Comparison of soft-tissue serum markers in stable intertrochanteric fracture: Dynamic hip screw versus proximal femoral nail—A preliminary study
Introduction
Intertrochanteric fractures are commonly encountered in osteoporotic elderly patients, and recent developments in orthopaedic surgery indicate that intertrochanteric fractures can be treated successfully using advanced implants. Dynamic hip screws (DHSs) and proximal femoral nails (PFNs) are commonly used to treat intertrochanteric fractures and both produce good results.4, 5, 28, 32 Nevertheless, surgeons are commonly concerned about the decision to adopt the DHS or PFN option. If good fracture healing and reduction can be obtained using both devices under similar surgical indications, then, the determining factors could well be surgeon's convenience or habit.
Minimally invasive surgery has been reported recently to produce good results for the treatment of intertrochanteric fractures.9, 22, 30 A minimal incision approach has been used for PFN devices for some time, but the introduction of a less-invasive DHS device and a minimal invasive approach for DHS has redressed the balance.22 Soft tissue is also an important factor because intertrochanteric fractures often occur in the elderly, in whom tissue healing is as important as the fracture. Accordingly, soft-tissue preservation is an important determinant of device selection. However, no comparative study has been conducted on soft-tissue damage after intertrochanteric fractures have been treated with these two devices. We considered that a comparison of the soft-tissue invasivenesses of these two devices would provide useful information to surgeons considering which device to use. Accordingly, the aim of this study was to determine the soft-tissue invasiveness of the two devices after surgery for stable intertrochanteric fractures in the elderly.
Section snippets
Study design and patients
Twenty patients operated on between May 2009 and October 2009 by a single surgeon (JHY) were enrolled in this consecutive, prospective, randomised study. The inclusion criteria were an intertrochanteric fracture in a patient over 60 years old with no concurrent fracture or injury, an AO classification A1 or A2 fracture, surgery within 2 weeks of trauma and no prior disease that could have possibly affected serum markers. The exclusion criteria were a pathologic fracture, multi-trauma or open
Results
No differences were observed between the DHS and PFN groups with respect to preoperative demographic data, and the two groups were similar in terms of intra-operative results, including surgery time, incision length and blood loss (p > 0.05) (Table 1). No malunion or nonunion was encountered in either group, and no implant-related complications were evident at final follow-up (minimum 6 months after surgery).
In terms of serum marker levels, the two groups showed similar temporal patterns.
Discussion
Intertrochanteric fractures of the femur are common in elderly patients, and rigid fixation with early mobilisation should be considered the standard treatment. Many implants and surgical techniques have been proposed, and of these, two main alternatives are available.6, 7, 11, 13, 20, 29 The first type of implant consists of a sliding neck screw or bolt connected to a plate in the lateral femoral cortex, and the second is a sliding neck screw that stabilises the head–neck fragment using an
Conclusion
Our analysis of serum markers revealed that absolute levels and temporal changes were similar in the DHS and PFN groups. Furthermore, our findings indicate that when used to treat stable intertrochanteric fractures in the elderly, DHS and PFN performed by the same surgeon using a common approach produce similar levels of soft-tissue damage. Accordingly, our findings suggest that DHS and PFN be viewed as good alternatives for the treatment of stable intertrochanteric fractures.
Conflict of interest statement
No benefits of funds were received in support of the study. Further, the authors declare that they have no vested interest that could be construed to have inappropriately influenced this study.
Acknowledgements
The authors thank Ms. Mun-Hee Lee and Ms. Mi-Nyeo Yoon for their assistance during the data collection.
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Functional recovery of elderly patients with surgically-treated intertrochanteric fractures: Preliminary results of a randomised trial comparing the dynamic hip screw and proximal femoral nail techniques
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