A Comparative Study of Proximal Femoral Nail Antirotation-II and Cemented Bipolar Hemiarthroplasty for the Treatment of Unstable Intertrochanteric Fractures in Elderly Patients

Abstract Introduction: The management of intertrochanteric fractures (ITFs) in elderly patients requires not only the promotion of early mobility but also the prevention of complications and morbidity. This study aimed to evaluate functional outcomes and compare the benefits, drawbacks, and complications associated with proximal femoral nail antirotation II (PFNA-II) and bipolar hemiarthroplasty (HA). Materials and Methods: From March 2022 to February 2023, 25 patients who fulfilled the predetermined inclusion and exclusion criteria were included in the PFNA-II and HA groups. The patients were monitored for up to 1 year and evaluated based on various factors, including complications and the Harris hip score. Results: The PFNA-II group showed a significant reduction in blood loss and surgery time compared with the HA group. The incidence of postoperative complications was higher in the HA group than that in the control group. In the initial six months, the HA group demonstrated a significantly superior Harris hip score (79.88 ± 3.14) compared to the PFNA-II group (72.48 ± 15.79), with P = 0.038. However, after 1 year, no notable differences ( P = 0.69) were observed in functional outcomes between the PFNA-II (85.68 ± 18.64) and HA groups (84.08 ± 3.82). Conclusion: PFNA-II internal fixation led to notable improvements in surgical outcomes and a decrease in postoperative complications. On the other hand, patients who received cemented HA experienced better functional outcomes in the early postoperative period, enabling them to support their weight and restore their preinjury mobility faster. Nevertheless, cemented HA is linked to an increased likelihood of cement-related complications, low blood pressure, and issues with wound healing.