Comparison of Proximal Femur Nail vs DCS in terms of Union for Subtrochanteric Femur Fracture in Patients Aged 50-60 Years

Abstract

Background: Because of their high cortical bone composition and tremendous biomechanical stress, subtrochanteric femoral fractures, which occur within 5 cm distal to the lesser trochanter, provide significant surgical problems.  In order to avoid sequelae, these injuries, which are frequent in both high energy trauma and osteoporotic falls in the elderly, require immediate and stable treatment.  Proximal Femoral Nail (PFN) and Dynamic Condylar Screw (DCS) are two of the most commonly used implants. As an extramedullary device, DCS gives angular stability, whereas PFN offers intramedullary fixation with greater biomechanical properties.  Comparing the clinical and radiological results of PFN and DCS in the treatment of subtrochanteric fractures was the goal of this investigation. Materials and Methods: A randomized controlled trial was conducted at department of orthopedics, Allied hospital, Faisalabad from 28 November 2024 to 28 May 2025. This study comprised 68 patients with subtrochanteric femur fractures who were surgically fixed with either a Dynamic Condylar Screw (DCS), or Proximal Femoral Nail (PFN). Patients of both sexes who are 50-60 years old and have radiologically verified subtrochanteric femur fractures are eligible to participate. Patients with pathological fractures and those who are skeletally immature are excluded. Fractures were classified by Russell-Taylor’s system. Outcomes included operative time, blood loss, union time, postoperative complications, and functional scores using the Salwati and Wilson system. Statistical analysis was performed using SPSS v25.0, with p < 0.05 considered significant. Results: In general, the PFN group experienced less postoperative problems. The DCS infection rate was 11.76%, whereas the PFN infection rate was 2.94%. In 8.82% of DCS patients, but not in any PFN instances, shortening of more than 2 cm was noted. 8.82% of cases (DCS) and 2.94% of cases (PFN) experienced implant failure. Union was seen in 25 (73.53%) DCS patients and 33 (97.06%) PFN patients.  PFN patients had a considerably lower mean length of hospital stay (11.3 ± 2.35 days) than DCS patients (15.6 ± 2.18 days, p < 0.001) and DHS patients (15.4 ± 1.95 days, p = 0.002 for DHS vs. PFN). In contrast to DCS (11.7 ± 1.79 weeks, p < 0.001), the PFN group attained radiological and clinical union earlier (mean: 9.4 ± 2.79 weeks). Conclusion: Compared to DCS, PFN provides more biomechanical stability, a quicker fracture union, less problems, and a superior functional recovery. For the majority of subtrochanteric fractures, it is the recommended fixation technique.