Functional and Radiological Outcomes of Proximal Femoral Nailing in Elderly Patients with Intertrochanteric Femur Fractures: A Cross-sectional Observational Study at a Tertiary Care Hospital
DOI:
https://doi.org/10.48047/70fjw778Keywords:
ntertrochanteric femur fracture, proximal femoral nail,, Harris Hip Score, elderly orthopaedics, fracture fixation outcomesAbstract
Background: Intertrochanteric femur fractures (ITF), a type of femur fracture, are among the most frequently occurring orthopaedic injuries in elderly, and are linked to high morbidity and mortality. The proximal femoral nail (PFN/PFNA) has become the implant of choice because of its biomechanical benefits, especially in unstable fracture patterns. This study evaluated functional and radiological outcomes of PFN/PFNA fixation in elderly patients (≥60 years) with intertrochanteric femur fractures at a tertiary care hospital. Methods: Eighty elderly patients (≥60 years) with AO/OTA 31-A / Boyd-Griffin type I–IV intertrochanteric fractures who underwent PFN/PFNA fixation were enrolled in this cross-sectional observational study with a minimum 6-month follow-up. Variables included demographics, comorbidity (Charlson Comorbidity Index), fracture classification, operative parameters, radiological outcomes (RUSH score, tip-apex distance), and functional outcomes (Harris Hip Score at 3 and 6 months). Multivariable logistic regression identified predictors of poor HHS (<70) at 6 months. Results: Mean age was 72 ± 8 years; 57.5% were female. Boyd-Griffin Type II fractures predominated (51.3%). Mean time to surgery was 4.2 ± 1.8 days; mean operative time 76 ± 18 minutes. Radiographic union was achieved by 16 weeks in 86.3%. Mean HHS at 6 months was 82 ± 9, with excellent/good results in 71.3%. Complications included cut-out (5.0%), SSI (6.3%), and 6-month mortality (7.5%). Independent multivariable predictors of poor HHS (<70) at 6 months: age ≥80 years (aOR 3.0), TAD >25 mm (aOR 2.8), unstable fracture (aOR 2.4), and time to surgery >5 days (aOR 1.9). Conclusion: PFN/PFNA fixation achieves satisfactory functional and radiological outcomes in the majority of elderly patients with intertrochanteric femur fractures. Surgical precision (low TAD), timely surgery, and stable fracture pattern are key determinants of good functional recovery. Multi-disciplinary perioperative optimisation and early mobilisation are essential for optimising outcomes in this vulnerable population.
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