Functional Outcome of Unstable Intertrochanteric Femur Fracture Treated Surgically With Long Proximal Femoral Nail

As the world's population ages, hip fractures become more common. The global incidence of hip fractures will rise to a million per year by 2040. Intertrochanteric femoral fractures are common fracture in older people, typically caused by low-energy falls. These fractures are also classified based on their stability, with unstable fracture patterns posing more challenges for surgical therapy and potentially resulting in worse functional recovery. Surgical fixation is the most effective treatment for these fractures since it restores motion while reducing complications. Intertrochanteric fractures occur between the lesser and greater trochanters of the femur. Unstable intertrochanteric fractures exhibit medial cortical comminution, fracture planes with reverse obliquity, and subtrochanteric extension. These characteristics contribute to the difficulty of achieving and maintaining reduction, as well as the likelihood of malunion, non-union, and eventual functional limitation.

To evaluate the functional outcomes of patients with unstable intertrochanteric femur fractures who undergo surgical treatment using a long proximal femoral nail (PFN) and to assess complication rates, radiographic evaluation, return to daily activities, and patient satisfaction.

This prospective cross-sectional study was conducted in the Department of Orthopaedics, Vinayaka Mission's Kirupananda Variyar Medical College, from November 2022 to September 2025. Thirty patients aged above 18 years presenting with unstable intertrochanteric femur fractures (Boyd and Griffin types I-IV) were included and treated surgically with a long PFN.

The mean Harris Hip score (HHS) at the 3rd and 6th months after surgery was 75 ± 7.5 (72-77) and 87 ± 6.6 (84-89), respectively, with a statistically significant (P < 0.001) improvement. A significant (P < 0.05) increase in proportion from 3% in 3 months to 40% in 6 months in an excellent HHS. The mean hip disability and osteoarthritis outcome score (HOOS)-12 pain, function, quality of life (QoL), and summary of the study participants at the pre-operative stage were 29.2 ± 3.9, 34.6 ± 5.8, 26.3 ± 7, and 30 ± 5.4, respectively. In the 3rd and 6th months, there were significant improvements in all domains of the HOOS-12 score.

The HHS was significantly increased at 6 months compared to HHS at 3 months. All the domains (pain, function, QoL, and summary) of the HOOS-12 and Visual Analog Scale pain scores increased significantly at the 3rd and 6th months from pre-operative.