynamic hip screw, including 3 wound liquification, 2 superficial infection and 1 deep infection. Fixation failure such as fixator cutting-out of femoral head or breakage was not found in any case. (3) Harris scores for hip joint showed that there were 23 cases excellent, 4 good, and 3 fine in DHS group, with excellent and good rate of 90.0%; 24 excellent, 4 good, and 2 fine in GN group, with excellent and good rate of 93.3%; 32 excellent, 2 good, and 1 fine in PFN group, with excellent and good rate of 97.1%. There were no significant differences (P > 0.05). CONCLUSION: Application of DHS, GN and PFN in treatment of intertrochanteric fractures in elderly exhibits no significant difference in efficacy. Gamma nail and PFN can shorten the operation time to reduce the amount of blood loss and postoperative complications. For the stable fracture, all three fixtures can be used, and the DHS is the cheaper; for instable fracture, PFN and GN due to the biomechanical advantages are good choices.