Incidence of Complications in Proximal Femoral Nailing for Comminuted Intertrochanteric Femur Fractures in a Rural Population: A Retrospective Analysis.

BACKGROUND

Unstable intertrochanteric fractures (AO Foundation/Orthopaedic Trauma Association (AO/OTA) 31-A2 and 31-A3) are technically demanding. In rural care pathways, delays to presentation and surgery, limited implant/operating resources, and restricted access to structured rehabilitation and follow-up may increase the risk of mechanical failure, wound complications, and delayed functional recovery.

METHODS

We retrospectively screened consecutive adults treated with proximal femoral nailing (PFN) for intertrochanteric femur fractures between January 2024 and December 2025. Stable AO/OTA 31-A1 patterns were excluded by design; only unstable AO/OTA 31-A2 and 31-A3 fractures with ≥6 months follow-up were included. Data were extracted from records and radiographs. The primary outcome was the Modified Harris Hip Score (MHHS) at final follow-up, and the secondary outcomes included time to radiological union and postoperative complications.

RESULTS

A total of 128 patients were included, with a mean age of 72.6 ± 9.4 years (55.5% were female, and 67.2% had at least one comorbidity). Fractures were 31-A2 in 78 (60.9%) and 31-A3 in 50 (39.1%). Radiological union was achieved in 120 patients (93.8%), with a mean union time of 12.1 ± 2.9 weeks; delayed union occurred in six (4.7%) and non-union in two (1.6%). Mean follow-up was 15.6 ± 4.9 months. The MHHS at final follow-up was 89.4 ± 8.7 for AO/OTA 31-A2 fractures and 84.8 ± 11.2 for AO/OTA 31-A3 fractures (unadjusted). Excellent or good outcomes were achieved in 103 patients (80.4%). Mechanical complications included Z effect in five (3.9%), screw cutout in seven (5.5%), and varus collapse greater than 5° in nine (7.0%). Surgical site infection occurred in eight (6.3%), and limb length discrepancy greater than 1 cm in 10 (7.8%). Outcomes and complication rates were less favorable in 31-A3 fractures compared with 31-A2 fractures.

CONCLUSION

PFN achieved high union rates and satisfactory functional outcomes in unstable intertrochanteric fractures treated in a rural setting, although mechanical complications and wound issues were observed, particularly in AO/OTA 31-A3 patterns.