Evaluating Functional and Radiological Outcomes: Dynamic Hip Screw (DHS) vs. Proximal Femoral Nail Anti-rotation (PFNA) in Stable Intertrochanteric Fracture Management

Nimrah Rasheed; Masab Ahmed; Naveed Iqbal; Syed Umar Rafiq; Affan Tayyab; Ghazanfar Ali Shah

doi:10.54112/bcsrj.v6i10.2200

Authors

Nimrah Rasheed Department of Trauma and Orthopedic Surgery, Shaheed Mohtarma Benazir Bhutto institute of trauma Karachi, Pakistan
Masab Ahmed Department of Trauma and Orthopedic Surgery, Shaheed Mohtarma Benazir Bhutto institute of trauma Karachi, Pakistan
Naveed Iqbal Department of Trauma and Orthopedic Surgery, Shaheed Mohtarma Benazir Bhutto institute of trauma Karachi, Pakistan
Syed Umar Rafiq Department of Trauma and Orthopedic Surgery, Shaheed Mohtarma Benazir Bhutto institute of trauma Karachi, Pakistan
Affan Tayyab Department of Trauma and Orthopedic Surgery, Shaheed Mohtarma Benazir Bhutto institute of trauma Karachi, Pakistan
Ghazanfar Ali Shah Department of Trauma and Orthopedic Surgery, Shaheed Mohtarma Benazir Bhutto institute of trauma Karachi, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i10.2200

Keywords:

Dynamic hip screw; Proximal femoral nail anti-rotation; Intertrochanteric fracture; Harris Hip Score; Radiographic Union Score for Hip

Abstract

Intertrochanteric femur fractures are common in the elderly and are associated with significant morbidity. Surgical fixation using devices such as the Dynamic Hip Screw (DHS) and Proximal Femoral Nail Anti-rotation (PFNA) is widely practiced. However, comparative evidence regarding functional outcomes, radiological healing, and complications in stable fracture patterns remains limited. Objective: To compare functional and radiological outcomes and complications between Dynamic Hip Screw (DHS) and Proximal Femoral Nail Anti-rotation (PFNA) in stable intertrochanteric femur fractures. Methods: This descriptive longitudinal study was conducted from 15 May to 15 August 2025 in the Department of Orthopaedics of a tertiary care hospital and included 60 patients with AO/OTA 31-A1 intertrochanteric fractures, divided into DHS (n=30) and PFNA (n=30) groups. outcome was assessed using Harris Hip Score (HHS) and radiological union using Radiographic Union Score for Hip (RUSH) at 3 and 6 months. Complications (infection, implant failure) were recorded. Group comparisons used t-test and Chi-square test, with post-stratification for age, gender and fracture classification; p≤0.05 was considered significant. Results: Mean age was similar in DHS and PFNA groups (65.6 ± 7.1 vs 65.5 ± 7.8 years; p=0.786), with no significant difference in gender. At 3 months, HHS and RUSH were comparable. At 6 months, PFNA showed significantly higher mean HHS (89.8 ± 2.9 vs 85.9 ± 3.7; p=0.02) and RUSH scores (11.49 ± 0.22 vs 10.95 ± 0.36; p=0.001). Infection rates were low and similar, whereas early implant failure at 3 months was higher with DHS (6.7% vs 0%; p=0.038). Age and gender did not significantly influence the proportion achieving good functional outcome (HHS ≥80). Conclusion: PFNA yielded better 6-month functional and radiological outcomes and fewer early mechanical failures than DHS in stable intertrochanteric fractures, without increased infection, and may be preferred when available.

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