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

INTRODUCTION

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.

OBJECTIVES

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.

MATERIALS AND

METHODS

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.

RESULTS

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%).

CONCLUSION

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.