386 Proximal Femoral Nail (PFN) Versus Dynamic Hip Screw (DHS) In Unstable Intertrochanteric Fractures of Femur -A Comparative Clinical Study

Introduction

The goal of treatment of an intertrochanteric femoral fracture is restoration of patient's mobility as early as possible. The dynamic hip screw (DHS) has been used for several decades to treat these fractures. Proximal femoral nails (PFN) are reported to have an advantage in such fractures. This study aims at comparing the results of unstable intertrochanteric fractures femur treated with PFN and DHS.

Method

This was a prospective, randomized study which includes sixty patients. All patients were available for follow up with 30 patients in each group. The data about intraoperative blood loss, time to union, leg length shortening was collected. The functional outcome at the end of one year was evaluated using Harris Hip Score.

Results

Blood loss, duration of surgery, time to union and leg length shortening was significantly less in the patients treated with PFN (p < 0.05). The mean harris hip score for patients managed with PFN was significantly more than in DHS group, 12 months after surgery (p = 0.05).

Conclusions

PFN requires a smaller incision, lesser operative time, less blood loss and has improved functional results. In our opinion PFN may be a better fixation device for most of the unstable intertrochanteric femur fractures.

Identification of the biopsy track in musculoskeletal tumour surgery: a novel technique using India ink

Local recurrence along the biopsy track is a known complication of percutaneous needle biopsy of malignant musculoskeletal tumours. In order to completely excise the track with the tumour its identification is essential, but this becomes increasingly difficult over time. In an initial prospective study, 22 of 45 patients (48.8%) identified over a three-month period, treated by resection of a musculoskeletal tumour, had an unidentifiable biopsy site at operation, with identification statistically more difficult after 50 days. We therefore introduced the practice of marking the biopsy site with India ink. In all 55 patients undergoing this procedure, the biopsy track was identified pre-operatively (100%); this difference was statistically significant. We recommend this technique as a safe, easy and accurate means of ensuring adequate excision of the biopsy track.

Ilizarov principles of deformity correction

Ilizarov frames provide a versatile fixation system for the management of bony deformities, fractures and their complications. The frames give stability, soft tissue preservation, adjustability and functionality allowing bone to realise its full osteogenic potential. It is important that we have a clear and concise understanding of the Ilizarov principles of deformity correction to best make use of this fixation system. In this review article, the history of Ilizarov frame, the basic sciences behind it, the mechanical principles governing its use and the clinical use of the fixation system are discussed.