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research study difference between PFN and DHS for IT fracture by Dr.Pothireddy Surednranath Reddy

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Alt: Dr. Pothireddy Surendranath Reddy performing PFN surgery 2018Summary of Dr. Pothireddy Surendranath Reddy's 2018 study comparing PFN and DHS in hip fracture management, including methodology and key outcomes.



Proximal Femoral Nail (PFN) vs Dynamic Hip Screw (DHS) in Intertrochanteric Fractures: A Comprehensive Research Study

Expert Analysis by Dr. Pothireddy Surendranath Reddy

Meta Title: PFN vs DHS in Intertrochanteric Fractures – Key Differences & Outcomes | Dr. P. Surendranath Reddy
Meta Description: Detailed comparative research study on PFN and DHS for IT fracture treatment by Dr. Pothireddy Surendranath Reddy. Learn differences in outcomes, complications, biomechanics, and clinical recommendations.
Focus Keywords: PFN vs DHS, intertrochanteric fracture fixation, proximal femoral nail, dynamic hip screw, clinical outcomes, orthopedic research
Secondary Keywords: PFN benefits, DHS limitations, intramedullary vs extramedullary fixation

1. Introduction

Intertrochanteric (IT) femur fractures are among the most common hip fractures, especially in the elderly population with osteoporosis or low-energy trauma. Choosing the optimal fixation method significantly impacts surgical success, functional recovery, and long-term mobility outcomes. The two major implants used worldwide are:

  • Proximal Femoral Nail (PFN) – an intramedullary fixation device

  • Dynamic Hip Screw (DHS) – an extramedullary implant with a side plate

This research review by Dr. Pothireddy Surendranath Reddy compares PFN and DHS in terms of operative parameters, functional outcomes, biomechanics, complications, and long-term recovery. It synthesizes results from randomized clinical trials, prospective studies, and meta-analyses to provide evidence-based insights. Journal of Population Therapeutics+2bmcj.org+2

2. Background: PFN and DHS Explained

2.1 What Is a Proximal Femoral Nail (PFN)?

The Proximal Femoral Nail is an intramedullary nail designed to fix IT fractures from within the bone’s canal. PFN devices may incorporate features such as:

  • Cephalomedullary screws for head-neck stabilization

  • Shorter lever arms reducing bending stress

  • Minimal soft-tissue disruption

PFN is biomechanically superior in unstable fracture patterns due to load sharing within the medullary canal and is frequently used in complex fractures. orthopaper.com

2.2 What Is a Dynamic Hip Screw (DHS)?

The Dynamic Hip Screw is an extramedullary plate and screw system that provides lateral cortical support and controlled impaction at the fracture site. It has long been considered the historical gold standard for stable IT fractures due to its simplicity and proven track record. orthopaper.com

3. Biomechanical Comparison: PFN vs DHS

3.1 Intramedullary vs Extramedullary Fixation

  • PFN acts as a load-sharing device within the bone’s axis, offering better biomechanical stability in unstable and osteoporotic fractures. This intramedullary placement reduces stress on the lateral wall and enhances early weight bearing. orthopaper.com

  • DHS, as a load-bearing plate, places more stress on the fracture site and lateral cortex, increasing risk of mechanical failure in unstable patterns. orthopaper.com

3.2 Implication for Rehabilitation

Biomechanical advantages of PFN contribute to earlier mobilization and weight-bearing, which is especially critical in elderly patients prone to postoperative complications related to immobility. bmcj.org

4. Operative Parameters: Comparative Data

4.1 Surgical Duration

Multiple studies have consistently shown that:

  • PFN has a shorter operative time than DHS. bmcj.org+1
    Example: A prospective study reported mean operative times of 58 ± 8 min for PFN vs 79 ± 11 min for DHS (p < 0.001). bmcj.org

4.2 Intraoperative Blood Loss

PFN often results in less intraoperative blood loss due to its minimally invasive nature:

  • Example: PFN group showed ~220 mL blood loss vs ~360 mL in DHS. bmcj.org

Meta-analyses corroborate these findings, reporting statistically significant reductions in operative time and blood loss with PFN compared to DHS. PubMed+1

4.3 Fluoroscopy Exposure

PFN may require slightly higher intraoperative fluoroscopy time than DHS due to the need for accurate intramedullary placement. However, this trade-off is often offset by better fixation stability. PubMed

5. Clinical Outcomes and Functional Recovery

5.1 Time to Full Weight-Bearing and Union

PFN consistently demonstrates earlier mobilization and radiological union:

  • Patients treated with PFN achieved full weight bearing earlier (e.g., ~7.5 weeks vs ~10.2 weeks). bmcj.org

  • Radiological fracture healing occurred faster in PFN groups (e.g., ~12–14 weeks vs ~15–16 weeks). bmcj.org+1

5.2 Functional Scores (Harris Hip Score)

Functional outcomes measured by Harris Hip Score (HHS) often favor PFN:

  • PFN groups tend to show higher early and mid-term HHS, indicating better functional recovery. Journal of Population Therapeutics+1

  • Some studies report comparable long-term scores (e.g., at 12 months) between PFN and DHS, but PFN excels in early recovery phases. bmcj.org

5.3 Patient-Reported Outcomes

Patients with PFN often report:

  • Less early postoperative pain

  • Better confidence in ambulation

  • Shorter rehabilitation periods

These benefits contribute to faster return to daily activities, especially important in elderly patients. The Profesional

6. Complication Profiles

6.1 Mechanical Complications

PFN Advantages:

  • Lower rates of screw cut-out

  • Fewer varus collapses

  • Reduced limb shortening
    have been documented in several comparative studies. PubMed+1

DHS Limitations:

  • Higher risk of implant failure in unstable fracture configurations

  • Increased sliding and varus deformity
    have been reported as more frequent with DHS. Ijos

6.2 Infection and Soft-Tissue Complications

Both PFN and DHS have comparable infection rates, though minimal soft-tissue disruption in PFN may reduce superficial wound issues. medscimonit.com

6.3 Reoperation and Revision Rates

While some large meta-analyses show no significant difference in revision surgery rates, PFN’s biomechanical advantages often reduce the need for early reintervention in unstable fracture patterns. PubMed

7. When to Choose PFN vs DHS: Expert Recommendations

7.1 PFN: Best Indications

Dr. Reddy emphasizes PFN for:

  • Unstable intertrochanteric fractures

  • Osteoporotic bone conditions

  • Reverse obliquity and comminuted fracture patterns

PFN’s biomechanical benefits support early weight-bearing and rehabilitation, reducing morbidity. orthopaper.com

7.2 DHS: Best Indications

DHS may still be suitable for:

  • Stable intertrochanteric fractures

  • Patients where intramedullary nailing is contraindicated

  • Situations requiring simplicity and surgeon familiarity

However, in unstable patterns, DHS may have higher mechanical failure risk. orthopaper.com

8. Limitations of Current Evidence

Despite numerous comparative studies:

  • Heterogeneity exists in study design and patient demographics. PubMed

  • Variations in surgeon expertise and implant design may influence outcomes.

  • Long-term comparative studies (beyond 2 years) are less common.

Dr. Reddy advocates for large multicenter randomized trials with standardized protocols to refine clinical guidelines further. PubMed

9. Summary of Key Differences

FeaturePFNDHS
Fixation TypeIntramedullaryExtramedullary
Operative TimeShorterLonger
Blood LossLessMore
Time to MobilizationFasterSlower
Early Functional OutcomeHigherLower
Long-term Functional OutcomeComparableComparable
Complication RiskLower in unstable fracturesHigher in unstable fractures

(Based on multiple clinical studies and meta-analyses.) Journal of Population Therapeutics+2bmcj.org+2

10. Conclusion

In conclusion, Proximal Femoral Nail (PFN) and Dynamic Hip Screw (DHS) remain pivotal solutions in intertrochanteric fracture fixation. However, evidence supports:

  • PFN is generally superior in unstable fracture patterns.

  • It offers reduced surgical trauma, earlier weight-bearing, better early functional outcomes, and fewer mechanical complications.

  • DHS still holds value for stable fractures and less complex cases.

Dr. Pothireddy Surendranath Reddy highlights that individual patient factors, fracture classification, bone quality, and surgeon expertise should guide implant selection. Emerging data continue to refine best practices in IT fracture management. orthopaper.com

11. Frequently Asked Questions (SEO Boost)

Q1: Which is better for intertrochanteric fractures – PFN or DHS?

A: PFN often provides better early functional outcomes and lower complication rates, especially for unstable fractures. bmcj.org

Q2: Is DHS still used for hip fractures?

A: Yes. DHS remains appropriate for stable intertrochanteric fractures and where intramedullary nailing is not suitable. orthopaper.com

Q3: Does PFN reduce hospital stay?

A: Many studies report shorter hospital stays with PFN due to earlier mobilization. Journal of Population Therapeutics

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1.    https://pothireddysurendranathreddy.blogspot.com/2025/12/the-principal-secretary-for-state-of_12.html                   finance

2.    https://pothireddysurendranathreddy.blogspot.com/2025/12/the-principal-secretary-for-state-of.html                          education

3.    https://pothireddysurendranathreddy.blogspot.com/2025/12/principal-secretary-for-state-of_12.html                                          home





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