Dynamic Hip Screw vs. Proximal Femoral Nail

Attribute	Dynamic Hip Screw	Proximal Femoral Nail
Implant Type	Compression screw and side plate	Intramedullary nail
Indications	Intertrochanteric and subtrochanteric fractures	Intertrochanteric and subtrochanteric fractures
Surgical Technique	Open reduction and internal fixation	Intramedullary nailing
Implant Placement	Extramedullary	Intramedullary
Complications	Non-union, implant failure, infection	Non-union, implant failure, infection

Introduction

When it comes to treating hip fractures, two common surgical options are Dynamic Hip Screw (DHS) and Proximal Femoral Nail (PFN). Both procedures have their own set of advantages and disadvantages, and it is important for surgeons to understand the differences between the two in order to make an informed decision for their patients.

Implant Design

The Dynamic Hip Screw consists of a lag screw that is placed into the femoral head, along with a side plate that is fixed to the lateral aspect of the femur. This construct allows for compression across the fracture site, promoting healing. On the other hand, the Proximal Femoral Nail is a single implant that is inserted into the femoral canal and fixed proximally and distally. This design provides stable fixation and allows for load-sharing between the implant and the bone.

Indications

Dynamic Hip Screw is typically used for stable intertrochanteric fractures, where there is minimal comminution and good bone quality. It is also preferred for fractures in younger patients with good bone stock. Proximal Femoral Nail, on the other hand, is often chosen for unstable intertrochanteric fractures, subtrochanteric fractures, and fractures in osteoporotic bone. It provides better stability in these more complex fracture patterns.

Surgical Technique

When performing a Dynamic Hip Screw procedure, the lag screw is first inserted into the femoral head, followed by the side plate fixation to the femur. This technique requires precise placement of the lag screw to achieve optimal compression. In contrast, the Proximal Femoral Nail is inserted into the femoral canal in a retrograde manner, with proximal and distal locking screws securing the implant in place. This technique is less technically demanding compared to the DHS procedure.

Complications

Both Dynamic Hip Screw and Proximal Femoral Nail procedures come with their own set of potential complications. With DHS, there is a risk of cut-out of the lag screw from the femoral head, as well as varus collapse of the fracture. On the other hand, PFN may be associated with implant failure, such as screw breakage or back-out. In addition, there is a risk of intraoperative fracture during nail insertion with PFN.

Rehabilitation

Rehabilitation following Dynamic Hip Screw surgery typically involves early mobilization with weight-bearing as tolerated. Patients are usually able to bear weight on the affected limb soon after surgery, with the goal of restoring function and preventing complications such as deep vein thrombosis. In comparison, patients who undergo Proximal Femoral Nail surgery may have restrictions on weight-bearing initially, depending on the stability of the fracture and the quality of bone. Physical therapy is often recommended to help regain strength and mobility.

Cost

When considering the cost of surgery, Dynamic Hip Screw tends to be more cost-effective compared to Proximal Femoral Nail. The DHS implant is typically less expensive, and the surgical technique may require less specialized equipment. On the other hand, PFN implants can be more costly, and the procedure may require fluoroscopy or other advanced imaging techniques for optimal placement.

Conclusion

In conclusion, both Dynamic Hip Screw and Proximal Femoral Nail are effective surgical options for treating hip fractures, each with its own unique attributes. Surgeons must carefully consider the patient's fracture pattern, bone quality, and overall health when deciding which procedure to perform. By understanding the differences between DHS and PFN, surgeons can provide the best possible care for their patients and achieve successful outcomes in hip fracture management.