A Prospective, Randomised Controlled Trial Comparing the use of the Proximal Femoral Nail - Antirotation and Dynamic Hip Screw for Stable Intertrochanteric Femur Fractures-Stable Trochanteric Fractures Intramedullary versus Extramedullary (STRIVE) Study.

INTRODUCTION

Intramedullary nailing in the management of hip fractures is gaining in popularity. Our study aims to determine if there are any clinical and radiological differences between the Proximal Femoral Nail Antirotation II (PFNA II) and the Dynamic Hip Screw (DHS) in the management of stable intertrochanteric (IT) femur fractures. This is a single blinded prospective randomised controlled trial of 33 patients, aged above 60, comparing the use of the PFNA II and the DHS for the treatment of stable IT femur fractures in a single tertiary centre with an established ortho-geriatric co-managed hip fracture care pathway.

RESULTS

Of the 33 patients enrolled, 18 patients were treated with the DHS and the rest with the PFNA II. The two groups had similar demographic profiles and pre-operative radiological parameters. There was no statistical difference between the two groups in terms of intra-operative bleeding, post-operative pain score and total surgical time. The median Harris Hip and Parker Mobility Scores for the DHS group were non-inferior compared to the PFNA II group. Surgical time, blood loss, post-op radiological parameters and functional outcomes including time to ambulation were similar in both groups.

CONCLUSION

We recommend the use of the DHS for stable IT fracture patterns in view of its cost savings and equivalent functional and radiological outcomes.