A Prospective Study of Functional Outcome of Intertrochanteric Fracture of Proximal Femur in Adults Treated with Proximal Femoral Nail.

Abstract

Introduction: Intertrochanteric (IT) fractures require stable fixation and early mobilization. This study evaluated the functional and radiological outcomes of proximal femoral nailing (PFN) in adults with IT fractures.

Materials and methods: A prospective observational study was conducted over 18 months in 48 patients aged 18-80 years with radiologically confirmed IT fractures treated with PFN. Functional outcome was assessed using the Modified Harris Hip Score (HHS) at 3 and 6 months. Radiological outcome was assessed using the radiographic union score for hip (RUSH), fracture alignment, and implant position. Post-operative complications were documented.

Results: The mean age was 56.37 years, and 62.50% were male. Accidental falls were the most common mechanism of injury (64.58%). The mean injury-to-surgery interval was 15.89 days, and the mean operative duration was 65.34 min. Arbeitsgemeinschaft für Osteosynthesefragen A2.2 fractures were most frequent (37.50%). Excellent or good functional outcomes increased from 50.00% at 3 months to 91.66% at 6 months, with a mean HHS of 88.75. A RUSH score of ≥26 was achieved in 70.83% of patients. Anatomical/acceptable alignment was observed in 83.34%, and optimal/acceptable implant position in 95.82%. Varus collapse and lateral migration of proximal screws were the most common post-operative complications (25.00% each). No non-union or mortality occurred.

Conclusion: In this single-center prospective observational cohort, PFN was associated with satisfactory functional and radiological outcomes at 6 months. Because the study had no comparator group, the findings describe outcomes after PFN and should not be interpreted as evidence of superiority over other fixation methods. Mechanical complications, particularly varus collapse and lateral migration of proximal screws, warrant attention to reduction, implant positioning, and follow-up.