A Prospective Comparative Study To Evaluate The Functional Outcome In Comminuted Intertrochanteric Fractures Among The Elderly Population Treated With Short Proximal Femoral Nail Versus Long Proximal Femoral Nail

Abstract

Introduction: Intertrochanteric fractures in the elderly population are common with high morbidity rates that can significantly impair mobility and quality of life. Surgical intervention plays a crucial role in restoring function and stability in these patients. Among the various surgical options, the use of proximal femoral nails (PFN) has been welldocumented. However, the decision between short proximal femoral nails (SPFN) and long proximal femoral nails (LPFN) remains a topic of debate. This study aims to  prospectively compare the functional outcomes of elderly patients with  comminuted intertrochanteric fractures treated with SPFN and LPFN. 

Methodology: The study was conducted in patients of > 60 years treated for Intertrochanteric fractures (AO/OTA 3A.A2.1  3A.A2.2 , 3A.A2.3 ) at ADHICHUNCHANGIRI INSTITUTE OF MEDICAL SCIENCE, BG Nagara from the month of MARCH 2023 to AUGUST 2024. Forty such cases were allocated alternatively into two groups i.e., Short PFN and Long PFN. Functional outcomes were assessed using the Harris Hip  Score (HHS) at 6 months with mean age of 69.55 years and 68.48 years  for Short PFN and Long PFN respectively. 

Results: The study analyzed 80 elderly patients with intertrochanteric fractures, equally divided into short PFN and long PFN groups. Descriptive statistics revealed that the mean age of patients was 69.55 years in the short PFN group and 68.48 years in the long PFN group, with no significant age difference between the two groups (p=.574). Gender distribution was also similar, with 32.5% males and 67.5% females in the  short PFN group, and 25% males and 75% females in the long PFN group  (p=.459). The side of injury (right vs. left) and mode of injury (trivial fall  vs. RTA) showed no significant association with the fixation method  (p=.256 and p=.456, respectively). Additionally, AO/OTA classification  and comorbidities did not significantly differ between the two groups 

(p=.506 and p=.593, respectively). However, significant differences were observed in surgical outcomes. Patients treated with long PFN had a longer mean surgical duration (99.88 minutes) compared to short PFN (66 minutes, p=.001). Blood loss  was also significantly higher in the long PFN group (mean=171 ml)  compared to the short PFN group (mean=144.75 ml, p=.001). Despite  these differences, functional outcomes such as full weight-bearing time  and Harris Hip Scores were comparable between the two groups. The  mean full weight-bearing time was 6.93 days for short PFN and 6.35 days  for long PFN (p=.131), while the mean Harris Hip Scores were 90.15 for  short PFN and 92.80 for long PFN (p=.094), indicating no significant  difference in postoperative recovery or hip function.