الفهرس 
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Abstract
I
ntertrochanteric femoral fractures are common in the elderly. They account for more than 50% of all hip fractures and are a common orthopedic problem in this age group. They are extra capsular fractures of the proximal femur between the greater and lesser trochanters. Due to the mortality and significant morbidity associated with these fractures, they constitute a major challenge to all orthopedic surgeons.
The incidence of hip fractures increases upon aging, so that 90% occur after the age of 70. The lifetime risk of hip fracture is 23.3 % for a woman and 11.2% for a man respectively. The estimated rate for elderly people sustaining a hip fracture by the age 90 is 30%.
The aim of the study is to compare between the use of DHS and proximal femoral nail in treatment of unstable intertrochanteric fractures of the Femur through systematic review and met analysis.
A comprehensive and detailed search of the literature was conducted from Jan. 2000 to May 2021 through the PubMed, Embase, Scopus, ScienceDirect/Elsevier, Cochrane, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar databases including articles related to fixation of unstable intertrochanteric fractures of femur by Proximal Femoral Nail or Dynamic Hip Screw. Searches were performed with a combination of MeSH (medical subject headings). The following search string is used in all chosen databases: (”Unstable intertrochanteric femur fractures, PFN, DHS, Trochanteric stabilizing plate”).
This is a systematic review including a discussion of all available studies done on unstable intertrochanteric femur fractures fixed by DHS or PFN.
The mortality rate for those patients treated within six hours was significantly lower than that for those treated after this time and it was highest for patients who were operated on after more than 36 hours.
The helical blade of PFN allows improved purchase in the femoral head by radial compaction of the cancellous bone around the blade during insertion. Its improved purchase in osteoporotic bone has been demonstrated biomechanically.
This study demonstrates that the frequency of Blood loss, post-operative Infection and Non-Union are less after treatment with proximal femoral nail as compared to dynamic hip screw in unstable intertrochanteric fractures of femur. We recommend proximal femoral nail fixation should be used as a first line fixation device for unstable intertrochanteric fractures in order to reduce the morbidity of patients.