• Kashif Memon St Peter and Ashford Hospital NHS Trust
  • Athar Muneeruddin Siddiqui AO Hospital
  • Zainab Aqeel Khan AO Hospital
  • Al Wardha Zahoor Ziauddin University


Background: There are various implant choices to fix unstable per- trochanteric fractures.Theaim of this study was to compare the outcomes of dynamic hip screw and proximal femur nail for unstable per-trochanteric fractures including complications associated with both fixations. Methods: A retrospective analysis done on pertrochanteric fractures of femur who were treated with Dynamic hip Screw (DHS) and Proximal Femur Nail (PFN). The data was taken from our hospital hip data base for the past two years from January 2017 to January 2019. Data of 174 patients was analysed, divided in to Group A with DHS (n=122) and Group B with PFN (n=52). Follow up included X-ray (anteroposterior and lateral) views for fracture union and collapse, femur neck shortening, implant position and identification of mode of failure or collapse (cut out risk) by using tip-apex distance. The Harris hip score used to evaluate mobility status and other functional outcomes.Result: The mean age in years of patients treated with PFN and DHS were 55.9 and 59.8, ranging from 39-83 years. The mean of Harris hip score at 2 year was 69.28±9.99 in DHS group and 72.12±9.71 in PFN group with the p-value 0.31. The mean of limb shortening was 12mm in DHS and 9mm in PFN group. In DHS group, four cases had tip-apex distance of 39 mm and reported implant cut out that needs revision of surgery.Conclusion: Proximal Femur Nailgroup demonstrated no implant cut out and less mean limb length shortening whereas other parameter like functional outcomes, fracture union, rate of infection, hospital stay and postoperative pain are not significantly different in two groups. Keywords: Per trochanteric fracture;Dynamic hip screw;Proximal femur nail;Functional outcomes  

Author Biographies

Kashif Memon, St Peter and Ashford Hospital NHS Trust

MBBS, FCPS, FEBOT,Chm, FRCS(T&O)Upper limb surgery fellow

Athar Muneeruddin Siddiqui, AO Hospital

MBBS, MRCS (Eng), DBS (London), MCh (Edinburgh), FEBOT (Lisbon), SICOT(Canada), European Spine Diploma (France), FRCS Tr & Orth (Eng)Consultant Spinal Surgeon Clinical Lead Spine Directorate A.O Hospital PVT LTD

Zainab Aqeel Khan, AO Hospital

Research associate and senior physiotherapist at AO hospitalDpt, masters of science in biostatistics and epidemiology

Al Wardha Zahoor, Ziauddin University

Senior Lecturer in Ziauddin College of Rehabilitation Sciences, Ziauddin University.


Parker M, Johansen A. Hip fracture. Bmj. 2006 Jun 29;333(7557):27-30.

Kanis JA, Oden A, McCloskey EV, Johansson H, Wahl DA, Cooper C. A systematic review of hip fracture incidence and probability of fracture worldwide.Osteoporos Int. 2012 Sep 1;23(9):2239

Saarenpää I, Heikkinen T, Ristiniemi J, Hyvönen P, Leppilahti J, Jalovaara P. Functional comparison of the dynamic hip screw and the Gamma locking nail in trochanteric hip fractures: a matched-pair study of 268 patients. IntOrthop. 2009 Feb 1;33(1):255-60.

Nelson OA, inventor. Orthopedic implant used to repair intertrochanteric fractures and a method for inserting the same. United States patent US 6,562,042. 2003 May 13.

Schipper IB, Steyerberg EW, Castelein RM, Vugt AB. Reliability of the AO/ASIF classification for pertrochanteric femur fractures.ActaOrthop Scand. 2001 Jan 1;72(1):36-41.

Chua IT, Rajamoney GN, Kwek EB. Cephalomedullary nail versus sliding hip screw for unstable intertrochanteric fractures in elderly patients. J Orthop Surg. 2013 Dec;21(3):308-12.

Baumgaertner M, Curtin S, Lindskog D, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am. 1995;77:1058-64.

Joshua Langford, MD,* Gita Pillai, MD, † Anthony D. Ugliailoro, MD, ‡ and Edward Yang, MD† Perioperative Lateral Trochanteric Wall Fractures: Sliding Hip Screw versus Percutaneous Compression Plate for Intertrochanteric Hip Fractures. J Orthop Trauma _ Volume 25, Number 4, April 2011

Santoni BG, Diaz MA, Stoops TK, Lannon S, Ali A, Sanders RW. Biomechanical Investigation of an Integrated 2-Screw Cephalomedullary Nail Versus a Sliding Hip Screw in Unstable Intertrochanteric Fractures. J Orthop Trauma. 2019 Feb 1;33(2):82-7.

Harrington P, Nihal A, Singhania AK, Howell FR. Intramedullary hip screw versus sliding hip screw for unstable intertrochanteric femur fractures in the elderly. Injury. 2002 Jan 1;33(1):23-8.

Veeragandham P, Sahu RK, Misra S. Comparative study between proximal femur nailing and dynamic hip screw with proximal femur locking compression plates in intertrochanteric fracture of femur. Int J Res Orthop. 2017 May;3(3):339-49.

Parker MJ. Sliding hip screw versus intramedullary nail for trochanteric hip fractures; a randomised trial of 1000 patients with presentation of results related to fracture stability. Injury. 2017 Dec 1;48(12):2762-7.

Banerjee U, Chattopadhyay A, Dey NK, Sinha PK, Chattaraj W, Sen S. A study of management of trochanteric fracture of femur treated with dynamic sliding hip screw-plate device vs. proximal femur nail. Int J Res Orthop. 2017 May;3(3):524.

Fujii T, Nakayama S, Hara M, Koizumi W, Itabashi T, Saito M. Tip-apex distance is most important of six predictors of screw cutout after internal fixation of intertrochanteric fractures in women. JBJS Open Access. 2017 Dec 28;2(4).

Nilsdotter A, Bremander A. Measures of hip function and symptoms: Harris hip score (HHS), hip disability and osteoarthritis outcome score (HOOS), Oxford hip score (OHS), Lequesne index of severity for osteoarthritis of the hip (LISOH), and American Academy of orthopedic surgeons (AAOS) hip and knee questionnaire. Arthritis care & research. 2011 Nov;63(S11):S200-7.

Zehir S, Zehir R, Zehir S, Azboy İ, Haykir N. Proximal femur nail antirotation against dynamic hip screw for unstable trochanteric fractures; a prospective randomized comparison. Eur J Trauma Emerg S. 2015 Aug 1;41(4):393-400.

Ma KL, Wang X, Luan FJ, Xu HT, Fang Y, Min J, Luan HX, Yang F, Zheng H, He SJ. Proximal femoral nails antirotation, Gamma nails, and dynamic hip screws for fixation of intertrochanteric fractures of femur: a meta-analysis. Orthopaedics& Traumatology: Surgery & Research. 2014 Dec 1;100(8):859-66.

Sciacca S, Lidder SS, Grechenig C, Grechenig S, Staresinic M, Bakota B, Gänsslen A. Variations of treatment in selected proximal femur fractures among surgeons with different surgical experience—A survey at an international AO course. Injury. 2015 Nov 1;46:S57-60.

Zhong B, Zhang Y, Zhang C, Luo CF. A comparison of proximal femoral locking compression plates with dynamic hip screws in extracapsular femoral fractures. Orthopaedics& Traumatology: Surgery & Research. 2014 Oct 1;100(6):663-8.

Shen L, Zhang Y, Shen Y, Cui Z. Antirotation proximal femoral nail versus dynamic hip screw for intertrochanteric fractures: a meta-analysis of randomized controlled studies. Orthopaedics& Traumatology: Surgery & Research. 2013 Jun 1;99(4):377-83.

Carulli C, Piacentini F, Paoli T, Civinini R, Innocenti M. A comparison of two fixation methods for femoral trochanteric fractures: a new generation intramedullary system vs sliding hip screw. Clinical Cases in Mineral and Bone Metabolism. 2017 Jan;14(1):40.

Guerra MT, Pasqualin S, Souza MP, Lenz R. 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. Injury. 2014 Nov 1;45:S26-31.

Pajarinen J, Lindahl J, Michelsson O, Savolainen V, Hirvensalo E. Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail: a randomised study comparing post-operative rehabilitation. The Journal of bone and joint surgery. British volume. 2005 Jan;87(1):76-81.

Zeng C, Wang YR, Wei J, Gao SG, Zhang FJ, Sun ZQ, Lei GH. Treatment of trochanteric fractures with proximal femur nail antirotation or dynamic hip screw systems: a meta-analysis. J Int Med Res. 2012 Jun;40(3):839-51.

Huang X, Leung F, Xiang Z, Tan PY, Yang J, Wei DQ, Yu X. Proximal femur nail versus dynamic hip screw fixation for trochanteric fractures: a meta-analysis of randomized controlled trials. Sci. 2013;201