Study internal fixation of subtrochanteric fracture of femur with dynamic hip screw, dynamic condylar screw and proximal femoral nail-a retro-prospective study

Sandeep Kumar Mishra, Deepak C. E., Kushal Goari, Shurendra Shukla


Background: Sub trochanteric fracture is commonly seen in young adult and middle age man by high velocity trauma. Present study was taken up to study fracture fixation by PFN, DHS and DCS and compare their result in view of union rate, complication, functional out come, operative risk and effectiveness of implant. This study helps to decide appropriate implant for sub trochanteric fracture. In literature comparison of these PFN, DHS, DCS commonly used implants are rare and most of the studies are done in western population by using one or two implants.

Methods: Study is done clinically, in a retro to prospective manner by comparing 75 (50 cases retro and 25 cases prospectively) cases of either sex above the age of 18years from May 2010 to May 2014. All fractures are classified by Seinsheimer classification system. Fracture is fixed with DHS, PFN or DCS in 25 cases each.

Results: Males with an average age group 21-40-year were commonly affected with right femur fracture due to high velocity RTA. Fracture pattern was commonly type IIC as per seinsheimer classification. Mean union rate and clinical outcome for PFN is high.

Conclusions: PFN attempts to combine advantage of a sliding hip screw with those of intramedullary fixation devices. Cases treated with PFN nail have shown easier rehabilitation, less blood loos, less surgical trauma, early mobilization, early rate of fracture union when compared to those cases treated with DHS and DCS barrel plate as per observation of our study. With our study PFN has given us encouraging results over conventional DHS and DCS. Hence, we recommend PFN as better implant for fixation of sub-trochanteric fracture.


DCS (Dynamic condylar screw), DHS (Dynamic hip screw), PFN (proximal femoral nail), Sub-trochanteric fracture

Full Text:



Marsh JL, Saltzman CL, Bucholz R, Heckman J. Rockwood and Green's fractures in adults. 2001;2(6):827-1844.

LaVelle DG. Chapter 52-Fractures and Dislocations of the Hip. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, PA: Mosby. 2007;3:3237-3308.

McLaurin TM, Lawler EA. Treatment modalities for subtrochanteric fractures in the elderly. Techniques in Orthopaedics. 2004;19(3):197-213.

DeLee JC, Clanton TO, Rockwood CA Jr. Closed treatment of subtrochanteric fractures of the femur in a modified cast-brace. J Bone Joint Surg Am. 1981;63(5):773-9.

Baumgaertner MR, Curtin SL, Lindskog DM, 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(7):1058-64.

Vanderschot P, Vanderspeeten K, Verheyen L, Broos P. A review on 161 subtrochanteric fractures--risk factors influencing outcome: age, fracture pattern and fracture level. Der Unfallchirurg. 1995;98(5):265-71.

Boldin C, Seibert FJ, Fankhauser F, Peicha G, Grechenig W, Szyszkowitz R. The proximal femoral nail (PFN)-a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up of 15 months. Acta Orthop Scand. 2003;74(1):53-8.

Roberts CS, Nawab A, Wang M, Voor MJ, Seligson D. Second generation intramedullary nailing of subtrochanteric femur fractures: a biomechanical study of fracture site motion. 2002. J Orthop Trauma. 2003;17(8 Suppl):S57-64.