Comparison of functional outcome of femur intertrochanteric fracture fixation with hemiarthroplasty and proximal femoral nailsystems

Abstract

Introduction: Intertrochanteric femur fractures represent a significant health challenge in the elderly population, associated with considerable morbidity, mortality, and socioeconomic burden. While proximal femoral nail (PFN) systems are widely accepted as the standard treatment for these fractures, hemiarthroplasty has emerged as an alternative approach, particularly for elderly patients with osteoporotic bone. Despite ongoing debate regarding the optimal management strategy, comparative studies evaluating functional outcomes between these two approaches remain limited. This study aimed to compare the functional outcomes, pain control, and rehabilitation milestones between hemiarthroplasty and PFN for the treatment of intertrochanteric femur fractures in elderly patients. Methods: This prospective comparative study included 50 patients with intertrochanteric femurfractures, divided equally between hemiarthroplasty (n=25) and PFN (n=25) groups. Demographic data, operative parameters, and hospital stay duration were recorded. Functional outcomes were assessed using the Harris Hip Score at 1, 3, and 6 months postoperatively. Pain was evaluated using the Visual Analog Scale (VAS) at the same intervals. Time to fully weight-bearing was documented for all patients. Statistical analysis was performed using appropriate tests with significance set at p<0.05. Results: The groups were comparable regarding age, gender distribution, comorbidities, and BMI.Operative time was significantly shorter in the PFN group (71.6±13.9 vs. 81.3±12.6 minutes, p=0.01), while hospital stay was similar between groups. The PFN group demonstrated significantly lower painscores at all follow-up intervals (p<0.05). At 1 month, functional outcomes favored hemiarthroplasty, with all patients achieving fair Harris Hip Scores compared to poor scores in the PFN group. However, by 3 months, the PFN group showed better improvement (p=0.02), and at 6 months, the PFN group demonstrated superior outcomes with 56% achieving excellent scores versus 24% in the hemiarthroplasty group (p=0.006). Patients in the hemiarthroplasty group achieved fully weight-bearing status significantly earlier than those in the PFN group (7.28±1.79 vs. 9.32±1.95 weeks, p<0.001). Conclusion: While hemiarthroplasty offers advantages in terms of earlier weight-bearing and better initial functional scores, PFN provides superior outcomes in terms of operative efficiency, pain control, and mid-term functional recovery. The optimal treatment approach should be individualized based on patient characteristics, fracture pattern, and rehabilitation potential. For patients with good rehabilitation potential and reasonable life expectancy, PFN may offer better overall functional outcomes despite delayed weight-bearing.