• Faisal Farooq Butt Ayub medical college Abbottabad Pakistan
  • Adnan Shabbair Hussain Sindh medical college
  • Ahmed Mushtaq Khan Pakistan Military
  • Maria Sharif Rawalpindi medical College Pakistan


Neck of femur fractures are the most prevalent type of injury in elderly trauma patients. Both intra and extra capsular type of fractures are equally distributed in the given population. Traditionally, Extra capsular fractures are fixed with Dynamic Hip screw or Intra medullary nailing based on the type of fracture. NICE (National institute of clinical excellence) recommends fixing 31-A1 and 31-A2 fractures with DHS (Dynamic Hip Screw) whereas AO recommends fixing 31-A1 with DHS and 31-A2.1 subtype with DHS and 31-A2.2 and 31-A2.3with IMN (Intra medullary nail). In regional trauma centre 178 patients, 125 females and 53 males with extra capsular neck of femur fractures fixed were selected in a retrospective study. The data was spanning over a period of 1 year. Fractures were classified as per AO classification by two registrars. The implant selection was analysed in terms of the short term out come to find out the cost effectiveness of one over the other. The quality of reduction was assessed as per standard criteria and consideration of lateral femoral wall thickness was taken into account to assess the stability of fracture. The study found more risk of peri prosthetic fractures associated with Intra medullary nailing as compared to Dynamic Hip screw and more risk of Varus collapse was found to be associated with DHS as compared to IM Nail. Moreover, despite of Nail being costly as compared to DHS, the study did not reveal its superiority in terms of inpatient hospital stay. In appropriately selected patient DHS provides results in terms of hospital stay, revision rate and wound complications comparable to IM Nail in the short term justifying its use in the above-mentioned fracture patterns as per the standard National Institute of clinical Excellence guidelines.Keywords: femur fractures; screw; Intramedullary nailing; trauma centre; acetabulum

Author Biographies

Faisal Farooq Butt, Ayub medical college Abbottabad Pakistan

Registrar Trauma & Orthopadeics Royal Berkshire Hospital Reading

Adnan Shabbair Hussain, Sindh medical college

Registrar trauma & Orthopaedics


Hip fracture in adults. Guidance and guidelines. [Internet]. NICE [cited 2017 Jan 1]. Available from:

Petrie J, Sassoon A, Haidukewych GJ. When femoral fracture fixation fails: salvage options. Bone Joint J 2013;95-B(11 Suppl A):7–10.

Bojan AJ, Beimel C, Taglang G, Collin D, Ekholm, Jonsson A. Critical factors in cut-out complication after Gamma Nail treatment of proximal femoral fractures. BMC Musculoskeletal Disord 2013;14(1):1.

Socci A, Casemyr NE, Leslie MP, Baumgaertner R. Implant options for the treatment of intertrochanteric fractures of the hip rationale, evidence, and recommendations. Bone Joint J 2017;99–B(1):128–33.

Porter, B. B. and Neill, O. (no date) ‘FAILURE FEMORAL INTERNAL FRACTURES’, pp. 26–31.

Hsu CE, Shih CM, Wang CC, Huang KC. Lateral femoral wall thickness: A reliable predictor of post-operative lateral wall fracture in intertrochanteric fractures. Bone Joint J 2013;95-B(8):1134–8.

Huang X, Leung F, Xiang Z, Tan P-Y, Yang J, Wei D-Q, et al. Proximal Femoral Nail versus Dynamic Hip Screw Fixation for Trochanteric Fractures: A Meta-Analysis of Randomized Controlled Trials. Sci World J 2013;2013:1–8.

Yeganeh A, Taghavi R, Moghtadaei M. Comparing the Intramedullary Nailing Method Versus Dynamic Hip Screw in Treatment of Unstable Intertrochanteric Fractures. Med Arch 2016;70(1):53–6.

Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. In: The Cochrane Collaboration, editor. Cochrane Database of Systematic Reviews [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2010 [cited 2017 Jun 1]. Available from:

Kashigar A, Vincent A, Gunton MJ, Backstein D, Safir O, Kuzyk PR. Predictors of failure for cephalomedullary nailing of proximal femoral fractures. 2014;96(8):1029–34.

Zhang K, Zhang S, Yang J, Dong W, Wang S, Cheng Y, et al. Proximal Femoral Nail vs. Dynamic Hip Screw in Treatment of Intertrochanteric Fractures: A Meta-Analysis. Med Sci Monit 2014;20:1628–33.