A comparative prospective study of dynamic variable angle hip screw and Gamma nail in intertrochanteric hip fractures

Purpose: To compare the results between a variable angle dynamic screw-plate(DMS) and the Gamma nail in the treatment of intertrochanteric hip fractures. Methods: A comparative prospective study of 142 patients (AO/OTA Type 31-A1; A2; A3 and B2) treated by variable angle dynamic screw-plate ( DMS Group = 71) or by intramedullary nailing ( Gamma Nail Group = 71). Results: At the 12-month follow-up, we did not find any statistically significant difference, intraoperatively, radiographically, or clinically, between the two groups of patients, except for shortening. In 12 patients in the DMS group ( 17%) and in one patient in the Gamma nail group, there was shortening of the operated leg between 1 cm and 3 cm ( p = 0.02). In all instances, shortening occurred in patients who sustained A. O. type fractures 31A2. 2 and 3 ( 19 patients), which are unstable and comminuted. Conclusions: The DMS allows effective management of intertrochanteric fractures of the femur. Surgeons should consider choosing surgical treatment according to the type of intertrochanteric fracture. In less comminuted fractures, a compression hip screw may be a faster and safer surgical solution. In comminuted fractures, surgical difficulties may increase in parallel to fracture complexity.