Abstract:

BACKGROUND: How to choose an appropriate internal fixation method for the treatment of intertrochanteric fracture of femur is a common problem in clinic.
OBJECTIVE: To compare the biomechanical functions and clinical effects of dynamic hip screw (DHS), proximal femur nail antirotation (PFNA) and the third generation Gamma nail (Gamma3).
METHODS: A total of 18 fresh specimens of proximal femur were prepared into models of intertrochanteric fracture, which were fixed with DHS, PFNA and Gamma3. The different internal fixation methods were tested and proved by means of experiment stress analysis. Clinical effects of 392 cases of intertrochanteric fracture of femur undergoing fixation with the above three methods were retrospectively analyzed.
RESULTS AND CONCLUSION: The stress analysis proved that the biomechanical functions of Gamma3 and PFNA were better than DHS (P < 0.05). There was no obvious difference between Gamma3 and PFNA. The DHS group had the most average intraoperative bleeding and greatest incidence of complications related with internal instrument (P < 0.05). The Harris score of the PFNA and Gamma3 groups in earlier period was better than the DHS group (P < 0.05). There was no obvious difference in the long-term scores between the three groups (P > 0.05). DHS is not recommended for the treatment of the type-A2 intertrochanteric fractures. PFNA and Gamma3, which present excellent biomechanical nature and clinical effects, especially are suitable for the osteoporotic patients of type-A2 or type-A3 intertrochanteric fractures.