Functional and Radiological Outcomes of Proximal Femoral Nailing in Unstable Peritrochanteric Fractures: A...

Unstable peritrochanteric fractures of the femur are among the most challenging injuries in orthopaedic trauma, especially in the elderly with osteoporotic bone. The proximal femoral nail (PFN), a cephalomedullary device, offers potential biomechanical and clinical advantages.

To assess (1) the functional outcome of PFN in unstable peritrochanteric femoral fractures using the Harris hip score (HHS); (2) the radiological outcome using the radiographic union score for hip (RUSH); and (3) complications associated with PFN fixation.

A prospective observational study was conducted at the Department of Orthopaedics, Gajra Raja Medical College and J.A. Group of Hospitals, Gwalior (M.P.), from September 2022 to June 2024. A total of 74 patients with unstable peritrochanteric fractures (Arbeitsgemeinschaft für osteosynthesefragen [AO] 31A2.2-A3.3) were operated on using PFN. Functional outcome (HHS) and radiological outcome (RUSH) were evaluated at 6 weeks, 3 months, and 6 months postoperatively. Statistical analysis was performed using Statistical Package for the Social Sciences v26 with paired t-tests, considering P < 0.05 significant.

The mean patient age was 54.3 ± 10.7 years; 67.5% were males. The most common fracture pattern was AO 31-A2.2 (40.5%). The mean operative time was 67.5 ± 11.1 min. Mean HHS improved significantly from 57.8 ± 8.9 at 6 weeks to 72.2 ± 4.7 at 3 months and 85.7 ± 6.2 at 6 months (P < 0.001). Radiological union (RUSH >18) was seen in 6.7% at 6 weeks, 54.1% at 3 months, and 98.6% at 6 months. Complications included superficial infection (4.05%), screw back-out (1.3%), reverse Z-effect (1.3%), and non-union (1.3%).

PFN provides stable fixation, early rehabilitation, and high union rates in unstable peritrochanteric fractures. Its minimal soft-tissue dissection and superior biomechanical profile make it a preferred implant, especially in osteoporotic bone.