A Prospective Comparative Study Of Proximal Femoral Nailing And Bipolar Hemiarthroplasty In Comminuted Intertrochanteric Fractures

Abstract

Introduction: Comminuted intertrochanteric fractures in the elderly present a significant surgical challenge, balancing the goal of early mobilization against the risks of implant failure and complications associated with osteoporosis. While proximal femoral nailing (PFN) is a standard osteosynthesis technique, bipolar hemiarthroplasty (BHA) has emerged as an alternative promising immediate stability and early weight-bearing. This study aims to compare the functional outcomes of these two surgical modalities.

Methods: A prospective comparative study was conducted from February 2023 to February 2025, involving 40 elderly patients (≥60 years) with comminuted intertrochanteric fractures (AO/OTA 31-A2, Evans type III-V). Patients were randomly allocated to either PFN (n=20) or cemented BHA (n=20) groups. Intraoperative parameters (duration of surgery, blood loss, incision length), postoperative complications, time to mobilization, and functional outcomes assessed via the Harris Hip Score (HHS) at six months were evaluated and compared.

Results: The mean age of participants was 72.8 years, with a female predominance (60%). Trivial fall was the most common mechanism of injury (82.5%). The PFN group demonstrated significant advantages in intraoperative metrics, including shorter surgical duration (70±8.16 vs. 120±10.80 minutes, p<0.001), less blood loss (131.5±31.97 vs. 214.5±31.48 ml, p=0.001), and smaller incisions (7.5±1.35 vs. 12.6±1.26 cm, p<0.001). Conversely, the BHA group achieved significantly earlier full weight-bearing (30 vs. 60 days, p=0.0015). At the six-month follow-up, the mean HHS was excellent in the BHA group (85.9±6.09) and good in the PFN group (82.95±5.80), though this difference was not statistically significant (p=0.134). The PFN group showed a superior range of motion (100° vs. 86°, p=0.0015). Complication rates were comparable between groups (PFN: 6, BHA: 5), with wound infection and limb length discrepancy being the most common.

Conclusion: Both PFN and BHA are effective treatments for comminuted intertrochanteric fractures in the elderly, yielding good functional outcomes. The choice of procedure should be individualized. PFN offers a less invasive approach with better hip mobility, leveraging biological healing. BHA facilitates dramatically earlier weight-bearing, which is crucial for mitigating the risks of prolonged immobility in frail patients. The decision should be guided by fracture geometry, bone quality, surgical expertise, and, most importantly, the patient's physiological demands and lifestyle requirements.