POST OPERATIVE AND INTRAOPERATIVE BLOOD TRANSFUSION REQUIREMENT AND NON UNION (SURGERY) IN INTERTROCHANTERIC FRACTURES TREATED WITH PROXIMAL FEMORAL NAIL VS DYNAMIC HIP SCREW: RETROSPECTIVE COMPARATIVE STUDY

Abstract

Peritrochantric (intertrochantric and subtrochantric) fractures are one of the commonest fractures in elderly patients with osteoporotic bones. Implant of choice for such fractures is always debatable. Commonly used implants are proximal femoral nail (PFN) and dynamic hip/condylar screw (DHS/DCS). Both implants have list of merits and demerits, Specific and relative indications. Objective of this retrospective comparative study is to compare post operative and intra operative blood (whole blood or component) transfusion requirement and non union (resurgery) when peritrochantric fractures treated with PFN and DHS/DCS. In this retrospective study we compared intra operative or post operative blood or component transfusion in 30 patients of peritrochantric fracture treated with PFN(intramedullary fixation)  with 30 patients of same fracture treated with DHS/DCS(extramedullary fixation). Mean age is 59.9±1.1 year, 34 (57%) male, 26 (43%) female. Domestic fall on floor is the commonest cause 39(65%) patients. Other are road traffic accident 10(17%), fall from stairs 8(13%) and fall from height 3(5%). In intramedullary group (PFN) blood or component transfusion is required in 3 (10%) cases. In extramedullary group blood or component transfusion is required in 11 (37%) cases. P- Value in two groups for blood or components transfusion requirement is significant (P<0.05). Non union (resurgery) is reported in 3 cases in intramedullary (PFN) group and in 7 cases in extramedullary (DHS/DCS) group. In present study we concluded that less post operative or intra operative blood or components transfusion is required in intramedullary (PFN) group as compare to extramedullary (DHS/DCS) group. We also concluded that non union rate is slightly more in extramedullary (DHS/DCS) group as compare to intramedullary (PFN) group. But this difference is stastically insignificant (p>0.05)

Keywords: blood transfusion, peritrochantric fractures, Proximal Femoral Nail (PFN), Dynamic Hip Screw (DHS), Dynamic Condylar Screw (DCS), Non union, Resurgery