[A comparative study of unstable per- and intertrochanteric femoral fractures treated with dynamic hip screw (DHS) and trochanteric butt-press plate vs. proximal femoral nail (PFN)].

The aim of the present paper is to compare the results obtained using two osteosynthesis systems developed for the surgical treatment of unstable fractures of the trochanteric region of the femur: the proximal femoral nail (PFN) and the dynamic hip screw (DHS) with trochanteric butt-press plate (TBPP). From December 1997 to November 2000, 173 patients with instable trochanteric fractures (type 31 A-2 and A-3 according to the AO-classification) had osteosynthesis by PFN (n = 122) or DHS/TBPP (n = 51). The average patient age was 74 years (range 27 to 98). No significant differences between the two study groups were observed with regard to age, sex, and rate of fracture types. At an average follow-up of 17 months the radiological and clinical outcome according to the score of "Merle d'Aubigné" was analysed in 61 % of all patients. All fractures were healed with no difference in functional outcome between the two groups. In the case of PFN 17.2 % revisions were necessary and in the case of DHS with TBPP 21.6 %. A shorter operation time (43 vs. 61 min) and a considerable shorter in-patient stay (20 vs. 24 days) were common with PFN. Full-weight-bearing immediately after the osteosynthesis was possible for 98 % of the PFN patients and 81 % of the DHS/TBPP patients. The DHS/TBPP osteosynthesis in instable trochanteric fractures is associated with a higher incidence of complications. Therefore we recommend to treat instable fractures of the trochanteric region with the PFN.