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    It Fractures Management Dhs Vs PFN: Sayeeda Qudsia

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    sayeeda
    1) The document compares the use of dynamic hip screws (DHS) versus proximal femoral nails (PFN) for treating intertrochanteric fractures. 2) A meta-analysis found that PFN resulted in less blood loss, shorter incisions, lower rates of lag screw cut out, and lower re-operation rates compared to DHS. 3) However, PFN can also cause complications like the "Z-effect" where the screws cut through the femoral head in rare cases.

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    It Fractures Management Dhs Vs PFN: Sayeeda Qudsia

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    sayeeda
    61 views26 pages
    1) The document compares the use of dynamic hip screws (DHS) versus proximal femoral nails (PFN) for treating intertrochanteric fractures. 2) A meta-analysis found that PFN resulted in less blood loss, shorter incisions, lower rates of lag screw cut out, and lower re-operation rates compared to DHS. 3) However, PFN can also cause complications like the "Z-effect" where the screws cut through the femoral head in rare cases.

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    Dynamic hip screw vs PFNA

    Original Title

    Ortho

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    1) The document compares the use of dynamic hip screws (DHS) versus proximal femoral nails (PFN) for treating intertrochanteric fractures. 2) A meta-analysis found that PFN resulted in less blood loss, shorter incisions, lower rates of lag screw cut out, and lower re-operation rates compared to DHS. 3) However, PFN can also cause complications like the "Z-effect" where the screws cut through the femoral head in rare cases.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    61 views26 pages

    It Fractures Management Dhs Vs PFN: Sayeeda Qudsia

    Uploaded by

    sayeeda
    1) The document compares the use of dynamic hip screws (DHS) versus proximal femoral nails (PFN) for treating intertrochanteric fractures. 2) A meta-analysis found that PFN resulted in less blood loss, shorter incisions, lower rates of lag screw cut out, and lower re-operation rates compared to DHS. 3) However, PFN can also cause complications like the "Z-effect" where the screws cut through the femoral head in rare cases.

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    You are on page 1of 26

    IT FRACTURES

    MANAGEMENT
    DHS VS PFN
    SAYEEDA QUDSIA
    Intern - 2014 batch
    DCMS
    What is an IT # ?
    An Intertrocheric fracture is the one which occurs
    between the greater trochanter , where the gluteus
    medius and minimus muscles attach, and the lesser
    .trochanter, where the iliopsoas muscle attaches
    :FEATURES
    ◦ Completely extra capsular
    ◦ MC in elderly osteoporotic women
    ◦ Unites easily
    ◦ Avascular necrosis is rare
    DIAGNOSTIC
    IMAGING
    • Xrays are
    standard
    diagnostic tool
    • When fracture is
    suspected & not
    apparent on an
    xay,a
    technetium bone
    scan or MRI
    should be
    advised
    • MRI is as
    accurate as
    bone scan &
    reveals a
    fracture within
    24 hours of
    injury
    MANAGEMENT

    NON OPERATIVE OPERATIVE


    Management
    ◦ NONOPERATIVE TREATMENT
    INDICATIONS:-
    1. Terminally ill
    2. Poor medical & surgical risk patients
    ◦ METHODS:-
    1. Buck’s traction – very old patients
    2. Plaster/hip spica
    3. Skeletal traction through distal femur or tibia for 10-12 weeks with BOHLER-BRAUN
    SPLINT
    4. Derotation boot
    5. Thomas splint immobilisation
    COMPLICATIONS
    ◦ Decubiti
    ◦ Urinary tract infections
    ◦ Joint contractures
    ◦ Hypostatic pneumonia
    ◦ Thromboembolism
    ◦ # healing accompanied by varus deformity & shortening (due to inability of traction
    to effectively counteract deforming muscle forces) MALUNION
    OPERATIVE TREATMENT
    ◦ IT fractures are almost always treated by early internal fixation because best
    possible position is obtained & early ambulation can be achieved thereby reducing
    the risk of complications
    TREATMENT OPTIONS:-

    •Extra Medullary – dnamic hip screw


    - Trochanteric stabilizing plate
    - 95 degree Angle blade plate
    •Intramedullary –Gamma Nail
    –Intramedullary hip screw
    –Condylar blade plate
    •External fixator
    •Replacement arthroplasty
    • Generally, Dynamic Hip Screw (DHS) internal fixation is one of
    the most primary options. For stable or minimally displaced
    pertrochanteric fractures(basicervical fractures and simple
    pertrochanteric fractures), the DHS fixation produces reliable
    results. However, in unstable fractures, the DHS device
    performs less well with a relatively higher incidence of internal
    fixation failure.

    The Proximal Femoral Nail Antirotation (PFNA) is an


    intramedullary device with a helical blade rather than a screw,
    for better purchase in the femoral head and has been adopted
    for patients with unstable peritrochanteric fractures
    Thus, to provide the most comprehensive assessment of the PFNA and
    DHS for peritrochanteric fractures meta-analysis based on all relevant
    randomized controlled trials was performed.

    COMPARISON CRITERIA:

    1Intraoperative blood loss


    2. Length of incision
    3. Post operative infection rate
    4. Lag screw cut out rate
    5. Re operation rate

    The hypothesis of present study was that


    “PFNA achieved better efficacy for peritrochanteric
    fractures compared with DHS.”
    ADVANTAGES OF PFN
    ◦ Minimally invasive thereby less surgical trauma
    ◦ Less blood loss
    ◦ Reduced operation time
    ◦ Length of incision is small
    LAG SCREW CUT OUT RATE
    DYNAMIC HIP SCREW: PROXIMAL FEMUR NAIL:
    ◦ uses single screw thereby more ◦ Uses 2screws. Larger one goes into
    rotational instability femur neck for carrying load & smaller
    hip pin goes into head for rotational
    ◦ Flexion-Extension of limb results in stability
    loosening of the bone-screw interface
    ◦ Cut out rates are lower by placing
    ◦ Screw is placed improperly in antero-
    screws in the SAFEZONE i.e, second
    superior quadrant
    quarter interface line
    RE OPERATION RATE
    ◦Varus collapse of the head is caused by
    1. Screw cut outs
    2. Lateral protrusion
    ◦ This is the most important post operative complication leading to reoperation
    ◦ This risk is very less in pfn
    DISADVANTAGES OF PFN
    The Z- EFFECT:- involves the lateral migration of the inferior
    screw, varus collapse of the fracture and perforation of the
    femoral head by the superior screw .
    REVERSE Z- EFFECT:- involves the lateral migration of the
    superior screw accompanied by the medial migration of the inferior
    screw.
    The first account of the Z-effect has been attributed to Werner-
    Tutshcku et al. [9], who reported a series of 70 cases of fractures
    treated using PFN.
    These authors also advised that fixation of thefracture at a cervico-
    diaphyseal angle of <125° is a predisposing factor for the Z-effect
    and reverse Z -effect, as well as for cut-out of the femoral head by
    the screw.
    CONCLUSION

    ◦In conclusion, PFNA can benefit


    peritrochanteric fractures patients
    with less blood loss and fewer
    complications compared with
    DHS.

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